Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30General SciencesA Brief Review on Medicinal Plants from South India, Endophytes and their Antidiabetic Properties English0104Aditi Makarand RanadeEnglish Arjun VigneshEnglish Gayathri M.EnglishThis paper seeks to review the potential treatment of diabetes with a focus on novel therapeutic effects produced by endophytic fungi that are associated with certain plants. Diabetes is a growing concern among the Indian population, and as a result, there has been an increasing amount of research done to discover new drugs and remedies. South India, with its unique geographical terrain is conducive for the growth of several indigenous plants that have medicinal properties. These plants are known to also be associated with some fungal strains that have metabolites with potentially anti-diabetic properties. This review looks at such plants, and how best to grow endophytic fungi accordingly. EnglishDiabetes mellitus, Endophytic fungi, Medicinal plants, South IndiaINTRODUCTION There is currently a growing need for compounds of high potency and low toxicity with therapeutic properties for various medicinal applications. This, along with the search for microbial drug resistance has led to great interest in the research of endophytic fungi. Endophytes collectively refer to those fungi and certain bacterial strains exhibiting a mutualistic relationship with a host organism, thereby preventing the entry of a variety of pathogens into the host. As a result of years of co-evolution coupled with some degree of genetic recombination, endophytic fungi possess biosynthetic capabilities greater than that of the host organism.(1) This manifests as them being a source of novel organic compounds with unique biological activities- including anitbiotics, antimycotics, immunosuppresants, anticancer and antidiabetic ones.   Endophytes - Endophytes describe those microorganisms which inhabit healthy tissues of living plants, but do not result in any apparent symptoms of diseases. They are found loaded in some part or the other of every plant. Studies have shown that there exists a balance between the host’s defence mechanism and the virulent nature of the endophyte. Although they usually do not cause any disease, if there is any disturbance in this balance, a disease condition can develop.(2) Endophytes often produce various metabolites, and the properties of these metabolites vary according to the source. Secondary metabolites produced by the endophytes are similar to those produced by the host, as a consequence of genetic exchange.   Diabetes Mellitus: Type II Diabetes - Diabetes mellitus is a group of metabolic disorders that is most commonly associated with one common manifestation in the form of hyperglycaemia- a condition in which there is excessive amounts of glucose circulating in the blood plasma. Chronic hyperglycaemia may damage the eyes, kidneys, nerves, heart and blood vessels.(3) An inherited or acquired deficiency of insulin produced by the pancreas, or the ineffectiveness of the insulin which is produced causes this condition. The WHO has recently released records of 30 million people who were diagnosed with diabetes in 1985. Since then, the number has increased to more than 171 million in 2000. It is estimated that over 367 million people will suffer from diabetes by the year 2030.(4) Highest incidences of diabetes are predicted to take place in developing countries, between the age groups of 45 and 65.   Traditional treatment for Diabetes Mellitus - There is a lot of ongoing research to determine methods of chemical treatment and discovering biological drugs in order to treat this condition. Traditionally, metabolites from plants have been used to treat many disorders. India is famous for Ayurveda- a system that stresses the use of plant based herbs and pastes to help cure disorders that are common, helping people maintain a healthy lifestyle.(5) Technology and an increasing pool of knowledge have led to research being carried out into potential use of drugs from plants.(6) Indian tribes have used various plant species specifically to treat diabetes, as detailed in the literature on traditional phytotherapy of Indian Medicinal Plants. These include- Asparagus racemosus, Butea monosperma, Cathanranthus roseus, Coccinia indica, Gymnema sylvestre, Syzygium cumini and Momordica charantia. They are also currently being used in modern medicine.(7) Endophytes from potential medicinal plants are subject to bioprospecting during isolation as the choice of the plant is important. Metabolites which are produced and screened are usually composed of compounds such as steroids, quinones, coumarins and phenols. Since the early ages, substances that have been harvested from plants have aided towards the treatment of various bacterial and viral infections. With the advent of more research, there is an increasing focus on the endophytes associated the plants as opposed to the plant itself. Medicinal plants are used by 80% of the world to help cure diseases.(8) Ancient Indian literature such as the Ayurveda has a mention of medicinal plants that possess endophytesto treat various ailments. A few plants that have been specifically reviewed for possessing anti-diabetic activity include Allium sativum, Allium cepa, Aloe vera, Cajanus cajan, Coccinia indica, Caesalpinia bonducella, Ficus bengalenesis, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Pterocarpus marsupium, Syzigium cumini, Swertia chirayita, Tinospora cordifolia and Trigonella foenum graecum.(5) Apart from these, there are about 400 species that have been identified to possess anti- diabetic effects. These plants have antihyperglycemic effects that can help control diabetes mellitus. These effects are due to their ability to alter pancreatic tissue function. This is achieved by either decreasing the absorption of glucose in the intestine or increasing the insulin output or by even facilitating metabolites in processes that heavily depend on insulin.(9) Novel bioactive compounds extracted from these plants have hypoglycemic effects that are equal to the known oral agents that are used presently. These plants can be further exploited for endophytes and these endophytes can then be tested for production of substances with hypoglycemic activity.(10)   South Indian plants with anti-diabetic properties - Annona squamosa Linn. (Annonaceae), is a plant grown throughout India, and is known as Custard Apple more commonly. The active pharmacological components can be found in the seeds and leaves of the plants. They show both hypoglemic and antidiabetic properties, by increasing the level of insulin from the pancreatic islets. This result in more glucose being utilized in the muscle and output of glucose from the liver being inhibited. Leaves are additionally used to maintain cholesterol levels. Extracts from this plant have a high margin of safety.(11) Bougainvillea spectabilis Linn. (Nyctaginaceae), is a widely used ornamental plant in India. It traditionally has shown to possess antidiabetic activity, with a potential to lower the blood glucose level. The effect has been reported on streptozotocin-induced type 1 diabetic albino rats.(12) An ethanolic extract of the leaf increases glucose uptake by enhancing the glycogenesis process in the liver as well as the insulin sensitivity. This is an example of antihyperglycemic activity. Casearia esculenta Roxb. (Flacourtiaceae), is a shrub in South India more widely known as wild cowrie fruit. The root extract of this plant has shown to lower blood sugar levels by influencing metabolism of certain proteins as well as important enzymes. C. esculenta root extract has the hypoglycemic and antihyperglycemic effect. However, it may elevate liver and renal damage.(13) Cassia kleinii (Caesalpiniaceae), is used by the common folk as a remedy, as well as by some medical practitioners. Phytomedicines have been shown to develop from this plant, as they show antihyperglycemic activity on the glucose feed. It has use in insulin dependent diabetes, while the action that the drug does is similar to that of insulin on glucose metabolism. Terminalia catappa Linn. (Combretaceae), is the Indian almond plant and is found growing in warmer parts of India. The fruit of this plant with petroleum ether and a methanolic extract has an effect on blood glucose levels. The plant acts via β-cells regeneration. The effect may be due to β-carotine in preventing complications such as glycosylation in diabetic rats.(14)     Plant Name Common name/ Herbal Formulation Anti-Diabetic and other beneficial effects Annona squamosal Sugar apple Ethanolic leaf extract has antihyperglycemic effect Artemesia pallens Davana Reabsorption of glucose is inhibited Areca catechu Supari Utilization of peripheral glucose increases Beta vulgaris Chukkandar Enhances glucose tolerance Boerhavia diffusa Punarnava Antioxidant, plasma insulin level increases, activity of hexokinase increases Bombax ceiba Semul Hypoglycemic Camellia sinensis Tea Antioxidant and antihyperglycemic Capparis decidua Pinju Hypolipidemic, antioxidant and hypoglycemic Coccinia indica Bimb or Kanturi Hypoglycemic and insulin secretogogue Emblica Amla Hypoglycemic and decreases lipid peroxidation Ficus bengalensis Bur Hypoglycemic Gymnema sylvestre Gudmar or Merasingi Antihyperglycemic and hypolipidemic Hemidesmus indicus Anantamul Anti-snake venom activity and anti-inflammatory Hibiscus rosa-sinesis Gudhal or Jasson Triggers insulin release from pancreatic beta cells Ipomoea batata Sakkargand Insulin resistance is decreased Momordica cymbalaria Kadavanchi Hypoglycemic Murraya koenigii Curry patta Enhances glycogenesis and inhibits gluconeogenesis Musa sapientum Banana Antihyperglycemic, antioxidant Phaseolus vulgaris White kidney bean Inhibits alpha amylase activity Punica granatum Anar Antihyerglycemic Salacia reticulata Vairi Alpha glucosidase inhibitor   Table 1: List of notable South Indian plants and their anti-diabetic properties.(7) Optimization of growth of endophytic fungi - If we wish to investigate the endophytic fungi and their benefits, it is important to cultivate them under the appropriate laboratory conditions. In this regard, isolation is the first step.(15,16) Surface sterilization followed by crushing plant tissues and plating on to a nutrient medium is a commonly used protocol. Sodium hypochlorite, Hydrogen peroxide and ethanol have all been used for this purpose. The plant tissues are usually submersed into sodium hypochlorite and then rinsed with distilled water. If done well, there will be high amounts of growth as there is no damage to the endophytic colonies from sterilization. An efficient surface sterilization results in high amounts of endophytic growth on agar plates which indicates that there is no damage from the sterilization to the endophytic population. Next, the choice of nutrient medium also could influence the efficiency of the isolation process. For endophytes, there are two types of media used most commonly- one that is complex and rich containing high amounts of undetermined nutrients and another that is minimal, containing much lesser but precise amounts of nutrients. The number of colonies as well as the diversity of endophytes grown is determined by the choice of nutrient media.(17) Studies show that less than 1% of the endophytes are usually cultivable, and some that are grown initially cannot be recultivated later. This is mostly because residual compounds and metabolites specific to certain plants are not present at all stages. Tissues contain some compounds that are not present in the media for growth, but are nonetheless important for their growth. Both types of media contain elements that are vital for non-selective growth of endophytes. Complex media contains water, carbon sources, salts and a source of amino acids from fungal, plant or animal origin (yeast extract, tryptone, peptone, etc). These are undefined because the composition of the source of the amino acid is unknown. These media are called undefined because the exact composition of the amino acid source is not known.(18) Trypticase Soy Agar (TSA) and Caesin Starch are examples. They have high quantities of nutrients, and hence many dominant strains grow fast and grow over those strains that take longer. Minimal media however provides a precise amount of nutrients leading to selective growth. This mimics the actual conditions of the plant and as a result, might allow the endophytes to adapt easier.(19) As a gelling agent, Agar is commonly used. However, it might be the case that some fungal strains are unable to grow. To overcome this, gellan gum has been used, as it is a bacterial polysaccharide that is used for human tissue culture. This is produced by Sphingomonas sp. Literature reviews have shown a higher amount of endophytic growth on complex media.(20)   DISCUSSION While there have been several attempts to come up with commercially viable drugs and methods of treatment for diabetes, each of them come with their own set of hurdles and challenges. However, the use of endophytes from natural plant sources as prospective anti-diabetic agents confers various advantages that are otherwise lacking in our conventional approaches to treating the disease. South India’s ambient geographic conditions, both in terms of weather as well as terrain, make it conducive for the growth of innumerable varieties of plants, and as a result- an even larger number of endophytes associated with them. It is imperative that our research focus shifts to the use of these plant sources, as it may be possible to scale up their pharmaceutical activity as anti-diabetic agents into sustainable drugs by optimizing the conditions for their growth, cultivation and isolation.   CONCLUSION A lot of medicinal plants have been under research for treatment of various disorders, be it common flu, HIV or diabetes. But due to the risk of increasing microbial resistance to the already existing drugs, there has been shift from plant metabolites to endophytic metabolites for treatment of different kinds of disorders. The easy availability of endophytes throughout the plant is a major advantage. Extraction and isolation of specific endophytes thus becomes a relatively simple process. Another important thing to note is the relation between the source of the endophyte and endophyte itself. The plants that are known to have specific pharmaceutical importance will definitely possess endophytes with similar properties. Therefore, the main area of focus is the endophytes collected from medicinal plants known to possess anti-diabetic properties. South India is a rich source of medicinal plants and there have been various literatures and manuscripts that talk about the same. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.   SOURCE OF FUNDING This review article has been prepared without funding and as independent study under the guidance of Dr. Gayathri M.   CONFLICT OF INTEREST The authors express no conflict of interest.   ABBREVIATIONS USED WHO: World Health Organization. HIV: Human Immunodeficiency Virus.       Englishhttp://ijcrr.com/abstract.php?article_id=2344http://ijcrr.com/article_html.php?did=2344REFERENCES 1. Mujesh R, Namita P. Medicinal Plants with Antidiabetic Potential - A Review. Am J Agric Environ Sci. 2013;13(1):81-94. 2. Divya VC, Sathasivasubramanian S. Submandibular sialolithiasis - A report of two cases. Biomed. 2013;33(2):279-83. 3. Dey A. Alstonia scholaris R.Br. (Apocynaceae): Phytochemistry and pharmacology: A concise review. J Appl Pharm Sci. 2011;1(6):51-7. 4. Publishers BS. Current Medicinal Chemistry. Curr Med Chem. 2010;14(15):2011. 5. Eldeen IMS, Effendy MAW. Antimicrobial agents from mangrove plants and their endophytes. 2013;872-82. 6. a JB, V RR, Samaga P V. Evaluation of the antimicrobial activity of three medicinal plants of South India. 2011;7(1):14-8. 7. Modak M, Dixit P, Londhe J, Ghaskadbi S, Paul a DT. Indian herbs and herbal drugs used for the treatment of diabetes. J Clin Biochem Nutr. 2007;40(3):163-73. 8. Chitravadivu C, Manian S, Kalaichelvi K. Qualitative analysis of selected medicinal plants, Tamilnadu, India. Middle-East J Sci Res. 2009;4(3):144-6. 9. Rai MK. A review on some antidiabetic plants of India. Anc Sci Life. 1995;14(3):168-80. 10. Mary Shoba Das C, Gayathri Devi S. In vitro glucose binding activity of Terminalia bellirica. Asian J Pharm Clin Res. 2015;8(2):320-3. 11. Miller KI, Qing C, Sze DMY, Roufogalis BD, Neilan BA. Culturable Endophytes of Medicinal Plants and the Genetic Basis for Their Bioactivity. Microb Ecol. 2012;64(2):431-49. 12. Kaul S, Gupta S, Ahmed M, Dhar MK. Endophytic fungi from medicinal plants: A treasure hunt for bioactive metabolites. Phytochem Rev. 2012;11(4):487-505. 13. Sharma D, Pramanik A, Agrawal PK. Evaluation of bioactive secondary metabolites from endophytic fungus Pestalotiopsis neglecta BAB-5510 isolated from leaves of Cupressus torulosa D.Don. 3 Biotech. Springer Berlin Heidelberg; 2016;6(2):1-14. 14. Wang J, Quan C, Wang X, Zhao P, Fan S. Extraction, purification and identification of bacterial signal molecules based on N-acyl homoserine lactones. Microb Biotechnol. 2011;4(4):479-90. 15. Jalgaonwala RE, Mohite B V, Mahajan RT. Evaluation of Endophytes for their Antimicrobial activity from Indigenous Medicinal Plants belonging to North Maharashtra region India. Int J Pharm Biomed Res. 2010;1(5):136-41. 16. Tan RX, Zou WX. Endophytes: a rich source of functional metabolites. Nat Prod Rep. 2001;18(March):448-59. 17. Isolation and Identification of Endophytic Fungi in Trigonella foenum-graceum L . and their Antibacterial Activity. 2016;(9):516-21. 18. Value SJRI, Roy S, Majumdar P. Available online http://www.ijddr.in Covered in Official Product of Elsevier , The Netherlands Hydro-Gel Swelling Study and Modelling Full Length Research Manuscript Full Length Research Manuscript. Int J Drug Dev Res. 2013;5(2):145-50. 19. Sandhya B, Thomas S, Isabel W, Shenbagarathai R. Ethnomedical plants used by the Valaiyan community of Piranmalai Hills (reserved forest), Tamilnadu, India - A pilot study. African J Tradit Complement Altern Med. 2006;3(1):101-14. 20. Ayyanar M, Sankarasivaraman K, Ignacimuthu S. Traditional Herbal Medicines Used for the Treatment of Diabetes among Two Major Tribal Groups in South Tamil Nadu , India. Ethonobotanical Leafl. 2008;12:276-80.  

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareMethotrexate a Double Edged Sword - Effect of Methotrexate in patients of Psoriasis due to Medication Errors English1013Yogesh KalyanpadEnglish Vidya KharkarEnglish Uday KhopkarEnglish Sarvesh ThatteEnglishMethotrexate is one of the most commonly used anti-neoplastic and disease modifying drug today. Side effects of methotrexate at high dose may be life threatening; however, these side effects oral dosing are variable because of the inter-individual variability of gastrointestinal absorption of this drug. Because of confusing nature of its dosing schedule and different routes of administration there are high chances of misinterpretation of prescription. Medication errors involving methotrexate revealed that errors occurred during all phases of use, often resulted from confusion about dosage, and often caused death or other serious adverse effects. Here we present three cases of toxicity due to methotrexate medication error. All cases presented with multiple erosions and ulcers on skin and mucous membrane, organ failures, bone marrow suppression. EnglishMedication error, Methotrexate, ToxicityIntroduction Methotrexate is an anti-folate first developed to treat certain types of cancers including acute lymphoblastic leukaemia, osteosarcoma and non-Hodgkin's lymphoma. But recently it has been used commonly to treat certain non-malignant diseases like rheumatoid arthritis, psoriasis, other autoimmune diseases and ectopic pregnancy. Doses of methotrexate for rheumatoid arthritis can be as low as 2.5 mg, while 15 g/m2 can be used along with leucovorin rescue therapy in osteosarcoma with a staggering 10,000-fold difference. Scheduling of doses also varies widely, from cyclical protocols for cancer chemotherapy to weekly for rheumatoid arthritis and sarcoidosis. Methotrexate can be administered orally, intravenously, intramuscularly or intrathecally which further adds to this complexity.1 Side effects of high dose of methotrexate may be life threatening, however these side effects of oral methotrexate are variable because of the inter-individual variability of gastrointestinal absorption of this drug. Since folic acid plays a major role in cell division, its inhibition is directly associated with major toxicity. Bone marrow, gastrointestinal mucosa, skin and hair are particularly vulnerable to the effects of methotrexate, secondary to their high rate of cellularturnover.2 Frequent serious medication errors involving methotrexate have been reported and some patients have died. The errors have involved some aspect of the dosage regimen and patient negligence3, 4. We report three cases of methotrexate induced fatal drug reactions which were associated with medication errors. Methods and materials Patient presenting with history of methotrexate consumption for skin condition (psoriasis) and developing a skin rash, oral lesions and systemic symptoms were selected. Detailed history along with a thorough clinical examination was carried out. Investigations included all routine tests like complete blood count, liver function tests, renal function test serum electrolytes, X-ray chest, urine and stool examination. A skin biopsy was performed for all the patients. Results First case wasa62-year-oldmalepresented with multiple erosions in the oral cavity, trunk and extremities of duration four days(Fig 1). There was gradual worsening of his symptoms with odynophagia, dysphagia and diarrhoea. Patient was diagnosed as psoriasis and treated by an Ayurveda practitioner since one and half years. Patient also gave history of start of new medication since last two weeks On enquiry patient was taking oral methotrexate 2.5 mg once daily for 10 days. Then to reduce itching patient himself increased dose to 5 mg two times a day for last 4 days. The haematological examination showed severe neutropenia, thrombocytopenia and elevated liver enzymes (SGPT & SGOT), serum creatinine and blood urea nitrogen levels (Table 1). A skin biopsy sample was taken from erythematous tender plaque. Histopathological examination showed generalized thinning of epidermis & irregular hyperplasia. Extreme thinning of rete ridges and marked dilation of vessels, on higher magnification occasional necrotic keratinocyte and abnormal mitotic figures seen.On clinic-pathological correlation the patient was diagnosed as a case of methotrexate toxicity (Fig 2). Patient was admitted in medicine ward and started on Inj. Folinic acid 150 mg 6 hourly, Inj. GCSF 300 mg once daily, Inj. vancomycin 1 gm once daily, Inj. fluconazole 200mg once daily, Inj. metronidazole 400 mg three times daily, with adequate hydration and alkalization of urine. Repeated haematological investigation showed no significant improvement. The same day patient succumbed to death due to septic shock with acute renal failure secondary to febrile neutropenia because of methotrexate toxicity. Second case was a 45 year old female presented with psoriatic erythroderma, pustules with arthropathy and was admitted for the same.(Fig 3) The haematological investigations showed blood cell counts including white blood cells and platelet count within normal limits. After investigations, patient was started on oral acitretin 25 mg once daily along with tablet methotrexate 7.5 mg once a week which was increased to 15 mg once a week after two weeks. Despite intensive treatment no improvement was seen and pustules continued to occur. Hence Cyclosporine 100 mg twice daily was added for quick response. Patient responded well to the treatment with clearance of erythema and scaling. With all normal haematological parameters, patient was discharged with tapering doses of cyclosporine 100 mg once daily along with capsule acitretin 25 mg once daily and methotrexate 15 mg once a week orally. After 10 days of discharge, patient presented with fever with chills, odynophagia, oral ulcers, congestion of eyes, epistaxis and crusted lips. In spite of proper counselling at the time of discharge patient had followed advice from local chemist and had taken methotrexate 15 mg once daily for last 10 days except on Sunday when she took folic acid. On investigation patient had severe anaemia, leukopenia, thrombocytopenia, slightly raised liver enzymes (SGPT), markedly raised serum creatinine, blood urea nitrogen and PT/INR (17.7/1.4) values. On clinico-histological evidence, the case was confirmed as methotrexate toxicity. Patient was admitted in medicine ward and started on treatment similar to patient described as case 1. Patient went into septic shock with peripheral circulatory failure. Patient similarly succumbed to death. Third case was a55-year-old female came with complaints of painful erosions all over body and fever with chills for 4 days(Fig 4). On examination she had pallor and blood pressure was 84/60 mm of Hg at the time of admission. She was diagnosed as psoriasis and started on methotrexate by physician. On enquiry instead of taking methotrexate 7.5 mg in three divided doses as prescribed by physician patient took 7.5 mg three times a day that is 22.5 mg per week, for three weeks. On haematological investigation patient was found to have anaemia, sever leukopenia and thrombocytopenia, raised liver enzymes (SGPT) and serum creatinine (Table 1). Skin biopsy showing extreme thinning of rete ridges appearing like swords with abnormal keratinocyte and mitotic figures. On clinic-pathological correlation with patient history, diagnosis of methotrexate toxicity was made (Fig 5). Patient succumbed to death due to septic shock with acute renal failure and febrile neutropenia due to methotrexate toxicity. Discussion: The National Coordinating Council for Medication Error Reporting and Prevention defines a "medicationerror as any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the healthcare professional, patient or consumer.5 Methotrexate is one of the most commonly used anti-neoplastic and disease modifying drug today. It is also one of the most toxic drugs. In 1951 Gubner et al recognised methotrexate was effective for the treatment of psoriasis. In all the cases described above, patients were taking methotrexate for their primary disease. All of them presented with extensive erosions in oral cavity and all over body. Excess ingestion of multiple doses of methotrexate was found due to medication error. Signs of acute organ failure and myelosuppression were also observed. Therefore, in the literature, most cases of cutaneous lesions showed some form of pre-existing cutaneous pathology, i.e. either physical insults or underlying dermatosis. This is seen with almost all the cases described above.6 A study by Moore TJ et al had showed that total of 106 cases of reported medication errors associated with methotrexate were identified over a period of 4 years7. The medication errors resulted in 25 deaths (24%) and 48 other serious outcomes (45%). The most common types of errors involved confusion about the once-weekly dosage schedule (30%) and other dosage errors (22%). Hence medication errors seen with use of methotrexate can be due to many drug related factors. The problem can beginat the level of physician which could be due to inadequate counselling about drug dosage, lack of re-emphasis about weekly dosage system or use of confusing brand names. This can also be seen at pharmacy level when modified dosage forms are prescribed or when medications provided over the counter. Finally, and most commonly it can be because of patient related factors like confusion among various drugs, misinterpretation about dosage, for faster relief self-administration of larger dosage or forgetfulness of ingested dosage in old patients.7 One of the best preventive practices while using drugs like methotrexate is to educate the patient about their medications. Illiterate patients should be asked to verify the dispensed drug with the doctor or any literate person at home or in the neighbourhood. They should also be educated about the outcomes of pharmacotherapy by written handouts and audio-visual teaching aids onmedication.8Involvement of close relative during counselling and creating awareness among patient as well relatives about possible side effects can be crucial. Conclusions Medication errors in methotrexate consumption can lead to serious complications and even death can occur. Our three patients despite the timely right diagnosis of methotrexate toxicity and treatment unfortunately succumbed to death. These medication errors can be prevented not only at the physician and pharmacist level but most importantly at patients level with adequate counselling and creating awareness about side effects. 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. Table 1: Laboratory investigation of patients at the time of admission   Values on admission Case 1 Case 2 Case 3 Hb (gm %) 11.2 6.5 9.2 WBC (cells/ml) 300 300 300 Platelet (cells/ml) 20000 60000 60000 SGPT (IU) 99 42 55 SGOT (IU) 38 05 32 Sr.creatinine (mg/ml) 2.2 6.2 1.2 BUN (mg/ml) 96 87 -   Parameter Englishhttp://ijcrr.com/abstract.php?article_id=2345http://ijcrr.com/article_html.php?did=2345  Baughman RP, Lower EE. A clinical approach to the use of methotrexate for sarcoidosis. Thorax 1999; 54:742-6. Gaies et al., Methotrexate Side Effects: Review Article. J Drug MetabToxicol 2012, 3:4. Lomaestro BM, Lesar TS, Hager TP. Errors in prescribing methotrexate. JAMA 1992; 268:2031-2. Sweet JM, Holstege CP. Bone marrow failure from medication error: diagnosis by history, not biopsy. Arch Intern Med 2001; 161:1911-2. National Coordinating Council for Medication Error Reporting and Prevention Medication ErrorIndex. Updated c1998-2011. Cited 2014 Dec 17. Available from: http://www.nccmerp.org/aboutMedErrors.html. Lee HJ, Hong SK, Seo JK, Lee D, Sung HS. A Case of Cutaneous Side Effect of Methotrexate Mimicking Behçet's Disease. Ann Dermatol. 2011; 23:412-4. Moore TJ, Walsh CS, Cohen MR. Reported medication errors associated with methotrexate. Am J Health Syst Pharm 2004; 61:1380-4 Malhotra K, Goyal M, Walia R, Aslam S. Medication Errors: A Preventable Problem. Indian Journal of Clinical Practice 2012; 23:17-21.  

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareEffect of Moderate and High Intensity Exercise on Maximum Oxygen Consumption and Health Related Quality of Life among Type 2 Diabetes Mellitus Participants-Pilot Study English1418Jyoti ChakrabortyEnglish Gopal NambiEnglish Kalindi DevEnglish ShanmugananthEnglishAim: To determine the effectiveness of moderate and high intensity exercise on maximum oxygen consumption and health related quality of life among type 2 diabetes mellitus participants. Method: In this study 10 individuals with type 2 diabetes mellitus were selected based on inclusion and exclusion criteria. They are divided into two groups by Odd and Even method. Group A content of 5 participants, received moderate intensity exercise and group B content of 5 participants, received high intensity exercise. Outcomes are maximum oxygen consumption and health related quality of life were taken at the baseline and 4 weeks after the treatment. Both the groups participants continued their medications during study period. Results: The post-test mean ±SD value of VO2max for Group-A is 38.64±4.18 and for Group-B is 47.98±5.58 this shows that Group-B is greater than Group A with P value 0.0171(p EnglishType 2 diabetes mellitus, Moderate intensity Exercise, High intensity Exercise, VO2max, HRQoLINTRODUCTION Diabetes mellitus is the one of the major chronic diseases, in that type 2 affect millions of people in the world. It is a metabolic disorder characterized by glucose intolerance. This systemic disease is caused by an imbalance between insulin supply and insulin demand[1]. 422 million adults were living with diabetes in 2014 globally, compared to 108 million in 1980[3]. In India, The prevalence of type 2 diabetes mellitus is 2.4% in rural population and 11.6% in urban population [2]. In Tamil Nadu 1 out of 10 people are diabetic, and every two persons in a group of 25 are in the pre-diabetic stage[3]. The development of T2DM is caused by a combination of lifestyle and genetic factors. While some of these factors such as diet, obesity, increasing age, female gender, and genetics[4].β-Cell dysfunction is initially characterized by an impairment in the first phase of insulin secretion during glucose stimulation and may antedate the onset of glucose intolerance in type 2 diabetes[5] Regular exercise has many beneficial effects other than improving blood glucose levels as it also improves cardio-respiratory fitness and psychological state of health in diabetic[6]. Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate (64%-76% HRmax) and break a sweat. One way to tell is that you'll be able to talk, but not sing the words to your favourite song. High-intensity aerobic activity means you're breathing hard and fast, and your heart rate (77%-95% HRmax ) has gone up quite a bit. If you're working at this level, you won't be able to say more than a few words without pausing for a breath.[7,8,16] Individuals with T2DM mellitus are at high risk for both micro and macrovascular complications. Microvascular including retinopathy, nephropathy and neuropathy and Macrovascular such as cardiovascular comorbidities[9]. Environmental factors like obesity, an unhealthy diet and physical inactivity. The insulin sensitivity can be increased by doing regular exercise and patient can also maintain the blood glaucous at normal level[10]. The regular exercise is always advised to type 2 diabetes mellitus patient, but they fail to do so. By the help of this study we can plan a particular intensity for them and we can reduce the burden and time duration for the type 2 diabetes mellitus patients. Exercise is integral to the management of type 2 diabetes. Unfortunately, majority of the adults with type 2 diabetes mellitus do not engage in regular exercise. There are evidence that Aerobic exercise have beneficial effects on type 2 diabetes mellitus but there is lack of at what intensity the exercise should be performed [11]. So the need for the study is to check the effect of high intensity with moderate intensity exercise on maximum oxygen consumption, health related quality of life among type 2 diabetes mellitus. METHODOLOGY 10 individuals with type 2 diabetes mellitus were selected based on inclusion and exclusion criteria. They are divided into two groups by Odd and Even method. Group A 5 participants, received moderate intensity exercise and group B 5 participants, received high intensity exercise. Outcome measures are taken at the baseline and 4 weeks after the treatment. Both of the groups are continued their medications during study period. Study Setting: Saveetha Physiotherapy Clinic, Saveetha Medical College & Hospital, Saveetha University. Inclusion criteria: Age group - 30 to 40 years, Both male and female were included, Participants not performed any aerobic exercise for last six weeks were included, Participants perform six minute walk test successfully were included, Participants willed to come continuously for 4 weeks. Exclusion criteria: Uncooperative, Unstable angina, Any cardiovascular disorder, Any neurological disorder, Any musculoskeletal disorder, Any other systemic illness, Obesity (Body Mass Index 30 and above). Materials used: Cycle ergometer, Two cone, Stopwatch, Inch tap, Digital pulse oximeter. OUTCOME MEASURES Maximum oxygen consumption (vo2max) VO2maxis the maximum rate of oxygen consumption as measured during incremental exercise. Maximal oxygen consumption reflects the aerobic, physical fitness of the individual, and is an important determinant of their endurance capacity during prolonged, moderate exercise [12].Unite is ml/min/kg.VO2max is calculated through 6 minute walk test, using cahalin formula Cahalin formula [VO2max = 0.006 x 6MWD(feet) + 3.38] (6MWD-six minute walk distance) 2. Health related quality of life Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning. EuroQol five dimensions questionnaire (EQ-5D) is a standardized instrument for measuring generic health status[13] Treatment procedure: Group A (n=5) Moderate intensity exercise Warm up for 10 minutes(include heel digs, knee lift, shoulder rolls, knee bends, jumping jacks, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition) Cycling for 20 minutes, maintaining the heart rate percentage between 64% to 76% of maximum heart rate. Cool down for 10 minutes (included relaxation, marching on spot, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition). Group B (n=5) High intensity exercise Warm up-10 minutes(included heel digs, knee lift, shoulder rolls, knee bends, jumping jacks, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition) Cycling for 20 minutes maintaining the heart rate percentage between 77% to 96% of maximum heart rate. Cool down for 10 minutes (included relaxation, marching on spot, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition). Treatment Protocol:(Both A & B Group) Duration of each session : 40 minute s(Warm up-10minutes, Conditioning period-20minutes, Cool down-10minutes) Sessions : 1 session/day Frequency : 5 days/week Duration : 4 weeks Statistical method : The collected data was tabulated and analyzed using descriptive and quartiles statistics. To all parameters mean and standard deviation (SD) was used. Parametric Paired t-test and Independent t test is used for intra and inter group comparison for VO2max. Non parametric Wilcoxson Mann Whitney test is used for intra and inter group comparison for HRQoL score. Result : The pre-test mean+SD value of Group A Maximum Oxygen Consumption is 25.7±2.03 and post-test value is 38.64±4.18 this shows that Maximum Oxygen Consumption scores are gradually increased, with P value is 0.004,showing that there is significant difference between pre and post values of Maximum Oxygen Consumption score of Group A. The pre-test mean ±SD value of Group B VO2max is 25.88±1.95 and post-test value is 47.98±5.58 this shows that Maximum Oxygen Consumption scores are gradually increased, with P value is 0.001,showing that there is significant difference between pre and post values of Maximum Oxygen Consumption score of Group B. The post-test mean±SD value of Group-A Maximum Oxygen Consumption is 38.64± 4.18 and for Group-B is 47.98±5.58 this shows that Group-B is greater than Group A with P value 0.0171 (p Englishhttp://ijcrr.com/abstract.php?article_id=2346http://ijcrr.com/article_html.php?did=23461. "Knowledge of patients and family members regarding diabetes mellitus and its treatment" by HN Shilubane. http://uir.unisa.ac.za/bitstream/handle/10500/1450/02chapter1.pdf , Date:10/04/17 Time:18.00 hrs 2. "Park's Textbook of Preventive and Social Medicine", by K. Park.23rd Edition. Date:10/04/17 Time:18.30 hrs 3."The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study: Methodological Details" by Ranjit Mohan Anjana.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192597/, Date:10/04/17 Time:19.30 hrs 4."Diabetes mellitus Type 2"https://en.wikipedia.org/wiki/Diabetesmellitustype2. Date:10/04/17 Time:20.00 hrs 5. "Clinical aspects of islet B cell function in non-insulin dependent diabetes mellitus" by Ward WK, Beard JC, Diabetes Metab Rev.2:297-313. Date:10/04/17 Time:20.30 hrs 6."Effects of Exercise on Cardiovascular Risk Factors in Type 2 Diabetes A meta-analysis" by Anna chudyk, Robert J. petrella,http://agris.fao.org/agris-search/search.do?recordID=US201400146005, Date:10/04/17 Time:21.00 hrs 7. "Enhancing the Aerobic Fitness of Individuals with Moderate and Severe Disabilities: A Peer-Mediated Aerobic Conditioning Program".by Kane, James W, Date:10/04/17 Time:21.30 hrs http://files.eric.ed.gov/fulltext/ED336906.pdf 8."Therapeutic Exercise foundations and techniques" by Carolyn Kisner.7thedition, Date:10/04/17 Time:22.30 hrs 9. "Type 2 diabetes mellitus" by DeFronzo RA, Date:12/04/17 Time:16.30hrs https://www.ncbi.nlm.nih.gov/pubmed/27189025 10."Blood Glucose Control and Exercise" by American Diabetes Association.http://diabetes.org/food-and-fitness/fitness/get-started-safely/blood-glucose-control-and-exercise.html?referrer=https://www.google.co.in/, Date:12/04/17 Time:17.00 hrs 11. "Exercise and Type 2 Diabetes" by Sheri R. Colberg, Date:12/04/17 Time:18.00hrs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/ 12. "VO2max"https://en.wikipedia.org/wiki/VO2max, Date:12/04/17 Time:19.00hrs 13. "EuroqolEQ-5D-5L". http://www.euroqol.org/eq-5d-products/eq-5d-5l.html, Date:13/04/17 Time:10.00hrs 14."U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Diabetes-National Diabetes Fact Sheet"https://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf, Date:15/04/17 Time:14.00hrs 15."Standards of medical care in diabetes"-2010 by American Diabetes Association.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797382/, Date:13/04/17 Time:11.00hrs 16."WHO|What is Moderate-intensity and Vigorous-intensity Physical Activity"http://www.who.int/dietphysicalactivity/physicalactivityintensity/en/, Date:12/04/17 Time:11.00hrs 17. "Diabetes, Heart Disease, and Stroke|NIDDK"https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke. Date:15/04/17 Time:16.00hrs 18."Exercise Makes It Easier to Control Your Diabetes" by Amy Hess-Fischlhttps://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-exerciseDate:13/04/17 Time:15.00hrs 19."Physical Activity/Exercise and Type 2 Diabetes" by Ronald J Sigalhttp://care.diabetesjournals.org/content/29/6/1433.Amy Hess-FischlDate:10/04/17 Time:14.00hrs 20."Relation Between The 6-Minute Walk Test and The Maximum Oxygen Consumption" by Walter Villalobos,http://journal.chestnet.org/article/S0012-3692(16)44306-0/fulltextDate:11/04/17 Time:16.00hrs 21.'Type II diabetes and quality of life: a review of the literature' by HörnquistJO,https://www.ncbi.nlm.nih.gov/pubmed/10158997. Date:11/04/17 Time:17.00hrs

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareTo Analyse the Physical Fitness of Female Physiotherapy Students and its Correlation with Depression and Anxiety English1923V. RajalaxmiEnglish B. VijayalakshmiEnglish V. ShaliniEnglish L. MotcharakkiniEnglish G. TharaniEnglishAim: The aim of the study is to analyze the physical fitness of female Physiotherapy students in correlation with depression, anxiety and stress. This study also aims to create awareness among the students to engage them in the physical activities to improve their physical and mental fitness. Background of the Study: The effectiveness to carry out daily task with vigor and alertness, without undue fatigue is not easy, therefore in order to complete all of these tasks; one must consistently address their fitness. Schools and colleges are also marked as a stressful environment that often has a negative effect on students’ academic performance, physical health, and psychosocial well-being. Methodology: After getting proper approval from the Institutional review board, 50 female physiotherapy students were selected from 75 volunteers based on the inclusion criteria(age of 17-22, normal BMI, healthy human being). The samples with psychological problems, tachycardia, and wheezing was been excluded. This observational study was carried out for the duration of 1 week among the students of faculty of physiotherapy. After getting consent from the samples they were assessed by six minute walk test (6MWT) focusing on gauging the aerobic capacity and endurance and psychological status by depression anxiety stress scale (DASS 21). Result and Conclusion: In analyzing the data it shows that the subject with less fitness have more anxiety, depression and stress and the samples with more fitness have less depression anxiety and stress.                                                                   EnglishPhysical fitness, 6MWT, DASS 21, Anxiety, Stress, Depression INTRODUCTION: Our ability to carry out daily tasks and routine activities without undue fatigue is called physical fitness. Physical fitness is generally achieved through proper nutrition, vigorous physical exercise. In order to achieve physical fitness one must consistently address their physical activities. The six walk test is a low cost, simple test that requires little equipment and shows good to excellent test- retest reliability across the literature. The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD)(1,2).To access the emotional syndromes like depression and anxiety, a scale called as depression anxiety stress scale (DASS21) can lead to a useful assessment. The short version of the depression anxiety stress scale (DASS 21) was developed to provide a self-report measure of anxiety depression and stress signals(3). The level of depression in the group who do physical activity in their leisure time comparing with group who do sedentary activity instead, had significant difference(4). The main symptoms of depression are psychological aerosol, low self-esteem, and hopelessness, devaluation of life, self-deprecation and inertia. The stress construct of the scale emerged empirically during the development of the depression and anxiety scales, through aggregation of items relating to difficulty relaxing, tension, impatience, irritability and restlessness. The prevalence of depression among students in public universities has been estimated to be 10.4% in Greece (5), 15.2% in USA (6) 21.7% in Malaysia (7), 24%in UK (8), 29.1% in India (9), and 43.8% in Pakistan (10). The prevalence of depression among medical students, however, has been estimated to be 19% in USA (11), 49.1% in India (12), and 60% in Pakistan(13). METHODOLOGY: After the approval from the institutional review, board 50 female physiotherapy students were selected from 75 volunteers among the students faculty of physiotherapy. The age group was 17-22yrs (early adolescent). The inclusion criteria normal Body mass index (BMI), normal healthy human being (not merely absence of disease), we have excluded psychological problems, tachycardia and wheezing criteria. The subjects were assessed by six minute walk test (6MWT) which focuses on gauging the aerobic capacity and endurance giving us picture about their physical fitness. The equipment used was stopwatch, measuring tape, cones and chairs, colour tapes. We setup cones as either end of 30m stretch corridor or surface (plane and non-skit), by having chairs on both sides and half way along the walking stretch. Performance ability is assessed using 6 MWT walk test. The objective of this test is to walk as far as possible for six minutes. The students have to walk back and forth with 30 meter corridor. They could be encouraged but the walking speed must not be influenced. Walking cones are placed along the participant just behind them and should lead them. The distance walked is calculated from total laps and in meters recorded. To gauge the psychological aspect the short form version of depression anxiety stress scales (DASS21). Students were explained about the questionnaire and asked to answer truthfully. The mode of Depression, Anxiety, and Stress level that is Mild, Moderate and severe for every female physiotherapy students were also calculated. SPSS version 16 is used for the statistical analysis. RESULT: In analysing the mean values of the data collected shows that the subjects with less fitness have more anxiety depression and stress and the samples with more fitness have less depression, anxiety and stress. Hence the study emphases on regular physical activities to have a good psychological well-being resulting in good academic record. DISCUSSION: In this study, 50 females were selected based on the inclusion criteria from 75 volunteers and have undergone 6 MWT and asked to fill a questioner to know their level of mental fitness to measure depression, anxiety and stress. This is done to correlate distance walked during 6MWT with psychological parameters (Depression, anxiety and stress). The mean value shows that as the mean value of 6 MWT increases, the mean of depression decreases showing a negative correlation. The mean value shows that as the mean value of 6 MWT increases, the mean of Anxiety decreases showing a negative correlation. The mean value shows that as the mean value of 6 MWT increases, the mean of stress also increases showing a positive correlation. This clearly states that a person in depression and anxiety don't have a proper physical fitness nor unable to perform in any physical task efficiently. In other words a person whose physical fitness is compromised or sedentary for long time will lead to depression and anxiety later. Person with stress are able to perform better in physical fitness tasks as stress is a temporary one which can be easily handled by engaging in physical task. Untreated depression and anxiety are likely to be related to a student's suicidal behaviour, poor scholastic performance, and withdrawal from their course. Identifying the Factors which precipitate stressors for depression and anxiety may facilitate clinicians' and educational organisations to know the important stressors faced by depressed and anxious students during their program(14). Exercise and cognitively based distraction techniques were shown to have equal effectiveness at reducing state anxiety, however exercise was more effective in reducing trait anxiety(15).Moreover, in a study of elementary students as subjects, physical fitness is significantly correlated with mental health (16).The Hypothalamic-Pituitary-Adrenal(HPA) axis plays a critical role in developing adaptive responses to physical and psychological stressors (17). Dysregulations in the HPA axis have been implicated in the manifestations of depression and anxiety symptoms. The findings suggest that exercise induced changes in the HPA axis modulates stress reactivity and anxiety in humans. CONCLUSION: Even though they are physically fit, due to lack of some physical activities, there is a decline in DASS. Therefore, each student should be individually involved in fitness along with their daily physical activities. Hence, this study concludes that regular physical activities are required to have a perfect physical and mental well-being. Acknowledgement: I would like to thank the authorities of Dr MGR Educational and Research Institute University and Principal Faculty of Physiotherapy for providing me with facilities required to conduct the study. 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 Considerations: This study is approved by the Institutional Review board of faculty of physiotherapy. All the procedures were performed in accordance with the ethical standards of the responsible ethics committee both (Institutional and national) on human experimentation and the Helsinki Declaration of 1964 (as revised in 2008). Conflict of Interest: 'Conflicts of interest: none' Funding: This is a self-funded study. TABLE -1 Depression Anxiety Stress Scale(DASS) Depression Anxiety Stress   F   SIGNIFICANCE M SD M SD M SD NORMAL 6.20 1.79 6.20 1.79 10.13 3.10 6.438 .006 MILD 11.44 1.01 nil Nil 16.67 1.40 72.902 .000 MODERATE 16.72 2.14 11.91 1.38 21.56 2.19 60.098 .000 SEVERE 24.00 2.31 16.38 1.56 29.00 2.14 111.13 .000 VERY SEVERE 34.36 5.80 28.86 7.42 39.80 3.56 6.539 .004                       TABLE -1, shows the mean value and standard deviation Of Depression Anxiety Stress Scale (DASS), F-value and significance TABLE -2 6 minute walk test (6MWT) Depression Anxiety Stress   F   SIGNIFICANCE M SD M SD M SD NORMAL 420.00 70.36 420.00 72.36 375.00 70.14 1.264 .301 MILD 336.67 51.48 nil nil 380.00 46.71 4.059 .058 MODERATE 373.33 53.69 354.56 62.67 360.00 58.09 0.406 .669 SEVERE 381.43 53.98 373.85 49.92 371.25 53.03 0.078 .925 VERY SEVERE 384.56 46.12 375.71 48.95 396.00 25.10 0.439 .649                       TABLE -2, shows the mean value and standard deviationOf 6MWT, F-value TABLE-3 Depression Dass Mean Standard deviation (SD)   6MWT Mean Standard deviation(SD) Englishhttp://ijcrr.com/abstract.php?article_id=2347http://ijcrr.com/article_html.php?did=2347REFERENCE: Harada, N., Chiu, V., et al, "Mobility-related function in older adults: assessment with a 6-minute walk test." Archives of physical medicine and rehabilitation 1999 80(7): 837-841. American Thoracic Society, Am J Respir Crit Care Med Vol 166. pp 111-117, 2002,DOI: 10.1164/rccm.166/1/111.ATS Statement: Guidelines for the Six-Minute Walk Test Lovibond, S.H. andLovibond, P.F. (1995). Manual for the depression anxiety and stress scales. (2 Ed.)Sydney: Psychology Foundation. Samira Aliabadi a*, Majed Zobairy b, Layla Zobairy c. The Relationship between Depression and Leisure Time Activity in Female High School Students. Procedia - Social and Behavioral Sciences 84 ( 2013 ) 256 - 258 S. Mancevska, L. Bozinovska, J. Tecce, J. Pluncevik-Gligoroska, and E. Sivevska-Smilevska, "Depression, anxiety and substance use in medical students in the Republic of Macedonia," Bratislavske Lekarske Listy, vol. 109, no. 12, pp. 568-572, 2008. 6. J. Tjia, J. L. Givens, and J. A. Shea, "Factors associated with undertreatment of medical student depression," Journal of American College Health, vol. 53, no. 5, pp. 219-224, 2005. 7. M. S. B. Yusoff, A. F. A. Rahim, and M. J. Yaacob, "The prevalence of final year medical students with depressive symptoms and its contributing factors," International Medical Journal, vol. 18, no. 4, pp. 305-309, 2011. 8. M. E. Dahlin and B. Runeson, L"Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study," BMC Medical Education, vol. 7, article 6, 2007. 9. S. Sidana, J. Kishore, V. Ghosh et al., "Prevalence of depression in students of a medical college in New Delhi: a cross-sectional study," Australasian Medical Journal, vol. 5, no. 5, pp. 247-250, 2012. 10. N. A. Jadoon, R. Yaqoob, A. Raza, M. A. Shehzad, and Z. S. Choudhry, "Anxiety and depression among medical students:a cross-sectional study," Journal of the Pakistan Medical Association, vol. 60, no. 8, pp. 699-702, 2010. 11.M. S. Hendryx, M. G. Haviland, and D. G. Shaw, "Dimensions of alexithymia and their relationships to anxiety and depression," Journal of Personality Assessment, vol. 56, no. 2, pp. 227-237, 1999. 12.A. Singh, A. Lal, and A. Shekhar, "Prevalence of depression among medical students of a private medical college in India," Online Journal of Health and Allied Sciences, vol. 9, no. 4, pp. 8-12, 2010. 13. S. N. Inam, A. Saqib, and E. Alam, "Prevalence of anxiety and depression among medical students of private university," The Journal of the Pakistan Medical Association, vol. 53, no. 2, pp. 44-47, 2003. 14.Coumaravelou Saravanan and Ray Wilks. Medical Students' Experience of and Reaction to Stress: The Role of Depression and Anxiety, The Scientific World Journal Volume 2014, Article ID 737382, 8 pages. 15.Petruzzello, S. J., Landers, D., Hatfield, B., Kubitz, K., and Salazar, W. A. (1991). A meta-analysis on the anxiety reducing effects of acute and chronic exercise. Outcomes and mechanisms. Sports Med. 11, 143-182. 16. Choi HG. Association of blood leptin level with cardiorespiratory fitness, body composition and metabolic syndrome in female college students. Journal of Korean Physical Education Association for Girl and Wom­en 2008;22:137-148. 17. De Kloet, E. R., Joëls, M., and Holsboer, F. (2005). Stress and the brain: from adaptation to disease. Nat. Rev. Neurosci. 6, 463-475.        

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareHistopathological Study of Ocular Surface Squamous Neoplasia in Biopsies Received at Tertiary Care Centre English2429Neetal DesaiEnglish Ami ShahEnglish Hansa GoswamiEnglishIntroduction: Ocular surface squamous neoplasia(OSSN) is an encompassing term for pre-cancerous and cancerous epithelial lesions of the conjunctiva and cornea which includes Dysplasia, Carcinoma in-situ (CIS) and Invasive Squamous Cell Carcinoma. OSSN is mostly unilateral, occurs in middle aged to older patients. It is associated with factors such as HIV and xeroderma pigmentosum. Aims and Objectives: 1) To evaluate incidence of Dysplasia and Squamous Cell Carcinoma in biopsies received 2) To study the spectrum of histopathological findings in Ocular Surface Squamous Neoplasia Materials and Method: We examined 52 ocular surface biopsies received in our tertiary care centre during the period of 22 months (August-2015 to May-2017). Slides stained with Hematoxylin and Eosin were examined and dysplasia found in biopsies were categorized into mild, moderate and severe. Invasive squamous cell carcinomas were again categorized according to differentiation into well differentiated, moderately differentiated and poorly differentiated. In addition to these 52 biopsies, 10 biopsies were excluded from the study which showed normal or only hyperplastic squamous epithelium. Results: Out of 52 biopsies examined, 2 cases showed squamous papilloma,13 cases showed dysplasia-mild being the commonest and 37 cases showed invasive carcinoma, moderate differentiation being the commonest. Conclusion: OSSN is common in middle age and male gender and usually occurs in limbal conjunctiva. Histopathology remains the gold standard for accurate diagnosis and grading of OSSN. Despite increasing awareness, Invasive carcinoma is more prevalent than dysplasia. Prognosis largely depends upon grade and differentiation of tumor and specific microscopic type. EnglishDysplasia, Squamous Cell Carcinoma, HIV, Xeroderma PigmentosumIntroduction: Ocular Surface Squamous Neoplasia(OSSN) is an embracing term for pre-cancerous and cancerous epithelial lesions of the conjunctiva and cornea. It includes the spectrum of Dysplasia, Carcinoma in-situ (CIS) and Invasive Squamous Cell Carcinoma(SCC)(1-3). OSSN is mostly unilateral and is seen in middle age and older patients. Rarely, it is bilateral especially in immunocompromised patients. Factors causing development of OSSN are exposure to sunlight, HPV type 16 infections and HIV infection(2,5). There is a systemic association of xeroderma pigmentosum with OSSN patients. Other factors associated are old age, heavy cigarette smoking, male sex and light complexion. Clinically, we cannot distinguish CIS from invasive SCC. The presence of feeder vessels, intrinsic vascularity and a nodular lesion should raise suspicion of invasive SCC. This usually presents either as a fleshy, gelatinous lesion or as a sessile, papillomatous lesion mostly in the interpalpebral region. Unless the lesion is encroaching onto the pupillary area, vision is spared. Presenting clinical features of this entity are swelling, redness, irritation and feeder vessels surrounding the lesion (1,2,5,7,8). Advanced cases can invade the cornea and sclera (9) and on rare occasions the tumor may infiltrate into the orbit causing proptosis. Treatment includes complete surgical excision with 4mm margin clearance without touching the tumor, so called 'No Touch Technique'(1,10,11). Cryotherapy is also useful (8) Reported recurrence rate of OSSN is 15-52%. Lee and Herst reported a 17% recurrence after excision of conjunctival dysplasia, 40% after excision of CIS and 30% for SCC of conjunctiva2. The recurrence rate can be limited to less than 5% with the above technique. OSSN has a good prognosis. The recurrence rate is about 5% and regional metastasis rate is about 2% With the modern techniques(1,5,12,13) .   Aims and objectives: 1)To evaluate incidence of Dysplasia and Squamous Cell Carcinoma in biopsies received 2)To study the spectrum of histopathological findings in Ocular Surface Squamous Neoplasia   Materials and method: We examined 52 ocular surface biopsies received in our tertiary care centre during the period of 22 months(August-2015 to May-2017).Slides were stained with Hematoxylin and Eosin. Dysplasia found in biopsies were categorized into mild, moderate and severe (Conjunctival Intraepithelial Neoplasia(CIN)-I,II and III respectively). Slides were carefully examined for foci of invasion. Invasive squamous cell carcinomas were again categorized according to differentiation into well differentiated, moderately differentiated and poorly differentiated. In addition to these 52 biopsies, 10 biopsies were excluded from the study which showed normal or only hyperplastic squamous epithelium.   Results: Out of 52 biopsies examined, results are as shown in (Table:1), with comparison with the study done in 2016 by Kabra RC et al(14).(Table: 2) Two cases of poorly differentiated carcinoma showed histomorphology of spindle cell variant-a known variant of invasive ocular squamous cell carcinoma. One of them was HIV positive patient. In the study by Kabra RC et al, more patients were HIV positive(14). A few cases with moderately and poorly differentiated carcinoma showed extensive stromal necrosis. Maximum(42) cases were found between the age group of 41-80 years, mean age being 57.5 years. A few cases of moderate dysplasia and well differentiated carcinoma were found in the younger age group(2/3rd of the epithelium shows dysplasia, however surface maturation is preserved.   (*CIN- Conjunctival Intraepithelial Neoplasia)                 Englishhttp://ijcrr.com/abstract.php?article_id=2348http://ijcrr.com/article_html.php?did=2348References: (1) Shields CL, Shields JA. Tumours of the conjunctiva and cornea. Surv Ophthalmol. 2004;49:3-24.[PubMed] (2) Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995;39:429-50. [PubMed] (3) Pe'er J. Ocular surface squamous neoplasia. Ophthalmol Clin North Am. 2005;18:1-13. vii. [PubMed] (4) Lee GA, Hirst LW. Retrospective study of OSSN. Aust NZJ Ophthalmol. 1997;25:269. [PubMed] (5) Shields JA, Shields CL. Eyelid, Conjunctival and Orbital Tumours. An Atlas and Textbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. pp. 250-445. (6) Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumours. Ophthalmology. 2004;111:1747-54. [PubMed] (7) Farah S, Baum TD, Conton MR. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia: WB Saunders; 2000. Tumours of cornea and conjunctiva. In: Albert DM, Jakobiec FA, editors; pp. 1002-19. (8) Honavar SG, Manjandavida FP. Tumours of the ocular surface: A review. Indian J Ophthalmol. 2015;63:187-203. [PMC free article] [PubMed] (9) Nicholson DH, Herschler J. Intraocular extension of squamous cell carcinoma of the conjunctiva. Arch Ophthalmol. 1977;95:843-46. [PubMed] (10) Mauriello JA, Napolitano J, McLean I. Actinic keratosis and dysplasia of the conjunctiva: A clinicopathological study of 45 cases. Can J Ophthalmol. 1995;30:312-16. [PubMed] (11) Shields JA, Shields CL, De Potter P. Surgical management of conjunctival tumours. The 1994 Lynn B. McMahan Lecture. Arch Ophthalmol. 1997;115:808-15. [PubMed] (12) Cervantes G, Rodríguez AA, Leal AG. Squamous cell carcinoma of the conjunctiva: Clinicopathological features in 287 cases. Can J Ophthalmol. 2002;37:14-19. [PubMed] (13) Shields CL, Fasiuddin AF, Mashayekhi A, Shields JA. Conjunctival nevi: Clinical features and natural course in 410 consecutive patients. Arch Ophthalmol. 2004;122:167-75. [PubMed] (14)Kabra RC, Morawala A, Maheshwari VN. Clinicopathological analysis of 55 cases of ocular surface squamous neoplasia. Ophthal Rev: Int J ophtha and Oto. 2016;1(1):10-16. doi: 10.17511/jooo.2016.i1.04. (15)Pizzarello L.D., Jakobiec F.A. Bowen's disease of the conjunctiva: a misomer. In: Jakobiec F.A., editor. Ocular adnexal tumors. Aesculapius; Birmingham, AL: 1978. pp. 553-571. (16) Alexandre N. Odashiro, Thomas J. Cummings, Miguel N. Burnier, Jr. Eye and Ocular Adnexa. In: Stacey E. Mills, editor; Joel K. Greenson, Jason L. Hornick, Teri A. Longacre, Victor E. Reuter, Associate editors.Sternberg's diagnostic surgical pathology. 6th ed. Philadelphia: Wolters Kluwer Health; 2015. p. 1074-1075. (17)Sjö N, Heegaard S, Prause JU. Conjunctival papilloma.A histopathologically based retrospective study.Acta Ophthalmol Scand 2000;78:663-666. (18)Mittal R, Rath S, Vemuganti GK. Ocular surface squamous neoplasia - Review of etio-pathogenesis and an update on clinico-pathological diagnosis. Saudi Journal of Ophthalmology. 2013;27(3):177-186. doi:10.1016/j.sjopt.2013.07.002. (19)Ramon L Font, J Oscar Croxatto, Narsing A Rao.Tumors of the Eye and Ocular Adnexa, AFIP Atlas of Tumor Pathology. Series 4, fascicle 5. The American Registry of Pathology in collaboration with the Armed Forces Institute of Pathology; 2006. p. 1-10.      

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareRelationship of Physical Fitness Parameters with Performance among the College Level Football Players English3034Kanwar Mandeep SinghEnglish Karanjit SinghEnglish Satinder KumarEnglish Sartaj Singh ChhinaEnglishAim: The purpose of this study was to ascertain relationship of physical fitness parameters with performance among college level football players and also to predict football performance on the basis of physical fitness parameters. Methodology: Total two hundred and fifty male football players, aged 18-25 years, from the colleges of Punjab were selected to participate in the study. Body weight of the subjects was measured with a portable weighing machine. Height measurements were taken using the standard anthropometric rod. Power was measured by applying standard test of Standing Broad Jump. Agility was measured by applying standard test of zig-zag run. Strength was measured by applying standard test of Medicine Ball Put. Speed was measured by applying standard test of 50 yard dash. Endurance was measured by applying standard test of 600-yard run-walk. The performance of the college football players was measured with the help of Dr. J.P. Thomas soccer skill test. Results: Karl Pearson’s product moment co-efficient of correlation revealed that the time of the speed (pEnglishPhysical Fitness, Football, Performance, SpeedINTRODUCTION At competitive, organized levels, football is an endurance sports that incorporates periods of intense exercise interspersed with lower levels of activity over a 90-minute period (Reilly, 1996). In recent years, the performance and standard of football have also increased which led the sports scientists and coaches to think and to find out the various possible ways for further improvement in the field of performance. The sports performance depends on many factors such as motor abilities, physiological variables, techno-tactical abilities, psychological maturity, kinanthropometric characteristics, socio economic status and some external factors. The motor abilities along with technical abilities have been considered as most important prerequisite for all sportsmen to secure the top level performance in the game. A close connection is existed amongst physical, technical, conditional and tactical components. The contribution of various performance factors is a very complex combination and they superseded each other. In order to improve performance in sports, motor fitness preparation of the players play an important role and lays a strong foundation for all other aspects of sports performance. The fitness of a player is the sum total of several motor abilities namely; strength, speed, endurance, flexibility, agility and coordination. These motor abilities and their complex form i.e. strength endurance, speed endurance, explosive strength etc, are the basic prerequisites for human motion. Motor fitness as a term refers to the total dynamic physiological state of the individual. Motor fitness is to be measured by performance and this performance is based on a composition of many factors. Some of these factors evidently more dominant than others and thus have a higher relation with physical fitness. Most sports, of course, require a contribution from a number of components of fitness in varying degrees. Speed, power, balance, agility, strength, reaction time and kinesthetic perception are the traits of motor performance, and these traits plays major role in enhancing the performance of any game’s skills. With a good and well efficient combination of all these motor performance traits a player can give all his/her utmost throughout the most strenuous of competitive matches (Nabhendra Singh, 2010). In football, speed of the movement of various body segments, speed for a very short distance, is of great importance. Speed is the ability to perform a movement within a short period of time (Neiman, 1995). In court, proper movements of the body parts both in offensive and defensive moves of the game are very essential. On the other hand, strength further increases the performance of a sportsperson. In case of football, it helps in powerful shooting into the opponent’s goal and covering a longer distance with the kicks. Strength in lower limbs is an obvious concern in football, the quadriceps and hamstring group of muscles should generate high force for jumping and kicking. Though the strength is its pre-requisite, which is to be developed in the beginning, it is later to be transferred directly into explosive strength. Muscular power, often referred to as explosive power, is a combination of speed and strength an important in vigorous performance because it determines how hard a person can hit, jump and push etc. There are various means and method to increase power by increasing strength without sacrificing speed, by increasing speed of movement without sacrificing strength and by increasing both can be stressed by applying strong force through rapid motion (Nabhendra Singh, 2010). Agility is the ability to change the direction of body or its parts rapidly’ is dependent on strength, reaction time, speed of movement and muscular coordination. Quick start and stops and quick changes in direction are fundamental to good performance in Football (Nabhendra Singh, 2010). In the present times, competitions at the top ranking level are very tough and closely contested. So for attaining top position in high level competition, an athlete has to tolerate the high pressure training load every day. Tolerance of high pressure training-load depends on the ability of any athlete to recover quickly. Therefore, better the fitness, quicker will be the recovery ability. Hence, the motor fitness is directed towards the perfection of technique, tactics and its effective use during trainings as well as competition. Therefore, the abilities of physical performance specific to football determining the fitness are very important. In team games, the performance of the players is dependent upon a complex combination of factors, which are difficult to objectively measure. Such is the case in football, in which player performance relies on interplay of individuals of in tactical moves, the competence of players in the basic skills of passing, dribbling, kicking, tackling and shooting and in the more specific skills associated with particular playing positions. In such contexts, the assessment of player performance must consider the physical attributes, as well as the tactical and technical aspects of performance. Prediction tests are as important in the field of physical education as in other fields of education. These tests have been fairly well developed in some branches of athletics and team sports such as basketball (Hoare, 2000) using physical performance variables while in other areas, such as football, very little has been done. Most football coaches still rely on the subjective observation method for predicting football ability. The present study, therefore, aims to find out the relationship in physical fitness parameters and football performance among college level football players and also to predict the performance on the basis of physical fitness parameters of football players. METHODOLOGY The subjects of the present study were purposively selected from the college level male football players. A total two hundred and fifty male football players, aged 18-25 years, from the colleges affiliated to Guru Nanak Dev University, Amritsar, Panjab Universiy, Chandigarh and Punjabi University, Patiala were selected to participate in the study. Body weight of the subjects was measured with a portable weighing machine to the nearest 0.5 kg. Height measurements were taken using the standard anthropometric rod to the nearest 0.5 cm (HG-72, Nexgen ergonomics, Canada). Power was measured by applying standard test of Standing Broad Jump. Agility was measured by applying standard test of zig-zag run. Strength was measured by applying standard test of Medicine Ball Put (Barrow and McGee, 1979). Speed was measured by applying standard test of 50 yard dash. Endurance was measured by applying standard test of 600-yard run-walk (AAPHER Youth Fitness Test, 1976). Football Playing Ability The performance of the college football players was measured with the help of Dr. J.P. Thomas soccer skill test. This test includes following items Soccer dribble test Soccer kick for distance Soccer place-kick for accuracy Soccer throw-in for distance Throw-in for accuracy Shooting at the goal from the penalty point Statistical analysis Statistical analysis was performed using SPSS version 16.0 for windows (SPSS Inc, Chicago, IL, USA). The data was presented as descriptive statistics such as mean, standard deviation, minimum value, maximum value etc. Karl Pearson's product moment co-efficient of correlation was computed to assess the relationship between physical fitness parameters and performance among the football players. To predict the performance in football from physical fitness parameters, multiple regression analysis was applied. Significance levels were set at pEnglishhttp://ijcrr.com/abstract.php?article_id=2349http://ijcrr.com/article_html.php?did=2349REFERENCES AAPHER. (1976). AAPHER Youth Fitness Test manual. Washington D.C. Borrow, H.M., McGee, R. (1979). A practical approach to measurement in physical education. Lea and Febiger, Philadelphia. Bandyopadhyay, A. (2007). Anthropometry and body composition in soccer and volleyball players in West Bengal, India.J Physiological Anthropology, 26(4), 501-505. Dey, S.K., Kar, N., Debray, P. (2010). Hoare, D.G. (2000). Predicting success in junior elite basketball players - the contribution of anthropometric and physiological attributes. J. Sci. Med. Sport 3, 391-405. Joksimovic, A., Smajic, M., Molnar, S., Stankovic, D. (2009). An analysis of anthropomorphological characteristics of participants in the 2008 European football championship. Serbian Journal of Sports Sciences, 3(2): 71-79. Meckel, Y., Machnai, O., Eliakim, A. (2009). Relationship among repeated sprint tests, aerobic fitness, and anaerobic fitness in elite adolescent soccer players. Journal of Strength and Conditioning Research 23(1):163-169. Nabhendra Singh. (2010). A Comparative Study of Motor Performance Level among Categorized Skilled Hockey Players. International Journal of Educational Administration, 2(2):403-410. Neiman, D. (1995). Fitness and Sports Medicine: A health related approach. (3rd ed.). Mountain View, California, Mayfield Publishing Company. Nikolaidis, P.T., Karydis, N.V. (2011). Physique and body composition in soccer players across adolescence. Orhan, O., Sagir, M., Zorba, E., Kishali, N.F. (2010). A comparison of somatotypical values from the players of two football teams playing in Turkcell Turkish super league on the basis of the players' positions. Journal of Physical Education and Sport Management,1(1):1-10. Reilly T (1996). Science and Soccer. E and FN Spon, London. Reeves, S.L., Poh, B.K., Brown, M., Tizzard, N.H., Ismail, M.N. (1999) Anthropometric measurements and body composition of English and Malaysian footballer. Mal. J. Nutr., 5:79-86. Rogan, S., Hilfiker, R., Clarys, P., Clijsen, R.,Taeymansa, J. (2011). Position-specific and team-ranking-related morphological characteristics in German amateur soccer players - a descriptive study- anthropometry in amateur soccer players. International Journal of Applied Sports Sciences, 23(1): 168-182. Sawyer, D.T., Ostarello, J.Z., Suess, E.A., Dempsey, M. (2002). Relationship between football playing ability and selected performance measures. , 16(4):611-616.      

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareCorrelation of Frozen Section and Routine Histopathological Findings in Brain Tumors English3538Ruchi PatelEnglish Ina ShahEnglish Hansa GoswamiEnglishIntroduction: One of the most crucial part of the line of management of patients having space occupying lesions of central nervous system is intra-operative consultation. In order to maintain the integrity of quality assurance in surgical pathology, correlation between intra operative frozen section diagnoses with final histopathological diagnosis is fundamental. Aim of Study: 1) To learn the correlation between routine histopathology and frozen section in the diagnosis of various brain tumors. 2) To find out incidence of various types of tumors of Central Nervous System. 3) To study the comparative sensitivity of frozen section and routine histopathology for the diagnosis of SOLs of CNS. 4) To evaluate the diagnostic parameters of intra operative frozen sections in suspected intracranial tumors that are to be reported with frozen section followed by routine histopathology Materials and Methods: Total 130 cases of brain tumors in tertiary care centre from January 2016 to February 2017 were studied retrospectively. These cases were reported both on frozen section and paraffin section. The diagnosis on frozen sections were compared with the final assessment to assess the concordance and discordance rates between both as well as to find out the incidence of various lesions of CNS. Results: In present study, the overall concordance rate was 81.5%, discordance rate was 18.5%.In cases where the frozen section and the routine histopathology diagnosis were discordant the final diagnosis was derived from the findings of routine histopathological examination. Astrocytoma (44.6%) was the most common brain tumor. Concordance rate varies and lowers in low-grade tumors than in high-grade tumors. EnglishFrozen Section, Brain tumor, HistologyIntroduction The technique of frozen section was first introduced by the pathologist, William H. Welch, in 1891. In 1920s the technique became popular and was used for intra operative consultation. In the 1960s, the preparation of frozen section was made easier by the use of cryostat, a cabinet with -20 to -30 degree Celsius cooling and enclosing a microtome blade. Intra operative frozen section diagnosis is now a day a routine practice in most institutions, thus accuracy in diagnosis of frozen section must be assessed and compared with the final diagnosis of routine histopathology. Intra operative frozen section examination has been remain an excellent diagnostic tool for neurosurgeon to confirm that the target lesion is tumor tissue or not and to plan surgical strategy (1). While awaiting the result of histopathology which takes longer time, frozen section result is useful to inform patient and start adjuvant therapy (2). Internationally published studies have confirmed the overall accuracy of intra operative frozen section and squash preparation examination (3) (4) (5). Materials and Methods A retrospective study of 130 cases (table -I)of frozen sections and routine histopathology was done at tertiary care hospital, Ahmadabad for period of 1st January 2016 to 31 February 2017. Five-micrometer sections were cut by use of cryostat and sections were stained by the rapid HandE method. Afterwards, the specimen was fixed overnight in 10% buffered formalin and subsequently taken the next day for grossing wherein appropriate representative sections were taken. The permanent sections were evaluated on HandE stained sections. Agreement between frozen section and paraffin section diagnosis was classified in to four categories shown in table-II. Results Out of total 130 cases in this study, 72% cases were in group 1, and 9.5% cases are in group 2, giving a concordant diagnostic frequency of total 81.5%.While remaining cases were discordant and fall into group 3, with a discordant diagnostic frequency of 18.5%.The highest number of concordance frequency was observed for astrocytoma (58 cases, 44.6%) on frozen section and as well as routine histopathology. So, the highest numbers of cases received and reported on frozen section and followed by confirmation on routine histopathology (highest incidence) were of Astrocytoma followed by meningioma. In 2 cases the FS diagnosis were 'no tumor tissue', but later on, histopathogy findings were of high grade glioma. Discussion The accuracy of fro'zen section diagnosis at pathology department, tertiary care hospital, Ahmedabad, can be interpreted as comparable with most international quality control statistics for frozen section. Due to known interobserver variability in the histopathological diagnosis (6, 7, 8, 9), agreement between frozen section and routine histopathology diagnosis would be improved if both are given by same pathologist (2). In this study not all but most of the diagnoses were given by same pathologist. Agreement varies between various histopathological entities. It is lower in low grade tumors than in high grade tumors. In our study, there is 100% agreement seen in pituitary adenoma cases. In present study the discordant diagnostic frequency was 18.5%, and the concordant diagnostic frequency was 81.5%. These findings are quite comparable with published CAP (college of American pathologist) studies by Zarbo, et al. 1991(10) and Novis, et al. 1996 (11). (Table III) Causes of discrepancies in our study were mostly due to: Sampling errors Sectioning errors Improper Staining Errors in classifying the lesion Errors in differentiating the lesion Conclusion The above study shows that surgical intervention done in about 81.5% cases are correct owing to 81.5% of the diagnosis given on frozen section being consistent with paraffin section. Frozen section do influence the immediate interventions and surgical procedures yet not affecting management protocol as a high diagnostic accuracy has been achieved as per the study at least as far as grading of tumors is concerned in maximum cases. Improvement in terms of diagnosis and turn around time is possible with inclusion of this part of histopathology in routine practice. So that better intra-operative diagnosis and hence patient care can be given. To summarize, in terms of diagnostic accuracy routine paraffin section takes a lead over frozen section. ABBREVIATIONS FS- Frozen section SOL- Space occupying lesion CNS- Central nervous system HandE- Hematoxyline and eosin ACKNOWLEDGMENT The author acknowledges the help received from Professor and Head, Department of Pathology for teaching me the scientific approach of the subject and its subtle aspects, I am also thankful to my PG Guide for motivating me for doing the work meticulously and her kind co-operation. I would like to give my special thanks to all the technicians of Histopathology Section, for helping me while conducting the present study. Last but not least Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. TABLE: I NO. OF CASES OF VARIOUS TYPES OF CNS TUMORS LESIONS NO OF CASES(130) FROZEN SECTION ROUTINE HISTOPATHOLOGY ASTROCYTOMA 58(44.6%) 55 MENINGIOMA 16(12.3%) 15 SCHWANNOMA 12(9.2%) 11 MEDULLOBLASTOMA 10 (7.6%) 5 PITUITARY ADENOMA 8(6.1%) 8 EPENDYMOMA 7(5.4%) 5 OLIGODENDROGLIOMA 5(3.8%) 2 BENIGN CYSTIC LESION 3 (2.3%) 3 HEMANGIOPERICYTOMA 3 (2.3%) 2 CHOROID PLEXUS PAPILLOMA 2 (1.5%) 1 CENTRAL NEUROCYTOMA 2 (1.5%) 1 CRANIOPHARYNGIOMA 2 (1.5%) 1 MALIGNANT ROUND CELL TUMOR 2 (1.5%) 1 TABLE: II DEFINITION OF AGREEMENT BETWEEN FROZEN SECTION DIAGNOSIS AND FINAL HISTOPATHOLOGICAL DIAGNOSIS Group 1- complete agreement Intraoperative FS and final paraffin section match exactly Group-2 partial agreement         Agreement between FS and final paraffin section but diagnosis of both is too wide to be classified as group-1. FS and final paraffin section does not match exactly but remain in the same WHO group. Group 3- no agreement No agreement between FS and final paraffin section Group 4- not classifiable FS diagnosis of uncertain neoplastic. TABLE NO: III COMPARISION OF CONCORDANCE AND DISCORDANCE RATES WITH RESULTS OF VARIOUS STUDIES   PRESENT STUDY   STUDY DONE BY (Zarbo, et al. 1991)10 STUDY DONE BY (Novis, et al. 1996)11 CONCORDANCE RATE   81.5% 98.3% 98.2% DISCORDANCE RATE   18.5% 1.7% 1.2% FIGURES SHOWING HISTOLOGY PICTURE OF FROZEN SECTION AND PARAFFIN SECTION.                                                                                                                   Englishhttp://ijcrr.com/abstract.php?article_id=2350http://ijcrr.com/article_html.php?did=2350Bibliography   1) Intraoperative consultation (frozen section). In: Rosai J, editor. Rosai and Ackerman's Surgical Pathology. 9 th ed. vol 1 ,   2) Tofte K, Berger C, Torp SH, Solheim O. The diagnostic properties of frozen sections in suspected intracranial tumors: A study of 578 consecutive cases. Surgical Neurology International. 2014;5:170. doi:10.4103/2152-7806.146153.   3) Oneson RH, Minke JA, Silverberg SG. Intraoperative pathologic consultation: An audit of 1,000 recent consecutive cases. Am J Surg Pathol 1989?13:23743.   4) Howanitz PJ, Hoffman GG, Zarbo RJ. The accuracy of frozen section diagnoses in 34 hospitals. Arch Pathol Lab Med 1990?114:3559.   5) Rogers C, Klatt EC, Chandrasoma P. Accuracy of frozen section diagnosis in a teaching hospital. Arch Pathol Lab Med 1987?111:5147.   6) Aldape K, Simmons ML, Davis RL, Miike R, Wiencke J, Barger G, et al. Discrepancies in diagnoses of neuroepithelial neoplasms: The San Francisco Bay Area Adult Glioma Study. Cancer. 2000;88:2342-9.   7) Mittler MA, Walters BC, Stopa EG. Observer reliability in histological grading of astrocytoma stereotactic biopsies. J Neurosurg. 1996;85:1091-4.   8) Prayson RA, Agamanolis DP, Cohen ML, Estes ML, Kleinschmidt-DeMasters BK, Abdul-Karim F, et al. Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading. J Neurol Sci. 2000;175:33-9.   9) van den Bent MJ. Interobserver variation of the histopathological diagnosis in clinical trials on glioma: A clinician's perspective. Acta Neuropathol. 2010;120:297-304.   10) Zarbo RJ, Hoffman GG, Howanitz PJ. Interinstitutional comparison of frozen section consultation: A College of American Pathologists Qprobe study of 79,647 consultations in 297 North American institutions. Arch Pathol Lab Med 1991?115:118794.   11) Novis DA, Gephardt GN, Zarbo RJ? College of American Pathologists. Interinstitutional comparison of frozen section consultation in small hospitals: A College of American Pathologists Qprobes study of 18,532 frozen section consultation diagnoses in 233 small hospitals. Arch Pathol Lab Med 1996?120:108793.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30TechnologyMulti-stage Strategy to Classify Handwritten Characters of Telugu English3942T. R. Vijaya LakshmiEnglishThe aim of this work is to recognize handwritten characters of Indian language, Telugu. Single stage of classifying similar Telugu characters leads to low recognition rate. However similar characters of Telugu (Indian language) are recognized in two stages in the current work. Various preprocessing steps are carried out first to extract characters from the handwritten documents. The preprocessed characters are then utilized to extract features from them. These features are further used in the proposed two-stage classification. The misclassified characters from the first stage of classification are fed to the second classifier in the proposed method. The recognition rates obtained with the two stage system are better compared to the single stage classification system. EnglishHandwritten characters, Two-stage strategy, Instance-based classifier, Support vector machine, Histogram profileIntroduction Exhaustive work has been contributed on printed text and relatively very less amount of research has been reported on handwritten text [1,2,3,4,5,6,7,8,9,10]. A comprehensive survey on handwritten character recognition were reported in [11,12,13,14]. Relatively very less amount of research was found on South Indian languages like Tamil, Kannada and Telugu etc. [14,15,16,17,18,19,20,21]. There are several benchmark datasets available for Latin numerals such as MNIST, CEDAR, NIST and CENPARMI [22]. The standard dataset available for English alphabets is UNIPEN. A few Chinese standard/benchmark handwritten databases are as follows: HCL 2000 for Chinese alphabetical characters. ETL8B and ETL9B datasets comprises 956 and 3036 character classes, respectively. SCUT-IRAC for Chinese numerals. CASIA-HWDB 1.1 for Chinese alphabets, numerals and punctuation marks. A few Devanagari (Indian script) standard small datasets available are V2DMCHAR and ISIDCHAR. As such no standard database available for other Indian scripts to conduct tests. This is the major problem to do research on Indian scripts [23]. All the earlier studies have been reported on collection of small datasets from laboratory environment. It is evident from the literature survey [23] that no standard dataset of Indian languages is readily available for the research activity. Hence, there is a need to develop the dataset in the laboratory environment for any Indian language [23]. Therefore in the present work the first stage of research is to develop and build a handwritten Telugu character dataset. Most of the Telugu characters are similar and recognizing such characters is highly challenging task. The number of vowels in the script is 16 and the number of consonants is 36. Identifying such similar characters is a very difficult task. This paper deals with the handwritten character recognition for Telugu script written on paper documents. It includes the methodology used for handwritten Telugu database, the various preprocessing steps, feature extraction methods and various classifiers involved in the current work. To develop the dataset, various scribers of different age groups are used to scribe on paper documents. These documents are scanned at 300 dpi and stored in the hard disk of the computer system. In the next step, preprocessing operations are performed to extract characters. The various feature extraction algorithms such as 'cell-wise pixel count' and 'Histogram profile' are employed to extract features from the preprocessed character images. In the proposed two-stage classification system, the classifiers employed are k-NN (k Nearest Neighbor) and SVM (Support Vector Machines) to classify the characters. Data collection and preprocessing Due to lack of standard data set to conduct experiments on handwritten Telugu characters [23], the data is collected from various scribers from different age groups in the laboratory environment. The characters written on high quality papers in an isolated manner, from 360 individuals are collected to develop the handwritten Telugu character set. The number of basic handwritten Telugu characters considered in this work is 50, this account to 18,000 samples in total (50 x 360). All the documents collected from various scribers are scanned at 300 dpi and stored as images. The preprocessed character samples are divided into folds. Each fold contains characters written by equal number of scribers. To test tth fold, the remaining (V-1) folds are used as training. The average classification rates obtained from all these folds is considered as the classification rate/recognition accuracy of the model. The number of characters considered for simulation is 18,000 containing 50 different classes, written by 360 different scribers. Thereby the number of samples per class is 360. All the characters are cross validated, by dividing them into 8 folds. Each fold contains characters written by 45 different scribers. The number of samples considered in each fold is 2,250 i.e., 50 x 45 (where 50 is number of classes and 45 is the number of scribers). To test a fold of characters, the remaining 15,750 characters are used as training. These preprocessed character images are used in the proposed step by step algorithm as discussed below. RESEARCH METHODOLOGY The flowchart of the proposed two-stage classification strategy for handwritten Telugu characters is shown in Figure 1. The raw preprocessed character image after noise removal and character extraction phases is first transformed into useful features. Each character image is represented in the form of a vector after the feature extraction stage. Each fold of characters is tested in two stages. In the first stage of classification, 'Classifier-1' is trained with the training set to classify the characters under test fold. If the predicted class of the test character is same as that of its actual class then it is said to be recognized. The Recognition Accuracy (RA) of Tth testing fold is computed from the confusion matrix generated and is depicted in Equation (1). where CR1is the number of characters correctly classified in stage-1. Based on the confusion matrix generated by 'Classifier-1' in the first stage, the most confusing Telugu characters are found out and are classified in the second stage of classification. The unrecognized characters of the Tth test fold from the first stage are stored in a bin and are tested in the second stage of classification. To improve the character recognition rate, the unrecognized characters from the first stage are once again classified using another classifier i.e., 'Classifier-2'. To classify the unrecognized characters in the second stage, 'Classifier-2' is trained with the same training set, as indicated in Figure 3. The overall recognition accuracy (ORA) of the two-stage classification system for Tth testing fold is computed as depicted in Equation (2). where CR2 is the number of characters classified in stage-2. The overall classification rate is improved with this two-stage classification strategy. The procedure is repeated for all the 'V' folds and the average recognition accuracy from all these folds is considered as the recognition accuracy of the model. The various features extracted in the two-stage classification strategy are as follows. FEATURE EXTRACTION a. Cell-wise pixel count: The image, I, is divided into cells. The number of cells obtained from a M x M character pattern is M2/n2, where nxn is the size of the cell. The number of object pixels is counted in each cell/zone i.e., the pixels distributed in various cells are considered as features to classify the handwritten Telugu characters. For each cell/zone i.e., say z11 the number of foreground pixels are summed up and is considered as a feature. This procedure is repeated for other cells. The features computed from these cells/zones of the character image are concatenated to form a feature vector, represented by Cf = [z11, z12, z13, ..... z54, z55]. Hence for an image, I, in the proposed work 25 features are extracted (for M=50). In this way for all the database images feature set consisting of 25 features for each image are extracted. b. Histogram profile: The flowchart of histogram profile is shown in Figure 2. The histograms of the character image are computed along four directions. This is described in the flowchart. All these profiles are appended to form a feature vector of size 298 for a normalized character image of size 50 x 50. Figure: 2. Flowchart of histogram profile Results The two-stage classification model is developed on a system having i5 processor of 2.2 GHz CPU clock speed with 4 GB RAM and 64 bit operating system running with Windows 8.1 using MATLAB 2014a. The number of characters considered for simulation is 18,000 from 50 different classes, written by 360 different scribers. The number of samples per class is 360. All the characters are cross validated, by dividing them into training and testing sets. Each fold contains characters written by 45 different scribers. The number of samples considered in each fold is 2,250 i.e., 50 x 45 (where 50 is number of classes and 45 is the number of scribers). To test a fold of characters, the remaining 15,750 characters are used as training. With 8-fold cross validation all the characters are tested once, provided the training and testing sets are disjoint. The average classification rates obtained from all these folds is considered as the classification rate/recognition accuracy (RA) of the model. In the first stage, once the characters undergo tests using k-NN (k-nearest neighbor) classifier, the unrecognized character images from this stage are forwarded to undergo classification in the second stage. In the second stage, SVM (Support Vector Machine) classifier is trained with the same training set to classify only the unrecognized characters from the test set. This is done to improve the recognition accuracy and to reduce the misclassification rate. The recognition accuracies obtained with the two stage classification system are tabulated in Table 1. Table 1: Two stage results obtained using k-NN and SVM classifiers Feature extraction % Recognition accuracy k-NN SVM k-NN+SVM Cell-wise pixel count 82.3 88.4 90.8 Histogram profile 73.5 77.9 79.3 DISCUSSIONS It is evident from Table 1 that with the framework of two stage classification, there is a significant improvement in recognition rates. With the two stage classification framework, the cell-based approach gave a quantum improvement in recognizing the handwritten Telugu characters, compared to the Histogram profile-based approach. An improvement of 4-5% in recognition accuracy is obtained using the two-stage framework with both the feature extraction approaches. CONCLUSION There is no standard dataset for Indian scripts to conduct experiments for handwritten character recognition. Hence, in this work a dataset containing 18,000 handwritten Telugu isolated basic characters is developed. The various feature extraction algorithms employed for character recognition are cell-wise pixel count and histogram profile. The performance of these feature sets are tested with the proposed two-stage classification system. An improvement of 3-5% in recognition rate is achieved with the proposed two-stage classification system when compared to single-stage classification for the feature extraction approaches considered. The best recognition accuracy obtained using the proposed two stage classification framework is 90.8% with 'cell-wise pixel count' feature set. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=2351http://ijcrr.com/article_html.php?did=2351[1] M. Cheriet, M. E. Yacoubi, H. Fujisawa, and D. Lopresti, "Handwritten recognition research: twenty years of achievement... and beyond," Pattern Recognition, vol. 42, no. 12, pp. 3131 - 3135, 2009. [2] A. Amin, "Off line Arabic character recognition: a survey," Proceedings of the Fourth International Conference on Document Analysis and Recognition, vol. 2, pp. 596-599, 1997. [3] M. S. Khorsheed, "Off-line Arabic character recognition-a review," Pattern analysis & applications, vol. 5, no. 1, pp. 31-45, 2002. [4] T.-H. Su, T.-W. Zhang, D.-J. Guan, and H.-J. Huang, "Off-line recognition of realistic Chinese handwriting using segmentation-free strategy," Pattern Recognition, vol. 42, no. 1, pp. 167-182, 2009. [5] P.-K. Wong and C. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241920EnglishN-0001November30HealthcareAssociation of Parental ABO Phenotypes with Gender of the Child English0509Mehar Preet SinghEnglish Kulbir Kaur M.D.EnglishBackground: The study of blood groups is not only important in blood transfusion and organ transplant practices but prevalence of its types is also important in genetic research, anthropology and inheritance related studies. Objective: To find the association of parental ABO phenotypes with the gender of the child born. Material and Methods: This was a prospective, observational study, performed from Nov 2016 to June 2017on 332 fertile couples experienced child birth in a teaching tertiary care hospital. ABO and Rh Blood grouping of these couples was performed by microplate hem-agglutination method and maternal record of all the couples was recorded for live birth including gender of child. Results: There were total 555 live births from 332 fertile couples including 279 females (50.3%) and 276 males (49.7%) with average of 1.67 births per mating in which B-B and AB-A had maximum rate of 1.80 each and lowest as1.40 in A-AB. AB-O combination had maximum male child (72.7%) and A-A had female child (70.4%). Overall sex ratio was 1.01.Association of the gender of the child born and parents mating type was found insignificant (p=0.269). Further it was found that O type father had maximum female child (55.6%) and AB type had maximum male child (55.3%). Statistically it was also found insignificant (p >0.050). Conclusion: It was concluded that different mating types of the parents having same and different ABO and Rh phenotypes and type of paternal phenotype has no effect on the gender of the child born. These results may help the researchers in the genetic and anthropology related studies and to understand the inheritance related issues. EnglishIntroduction Since Landsteiner's discovery in 1901, that human blood groups existed, a vast body of serological, genetic and biochemical data on red cell (blood group) antigens has been accumulated and more recently the biological function of some of these antigens have been appreciated. (1) A total of 36 blood group systems have been described till date in the numeric catalogue of red cell antigens maintained by International society of Blood Transfusion working party.(2) Each system is identified by the presence of series of red cell antigens which are determined either by a single genetic locus or very closely linked loci. Alternative forms of a gene coding for red cell antigens at a locus are called alleles and individuals may inherit identical or non-identical alleles. Most blood group genes have been assigned to specific chromosomes e.g. ABO system on chromosome No. 9 and Rh system on chromosome No. 1. The expression of ABO antigens is controlled by three separate genetic loci: ABO located on chromosome 9, FUT1 (H) and FUT2 (Se) on chromosome 19. The genes from each locus are inherited in pairs as Mendelian dominants.(1)ABO antigens although most important in relation to transfusion are also expressed on most endothelial membranes and are important histocompatibility antigens. (3) In Humans, there are total 46 chromosomes arranged in 23 pairs including 22 pairs of autosomes and one pair of sex chromosomes (X and Y). The type of sex chromosome always determines the sex of a person i.e. females have two X chromosomes whereas males have one X and one Y chromosome. X chromosome is relatively large as compared to the Y and contains many genes. The Y chromosome on the other hand contains only a few genes. The female always passes X Chromosome to her offspring through the female gamete (egg). The male can pass on either the Y or the X chromosome through the male gamete (sperm). During chance of fertilization, if the male gamete having X chromosome meets the egg, then the growing embryo will develop into a girl and if the male gamete having Y chromosome meets the egg, then the growing embryo will develop into a boy. So, therefore gender or sex of the new born is always dependent on the chance of type of male gamete to unite with the female gamete or we can say that gender of child always depends on whether the sperm which fertilizes the egg is carrying an X or a Y chromosome. Characters and traits are always inherited from biological parents to their children irrespective of the gender. These traits may be in the form of pathological, physiological or genetical disorders or in the form of personality wise characteristics. Children usually resemble their parents in many ways including the physical appearance, mental abilities or disabilities, personality, behaviour and other characteristics due to inheritance of genes from both. Observation of different disease processes and their likely association with genetical characters like blood group may have motivated the scientists to establish these associations at molecular level and in which they have succeeded also. The study of blood groups is not only important in blood transfusion and organ transplant practices but prevalence of its types is also important in genetic research, anthropology and inheritance related studies. Now there are many studies which have indicated the probable association of different disease processes with ABO and other blood groups systems. Many of these explored the most important ABO system which is the most elaborated system till date. Most of these studies found association of blood groups with different attributes of the human pathology, physiology, personality, behaviour etc. So, to further explore the subject of inheritance, this is one of the original research planned in the dept. of Obstetrics and Gynaecology (OBG) and dept. of Blood Transfusion and Immunohematology of Punjab Institute of Medical Sciences (PIMS), Jalandhar with the aim and objective to find the association of maternal and paternal ABO phenotypes with the gender of the child born. This is the first ever research conducted in this region. Material and Methods: This was a prospective, observational study, performed on the 332 fertile couples who experienced child birth, attended the department of Obs. and Gynae (OBG) of Punjab Institute of Medical Sciences (PIMS) Jalandhar from Nov 2016 to June 2017. ABO and Rh Blood grouping was performed by microplate Hem-agglutination method on fully automatic Immunohematology analyser Galileo-Echo (Immucor, USA) in the dept. of Blood Transfusion and Immunohematology. All discrepant and further advance immune-haematological investigations were performed using conventional tube technique (CTT) and ID-Gel technology. All the Rh-D Negative groups were retested for weak-D antigen. Samples for subgroup typing were sent to Immucor Reference Laboratory. The maternal record of all the couples was recorded for live birth including gender of child through a questionnaire with the consent of participants. Statistical Analysis: The tabulated data was analysed by using IBM SPSS Statistics 23 software and tested for significance of association between gender of child with the phenotypes of parents. Observation and Results: From the total 332 selected fertile couples, 159 couples had only one child, 134 had two, 31 had three, 6 had four, two couples had five and six children each including 279 females and 276 males.156 couples had only one female child, 48 couples had two girl children, 9 couples had three girl children and 112 couples had only female children in their family. Table 1: Gender wise child birth status in the fertile couples (n=332)   Live Birth Couples having Female Child Couples having Male Child No. of couples No. per couple Total Live Birth No. of Couple No. per Couple Total No. No. of Couple No. per Couple Total No. 159 1 159 119 0 0 112 0 0 134 2 268 156 1 156 169 1 169 31 3 93 48 2 96 46 2 92 6 4 24 9 3 27 5 3 15 1 5 5 1 6 6 332   555 332   279 332   276   169 couples had single male child, 46 had two, 5 had three male child and 119 couples had only male children in their family (Table 1). On analysing the child birth status as per different combination of the mother and father mating, there were total 16 mating types among the 332 couples and maximum of 60 couples (18.07%) had B-B mating type and minimum of only two couples (0.60%) had AB-AB. Table 2: Status of Live Birth in the different mating types of study population (n=555) Mating Type No. of Couples Live Births Male Female O-O 26 (7.83) 45 (1.73) 15 (33.3) 30 (66.7) O-A 21 (6.33) 35 (1.67) 16 (45.7) 19 (54.3) O-B 49 (14.76) 81 (1.65) 42 (51.9) 39 (48.1) O-AB 4 (1.20) 6 (1.50) 4 (66.7) 2 (33.3) A-O 22 (6.63) 35 (1.59) 18 (51.4) 17 (48.6) A-A 16 (4.82) 27 (1.69) 8 (29.6) 19 (70.4) A-B 30 (9.04) 48 (1.60) 26 (54.2) 22 (45.8) A-AB 5 (1.51) 7 (1.40) 5 (71.4) 2 (28.6) B-O 32 (9.64) 53 (1.66) 23 (43.4) 30 (56.6) B-A 26 (7.83) 42 (1.62) 25 (59.5) 17 (40.5) B-B 60 (18.07) 108 (1.80) 57 (52.8) 51 (47.2) B-AB 14 (4.22) 22 (1.57) 10 (45.5) 12 (54.5) AB-O 7 (2.11) 11 (1.57) 8 (72.7) 3 (27.3) AB-A 5 (1.51) 9 (1.80) 5 (55.6) 4 (44.4) AB-B 13 (3.92) 23 (1.77) 12 (52.2) 11 (47.8) AB-AB 2 (0.60) 3 (1.50) 2 (66.7) 1 (33.3) Total 332 555 (1.67) 276 (49.7) 279 (50.3) p value 0.269 There were total 555 live births from 332 fertile couples including 279 females (50.3%) and 276 males (49.7%) with average of 1.67 births per mating in which B-B and AB-A had maximum rate of 1.80 each and lowest of 1.40 in A-AB mating type. (Table 2) Among the different mating types, AB-O combination had maximum male child (72.7%) and A-A had maximum of female child (70.4%) and vice versa for the same. Overall sex ratio is 1.01 in the observed results. The results when tested for significance of association of different mating types with gender of the child born was found insignificant (p=0.269). There were three types of mating combinations observed as far as the Rh phenotype of the couples was concerned i.e. Rh Neg. wife with Rh +ve husband (Group 1), Rh +ve wife with Rh +ve husband (Group 2) and Rh +ve wife with Rh Neg. husband (Group 3) having 22, 295 and 15 couples respectively. Male dominancy was observed in group 1 and female in group 2. The Rh-negative group was more prevalent in female partners than male partners. (Table 3). Table 3: Live Birth Status and Rh Phenotype combinations of parents (n=332) Group Rh Mating types No. of Couples Total Live Births Female Male 1 Wife (-ve) + Hus (+ve) 22 37 (1.68) 16 (43.2) 21 (56.8) 2 Wife (+ve) + Hus (+ve) 295 486 (1.65) 248 (51.0) 238 (49.0) 3 Wife (+ve) + Hus (-ve) 15 32 (2.13) 15 (46.9) 17 (53.1)   Total 332 555 (1.67) 279 (50.3) 276 (49.7) p value 0.609   When the results were observed from another aspect to find the association of gender with phenotype of the father, then it was found that from the total 332 couples, 87 fathers had O Phenotype, 68 had A, 152 had B and 25 fathers had AB Phenotype. O phenotype type fathers were responsible for 144 live births with 64 male children (44.4%) and 80 females (55.6%). A type fathers had 133 live births including 54 males (47.8%) and 59 female children (52.2%). B type father had 260 live births including 137 males (52.7%) and 123 female children (47.3%). AB type father had 38 live births of 21 male (55.3%) and 17 female children (50.3%)(Table 4) Table 4. Paternal phenotype and status of live birth in the study population (n=555) Father's Phenotype No. of Couples Live Births Male Female O 87 (26.2) 144 (1.66) 64 (44.4) 80 (55.6) A 68 (20.5) 113 (1.66) 54 (47.8) 59 (52.2) B 152 (45.8) 260 (1.71) 137 (52.7) 123 (47.3) AB 25 (7.5) 38 (1.52) 21 (55.3) 17 (44.7) Total 332 555 (1.67) 276 (49.7) 279 (50.3) p value 0.368   Apparently on seeing the results from table 4 it was found that O type father had maximum female child i.e. 55.6% and AB type had maximum male child i.e. 55.3% and vice versa. But when tested statistically then it was found that phenotype of the father had no effect on the gender of the child born or we can say that gender of the child and phenotype of the father were both independent attributes (p=0.368). Discussion: On review the different literatures for association of blood group with different attributes like disease, personality, behaviour etc, we found that some of the studies established the association of blood group with these attributes at molecular level and some are based on the observations. Blood Group and diseases: Group A individuals rarely may acquire a B antigen from a bacterial infection that results in the release of a deacetylase enzyme. This converts N-acetyl-D-galactosamine into α- galactosamine, which is similar to galactose, the immunodominant sugar of group B, there by sometimes causing the red cells to appear to be group AB. In the original reported cases, five out of seven of the patients had carcinoma of gastrointestinal tract. Case reports attest to the danger of individuals with an acquired B antigen being transfused with AB red cells, resulting in a fatal haemolytic transfusion reaction following the production of hyperimmune anti-B. (1) Table 5 Type of diseases associated with blood groups and their risk profile S. No. Associated disease Risk Profile Blood group 1 Squamous cell carcinoma of skin[7] Low O 2 Basal cell carcinoma of skin[7] Low O 3 Breast cancer[8] High O 4 Cervix cancer [8] High B O 5 Lung cancer[8] High B 6 Buccal cancer[8] High B 7 Ovarian cancer[9] High B 8 Gastric cancer[10] High Low A O 9 Pancreatic cancer[7,11] Low O 10 Ischemic heart disease[12] High AB 11 Otitis media with effusion[13] Low O 12 Venous thromboembolism[14] High A,B,AB 13 Malaria[14] Low O 14 Cholera and GI infections by E.coli[14] High O 15 Smallpox[14] High A 16 Plague[14] Low O 17 H.pylori infection andGI Ulceration[14] High O 18 Diabetes mellitus type 2 (15) High B The inheritance of ABH antigens is also known to be weakly associated with predisposition to certain diseases. Group A individuals have 1.2 times the risk of developing carcinoma of the stomach than group O or B; group O individuals have 1.4 times more risk of developing peptic ulcer than non-group O individuals; and non-secretor of ABH have 1.5 times the risk of developing peptic ulcer than secretor. (4) The ABO group also affects plasma von Willebrand Factor (VWF) and Factor VIII levels, group O healthy individuals have level around 25% lower than those of other ABO groups. (5) ABO blood group appears to mediate its effect by accelerating clearance of VWF but the mechanism is not yet clear. (6) ABH antigens are also frequently more weakly expressed on the red cells of persons with leukaemia. Table 5 shows the association of different diseases with different blood groups and their respective risk profile. From this table, it is apparent that risk profile of Cervix cancer, lung cancer, Buccal cancer and Ovarian cancer is high in B type phenotype. Risk of Squamous cell carcinoma of skin, Basal cell carcinoma of skin, Pancreatic cancer, malaria, otitis media, and plague was found low in O type and this group faces substantial risk of Breast cancer, cholera and GI infections by E. coli and infection by H. pylori and GI ulceration. Group A people are in high risk zone of Gastric cancer, venous thromboembolism and small pox and Group AB of IHD. Blood group B people are at elevated risk while individuals with blood group O are at low peril of evolving type 2 diabetes. Not sufficient literature is available on this topic except the research work of Rex-Kiss B, who concluded that due to the feto-maternal blood group incompatibility the sex ratio of the newborn will be higher. The most probable explanation for this fact is that the feto-maternal blood group incompatibility exerts a negative effect on the X chromosome, in consequence of which the elimination rate of the zygotes fertilized by Y chromosome-carrying sperms decrease and thus the sex ratio will be higher. The highest sex ratio was found among the D-negative new born of D-positive mothers (172.7), whereas the lowest one among the D-positive children of D-positive mothers (113.5). The incompatibility existing in the other antigens of Rh-system and in the ABO-system also elevated the sex ratio to a minor degree.(16) Conclusion: It was concluded from the observations that different mating types of the parents and paternal phenotype has no effect on the gender of the child born. As no such study is available for reference which indicates any association of parental phenotype with the gender of the child. So, there is further scope of research on this topic with much bigger study population. These results may help the researchers in the genetic and anthropology related studies and to understand the inheritance related issues. Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Conflict of Interest:No Source of Funding: No Englishhttp://ijcrr.com/abstract.php?article_id=2352http://ijcrr.com/article_html.php?did=2352 Fiona Regan. Blood cell antigens and antibodies. Dacie and Lewis Practical Hematology. 11th edition. USA: Churchill Livingstone Elsevier; 2012.p. 483-7. International Society of Blood Transfusion (ISBT) working party. Available at http://www.isbtweb.org/working-parties/red-cell-immunogenetics-and-blood-group-terminology/updated on Feb 2017, accessed on 17.9.2017 Eastlund T. 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Aird I, Bentall HH, Roberts JA.A relationship between cancer of stomach and the ABO blood groups. British Medical Journal. 1953;1(4814):799-801. Amundadottir L, Kraft P, Stolzenberg-Solomon RZ, et al. Genome-wide association study identifies variants in the ABO locus associated with susceptibility to pancreatic cancer. Nature Genetics 2009;41(9):986-90. Meade TW, Cooper JA, Stirling Y, et al. Factor VIII, ABO blood group and the incidence of ischaemic heart disease. Br J Haemator1994;88:601-7. Apostolopoulos K, Labropoulou E, Konstantinos B, et al. Blood group in otitis media with effusion. J Otorhinolaryngol Relat Spec 2002;64:433-5. David J Anstee. The relationship between blood groups and disease. Blood; Journal of the American Society of Hematology 2010;115(23):4635-43. Meo SA, Rouq FA, Suraya F, Zaidi SZ. Association of ABO and Rh blood groups with type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci. 2016;20(2):237-42. Rex-Kiss B. 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