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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareCharacterization of Diabetic and Non Diabetic Human Nuclear Cataract using Optical Spectroscopy Techniques
English0106Akarsh KalapalaEnglish Anil Kumar ChaudhryEnglish Male Shiva RamEnglishAim: The aim of present study is to understand the mechanism of calcification and deposition of how protein and carbohydrate deposits in Diabetic and Non Diabetic induced Nuclear Cataract Lenses.
Methods: This Experimental comparative study conducted on Twenty six cataract samples after Small Incision Cataract Surgery (SICS) collected and stored in formalin and saline solution to avoid contamination. The Cataract lens specimens were dried for one week at 25oC, under specific Relative Humidity (RH) conditions, and then used for spectral investigation to determine its biophysical characteristics and molecular composition by using FTIR spectroscopy and X-ray Diffraction technique.
Results: FTRI technique on the diabetic nuclear cataracts we have found unsaturated aldehydes groups are found at a frequency of 1688(narrow peak) and also aldehydes are found at a frequency of 2823 (medium peak) and XRD technique resulted that there is difference in the presence of electron density in different samples and mainly in the diabetic nuclear cataracts and non diabetic nuclear cataract.
Conclusion: We can understand that if we can be able to reduce aldehydes groups’ formation in the diabetic cataract lenses then we can be able to reduce the formation of cataract in diabetic patients. The X-ray Diffraction techniques conclude that Diabetic Lenses have different electron density which is different from Non Diabetic Cataract lenses.
Clinical Significance: The significance of this study explained about molecular bonding and aldehyde groups in the diabetic cataract lenses. Hence we found that this technique and further experiments may shed light and give us the better understanding on the Calcification in diabetic cataractous crystalline lens.
EnglishFTIR (Fourier transform infrared spectroscopy), XRD (X-ray Diffraction), Spectroscopy, Nuclear cataract, KBr (Potassium Bromide).INTRODUCTION
Cataract is a painless vision loss with leading cause of blindness in the world. Nuclear cataracts are the most common, typically known as “age-related cataract.” Found in the center of the lens, they interfere with the ability to see distant objects [1] . There are various cataract types but nuclear cataract is common in tropical climate countries and there were many studies on treatment and management options for cataract, only few studies reported cataractous lens molecular bonding studies. In the world more than 285 million people are affected by diabetes mellitus. This number is expected to increase to 439 million by 2030 according to the International Diabetes Federation. [2]
Diabetes is epidemic and fast gaining the status in India , approximately more than 62 million diabetic individuals currently diagnosed with the disease. India (31.7 million)topped the world with the highest number of people with diabetes. And india also known as diabetic capital of world from the recent news papers statements [3]
However Cataract is considered a major cause of visual impairment in diabetic patients as the incidence and progression of cataract is elevated in patients with diabetes mellitus. The association between diabetes and cataract formation has been shown in clinical epidemiological and basic research studies. Due to increasing numbers of type 1 and type 2 diabetics worldwide, the incidence of diabetic cataracts steadily rises. [4] Calcification seems not to influence the secondary structure of lens protein because both IR and Raman spectra for the crystalline lens protein in the no calcified area and calcified plaque were similar. [5] Infrared spectroscopy had found potential application in the study of molecular structure of various biological and chemical samples due to its high resolution, simplicity in direct recording, absorption, and transmission signal with great accuracy. The electromagnetic spectrum which has very broad range including UV-VIS-IR range which is popularly known as optical frequency range. All the chemical and biological molecules have their characteristic finger print absorption in Mid-IR to IR region. These regions provide vital information about the vibration and rotational lines of organic molecules. In addition, Raman absorption bands are also an important part of the vibrational spectroscopy and helpful to confirm the identity of particular compounds in mineralized tissue. [6] Previously reported research work on cataract lenses using FTIR spectroscopy show the changes in conformational structure of lens lipid and protein induced by glaucoma than by senile cataract. And it has been reported that the age-related cataractous lens undergoes major biochemical and biophysical alterations, mainly due to the changes with age in protein and lipids of lens membrane crystalline. However, lens calcification is one of the severe problem causing human cataracts. The pathogenesis and mechanism of lens calcification in ocular diseases are not yet completely understood. Several analytical methods have been used to investigate the mechanism of calcium-phosphate deposition in the calcified CL but their operations are very complicated and take much time. Here the investigators have chosen only senile cataractous lens and identified the calcified plaque and quantified it's chemical composition using FTIR and Raman spectroscopy and this study suggests that both microscopic FTIR (Fourier transform infrared spectroscopy) and Raman spectroscopy's were easy to perform and capable to determine the chemical composition of a calcified Cataract lens. [7] In present study we have focused our attention to understand the chemical mechanisms of calcification in six extracted Cataractous lenses collected from different patients in whom two patients were Diabetic and four were Non Diabetic. This paper focused about Nuclear sclerotic cataract Lenses and identified the calcified plaque and quantified its chemical composition using different devices such as FTIR, and XRD optical spectroscopy.
MATERIALS AND METHODS
Participants and Specimens
All the participants accepted to participate in this study by donating their cataract extraction samples with an age group of 45-75 years. A total Twenty six samples collected in which 14 Males and 12 Female. It also includes Diabetic induced nuclear cataracts (8 male and 4 female) and remaining are Non Diabetic Nuclear Cataract patients which are 14 samples. We had collected the Human Cataract Lens Samples after Small Incision Cataract Surgery (SICS) from Indo Us Hospital, at Hyderabad. Written and verbal consent followed by no objection forms duly signed by the participants was received and this project also conducted tenure to Declaration of Helsinki rules.
Sample collection and storage
All the Twenty six collected cataract samples were stored in formalin saline solution to avoid contamination of sample, generally previous researches reports that human organs are collected or stored in formaldehyde solution to avoid contamination. [8] The Cataract lens samples were dried for one week at 25 °C, under specific Relative Humidity (RH) conditions, and then used for spectral investigation to determine its biophysical characteristics and molecular composition by using FTIR spectroscopy the sample images can be seen in Figure-1 and 2
Preparation of K Br Pallets for IR spectra
For preparing K Br pallet for IR from the solid sample. Here we need the gate mortar and pastel, sample and KBr crystals. This KBr has been dried in the vessel and taken out before we use for KBr pellet preparation. We want to make the sample with the KBr in the proportion of 1:50 ratio it means for 1mg of sample then we added about 50mg of KBr and weighted with electronic weighting machine. Secondly we took KBr in the mortar, pastel with two tip spoons in the spatula and grained it into a very fine powder along with this media; we added the sample in the ratio of 1:50. We took small amount of sample and mixed well and grained. Checked for proper mixing, later finished and converted this into a pellet. We used the carver press to apply the pressure on the sample mixture in the dye and convert this into a fine pallet. Finally placing the pellet on the sample holder and measured the IR spectra of our sample which has been prepared as a KBr pallet.
Instrumentation and Experimental setup.
We had studied the extracted nuclear cataractous lens characteristics with below two different types of optical spectroscopy based instruments in our study.
1) Fourier Transform Infrared Spectroscopy.
2) X ray Diffraction
Experiment-1 with Fourier Transform Infrared Spectroscopy (FTIR)
We have used Thermo scientific FTIR. Model: Nicolet 380 for recording the different types of functional groups and vibrational bands present in Cataract Lenses. This instrument mainly works on the principle of Michelson's Interferometer.[9] And after the experimental process the results are collected ‚all the results were calculated with a mathematical technique called Fourier Transform. This Fourier Transform helps out to convert the raw data into the actual spectra in Cm-1. FTIR spectroscopy is a technique which is used to obtain an IR spectrum of absorption: (how much light is absorbed by the specimen)‚ transmittance (how much light passes through the specimen) and the area of IR region is very important in investigation the molecules can see in the below Tabel-1. Normal IR region is the main IR region, which focuses on investigation of molecules. So first we had taken a sample and put it into the spectrophotometer.IR radiation is passed and a spectra is plot. So for the active molecule, it shows the different types of vibrations.
Experiment-2 with X Ray Diffraction Spectroscopy
We had used low intensity XRD instrument for the second experiment and done it by powdering the sample which is a solid because the instrument is a powdered low intensity XRD. By doing this technique we had observed that the cataract is in the form of amorphous and also observed couples of peaks are present at same intensity and angle so we were unable to distinguish the electron present. But we have observed a unique thing that Diabetic samples graphs is different from Non Diabetic sample by this we can understand that electron density in Diabetic Nuclear lenses is different from Non Diabetic cataract lens. We had performed this technique on six cataract samples.
RESULTS
All the analysis done based on the spectroscopic analysis and bonding shown under various spectroscopes Here with FTIR technique we have found that in the Diabetic and Non Diabetic induced Cataracts there is difference in chemical bonds and also in functional groups formed and also we have found that there are some functional groups and chemical bonds formed commonly in all cataract lenses. And there are some chemical and functional bonds which are present in Diabetic and not found in Non Diabetic Nuclear Cataracts can see in below TableN-2 and Figure-3. However in the diabetic nuclear cataracts we have found unsaturated aldehyde groups are found at a frequency of 1688narrow peak) and also aldehydes
are found at a frequency of 2823 (medium peak) can see in Table-3 and Figure-4 and 5. With XRD technique we have found that there is difference in the presence of electron density in different samples and mainly in the diabetic nuclear cataracts and non diabetic nuclear cataract. The graphs explain it clearly that the presence of electron density in diabetic cataract lenses is similar and they are also different from the non diabetic cataract lenses which can see in the Figure 6 and 7 .
DISCUSSION
The focus of this study is to understand the difference between in Diabetic and non diabetic induced nuclear cataract calcification with optical spectroscopy techniques, we could not find any supportive study that either agreed with or contradicted. But interestingly in our experiment We had observed that different chemical bonds and functional groups in diabetic and non diabetic cataract lenses. To discuss about this in diabetic nuclear cataracts we had found unsaturated aldehydes groups are at a frequency of 1688 (narrow peak) and also aldehydes are found at a frequency of 2823 (medium peak) in Diabetic induced nuclear cataract lens specimens and in non diabetic specimens no aldehydes groups were found. And there are some commonly found chemical bonds in all the samples which are as follows. In a frequency range of 3331-3380 all the samples have resulted N-H stretch with primary, secondary, amines and amide groups. And also at a frequency range of 2823-2871 all the samples have commonly resulted in the C-H stretch with alkenes functional groups. And also at frequency range of 1517-1577 (N-O) asymmetric stretch with nitro compound functional groups are found. By this we can understand that if we can be able to reduce aldehydes groups' formation in the diabetic cataract lenses then we can be able to reduce the formation of cataract in diabetic patients. There is no earlier studies reported on this topic but we have compared our study with (Chen et.al 2005) He explained that calcification process is still unclear but concluded that many glycoprotein's and phosphor lipids play a role in calcification.[7] Our study found a new results that compounds in all the samples are similar to that of normal lenses but aldehydes groups are found newly and in only Diabetic samples this unique compound was not reported in earlier studies.
However from the graphs of XRD (X-ray Diffraction spectroscopy technique) we had come out with an interesting point that there is difference in electron density in diabetic and non diabetic induced cataract lenses. We had also investigated the compositions from lens specimen it is in amorphous form which are non crystalline. From the graphs extracted from XRD we can observe that diabetic samples graphs peaks are similar to each other .But rest of four non diabetic specimens graphs are showing different graph peaks that can see in Figure- 8. Moreover there was no research studies reported on this technique, so we are unable to compare with previous research studies. This study also supports that by increasing the specimen size we can get a further better results in future studies.
CONCLUSION
The outcome of present study concludes that Using FTIR confirms that the age-related cataractous lens undergoes major biochemical and biophysical alterations, due to the changes with age in protein and lipids of lens membrane, in the structure and proteins of the cytoskeleton, and in the lens crystalline .We also found that there are similar peaks in the same frequency range for Six cataract lens. So our results show that the calcification in the lens seemed not to influence the secondary structure of the lens protein. We can understand that if we can be able to reduce aldehydes groups' formation in the diabetic cataract lenses then we can be able to reduce the formation of cataract in diabetic patients.
The X-ray Diffraction techniques conclude that Diabetic Lenses have different electron density which is different from Non Diabetic Cataract lenses. There are no research studies reported on this technique so further studies with this technique can gives us better understanding on the Calcification in crystalline lens.
ACKNOWLEDGEMENT
I would like to thank Dr. L V Krishnan Raju, Pushpagiri eye institute and Dr. Sonali Tripathy , Indo US Hospital, Hyderabad And my sincere thanks to Lab members and assistants.
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
COMPETING INTERESTS
All the authors declare that No competing interests exits.
AUTHORS CONTRIBUTION
KALAPALA A: Conceptulization , Conducted study, collected data, experimental design, wrote manuscript, reviewd.
AK CHAUDHARY: Sources, research guidance, reviewed manuscript,
SR MALE: reviewed manuscript , research assistance in experimental design, Literature review.
Englishhttp://ijcrr.com/abstract.php?article_id=2453http://ijcrr.com/article_html.php?did=2453
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareSignificance of Secreted Frizzled Related Protein 4 (SFRP4) in Type 2 Diabetic and non Diabetic Subjects in the Rural Agricultural Population Who are Exposed to Pesticides for the Prediction of Diabetes Mellitus
English0709Velayutharaj A.English Muthumani L.English Senthilnathan R.English Rajendran S.M.English Shivakumar R.English Saraswathi R.EnglishIntroduction: Diabetes mellitus and its complications have become a major health problem for the public of South East Asians especially in India. Exposure to organophosphorus pesticides which are very much in use for the agriculture purpose worldwide produces disorders of glucose homeostasis, because there is increasing evidence of environmental pollutants especially pesticides to the development of insulin resistance and type2 diabetes mellitus. Background: To study the significance of Secreted Frizzled Related Protein4 (SFRP4) levels in both diabetic and non diabetic rural agriculture population who are exposed to pesticides for the prediction of diabetes mellitus. Total 46 Type 2 Diabetic patients and 42 non diabetic subjects were included in this study.
Results: The Pearson correlation coefficient was used to find the correlation between SFRP4 and Glycated hemoglobin (HbA1c) and Fasting glucose. And the correlation was found between SFRP4 levels with HbA1c (R=0.65) and also found between SFRP4 and fasting glucose levels (R=0.54) and both are statistically significant (p-EnglishSFRP4-Secreted Frizzled Related Protein, HbA1c-Glycated Hemoglobin, T2DM-Type 2 Diabetes Mellitus, OPCOrgano phosphorous compounds.Introduction:
With all precautionary and therapeutic approaches by the Government and Non-governmental organizations diabetes and its complications have become a major health problem for the public of South East Asians especially in India. There are many risk factors have been identified like lifestyle factors, genetic factors and for the prediction of diabetes that have been proposed and tested. Apart from these lifestyles and genetic factors, pesticides like organophosporous compounds (OPCs) which are very much in use for the agriculture purpose worldwide, disorders of glucose homeostasis are one of the most important complications following exposure to organophosphorus pesticides , because there is increasing evidence of environmental pollutants especially pesticides to the development of insulin resistance and type2 diabetes mellitus1 . Hectors et al. stated that beta cell function has been found to be disrupted by the organophosphate pesticides like malathion and disturbance in carbohydrate metabolism2. Many previous studies have proved that the use of OPCs like malathion, diazinon, chloripyrifos, dichlorvos without any proper precautionary measures may cause different health problems, including endocrine, reproductive, nervous, and immune systems3, 4, 5.
An adipocytokine known as Secreted frizzled related protein4 (SFRP4) one of the recently discovered group of 5 proteins has been described as a potential bio marker of early pancreatic beta cell dysfunction6. And it was stated in a study that there was a significant inverse correlation of SFRP4 expression in human pancreatic islets with insulin secretion and positive relationship with HbA1C levels was observed7. There was much focus on the risk factors for diabetes has been elaborated on the basis of life styles and genetics. So the aim of the study is to know the relationship between SFRP4 levels and type-2 diabetes mellitus among pesticide users in the rural population.
Aim: To study the significance of SFRP4 levels in both diabetic and non diabetic rural agriculture population who are exposed to pesticides for the prediction of diabetes mellitus.
Objectives:
1.To know the levels of SFRP4 in Diabetes and non-diabetes persons.
2. To reveal the role of pesticides in relation to the SFRP4 levels in Diabetes and non-diabetes persons.
Materials and Methods:
46 Type2 Diabetic (T2DM) and 42 non diabetic Male and Female subjects with age ranges from 20 to 75 were included in this study.
Inclusion criteria: The study subjects who were exposed to pesticides for more than one year living in the rural area near by the Tertiary Care Teaching Hospital
Exclusion criteria: Type-1Diabetes Mellitus(DM), Secondary causes of DM, Gestational DM and Diabetic patients with its complications were excluded from this study
After got the informed written consent from all patients and subjects, 5 ml of fasting blood sample was collected, 3ml in a clot activator tube for the analysis of Fasting plasma glucose in BS 420 auto analyzer, serum quantitative analysis of SFRP4 by ELISA method in the Biorad-680 system and 2 ml of blood into the EDTA tube for the analysis of HbA1c% by NGSP/IFCC approved method.
Results: The results were analyzed in SPSS16.0 version. The Mean value of SFRP4 among diabetic study subject was 3.2 + 0.6 (Normal value considered was Englishhttp://ijcrr.com/abstract.php?article_id=2454http://ijcrr.com/article_html.php?did=2454
Swaminathan K . Pesticides and human diabetes: a link worth exploring? 2013. Diabet Med.30(11):1268-71
Hectors TL1, Vanparys C, van der Ven K, Martens GA, Jorens PG, Van Gaal LF, Covaci A, De Coen W, Blust R. Environmental pollutants and type 2 diabetes: a review of mechanisms that can disrupt beta cell function. Diabetologia. 2011 Jun;54(6):1273-90. Epub 2011 Mar 27. [PubMed ]
Soltaninejad K, Abdollahi M. Current opinion on the science of organophosphate pesticides and toxic stress: A systematic review. Med Sci Monit 2009;15:75-90.
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Mostafalou S, Abdollahi M. Concerns of environmental persistence of pesticides and human chronic diseases. Clin Exp Pharmacol 2012;S5:e002.
K. Bergmann, G. Sypniewska Secreted frizzled-related protein 4 (SFRP4) and fractalkine (CX3CL1) - Potential new biomarkers for β-cell dysfunction and diabetes. Clinical Biochemistry 47 (2014) 529–532
Grazyna Sypniewska . How to diagnose diabetes? Biochemia medica 2014:24(Suppl 1) S3134
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.Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up .2015. Environ Res. 137:485-94
Hansen MR, Jørs E, Lander F, Condarco G, Schlünssen V.Is cumulated pyrethroid exposure associated with prediabetes"? A cross-sectional study. J Agromedicine. 2014;19(4):417-26.
Michael M Hoffmann, Christian Werner, Michael Böhm, Ulrich Laufs and Karl Winkler. Association of secreted frizzled-related protein 4 (SFRP4) with type 2 diabetes in patients with stable coronary artery disease. Cardiovasc Diabetol. 2014; 13: 155.
Wilson C. Diabetes: SFRP4—a biomarker for islet dysfunction? Nature Reviews Endocrinology 2013: 9‚ 65.
Mahdi T, Hänzelmann S, Salehi A, Muhammed SJ, Reinbothe TM, Tang Y, Axelsson AS, Zhou Y, Jing X, Almgren P, Krus U, Taneera J, Blom AM, Lyssenko V,Esguerra JL, Hansson O, Eliasson L, Derry J, Zhang E, Wollheim CB, Groop L, Renström E, Rosengren AH. Secreted frizzled-related protein 4 reduces insulin secretion and is overexpressed in type 2 diabetes. Cell Metab. 2012 Nov 7;16(5):625-33.
Shazia Anwer Bukhari , Waseem Akhtar Shamshari , Mahmood-Ur-Rahman , Muhammad Zia-Ul-Haq, and Hawa Z. E. Jaafar. Computer Aided Screening of Secreted Frizzled-Related Protein 4 (SFRP4): A Potential Control for Diabetes Mellitus. Molecules 2014, 19, 10129-10136;
Brix JM, Krzizek EC, Hoebaus C, Ludvik B, Schernthaner G, Schernthaner GH Secreted Frizzled-Related Protein 4 (SFRP4) is Elevated in Patients with Diabetes Mellitus. Horm Metab Res. 2016 May;48(5):345-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareCoronary Artery Status in Young Age Group in Autopsy Study
English1013Nidhi DhinganiEnglish Bhavika VaghelaEnglish Hansa GoswamiEnglishIntroduction: The coronary atherosclerosis is one of the common diseases in elders. Now it is growing fast among young age group in developing countries. The purpose of this study is to analyze the changing epidemiological trends and prognosis of CAD in young population.
Material and Method: This study was conducted from January 2016 to June 2017 at Department of Pathology, B.J. Medical College, Ahmedabad, Gujarat. This is a retrospective study. Data taken from autopsy section, B.J. Medical college, Ahmedabad.
Result: A total of 708 autopsy cases were studied. In the study 536 (75.7%) were males and 172 (24.3%) were females. Among them 260(48.5%) males and 128(74.5%) females below 40 years of age had coronary artery lesions. Most commonly involved coronary artery was Left coronary artery.
Conclusion: The study showed alarmingly high prevalence of Atherosclerosis in young age. So screening for the same should begin at an early age. The incidence of atherosclerosis is more common in males compared to females; though coronary atherosclerosis is an important risk factor for IHDs in both sex.
EnglishAtherosclerosis, Younger age, Coronary vessels, AutopsyText:
Introduction:
Coronary artery disease occurring below the age of 45 years is termed as young coronary artery disease (CAD)[1]. Atherosclerosis is a chronic degenerative condition of arteries responsible for significant cardiovascular morbidity and mortality worldwide. In the Indian subcontinent‚ it is reported to be responsible for more than 25% of deaths [2‚3]. The prevalence of coronary artery disease (CAD) among Asian Indians is higher than among Europeans, Americans and other Asians [4‚5]. Many studies showed that the case load of CAD in India is alarming. According to the World Health Report 2002‚ 45 million people in India are suffering from CAD and it is contributing to one fifth of the deaths in India and also‚ by the year 2020, CAD will account for one third of all deaths. The same report estimated that heart disease in Indian population occurs 10 to 15 years earlier than in the western population [6]. Atherosclerotic lesions start developing at an earlier age and are found to be in more advanced stage in Indian population as compared to the population in western countries. Atherosclerosis can lead to various complications like myocardial infarction (MI)‚ stroke‚ embolization‚ ulceration‚ thrombosis,aneurysm which cause considerable morbidity and mortality‚ thus affecting the life span and the quality of life of a large segment of population.
Material and method:
This study was conducted from January 2016 to June 2017 at Department of Pathology‚ B.J. Medical College‚ Ahmedabad‚ Gujarat. The deceased patients who underwent autopsy at the hospital and their past medical history were recorded and their hearts were sent to our department for histopathological analysis. The Hearts were grouped according to age and sex. The specimen were fixed in 10% formalin solution for 2-5 days. The coronary arteries dissected and examined grossly for other anomalies. Identified segments of coronary arteries viz. left and right coronary artery were sectioned at 3 mm interval and histopathological slides were made. All the histological sections were examined microscopically for the presence of atheroma and MI. Grading of atherosclerotic plaque according to American Heart Association was done below.
Grade 0
Sections showing normal histology or adaptive thickening without macrophages or foam cells.
Grade 1
Presence of isolated macrophages and foam cells.
Grade 2
Mainly intracellular lipid accumulation.
Grade 3
Grade 2 lesions along with small extracellular lipid pools.
Grade 4
Grade 2 changes along with a core of extracellular lipid.
Grade 5
Lipid core and fibrotic layer or multiple lipid cores and fibrotic lipid layers; mainly calcific or fibrotic.
Grade 6
Surface defect‚ hematoma‚ hemorrhages or thrombus formation.
The degree of atherosclerosis was classified as :
unremarkable (Grade 0)‚
mild (Grade 1-2)‚
moderate (Grade 3-4)‚
severe (Grade 5-6).
Result:
Discussion:
Morbidity and mortality due to coronary atherosclerosis in India has reached alarming proportions and these numbers are expected to maintain the upward trend in the next decade. Atherosclerosis is a commonly observed pathological finding in almost all ethnicities and societies worldwide‚ but with variable prevalence in different races. The onset of atherosclerosis starts early in life from childhood and gradually progresses through young adulthood to form the lesion that causes coronary heart disease. In the present study, the overall incidence of atherosclerosis was found to be 82.34%‚ which is higher than what has been founded in earlier studies by Dhruva et al.‚ (23.3%) [7]; Golshahi et al.‚(28.9%)[8]; Garg et al., (46.4%)[9] and Yazdi et al.,(40%)[10]. Ischemic heart disease (IHD) due to coronary vascular lesion is mainly caused by atherosclerosis. The Indian population is vulnerable to coronary vascular disease and the disease also has an earlier onset in our population. In our study we found that there is a progressive steady increase in atherosclerosis in coronary vessels in early age group. So screening for cardiovascular Risk factor should be start from younger age group.
Lack of exercise and poor dietary habits like intake of junk food and increased use of refined and processed food items in place of whole grains and fresh fruits and vegetables can be important risk factors for earlier initiation of development and progressive increase in atherosclerotic lesions in this young Indian population. Males have a relative preponderance for coronary heart disease as is evident from multitude of national and international studies conducted in the past.
In the study conducted by Garg et al.,[9]; they found coronary atherosclerotic lesions in 80.9%(93)males as compared to 19.1%(22) females. Bhargava and Bhargava[11] reported coronary atherosclerotic lesions were more prevalent in 74.8% males in comparison to 24.2% females in their study. Murthy et al.‚[12]‚ studied 150 cases of coronary atherosclerotic lesions, out of which 123(80%) were males and 27(18%) were females. Singh et al., [14] also reported coronary atherosclerotic lesions in 200 cases and found that these lesions were more frequently found in males(85%) as compared to females(15%). Padmavati and Sandhu [15%]found that 66.5% males and 33.5% females were affected by coronary atherosclerotic lesions. In the present study too, we found a male (75.7%) preponderance for coronary atherosclerosis as compared to females(24.3%). The findings of our study corroborates well with the findings of previous studies. There may be a protective role of female hormones like estrogen against atherosclerosis. Moreover, there is greater indulgence of males in smoking and alcoholism as compared to females, which may possibly explain the male preponderance towards development of more severe and progressive atherosclerosis.
Incidence of Left coronary artery involvement was 85%, Right coronary artery involvement was 63%. This was in concordance with Data given by sudha et al., [15] and Yazdi et al.,[10], left coronary artery is more commonly involved than right coronary artery.
In left coronary artery, left anterior descending artery is the commonest artery to be involved.
Acute MI was seen in 13% cases compared to observations of 9.72, 6.5 and 3% acute MI cases observed by Dhruva et al.,[7] Maru [16], garg et al.,[9] respectively. The percentage of MI is slightly higher than previous study. Incidence of MI attack alarmingly increasing in younger age group.
Conclusion:
The study showed unexpectedly high prevalence of coronary artery lesion ahmedabad in India. Though the incidence of atherosclerosis is more in males as compare to females, but there is a progressive increase in the proportion of females who present with coronary atherosclerosis. This study highlights the importance of cardiovascular risk factors screening for early ages. The study of human atherosclerotic lesion is an extremely difficult task in a living subjects and autopsy study is the best possible way to work on it. Though our study involved only small numbers of cases, it highlights the early onset and increasing prevalence and severity of atherosclerotic lesions in Indian populations.
Englishhttp://ijcrr.com/abstract.php?article_id=2455http://ijcrr.com/article_html.php?did=24551. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J 2005; 81: 741-745 [PMID: 16344295 DOI: 10.1136/pgmj.2004.027532]
2.Indrayam A. Forecasting vascular disease and associated mortality in india. NCMH Background papers: Burden of disease in India. National Commission on macroeconomics and Health , Government of india 2005:197-215
3.Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and Causation of coronary heart disease and stroke in India. Heart 2008:16-26 (pubmed)
4. Reddy KS. India wakes upto the threat of cardiovascular disease. [1] J Am Coll Cardiol. 2007;50:1370-72.
5.Gupta R. Recent trends in Coronary heart disease epidemiology in India. Indian Heart J. 2008;60(2suppl-B):B4-18.
6. Alarming Statistics from India. [Internet] 2015 [Cited 2015 FEB 19]. Available from http://neocardiabcare.com/alarming-statistics-india.htm.
7.Dhruva GA, Agravat AH, Sanghvi HK. Atherosclerosis of coronary arteries as predisposing factor in myocardial infarction: An autopsy study.(Last assessed on 2013 Dec 13);Online J Health Allied Sac.2012 11:1.Available From: http://www.ojhas.org/issue43/2012-3-1.htm
8.Golshahi J, Rojabi P, Golshahi F. Frequency of atherosclerotic lesions in coronary arteries of autopsy specimens in Isfahan forensic medicine centre. J Res Med.2005;1:16-9.
9.Garg M, Agraval AD, Kataria SP. Coronary atherosclerosis and myocardial infarction: An autopsy study. J Indian Acad Forensic Med.2011 33:39-42. Available from:http://medind.nic.in/jal/t11/il/jalt11ilp39.pdf.
10.Yazdi SA, Razaei A Azari JB, Hezari A, Shakeri MT, Shahri MK. Prevalence of atherosclerotic plaques in autopsy cases with noncardiac death. Iran J pathol. 2009;4:101-4
11.Bhargava MK, Bhargava SK. Coronary atherosclerosis in North Karnataka. Indian J. pathol Microbiol.1975;18:65-79.(pubMed)
12.Murthy MS, Dutta BN, Ramalingaswami V. Coronary atherosclerosis in North india(Delhi india)J pat hol Bacteriol.1963;85:93-101 (pubMed)
13.Padmavati S, Sandhu I. Incidence of coronary artery disease in Delhi from medico-legal autopsies. Indian J Med Res.1969;57:465-76 (pubMed)
14.Singh H, Oberoi SS, Gorea RK, Bal MS. Atherosclerosis in coronaries in malwa region of Punjab. J Indian Acad Forensic Med.2005;27:32-5s
15.Sudha ML. Sundaram S, Purushotaman KR,K Kumar PS, Prathiba D. Coronary atherosclerosis in sudden cardiac death :An autopsy study. Indian J Pathol Microbiol.2009:52:486-9. (pubMed)
16.Maru M. Coronay atheraosclerosis and myocardial infarction in autopsied patients in Gondar. Ethiopia. JR soc Med.1989;82:399-401.(PMC free article)(PubMed)
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareColonoscopy as a High Yielding Diagnostic Tool for per Rectumbleeding – An Overview
English1419Unmesh TakalkarEnglish Kuldeepsingh DodmaniEnglish Umesh KulkarniEnglish Bharat KumarEnglishPer rectum (PR) bleeding is a common cause of hospitalization and continues to be a problem for physicians. PR bleeding is defined as bleeding emanating from a source distal to the ligament of Treitz. Although bleeding stops spontaneously in 80% cases, 25% risk of re-bleeding persists along with a difficulty of identifying the bleeding source. Patients with major hemorrhage/ ongoing bleed require rapid diagnosis and intervention to achieve hemostasis. Refinement of Endoscopic techniques has greatly improved the diagnosis and treatment of gastrointestinal bleeds. Colonoscopy is considered to be the primary mode of diagnosis, risk analysis and treatment of few common causes of colonic bleeding. The following review discusses the etiology of PR bleeds and reviews its colonoscopic diagnosis and treatment, along with the pros and cons of colonoscopy.
EnglishPer Rectum Bleeding, Colonoscopy, LGIBINTRODUCTION
Gastrointestinal (GI) bleeding refers to any form of hemorrhage/blood loss occurring in the gastrointestinal tract, a passage ranging from mouth to anus, and is divided into:
Upper GI bleeding (UGIB): Includes bleeding in esophagus, stomach, or initial part of the small intestine.
Lower GI bleeding (LGIB) Includes bleeding in remaining of the small intestine, large intestine, rectum, or anus.1
PR bleeding refers to bleeding into enteric lumen originating distal to the ligament of Treitz. 1 It can be classified into occult, moderate or severe depending upon the amount of bleeding. Common clinical presentation includes passage of stools with bright red/maroon red blood, i.e., visible bleeding, iron deficiency anemia or positive fecal occult blood test.1 Rectal bleeding is a common symptom occurring in about 20% of the general population, but only about 7 per 1000 patients per year seek medical opinion.2 It is estimated that UGIB, LGIB and obscure bleeding account for 50%, 40% and 10% of GI bleeding respectively.3 Although LGIB stops spontaneously in 80% cases without needing hospitalization, identification of the bleeding source remains challenging and re-bleeding can occur in 25% of cases.4‚5
Etiology
Literature6categorizes the etiologies of LGIB as follows:
Diverticular Disease
Colonic diverticulais characterized by arterial bleeding occurring either at dome or neck of the diverticulum and presents as acute, painless hematochezia. It affects about two-third of the population above 80 years of age and the prevalence increases with age. These structures are the most common cause of acute LGIB (22% cases),considered to be the cause if no other source is found and identified by active bleeding or presence of a visible vessel/adherent clot.4 Bleeding is mostly (60% cases) observed in the left colon when diagnosed using colonoscopy but, is localized in right colon with angiography.6‚7 Bleeding stops spontaneously in about 80% of cases with a 25% cumulative risk of re-bleeding after 4 years.6After endoscopic therapy, recurrence rate of bleeding is inconsistent; though Bloomfeld and colleagues reported an early recurrence in 38% of patients.8
Angiodysplasia
Angiodysplasias (aka vascular ectasias or angioectasias), though documented as cause of 30%LGIBcases, in reality cause only 3-12% of them.9 They majorly localize in the right hemicolon, often as multiple lesions with number increasing with age. The mucosal lesions are one millimeter to few centimeters in size and endoscopically appear circumscribed and red.10They are seldom found during routine colonoscopy as most do not bleed, making patients asymptomatic warranting no therapy11
Colitis
Colitis includes patients with inflammatory bowel disease (IBD), Crohn's disease, ulcerative, ischemic, infectious and pseudomembranous colitis.
Patients with IBD are usually characterized by non-life threatening bloody diarrhea. In one review, 50% patients with IBD caused intestinal hemorrhage experienced spontaneous halt in bleeding, while 35% experienced a re-bleeding episode;12 a high recurrence rate warranting recommendation of semi-elective surgery after the first episode of severe GI bleeding secondary to IBD. Symptoms associated with Crohn's depend on the site, most common being terminal ileal or ileocecal disease.13 Ulcerative colitis, which affects only mucosa and sub-mucosa of the rectum and colon, cause only 2-8% of all LGIBs, out of which about 10% require emergent colectomies.4‚14
The cause of ischemic colitis is sudden, often temporary, reduction in mesenteric blood flow caused by hypotension/vasospasm. Patients experience sudden onset of mild abdominal pain usually followed by hematochezia/bloody diarrhea. Mostly bleeding ceases without interference; but colonic ischemia is linked with a high-risk mortality.15
In infectious colitis (including pseudo-membranous colitis), hemorrhage is rarely life threatening. Although any type of infectious colitis may cause hematochezia, the most common types are Enterohemorrhagic Escherichia, Salmonella, Histoplasma, and Cytomegalovirus.7,13
Neoplasia
Neoplasia, though usually associated with microscopic blood in stool, is a lesion that can cause gross hematchezia when they wear down into underlying vessels caused by erosions of the luminal surface or polyps. Benign and malignant neoplasms of colon are the cause of LGIB in 10-20% of elderly cases.16 Bleeding is the initial presenting symptom in 26% of patients with colorectal neoplasms.17
Colorectal Cancer and Polyp
Carcinomas account for 2-9% of the LGIB cases.18 Erosions and ulceration on the surface of the tumor might bleed, and bleeding is often aggravated by the use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Carcinoma in the left colon leads to rectal bleeding, but often present as iron-deficiency anemia in the right colon. Colonic polyps are cited as the source of LGIB in 5-11% of patients and usually, only those larger than 1 cm bleed.14
Postpolypectomy Bleeding
Polypectomy procedure is associated with massive arterial bleeding which is caused by inadequate hemostasis of the blood vessel in polyp stalk.19It is commonest complication of colonoscopy and is seen in 0.2-1.8% cases accounting for 2-8% cases of acute LGIB.20 Delayed bleeding might occur up to 14 days after polypectomy.21
Anorectal Diseases
Chronic recurrent passage of red blood in small amounts is indicative of the bleeding source in anus, rectum or sigmoid. Hemorrhoids and chronic anal fissures are the most common bleeding source in young (Englishhttp://ijcrr.com/abstract.php?article_id=2456http://ijcrr.com/article_html.php?did=2456[1]Davila RE, Rajan E, Adler DG, Egan J, Hirota WK, Leighton JA, et al. ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc 2005;62:656-60.
[1]Fijten GH, Muris JW, Starmans R, Knottnerus JA. The incidence and outcome of rectal bleeding in general practice. FamPract 1993;10(3);283-7.
[1]Savides TJ and Jensen DM. Gastrointestinal Bleeding. In: Feldman M, Frience S and Brandt LJ (eds), Sleisenger and Fordtran’s. Gastrointestinal and Liver Disease. 9th ed. Elsevier Medicine; 2010.
[1]Jensen DM, Machicado GA, Jutaba R, Kovacs Tao. Urgent colonoscopy for the diagnosis and treatment of severe diverticular heamorrhage. N Engl J Med 2000;342:78-82.
[1]Imdahl A. Genesis and pathophysiology of lower gastrointestinal bleeding. Langenbecks Arch Surg 2001;386:1-7.
[1]Lubis M, Zain LH. Etiology Profile of Lower Gastrointestinal Bleeding. Indones J GastroenterolHepatol Dig Endosc 2012;13(2):94-6.
[1]Farrel JJ Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment. Pharmacol. Ther. 2005;21:1281-98.
[1]Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am. J. Gastroenterol. 2001;96:2367-72.
[1]Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointest. Endosc. 1999;49:228-38.
[1]Richter JM, Christensen MR, Colditz GA, Nishioka NS. Angiodysplasia. Natural history and efficacy of therapeutic interventions. Dig. Dis. Sci. 1989;34:1542-6.
[1]Foutch PG. Angiodysplasia of the gastrointestinal tract. Am. J. Gastroenterol. 1993;88:807-18.
[1]Pardi DS et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest. Endosc. 1999;49,153-7.
[1]Dent MT, Freeman AH, Dickinson RJ. Massive gastrointestinal bleeding in Crohn’s disease. J R Soc Med 1985;78:628-9.
[1]Robert JR, Sachar DB, Greenstein AJ Severe gastrointestinal hemorrhage in Crohn’s disease. Ann Surg 1991;213:207-11.
[1]Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin. Gastroenterol. Hepatol. 2008;6:1004-10.
[1]Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ Lower intestinal bleeding in the elderly. Am J Surg 1979;137:57-64.
[1]Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol 1997;92(6):924-8.
[1]Barnert J. Acute and chronic lower gastrointestinal bleeding. In: Messmann H editor. Atlas of Colonscopy. Thieme, Stuttgart New York; 2006.p.118-42.
[1]Kim HS et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am. J. Gastroenterol. 2006;101:1333-41.
[1]Heldwein W et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005;37:1116-22.
[1]Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 2008;40:115-9.
[1]Ganguly S, Sarin SK, Bhatia V, Lahoti D. The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension. Hepatology 1995;21:1226-31.
[1]Maglinte DD, Chernish SM, DeWeese R et al. Acquired jejunoileal diverticular disease: subject review. Radiology 1986;158:577-80.
[1]Yen HH, Chen YY, Yang CW et al. Diagnosis and management of jejunoileal diverticular haemorrhage: a decade of experience. J Dig Dis 2012;13:316-20.
[1]Sagar J, Kumar V, Shah DK. Meckel’s diverticulum: a systematic review. J R Soc Med 2006;99:501-5.
[1]Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterology 2007;133:1697-717.
[1]Chan FK , Lanas A. Scheiman J, Berger MF , Nguyen H, Goldstein JL; Celecoxib versus omperazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR) : a randomized trial. Lancet. 2010;376 (9736);173-9.
[1]Eisen GM et al. An annotated algorithmic approach to acute lower gastrointestinal bleeding. Gastrointest. Endosc. 2001;53:859-63.
[1]Steer ML, Silen W. Diagnostic procedures in gastrointestinal hemorrhage. N Engl J Med 1983; 309(11);646-50.
[1]Sakurai OT. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion 2000;61(3);189-92.
[1]Strate LL. Timing of colonscopy; impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol 2003;98(2);317-22.
[1]Swain CP et al. Which electrode? A comparison of four endoscopic methods of electrocoagulationin experimental bleeding ulcers. Gut 1984;25:1424-31.
[1]Kwan V et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am. J. Gastroenterol. 2006;101:58-63.
[1]Muhldorfer SM, Kekos G, Hahn EG, et al. Complications of therapeutic gastrointestinal endoscopy. Endoscopy. 1992;24:276-83.
[1]Green BT, Rockey DC, Portwood G, Tarnsky PR. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage; Am J Gastroenterol 2005;100(11): 2395-402.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcarePattern of Lower Gastrointestinal Diseases by Colonoscopy and Histopathological Examination:
A Retrospective Study
English2025S. PadmaEnglish R. PramilaEnglishColonoscopy is the main investigation to detect the abnormalities in the colon and it is the main supportive measure for clinical diagnosis. Colonoscopic biopsy helps to get a definitive diagnosis of colonic diseases, which helps the clinician to give appropriate treatment.
Aim of the Study: To know the pattern of colonic diseases by colonoscopy and histopathological examination in Chennai Medical College Hospital & Research centre (CMCH&RC) Irungalur Thiruchirapalli District. a tertiary care hospital in rural part of
south India.
Materials and Methods: A retrospective study of patients who had undergone colonoscopy from November 2014 to December 2017 at CMCH&RC was done. Data, from endoscopy register & from histopathology register during that period were collected and analysed.
Results: A total of 919 patients registered for colonoscopy. Male: Female ratio was 614:305.913 patients tolerated the procedure. The most common indications were bleeding per rectum 208 cases (22.78%), clinical suspicion of irritable bowel syndrome 151 cases (16.54%), constipation 115 cases (12.60%), abdominal pain 62 cases (6.79%). The colonscopic findings were, normal study in 47.65%, hemorrhoids in 17.42%, polyps in 8.65%, carcinoma in 6.68%, inflammatory bowel disease in 7.56% of case. About 137 biopsy taken by colonoscopy during this period. The results were malignant lesions in 52, non specific colitis in 27 , benign neoplastic lesions in 14, ulcerative colitis were 13 cases.
Conclusion: The commonest lesion by colonoscopy was hemorrhoids, Histopathological examination supports the colonoscopic study. Commonest lesion by histopathology was malignancy. The increasing incidence of malignancy in younger age group needs further prospective study.
EnglishColonoscopy, Histopathology, CarcinomaINTRODUCTION
The lower gastrointestinal tract extend from caecum to anal canal which is affected by both neoplastic and non neoplastic diseases. The various diseases affecting the colon are infections, inflammatory diseases, tuberculosis, polyps, colorectal tumours. There may be overlapping of the symptoms in these diseases, which sometimes find difficult to get the final diagnosis clinically1. The colonoscopy helps to locate the exact site of lesion and the type of lesion, Colonic mucosal biopsy by colonoscopy helps to clinch correct diagnosis.
Colonoscopy and colonoscopic biopsy has radically changed the diagnosis and treatment of lower gastrointestinal tract diseases1. Diagnosing a polyp and removal by colonoscopy and histopathological examination has reduced many open surgical procedures2 . In developing countries like India where tuberculosis and infective pathology are common, the incidence inflammatory bowel diseases are showing increasing trend. The histopathological examination of colonic mucosal biopsies by colonoscopy plays an important role in diagnosing inflammatory bowel disease3 as well as early detection of colonic epithelial tumours4.
The aim of our study was to know lower gastrointestinal disease pattern by colonoscopy and also by histopathplogical examination in our area a rural part of south India.
MATERIALS AND METHODS
It is a retrospective study of the available data from colonoscopy procedures performed by the medical gastroenterologist at Medical gastroenterology department at Chennai Medical College Hospital and Research centre (CMCH and RC) Irungalur Thiruchirapalli Dt. a tertiary care hospital in rural part of south India. Data from November 2014 to December 2017 was reviewed. Histopathological reports of the colonoscopic mucosal biopsies done during the period was also reviewed.
Patients with any of these symptoms of (Table.2)
Bleeding per rectum
Clinical suspicion of Irritable Bowel syndrome, carcinoma colon
Constipation
Chronic diarrhea
Abdominal pain
Anemia
Right iliac fossa pain and masswere included. Inpatients from wards as well as outpatients with any of these symptoms were examined by the medical gastroenterologist and colonoscopy was done selectively. Colonoscopy was done after proper bowel preparation. Colonoscopy was done without sedation. Biopsies were taken whenever there was suspicious lesion by colonoscopy. Proper preservation and transferring of biopsy specimen was done as per pathologist guidance. Biopsy specimens were analysed by pathologists and the reports were furnished.
Data analysis includes
All the cases posted for colonoscopy, including the cases where the colonoscopy could not reach the caecum & the data reported in the histopathological examination register.
RESULTS
Total of 919 patients were selected for colonoscopy. 913 patients underwent colonoscopy Table.2. The number of males: females were 614:299. The age and sex distribution of cases shown in Table 1.
The common indications were bleeding per rectum 208 cases (22.78%), Irritable bowel syndrome 151 cases (16.54%), constipation 115 cases (12.60%), chronic diarrhea 59 cases (6.46%), ileo caecal kochs 48 cases (5.26%), anal fissure 36 cases (3.94%), anemia 46 cases (5.04%), fistula in ano 38 cases (4.16%), abdominal pain 62 cases (6.79%),carcinoma colon 33 cases (3.61%), right iliac fossa pain and mass 12 cases (1.31%), surveillance scopy (which includes colonoscopy done for inflammatory bowel disease, melena, alcoholic liver disease, hepatomegaly, portal hypertension, multiple gastric polyps etc.) 105 cases (11.50%)( Table.2).
The colonoscopic findings were Normal study in 435 cases (47.65%), Hemorrhoids in 159 cases (17.42%), Carcinoma in 61 cases (6.68%), Inflammatory bowel disease (both ulcerative colitis and chrons disease) in 69 cases (7.56%), Polyp colon in 79 cases (8.65%), Kochs lesion in 20 cases (2.19%), Proctitis in 14 cases (1.53%), Diverticular disease in 16 cases (1.75%), Solitary rectal ulcer in 11 cases (1.20%),Non specific ulcers rectum in 4 cases (0.44%), Pancolitis in 4 cases (0.44%), others (caecal telengectasia, porta hypertensive colopathy, pseudo membranous colitis, extraneous compression etc.) 37cases (4.05%) ,and incomplete study in 4 cases (0.44%) (Table .3).
Out of 79 cases of polyps 16 were diminutive polyps, 30 were sessile polyps, 33 were colonic polyps. Polypectomy done in 14 cases.
Colonoscopy showed ulcero proliferative lesion in 41 cases, circumferential lesion in 6 cases, ulcero infiltrative lesion in 3 cases, synchronous lesion in 3 cases, nodulo ulcerative lesion in 2 cases, ulcerative lesion in 2 cases, pigmented lesion in 1 case, polypoid lesion in 1 case, recto sigmoid proliferative lesion with multiple polyps in 1 case, verrucous lesion 1 case. 18 (29.50%) lesions were in proximal colon and 43 (70.50%) lesions were in distal colon.(Table.4)
Total of 137 colonic biopsies taken and was analysed by the pathologist. The malignant lesion reported were in 52 biopsies (37.95%),non specific colitis in 27 (19.70%), benign neoplastic lesions in 14 (10.21%),ulcerative colitis in 13 (9.45%), tuberculous colitis in 9 (6.56%) chrons colitis in 4 (2.92%), acute infective colitis in 3 (2.18%), pseudo membranous colitis in 3 (2.18%), acute on chronic colitis in 2 (1.45%), adenoma with dysplasia in 1 (0.73%), chronic eosinophilic colitis in 1 (0.73%), chronic lymphocytic colitis in 1 (0.73%), ischemic colitis in 1 (0.73%), diverticulitis and diverticulitis with dysplasia each 1 (0.73% each),solitary rectal ulcer 1(0.73%), normal rectal mucosa with surface ulceration in 1(0.73%), reports not traceable in 2.(Table.5).
Of the 137 biopsy specimens 14 were polypectomy specimen, adenomatous polyp in 1specimen,adenomatous polyp with dysplasia in 1 specimen, hyperplastic polyps in 4 specimens , inflammatory polyp in 3 specimens ,hamartomatous polyp in 2 specimens, juvenile polyp in 1 specimen, retention polyp in 1 specimen, 1 polyp was adeno carcinoma.(Table.6)
Of 14 benign neoplastic lesions reported by histopathological examination, 13 specimens were from polypectomy and 1 specimens were mucosal biopsies from colonoscopically suspected malignant lesions where the report was tubular adenoma.
Of the 61 lesions suspected by colonoscopy, histopathological examination showed malignancy in 52 cases (adeno carcinoma in 46, melanoma in 2, gastro intestinal stromal tumour in 1,carcinoid tumour in 1, baso squamous in carcinoma 1,carcinoma in situ in 1 case) (Table.7).5 lesions were benign (1 tubular adenoma, 1adenoma with dysplasia, 2 chrons, 1kochs).4 results not traceable. The age and sex wise distribution of malignancy shown in Table.8.
DISCUSSION
The patients with lower gastrointestinal disease may present with single or combination of symptoms like bleeding per rectum, anemia, abdominal pain, diarrhea, weight loss, constipation, altered bowel habits5. The commonest indication for colonoscopy in our study was bleeding per rectum-22.78% and this was the commonest indication for colonoscopy in the study by H N Dhinesh et al 6(24.8%) and Md Abu Sayeed et al 7(32.53%).
The hemorrhoids (17.42%) was the most common colonoscopic finding in our study and was similar to the study by Raju H. Badiger et al8 (48.4%). In our study the polyps constitute to 8.65% of total cases which was similar to the study by Md Abu Sayeed et al7 who reported as 8.73%.
The colonoscopic suspicion of malignancy in our study was 6.68% which was almost equal to the study by Dhinesh et al6 (7.06%) .The most common location of carcinoma was distal colon 70.50% in our study which was similar to the study by Musthafa et al9 who reported as 74%.The mean age of presentation of malignancy was 69 years in the western population10. Deo et al11 reported mean age at presentation was 45.3 years. In our study the mean age at presentation was 55.13 years.
In our study the out of 135 histopathological reports, non neoplastic lesions were 51.84% and neoplastic lesions were 48.16%, which is similar to the study by Abilash et al1 where the non neoplastic lesion (60.8%) was more than neoplastic lesion.
In non neoplastic lesions non specific colitis constitute to 19.7% in our study which was low compared to the studies by Abilash et al1 Abduikader12 , which was 52.6% and 46.7% respectively. The chronic non specific colitis may represent the early stage of inflammatory diseases like ulcerative colitis and chrons disease.13‚14
Ulcerative colitis was reported in 9.50% of cases in our study, which was less compared to the study by Abduikader12 Saira Bashir et al15 , whose reports were 11.8%, 31.7% respectively.
Tuberculosis was seen in 6.56% of the cases which was slightly high compared to the studies by Ritesh Sulegaon et al16, Pavani Manthini et al17 whose findings were 5.26% and 4.9%.
In our study malignancies were seen in 37.95% (52 cases) of biopsies and 88.46% (46 cases) were adenocarcinomas among them. Out of these adenocarcinomas, 54.34% (25 cases) were well differentiated, 34.78% (16cases)were moderately differentiated, 4.34% (2 cases) were poorly differentiated, 6.52% (3 cases) were mucinous adenocarcinomas. In the study by Chaitanya et al18 the predominant finding was well diffentiated adenocarcinoma 63.16%, moderately differentiated was 13.16%, poorly differentiated was 2.63%, mucinous adenocarcinomas was15.79%. He reported 2.63% as neuro endocrine tumour which was little high compared to our study of 1.92%,
Rectal malignant melanoma account for 0.2% to 0.3% of all malignant melanomas, 0.1 to 4.6% of malignant tumours of rectum and anus19. In our study 2 cases (3.8%)of melanoma rectum reported and it was presented in the age group of 50 to 60. Carcinoma in situ was identified in IBD with pseudopolyps. The GIST & carcinoid tumour was reported in the age group of 21-30. 40.38% of malignant lesions were below 50 years which was high compared to 36% reported by Rajbhandari et al14. Exposure to chemicals used in agriculture for growing rice and soya beans are one of the major environmental carcinogen responsible for colorectal carcinoma among adolescents20. Since our study was retrospective, which lacks the environmental factors, food habits, familial history, it needs further prospective study to find out the increased incidence below 50 and also the causative factors of malignancy.
The incidence of malignancy in sessile polyps and diminutive polyp and polyp less than 1cm is less. Polypectomy was not done routinely in all cases in our study. But follow up colonoscopy could pick up malignant changes if occurs.
CONCLUSION
This retrospective colonoscopic study helped us to know the pattern of lower gastrointestinal diseases in our area. Though the normal study was high, colonoscopy helped to pick up malignant lesions in younger age group. There was good correlation between colonoscopic findings and histopathological findings in malignancy. Histopathological examinations detected benign features in malignant lesion suspected by colonoscopy, thereby helps the clinician to avoid major surgeries. It needs further prospective study to evaluate the factors that causes malignancy in our area.
Acknowledgement:
The Authors acknowledge with thanks the great help rendered by Gasteroenterologist, Pathologist, the Department of Gasteroenterology and the Department of Pathology in CMCH&RC for providing access to the records for analysing the data for this study.
The Authors thank the Officials at CMCH&RC for the encouragement and support provided for bringing out the study which gives an insight into the Lower GI tract disease pattern among the rural population around the Institution.
The 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 this article has been reviewed and discussed.
ETHICAL CLEARANCE :
Ethical clearance for the use of clinical data and preparation of this Research paper has been obtained from the Management of CMCH&RC , Irungalur. Tiruchirappalli Dt. Tamilnadu.
INFORMED CONSENT :
Not applicable.
SOURCE OF FUNDING:
There is no source of funding for this study.
CONFLICT OF INTEREST:
There is no conflict of interest in the preparation and submission of this Research Paper.
Englishhttp://ijcrr.com/abstract.php?article_id=2457http://ijcrr.com/article_html.php?did=2457
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareA Study of Academic Anxiety in Relation to Mental Health in Adolescents
English2630Munni KumariEnglishThe present study was a preliminary attempt towards the study of Academic Anxiety in relation to Mental Health of Adolescent students of District Faridabad. For the present venture, Descriptive Survey was conducted on a sample of 100 Senior Secondary
school students. The value of the sample was assessed using standardized tests namely Educational Anxiety Inventory by Dr. Vishal Sood & Dr. Arti Anand and Mental Health Battery by Arun Kumar Singh & Alpana Sen Gupta. The objective of the study was to find out the relationship between Academic Anxiety and Mental Health of Adolescents students. The obtained data were quantitatively analyzed by using descriptive and inferential statistics. The findings revealed that there is significant relationship between Academic Anxiety and Mental Health of Adolescent Boys and Girls of secondary schools at 0.01 and 0.05 levels of significance and they are negatively correlated.
EnglishAcademic Achievement, Mental Health and AdolescentsINTRODUCTION
Present age is the age of competition. Scientific and technological advancement all over the globe has been made man very conscious and sensitive about his studies, vocation, life style, relations etc. This immense progress has given rise to certain problems. One of the major problems of today's world is “Anxiety”. Every person has a unique nature as regard to capabilities, attitude, personality characteristics and interests. The adolescents have a major impact of anxiety due to bloodshed competition in every field. The parents and teachers are eager to know the various factors, which enhance the anxiety among the students. Academic achievement expectations have created so much fear among the students hat they are not able to utilize their basic potential. They are to only concentrate on their academic performance. Every child is not able to get first division as the level of mental health is not same in every child. Academic anxiety is a common issue that students cannot ignore if they want to succeed in school.
Academic anxiety is a kind of anxiety which relates to the imminent danger from the environment of the educational institutions together with teacher and certain subjects like Chemistry, Physics for numerical, Mathematics, and English to some extent for some north Indian states. It is a mental sensitivity of uneasiness or distress in response to school or college circumstances that is perceived negatively. Academic anxiety is totally not a bad thing. However it is true that a high level of anxiety interferes with concentration and memory which are critical for day to day academic performance and success, however it is also true without any anxiety, majority of us would lack the enthusiasm and motivation to study for exams, do everyday homework or write any research papers.
Mental Health means health of mind. It means harmonious functioning of the whole personality and measure of a person's ability to shape his environment and to adjust to life with a reasonable amount of success efficiency and happiness. Mentally healthy persons are generally good workers, good friends and good citizens. A healthy mind maintains an even temper, an alert intelligence, socially considerable behavior and a happy disposition. The word MENTAL usually implies something more than pure cerebral functioning of a person. It also stands of his emotional effective starts, the relationship he establishes in his socio-cultural context. Similarly, HEALTH refers to more than physical health. Many people, when they hear of the term mental health think of absence of mental illness. When we speak of happiness, peace of mind and enjoyment of satisfaction, we are usually talking about mental health. It has to do with everybody's everyday life. It means overall ways in which people gets along with their peers in their community.
SIGNIFICANCE OF THE STUDY
21ST century can be indicated as the century of competition. Everywhere there is a race, a competition. With the huge development in science and technology, all part of the world is connected with this competition. Especially in the field of education, this competition rapidly increased among the students. Curriculum and co-curricular offerings have tremendously expanded, gripping the students in the adjustment problems. Feeling the insecurity, conflicts within themselves, bad company and low achievement creates emotional tensions and anxiety among the students. They are unable to face the changing trends in the society, the students are taking to drug addiction and even the suicidal note is increasing. To survive in this competitive and complicated world, Good Mental Health is required to all to cope up with all such adjustment problems and anxious atmosphere but school students have been found to have high prevalence of mental health problems.
In recent years, issues related to mental health are often propaganda in mass media not only in a country and even around the world. Mental health is a way of thinking, feeling and behaviour in a person's daily lives. A Person with a healthy mental health can recognize himself on the ability, willing to accept failure, able to control his/her emotions and appreciate him / her . Mental health may deteriorate and its negative effects will affect the daily lives without treatment. Poor mental health leads to stress, anxiety and poor performance in the scholastic skills.
Different studies of Academic Anxiety and Mental Stress have been conducted like Agashe (1991) [2] , Mohanty (1992) [9] , Ojha and Rani, (2004) [10] , Dholakiya and Jansari (2005) [5] , Sanwal, Dube, and Bhatnagar (2006) [6] , Agarwal and Sarna, (2009) [1] , Gupta and Kumar, (2010) [7] , Kumari, N. (2013) [8] , Das, Halder and Mishra(2014) [4] , Bartwal, R.S. (2014) [3] , Deb, Strodl and Sun (2015) [13] , Sharma and Sarin (2016) [12] and Sharma and Pandey (2017) [11] with different variables like Academic Achievement, Academic Stress, Spiritual Intelligence, Emotional Intelligence, Parental Rearing Styles, Parental Support, Self Esteem and Self Confidence etc. showing different results. But there is a dearth need of a study which sees the effect of Academic Anxiety and Mental Health together. Moreover, there are a few number studies have been conducted in the field of Mental Health. Mental Health is a deliberating factor which impact on students' Academic Anxiety. These factors necessitate a moral formal, systematic and intensive process of carrying on the methods of analysis. A systematic structure of investigation must be involved to improve the performance of students in different shapes to introduce an atmosphere conductive to intellectuals and to minimize the anxiety of students because a manageable level of Academic Anxiety is actually a good thing. Moderate Academic Anxiety provides the motivation students require to exert effort completing assigned schoolwork and preparing to take examinations. Academic Anxiety only becomes a problem that needs a solution when the amount experienced grows so excessive that a student is no longer able to function. There was a need of empirical study in this field. It was in this context that present venture was planned and executed. Present study is a humble effort to answer the query i.e. why students feel anxiety and is this academic anxiety is related to their mental health?
OBJECTIVES OF THE STUDY
The Present research was conducted keeping in mind the following objectives:
To study the difference between the mean scores of Academic Anxiety of Adolescent Boys and Girls.
To study the difference between the mean scores of Mental Health of Adolescent Boys and Girls.
To study the relationship between Academic anxiety and Mental Health of adolescent.
HYPOTHESES OF THE STUDY
The researcher will be used Null Hypotheses to remain unbiased. The following Hypotheses will be framed for the present study:
H1:- There will be no significant difference between the mean scores of Academic Anxiety of adolescent boys and girls.
H2:- There will be no significant difference between the mean scores of Mental Health of adolescent boys and girls.
H3:- There will be no significant relationship between Academic Anxiety and Mental Health of adolescents.
SAMPLE
The random sampling (students were chosen in such a way that each has an equal and independent chance of being selected) was used to carry out this research work. The figure that shows the distribution of sample has given below:
The sample was taken from two Private Schools namely S. D. Public Sr. Sec. School and Anupam Public School affiliated to Board of School Education (BSEH), from city Faridabad (Haryana). A random selection of 100 adolescent students, 50 adolescents' students from each school, of age group 13-16 years of Class IX were selected for the present study. From these 100 students, 50 students were Adolescent Boys and 50 students were Adolescents Girls.
METHODOLOGY
Keeping in mind the nature of the present research, the researcher has been used Descriptive Survey Method to conduct this study.
TOOLS and TECHNIQUES
Various devices are used for collecting new unknown data required for the study of any problem for each and every type of research. The following two tools will be used by investigator to conduct this study. They are:
Educational Anxiety Inventory of Dr. Vishal Sood and Dr. Arti Anand.
Mental Health Battery of Arun Kumar Singh and Alpana Sen Gupta.
STATISTICS USED FOR THE PRESENT STUDY
For the present study Mean was calculated for average Academic Anxiety and Mental Health.
Standard Deviation ( S.D.) was calculated to find out variability of Academic Anxiety and Mental Health.
t-value was calculated to study the comparison of Academic Anxiety on Adolescent Boys and Girls
t-value was calculated to study the comparison of Mental Health on Adolescent Boys and Girls.
Pearson's Product Moment coefficient of correlation was calculated to estimate the relationship of Academic Anxiety and Mental Health.
ANALYSIS AND INTERPRETATION
In the present chapter analysis and interpretation has been presented in the following manner:
Objective No 1: To study the difference between the mean scores of Academic Anxiety of Adolescent Boys and Girls.
It can be observed from the table 1 that the mean score of Boys and Girls on Academic Anxiety are found to be 120.02 and 135.38 with Standard Deviation (S.D.) 12.48 and 10.64 respectively. The t-value between the two genders comes out to be 2.08 which is greater than tabled value. It indicates that Boys and Girls differ significantly at 0.05 level. Therefore null hypothesis “There will be no significant difference between the mean scores of Academic Anxiety of Adolescent Boys and Girls” is rejected.
Further the comparison of mean scores reveals that the mean score of Girls are higher than that of Boys scores. Hence, it means that the Adolescents Girls show greater Academic Anxiety than Adolescents Boys. The result is supported by Kumari, Neelam (2013) and Das, Halder and Mishra(2014) [8, 4].
In order to see the mean and standard deviation scores of Adolescent Boys and Girls and t-value at a glance these results have been given in figure :2.
Objective No 2: To study the difference between the mean scores of Mental Health of Adolescent Boys and Girls.
Figure: 2 shows the mean scores of adolescent boys and girls on Academic Anxiety. And it can be interpreted that Girls have shown higher Academic Anxiety in comparison to Boys.
It can be observed from the table 2 that the mean score of Boys and Girls on Mental Health are found to be 105 and 92.38 with Standard Deviation ( S.D.) 9.71 and 10.92 respectively. The t-value between the two genders comes out to be 2.13 which is greater than tabled value. It indicates that Boys and Girls differ significantly at 0.05 level. Therefore null hypothesis “There will be no significant difference between the mean scores of Mental Health of Adolescent Boys and Girls” is rejected.
Further the comparison of mean scores reveals that the mean score of Boys are higher than that of Girls scores. Hence, it means that the Adolescents Girls show better Mental Health than Adolescents Boys. The result is also supported by Agarwal and Sarna (2009) and Gupta and Kumar (2010) [1, 7].
In order to see the mean and standard deviation scores of Adolescent Boys and Girls and t-value at a glance these results have been given in figure:3.
Objective No 3: To study the relationship between Academic Anxiety and Mental Health of Adolescents Boys and Girls
It could be observed from table 3 that obtained coefficient of Pearson's Product Moment Correlation of Academic Anxiety and Mental Health of Adolescent Boys and Girls is 0.19 which is greater than the tabled value at 0.01 and 0.05. Therefore null hypothesis “There will be no significant relationship between Academic Anxiety and Mental Health of Adolescent Boys and Girls” is rejected. Thus it can be reframed as Academic Anxiety and Mental Health of Adolescent Boys and Girls related significantly. Thus it can be interpreted that Academic Anxiety and Mental Health are negatively correlated with each other.
In order to see the coefficient of Pearson's Product Moment Correlation of Academic Anxiety and Mental Health of Adolescent Boys and Girls at a glance this result have been given in figure 4.
Figure 4 shows the scores of coefficient of Pearson’s Product Moment Correlation of Academic Anxiety and Mental Health of Adolescent Boys and Girls. And it can be interpreted that Academic Anxiety and Mental Health are negatively correlated.
RESULT OF THE STUDY
On the basis of statistical analysis of data, the study revealed the following finding:
1. There is significant difference between mean scores of Adolescent Boys and Girls of secondary schools on Academic Anxiety at 0.05 levels of significance.
2. There is significant difference between mean scores of Adolescent Boys and Girls of secondary schools on Mental Health at 0.05 levels of significance.
3. There is significant relationship between Academic Anxiety and Mental Health of Adolescent Boys and Girls of secondary schools at 0.01 and 0.05 levels of significance. But they are negatively correlated.
DISCUSSION
In this research paper, the relation of Academic Anxiety and Mental Health of Adolescent students was studied and the findings of first objective indicated that girls show more academic anxiety than boys. The finding of second objective of this study revealed that boys have better results in mental health in comparison to adolescent girls. And the third objective's finding showed that Mental Health and Academic Anxiety are correlated but they correlated negatively, it means that if the scores of mental health increases then academic anxiety scores decreases and if the scores of mental health decreases then academic anxiety scores increases.
CONCLUSION
The results of this study indicated that girls show more academic anxiety than boys and boys have better results in mental health. Another findings show that Mental Health and Academic Anxiety are negatively correlated. Therefore, it is important for teachers and parents to focus on Mental Health of the students and find out the ways to reduce their Academic Anxiety.
The concept of Academic Anxiety will help the teachers to identify the students who are suffering from academic anxiety.
Provide help to the students in reducing their anxiety level.
Teachers should provide empathetic behaviour to the students so that the students can easily express their anxiety level to their teachers easily and they get sound mental health.
This information helps the teachers to identify such students and help them to develop their trust towards teachers and parents.
Responsibility of Parents to provide better home environment for their children so that their anxiety level can be reduced.
Parents should not expect so much from their children so that they don’t get anxious and their mental health improved.
It is concluded that academic anxiety affects the mental health of adolescents and if not taken care of properly, may result in disorder. So, teachers and parents should bestow the quality time to adolescents to gain a better mental health.
Englishhttp://ijcrr.com/abstract.php?article_id=2458http://ijcrr.com/article_html.php?did=2458[1] Aarwal, R. and Sarna, R.P. (2009). Studied the Gender Differences in Associated with Mental Health of the College going Students of various Faculties. Behavioural Scientist, 10(2); 119-126.
[2] Agashe, C.D. (1991). A psycho-social study of the Mental Health of players and non-players Ph.D., Phy Edu., Ravishankar University. In Fifth Survey of Educational Research (1988-92). New Delhi, N.C.E.R.T.
[3] Bartwal, R.S. (2014). To Study The Mental Health Of Senior Secondary Students In Relation To Their Social Intelligence IOSR Journal Of Humanities And Social Science (IOSR-JHSS) Volume 19(2). PP 06-10 e-ISSN: 2279-0837, p-ISSN: 2279-0845.
[4] Das, S.K., Halder, U.K., and Mishra, B. (2014). A study on academic anxiety and academic achievement on secondary level school students. Indian Streams Research Journal, Vol. IV, Issue. VI.
[5] Dholakiya and Jansari. (2005). A study of mental health of the students residing in affected and non-affected earth quake area and gender. Gujarat Journal of Psychology, Vol.No.15.
[6] Dube and Bhatnagar. (2006). Mental health of adolescents with specific reference to “Integration of personality” (IP), Gujarat Journal of Psychology, Vol.No.18.
[7] Gupta, G. and Kumar, S. (2010). Mental Health in Relation to Emotional Intelligence and self-Efficacy among College Students. Journal of the Indian Academy of Applied Psychology, Vol. 36(1), Pp. 61-67.
[8] Kumari, Neelam (2013). Academic anxiety and achievement of secondary school students -a study on gender differences, International Journal of Behavioral Social and Movement Sciences, Vol.02, Issue 01.
[9] Mohanty, S. (1992). The Occupational Stress and Mental Health in executives: a Comparative study of the public and private Sectors. Ph.D., Psy., Utkal University. In Fifth Survey of Educational Research. (1988-92). New Delhi, N.C.E.R.T.
[10] Ojha and Rani. (2004). A comparative study of the level of life stress and various dimensions of mental health among working and non-working Indian women, Journal of Community Guidance and Research, Vol.21 No.3
[11] Sharma and Pandey (2017) Anxiety, Depression, and Stress in Relation to Academic Achievement among Higher Secondary School Students The International Journal of Indian Psychology ISSN 2348-5396 (e) | ISSN: 2349-3429 (p) Volume 4, Issue 2, No. 87, DIP: 18.01.051/20170402 ISBN: 978-1-365-71287-6
[12] Sharma and Sarin (2016) The relationship among Academic Stress, Anxiety, Remedial Measures Adopted and Its Satisfaction among Medical Students: A Systematic Review. International Journal of Health Sciences and Research
[13] Sibnath Deb, Esben Strodl, Jiandong Sun (2015)Academic Stress, Parental Pressure, Anxiety and Mental Health among Indian High School Students, International Journal of Psychology and Behavioral Sciences, Vol. 5 No. 1, 2015, pp. 26-34. doi: 10.5923/j.ijpbs.20150501.04.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareFulvestrant Efficacy in Artificial Menopausal Hormone Receptor Positive and Human Epidermal Growth Factor Receptor 2 Negative Metastatic Breast Cancer Patients under 50 Years Old
English3136Caglayan GeredeliEnglish Nurgul YasarEnglishIntroduction: This study investigated the efficacy of fulvestrant in premenopausal patients with metastatic breast cancer who developed artificial menopause using a luteinizing hormone releasing hormone analogue.
Methods: This retrospective study was conducted at the Istanbul Okmeydani Education and Research Hospital.
Results: A total of 37 patients were evaluated, with a median age of 39 years old (range 27–49) and a median follow-up time of 20.2 months (0–78). Of these patients, 86.5% had invasive ductal carcinoma, 5.4% had invasive lobular carcinoma. Bone metastasis was found in 83.8% of the patients, lung metastasis in 21.6%, lymph node metastasis in 16.2%, liver metastasis in 13.5%, and brain metastasis in 5.4%. The progression-free survival (PFS) was a median of 12 months after starting the fulvestrant. The PFS was relatively shorter in those with brain metastases, but there was no statistically significant difference. The median PFS
was 12 months in 2 series and 8 months in 3 and later series, which was statistically significant (p=0.025). The overall survival (OS) was a median of 77 months; it was 86% at 12 months, 63% at 36 months, and 56% at 60 months. The median OS of the 2nd line was 20 months. No grade 3-4 toxic effects were observed.
Conclusion: As in naturally postmenopausal patients, fulvestrant was found to be effective and tolerable in patients treated with artificial menopausal hormone receptor-positive metastatic breast cancer under the age of 50. The fulvestrant was more effective in those who did not previously receive hormonal therapy.
EnglishMetastatic breast cancer, Premenopausal, FulvestrantIntroduction
Endocrine therapy is the preferred form of treatment for hormone receptor (HR) positive early stage and advanced stage breast cancer.(1-3) Endocrine therapy agents that are not cross-resistant to sequential administration prolong the chemotherapy-free period, and they have limited toxicity-effective disease stabilization.(4) Tamoxifen has been the backbone of endocrine therapy for the last 30–40 years(1). In metastatic disease, the response rate has increased to 30% with the use of tamoxifen (1-3). Tamoxifen and its metabolites are linked to the estrogen receptor (ER), and this receptor modulation can cause antagonistic effects, such as estrogenic effects (4). Another group of drugs used in endocrine therapy includes aromatase inhibitors (AIs). In randomized clinical trials, AIs were superior to tamoxifen in the treatment of postmenopausal women (1,3). Fulvestrant, another drug used in endocrine therapy, is an ER antagonist that degrades and blocks ERs (5,6). This causes a decrease in the cellular levels of both ERs and progesterone receptors (PRs) (7, 8). In phase 3 randomized trials, fulvestrant was found to be as effective as anastrozole in postmenopausal women who had previously received endocrine therapy, and it was well tolerated (9, 10).
Fulvestrant can be used in combination with luteinizing hormone-releasing hormone(LHRH) analogues in the anti-estrogenic premenopausal period, although it is indicated in postmenopausal women for advanced disease treatment(7,8). In premenopausal women, the use of aromatase inhibition is ineffective without over-function suppression, which leads to high estrogen levels(9,11). Therefore, premenopausal women need to undergo artificial menopausal treatment by either surgical menopause or medication(9,11). LHRH agonists are as effective in reducing estrogen levels as a surgical oophorectomy(11). Moreover, combining tamoxifen with LHRH agonists is better than over-ablation alone (12). For this reason, tamoxifen in combination with LHRH analogues, aromatase inhibitors, and fulvestrant can be used for premenopausal women in cases of endocrine-responsive metastatic breast cancer(12). The clinical benefit rate of using anastrozole in combination with an LHRH agonist in HR positive metastatic breast cancer was approximately 70% (13).In addition, fulvestrant was found to be as effective as an AI in women with premenopausal metastatic breast cancer who had suppressed hormonal activity (14-16). A median progression-free survival (PFS) of 6 months and median overall survival (OS) of 32 months were found in patients who had previously received endocrine treatment in small-scale studies with an LHRH analogue plus 250 mg of fulvestrant (16). A subgroup analysis of the PALOMA-3 trial found a median PFS of 5.6 months with LHRH plus fulvestrant in patients with premenopausal HR positive metastatic breast cancer who had previously received endocrine therapy (17).
In this retrospective study, we investigated the efficacy and tolerability of fulvestrant in Turkish patients with artificial menopause-enhanced HR positive premenopausal metastatic breast cancer using an LHRH analogue.
Materials and Methods
This was a retrospective single center study conducted at the Istanbul Okmeydani Education and Research Hospital. The medical information was obtained from the archived files of patients with HR positive and HER2 negative metastatic breast cancer treated in the medical oncology clinic. Those patients using fulvestrant who developed metastasis while taking tamoxifen in the adjuvant period, those who were under 50 years old, and those with artificial menopause using an LHRH analogue in the premenopausal period were included in this research. On the basis of the information obtained from the patient files, the LHRH was used analogously, 3.6 mg of goserelin acetate was used every 28 days, and 500 mg of fulvestrant was administered intramuscularly every 28 days (500 mg loading after 14 days from the first dose). The PFS and OS durations were calculated using the date when starting the LHRH analogue and fulvestrant treatment, date of progression, and the date of the last visit from the patient files. The study was approved byLocal Ethics Committee.
Statistical Methods
The Statistical Package for the Social Sciences (SPSS) version 15.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. The comparisons of the ratios in the groups were made using a chi-squared analysis. The Monte Carlo simulation was applied when the conditions were not met. The survival analyses were performed with a Kaplan Meier analysis. The statistical significance level of alpha was accepted as p Englishhttp://ijcrr.com/abstract.php?article_id=2459http://ijcrr.com/article_html.php?did=24591. Bonneterre J, Buzdar A, Nabholtz JM, Robertson JF, Thürlimann B, von Euler M, et al. Anastrozole is superiortotamoxifen as first-line therapy in hormone receptor positive advanced beast carcinoma. Cancer 2001;92:2247–58.
2. Bajetta E, Procopio G, Ferrari L, Martinetti A, Zilembo N, Catena L, et al. A randomized multicenter prospective trial assessing long acting release octreotidepamoateplus tamoxifen as a first line therapy for advanced breastcarcinoma. Cancer 2002;94:299–304.
3. Paridaens R, Dirix L, Lohrisch C, Beex L, Nooij M, Cameron D, et al. Mature results of a randomized phase II multicenter study of exemestane versus tamoxifen as first-line hormone therapy for postmenopausal women with metastatic breast cancer. AnnOncol 2003;14:1391–8.
4. Dutertre M, Smith CL. Molecular mechanisms of selective estrogen receptor modulator (SERM) action. J Pharmacol Exp Ther 2000;295:431–7.
5.Wakeling AE, Dukes M, Bowler J. A potent specific püre antiestrogen with clinical potential. CancerRes1991;51:3867–73.
6.Fisher B, Jeong JH, Dignam J, Anderson S, Mamounas E, Wickerham D, et al. Findings from recent National Surgical Adjuvant Breast and Bowel Project adjuvant studies in stage I breastcancer. J Natl Cancer Inst Monogr 2001;30:62–6.
7.Howell A, Osborne CK, Morris C, Wakeling AE. ICI 182,780 (Faslodex): development of a novel, ‘pure’ antiestrogen. Cancer 2000;89:817–25.
8.Robertson JF, Nicholson RI, Bundred NJ, Anderson E, Rayter Z, Dowsett M, et al. Comparison of the short-term biological effects of 7alpha-[9-(4,4,5,5,5- pentafluoropentylsulfinyl)-nonyl]estra-1,3,5, (10)-triene- 3,17 beta-diol (Faslodex) versus tamoxifen in postmenopausal women with primary breast cancer. Cancer Res 2001;61:6739–46.
9.Howell A, Robertson JF, Quaresma Albano J, Aschermannova A, Mauriac L, Kleeberg UR, et al. Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 2002;20:3396–403.
10. Osborne CK, Pippen J, Jones SE, Parker LM, Ellis M, Come S, et al. Double-blind, randomized trial comparing the efficacy and tolerability of fulvestrantversus anastrozole in postmenopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial. J Clin Oncol 2002;20:3386–95.
11.Taylor CW, Green S, Dalton WS, Martino S, Rector D, Ingle JN, et al. Multicenter randomized clinical trial of goserelinversus surgical ovariectomy in premenopausal patients with receptor-positive metastatic breast cancer: an intergroup study. J Clin Oncol 1998;16:994–9.
12.Klijn JG, Blamey RW, Boccardo F, Tominaga T, Duchateau L. Combined hormone agents trial ists’ group and the european organization for research and treatment of cancer. Combined tamoxifen and luteinizing hormone-releasing hormoneagonists versus LHRH agonist alone in premenopausal advanced breast cancer: a meta-analysis of four randomized trials. J Clin Oncol 2001;19:343–53.
13.Cheung KL, Agrawal A, Folkerd E, Dowsett M, Robertson JF, Winterbottom L., et al. Suppression of ovarianfunction in combinationwith an aromatase inhibitor as treatment for advanced breast cancer in pre-menopausal women. Eur J Cancer 2010;46:2936–42.
14.Robertson JF, Semiglazov V, Nemsadze G, Dzagnidze G, Janjalia M, Nicholson RI, et al. Effects of fulvestrant 250mg in premenopausal women with oestrogen receptor- positiveprimarybreastcancer. Eur J Cancer 2007;43:64–70.
15. O.E. Young, L. Renshaw, E.J. Macaskill, S. White, D. Faratian, J.St.J. Thomas, J.M. Dixon. Effects of fulvestrant 750 mg in premenopausal women with oestrogen-receptor-positive primary breast cancer. Eur J Cancer 2008. 391-399
16.Bartsch R, Bago-Horvath Z, Berghoff A, DeVries C, Pluschnig U, DubskyP,et al.Ovarian function suppression and fulvestrant as endocrinetherapy in premenopausal women with metastatic breast cancer. Eur J Cancer 2012.1932-1938.
17-Loibl S, Turner NC, Ro J, Cristofanilli M, Iwata H, Im SA, et al. Palbociclib Combined with fulvestrant in premenopausal women with advanced breast cancer and prior progression on endocrinetherapy: PALOMA-3 Results. The Oncologist 2017;22:1028–1038
18-Ellis MJ, Llombart-Cussac A, Feltl D, Dewar JA, Jasiówka M, Hewson N, et al. Fulvestrant 500 mg versus Anastrozole 1 mg for the first-line treatment of advanced breast cancer: Overall survival analysis from the phase II F?rst Study. J Clin Oncol 2015.
19-Robertson JFR, Bondarenko IM, Trishkina E, Dvorkin M, Panasci L, Manikhas A, et al. Fulvestrant 500 mg versusanastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): An international randomised double-blind phase 3 trial. Lancet 2016; 388: 2997–3005
20-Bergh J, Jönsson PE, Lidbrink EK, Trudeau M, Eiermann W, Brattström D, et al.FACT: An open-label randomized phase ??? study of fulvestrant and anastrozole in combination compared with anastrozole alone as first-line therapy for patients with receptor-positive postmenopausal breast cancer. J Clin Oncol 2012.
21- Iwata H, Im SA, Masuda N, Im YH, Inoue K, Rai Y,etal.PALOMA-3: Phase III Trial of fulvestrant with or without palbociclib in premenopausal and postmenopausal women with hormone receptor–positive, human epidermal growth factor receptor 2–negative metastatic breast cancer that progressed on prior endocrine therapy—Safety and Efficacy in Asian Patients. J Glob Oncol 2017.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareEffect of Duration of Diabetes on Heart Rate Variability in Type 2 Diabetes Mellitus
English3742Amina Sultan ZaidiEnglish P. N. SinghEnglish Meenakshi GuptaEnglish Sheelu Shafiq SiddiqiEnglishIntroduction: Diabetes is a metabolic disorder with debilitating complications which affects several million people worldwide. Cardiac Autonomic Neuropathy (CAN) is the most common chronic complication of type 2 diabetes mellitus (T2DM), which is concealed for long period of disease. Heart rate variability (HRV) test is the simple and sensitive test for CAN. Diagnosing CAN at subclinical stage and knowing the correlation of HRV with duration of diabetes can help to prevent the morbidity and mortality because of this neuropathy.
Objective: This study aims to determine the correlation of HRV with duration of diabetes in type 2 diabetes mellitus.
Materials and Methods: This cross sectional study was conducted in Department of Physiology, in collaboration with Rajeev Gandhi Centre for Diabetes and Endocrinology on patients of T2DM attending Diabetes clinic in Jawaharlal Nehru Medical college hospital (JNMCH), AMU, Aligarh, from 2014 to 2016 after approval from the ethical committee of J. N. Medical College. Total 90 subjects were taken, among whom 60 subjects were diagnosed cases of T2DM, which were divided in two groups on the basis of duration of diabetes. Rest 30 subjects were non diabetic control group. For CAN heart rate variability test was done.
Statistical analysis was performed using SPSS version 21.0.
Results: In shorter duration Diabetes (3.31 ± 1.72 years T2DM), significant (p valueEnglishCardiac Autonomic Neuropathy, Chronic hyperglycemia, Low frequency power, High frequency powerINTRODUCTION:
Diabetes Mellitus (DM) is a metabolic disease characterized by hyperglycemia which results from defects in insulin secretion, insulin action or both. [1]. Diabetes is a debilitating disease which affects several million people worldwide. With a national DM prevalence of 8.6% and 668,468,800 numbers of people with DM, India stands second to China in relation to the burden of DM [2].
Patient with diabetes are at much higher risk for development of both microvascular and macrovascular complications, including peripheral neuropathy, nephropathy, retinopathy, and cardiovascular disease [3].
Autonomic nerve damage can be found in many diabetics often without accompanying symptoms. Cardiac autonomic neuropathy (CAN) is observed to be the most commonly seen diabetic complications and yet it is the most ignored one as well. CAN is now generally recognized as an independent risk factor for cardio-vascular diseases [4], [5]. The high mortality rate seen in diabetic patients is largely attributable to cardiac arrhythmias, silent myocardial ischemia, perioperative cardiovascular, and cardiorespiratory instability [6]. So, early diagnosis of cardiac autonomic neuropathy is required to prevent the debilitating complications. Heart rate variability test is one of the significant sensitive and early predictor of cardiac autonomic neuropathy, and which can be used for early deduction of complications among diabetes mellitus patients. It has been suggested that CAN diagnosis may be used for cardiovascular risk stratification in patients with and without established cardiovascular disease, as a marker for patients requiring more intensive pharmacotherapeutic and life-style management of co morbid conditions [7].
So this study was undertaken to study the effect of duration of diabetes on heart rate variability parameters in type 2 diabetes mellitus patients.
MATERIAL AND METHOD:
The present study was conducted in Rajeev Gandhi Centre for Diabetes and Endocrinology and Department of Physiology on patients of Type 2 Diabetes Mellitus (T2DM) attending Diabetes clinic in Jawaharlal Nehru Medical College & Hospital, AMU, Aligarh, from November 2014 to May 2016 after approval from the ethical committee of J. N. Medical College. Design of the study was cross sectional and total 90 subjects were taken. Out of these 90 subjects 60 were selected as cases for further study who met the inclusion and exclusion criteria and gave the valid consent in writing after explaining the procedure to the subject prior to entering for further investigations. A detailed history and physical examination was carried out for every subject who entered the study as per a pre-designed proforma. Selected cases of T2DM patients between age 30 to 69 years were assessed for diabetic cardiac autonomic neuropathy through heart rate variability test and were asked to report endocrinology laboratory after an overnight fasting of 10-12 hours in fasting state. Blood samples were collected in EDTA-Na vials for estimation of HbA1C Fluoride vials for plasma glucose, in plain vials for serum lipids and lipoproteins and serum creatinine. Blood for fasting and post prandial glucose estimation were collected on the same day.
All diabetic patients were divided in two groups based on duration of T2DM.
Group A1 (n=30) with less than 8 years
Group A2 (n= 30) with equal to or more than 8 years.
The findings were also compared with group of 30age, sex and BMI matched control group (Group A) who were free from diabetes mellitus, hypertension, coronary artery disease or any other illness which could hamper with the test results. The inclusion criteria of T2DM patients for this study were patients aged 30 - 69 years diagnosed with Diabetes on the basis of revised American Diabetic Association Criteria i.e. fasting plasma glucose 126 mg/dl (≥6.1 mmol/1) and 2 hours postprandial plasma glucose ≥ 200 mg/dl ( ≥1 1.1 mmol/1) [8]. The exclusion criteria of these patients were previous history of cardiac arrhythmia, hypertension. heart block, clinical coronary artery disease, and presence of thyroid disease (hypo or hyperthyroidism).
Heart rate variability was analysed with a PHYSIO-PAC SOFTWARE SYSTEM (Medicaid systems, Chandigarh 160002, India).Two –lead electrocardiographic data were recorded for 5 minutes and were downloaded to the HRV software analyser. Time domain analysis was done by Fast Fourier transformation. In the time domain we measured the root mean square of successive R-R interval differences (RMSSD) and the percentage of beats with a consecutive R-R interval difference >50ms (pNN50). In the frequency domain we measured high frequency power (HF), low frequency power (LF) and the LF/HF ratio.
STATISTICAL ANALYSIS
Analysis was performed using SPSS version 21.0 statistical package for windows (SPSS, Chicago, IL). Continuous variables were expressed as mean ± Standard Deviation (S.D) or range, and qualitative data was expressed in percentages. One way ANOVA with Post Hoc Tukey test were used for comparison of means between three groups. The association between continuous variables was tested by linear correlation using Pearson’s coefficient. All tests were two tailed, confidence intervals were calculated at 95% level and a p-value of Englishhttp://ijcrr.com/abstract.php?article_id=2460http://ijcrr.com/article_html.php?did=2460[1]Fauci, A S, Braunwald E, Kasper D L, Hauser S L, Longo Dan L, Jameson J Larry (2008). Harrison's Principle of Internal Medicine 17 Edition.
[2] International Diabetes Federation. IDF diabetes atlas. 6th Brussels: International Diabetes Federation, 2013.
[3] Fauci, A S, Braunwald E, Kasper D L, Hauser S L, Longo Dan L, Jameson J Larry (2008). Harrison's Principle of Internal Medicine 17 Edition
[4] A. I. Vinik, R. E. Maser, B. D. Mitchell, and R. Freeman, “Diabetic autonomic neuropathy‚“ Diabetes Care, vol. 26, no. 5, pp. 1553–1579, 2003.
[5] R. E. Maser and M. J. Lenhard,‚“Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment,”Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 10, pp. 5896–5903, 2005
[6] R. E. Maser, B. D. Mitchell, A. I. Vinik, and R. Freeman, “The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes a meta-analysis,” Diabetes Care, vol. 26, no. 6, pp. 1895–1901, 2003
[7] S. Tesfaye, A. J. M. Boulton, P. J. Dyck et al., “Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments,” Diabetes Care, vol. 33, no. 12, pp. 2285–2293, 2010.
[8]. American Diabetes Association, Diabetes Care 2015 Jan; 38 (Supplement 1); S8-S16
[9]. Kahn CR. Banting Lecture. Insulin action, diabetogenes, and the cause of type II diabetes. Diabetes 1994. Aug?43(8):10661084.
[10]. Robertson RP. Antagonist: diabetes and insulin resistance-philosophy, science, and the multiplier hypothesis. J Lab Clin Med 1995. May?125(5):560564, discussion 565.
[11] Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology: Heart rate variability: standards of measurements, physiological interpretation and clinical use. Circulation 1996; 93:1043–1065,
[12]. Acharya R, Hegde BM, Bhat PS, Rao A and Niranjan UC; Heart rate variability: a review. Med BiolEngComput.2006 Dec;44(12):1031-51. Epub 2006 Nov 17.
[1]]. Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science.1981;213:220-222
[14]. Singh JP, Larson MG, O'Donnell CJ, Wilson PF, Tsuji H, LloydJones
DM, et al. Association of hyperglycemia with reduced heart rate variability: The Framingham Heart Study. Am J Cardiol 2000?86:30912.
[15]. Kudat H, Akkaya V, Sozen AB, Salman S, Demirel S, Ozcan M, Atilgan D, Yilmaz MT, Guven O “Heart rate variability in diabetes patient” The Journal of International Medical Research 2006; 34: 291 – 296.
[16]. Spallone V, Bernardi L, Maiello MR, Cicconetti E, Ricordi L, Fratino P, Menzinger G Twenty-four-hour pattern of blood pressure and spectral analysis of heart rate variability in diabetic patients with various degrees of autonomic neuropathy. Comparison to standard cardiovascular tests; ClinSci(Lond). 1996; 91 Suppl: 1057.
[17] Neil HA, Thompson AV, John S, McCarthy ST, Mann JI. Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population. Diabetic medicine : a journal of the British Diabetic Association. 1989;6(1):20-4.
[18]Murata K, Sumida Y, Murashima S, Matsumura K, Takeda H, Nakagawa T, et al. A novel method for the assessment of autonomic neuropathy in type 2 diabetic patients: a comparative evaluation of 123I-MIBG myocardial scintigraphy and power spectral analysis of heart rate variability. Diabetic medicine: a journal of the British Diabetic Association. 1996; 13(3):266-72. Epub1996/03/01.doi: 10.1002/(SICI)1096-9136(199603)13:3 3.0.CO;2-4.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareSpectrum of Non-neoplastic Skin Lesions: A Histopathological Study based on Punch Biopsy
English4348Vivek KumarEnglish Hansa M. GoswamiEnglishIntroduction: Accurate diagnosis of skin is of utmost importance for management of different skin disorders presenting with the similar clinical signs and symptoms. Therefore to confirm the diagnosis and start treatment biopsy becomes inevitable and for obtaining diagnostic full-thickness skin specimens Punch biopsy is the primary method.
Aims & Objective: The present study was to analyse the incidence and age & sex distribution of dermatological disorders presenting to B.J. Medical College, Civil Hospital Ahmedabad (tertiary care centre), Gujarat and access their histopathological profile
Materials & Methods: This was a retrospective study carried out at the department of Pathology B.J. Medical College & Civil Hospital, Ahmedabad for a period of 1 year (1st January 2016 to 31st December 2016). With necessary clinical details obtained in a proforma, punch biopsy specimen is sent to the histopathology section for final diagnosis. Formalin fixed, paraffin embedded sections were prepared & slides were routinely stained with H & E and special stains applied wherever necessary. Data obtained was tabulated and analysed
Results: Total 232 cases were analysed. 21-30 years age group constituted 22% of the total cases. Male/Female ratio is 61/39. Hypopigmented patch/plaque was the most common clinical lesion (27%). Hansen’s disease was the most common histopathological diagnosis reported (30%) followed by vesiculobullous lesions (12%).
Conclusion: Punch biopsy is a very simple outdoor procedure and very useful for skin lesions. Hansen’s disease is still most common skin disease for which biopsy is done followed by vesiculobullous lesion. Tattoo induced granuloma is also a common lesion along with lichenoid lesion.
EnglishAccurate diagnosis, Punch biopsy, Non-neoplastic skin lesionsINTRODUCTION:
Several Studies conducted over a period of time have shown high prevalence of skin disorders in developing countries, the histopathological spectrum of which has been highly variable but the clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and a few others1. So the separation of each of these becomes important because the treatment and prognosis tends to be disease specific2. The punch biopsy is generally the most useful procedure as it is quick to perform convenient, and only produce a small wound. It create a full thickness sample of skin that allows the pathologist to get a good overview of epidermis, dermis and most of the time the subcutis also3. The aim of the present study was to classify the various skin disorders prevalent in the surrounding community and determine their demographic distribution.
AIMS & OBJECTIVES:
The present study was to analyse the incidence and age and sex distribution of dermatological disorders presenting to B.J. Medical College, Civil Hospital Ahmedabad (tertiary care centre), Gujarat and access their histopathological profile and also gives knowledge and understanding about usefulness of punch biopsy in skin lesion.
MATERIALS & METHODS:
This was a retrospective study carried out at the department of Pathology B.J. Medical College & Civil Hospital Ahmedabad for a period of 1year (1st January 2016 to 31st December 2016). Punch biopsy taken and necessary clinical details were obtained in a proforma, and sent to the histopathology section for final diagnosis. Formalin fixed, paraffin embedded sections were prepared & slides were routinely stained with H and E and special stains applied wherever necessary. Data obtained was tabulated and analysed.
Case selection and exclusion criteria:
Clinically diagnosed cases of non-neoplastic skin disorders were included.
Cases with tumorous histology were not included in our study.
Inadequate and autolysed skin biopsies were excluded from our study.
Punch biopsy technique4:
A. First we keep the punch biopsy instrument perpendicular to the surface of the lesion then we press it down into the lesion while it is rotated clockwise and anticlockwise, cutting down till the subcutaneous fat. After this the punch biopsy instrument is removed.
B. Then we gently lift the biopsy specimen with the help of needle to avoid crush artifact. At the level below the dermis we cut the specimen with help of a scissor. In case of small punch biopsy defects (2 to 3 mm) no need to suture it, but larger wounds (4 to 5 mm) must be closed to reduce healing time and scarring.
Punch biopsy can be kept from curling during fixation by placing them on a piece of file card prior to immersion. When the specimen is 0.3 mm or less in diameter, it is best processed into Paraffin in one piece. It may then be sampled at various levels in the block. It prevents loss of tissue during the facing up of the block and allows more adequate sampling.
Tissue processing5:
Paraffin embedding and block making, trimming, sectioning and staining.
Hematoxylin and Eosin Staining Procedure5:
Sections were dewaxed in 2 jars of Xylene, each for 2 min.
Slides were kept in 2 jars of absolute alcohol, each for 2 mins to remove xylene.
Put the slides for 1 min. in 90% alcohol
Put the slides for 1 min. in 70% alcohol
Rinsed in water.
Put the sections in Harris Hematoxylin for 7-10 min.
Wash in running water and the sections turn blue.
Then Sections were kept in 1% acid alcohol solution just for 5-10 sec.
Washed with the tap water for 5-6 mins.
Dipped in saturated solution of lithium carbonate till the section is completely blue.
Washing with the tap water for 5-6 mins.
Put the sections in 50% alcohol for 2 mins. Followed by 70% alcohol for 2 mins. And finally in 90% alcohol for 2 mins.
Then sections were kept in 1% Eosin Y for 60 seconds.
Rinsed for 2 min. in 95% alcohol 2 times each
Dehydrated with absolute alcohol for 2 mins. for 3 times.
3 changes in Xylene each for 2 mins. is done for clearing.
DPX. Mount.
Histopathological examination results of punch biopsy show the wide range of diagnosis even though the clinical features are similar in different patients. Total 232 cases were taken for a period of 1 year (1st January 2016 to 31st December 2016). Results show the male predominance with male to female ratio is 3/2. Patient with younger age group (< 40 years) are 59% with 22% of patients are between 21-30 years age group. With 30.6% of patients most common diagnosis in our study is Hansen's disease followed by vesicobullous lesions with 12.5% of cases. Within vesicobullous lesion pemphigus vulgaris is most common. Lichen planus consist of 8% of cases and Psoriasis consist of 3% of cases. Tattoo granuloma is also a major problem with 6% of total case studied. 5 cases of Histoid leprosy was also seen which is a rare form of Lepromatous Leprosy.
DISCUSSION:
This was a retrospective study carried out at the department of Pathology B.J. Medical College and Civil Hospital Ahmedabad for a period of 1year (1st January 2016 to 31st December 2016). In our study total 232 cases are analysed. 80 patients were analysed in the study by Rajasekhar et al6. 112 cases were analysed in the study by Singh et al.7. In the present study, 22% of the patients were in the age group of 21 to 30 years and 19.8% of the patients were in the age group of 31-40 years. 25% of the patients were in the age group of 21 to 30 years in the study by Yonus et al8. 23.75% of the patients were in the age group of 31 to 40 years in the study by Rajasekhar et al.
With 30.6% of patients most common diagnosis in our study is Hansen's disease followed by vesicobullous lesions with 12.5% of cases. In the study by Bharambhe et al.9 lichenoid lesions were most common (46.57%) followed by psoriasis (19.88%). Most common histopathological diagnosis was Psoriasis (42.5%)followed by Lichen planus in the study by Rajasekhar et al
CONCLUSION:
Histopathological spectrum of skin lesions have been highly variable but the clinical presentation shows very few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and a few others. Therefore for confirmation of diagnosis and initiation of treatment biopsy becomes inevitable in various skin disorders.
Punch biopsy is the basic technique for obtaining diagnostic full-thickness skin specimens and can be performed in OPD set up. It is very simple technique to learn and perform. Supervision is rarely needed after a physician has performed two or three procedures. when suture closure of the wound is performed only general surgical and suture-tying skills are required.
It is important to perform the skin biopsy at appropriate phase of the disease, from proper site, of proper thickness especially in cases of non infectious inflammatory dermatoses.
In diseases in which expected changes are quantitive rather than qualitative ( hyperkeratosis, acanthosis, increase in dermal thickness), the evaluation of these changes are best made by taking a punch biopsy also of clinically normal skin nearby, which represents the best possible control.
Hansen's disease is still most common skin disease for which biopsy is done followed by vesiculobullous lesion. Tattoo induced granuloma is also a common lesion along with lichenoid lesion.
ACKNOWLEDGEMENT:
I express my sense of deep gratitude towards my PG guide Dr. Hansa M Goswami Prof. and Head department of Pathology for her co-operation and help to prepare this paper for publication.
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=2461http://ijcrr.com/article_html.php?did=2461
Burns T, Breathnach S, Cox N, Griffiths C; Rook's Textbook of Dermatology. 2010.
Lever's histopathology of skin; Devid E Elder, Bernett Johnson Jr., Rosalle Elenltsas; 9th Edition
Rosai and Ackerman's Surgical pathology 10th edition
Brown JS. Minor surgery: a text and atlas. 3d ed. New York: Chapman and Hall, 1997
Bancroft JD, Stevens A; Theory and Practice of histological Techniques. 5th edition. Chruchill Livingstone, Edinburgh, 1990.
Reddy R, Krishna N. Histopathological spectrum of non-infectious erythematous, papulo-squamous lesions. Asian Pac J Health Sci. 2014;1(4S):28–34.
R. Singh, K. Bharathi, R. Bhat, C. Udaya Shankar. The Histopathological Profile Of Non-Neoplastic Dermatological Disorders With Special Reference To Granulomatous Lesions – Study At A Tertiary Care Centre In Pondicherry. Internet Scientific Publications/ Internet Journal of Pathology. Vol 13(3)
Younas M, Haque A. Spectrum of histopathological features in non-infectious erythematous and papulosquamous diseases. Int J Pathol. 2004;2(1):24–30.
D'Costa G, Bharambhe BM. Spectrum of NonInfectious Erythematous, Papular and Squamous lesions of the skin. Indian J Dermatol. 2010;55: 225-8.
Veldurthy VS, Shanmugam C, Sudhir N, Sirisha O, Motupalli CP, Rao N, Reddy SR, Rao N. Pathological study of non-neoplastic skin lesions by punch biopsy. Int J Res Med Sci 2015:;3(8):1985-8.
Neetu Goyal et al., Sch. J. App. Med. Sci., 2015; 3(1F):444-449
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareAn assessment of Knowledge of Prevention and Management of Rabiesin Second Year MBBS Students of American International Institute of Medical Sciences, Udaipur (Rajasthan)
English4952Abhilasha MaliEnglish Shiv Lal SolankiEnglishBackground: Rabies is a viral zoonotic disease and human infection usually occurs following transdermal bite or scratch by an infected animal. It is one of the most dangerous, fatal and completely preventable disease.
Objectives: The main objective of present research is to assess the knowledge regarding preventive measures, wound management of Rabies.
Methods: A cross sectional study conducted in November 2017 to December 2017. Data was collected by using questionnaire from undergraduate 150 students studying in second MBBS at AIIMS medical college, Udaipur (Rajasthan) India. Data was entered and analyzed using SPSS V.17. Descriptive statistics and chi-square test were applied. KAP score were calculated. pEnglishPost exposure prophylaxis, Infection, Zoonotic disease, FatalINTRODUCTION
Rabies is a viral zoonosis and human infection usually occurs following a transdermal bite or scratch by infected animal.1 The clinical signs in dogs include sudden behavioral changes, hyper salivation, paralysis, hydro and photophobia, restlessness, aggressiveness and biting inanimate objects.2 Rabies causes about 26,000 to 55,000 deaths worldwide per year, more than 95% of which occur in Asia and Africa.3 Every year, more than 15 million people worldwide receive a post?exposure vaccination to prevent the Rabies .We have to prevent hundreds of thousands of rabies death annually.5 Still, rabies is the 10th biggest cause of death due to infectious diseases worldwide.5
About 98% of the human rabies cases occur in developing countries that possess large number of dogs, many of which are stray. Rabies is 100% fatal diseasewhich can be prevented by timely and appropriate anti rabies prophylaxis. Earlier many studies have been done on medical studentshealth care veterinary personals and animal bite victims.6-9 The present study was under taken among second year MBBS students in AIIMS medical college, Udaipur.
Based on available evidence, a fair estimate of rabies burden in India is 2.74 rabies cases/100,000 populations annually.5 In India, the burden is unevenly distributed among different States.
Objectives
To assess the knowledge and preventive measures regarding rabies among second year MBBS medical students.
MATERIAL AND METHODS:
A cross-sectional study was conducted in November 2017 to December 2017 among 150 second year students of American International Institute of medical sciences, Udaipur (Rajasthan). There is no awareness of study about rabies and prevention among second year MBBS students so by considering 95% confidence interval sample size calculated is 150.
Data was collected once in a week, each week around 20-25 students were interviewed randomly, so by 8 weeks end total sample size we have got is 150. Data was collected using a semi structured, pre-designed interview method. The method consisted of questions regarding knowledge, attitude and practice of animal bite and rabies.Proper verbal consent was taken before filling out the questionnaire.
Data analysis was done in department of community medicine by using SPSS version 17. Percentages and chi square testwere applied to test association between categorical variables. KAP (knowledge, attitude and practice) scores were calculated as below
KAP scoring: 20 questions were asked for each participant regarding cause, sources and mode of transmissions, clinical features, pre-exposure prophylaxis and prevention practices and treatment measures of rabies which was resulted in a response of either, choose the correct answer (had got one mark) or wrong answer (had got zero mark) for each question. The mean scores were calculated for KAP.
The participants who had KAP score more than mean were considered as good and less than mean was considered as poor. Good knowledge was defined as those getting a score of 9 and above, poor knowledge as getting a score less than 9. The data show that majority of study participants were having poor KAP level.
RESULTS
From 150 study population 56 (37.33%) had good KAP whereas 94 (62.67%) had poor KAP about the prevention of Rabies and its treatment protocols.
Table-1
100% of the participants were familiar with the disease. In our study majority of the subjects 89.33% knew the mode of transmissions are bites, licks and scratches by infected animal.It was seen that 60% of the participants knew about other animal like bats, Jackets, pigs, mongoose, catsetc. as reservoirs. 93.33% were aware that infection was the cause ofRabies and 95.33% knew that rabies was transmitted from animal to human. 5.33% thought infection can spread by organ transplant and 83.33% could identify clinical feature of rabies in animal. 24.67% of the participants were not aware about clinical features of Rabies in humans. 38.67% of the participants correctly answered about the incubation period.
Table-2
36.67% of participants had proper knowledge about first aid after bite. Only 43.33% esponded for full course of vaccination. 66.67% were aware about anti rabies immune globulin whereas 43.33% had no idea about pre-exposure prophylaxis.
Table-3
It shows that 97.33% participants knew for immediate wash of wound of animal bite. 48.67%, 58%,84% of the participants correctly responded about antiseptic use, suturing and cauterization respectively.
Factors associated with preventive practice score towards rabies
Association between independent variables and KAP scores on rabies was assessed using Pearson's chi square. There was significantly association between Knowledge,attitude and practice score with sex (X2=4.853 pEnglishhttp://ijcrr.com/abstract.php?article_id=2462http://ijcrr.com/article_html.php?did=2462
WHO, 1992. Eighth report of the WHO Expert committee on rabies: Technical report. Available at http://onlinelibrary.wiley.com/doi/10.1111/j751-0813.1993.tb06098.x/abstract.
Fooks AR. Rabies the need for a ‘one medicine’ approach. Veterinary Record. 2006;161: 289-90.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859): 2095?128.
Rabies fact sheet. World Health Organization. Retrieved on 15.10.2014. Available at http: //www.who.int/mediacentre/factsheets/fs099/en/.
Baxter JM. One in a million or one in thousand. What is the morbidity of rabies in India? JOGH. 2012;2(1): 1?4.
Singh NK. Clinical knowledge and attitudesof clinicians toward rabies caused by animal bites. JEMDS.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241106EnglishN2018March28HealthcareFrom the desk of Editor-in-chief
English00Dr. Sachin B. IngleEnglishThis issue contains many articles, case reports of interest for the readers. It is not possible for me to cover all of them in my note, but I am sure that our young researchers and especially postgraduates would take the maximum benefit out of them. For a high IF, we need to have more of good quality original articles having high citation values. All senior members are urged to submit their prime research work and consider IJCRR as their first -choice journal. Further, suggestions of any type, especially related to any columns to be included, are most welcome.
EnglishColonoscopy, Histopathology, biopsyThis issue contains many articles, case reports of interest for the readers. It is not possible for me to cover all of them in my note, but I am sure that our young researchers and especially postgraduates would take the maximum benefit out of them. For a high IF, we need to have more of good quality original articles having high citation values. All senior members are urged to submit their prime research work and consider IJCRR as their first -choice journal. Further, suggestions of any type, especially related to any columns to be included, are most welcome. The colonoscopic biopsy is an efficient diagnostic tool for etiological diagnosis The article by S. Padma, R. Pramila emphasizes the challenges and problems in colonoscopy biopsies. The diagnostic algorithm for evaluation of colonic diseases would help the readers in their approach to diagnose problematic cases. The articles of this type will help postgraduates in their outlook to problematic cases. The nonneoplastic lesions of skin are rare with limited literature available regarding their diagnosis. Spectrum of Nonneoplastic Skin Lesions: A Histopathological Study based on Punch Biopsy by Vivek Kumar, Hansa M. Goswami is a useful study for pathological diagnosis of these lesions Breast carcinoma is on the rise, especially in India. The article “Fulvestrant Efficacy in Artificial Menopausal Hormone Receptor Positive and Human Epidermal Growth Factor Receptor 2 Negative Metastatic Breast Cancer Patients under 50 Years Old” by Caglayan Geredeli, Nurgul Yasar illustrated the innovative markers for future prospectus in the breast cancer.
Englishhttp://ijcrr.com/abstract.php?article_id=2463http://ijcrr.com/article_html.php?did=2463