Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411114EnglishN2019July23HealthcareCentral Corneal Thickness and Diabetes Mellitus - A Study of Correlation in Terms of Duration and Glycemic Control in North Indian Hilly Population English0105Shanti PandeyEnglish Vivekanand SatyawaliEnglish Dipti JoshiEnglish Govind Singh TitiyalEnglishIntroduction: Retinopathy is one of major micro vascular complication in long standing diabetes, but diabetic keratopathy has potential to decompensate following stress. The central corneal thickness is a sensitive indicator of health of cornea and may influence outcome in cataract, refractory surgeries and may lead to fallacy in Intraocular pressure measurement. Present study was cross sectional observational study, undertaken to determine the correlation between central corneal thickness (CCT), and diabetes control and duration in hilly north Indian patient. Material and Methods: This is a cross-sectional study conducted in the department of ophthalmology of a tertiary care centre in Kumaon region. 400 subjects from age group 40 to 80 years were studied. An ultrasound pachymeter was used to measure CCT. The subjects were divided into two groups, 200 of them were non-diabetic subjects, and 200 were diabetic patients. The collected data was transformed into variables, coded and entered in Microsoft Excel. Data was analysed and statistically evaluated using SPSS-PC-17 version. Results: The average central corneal thickness in diabetic patients was 527.01± 25.57 microns. The average central corneal thickness found in non-diabetic patients was 513.38 ± 27.01 microns. The statistically significant (pEnglishCentral Corneal Thickness, DiabetesIntroduction: Type II diabetes mellitus is a major public health concern in this modern day.[1]In the year 2000, India had 31.7 million diabetics and became the diabetic capital of the world, with the highest number of people with diabetes mellitus, followed by China with 20.8 million diabetics and the United States with 17.7 million diabetics, in the second and third places respectively.[1]Diabetes mellitus (DM) occurs when the pancreas is not able to produce enough insulin, or the body becomes resistant to insulin, or both, resulting in increased blood glucose levels. Although diabetic retinopathy is major concern and may lead to severe vision loss, keratopathy should also be kept in the mind in diabetics as diabetic cornea has higher potential to decompensate following stress. The central corneal thickness is a sensitive indicator of health of cornea and serves as an index for corneal hydration and metabolism. Measurement of CCT is essential to take decisions regarding cataract and refractive surgeries and avoiding fallacy during estimation of IOP in diabetics. There are functional changes in diabetic cornea as a result of increased central corneal thickness. There are two theories behind increased central corneal thickness, firstly in diabetics, sorbitol accumulation within corneal endothelial cells[2] and a decrease in Na+/K+ ATPase activity [3] induce dysfunction of the corneal endothelium cell layer leading to corneal hydration which translates to increased CCT measurements. Thus, corneal thickness indirectly indicates the functioning of the endothelial layer. Secondly, changes occur in corneal stroma in diabetics, which include structural alterations produced by collagen cross linking. Advanced glycation products accumulate in collagen proteins, resulting in the formation of covalent cross-linking bonds, and may lead to increased corneal thickening and biomechanical changes[4,5]Central corneal thickness is an important indicator of patency of corneal endothelium pump and can be objectively measured by variety of techniques like optical pachymetry, ultrasound pachymetry, confocal microscopy, ultrasound biomicroscopy, optical ray path analysis or scanning slit corneal topography and optical coherence tomography.[6] Ultrasound pachymetry is the current standard for corneal thickness measurement.[7]This study aimed to evaluate the effect of diabetes mellitus on corneal thickness (CCT) by comparing the CCT of diabetic and non-diabetic patients and association of CCT with duration of diabetes mellitus as well as serum level of HbA1c.              Subjects and Methods: Ethical clearance was obtained from the institutional ethical committee and a cross sectional study was designed in tertiary eye care centre. Two hundred diabetic patients (previously diagnosed by medical practitioners), whether on treatment or not, who gave consent were enrolled irrespective of level of blood sugar. Two hundred age matched controls (non diabetic by history and blood sugar level) were also enrolled. Informed consent was taken from all the participants in the study. After taking detailed history, complete routine anterior and posterior segment evaluation was done. The corneal thickness assessment was done for 400 eyes of 200 diabetic and 400 eyes of 200 non diabetic patients with the help of ultrasound pachymeter, in multiple reading single point mode by a single person between October 2016 to September 2018 at department of ophthalmology Government Medical College, Haldwani.  (1) Eyes with corneal pathologies like pterygium, corneal dystrophies  2) Any prior history of ocular surgeries 3) Active or any previous eye infection or inflammation 4) contact lens users Results: Four hundred patients included in this study were in age group of 40 to 80 year. Majority of the patients belonged to age group 51-60 years (33.75%) whereas the least common age group was 71 -80 years (9%). Mean Age of diabetic and non-diabetic patients was 58.23±9.77 years and 56.59±9.85 years respectively (Table 1) In non-diabetic group 99 (49.5%) were males and 101 (50.5%) were females with M: F ratio of 0.98. However, in diabetic group, 96 (48.0%) cases were males and 104 (52.0%) were females with M: F ratio of 0.91. Diabetic females had slightly higher preponderance 52.2%.  The mean CCT   in 400 eyes of 200 diabetic patients was 527.01µm with SD of 25.57, and in 400 eyes of 200 non- diabetics mean CCT was 513.38 µm with SD 27.09. Mean CCT was significantly higher in diabetics as compared to non- diabetics i.e. p value (Table 2 and Figure 1)   Maximum number of patients had diabetes for less than 5 year i.e. 95(47.5%), followed by patient who had diabetes >10 year i.e. 72 subjects (36.0 %) and least were patients who had diabetes between 5-10 years duration i.e. 33(16.5%). CCT tends to increase significantly with duration of diabetes (p value 10 year i.e. 542.92 µm, followed by 5-10-year duration i.e. 528.27 µm and least mean CCT was found among diabetics having duration less than 5 years i.e.514.19 µm.(Table 3 and Figure 2)   Table 4 depicts that diabetics having HbA1c more than 7% had higher mean CCT i.e. 540.01µm as compared to those having HbA1c upto 7% had mean CCT of 522.46µm. It was significant with p value10 years and HbA1c >7. In contrast Kenji Inoue et al [12] in Japan, compared the endothelial structure and thickness of the cornea in diabetic and non diabetic patients. They found no significant difference between CCT in the diabetic group to non -diabetic individuals. Corneal endothelial cell structure was damaged, but CCT was not increased in type II diabetic patients however, Allan Storr?Paulsen et al[13] establish that Type II diabetic subjects did not differ from the non?diabetic control subjects with regards to endothelial cell density, hexagonality or variation in CV, but showed a significant increase in CCT. Su et al.[14]also observed that among 3280 Malay adults aged 40 to 80 years, those with diabetes and hyperglycemia showed significantly thicker central corneas, which was independent of age and IOP levels Abdul ghani et al [15] in Sudanese population and Busted et al [16], reported similar results as present study. Central corneal thickness was observed higher in diabetic patient having duration more than 10 year that was 541±22.41µm as compared with diabetics having duration Englishhttp://ijcrr.com/abstract.php?article_id=2618http://ijcrr.com/article_html.php?did=2618 (1) Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. The Australas Med J. 2014;7(1):45.     (2) O'Donnell C, Efron N, Boulton A. J. M. A prospective study of contact lens wear in diabetes mellitus[J] Ophthalmic Physiol Opt. 2001;21:127–138. (3) Ziadi MZ, Moiroux P, D'Athis P, et al. Assessment of induced corneal hypoxia in diabetic patients[J] Cornea. 2002;21:453–457.  (4) Sady C, Khosrof S, Nagaraj R. Advanced Maillard reaction and crosslinking of corneal collagen in diabetes. BiochemBiophys Res Commun. 1995;214:793–797. (5)Kaji Y, Usui T, Oshika T, et al. Advanced glycation end products in diabetic corneas. Invest Ophthalmol Vis Sci. 2000;41:362–368. 18. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(suppl 1):S5–S10 (6)V Yaylali, SC Kaufman, HW Thompson, Corneal thickness measurement with orbscan topography system and ultrasonic pachymetry, J Cataract Refract Surg. 1997;23: 1345-50. (7) JJ Salz, SP Azen, J Berstein, P Caroline, RA Villasenor, DJ Schanzlin et al, Evaluation and comparison of sources of variability in the measurement of corneal thickness with ultrasonic pachymeter, Ophthal Surg. 1983;14:750-4. (8)Nangia V, Jonas JB, Sinha A et al. Central corneal thickness and its association with ocular and general parameters in Indians; The Central India Eye and Medical Study. ophthalmology. 2010;117:700-4.       (9)Sahin A, Bayer A, Ozge G, Mumcuoglu T. Corneal biomechanical changes in diabetes mellitus and their influence on intraocular pressure measurements. Investigative ophthalmology & visual science. 2009 Oct 1;50(10):4597-604.                                                                                                                      (10) Kumari R, Saha BC. Central Corneal Thickness and Diabetes–A Study of Correlation in Terms of Duration and Glycemic Control. world.;1:2. (11) Kaur P, Singh B, Bal BS, Kaur I, Brar V. Central Corneal Thickness in Type 2 Diabetic Patients And its Correlation with Duration, Hba1c Levels And Severity of Retinopathy. group (NPDR). 2016;47(569.4):15-04. (12) Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus.Japanese journal of ophthalmology. 2002 Jan 1;46(1):65-9. (13)Storr?Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Actaophthalmologica. 2014 Mar;92(2):158-60. (14) DH, Wong TY, Wong WL, Saw SM, Tan DT, Shen SY, Loon SC, Foster PJ, Aung T, Singapore Malay Eye Study Group. Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology. 2008 Jun 1;115(6):964-8.        (15).Abdulghani YS, Ali TO. Correlation between central corneal thickness and diabetes in sudanese patients. Natl J Med Res. 2013;3(4):309-11. (16) Busted N, Olsen T, Schmitz O. Clinical observations on the corneal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol. 1981;65(10):687-90.  (17) Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye. 2006 Mar;20(3):315 (18) Briggs S, Osuagwu UL, Al Harthi EM. Manifestations of type 2 diabetes in corneal endothelial cell density, corneal thickness and intraocular pressure.Journal of biomedical research. 2016 Jan;30(1):46  (19) Rio-Cristobal A , Martin R. Corneal assessment technologies: Current status. Surv Ophthalmol. 2014;59:599–614. PMID: 25223496, http://dx.doi.org /10.1016/j.survophthal.2014.05.001

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411114EnglishN2019July23Life SciencesSpatial Variation in Avifaunal Diversity from Various Green Spaces of Indore City, Madhya Pradesh English0615Priya GaurEnglish C. S. ShrivastavaEnglish S. GaherwalEnglishIndore city harbours a wide variety of birds. The objective of the present study was to assess the avian diversity and its spatial variation at four different locations of Indore city viz. Meghdoot Garden, Nehru Park, Lalbagh and Pipliyapala Regional Park. A yearly survey of avian fauna was carried out from January to December 2018 by adopting line transect and point count method.A total of 58 bird species belonging to 13 order and 34 families were recorded during the present study. The highest number of avian fauna was recorded in Pipliyapala Regional Park (58), followed by Lalbagh (41), then Meghdoot Garden(39) and the least number was 34 at Nehru Park. Order Passeriformes was found to be dominant in the study. Furthermore, family Columbidae was dominant having 8% contribution in Meghdoot Garden. Similarly, Muscicapidae was 12% in Nehru Park and Lalbagh each and family Muscicapidae was 10% dominant in Regional Park. This study highlights the need for conservation and importance of Green spaces in urban cities. EnglishAvian fauna, Meghdoot garden, Nehru park, Lalbagh, Pipliyapala Regional ParkINTRODUCTION Birds are significant element of global biodiversity [1]. There are about 1,314 species from Indian Subcontinent, out of which 450 species are reported from Central India [2]. In recent years, ornithologists have delved into various habitats and highlighted that birds are highly sensitive to obnoxious condition [3]. Estimation of avian diversity is an essential tool in assessment of ecological health (Qualitative and Quantitative) of an ecosystem [4]. Diseases, presence of predators and competition due to limited resources have led to decline in population of birds over the years [5]. Land use pattern have changed over the years; furthermore, urban cities have recreation parks and gardens which have succeeded in attracting good avifauna. [6]. Availability of different food resources makes it possible for birds to preferring different guilds and to choose variety of habitats. Proper maintenance of the garden and increase in plantation certainly would increase the number of birds in the near future [7]. Indore city consists of favorable environment for avian fauna to survive in this area and this city is also becoming green and clean day by day. The central idea of the proposed study is to find out the richness of avian fauna in green spaces of the urban city. The result of the present investigation is helpful in evaluating the spatial variation among all the four sites of Indore city. MATERIALS AND METHODS Study area: The study area of Indore city was divided into following zones based on the cardinal directions: Site - I: Meghdoot Garden It is one of the voluminous gardens in Vijay Nagar (Peripheryof Indore). Dominant trees in the place include Polyalthia longifolia, Ficus benghalensis var. krishnae, Mangifera indica and Ficus bengalensis. Site -II: Nehru Park It is the most crowded park of Indore city and is situated near main office of BSNL Indore. Polyalthia longifolia, Ficus religiosa, Ficus benghalensis var. krishnae, Mangifera indica, Sapodilla plum and Ficus bengalensis are few indigenous trees are present in the park. Site - III: Lal Bagh It is situated in the periphery of Indore city. It is maintained by the Archeological Department of the state. Trees present are perennial in nature and are exotic and indigenous both. Site - IV: Pipliyapala Regional Park It is also known as Atal Bihari Vajpayee Regional Park. It is developed by Indore Development Authority (IDA) and maintained by Nagar Nigam Indore. Trees like Callistemon citrinus, Annona squamosa and Butea monosperma are main attraction during spring season.   Study Period: The present study was conducted in one year (2018) and it was divided into following season. Winter season – (November to February) Summer season- (March to June) Rainy season- (July to October) Identifications of birds were done by the following books. Birds of the Indian Subcontinent by Richard Grimmett, Carol Inskipp and Tim In skipp [8]. A DSLR camera was used for photography birds at different locations.   Methods: The following two different methods were adopted for study Avifaunal Diversity. Method 1: Line Transect method While walking on a continuous pace, it is easier to locate and detect all the avian fauna around the transect line. It is possible to cover a large area in less time. This is better than adopting any other methods [9]. Method 2: Point Count Method This is the second method in which an observer sit or stand at a particular location of the study site and records all the birds seen around him/her by focusing on the bird call and keenly listening to every movement around him/her [9].   RESULTS Spatial Variation The result of spatial variation of birds of different study sites (Meghdoot Garden, Nehru Park, Lalbagh and Pipliyapala Regional Park) during January 2018 to December 2018 were represented in Table 1-4 and their graphical representation (family wise) is shown in Graph 1-4. Spatial variation of birds in Meghdoot Garden: In Meghdoot Garden total 39 species of avian fauna was recorded which belonged to 11 orders and 30 families. The observed species were represented in Table – 1. These species belongs to order Columbiformes, Cuculiformes, Pelecaniformes, Charadriiformes, Accipitriformes, Strigiformes, Bucerotiformes, Piciformes, Coraciiformes, Psittaciformes and Passeriformes.             The family wise percentage composition of these birds in Meghdoot Park was Columbidae (8%), Cuculidae (5%), Ardeidae (3%), Charadriidae (3%), Accipitridae (5%), Strigidae (3%), Bucerotidae (3%), Megalaimidae (3%), Meropidae (3%), Alcedinidae (3%), Psittaculidae (5%), Campephagidae (3%), Aegithinidae (3%),Dicruridae (3%), Rhipiduridae (3%), Corvidae (5%), Monarchidae (3%), Dicaeidae (3 %), Nectariniidae (3%),  Estrildidae (3%),  Passeridae (3%), Paridae (3%),  Cisticolidae  (3%), Hirundinidae (5%), Pycnonotidae (3%), Phylloscopidae( 3%),  Zosteropidae (3%), Leiothrichidae (3%), Sturnidae (5%) and Muscicapidae (5%). Spatial variation of birds in Nehru Park:                    In Nehru Park total 34 species of avian fauna was recorded which belonged to 12 orders and 26 families. The observed species were represented in Table – 2.             These species belongs to order Columbiformes, Caprimulgiformes, Cuculiformes, Pelecaniformes, Charadriiformes, Accipitriformes, Strigiformes, Bucerotiformes, Piciformes, Coraciiformes, Psittaciformes and Passeriformes.             The family wise percentage composition of these birds in Nehru Park was Columbidae (9%), Apodidae (3%), Cuculidae (3%), Ardeidae (3%), Charadriidae (3%), Accipitridae (6%), Strigidae (3%), Bucerotidae (3%), Megalaimidae (3%), Meropidae (3%), Alcedinidae (3%), Psittaculidae (3%), Oriolidae (3%),  Aegithinidae (3%), Dicruridae (3%), Rhipiduridae (3%), Corvidae (9%),  Dicaeidae (3 %), Nectariniidae (3%),  Passeridae (3%), Cisticolidae  (3%), Hirundinidae (3%), Pycnonotidae (3%), Leiothrichidae (3%), Sturnidae (3%) and Muscicapidae (12%). Spatial variation of birds in Lalbagh: In Lalbagh, total 41 species of avian fauna was recorded which belonged to 11 orders and 27 families. The observed species were represented in Table – 3. These species belongs to Order Columbiformes, Caprimulgiformes, Cuculiformes, Charadriiformes, Accipitriformes, Strigiformes, Bucerotiformes, Piciformes, Coraciiformes, Psittaciformes and Passeriformes.              The family wise percentage composition of these birds in Pipliyapala Regional Park was Columbidae (7%), Apodidae (2%), Cuculidae (5%), Charadriidae (2%), Accipitridae (5%), Strigidae (2%), Bucerotidae (2%), Megalaimidae (2%), Meropidae (2%), Alcedinidae (2%), Psittaculidae (2%), Campephagidae (5%), Oriolidae (2%), Aegithinidae (2%), Dicruridae (2%), Corvidae (7%), Nectariniidae (2%), Estrildidae (2%), Passeridae (2%), Motacillidae (2%), Cisticolidae (5%), Hirundinidae (5%), Pycnonotidae (2%), Zosteropidae (2%), Leiothrichidae (2%), Sturnidae (5%) and Muscicapidae (12%). Spatial variation of birds in Pipliyapala Regional Park:   In Pipliyapala Regional Park total 58 species of avian fauna was recorded which belonged to 13 orders and 34 families. The observed species were represented in Table – 4. These species belongs to Order Galliformes, Columbiformes, Caprimulgiformes, Cuculiformes, Pelecaniformes, Charadriiformes, Accipitriformes, Strigiformes, Bucerotiformes, Piciformes, Coraciiformes, Psittaciformes and Passeriformes.              The family wise percentage composition of these birds in Pipliyapala Regional Park was Phasianidae (2%), Columbidae (5%), Apodidae (2%), Cuculidae (5%), Ardeidae (3%), Charadriidae (2%), Accipitridae (7%), Strigidae (2%), Bucerotidae (2%), Megalaimidae (2%), Meropidae (2%), Alcedinidae (2%), Psittaculidae (5%), Campephagidae (3%), Oriolidae (2%), Aegithinidae (2%), Dicruridae (2%), Rhipiduridae (2%), Corvidae (5%), Monarchidae (2%), Dicaeidae (2%), Nectariniidae (3%), Estrildidae (2%), Passeridae (2%), Motacillidae (3%), Paridae (2%), Cisticolidae (3%), Hirundinidae (5%), Pycnonotidae (2%), Phylloscopidae (2%), Zosteropidae (2%), Leiothrichidae (2%), Sturnidae (3%) and Muscicapidae (10%). DISCUSSION A total of 58 bird species belonging to 13 order and 34 families were recorded during the present study. The highest number of avian fauna was recorded in Pipliyapala Regional Park with 58 bird species (Table – 4) followed by Lalbagh having 41 species (Table - 3), then at Meghdoot Garden (Table -1) having 39 bird species and least number of avian fauna recorded was 34 at Nehru Park (Table- 2).Species richness of 76 species of 13 order and 39 familieswere recorded in Ralamandal Wildlife Sanctuary[10] and 517 species were recorded in Madhya Pradesh and Chhattisgarh [11]. Family Columbidae was dominant having 8% contribution in Meghdoot Garden; Similarly, Muscicapidae was 12% in Nehru Park and Lalbagh which is also reported by several researchers [7, 12] and Muscicapidae was 10% in Regional Park [13]. Order Passeriformes was found dominant in our study with 23 species (58.9%) of the total richness in Meghdoot Park; 19 species having 55.8% contribution to the total fauna at Nehru Park; similarly, 26 species having 63.4% contribution in total avifaunal species in Lalbagh and35 species which is 60.3% of the total birds found in Pipliyapala Regional Park (Table1-4). Workers published a list of 32 species of Passeriformes [12]. Interestingly, Passeriformes dominance was concluded with 45 species [14] and68 species [15]in various study areas of the state. Thus, the results of present studycorroborate with above mentioned researchers. CONCLUSION The present study highlights the importance of green spaces in cities. These areas are species rich and require regular monitoring and development to increase its existing biodiversity. A total of 58 species belonging to 13 orders and 34 families were reported in all our study sites collectively and its spatial variation was estimated. This investigation was first ever study conducted at Meghdoot and Nehru Park. The present study will provide the baseline information in near future in terms of conservation, awareness and sustentation of avian diversity in Indore city. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. SOURCES OF FUNDING There is no funding agency for the above work. CONFLICT OF INTEREST There are no conflicts of interest to declare. Englishhttp://ijcrr.com/abstract.php?article_id=2619http://ijcrr.com/article_html.php?did=2619 Bamford A, Moore JL, Brooks T, Burgess N, Hansen LA: Conservation conflicts across Africa. Science 2001;291:2616-2619. Raju D, Ramachandran S:Photographic field guide Wildlife of Central India. 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