Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411115EnglishN2019August3HealthcareAwareness of Radiation Protection Among Trainee Dentists of Aurangabad, Maharashtra: A Questionnaire Based Study English0106Ashish Bhaskar ZopeEnglish Lata Madhukar KaleEnglish Sonia Kaur SodhiEnglish Vishwas Dattatratya KadamEnglish Aishwarya Madhukar KaleEnglishObjectives: The aim of this study was to test the interns for their understanding of the importance of radiology and its judicious use. Methods: The study was carried out with 16 pretested questions which were closed ended. The study was conducted among the trainee dentists who were pursuing internship. The duration of the study was 2 weeks. A total of 115 trainee dentists participated, 90 females and 25 males. The data obtained was fed into Microsoft Excel (Redmond WA). The statistical analysis was performed with SPSS Version 17 to check for statistical significance. Results: The results of the study are comprehensively presented in observation table and also in graph. Conclusions: Based on our study, it can be concluded that, the intern dentists have a satisfactory knowledge of radiation protection methods. However, in order to improve further, continuing education programmes, at regular intervals are necessary to keep them updated about radiation protection protocols. EnglishKey Words: Radiology, Safety, ExposureIntroduction: Dental Imaging is an integral part of clinical dentistry. As a result, radiographs are often referred to as the clinician's main diagnostic aid. However it carries a potential harm and the exposure to dental radiation should be minimized where practicable.[1] X-rays are a form of high-energy electromagnetic radiation. They can penetrate the human tissues. When X-rays strike matter such as a patient's tissues, the photons can completely be scattered with no loss of energy or can be absorbed with total loss of energy or scattered with some absorption and loss of energy or can be transmitted unchanged. The International Commission on Radiological Protection (ICRP) recommended that all patient exposure must be justified and kept as low as possible. So it is a mandatory to follow ALARA principle “As Low As Reasonably Achievable” during dentist routine work.[2,3] This principle was adopted to minimize radiation dose. In general, ALARA principle takes into consideration the justification for the radiological study and taking the imaging examination with the least amount of radiation that can produce radiographs of reasonable diagnostic quality. As a result radiographs should only be taken at the minimum dosage with reasonable information yield in as much as a safer method is not available.[4] Consequently operators of radiographic equipment should be thoroughly familiar with radiation safety practices and radiation regulations to protect themselves, their colleagues and the patients. The effects of x-rays are harmful to living tissues and it is sufficiently intense and detrimental to cause cancer, leukemia and genetic damage.[5,6] These biological effects can be divided into Deterministic and stochastic effects.[3] Deterministic effects are those effects in which the severity of the response is proportional to the dose. These effects occur in all people when the dose is large enough.[7] Stochastic effects are those for which the probability of occurrence of the change, rather than its severity, is dose dependent.[3] The stochastic effects thus lay the patient’s and the operating personals in a high risk zone as it does not have dose thresholds.[3] Thus, dental radiographs should be only prescribed for patients when the benefit of disease detection outweighs the risk of damage from X-rays.[8] Thus reducing the radiation dose should be an important consideration for dental professionals.[9] In order to reduce patient’s exposure to radiation, appropriate use of a lead apron, thyroid collar, right collimation and suitable technique are included in the practice of radiologic examination. Every radiographic exposure to the patient should be clinically justified and each exposure should be expected to give the benefit of a confirmed diagnosis.[10]                   This study focuses on the awareness level about radiation protection among trainee dentists. The aim of this study was to test the trainee dentists about their understanding of the importance of radiology and its judicious use. The study was carried out with 16 pretested questions which were closed ended.[12] Materials and Methods: A self formulated printed questionnaire consisting of 16 multiple choice questions was circulated among the trainee dentists and their responses were received. Only those dental students who were pursuing internship were included in this study. The duration of the study was 2 weeks. A total of 115 trainee dentists participated in the study of which 90 were females and 25 males. Statistical Methods: The data obtained was fed into Microsoft Excel (Redmond WA). The statistical analysis was performed with SPSS Version 17 to check for statistical significance. Results: The study was conducted among the trainee dentists who were pursuing internship. The duration of the study was 2 weeks. A total of 115 trainee dentists participated of which 90 were females and 25 males.  The results are comprehensively presented in observation table and also in graph. Discussion: Our study shows that 33.9% of the respondents, get exposed to radiation several times in a month, during clinical posting. 35.7% percent respondents feel that the importance of imaging in dentistry is high. When questioned about various methods to protect the patient from radiation exposure, majority (62.6%) responded as lead aprons, shields and time of exposure, which correlates with the study done in Chennai.[12] Our study reveals thyroid is the organ to be protected during radiologic exposure as responded by 53.9% of the participants, which correlates with the study done in Chennai.[12] 36.5% responded that, 6.0 REM/year, is maximum permissible dose for occupationally exposed persons, while, 33% responded 2.0rems/year as the maximum permissible dose for non-occupationally exposed persons. 40.9% respondents opined that the greatest risk of radiation induced thyroid cancers is above 30 years of age. 33% participants responded that, rectangular PID is best and another 33% participants responded that, round PID is best. 39.1%participants responded that E films cause 60% reduction in radiation as compared to D films. 40% participants responded that, 6 months is the minimum duration of exposure, for the usage of personnel monitoring device. For the question regarding the holding of film during exposure, 54.8% responded in the negative, which reduces unnecessary radiation exposure, which correlates with the study done in Vikarabad, Telangana, India.[11] When asked about the holding of radiographic tube during exposure, majority (62.6%) of the respondents of our study replied in the negative. 39.1% participants replied that radiographs can be taken for pregnant patients only after weighing risk benefit ratio. According to 46.1% participants, radiographs can be taken for a pregnant patients in 2nd trimester. It can be seen from the above histogram that, majority of the respondents (67.8%) of the study follow the position and distance rule and hence reduce their risk of radiation exposure significantly. 44.3% replied that X ray room can be made safe by lead walls and walls constructed of gypsum wallboard.  Analysis of subjective questions of our study (Question numbers 1, 2, 3, 11, 12 and 15) indicates fairly good understanding of radiation protection protocols. However, analyzing the response to objective questions (Question numbers 4, 5, 6, 7,8, 9, 10, 13, 14 and 16 of our study), only 293 correct responses were received against 1150 maximum possible, which indicates that level of awareness of radiation protection is fairly low among intern dentists. To help them in minimizing the exposure to the dental fraternity or patients with focus on welfare of the patients we emphasize continual education programs at regular intervals at institutional level and national level for strict observance of various radiographic protection guidelines.[11] Conclusion: Based on our study, it can be concluded that, the intern dentists have a satisfactory knowledge of radiation protection methods. However, in order to improve further, continuing education programmes, at regular intervals are necessary to keep them updated about radiation protection protocols. Acknowledgement: Authors are thankful for the skillful and generous support of Dr.AmrutaMadhukarBansode (M.D.S., O.M.R.) and Dr. Kapil Dhananjayrao Pawar (M.D.S., O.M.R.), (Sr. Lecturers, Department of Oral Medicine & Radiology; C.S.M.S.S. Dental College & Hospital; Kanchanwadi; Paithan Road; Aurangabad; Maharashtra). 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 financial / equipment support: None. Conflicts of interest                                 : Nil. Abbreviations: REM: Roentgen Equivalent Man. It is a measurement that correlates the dose of any radiation to the biological effect of that radiation. PID: Position Indicating Device.  It is a device to guide the direction of X ray beam during the exposure of dental radiographs. Annexure: Questionnaire: 1. How many times do you get exposed to radiation? A. several times in a day B. several times in a week C. several times in a month D. none of the above 2. In your opinion how important is imaging in dentistry? A. Low B. Moderate C. High D. Very high 3. Mark the various options to reduce radiation exposure to patient that you are aware of? A. lead aprons B. shields C. time of exposure D. all of the above 4. What is the most important organ that has to be protected during dental radiography? A. gonads B. thyroid C. skin D. bone marrow 5. What is the maximum permissible dose for occupationally exposed persons? A. 5.0 rems/year B. 6.0 rems/year C. 4.0rems/year D. 3.0 rems/year 6. What is the maximum permissible dose for non-occupationally exposed persons? A. 0.1 rem/year B. 1.0 rem/year C. 2.0 rems/year D. 0.2 rem/year 7. Greater risk of radiation induced thyroid cancers is seen in the age group of- A. Below 30 years B. Above 30 years C. Below 20 years D. Between 20 years and 30 years       8. Which is the best PID? A. Rectangular B. Round C. Either of the above D. Cannot say 9. I/O films of speed E reduce how much radiation as compared to D films? A. 50% B. 40% C. 60% D. 30% 10. What is the minimum duration of exposure for using personnel monitoring devices? A. 3 months B. 6 months C. 1 year D. 2 years 11. Do you hold the radiographic film during exposure? A. Yes B. No C. Sometimes D. Never 12. Do you hold the radiographic tube during exposure? A. yes B. no C. Sometimes D. Never 13. Can periapical radiographs be taken for a pregnant woman? A. Yes B. No C. Only after weighing risk benefit ratio D. Cannot say 14. Preferably in which trimester? A. First. B. Second. C. Third. D. Cannot say. 15. Do you follow the position and distance rule? A. Yes B. No C. Sometimes D. Never 16. What are the measures that have to be taken to make the X-ray room safe from exposure? A. Lead walls B. walls constructed of gypsum wallboard C. both D. none of the above Answer Key: 4-D; 5-A; 6-A; 7-A; 8-A; 9-A; 10-A; 13-C; 14-C; 16-C Englishhttp://ijcrr.com/abstract.php?article_id=2620http://ijcrr.com/article_html.php?did=26201. National Council for Radiation protection and Measurements (NCRP). Radiation protection in dentistry. Bethesda Md: National council for radiation protection and measurements; 2003. 2. ICRP. Recommendations of the ICRP. ICRP Publication 26. Ann ICRP, 1977; 1: 1-53. 3. White SC, Pharoah MJ. Chapter 2: Radiation biology in Oral Radiology Principles and Interpretation, Fifth edition. Mosby, St. Louis 2004, p. 25 – 46. 4. Freeman JP, Brand JW. Radiation doses of commonly used dental radiographic surveys. Oral Surg Oral Med Oral Pathol., 1994; 77: 285-9. 5. Royal College of Radiologists and National Radiological Protection Board. Patient dose reduction in diagnostic radiology. Document of the National Radiological Protection Board, 1990; 1(2). 6. Barr JH, Stephens RG. Radiological health, In Dental radiology, Pertinent basic Concepts and their Applications in Clinical Practice. Philadelphia, WB Saunders, 1980; p. 66 – 80. 7. Frommer HH. Biological effects of Radiation, In Radiology for Dental Auxillaries, 6th edition St. Louis, Mosby – year book, 1996; p. 49 – 67. 8. Haring JI, Lind LJ. Chapter 5: Radiation protection in Textbook of Dental Radiography Principles and Techniques. W.B. Saunders Company, 1996, p. 64 – 79. 9. Shahab S, Kavosi A, Nazarinia H, Mehralizadeh S, et al. Compliance of Iranian dentists with safety standards of oral radiology. Dentomaxillofac Radiol., 2012; 41:159-64. 10. Prabhat MP, Sudhakar S, Praveen B, Ramaraju K. Knowledge, attitude and perception(KAP) of dental undergraduates and interns on radiographic protection — A questionnaire based cross-sectional study. J Adv Oral Res., 2011; 2: 45-50. 11. Swapna et al.; BJMMR, 19(7): 1-7, 2017; Article no.BJMMR.30761 12. Tamizh Paavai .THA, Jayanth Kumar V. To Study Awareness About Radiation Protection Among Dental Students Of Chennai-A Questionnaire Based Study. Int J Pharm Bio Sci 2017 Jan ; 8(1): B 542-551

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411115EnglishN2019August3HealthcareA Randomized Trial to Compare Better Effect of Tai Chi Chuan or Pranayama in Improving Lung Function in Normal Individuals English1115Sharvari N. ChitnisEnglish Raziya NagarwalaEnglish Ashok ShyamEnglish Parag SanchetiEnglishObjectives: 1. To study the effect of tai chi on lung function 2. To study effect of pranayama on lung function 3. To compare the effects of tai chi chuan and pranayama on lung function. Methods: 60 healthy volunteers, males and females, aged 18-22 years were recruited for the study. Individuals were categorized into two groups by random allocation. Subjects who were doing any physical activity, practicing tai chi or pranayama, having preexisting history of musculoskeletal, neurological, cardiorespiratory disorders were excluded from the study. Pre assessment included-Chest expansion, Lung volumes- Forced Expiratory Volume1 (FEV1), Forced Vital Capacity (FVC), Forced Expiratory Volume1/Forced Vital Capacity (FEV1/FVC), Peak Expiratory Flow Rate (PEFR) and Maximal Voluntary Ventilation (MVV), HR and RR. Groups were trained to perform tai chi and pranayama for 6 weeks each. Post assessment was done after 6 weeks. Results: On statistical analysis, a significant change was seen in Forced Expiratory Volume1(FEV1), Forced Expiratory Volume1/Forced Vital Capacity (FEV1/FVC), Peak Expiratory Flow Rate (PEFR), and Maximal Voluntary Ventilation (MVV), chest expansion at all 3 levels in both groups after 6 weeks of intervention. No significant change was seen in FVC in both groups. There was no statistical significance seen between the two groups for lung function. Conclusion: Thus, it can be concluded that tai chi and pranayama can help in improving the lung function. As there is no statistical significance found between the two groups, both tai chi and pranayama seems to increase lung function effectively in young healthy individuals. EnglishTai chi chuan, Pranayama, Lung functionIntroduction- Tai chi chuan is a branch of Chinese martial arts which is focused on mind tranquility and its goal to achieve longevity through meditation and lifestyle modification. [1] Tai chi recognizes the interdependence of mind, body and spirit. It includes gentle exercises which bring balance and harmony and allows the ‘chi’ to flow. ‘Chi’ is understood as ‘life force’ and it’s the free flowing movement of chi throughout the body which is essential for a healthy life. Tai chi comprises of slow and gentle movements which can help in relaxation and helps the individual to function at its optimum level. [2] Tai chi is an ancient Chinese exercise which consists of slow and relaxed movements which helps in total self-development. [3] Tai chi is a low speed and low impact exercise. It includes graceful motions which are co-ordinated with diaphragmatic breathing to achieve mind tranquility. It is practiced in a semi-squat position and its exercise intensity can be adjusted by controlling the angle of knee. Tai chi chuan is beneficial to cardiorespiratory function, strength, endurance, flexibility, balance and motor control and psychosocial function and helps in prevention of falls in elderly.[4] Pranayama is the art of prolongation and control of breath. It helps in reshaping of breathing habits and patterns. [5]The inspiration of prana-vayu is Shwasa and expiration is prashwasa and cessation of both is characteristic of pranayama. The beneficial effects of different Pranayama are well reported and has sound scientific basis. [6-7]Yogic breathing or pranayama is part of all yoga’s and is the art of controlling the breath. [8] Pranayama incorporates a wide variety of practices which helps in improving the mental and physical health and as a deep breathing technique pranayama reduces dead space ventilation and decreases work of breathing. [9] Yoga practice consists of the five-principle including proper relaxation, proper exercise, proper breathing, proper diet, and positive thinking and meditation. Yoga consists of very slow, deep breaths with sustained breath hold after each inspiration and expiration. [10] Pranayama generally involves controlled breathing techniques affecting the respiratory rhythm, namely through prolongation and shortening of breaths, and sometimes breath-holding, all implying voluntary control of respiratory muscles. These voluntary acts influence the breathing pattern and it is normally determined by the autonomic respiratory control center in the brain. Thus, voluntary control of breathing (practiced for 6–10 weeks) induces persistent alteration of the breathing pattern at rest, shown in a reduced breathing frequency.[11] Pulmonary function tests [PFTs] are simple screening procedures and are performed using a standardized equipment (spirometer- Helios-401) to measure lung function. This study was designed to compare the effects of tai chi chuan and pranayama on lung function and to find out which method is more beneficial for the cardiorespiratory system. Methodology The study protocol was approved by the institutional ethical committee. The study was explained to the subjects and a written consent was obtained from each individual. The subjects were recruited based on the following criteria; Inclusion criteria- individuals aged between 18-22 years(mean age of tai chi-20.1±1.63, mean age of pranayama-18.4±0.50), both males and females. Exclusion criteria- Individuals already performing any kind of physical activity, those who were having any musculoskeletal, neurological, cardiorespiratory conditions. Subjects were categorized into two groups by random allocation using the paper chits with the words ‘group-1’ and ‘group-2’ respectively. Group -1 included the subjects who were performing tai chi chuan and Group-2 included the subjects who were performing pranayama. Pre assessment of all the volunteers was done. Pre assessment included lung function measurement using spirometer helios-401, chest expansion, pulse rate, respiratory rate. Chest expansion was measured using a standard tape at three levels. (Axilla, nipple and xiphisternum) Lung function measurement included forced expiratory volume (FEV1), forced vital capacity (FVC), FEV1/FVC, maximal voluntary ventilation (MVV), peak expiratory flow rate (PEFR). Vitals like pulse rate (PR) and respiratory rate (RR) were measured. Intervention- Subjects were trained to perform tai chi chuan and pranayama for 6 weeks respectively. Group 1(tai chi chuan group) performed tai chi for 30 minutes, 3 days a week for 6 weeks.[12] It included a warm up, shibashi which comprised of 14 manuvers and brocades which had 8 manuvers. Tai chi was performed along with a particular music which was soothing and helped the subjects to concentrate and perform tai chi more efficiently. Group 2(pranayama) performed 5 forms of pranayama- anulom vilom, omkara, bhramari, bhastrika, kapal bhati for 20 minutes per day, 3 days a week for 6 weeks.[15] Post assessment of all the parameters was done after 6 weeks of intervention. Results Statistical analysis was done using Microsoft Excel and statistical package for social sciences- version 16. Statistical analysis of pre and post assessment of both the groups individually was done using paired-t test. Statistical analysis for between the tai chi and pranayama group was done using an unpaired-t test. P-value of ≤0.05 was considered to be statistically significant. A significant change was seen in FEV1, FEV1/FVC, MVV, PEFR and chest expansion at all the three levels in tai chi chuan and pranayama group respectively. (p value0.05) [Table-1, 2] There was no significant change seen when both the groups were compared. (p value>0.05) [Table-3] Discussion- In the present study, it is evident that, there is a significant improvement in FEV1, FEV1/FVC, MVV, PEFR, chest expansion at all the 3 levels after 6 weeks of tai chi chuan and pranayama. Exercise training plays a major role in every individual’s life. Habitual physical activity may increase functional ability and thus enhance capacity for independence in various activities of daily life. [12] Tai chi chuan is a martial art which has recently been used for health benefits. When performing tai chi, abdominal and thoracic respiration co-ordinates to improve respiratory movement. Abdominal respiration can increase the intensity of diaphragm relaxation and shrinkage so as to enlarge the amplitude of its elevation and decline and constantly change the abdominal and thoracic pressure. Thus respiratory organs can get adequate blood supply and the pulmonary ventilation function can be improved. [13] During breathing, when a person breaths in, the lungs expand and there is less space in the body. So on breathe in, the venous blood is gently squeezed out. As the individual breathe out, the lung contract increasing the space and as there is vacuum which gets created the lungs expand and fresh arterial blood enters. [2] Tai chi demands for proper regular breathing pattern. Deep breathing enhances the expansion of the lungs and thus improves circulation and functioning. Ultimately it results in improving lung function. [2] Studies done by Qing-Hua Song et. al, Chin Lan MD et. al, Guohua Zheng et. al, suggested that tai chi chuan can be used as form of aerobic exercise which can improve lung function. In pranayama as there is deep breathing, airway resistance is reduced and there is increase in alveolar ventilation. Due to this compliance of lung thoracic system also increases. Thus, forceful exhalation becomes more efficient as deep and slow inhalation and prolonged exhalation causes efficient use of intercostal muscles and diaphragm to get emptied and filled more completely and efficiently. [14] Strengthening of respiratory muscles occurs during pranayama, there is inflation and deflation occurring at chest and lungs because of which the muscles are made to work at its maximal extent. [15] There is release of lung surfactant and prostaglandins into alveolar spaces which increases lung compliance and decreases the bronchiolar smooth muscle tone. Thus it is responsible for change in FEV1, MVV and PEFR. Due to pranayama, there is increase in maximal shortening of inspiratory muscles which have been shown to improve lung function. [15] There was a significant change seen in FEV1 (p value= 0.017) and heart rate (p value=0.05) when both the groups were compared. (Table-3) There was a significant change seen in heart rate after 6 weeks of tai chi chuan, p value=0.03 (Table-1) Change in heart rate is seen as there is increased workload on heart which stimulates the heart to pump more efficiently. [2] There was also a significant change seen in respiratory rate after 6 weeks of pranayama, p value=0.001 (Table-2) Change in respiratory rate is seen as there is a modification seen in functioning of bulbopontine complex. Breathing is usually regulated by the bulbopontine respiratory control mechanism which is further modified by suprapontine mechanisms. These suprapontine messages promote the voluntary inhalation and exhalation. Due to pranayama the bulbopontine complex’s activity is modified in such a way that its rhythm is slowed down. It is done by voluntary prolongation of phase of inhalation and exhalation by stretching to their fullest. So the bulbopontine complex is adjusted to a new pattern of breathing which is slower than basal rhythm. [15] Thus tai chi targets the cardiovascular system in a much efficient way when compared to pranayama whereas pranayama helps in improving the respiratory function more efficiently when compared with tai chi chuan. Conclusion As mentioned in the results, there was significant change seen in tai chi chuan and pranayama group respectively. So, it can be concluded that, practicing tai chi chuan and pranayama help in improving the lung function.   Since there was no statistical significance found when both the groups were compared, both tai chi chuan and pranayama seems to improve lung function effectively in healthy individuals. Acknowledgements- I take this opportunity to thank Dr. Dhara Kapoor (PT), Dr. Rachana Dabadghav (PT) for their valuable guidance and constant support during the whole study. I would like to thank our principal Dr. Nilima Bedekar (PT) for their support and guidance. I extend my warm gratitude to all the subjects for their participation and co-operation during the study. We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Funding- Self-funded Conflict of interests- None Ethical approval- Approved. Englishhttp://ijcrr.com/abstract.php?article_id=2621http://ijcrr.com/article_html.php?did=26211. Ching L, Chen SY, Jin-Shin L, Wong AM. Tai Chi Chuan in Medicine and Health Promotion. Evidence-Based Complementary and Alternative Medicine. 2013. 2. Khor G. Tai chi qi gong: for stress control and relaxation. 1st edition. New Delhi: Kuldeepjain; 2008. 119-122; 124-125. 3. Kuramoto AM. Therapeutic benefits of Tai Chi exercise: research review. WMJ-MADISON-. 2006 Oct; 105(7):42. 4. Lan C, Lai JS, Chen SY. Tai chi chuan.Sports Medicine. 2002 Apr 1;32(4):217-24. 5. Ankad RB, Herur A, Patil S, Shashikala GV, Chinagudi S. Effect of short-term pranayama and meditation on cardiovascular functions in healthy individuals. Heart views: the official journal of the Gulf Heart Association. 2011 Apr;12(2):58. 6. Madanmohan Thombre DP, Balakumar B, Nambinarayan TK, Thakur S, Krishnamurthy M, Effect of yoga training on reaction time, respiratory endurance and muscle strength. Indian J. Physiol Pharmacol1992, 36(4):229-233. 7. Yadav RK, Das S, Effect of yogic practice on pulmonary functions in young females. Indian J. Physiol Pharmacol 2001 and2005; 45(4):493-6. 8. Katiyar SK, Bihari S. Role of pranayama in rehabilitation of COPD patients–a randomized controlled study. Indian J Allergy Asthma Immunol. 2006;20(2):98-104. 9. Dinesh T, Venkatesan R, Venkidusamy S. Effect of 12 weeks of pranayama training on basal physiological parameters in young, healthy volunteers. Panacea J Med Sci. 2014;4(1):28-30. 10. Chanavirut R, Khaidjapho K, Jaree P, Pongnaratorn P. Yoga exercise increases chest wall expansion and lung volumes in young healthy Thais. Thai J Physiol Sci. 2006 Apr;19(1):1-7. 11. Beutler E, Beltrami FG, Boutellier U, Spengler CM. Effect of regular yoga practice on respiratory regulation and exercise performance. PloS one. 2016 Apr 7;11(4):e0153159. 12. Lan C, Lai JS, Wong MK, Yu ML. Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners. Archives of Physical Medicine and Rehabilitation. 1996 Jun 1;77(6):612-6. 13. Song QH, Xu RM, Shen GQ, Zhang QH, Ma M, Zhao XP, Guo YH, Wang Y. Influence of Tai Chi exercise cycle on the senile respiratory and cardiovascular circulatory function. International Journal of Clinical and Experimental Medicine. 2014;7(3):770. 14.Panwar S, Chourishi A, Makwana J. Effect of pranayama (yoga) on pulmonary function test of young healthy students. Int J Pharma Bio Sci. 2012;3(4):12-6. 15. Joshi LN, Joshi VD, Gokhale LV. Effect of short term pranayam, practice of breathing rate, & ventilatory functions of lung. Indian J Physiol Phamscol; 1992; 36 (2): 105. 1992;108.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411115EnglishN2019August3HealthcareA Study to Assess the Effectiveness of Simulation on Neonatal Basic Life Support Among Nursing Students – A Narrative Review English0710Ms. Wichamjailiu RingkangmaiEnglish Mr. Siva N.EnglishIntroduction: Neonatal period is characterized by transition to extra uterine life and rapid growth and development. Newborn period, just first 28 days of life, carries the greatest risk of mortality. Despite being less than 2% of total period of under 5 children, the newborn period accounts for over half of under 5 child mortality. Good care therefore not only improves survival of children but lays foundation of optimal log term physical and neurocogitive development. Aim: The aim of the study is to assess the effectiveness of simulation on neonatal BLS( basic life support) among selected colleges of nursing in Greater Noida , UP. The findings of the study can help the teacher to gain knowledge regarding the effectiveness of simulation on neonatal BLS( basic life support). Methodology: Intervention: Simulation of Neonatal BLS( basic life support). Types of studies: True Experimental study. Types of participants: Nursing students Setting: Selected colleges of Greater Noida, UP. Results: This narrative review result has proved that simulation of neonatal BLS( basic life support) has increased in terms of knowledge and skills among nursing students. EnglishSimulation of neonatal BLS (basic life support), Nursing studentsINTRODUCTION Neonatal asphyxia accounts for the major neonatal mortality rate which is a great hindrance in the country health status therefore it is essential for the health team members to have the required knowledge regarding the neonatal BLS (basic life support) . Newborn health is the key to child health and survival. In India, neonatal death account for 56% of under 5 and 69% of infant death. First week deaths alone account for 45% of total under 5 deaths. Preterm complications accounts for 35% of all neonatal death and constitutes the most important cause of neonatal mortality. Causes of mortality are birth asphyxia, congenital malformation and sepsis. Almost three forth of all neonatal death occurs among the low birth weight newborn. Of all the neonatal deaths, about 40% occur within 72 hours and three fourths within one week of birth. Health of the mother and child during pregnancy and childbirth has a profound influence on neonatal outcome. Of the 25 million infants born every year in India, 3-5 % experience asphyxia at birth. Asphyxia is characterized by a progressive hypoxia, hypercapnia, hypo perfusion and acidosis. When an infant is deprived of oxygen an initial brief period of rapid breathing occurs, if the asphyxia continues, the respiratory movements cease and the infants enters into  a period of apnoea known as primary apnoea.             Neonatal deaths are a major hindrance for the improvement of survival of  children in developing countries. An estimated 4 million babies die in the neonatal period yearly and approximately all of these deaths occur in developing and underdeveloped countries. The need for information on neonatal deaths is increasing because of an increase in the percentage of mortality with a current report of about 40% of global under-five mortality occurs in the neonatal period. World Health Organization defined birth asphyxia as the failure to initiate and sustain breathing at birth.  Every newborn should be considered at a high risk of birth asphyxia since most cases of asphyxia cannot be predicted.  Although neonatal death is multifactorial, the most important single causes of neonatal deaths are preterm birth, birth asphyxia, sepsis and pneumonia. An experimental study was conducted at SRM (Sri Ramaswamy Memorial) College of nursing. The students were explained about the nature and purpose of the study and a written consent was obtained from the participants prior to their recruitment in the study. 25 students for interventional group and 25 students for control group sample were randomly selected for this study. Firstly pretest knowledge was assessed from control and interventional group with the help of multiple choice questions on Neonatal BLS (basic life support) were done and it was collected back after 15 minutes. Simulation teaching was given to interventional group only. On the 7th day pos ttest was taken for both the groups and skill was checked for both the group through OSCE (objective structured clinical examination). Then data was collected for analysis. By using student’s unpaired t test statistically no significant difference was found in pretest knowledge score in between control and interventional group ( t=1.21 , p- value=0.56) and statistically significant difference is found in post test knowledge score between control and experimental group (t=15.37, p value=0.000). Hence it was concluded that the simulation teaching increase the post test knowledge score and psychomotor score of nursing students and simulation teaching is more effective for nursing students. Archana Maurya , (2016) A quasi experimental study was conducted at Rufaida College of Nursing New Delhi. Data was collected after obtaining formal permission from principal of Rufaida College of nursing, Jamia Hamdard University New Delhi. The sample of 24 students nurses studying GNM nursing 3rd year were selected by total enumerative sampling technique. Data was collected by self-introduction for establishment of rapport with students, provision of conductive environment for data collection; the samples were screened based on inclusion and exclusion criteria, taking informed consent from the participants for the research study. The mean pre test knowledge scores of control group were higher than the mean pre test knowledge scores of experimental group with a mean difference of 0.35.  The mean post test knowledge scores of experimental group was higher than the mean post test knowledge scores of control group with a mean difference of (16.1). Therefore it was concluded that the training program on PBLS( paediatric basic life support) on 2015 AHA( American heart association) guidelines is more effective in enhancing the knowledge and practice of 3rd year GNM nursing students regarding PBLS( pediatric basic life support). (Swati Sharma (2017) Another quasi experimental study was conducted at college of nursing Sultan Qaboos University. This study was to evaluate the effectiveness of simulation in critical care nursing among students in a public university. A single quasi experimental design was used to evaluate the effectiveness of simulation compared to videos and high fidelity simulation. A convenient sample of 100 students in the critical care nursing course was selected in the year 2015-2016. Standardized simulation instruments were used to measure the knowledge and performance and ANOVA and t test was used to analyze the findings. Mean overall satisfaction was higher among students exposed to high fidelity students than those students with video. Hence the study confirms that the overall satisfaction and self confidence was higher among the students exposed to high fidelity simulation students compared to the students exposed with video learning. ( Melba Sheila D’souza 2017) Experimental research study was conducted at Afyonkarahisar city of Turkey health training school. This study aimed to detect the overall evaluation of nursing students towards simulation throughout the practice education and to reveal their learning styles in relation to certain individual features. The study included 3rd yr nursing students in nursing department in Afyonkarahisar city of Turkey. An instructor demonstrated the practice steps by doing with a group of 10-12 students each week after theoretical lesson by means of utilizing simulation in the related topics. The questionnaire was administered to the students. According to the results 70.9% of the participants stated that laboratory setting along with simulation was suitable for education. (Yasemi Celik (2015) A cross sectional study was conducted in private medical college Mangalore, Karnataka India. This study was conducted to explore the perception of medical students towards simulation-based learning (SBL). A total of 247 participants from fourth, sixth, eighth semester and internship were chosen by convenience sampling method. Attitudinal data on perception towards simulation-based learning were collected using a self-administered questionnaire with responses in a 5-point Likert's scale.  The mean age of students was 21.3 (standard deviation 1.9) years, and males constituted 55.5% (137/247). Most participants 72.5% (179/247) had favourable perceptions of simulation based learning , with scores of 92-118 out of a possible 118 points. Favourable perception towards simulation based learning was seen significantly more among female students (P = 0.04) and senior MBBS students of sixth and eighth semesters (P = 0.05). Nearly, all students (90.7%; 224/247) agreed that simulation supports the development of clinical skills. As many as 29.6% (73/247) agreed that real patients might be replaced with simulated patients in practical examinations. Hence it was concluded that simulation based learning was perceived as favourable by a large number of participants in this study indicating a bright prospect for its implementation in the medical curriculum. (S Jindal 2013) MATERIAL AND METHOD: RESULTS The systematic search was conducted by formulating the terms separately and in integration with all synonyms, also according to the database. Likewise, a manual Google scholar search was undertaken using the keywords and search synonyms from already articles. An addition of 6 articles was found in the database. Initial search recovers 1270 articles over which 180 articles were selected manually. 100articles were rejected as a result of replication in the database. Replication was removed and reviewed 80 articles for acceptability. 74 more studies were rejected because of unreachable of the full text. Hence 6 articles were screened which includes quantitative study. DISCUSSION These findings are supported by a study conducted by Archana Maurya an experimental study conducted. An experimental study was conducted at SRM (Sri Ramaswamy Memorial) college of nursing.  The students were explained about the nature and purpose of the study and a written consent was obtained from the participants prior to their recruitment in the study. 25 students for interventional group and 25 students for control group sample were randomly selected for this study. Firstly pre-test knowledge was assessed to the control and interventional group with the help of multiple choice questions on Neonatal BLS were done and it was collected back after 15 minutes. Simulation teaching was given to interventional group only. On the 7th day post-test was taken for both the groups and skill was checked for both the group through OSCE (objective structured clinical examination). Then data was collected for analysis. By using student’s unpaired t test statistically no significant difference was found in pre-test knowledge score in between control and interventional group ( t=1.21 , p- value=0.56) and statistically significant difference is found in post-test knowledge score between control and experimental group( t=15.37, p value=0.000). Hence it was concluded that the simulation teaching increase the post-test knowledge score and psychomotor score of nursing students and simulation teaching is more effective for nursing students. CONCLUSION There was a significant increase in knowledge and skills related to simulation of neonatal BLS( basic life support) among the nursing students. Therefore the method of teaching by the means of simulation must be initiated in the academic and hospital setting for the health care professionals. SOURSE OF FUNDING: Self-funding Conflict of Interest: Nil ETHICAL CLEARANCE: Prior permission was obtained from the Dean of school of nursing sciences and research , Sharda university Permission was also obtained from the university ethical committee Informed written consent was taken from each participant under the study. Objective of the study was maintained with honesty, privacy confidentiality and anonymity. ACKNOWLEDGEMENT We would like to thank the authors whose works  have cited and included in this study such as Archana Maurya, Swati Sharma, Melba Sheila D’ souza, Yasemi Celik, AL Kadi AS Donnon T ,S Jindal and N Srivastava. We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We 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=2622http://ijcrr.com/article_html.php?did=2622 Archana Maurya(2016). A study to assess the effectiveness of simulation teaching of neonatal BLS among nursing students. International Journal of Science and Research volume 4 issue 1 page no 2319-3462 Swati Sharma, Smriti Arora, Urmila Bhardwaj(2017) A quasi experimental study to assess the effectiveness of training programme on knowledge and practice regarding pediatric Basic life support based on 2015 AHA guidelines among student nurses in a selected college of nursing, in Delhi, India. International Journal of Current Research  volume 9 issue 05 page no 44935-49939 Melba Sheila D’ souza, Ramesh Venkatesaperumal(2017). A study to evaluate the effectiveness of simulation in critical care nursing among students in a public university. Pubmed volume 6 issue 3 page no 2864-3056 Yasemi Celik, Yesim and Ceylantekin and Ibrahim Kiliv (2015). A study to detect the overall evaluation of nursing students towards simulation throughout the practice education. Journal of Nursing and Allied Health Science, volume 9 issue 7 page no 1862-174 AL Kadi AS Donnon T (2013). A study to assess the effectiveness of laparoscopic simulators on medical students. Journal of Medical Science and Clinical Research volume 4 issue 2 page no 2893-2898 S Jindal and N Srivastava (2013). A study to assess the perception of medical students in simulation based learning. Journal of Medical Science and Clinical Research. Volume 12 issue 8 page no 1864-1872

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411115EnglishN2019August3HealthcareA Study on the Anatomical Variations in Diaphyseal Nutrient Foramina of Humerus and its Clinical Implications English1622Chintala Durga SukumarEnglishAim: The study is aimed to determine number, location and direction of nutrient foramen, to assess whether nutrient foramen obeys rule of ossification, that is directed away from the growing end of the bone or not. Methodology: The study constituted n = 122 (68 right, 54 left) humeri collected from the Department of Anatomy, Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India. All the measurements were taken using standard anthropometric techniques. Results: Number, direction and location of nutrient foramen in relation with surfaces and zones of humeri were determined. Majority 79.51% of the humeri had single nutrient foramen, 13.93% double, 3.28% triple, whereas 3.28% humeri no nutrient foramina. Majority 85.24% of the nutrient foramina were located on antero-medial surface, followed by 10.65% on posterior surface and 6.56% on anterolateral surface of shaft of the humerus. In majority 85.24% of bones foramina were present in zone II, followed by zone I (9.02%), then zone III (5.74%). All foramina were found to be directed towards the lower end of humeri. Conclusion: The results confirm that the knowledge of the number and position of the nutrient foramina in humerus would be very useful in providing clinical information in preventing intra-operative injury of nutrient artery during orthopedic surgeries and will be relevant as reference for surgical procedures. EnglishClinical implications, Foraminal index, Humerus, Nutrient foramenIntroduction Humerus is largest and longest bone of upper limb and is supplied by a nutrient artery which is a branch of brachial artery. The nutrient foramen is an opening on the surface bone into the shaft of humerus bone, passing through cortex, ultimately opens into the medullary cavity. The main nutrient foramina is usually located on antero-medial surface of the humerus a little below its midpoint directed downwards[1], opens close to medial border, although various variations have been reported in number and position of the fo­ramina[2]. Henderson[3] also reported that their location in mammalian bones are variable and may alter during the growth. Any manipulation in this area in the form of close or open reduction may cause damage to nutrient arteries, leading to non-union or delayed union The nutrient artery of the humerus arises from the brachial artery, enters the shaft divides into ascending and descending branches in the medul­lary cavity and supply bone marrow and inner two-thirds of cortex of the humerus [4]. The diaphyseal nutrient artery is the main source of blood supply to long bones, especially during active growth period and the early stages of ossification [2] and it should be preserved in order to promote the fracture healing [5]. Moreover, the presence of preserved nutrient blood supply is essential for the survival of osteocytes in cases of tumor resection, trauma, and congenital pseudoarthrosis [6]. Nutrient arteries play important role particularly during active growth period in the embryo and fetus, uniting callus formation in fractured bone [1]. The knowledge regarding the number and location of nutrient foramen helps the surgeon to avoid these complications during certain surgical procedures like bone grafting and microsurgical vascularized bone transplantation [7] and manipulation in the fracture of humerus [8,9]. Though studies on the vascularization of long bones of various populations were conducted, the nutrient foramina of humeri among Andhra Pradesh population was rarely studied. This study was aimed at analyzing diaphyseal nutrient foramina with reference to variation in number, location, position and direction of nutrient foramina of the humerus of Andhra Pradesh population. The aim of the present study was to determine any variations in number, direction and location of nutrient foramen in humerus of Andhra Pradesh population and see whether the nutrient foramina obey the general rule that is, directed away from the growing end of the bone. Materials and Methods The present study was conducted consisting of 122 (68 right and 54 left) dried and cleaned humeri collected from the Department of Anatomy, Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India. All the bones were of adults (>20 years) and of unknown sex. The size determination was done for the entire material collected. All the humeri taken for the study were normal and with any fracture or pathological abnormalities was excluded from the study. Prior approval was taken from the College Ethical Committee to conduct the study. In each humerus, the nutrient foramen was examined and studied carefully under proper illumination for number, location and direction of nutrient foramina on its diaphysis. A magnifying lens was used to observe the foramina.  Osteometric board with sliding caliper, magnifying lens, scale and alpin were used for measuring the required parameters. Nutrient foramina (NF) was identified by the presence of a well-marked groove leading to the foramen, and by a well-marked often slightly raised margins at the edge of the foramen at the commencement of the canal. Only well-defined foramina on the diaphysis were accepted. Foramina at the ends of the bones were ignored. Location of NF in relation with surface and borders were observed and recorded. Direction of NF in relation with growing end of humerus was observed and noted by inserting an alpin. Total length of each bone and distance from proximal end of bone to each NF was measured with the help of osteometric board and sliding caliper in millimeters. Total length of each humerus was taken as distance between superior aspect of the head and most distal aspect of the trochlea. All measurements were taken to the nearest 0.1mm using Vernier caliper [7]. Foraminal index was calculated which can help clinicians to locate the nutrient artery. The position of nutrient foramen in relation to zone was determined by calculating a Foraminal Index (FI) using the Hughes formula [10,11]:  FI= (DNF\TL) x 100 Where, DNF - distance from proximal end of the bone to nutrient foramina. TL - Total length of bone in millimeter. The position of foramina was divided into three zones as follows: Zone I: FI up to 33.33%, the foramen in proximal third of the bone. Zone II: FI from 33.33% to 66.66%, the foramen in middle third of bone. Zone III: FI above 66.66%, the foramen in distal third of bone. Statistical analysis All measurements were recorded separately for right and left sided humeri using measuring scale, thread and vernier calliper. All the collected data were represented as mean and then analyzed with MS Excel 2007 software. The numerical data was statistically analyzed by calculating the percentage, mean and SD. Results Number of foramina The data of the distribution of number of the nutrient foramina (NF) recorded in the selected humeri is presented in Table 1. Of the total n = 122 subjects selected for the present study, n=68 were of right sided humeri and n = 54 were left sided. The frequency of bone with single NF was present in n = 55 (80.88%) and n = 42 (77.78%) of right and left sided humeri respectively, two NF in n = 9 (13.24%) right and n = 8 (14.82%) left humeri and three NF in n = 2 (2.94%) right humeri and n = 2 (3.70%) in the left sided humeri whereas, no humeri had four NF. The NF was absent in n = 2 (2.94%) right humeri and n = 3 (3.70%) in left sided humeri. When the right and left sided humeri were analyzed separately, the frequency of variation in the number of NF was almost similar. The data in the table shows that number of NF in humeri was variable. Of the total n = 122 subjects, the percentage of bones having one NF is 79.51% (n = 97), two in 13.93% (n = 17) and three in 3.28% (n = 4) humeri and 3.28% (n = 4) were found with no foramina. Location of foramina The data of frequency of distribution of NF in respect to the surface of right (n = 68) and left (n = 54) sided humeri subjects studied is presented in Table 1.   In relation to surfaces, NF were located on antero-medial surface (AMS) in 82.36% (n = 56) in right sided humeri and 87.04% (n = 47) NF in left sided humeri, NF located on posterior surface (PS) was observed in 10.29% (n = 7) right sided humeri and 7.41% (n = 4) in left sided humeri and location of NF on the antero-lateral surface (ALS) was found in 7.35% (n = 5) and 5.55% (n = 3) in the right sided and left sided humeri respectively. Of the total n = 122 subjects, majority (82.79%) of NF were located on the AMS of the shaft of humeri, followed by 10.65% on posterior surface (PS) and then 6.56% ALS of the shaft of humeri (Fig. 1). Location of nutrient foramen in respect to zone The distribution of NF in respect to the Zone (Fig 2) of the shaft of humerus observed in the present study humeri subjects is shown in Table 1. The incidence of NF present in upper one-third or Zone I of humeral shaft was found in n = 6 (8.83%) right sided humeri whereas, in n = 5 (9.26%) left sided humeri. Majority of the bones n = 58 (85.29%) and n = 46 (85.19%) had NF located in the middle one-third or Zone II of right and left sided humeri respectively. In n = 4 (5.88%), NF were present in lower one-third or Zone III of right sided humeri and n = 3 (5.55%) in Zone III of the left sided humeri. The higher incidence of NF was recorded in n=104 (85.24%) in Zone II of the humeral shaft, followed by upper one-third or Zone I in n= 11 (9.02%) and least in lower one-third or zone III of n = 7 (5.74%). Direction of foramina In the present study, the direction of the NF showed no deviation from the normal anatomical feature even in a single case. It was observed that all n = 122 (100%) NF (Table 1) were directed distally downwards, towards the elbow joint or towards the lower end of humerus i.e. away from the growing end. The mean total length of the present study humerus bones and mean distance from proximal end of humerus to NF (right and left sided) and the Foraminal Index are presented in Table 2. The mean total length was found to be 269.32 mm in right and 268.17 mm in left sided humeri, the mean distance from proximal end of humeri to NF was 151.24 mm in right and 150.85 mm in left humeri and the Foraminal Index (FI) was recorded to be 53.46% for right humeri and 53.83% for left humeri. Therefore, mean and SD values of total mean length of humeral bones was 268.64±21.42 mm; and mean distance from proximal end of humeri to NF was 150.82 ± 16.46. The mean foraminal index was 54.25%. Discussion The knowledge of variations of NF will be helpful for orthopaedic surgeons to avoid causing damage to the nutrient artery during an open reduction to improve fracture healing [5]. Inspite of giving optimal treatment, some fractures either heal slowly or fail to heal [9] and may be related to the severity of the injury, poor blood supply, age and nutritional status of the patient or other factors [12,13]. The arterial supply is very important factor for effective healing of a fractured bone [9,14,15]. Number of foramina In the present study, majority (79.51%) humeri bones had single NF followed by double (13.93%) and then triple foramina in 3.28%, 3.28% humeri had no foramina similar to earlier reports [5,12,16]. Similar findings were observed by several authors. Forriol et al. [17] reported 75% bones had single foramina from a sample size 36 collected from Medical School of Alcala de Henares University, Yaseen et al. [18] 79% among 100 sample size and Ramya Sree et al. [19] 80% in Telangana region of sample size 218. In contrast, several studies reported humeri with single foramen in only 58% [20] in Indian population. Similar findings were reported with incidence of 60.87% [22] in Nepalese population, 61.29% [23] in Haryana population, 63% [24] incidence among Gujarati population. Whereas, many studies reported higher incidence of single NF compared to the present study results. Asharani and Ajay Ningaiah [26] in their study on Karnataka samples reported 87%, Kizilkanat et al.[2] reported in 88% bones, 88.5% by Peirere et al.[27] in Southern Brazil samples, 90% by Bhatnagar et al. [28] in Uttar Pradesh, India samples, 90% by Khan et al. [29], 90.62% by Rita Kumari and Renu Prasad [30], Laing [15] reported the incidence of single foramen in 93%, and Aashish and Sanjay [31] in 94.12% humeri. The present study, 13.91% humeri bones had double NF similar to the findings of Longia et al. [5], Kizilkanat et al. [2], with their occurrence 13%, 13.91% and 22% humeral bones respectively. Similar findings were also observed by Halagatti and Rangasubhe [32] in 17.5%, Ukoha et al. [25] in 18% humeri bones. The incidence of double NF was lesser in studies made by Bhatnagar et al. [28] in 7.14% and Solanke et al. [33] in only 4% bones. In contrast to the present study results, higher incidence of double NF was reported by Mysorekar [20] in 42%, Shaheen [21] in 33.3%, Joshi et al. [24] in 33%, Mansur et al [22] reported in 28.85%, Carroll [9] in 28.16% and Kumar et al. [34] in 26% shaft of humeri. Only few authors observed the presence of triple NF in accordance with the present study results recording triple NF in 3.28% humeral bones. Kizilkanat et al. [2] reported triple NF in 7% humerus. Nearly similar results were reported by Kizilikant et al. [2] reported 6.93% in Turkey, Shaheen [21] in 6.7% among Saudi Arabia samples, Mansur et al. [22] in 6.32% of Nepal samples. Whereas, the findings of Bhatnagar et al. [28] were in 1.42%, and Halagatti and Rangasubhe [32] in 2%, Yaseen et al. [18] in 2% comparatively lesser than the finding observed in the present study (3.28%). None of the humeri in our study had more than three NF while, Mysorekar [20] and Kizilkanat et al. [2] have observed humeri with even up to 4 NF. In the present study, absence of NF was observed in 3.28% subjects. The results are almost in agreement with results reported by Vijayalakshmi et al. [16], Malukar and Joshi [7], Kizilkanat et al. [2], Asharani and Ajay Ningaiah [26]. Ankana et al. [35] reported absence of NF in 5% humeri. A higher incidence of absence of the nutrient foramina (26% of humeri) was reported by Ukoha et al. [25] study on 150 humeri in Nigerian population. Absence of NF in long bones is well known. Location of nutrient foramen in respect to surface of humeri The NF is located a little below its midpoint on the AMS close the medial border of humeri. However, location of the foramina may vary in position.   In the present study, 82.79% of the NF is situated on AMS of the humeri almost in accordance with the observations of Halagatti and Rangasubhe [32] showing 87% and Yaseen et al. [18] 88.5%.   In contrast to our results, higher incidence of NF located on the AMS of the humeral shaft were reported by Khan et al. [29] studies on 96% humeri of Pakistan population, Vikram Singh et al. [23] in 89.92%, However, several authors reported lesser incidence of NF on the AMS of humeri. Gopalakrishna et al. [37] reported in 70.97%, Vinay et al. [38] in only 30.23%. These findings are supported by another study made by Chandrasekaran and Shanthi [12].   In the present study, majority (82.79%) of the NF were located on AMS of the humeral shaft, followed by PS (10.65%) and later ALS (5.55%), in accordance with results of Yaseen et al. [18] showing 11% and 3.5% on the PS  and ALS respectively. In addition, the percentage of location of NF was recorded in 8.53% on PS and 1.55% on ALS, 2.67% on the PS and 1.33% on the ALS by Khan et al.[29] and Vikram Singh et al.[23] respectively. This finding is supported by the observations of NF located on the PS by Ukoha et al. [25] in humeri of Nigerian population with the incidence of 7.5% and Gopalakrishna et al. [37] 8.06%. However, a study conducted by Anusha and Naidu [39] reported higher incidence (19%) of the presence of NF on PS than the present study results. Similarly, Forriol et al. [17] reported 15.55% of foramina in Spanish population and Kizilikant et al. [2] (18.1%) in Turkish population comparatively higher than the present study results. Location of foramina in respect to zone of humeri In the present study, majority of NF (85.24%) were found to be located on zone II (the middle one-third) of the shaft of humeri and are in correlation with the studies conducted by Halagatti and Rangasubhe [32] who reported the incidence in 84%, Aashish and Sanjay [18] in 86.11%, Asharani and Ajay Ningaiah [26] in 87% of NF in the middle one-third of the shaft of humeri. Several authors in their studies reported high incidence of NF in zone II (middle one-third) of the shaft of the humeri similar to the present study results. Khan et al. [29] reported 96.20% in Pakistan cadavers, Mansur et al. [22] in 94.84%. While, Ukoha et al. [25] found 100% incidence in the humeri of Nigerian population, similar trend was recorded by Kumar et al. [34] with 100% incidence in Indian population which was much higher than the present study results. In the present study, in 9.02% bones the NF were found to be located in zone I and 5.74% in zone III of the humeral shaft. Asharani and Ajay Ningaiah [26] observed 11% in zone II and none of them were located in Zone I Yaseen et al. [18]. Asharani and Ajay Ningaiah[26] reported NF were located in 22% in Zone I and 2% in the Zone III. Direction of foramina In the present study, the direction of the NF showed no deviation from the normal anatomical feature even in a single case. It was also observed that all NF were directed distally downwards, away from the growing end. Several studies were conducted to observe the direction of NF in humerus to determine whether it follows the law of ossification or not. The data in the present study, showed that the direction of all the NF of humeri was directed towards the lower end of humeri supported by many studies (Halagatti and Rangasubhe [32], Khan et al. [29], Gopalakrishna et al. [37], Kumar et al. [34] which revealed that the direction of NF were constant and obeys the law of ossiossification. Foraminal Index In the present study, the mean total length of right and left sided humeri showed negligible variation recording 269.32 mm and 268.17 mm respectively (Table 2). Solanke, et al. [33] reported the mean length of right sided humeri as 28.53±1.78 cm and left sided humeri as 28.89 ±1.75cm. Mansur et al. [22] in their study on 253 adult humeri observed that the mean length of right side humeri as 27.05 cm and left sided as 26.99 cm, with foramen index 55.18%. In the present study, the mean total length and standard deviation and the distance from proximal end of the NF (mm) was observed to be 268.64 ± 21.42 and 150.82 ± 16.46 respectively and the Forminal Index 54.25%. Pereira et al. [27] reported mean foraminal index as 55.2% and Pramar et al. [42] also reported as 55.2% in accordance with the present study results. Ukoha et al. [25] recorded mean foraminal index of humeri as 56.28% in Nigerian population and Muralimanju et al. [43] reported 57.6% among Indian population slightly higher in comparison to the present study results. However, Halagatti and Rangasubhe[32] reported 52.65% mean foraminal index for humeri, slightly lower than the other results. CONCLUSION The anatomical knowledge of number, location, and direction of nutrient foramina of humerus are very important for orthopedic surgeons during various surgical operations on the humerus like treatment of fracture, bone repair, bone grafting, micro-surgical bone transplantation, in many fractures and during extensive stripping of the periosteum so that they can minimize the damage to the nutrient artery of humeri. It helps to prevent intra-operative injuries in orthopedic, as well as in plastic and reconstructive surgery. The knowledge about the location and variations in the position of the nutrient foramina may also be helpful for appropriate placement of internal fixation devices during open or close procedures to limit the chances of delayed or non-union during fracture of the humeral shaft. Acknowledgement The authors acknowledge the immense help received from the authors whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=2623http://ijcrr.com/article_html.php?did=2623[1] Standring S. Functional anatomy of the musculoskeletal system. Gray’s Anatomy. 40th ed., Ch. 5. London: Elsevier Churchill Livingstone. 2008; 85-91. [2] Kizilkanat E, Boyan N, Ozsahin ET, Soames R, Oguz O. Location, number and clinical significance of nutrient foramina in human long bones. Ann. Anat 2007; 189: 87-95. [3] Henderson RG. The position of the nutrient foramen in the growing tibia and femur of the rat. J Anat. 1978; 125(3): 593-599.  [4] Krishna Garg. BD Chaurasia’s Hand Book of General Anatomy. Blood supply of bones. 4th ed. 2011. CBS Publishers and Distributors Pvt. Ltd: 43-44.  [5] Longia GS, Ajmani ML, Saxena SK, Thomas RJ. Study of diaphyseal nutrient foramina in human long bones. 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