<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Warning</b>:  Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>234</b><br />
<?xml version="1.0"?>
<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>COVID-19 and Low Molecular Weight Heparin (LMWH)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>01</LastPage><AuthorList><Author>Dr. N. S. Neki</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2981</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2981</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study and Evaluation of Antibiotic Usage in Surgical Cases&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>07</LastPage><AuthorList><Author>Amol Jeur</Author><AuthorLanguage>English</AuthorLanguage><Author> Mayur Nagavekar</Author><AuthorLanguage>English</AuthorLanguage><Author> Yogesh P. Nikam</Author><AuthorLanguage>English</AuthorLanguage><Author> Mansing Adnaik</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: A surgical incision may be all the provocation bacteria need for the battle to begin. Notwithstanding the advances made in pre-employable asepsis, clean procedures, and prophylactic anti-toxins, patients exposed to tasks normally need to confront the danger of complexities. Aim: Study was aimed at the evaluation of antibiotic usages in surgical cases. Methods: A serial study of 200 patients was done who have undergone operative procedure due to some surgical problem, under the Department of Surgery. Results: Overall incidence of postoperative wound infection in this study is 31%.70% of wound infections occur above the age of 50 years. malnutrition (41.30%) and obesity (50%) have a higher SSI rate than that of averagely nourished patients (28.16%). The number of patients encountered in this study suffering from diabetes was 15. Conclusions: Infection rate rises with increasing degree of operative contamination; Risk of wound infection in elective and clean surgeries is airborne or endogenous, while in other categories The age of the patient exerts a direct influence on the occurrence of postoperative wound infection, Sex of the patient is apparently and indirectly related to the risk of infection, The rate of postoperative wound infection increases with poor nutritional status, poor hygiene and low socioeconomic status. To reduce the infection rate, nutritional status and hygiene of the patient should be improved, at least in elective surgical procedures.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Antibiotic, Preoperative, Postoperative, Infection, Prevalence </Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2982</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2982</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Urinary Thromboxane Production in Diabetic and Non-Diabetic Patients of Acute Coronary Syndrome&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>08</FirstPage><LastPage>14</LastPage><AuthorList><Author>Sheetal Chauhan</Author><AuthorLanguage>English</AuthorLanguage><Author> Yeshwanth Rao Karkala</Author><AuthorLanguage>English</AuthorLanguage><Author> Ajit Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Tom Devasia</Author><AuthorLanguage>English</AuthorLanguage><Author> Hashir Kareem</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Uppunda</Author><AuthorLanguage>English</AuthorLanguage><Author> Gunajn Bonde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Diabetes mellitus is an independent predictor of higher major adverse cardiac events (MACE) rate following percutaneous transluminal coronary angioplasty (PTCA) in acute coronary syndrome (ACS). Higher thromboxane production in diabetic patients has not been linked to aspirin resistance and recurrent events. Methods: This prospective observational cohort study aimed to investigate urinary 11-dehydro-thromboxane B2 (dh-TxB2) levels in diabetic and non-diabetic ACS patients undergoing PTCA and its association with MACE. The dh-TxB2 ELISA assay was performed during index admission in all patients, and they were followed-up for 1-year. Results: Out of the 192 patients enrolled, 84 (43.8%) were diabetic and 108 (56.2%) were non-diabetic. Median dh-TxB2 levels were higher among diabetics compared to non-diabetics [577.7 pg/mg Cr (IQR 991.2:62.8-1054.0) vs. 344.0 pg/mg Cr (IQR 691.4:73.4-764.8) respectively]. Patients with and without diabetes had 1-year MACE rates of 14.3% and 7.4% respectively (P=0.096). The patients who developed MACE had higher dh-TxB2 levels in both the groups [nondiabetics: 419.6 (non-MACE) vs. 1349.7 pg/mg Cr (MACE); p1496 pg/mg Cr developed more MACE than their counterparts in non-diabetics. The dh-TxB2 concentration may be used as a predictor of early MACE in diabetic ACS patients. &#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Acute coronary Syndrome, Diabetes Mellitus, Dehydro-thromboxane B2, Major Adverse Cardiac Events, Percutaneous Transluminal Coronary Angioplasty </Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2983</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2983</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Analgesics by Intraperitoneal Instillation for Laparoscopic Cholecystectomy: Efficacy Comparison between Ropivacaine and Bupivacaine&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>15</FirstPage><LastPage>20</LastPage><AuthorList><Author>Harshada Pangam</Author><AuthorLanguage>English</AuthorLanguage><Author> Reena Chhabada</Author><AuthorLanguage>English</AuthorLanguage><Author> Shradha Rastogi</Author><AuthorLanguage>English</AuthorLanguage><Author> Pratiksha Holani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background and Aim: Postoperative pain relief following Laprascopic cholecystectomy is a major concern as it may affect functional outcome. The present study was conducted to compare the analgesic efficacy of ropivacaine and bupivacaine as an intraperitoneal Instillation during laparoscopic cholecystectomy under general anaesthesia and during the post-operative period. Material and Methods: Sixty patients were allocated meeting the necessary criteria were divided equally into two groups(30 per group) to receive either 20 ml 0.5% ropivacaine (Group A) or 0.5% bupivacaine(Group B) Instillation intraperitoneally at the end of surgery. The patients were given rescue analgesia when visual analogue scale (VAS)was more than or equal to 4 and/or visual rating scale (VRS) was more than or equal to 3. The primary objective was to compare VAS and VRS and rescue analgesic requirement. Secondary objectives were to assess post-operative adverse effects and complication if any. Results: The mean VAS score and VRS score were comparable in both groups. Bupivacaine provides a slightly longer duration of analgesia and on other had Ropivacaine has higher safety profile at higher doses. Both have similar rescue analgesic doses and in systemic safety profile at this concentration. Conclusion: Bupivacaine or ropivacaine in equal volume and concentration instilled intraperitoneally at the end of surgery in patients undergoing laparoscopic cholecystectomy shows comparable efficacy in relieving post laparoscopy pain especially in early postoperative hours.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Intraperitoneal Instillation, Visual analogue scale, Visual rating scale, Ropivacaine, Bupivacaine</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2984</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2984</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Development of Cost Effective Regeneration Protocol for Aerides multiflora Roxb. and Rhynchostylis retusa (L.) Blume&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>21</FirstPage><LastPage>26</LastPage><AuthorList><Author>Ankita Lal</Author><AuthorLanguage>English</AuthorLanguage><Author> Manu Pant</Author><AuthorLanguage>English</AuthorLanguage><Author> L.M.S. Palni</Author><AuthorLanguage>English</AuthorLanguage><Author> Anil Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Kholiya</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Objective: Tissue culture technology is firmly footed from the stage of &#x2018;concept&#x2019; to &#x2018;commercialization&#x2019; and plays a pivotal role in the global trade of orchids. The large scale use ofthis technology is limited due to the high production cost of regenerants and efforts are needed to develop cost-effective protocols without compromising the quality of propagules. Methods: More than 80 % of the production cost is attributed to the expensive medium components (carbon source, gelling agents, etc.). The present study reports a system for effective low-cost micropropagation of Aerides multiflora and Rhynchostylis retusa on medium formulated with alternatives to gelling agents, carbon and water source. Results: Medium formulated with table sugar and isabgol as carbon source and gelling agent, and autoclaved tap water gave optimal results without compromising the plantlet quality and total cost of medium preparation declined from INR 87.24 to INR 26.02. Under field conditions, the survival rate of the in vitro raised plantlets in a potting mix of moss, charcoal and mango bark shavings (2:1:2) was ~80%. Conclusion: 70% reduction in the total medium-cost was achieved by using low-cost substitutes which can easily replace sucrose and agar in the medium.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Low cost, in vitro, Micropropagation, Isabgol, Table sugar, Acclimatization</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2985</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2985</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Mental Health Among Orphan and Non-Orphan Adolescents in Delhi National Capital Region (NCR)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>27</FirstPage><LastPage>30</LastPage><AuthorList><Author>Ashu Kumari</Author><AuthorLanguage>English</AuthorLanguage><Author> Nudrat Jahan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Mental health is defined as a state of happiness in which each person understands his or her own protentional of handling challenges of life. A mentally healthy person can work effectively and joyfully and can make an influence on others. An orphan is a person who has lost both his parents and mostly learn to cope with the issues while experiencing life adversity. Aim: The main aim of this study to find mental health among the orphan and non-orphan adolescents in Delhi. Method: 40 orphan adolescents were selected from the different orphanages of the national capital region of India using purposive sampling method, similarly 40 non-orphan adolescents were selected from different schools. General health questionnaire28 was used to measure somatic, anxiety, social dysfunction and depression. Result: Both the group were found significantly different on somatic (t.= 10.30; p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mental health, Orphan adolescents</Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;Mental health comprises of our feelings, cognitive process and enlightenment. It affects our thinking, feeling, life processes and also effects our stress handling skills. Mental health is very important at every stage of life 1. Many factors such as biological, brain chemistry genes, life experiences such as trauma or abuse and family history of mental health are causes of mental health problems. According to the World Health Organization when children do not achieve social and behavioural potential then they lose their confidence and suffer from many mental health issues 2.&#xD;
&#xD;
&#xA0;Mental health play important role in Adolescent life. In this period adolescents feel lots of changes in their life.&#xA0; when they enter social life. They feel lots of changes and face many issues. Social problems like delinquency, crime, suicide, alcoholism, drug addiction, prejudice, underachievement and dropping out of school are more sensitive problems in adolescent 3. WHO says that worldwide 10-20% of adolescents experience mental health half of all mental illnesses begin in the age of 14 and two -quarters by mid20s. Therefore, Adolescents face major challenges like stigma, isolation and discrimination, as well as lack of access to health care and education facilities. &#xD;
&#xD;
Recent studies have identified mental health problems - in particular depression, as the largest cause of the burden of disease among young people. &#xD;
&#xD;
Poor mental health can have serious effects on the wider health and development of adolescents and association with health and social outcomes such as higher alcohol, tobacco and illicit substances use, adolescent pregnancy, school dropout and delinquent behaviours. Parenting style refers to the way parents interact with each other and with children. Studied had shown that parents -child interactions and relationships and parenting style affect mental health both in positive and negative ways 4.&#xD;
&#xD;
According to the National Health Survey -3 which includes data from 2005 to 2006, 41 % of India&#x2019;s population is under 18 and It was also the largest child population in the world.&#xA0; &#xA0;According to the study, an additional 13 per cent of these children live in single-parent households, who are also socially and economically marginalized than those houses with both parents. 85% of children with single -parents are mostly living with their mothers and 4% of the Indian population are orphans. However, challenges of mental health are different for orphans. &#xD;
&#xD;
Orphan is defined as abandoned children, who have lost their parents. Studies reveal that India is home to 20 million orphans. states Uttar Pradesh, Madhya Pradesh, Chhattisgarh are home to billions of orphan children under age 18. This may rise to 7.1 million and states in eastern region Bihar, Orisha, Jharkhand and West Bengal have up to 5.2 million till 2021. These states have a double number of orphan children. Poverty has played a significant role to increase the number of abandoned and orphan children in these states. Military affected areas are also to be partially blamed. The importance is given to understand their physical states and mental health by several organizations all over the world. According to United Nations International Children&#x2019;s Emergency Fund (UNICEF), children those who have no parents or have a single parent, are malnourished and don&#x2019;t reach till their full potential of psychological and intellectual capabilities 5. Another study in Tanzania shows a comparison of the psychological health of orphans and non-orphans, originates wide evidence of reduced psychological wellbeing for orphans. This shows most orphans having a psychological impairment, especially affected behaviour changes such as depression, anxiety and low self-esteem6. The world bank also says orphans have higher tendencies toward social disorganization than non-orphans 7.&#xA0;&#xA0; To fulfil this gap present study was conducted with the following objectives. &#xD;
&#xD;
Need for the study:&#xD;
&#xD;
Mental health is a major concern worldwide. Due to natural disasters, war, illnesses and poverty a large number of populations is living as an orphan in orphanages. The orphan needs care, support, and safety from society to resettle in life by getting employment and Making family. Mental health is an important component of human health which leads to the successful adjustment.&#xA0; This study will develop an understanding of the status of mental health among orphan adolescents and compare it with non-orphan adolescents living in NCR region.&#xA0; It will help to plan and improve the services in orphanages by mental health professionals, government and non-government organizations (NGO) working for orphans. We believe this finding will be of interest to the readers of this journal. &#xD;
&#xD;
Objectives: &#xD;
&#xD;
&#xD;
	&#xD;
	To study the somatic, social dysfunction, anxiety and depression issues among the orphan and Non-orphan adolescents.&#xD;
	&#xD;
	&#xD;
	To study the difference in somatic, social dysfunction, anxiety and depression issues among the orphan and Non-orphan adolescents.&#xD;
	&#xD;
&#xD;
&#xD;
Hypothesis: &#xD;
&#xD;
&#xD;
	&#xD;
	There would be somatic, social dysfunction, anxiety and depression issues among the orphan and Non-orphan adolescents.&#xD;
	&#xD;
	&#xD;
	There would be a significant difference in somatic, social dysfunction, anxiety and depression issues among the orphan and Non-orphan adolescents.&#xD;
	&#xD;
&#xD;
&#xD;
Methodology:&#xD;
&#xD;
Design: Descriptive correlational research design was used to conduct the study.&#xD;
&#xD;
Sampling: &#xD;
&#xD;
Sampling technique. Purposing sampling was used.&#xA0; &#xD;
&#xD;
The samples were selected from 5 orphanages located in Delhi NCR.&#xA0; A total number of 40 orphan adolescent and 40 non-orphan adolescents were selected as per following inclusion and exclusion criteria&#x2019;s: &#xD;
&#xD;
Inclusion Criteria: &#xD;
&#xD;
Age range 10 to 19 year only. &#xD;
&#xD;
English and Hindi speakers only.&#xD;
&#xD;
Minimum education Higher Secondary School.&#xD;
&#xD;
Orphans living in an orphanage only.&#xA0; &#xD;
&#xD;
Non-orphans living with both the parents.&#xD;
&#xD;
Exclusion Criteria:&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Subjects who were uninterested in study.&#xD;
&#xD;
Subjects who were suffering from any serious physical or mental issues.&#xD;
&#xD;
Physically handicapped subjects.&#xD;
&#xD;
Non-orphan living with a single parent. &#xD;
&#xD;
Tools:&#xD;
&#xD;
General health questionnaire 28:&#xD;
&#xD;
The GHQ-28 was developed by Goldberg in 1978 and has since been translated into 38 languages. Developed as a screening tool to detect those likely to have or to be at risk of developing psychiatric disorders, the GHQ-28 is a 28-item measure of emotional distress in medical settings. Through factor analysis, the GHQ-28 has been divided into four subscales. These are somatic symptoms (items 1&#x2013;7); anxiety/insomnia (items 8&#x2013;14); social dysfunction (items 15&#x2013;21), and severe depression (items 22&#x2013;28) It takes less than 5 minutes to complete 8. &#xD;
&#xD;
Procedure:&#xD;
&#xD;
To fulfil the objectives of the study, 31 orphanages located in Delhi-NCR were approached, among those 5 orphanages permitted to collect the data. 670 orphans living in orphanages were interviewed for their counselling needs.&#xA0; The duration was also used to identify the subject as per the inclusion and exclusion criteria of the sample. 40 orphans were selected based on inclusion and exclusion criteria. The subject was given detailed information about the study, and consent was taken from the subject to use the data for research purpose. Data were collected by using the general health questionnaire. &#xD;
&#xD;
Results Analysis:&#xD;
&#xD;
&#xA0;In this study, the data obtained was analysed by using the Statistical Package for Social&#xA0;Sciences (SPSS) -21 version, paired sample t-test was calculated to see the difference between both the groups Obtained result is mention below.&#xD;
&#xD;
&#xD;
&#xD;
The above result shows that in somatic complaints, there was a significant difference between orphans and Non-orphans (t.=; p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2986</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2986</Fulltext></URLs><References>1. National Institute of Mental Health (US). National Institute of Mental Health. US Department of Health, Education, and Welfare, Public Health Service, National Institute of Mental Health; 1960.&#xD;
&#xD;
&#xA0;www.mentalhealth.gov/basics/what-is-mental-health .&#xD;
&#xD;
2. SOS Children&amp;#39;s Villages Canada is a registered charity in Canada.&#xD;
(Charity Registration Number 13824 7259 RR0001)&#xD;
&#xD;
&#xA0;https://www.soschildrensvillages.ca/india-now-home-20-million-orphans-study-finds&#xD;
&#xD;
3. A Study on Mental Health among the Adolescent Orphan Children Living in Orphanages. 2017;7 &#xD;
&#xD;
https://iiste.org/Journals/index.php/RHSS/article/download/38534/39618&#xA0;&#xB7; PDF file.&#xD;
&#xD;
4. Dwairy M, Menshar KE. Parenting style, individuation, and mental health of Egyptian adolescents. Journal of adolescence. 2006 Feb 1;29(1):103-17.&#xD;
&#xD;
european-science.com/eojnss/article/view/5165&#xD;
&#xD;
5. World Health Organization. Early Child Development. Fact sheet N 332. Retrieved May. 2009; 21:2012.&#xD;
&#xD;
6. Foster G, Makufa C, Drew R, Kambeu S, Saurombe K. Supporting children in need through a community-based orphan visiting programme. AIDS Care. 1996 Aug 1;8(4):389-404.&#xD;
&#xD;
7.&#xA0; Doryan E, Hunter S, Subbarao K, Walker C, Lukoda M, Ghebrekidan AT, Baingana F, Maclean H, Frederiksen B, Kamwendo C, Muwonge J. Orphans and other vulnerable children: what role for social protection world bank vision, Conference, 2001;7.&#xD;
&#xD;
8. Goldberg DP. Manual of the General Health Questionnaire. Windsor. England: NEFR Publishing. 1978.&#xD;
&#xD;
9. Greydanus D, Hawver EK, Greydanus MM, Merrick J. Marijuana: current concepts. Frontiers in public health. 2013 Oct 10; 1:42.&#xD;
&#xD;
10. Bhatt AA, Rahman S, Bhatt NM. Mental health issues in institutionalized adolescent orphans. Int J Indian Psychol. 2015; 3:57-77.&#xD;
&#xD;
11. Naqshbandi MM, Sehgal R, Hassan F. Orphans in orphanages of Kashmir &#x201C;and their psychological problems&#x201D;. International NGO Journal. 2012 Oct;7(3):55-63. &#xD;
&#xD;
12. Thabet L, Thabet AA. Mental health problems among orphanage children in the Gaza Strip. Adoption &amp; Fostering. 2007 Jul;31(2):54-62.&#xD;
&#xD;
13. Afework T. A Comparative Study of Psychological Well-being Between Orphan and Non-orphan Children in Addis Ababa: The Case of Three Selected Schools in Yeka Sub-City. The school of psychology Addis Ababa University. 2013.&#xD;
&#xD;
14. Dorsey S, Lucid L, Murray L, Bolton P, Itemba D, Manongi R, Whetten K. A qualitative study of mental health problems among orphaned children and adolescents in Tanzania. The Journal of nervous and mental disease. 2015 Nov;203(11):864.&#xD;
&#xD;
15. Mohammad Zadeh M, Awang H, Shahar HK, Ismail S. Emotional health and self-esteem among adolescents in Malaysian orphanages. Community mental health journal. 2018 Jan 1;54(1):117-25.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study the Effectiveness of Bilateral Arm Training on Upper Extremity Motor Function and Activity Level in Patients with Sub-Acute Stroke&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>31</FirstPage><LastPage>37</LastPage><AuthorList><Author>Darshana Dhakate</Author><AuthorLanguage>English</AuthorLanguage><Author> Radha Bhattad</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aims and Objectives: To study the effectiveness of Bilateral Arm Training on upper extremity motor function and activity level in patients with sub-acute stroke. Sample Size: 40 patients (20 in each group), Study Design: Experimental Study, Study setting: Hospitals and Rehabilitation centres in and around the metropolitan city Sample and Sampling method: 40 patients were randomly selected and assigned in 2 groups, as Group 1(conventional group), Group 2 (experimental group) in equal numbers Exclusion Criteria. The total subjects of 40 were included in the study the inclusion and exclusion criteria were Inclusion Criteria: 45 years to 65 years, Both ischemic and hemorrhagic stroke (middle cerebral artery involvement),1 month from onset to 6 months (sub-acute stage), the score of 21 or higher on mini-mental state examination, Voluntary control grading (Brunnstrom) for upper extremity- Stage 4 Or 5, Patients with a fair grade of sitting balance. Exclusion Criteria: Upper extremity musculoskeletal disorders e.g. subluxation of shoulder, shoulder pain, any contractures or deformity of any of the upper extremity, Neurological disorders other than stroke, visual impairments, Patients with Unilateral neglect, Patients with perceptual disorders, psychological problems. Result: There was a significant difference (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Bilateral Arm Training, Mins: Minutes, FMA (UE): Fugl- Meyer Assessment (Upper Extremity), MAL: Motor Activity Log, FIM: Functional Independence Measure Scale</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Stroke or brain attack is the sudden loss of neurological function caused by an interruption of the blood flow to the brain, this can be due to ischemia (absence of blood gracefully), brought about by apoplexy or embolism or because of leakage that happens when veins rupture causing spillage of blood in or around brain1Intense stage is considered from the hour of beginning till one month 1 month from onset to 6 months is considered as sub-acute stage whereas more than 6 months is considered as a chronic stage of stroke. 1,2&#xD;
&#xD;
Approximately 80% of all stroke cases are ischemic and most ischemic stroke affects one of the cerebral hemispheres by occlusion of the middle cerebral artery.1 The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/100,000 in urban areas. The incidence rate is 119-145/100,000 based on recent population-based studies. There is also a wide variation in case-fatality rates with the highest being 42% in Kolkata.3 The term hemiplegia is often used generically to refer to the wide variety of motor problems that result from stroke1.&#xD;
&#xD;
20% to 80% of the patients show incomplete arm recovery after stroke depending on the initial impairment. Upper - limb dysfunction in stroke is characterized by paresis, loss of manual dexterity, and movement abnormalities that may impact considerably on the performance of ADL&amp;#39;s.5,6 The main aim of organized stroke rehabilitation is to achieve a level of functional independence that enables patients to return home and reintegrate into community life that lives up to their expectations and desires as much as possible. 18&#xD;
&#xD;
Need for study:- &#xD;
&#xD;
Based on Various strategies, the combination of whole arm functional task training and device-driven bilateral training types. The usage of techniques that involve more functional activities can have a better outcome compared to the other strategies Also it can be seen that the duration of the stroke is a very important variable which can have its effect in the outcome of bilateral arm training treatment sections. Studies in which bilateral arm training have been given to acute patients with post-stroke is comparatively very less in nature concerning sub-acute and chronic patients with post-stroke. Taking this aspect into consideration we have formulated the study frame in an acute case of patients with post-stroke. Thus the need for the study is justified by taking acute patients and conducting an experimental study using bilateral arm training. Hence we are trying to find out the effect of bilateral arm training in improving the upper extremity function among the individuals with acute stroke.&#xD;
&#xD;
AIMS and OBJECTIVES&#xD;
&#xD;
To find out the effect of Bilateral Arm Training on upper extremity motor function assessed using Fugl &#x2013; Meyer assessment UE scale and activity level assessed using Functional Independence Measure and Motor Activity Log on activity level in patients with sub-acute stroke.&#xD;
&#xD;
2) To find out the effect of Conventional physiotherapy training on upper extremity motor function assessed using Fugl &#x2013; Meyer assessment UE scale and activity level assessed using Functional Independence Measure and Motor activity log in patients with sub-acute stroke.&#xD;
&#xD;
3) To compare the effect of&#xA0; Bilateral Arm Training and Conventional Training on upper extremity motor function assessed using Fugl- Meyer assessment UE and activity level assessed using Functional Independence Measure and Motor activity log in patients with sub-acute stroke. &#xD;
&#xD;
MATERIAL AND METHODOLOGY&#xD;
&#xD;
RESEARCH DESIGN OF THE STUDY: Experimental Study&#xD;
&#xD;
STUDY SETTING: Hospitals and Rehabilitation centres in and around the metropolitan city&#xD;
&#xD;
SAMPLE SIZE: 40 subjects&#xD;
&#xD;
SAMPLING TECHNIQUE: Simple random sampling &#xD;
&#xD;
STUDY DURATION: 1 year&#xD;
&#xD;
METHODOLOGY:&#xD;
&#xD;
The study was conducted after taking approval from the institutional research ethics committee, approval no. P.E.S/MCOP/387C-2015-2016) in the Department of Neuroscience clearance was obtained from the Institutional ethical committee. Subjects who satisfied the study criteria were enrolled and briefed about the study. Later, Informed Consent was obtained from the subjects in the study.&#xA0; Total of 40 subjects was included in the study following the fulfilment of the criteria. 20 subjects in the experimental group (Group A) and 20 patients in the conventional treatment group (Group B) were enrolled.&#xD;
&#xD;
&#xD;
	&#xD;
	All the patients in the experimental group received Bilateral Arm Training (BAT) using 8 Bilateral symmetrical functional activities. &#xD;
	&#xD;
&#xD;
&#xD;
The intervention period was for 4 weeks. (5 days a week for 55 minutes which started with 5 min of warm-up exercises followed by bilateral symmetrical functional activities with 10 min rest period after completing 4 activities)38 Each task performed by the patient for 5 mins.&#xD;
&#xD;
PROCEDURE:-&#xD;
&#xD;
The Bilateral Arm Training included the following 8 activities-&#xD;
&#xD;
1)Lift a shoebox overhead and keep it again in front on the table (medium size shoebox)-&#xD;
&#xD;
Position of the patient- Sitting on a chair comfortably in front of the table&#xA0; &#xD;
&#xD;
Position of the therapist- Standing by the affected side of the patient &#xD;
&#xD;
Position of the material- An empty shoebox placed in front of the patient on the table.&#xD;
&#xD;
Task &#x2013; Therapist asked the patient to lift a box overhead (holding the width of the box) simultaneously with bilateral upper extremity and keep it again on the table. The same activity was repeated for 5 mins.&#xD;
&#xD;
&#xD;
&#xD;
Pull a chair (plastic chair)-&#xD;
&#xD;
Position of the patient- Sitting on a chair comfortably &#xD;
&#xD;
Position of the therapist- Standing by the affected side of the patient &#xD;
&#xD;
Position of the material- A plastic chair with its back facing to the patient kept in front of the patient at his arm&amp;#39;s length.&#xD;
&#xD;
Task &#x2013; Therapist asked the patient to pull a chair (holding backrest of the chair) simultaneously with bilateral upper extremity towards him while trunk remained still and therapist kept the chair back and again patient asked to pull the chair. The same activity was repeated for 5 mins. &#xD;
&#xD;
&#xD;
&#xD;
Lift&#xA0; 2 polystyrene cups simultaneously with bilateral upper extremity (diameter 8.0 cm, height 10.0 cm)24&#xD;
&#xD;
Position of the patient- Sitting on a chair comfortably in front of the table&#xD;
&#xD;
Position of the therapist- Standing by the affected side of the patient &#xD;
&#xD;
Position of the material- 2 polystyrene cups (half water-filled cups) placed on the table &#xD;
&#xD;
Task &#x2013; Therapist asked the patient to lift polystyrene cups (holding one cup by one hand) simultaneously with bilateral upper extremity; then asked the patient to keep it back. The same activity was repeated for 5 mins.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;Conventional Training program-&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All the patients in Group B were treated by using Conventional Physiotherapy Program for affected upper extremity38,&#xA0; the affected lower extremity and Trunk .1, 19&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Pre-intervention (t1) the motor function assessed by using Fugl- Meyer assessment (FMA-UE) scale and activity level was assessed using, Functional Independence Measure scale (FIMS) which is a structured interview and motor activity log scale (structured interview)&#xA0; for the upper extremity.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The Conventional Physiotherapy Program period was for 4 weeks (5 days a week for 55 minutes which was started with 5 min of warm-up exercises).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Post-intervention (t2) the motor function assessed by using Fugl- Meyer assessment (FMA-UE) scale and activity level was assessed t using, Functional Independence Measure scale (FIMS) which is a structured interview and motor activity log scale (structured interview)&#xA0; for the upper extremity.&#xD;
&#xD;
Conventional Treatment Program included:1, 30, 38&#xD;
&#xD;
Weight-bearing on the affected UE, Weight shifts, Manipulation activities, Dexterity activities (Holding key)&#xD;
&#xD;
Dexterity activities (Holding Comb), Functional reaching activities, Co-ordination exercises for affected UE, Gripping activities for affected upper extremity, Each exercise was performed for 5 minutes for affected upper extremity&#xD;
&#xD;
&#xD;
&#xD;
WEIGHT BEARING EXERCISE ON AFFECTED UPPER&#xD;
&#xD;
LIMB&#xD;
&#xD;
DATA ANALYSIS &#xD;
&#xD;
The Motor function was analyzed using the Fugl- Meyer Assessment Scale for Upper Extremity and Activity level using functional Independence Measure and Motor Activity Log. For this purpose, data were collected by the primary investigator. The data were entered into an excel spreadsheet, tabulated and subjected to statistical analysis. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xD;
&#xD;
1) Paired t-test- To see the difference between pre and post measurements within the group.&#xD;
&#xD;
2) Unpaired t-test- To see the difference between pre and post measurements between the group. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Effect of Bilateral Arm Training and conventional Treatment on Activity level in subacute stroke was analyzed using Non-parametric tests.&#xA0; &#xD;
&#xD;
1) Wilcoxon sign rank test- to see the difference in the group.&#xD;
&#xD;
2) Mann Whitney test - To compare between two independent groups. 39&#xD;
&#xD;
RESULTS &#xD;
&#xD;
The Data was analyzed with the help of the Statistical Package of Social Services SPSS (Version 20.0). &#xD;
&#xD;
There was a significant difference (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2987</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2987</Fulltext></URLs><References>1. Sullivan OS. Physical rehabilitation: 5th ed. 2007: 705-775.&#xD;
&#xD;
2. Murase N, Duque J, Mazzocchio R, Cohen LG. Influence of interhemispheric interactions on motor function in chronic stroke. Ann Neurol 2004;55:400&#x2013;409. [PubMed: 14991818] &#xD;
&#xD;
3. Jeyaraj Durai, Pandian, A Paulin Sudhanb. Stroke Epidemiology and Stroke Care Services in India Journal of Stroke:2013;15(3):128-134 &#xD;
&#xD;
4. Platz T, winter T et al. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind randomized controlled trial. Arch Phys Med Rehab:2001;82;961-96. &#xD;
&#xD;
&#xA0;5.&#xA0; Nakayama H, Jorgensen HS, RaaschouHparkerO, Olsen TS. Recovery of Upper Extremity Function in Stroke Patients: The Copenhagen Study. Archives of Physical Medicine and Rehabilitation 1994;75:852&#x2013;857. [PubMed: 8053790]&#xD;
&#xD;
6. Anne Shumway-cook, Marjorie H. Woollacott. Motor control translating research into clinical practice; 3rd edition.&#xD;
&#xD;
Mudie MH, Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in the reconstruction of neural networks damaged by stroke? Disabil Rehabil 2000; 22: 23&#x2013;37.&#xD;
&#xD;
8. Luft A, McCombe Waller S, et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke. A randomized controlled trial.JAMA. 2004;292:1853-1861. &#xD;
&#xD;
9.&#xA0; Hesse S, Werner C, Pohl M, Rueckriem S, Mehrholz J, Lingnau ML. Computerized arm training improves the motor control of the severely affected arm after stroke. A single-blinded randomized trial in two centres.Stroke. 2005;36:1960-1966. &#xD;
&#xD;
&#xA0;10. Summers JJ, Kagerer FA, Garry MI, Hiraga CY, Loftus&#xA0; A, Cauraugh JH. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study.&#xA0; J Neurol Sci. 2007;252:76-82. &#xD;
&#xD;
11. Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:1237-1245. &#xD;
&#xD;
12. Mudie MH, Matyas TA. Upper extremity retraining following stroke: effects of the bilateral practice. J NeurolRehabil. 1996;10:167-184. &#xD;
&#xD;
13. &#xA0;Chung Lin SD, Yi A, Chen MS et al: The effects of Bilateral arm training on motor control and functional performance in chronic stroke: A randomized controlled trial: Neurorehabilitation and neural repair: 2010&#xD;
&#xD;
14. Nafeez Syed, AbhisekBiswas, Bilateral Versus Unilateral Upper Extremity Training on Upper Limb MotorActivity in Hemiplegia; Int J Neurorehabilitation 2015, 2:1&#xD;
&#xD;
15. Cauraugh JH; Two coupled motor recovery protocols are better than one; EMG triggered neuromuscular stimulation and bilateral movement; stroke 2002;33:1589-94&#xD;
&#xD;
16. Whitall J, McCombe Waller S, Silver KHC, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000;31:2390-2395.&#xD;
&#xD;
17.NeuroRehabilitation. Author manuscript. Bilateral arm training why and who benefits? NIH-PA Author Manuscript. 2010.&#xD;
&#xD;
18.VanPeppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, WeesPJ Van der, Dekker J: The impact of physical therapy on functional outcomes after stroke: what&amp;#39;s the evidence? ClinicalRehabilitation. 2004, 18(8):833-862.&#xD;
&#xD;
19. Kaplan PE, Cailliet R, Kaplan CP: Rehabilitation of stroke. 1st edition.Burlington: Butterworth-Heinemann; 2003.&#xD;
&#xD;
20. Lewis GN, Byblow WD. Neurophysiological and behavioural adaptations to a bilateral training intervention in individuals following stroke. Clin Rehabil. 2004;18:48-59. &#xD;
&#xD;
21. Richards LG, Senesac CR, Davis SB, Woodbury ML, Nadeau SE. Bilateral arm training with rhythmic auditory cueing in chronic stroke: not always efficacious. Neurorehabil Neural Repair. 2008;22:180-184.&#xD;
&#xD;
22.Schaechter JD. Motor rehabilitation and brain plasticity after hemiparetic stroke. Prog Neurobiol. 2004;73:61-72.&#xD;
&#xD;
23. Nyeonju Kang, Jerelyne Idica1, Bhullar Amitoj1 and James H Cauraugh2; Motor recovery patterns in arm muscles: coupled bilateral training and neuromuscular stimulation; J. NeuroEngg. Rehabilitation. 2014, 11:57.&#xD;
&#xD;
24. Duncan PW, Propst M, Nelson SG: Reliability of the Fugl-Meyerassessment of sensorimotor recovery following cerebrovascular accident. Physical therapy 1983, 63(10):1606-1610&#xD;
&#xD;
. McCombe Waller S, Whitall J. Bilateral arm training: why and who benefits? Neuro Rehabilitation. 2008;23:29-41.&#xD;
&#xD;
26.StewartkC, Cauraugh JH, Summers JJ. Bilateral movement training and stroke rehabilitation: a systematic review and meta-analysis. J Neurosci 2006; 244: 89&#x2013;95 &#xD;
&#xD;
27. Park Y: The effect of mirror therapy with task-specific training on upper extremity function and self-care in stroke patients; J. Phy Ther. 27:1499-1501:2015&#xD;
&#xD;
28. Stinear JW, Byblow WD. Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity post stroke: a pilot study. J Clin Neurophysiol.2004;21:124-131.&#xD;
&#xD;
29.EQ van Delden, C (Lieke) E Peper,: Comparing unilateral and bilateral upper limb training: TheULTRA-stroke program design.BMC Neurology 2009, 9:57&#xD;
&#xD;
30. Umphred, Darcy A. Neurological rehabilitation; fifth edition.&#xD;
&#xD;
31. Feys HM, De Weerdt WJ, Selz BE, Cox Steck GA, Spichiger R, et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke. 1998; &#xA0;29: 785-792.&#xD;
&#xD;
32. Uswatte G, Giuliani G, Winstein C, Zeringue A, Hobbs L, Wolf SL. The validity of accelerometry for monitoring real-world arm activity in patients with subacute stroke: evidence from the extremity constraint-induced therapy evaluation trial. ArchPhys Med Rehabil. 2006;87:1340-1345&#xD;
&#xD;
33. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S: The post-stroke hemiplegic patient. A method for evaluation of physical performance.Scand J Rehabil Med 1975, 7:13-31&#xD;
&#xD;
34. McCombe Waller S, Liu W, Whitall J. Temporal and spatial control following bilateral versus unilateral training. Hum Mov Sci. 2008;27:749-758.&#xD;
&#xD;
35. Keith RA, Granger CV, Hamilton BB, Sherwin FS: The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil1987, 1:6&#x2013;18.&#xD;
&#xD;
36.Edward Taub, Karen McCulloch: UAB CI Therapy Research Group: Motor activity log:2011&#xD;
&#xD;
37.McDonnell MN, Hillier SL (2007) Influence of combined afferent stimulation and task-specific training following stroke: a pilot randomized controlled trial. Neurorehabil. Neural Repair. 21:435-443.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Peritonitis with Ascites Following Caesarean Delivery: A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>38</FirstPage><LastPage>41</LastPage><AuthorList><Author>Deepali Ghungrud</Author><AuthorLanguage>English</AuthorLanguage><Author> Ranjana Sharma</Author><AuthorLanguage>English</AuthorLanguage><Author> Ruchira Ankar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Over the last few decades, the caesarean section has increased all over the world. More issues are likely to be observed as caesarean section rate increases. Infection is the leading cause of maternal morbidity and mortality. Postoperative peritonitis and ascites are very rare complications in lower segment caesarean section delivery. The final cause is unknown, but sometimes it causes due to allergic or inflammatory reaction of the peritoneum. If it occurs after caesarean then creates very serious issues with the woman health. Case Presentation: Here we are mentioning a very rare surgical case of peritonitis with ascites of unknown cause after lower segment caesarean section delivery. In this case, on physical examination and investigation, it was found that, after the caesarean patient has developed severe abdominal pain, fever, nausea, vomiting, abdominal distension, swelling on face and foot. To overcome this sudden issue, an emergency exploratory laparotomy was done. During the surgical exploration of the abdominal cavity maximum amount of clear fluid was seen and that was aspirated by suctioning and peritoneal lavage was given. There was no sign of tissue or organ damage by surgery or no other abnormality was detected during operation. No bacterial growth observed in fluid cultures on the investigation of fluid drained from the abdomen. The working diagnosis was finalized by surgeon i.e. reactive peritonitis with ascites. After expert surgical management and excellent nursing care patient was discharged with full recovery. Conclusion: In this study, we mainly focus on expert surgical management and excellent nursing care helped in managing the complicated case very nicely. All the patient response was positive for conservative and nursing management and after treatment, the patient was discharged without any postoperative complications and satisfaction with full recovery.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Ascites, Caesarean delivery, Complication, Peritonitis, Postoperative</Keywords><Fulltext>Introduction&#xD;
&#xD;
Over the last few decades, the caesarean section has increased all over the world. More issues are likely to be observed as caesarean section rate increases. Infection is the leading cause of maternal morbidity and mortality. Maternal sepsis was among the causes of maternal mortality in the last confidential investigation on maternal death1.&#xD;
&#xD;
Postoperative peritonitis or inflammation of the peritoneum and fluid accumulation in the peritoneal cavity is one of the very rare complications of caesarean section delivery. It&#x2019;s a life-threatening situation and is a very serious issue concerning caesarean delivery2.&#xD;
&#xD;
The main cause of peritonitis is mostly bacterial infection, foreign bodies in the peritoneum or any chemical agents. Due to these factors, organs or tissues may perforate and sterile peritoneum becomes infected. Sometimes in this situation, women experience localized peritonitis due to infection of the fallopian tube or a ruptured peritoneum3. &#xD;
&#xD;
In these cases, bleeding or iatrogenic injuries, i.e. any tissue or organ damage of the small and large intestine or urinary tract injury should be eliminated on time to improve patient survival and decrease mortality also. Sometimes, the exact cause cannot be found after an extensive diagnostic work-up. In these cases, very rarely idiopathic allergic and inflammatory peritoneal reaction may be the final diagnosis4.&#xD;
&#xD;
Case history&#xD;
&#xD;
A surgical case was taken by Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Medical Sciences, (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India. After caesarean section delivery, this complicated case was taken care of nicely by the hospital because of expert surgical team management and excellent nursing care. &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
&#xD;
Patient information&#xD;
&#xD;
We report a 26-year-old- woman was pregnant with her first child, complete pregnancy period and all routine laboratory blood test was normal. During delivery an emergency lower segment caesarean section delivery was done at full term, the postoperative period was good. Hence, she was discharged on the 7th day after recovery. But after 2 months patient suddenly developed severe abdominal pain. Generalized pain was dull, aching, and also she had a history of multiple episodes of nausea and vomiting. Vomitus had only fluid, blood was not found. She also had diarrhoea, fever (38.5?&#xB0;C), swelling on face, hand and foot, and abdominal distension. With all these complaints she was admitted in the surgery ward. &#xD;
&#xD;
Patient belonged to the middle-class family. Her family members had no complaints of communicable and non-communicable diseases. She maintained a good interpersonal relationship with family members and relatives and neighbours also. But due to this condition, she had developed postpartum symptoms like irritability, anxiety, crying and restlessness and found it difficult in bonding with her baby. She was behaving like this due to separation from her 2-month child. Previously and at the time of admission, the patient doesn&#x2019;t have the communicable and non-communicable disease. &#xD;
&#xD;
After admission, Ryle&#x2019;s tube intubation was inserted. On admission, her vital sign was normal but systolic and diastolic blood pressure was 90/60 mm of Hg, while abdominal on examination was distended. Overall, this condition was managed by administration of intravenous fluid and antibiotic treatment. Blood investigation and the ultrasonography were done, ultrasonography report impression was Hepatosplenomegaly with ascites.&#xD;
&#xD;
Physical Examination&#xD;
&#xD;
Her Physical examination was done and on examination caesarean scar was present on the abdomen. The abdomen was distended and she had swelling on face, hand, and foot. Other than there was no abnormality was detected.&#xD;
&#xD;
Diagnostic assessment&#xD;
&#xD;
The laboratory test was conducted&#xA0; and &#xA0;results were: Hemoglobin 8.9 gm /dl (12.1-15.1 gm/dl), and total leukocyte count&#xA0; was 17,000 cell/m3 (5000-11,000 cell/m3), urine analysis result was&#xA0;&#xA0; creatinine 2.4 mg/dl (0.6-1.4 mg/dl), and blood urea nitrogen level was 63 mg/dl (8-25 mg/dl), sodium level 135 (135-145 mEq/l) and potassium 4.3 mEq/l (3.5-4.8 mEq/l) and serum albumin level was 2.3 mg/dl. Serum bilirubin was 1.5, a liver function test report was shows liver enlarged i.e. 16.2 cm. and radiologist mentioned in ultrasonography report, i.e. Hepatosplenomegaly with ascites. &#xD;
&#xD;
Preoperative care&#xD;
&#xD;
Nasogastric tube intubation was done as per doctors ordered and Ryle&#x2019;s tube aspiration was done 2 hourly. The abdominal girth was recorded 2 hourly. The bladder was catheterized as per doctor&#x2019;s orders and maintained intake and output strictly. Doctors tried to treat this condition with the help of conservative management, i.e. Inj Ceftriaxone 1 gm antibiotic intravenously, Inj. Metronidazole 100ml antimicrobial intravenously, Inj tramadol pain killer in an IV drip, Inj Entomol 100ml antipyretic intravenously given, but the only operation was next choice for the surgeon to handle this case and before start surgical operation preparation wrote consent was taken by her husband and physical and psychological preparation was done preoperatively. All these conditions were very threatful to the patient because her 2 months the male child was at home and she was so much worried about him and she was continuously asking her husband regarding her child. On observation, she looked very tensed.&#xD;
&#xD;
But the exact cause was not found and finally, an exploratory laparotomy was done 2400 cubic centimetre straw-coloured accumulated fluids was removed, for investigation and sent that in the laboratory to rule out the cultured. Ovaries, uterus and urinary system organs, i.e. ureter, bladder and gastrointestinal tract were found normal. The abdomen was closed with the use of good quality of suture materials and drain tube. &#xD;
&#xD;
Postoperative care&#xD;
&#xD;
Postoperatively the patient shifted in the surgery Intensive Care Unit; semi fowler&#x2019;s position was given, 4 hourly Ryle&#x2019;s tube aspiration and abdominal girth were measured. Postoperatively continuous cardiac monitoring was done, Inj. Piptaz 4.45 gm higher antibiotic intravenously, Injection. Metronidazole 100ml antimicrobial intravenously, Inj Pantoprazole antacid 40 mg intravenously, Inj. Emset 4 mg antiemetic intravenously, Inj Tramadol pain killer in an IV drip, Inj Neomol 100ml antipyretic intravenously given as per doctors ordered. &#xD;
&#xD;
&#xA0;Nursing management&#xD;
&#xD;
Postoperatively the patient was under strict observation of on-duty staff. Intravenous fluid administered as per calculation. Observation and reading of the character of the drainage were done postoperatively. Platelets were given, care of the wound and the daily dressing was done. Drainage care was taken and intake and output were maintained 2 hourly. Vital signs were recorded strictly. In the cytology report, no malignant cells were found. Overall her response was positive for treatment and patient condition too improved progressively. The drain output became less and was removed after 3 days. Then the patient was shifted in the surgical ward from surgical ICU after recovery.&#xD;
&#xD;
Excellent nursing care was given and the patient herself reported to nursing staff that. She was very satisfied with nursing care. Complete discharge procedure was explained by nursing staff to the patient and her family members along with medication prescribed at home as advised by the surgeon. The patient was discharged from the ward after 15 days post laparotomy without any complications. &#xD;
&#xD;
The patient visited regularly at surgery OPD and also visited the hospital at pediatric OPD for her baby for a daily routine checkup, during this period routine checkup was done and she had no any complaints, therefore no furthermore evaluation was found. &#xD;
&#xD;
Discussion&#xD;
&#xD;
This was a very rare surgical case of peritonitis with ascites after caesarean section delivery and fluid accumulation in the peritoneal cavity after an emergency caesarean section delivery without any signs of bleeding, tissue or organ damage of the small intestine and large intestine or ureter, bladder nor peritoneal contamination. No exact cause was found even after performing a thorough postoperative cytological investigation of the peritoneal fluid. Following exploratory laparotomy and drain of the fluid. No, any additional medical treatment was given other than intravenous antibiotics and antimicrobial injections. Pain killer and antiemetic2. &#xD;
&#xD;
We can notice the development of fluid accumulation in the peritoneal cavity due to an idiopathic allergic condition and inflammatory peritoneal reaction. Till now, there is no any exact information in the literature to assume the possibility of a peritoneal allergic reaction or any other inflammatory reaction due to handling of the peritoneum during caesarean section and chemical agents used at the time of surgery, and in the case where vital organ injury. The cause and effects of the disease have not been identified, it is limited to isolated case reports only. Most of the reports are related to this topic are based on patients undergoing gynaecological procedures5.&#xD;
&#xD;
Postoperative peritonitis i.e. inflammation of peritoneum and ascites fluid collection in the peritoneum cavity of unknown cause has been mentioned after laparoscopic surgeries like Appendicectomy, Cholecystectomy, laparotomy for resection of ovarian cyst and salpingectomy6,7.&#xD;
&#xD;
The same condition of the previous reports has suggested that if chemical agents used at the time of surgery, then there may be chances of an allergic reaction during laparoscopy or laparotomy (antiseptic peritoneal lavage and methylene blue dye) or some other substances used like carbon dioxide, electricity light or heat, diathermy and latex powder8. &#xD;
&#xD;
But in this patient, the surgeon did not use any types of allergic chemical agents or intraperitoneal cauterization. During the caesarean section, the colour of ascites was not in favour of bacterial ascites4. It may occur in an allergic reaction. Patient&#x2019;s low immunity power because her haemoglobin was 8.9 gm/dl.&#xD;
&#xD;
Sometimes, if an aseptic technique is not followed during surgery, it may result in incision site wound sepsis. Without any organ or tissue damage patient may have post-operative peritonitis, it will happen because of a patient&#x2019;s immune system and allergic reaction or patient may or may not be anemic4.&#xD;
&#xD;
Ascites is a medical condition in which there is an abnormal accumulation of peritoneal fluid in the peritoneum cavity, caused due to any serious injury to the small or large intestine and urinary tract injuries. But in her case ascites may be occurred due to portal venous pressure and low plasma protein. But no pieces of evidence were found. If peritoneal irritation found present, then leakage of lymphatic fluid in peritoneal cavity2.&#xD;
&#xD;
While performing surgery a surgeon should be very conscious while handling vital organs to prevent further postoperative complications. The gastrointestinal tract was investigated and there was no sign of perforation was found. The patient had no clinical finding in favour of pancreatitis, preoperatively ultrasonography was done liver was enlarged shown Hepatosplenomegaly with ascites. &#xD;
&#xD;
Gynaecologist has a major responsibility while performing lower segment caesarean section delivery. During surgery use, non-allergic chemical agents, before starting operation nurse has a responsibility to account all instruments that are necessary for surgery, sponges, and gauze pieces also count. Before the closure of the abdomen, the Surgeon should take feedback from the nurse regarding the counting of instruments, sponges and gauze pieces. The surgeon should be very careful and conscious while handling peritoneum and about tissues or organ damaging. Otherwise, it will be a life-threatening condition for the patient. The serious complication may cause morbidity and mortality.&#xD;
&#xD;
Conclusion:- &#xD;
&#xD;
Postoperative peritonitis and ascites due to unknown cause after a caesarean section delivery is a rare complication. In this case, the patient was completely investigated and monitored is there any possibility of bleeding of an organ or tissue damage of the small intestine and large intestine or urinary tract injury during the caesarean section. To manage all the situation emergency exploratory laparotomy is one of the surgical choices as early treatment and investigation; if the patient developed signs of peritonitis no definitive cause for the fluid accumulation can be found. Then many times this condition can be created through idiopathic allergic or inflammatory reaction of the peritoneum. On observation, it shows that after draining the fluid, patients recover well and no further medical intervention was required.&#xD;
&#xD;
Overall, this condition was very complicated for the patient. But due to the surgeon&#x2019;s expert team and excellent nursing care her condition was improved. In such type of cases, if a patient diagnosed at an early stage we can prevent morbidity and mortality in women. Otherwise, it will be very serious issues for the patient and patient life can be spoiled.&#xD;
&#xD;
On admission a 26-year-old- woman condition was life-threatening. It was complicated to handle because of all these condition patients were so fearful and tensed, the patient also developed postpartum symptoms and hence it was difficult to handle but after treatment and surgery slowly her condition was improved. She had multiple doubts regarding the overall condition and her every doubt were cleared. Excellent nursing care was given and she had given positive feedback to nursing staff, she felt better after surgery and she was satisfied. She always talked to every nursing personnel very nicely and given full co-operation to nursing personnel while giving therapeutic care and she was discharged from hospital with full recovery without any post-operative complication and satisfaction, with happy face along with her family members.&#xD;
&#xD;
Acknowledgement &#xD;
&#xD;
The author thanks Dr.Seema Singh, Professor, and Principal, Smt.Radhikabai Meghe Memorial College of Nursing. Datta Meghe Institute of Medical Sciences, Sawangi (Meghe) Wardha Maharashtra, India. For her timely support and valuable suggestions. Mrs.Vaishali Taksande, Professor, Dean, Dept. of OBGY, DMIMS (DU) for her continuous support and valuable suggestions. The author also thanks Mrs. Maurya, Professor, Dept. of Child Health Nursing. For her timely supports. Also, special thanks to Dr. Geet Mitha, Assistant Professor, General surgery unit, Acharya Vinoba Bhave Rural Hospital, DMIMS(DU), Sawangi (Meghe), Wardha, Maharashtra India.&#xD;
&#xD;
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. The authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this case report.&#xD;
&#xD;
Ethical approval&#xD;
&#xD;
Not applicable &#xD;
&#xD;
Patient Inform consent&#xD;
&#xD;
While preparing a case report and for publication patient&#x2019;s informed consent has been taken.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
The Author declares that there are no conflicts of interest.&#xD;
&#xD;
Funding &#xD;
&#xD;
Not applicable &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2988</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2988</Fulltext></URLs><References>1. Al Qahtani N. Caesarean section scar dehiscence with peritonitis: Does late surgical intervention minimize the risk of hysterectomy. Int J clinical &amp; case. 2017; 1(5):105-7.&#xD;
&#xD;
2. Rabiei M, Ghozat R. An unusual case of postoperative ascites after cesarean section delivery. Case Reports in Clinical Practice. 2016; 1(3):68-70.&#xD;
&#xD;
3. Daley BJ, Katz J, Anand BS. Peritonitis and abdominal sepsis. Medscape. Updated: Feb. 2015; 23.&#xD;
&#xD;
4. Gado A, Badawi H, Karim A. An unusual case of peritonitis following caesarean delivery. Alexandria journal of medicine. 2018; 54(4):369-71.&#xD;
&#xD;
5. Halfon JK.&#xA0;Post-??Cesarean Section Peritonitis at a Referral Hospital in Rwanda: Factors Associated&#xA0;(Doctoral dissertation, Duke University).&#xD;
&#xD;
6. Launey Y, Duteurtre B, Larmet R, Nessler N, Tawa A, Mall&#xE9;dant Y, Seguin P. Risk factors for mortality in postoperative peritonitis in critically ill patients. World journal of critical care medicine. 2017 Feb 4; 6(1):48.&#xD;
&#xD;
7. SN Chugh. Textbook of Medical-Surgical Nursing. First edition: 2013. Avichal publishing&#xD;
&#xD;
Company; 199&#x2013;201&#xD;
&#xD;
8.Mabewa A, Seni J, Chaya PL, Mshana SE, Gilyoma JM. Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania. World Journal of Emergency Surgery. 2015 Dec 1; 10(1):47&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Prevalence of Microalbuminuria in Type 2 Diabetes Mellitus: A Cross-sectional Study in Central India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>42</FirstPage><LastPage>45</LastPage><AuthorList><Author>Gajanan V. Wasalwar</Author><AuthorLanguage>English</AuthorLanguage><Author> D.S. Wasnik</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Type 2 diabetes mellitus(T2DM) is the most common disease that occurs when the body becomes insulin resistant or is not producing enough insulin. Nearly 30% of type 1 diabetes mellitus (DM) and about 25% of T2DM patients suffer from diabetic nephropathy. It is observed that there is an increase in urinary extraction of albumin i.e. microalbuminuria in the early phase of diabetic neuropathy. In diabetic nephropathy as well as morbidity and mortality by cardiovascular disease, microalbuminuria is one of the early markers. The present study is undertaken to know the presence of microalbuminuria in T2DM cases of Indian population living in central India. Material and Methods: Present cross-sectional study on 212 patients diagnosed with type 2 diabetes mellitus study was done at Govt. Medical College Chandrapur in collaboration with IGMC Nagpur. Criteria laid by American Diabetes Association (ADA) was used to define diabetes. Microalbuminuria was diagnosed if in albumin to creatinine ratio in urine ranged between 30-300mg/g. Results: Prevalence of microalbuminuria in the present study was observed to be 38.2%. Various parameters viz. age, duration of diabetes, fasting blood sugar, blood pressure significantly differed between those who had microalbuminuria vs in those with normoalbuminuria. Conclusion: In our study, 81 patients among 212 patients were diagnosed with albuminuria with the prevalence of 38.2% similar to that reported in a study of southern India. The high prevalence of diabetes in India indicates that it is necessary to detect diabetes early to reduce the burden of diabetic kidney disease in future.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> T2DM, ADA, Microalbuminuria, Heart, Blood vessels, Eyes, Kidneys and nerves</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Diabetes mellitus (DM) is a chronic, metabolic condition associated with elevated blood glucose (or blood sugar) levels, resulting in a significant heart problem, blood vessels, lungs, kidneys and nerves over time. Type 2 diabetes mellitus(T2DM) is the most common disease that occurs when the body becomes insulin resistant or is not producing enough insulin. The prevalence of T2DM has raised significantly in countries of all income levels during the past three decades.&#xA0; Globally diabetes has affected nearly 422 million people. A major proportion of people with the disease living in middle- and low-income countries[i].&#xA0; About 109 million people are expected to be affected by diabetes by 2035 in India, according to the International Diabetes Federation (IDF)[ii].&#xD;
&#xD;
T2DM, one of the major causes of mortality as well as morbidity and globally prevalent is considered to be a major risk factor for cardiovascular events[iii]. &#xA0;Nearly 30% of type 1 diabetes mellitus (DM) and about 25% of T2DM patients suffer from diabetic nephropathy. It is observed that there is an increase in urinary extraction of albumin i.e. microalbuminuria (MA) in the early phase of diabetic neuropathy.&#xA0; An only sensitive assay for urinary albumin can detect microalbuminuria. In about 30-40% of T2DM patients, abnormal levels of urinary albumin are observed. Microalbuminuria is an independent risk factor for cardiovascular disease and an early marker for diabetic nephropathy3. Excess secretion of urinary albumin may represent a more severe vascular damage compared to renal microvascular injury[iv]. Globally diabetic nephropathy is the top cause of end-stage renal disease and it has been proven that failure of the kidney is a major cause of death in T2DM patients[v],[vi]. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Diabetic neuropathy is developed by various stages including frank proteinuria (macroalbuminuria), hyperfiltration and microalbuminuria (MA). In diabetic nephropathy as well as morbidity and mortality by cardiovascular disease, MA is one of the early markers[vii]. Albumin levels of 30 to 300 mg in urine collected for 24 hours characterizes microalbuminuria[viii],9. Nearly half of the cases reach last-stage renal disease in 7 to 10 years when noticeable proteinuria is present. MA may be present at the time of diagnosis in T2DM patients which is more commonly accompanied by hypertension. In Type 2 diabetes (T2DM) patients microalbumin present in urine is probably an important early sign indicating the onset of systemic vasculopathy and is associated with damage of organs like brain, kidney and heart 6,10. &#xD;
&#xD;
All over the world, India has the highest number of patients suffering from diabetes which are further expected to rise in coming years 11. Therefore it is necessary to conduct studies on complications related to diabetes to evaluate the burden of disease. &#xA0;The present study is undertaken to know the presence of microalbuminuria in T2DM cases of Indian population living in central India. &#xD;
&#xD;
MATERIAL AND METHODS:&#xD;
&#xD;
The present study was done at Govt. Medical College Chandrapur in collaboration with IGMC Nagpur. This cross-sectional study was done on 212 subjects attending medicine OPD who were diagnosed with T2DM. The present study was carried out from October 2019 to January 2020. The following criteria laid by the American Diabetes Association (ADA)12 was used to define diabetes:&#xD;
&#xD;
&#xD;
	&#xD;
	Blood glucose(fasting) &#x2265; 126 mg/dL, where fasting is at least 8 hours with no intake of calories&#xD;
	&#xD;
	&#xD;
	HbA1C &#x2265; 6.5 %&#xD;
	&#xD;
	&#xD;
	During an oral glucose test plasma glucose (Two hours) &#x2265; 200mg/dl&#xD;
	&#xD;
	&#xD;
	Rand plasma glucose was greater than 200mg/dl in patients showing classical symptoms of hyperglycemia or its crisis.&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;Informed consent had been obtained from patients included in study and patients with DM type 1, pregnant women, macroalbuminuria congestive cardiac failure, primary kidney disease, infection of the urinary tract and patients with hypertension were excluded. &#xA0;Demographic details such as age, sex, duration of diabetes of patients were recorded. BMI (Body Mass Index) of patients was calculated from their height and weight and BMI &lt; 25kg/m2 was considered as normal. The upper right arm was used to record blood pressure. It was recorded in sitting position after rest of 5 minutes with aid of mercury sphygmomanometer. If the systolic blood pressure and/or diastolic blood pressure exceeded 130 mmHg and 85 mmHg, the patient was attributed as hypertensive. Patients were further subjected to testing of blood sugar (fasting), glycosylated haemoglobin HbA1c, serum triglyceride and serum cholesterol. HbA1c &lt; 7% was considered to be normal. The enzymatic method was used to determine blood sugar, cholesterol and triglyceride level. After fasting overnight, samples of urine were collected in the morning early. If the first sample of urine indicated macroalbuminuria, the subject was not considered in the study. Assessment of first urine was done to check if the gravity of urine exceeded 1.015 and the presence of hematuria and absence of infection of urine.&#xD;
&#xD;
Microalbuminuria was diagnosed if in two of three readings the albumin to creatinine ratio in urine ranged between 30-300mg/g. If the albumin-creatinine ratio was </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2989</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2989</Fulltext></URLs><References>&#xD;
	&#xD;
	Diabetes, https://www.who.int/health-topics/diabetes#tab=tab_1, accessed on May 3, 2020&#xD;
	&#xD;
	&#xD;
	Ramachandran A, Snehalatha C, Ma RC. Diabetes in South-East Asia: an update. Diabetes Res Clin Pract. 2014;103:231-7.&#xD;
	&#xD;
	&#xD;
	&#xA0;Ajonish Kamble, Ranjit S. Ambad, Mangesh Padamwar, Anupam Kakade, Meenakshi Yeola. To study the effect of oral vitamin D supplements on wound healing in patient with diabetic foot ulcer and its effect on lipid metabolism. Int. J. Res. Pharm. Sci., 2020, 11(2), 2701-2706.&#xD;
	&#xD;
	&#xD;
	Review Dyslipidemia in patients with type 2 diabetes. relationships between lipids, kidney disease and cardiovascular disease. Battisti WP, Palmisano J, Keane WE Clin Chem Lab Med. 2003 Sep; 41(9):1174-81. &#xD;
	&#xD;
	&#xD;
	Kassab A, Ajmi T, Issaoui M, Chaeib L, Miled A, Hammami M. Homocysteine enhances LDL fatty acid peroxidation, promoting microalbuminuria in type 2 diabetes. Ann Clin Biochem; 2008;45:476-80.&#xD;
	&#xD;
	&#xD;
	Ranjit S. Ambad, Rakesh Kumar Jha, Lata Kanyal Butola, Nandkishor Bankar, Brij Raj Singh, Archana Dhok. Relationship between uric acid and creatinine in pre-diabetic and diabetic patients: Vidarbha region of Maharashtra. Int. J. Res. Pharm. Sci., 2020, 11(3), 3412-3417.&#xD;
	&#xD;
	&#xD;
	Jerums G, MacIsaac RJ. Treatment of microalbuminuria in patients with type 2 diabetes mellitus. Treat Endocrinol 2002;1:163-73.&#xA0;&#xD;
	&#xD;
	&#xD;
	American Diabetes Association: Standards of medical care in diabetes. Diabetes Care 28(Suppl. 1): S4&#x2013;S36, 2005.&#xD;
	&#xD;
	&#xD;
	Bhinder, H.H.P.S., and T.K. Kamble. &#x201C;The Study of Carotid Intima-Media Thickness in Prediabetes and Its Correlation with Cardiovascular Risk Factors.&#x201D; Journal of Datta Meghe Institute of Medical Sciences University. 2018;13(2): 79&#x2013;82.&#xD;
	&#xD;
	&#xD;
	Bhinder, H.H.P.S., and T.K. Kamble. &#x201C;The Study of Carotid Intima-Media Thickness in Prediabetes and Its Correlation with Cardiovascular Risk Factors.&#x201D; Journal of Datta Meghe Institute of Medical Sciences University. 2018;13(2): 79&#x2013;82&#xD;
	&#xD;
	&#xD;
	Ramachandran A, Snehalatha C, Latha E, et al. Rising prevalence of NIDDM in an urban population in India. Diabetologia 1997; 40:232&#x2013;237.&#xD;
	&#xD;
	&#xD;
	&#xA0;Standards of Medical Care in Diabetes--2019. Diabetes Care 2019;42:S13-28.&#xD;
	&#xD;
	&#xD;
	Udit Narang, Vipin Jagadhami, Mohit Singla, Kiran Kumar Singal, Rajat Agarwal, Madhav Arora. A study of the prevalence of microalbuminuria and diabetic retinopathy in rural patients presenting to a tertiary care hospital in North India. International Journal of Contemporary Medical Research 2019;6(8): H18-H22.&#xD;
	&#xD;
	&#xD;
	Mohan MM, Chandra Sekhar V. Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus. Int J Adv Med 2015;2:383-6.&#xD;
	&#xD;
	&#xD;
	Ranjit Sidram Ambad, Gaikwad S B, Anshula G, Nandkishor Banker. Polyherbal antidiabetic drug: An approach to cure diabetes. Int. J. Res. Pharm. Sci., 2020, 11(2), 2679-2683.&#xD;
	&#xD;
	&#xD;
	A Varghese, R Deepa, M Rema, V Mohan. Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetes centre in southern India. Postgrad Med J 2001;77:399&#x2013;402.&#xD;
	&#xD;
	&#xD;
	Velayutharaj A., Muthumani L., Senthilnathan R., Rajendran S.M., Shivakumar R., Saraswathi R.. Significance 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 International Journal of Current Research and Review. 2018;10 (06): 07-09.&#xD;
	&#xD;
	&#xD;
	Suraj P Wagh, Shweta P Bhagat, Nandkishor Bankar, Karan Jain. Role of Vitamin-C Supplementation in Type II Diabetes Mellitus International Journal of Current Research and Review. 2020;12 (13): 61-64.&#xD;
	&#xD;
	&#xD;
	Haffner SM, Morales PA, Gruber MK, et al. Cardiovascular risk factors in non-insulin-dependent diabetic subjects with microalbuminuria. ArteriosclerThromb1993;13:205&#x2013;10.&#xD;
	&#xD;
	&#xD;
	Nelson RG, Kunzelman CL, Pettit DJ, et al. Albuminuria in type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia1989;32:870&#x2013;6.&#xD;
	&#xD;
	&#xD;
	Hamman RF, Franklin GA, Mayer EJ, et al. Microvascular complication of NIDDM in Hispanics and non-Hispanic whites. Diabetes Care. 1991;14:655&#x2013;63.&#xD;
	&#xD;
	&#xD;
	Vijay V, Snehalatha C, Shina K, et al. Familial aggregation of diabetic kidney disease in type 2 diabetes in south India. Diabetes Res Clin Pract. 1993;43:167&#x2013;71.&#xD;
	&#xD;
	&#xD;
	Phadnis, P., M.A. Kamble, S. Daigavane, P. Tidke, and S. Gautam. &#x201C;Prevalence and Risk Factors &#x2013; Hemoglobin A1c, Serum Magnesium, Lipids, and Microalbuminuria for Diabetic Retinopathy: A Rural Hospital-Based Study.&#x201D; JDMIMSU. &#xA0;2017;12 (2): 121&#x2013;32.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Mini-Review on Coronavirus Disease: A Novel Global Threat&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>46</FirstPage><LastPage>51</LastPage><AuthorList><Author>Farhath Sherin</Author><AuthorLanguage>English</AuthorLanguage><Author> Gomathy S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Novel Coronavirus is a single-stranded RNA Viruses infected by Severe Acute Respiratory Syndrom-Coronavirus-2 (SARS-CoV-2) which is first reported on Wuhan, China on January 7, 2020, and spreading all over the world rapidly. The new virus is threatening the whole world and the world is scared in front of the virus. WHO declared the outbreak as a pandemic on March 11, 2020. Report: It is reported that the viral infection is transmitting via airborne from human to human or animal to human. Pneumonia, cough, sneezing, cold and respiratory disease are the main symptoms of this viral infection. Unfortunately, there are no vaccines or clinically proved antiviral drugs for COVID-19. So we should strictly keep social distance and should maintain personal hygiene. It is better to identify the active cases as soon as possible and isolate the infected ones to break further spreading. Conclusion: In this review, we are discussing the background, etiology, transmission, clinical symptoms, Risk factors, treatment and preventive methods against COVID-19&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Coronavirus, COVID-19, SARS-CoV-2, MERS-CoV, SARS-CoV</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2990</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2990</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Hospital Nutritional Menu Customization System Integrated with Web-based Technology&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>52</FirstPage><LastPage>60</LastPage><AuthorList><Author>Heng Chin Yee</Author><AuthorLanguage>English</AuthorLanguage><Author> Zety Marlia Zainal Abidin</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Hospitals aimed to serve their patients with the best medical care services and saving lives. Yet, while most attention and financial cost are spent on the medical investigation, purchasing the latest technology and machines, the food and nutrition provided to patients are having less concern. Food consumed is one of the important factors that affect patient body health recovery. Majority of the hospitalized patients are dependent on the hospital food as their nutritional resources. Problem: A nutritious, wholesome and well-balanced meal can essentially increase patient&#x2019;s rate of recovery without using the unnecessary nutritional supplement. However, majority hospital serves the patient with the same meal which does not suit every patient&#x2019;s body condition. Therefore, the patient is unable to obtain enough nutrition to support body health and recovery. This may not bring big affection to the patient who are short-term hospitalization but to those who are long term hospitalized or having serious health problems. Also, the traditional way of taking the order lead to several problems, including patient inconvenience and data lost. Objective: In this paper, a hospital nutritional menu customization system has been proposed to resolve the mentioned problems. The proposed system is designed for hospital-use to allow the patient to customize their meal based on their food preference, food portion and nutritional needs. This system aims to solve the problem of the existing manual paper-based food ordering system and increases the efficiency as well as the data accuracy.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Health Information Management, Hospital, Food, Nutrition, BMI, Electronic Health Records</Keywords><Fulltext>Introduction &#xD;
&#xD;
Hospitals aimed to serve their patients with the best medical care services and saving lives. Yet, while most attention and financial cost are spent on the medical investigation, purchasing the latest technology and machines, the food and nutrition provided to patients are having less concern. Food consumed is one of the important factors that affect patient body health recovery.&#xA0; &#xD;
&#xD;
However, the food served in the majority hospital does not meet the food quality which suitable for the patient&#x2019;s recovery. To mass-produce patient meals with limited budgets, the majority hospital cuts down the budget spent on food preparation and mass-produce patient food economically. Some hospitals have abandoned the method of preparing raw food materials in-house. The patient meals are prepared through varies methods, including purchase from food catering sellers and purchase a frozen meal and partially prepared on the hospital dietary service department. This cause the unhealthiness in-hospital meal, which some of the food in their meals might even high in sugar, unhealthy fats and salt. 1,2&#xD;
&#xD;
Besides, the food served in the hospital is compulsorily the same, but it does not suit every patient&#x2019;s body condition. Therefore, the patient is unable to obtain enough nutrition to support body health and healing. This may not bring big affection to the patient who is short-term hospitalization but to those who are long term hospitalized or having serious health problems. Also, the traditional way of taking the order lead to several problems, including patient inconvenience and data lost. To solve the mentioned problems, the nutritional menu customization system is proposed. This system offers the patient with a wide variety of meal selection which matches with their health condition as well as their dietary restrictions. The proposed system aimed to satisfy the patient by providing a list of hospital meal that suits for patient&#x2019;s health condition and allow customization in portion and their dietary preferences.&#xD;
&#xD;
During hospitalization, patient meals are one of the crucial factors that lead to recovery. Majority of the hospitalized patients are dependent on the hospital food as their nutritional resources1.&#xA0; A nutritious, wholesome and well-balanced meal can essentially increase the patient&#x2019;s rate of recovery without using unnecessary nutritional supplement2. Therefore, the hospital shall provide food that satisfies the patients and meet the nutritional requirements.&#xD;
&#xD;
One problem of the current hospital catering service is the food wastage. One study has been carried out in the University hospitals to observe the amount of food wastage. During the 28-day-observation, more than 60% of hospital food is wasted. Total cost for the food wastage was 13,965 pounds3. The factor of causing the food wastage is mainly because the patient could not finish the food portion, lack of appetite and dissatisfied about the food quality4. &#xD;
&#xD;
A survey is conducted in two London teaching hospitals with a total amount of 48 patients who are from 8 different acute wards to get feedback about the food quality from the patient&#x2019;s perspective. According to the result of the survey, the majority of the patients are satisfied with the quality of food provided, however, the quantity served does not suit every patient. Almost half of the patients reported a problem of feeling hungry during hospitalization while a few reported could not finish the food portion5. This reflects the problem of food quantity measurement. Also, the patients complained about the difficulty of accessing food, including menus not enabling informed decision about what food met their needs and inflexible ordering systems. To solve the problem of food waste and improve the user experience of hospital food ordering system, nutritional menu customization allows patients to make the customization on their food menu. With this system, the patient can select their desire food portion, and this highly prevents food wastage. 3,4&#xD;
&#xD;
Currently, the majority of hospitals are still using the paper system to record their patient meals. One of the biggest problems is that the patient who missed the chance to fill in the food menu before the nurse collects the paper menu will be given random meals. This action may reduce the patient&#x2019;s satisfaction towards the hospital meals. Another problem with the paper system is not user friendly to the patient with special physical needs that could not fill out the paper menu by himself6. This again led to the problem of the patient cannot select meals based on their preference. Other than that, by using the paper system, the margin for error is huge. Food allergy might occur as patients forgot to fill out their orders or neglected their dietary restrictions, or the nurse forgot to inform to the dietary service department. With the nutritional menu customization system, the user can select the meal customized for them and make remarks on their dietary restrictions.7,8&#xD;
&#xD;
To deliver a nutritional menu customization system which can generate wholesome meal that provides sufficient nutrition and satisfies patient&#x2019;s preference, with the least amount of food wastage.&#xD;
&#xD;
-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To investigate the majority patient&#x2019;s meal preference and desired portion&#xD;
&#xD;
-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To study food ingredient that rich of nutrients&#xD;
&#xD;
-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To research the ingredients that help in patient&#x2019;s body recovery&#xD;
&#xD;
-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To store the patient&#x2019;s health condition and level of nutritional needs. &#xD;
&#xD;
-To produce a recipe after considering the patient&#x2019;s body condition as well as restriction, eg: lactose intolerant, allergen&#xD;
&#xD;
-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To allow the patient to schedule their meal of the day from the generated menu&#xD;
&#xD;
There are four user types in the HNMC system, which are patient, nutritionist, admin and food service worker. The patient can create the meal, edit meal detail, view meal detail and delete meal. Besides, the patient can add meal to a meal schedule, view meal schedule, edit meal schedule and view personal BMI. A nutritionist can register new patient, view patient information, edit patient detail and delete patient. Furthermore, the nutritionist can suggest nutritional food to the patient and view the patient&#x2019;s meal schedule. Admin can register nutritionist and food service worker account, edit nutritionist and food service worker information, view all nutritionists and food service worker and delete nutritionist and food service worker account. A food service worker can view a meal delivery schedule and information. &#xD;
&#xD;
Literature Review&#xD;
&#xD;
Hospital meal plays an important role in the patient&#x2019;s body health recovery. A healthy meal is essential for the patient that every hospital should provide to their patient. However, the current hospital menu ordering system does not satisfy the patient in various ways. Malnutrition is a common problem among hospitalized patient7. The purpose of hospital food is to provide a healthy diet to the patient during hospitalization to help them in modelling their diet behaviour. However, inappropriate hospital meal can bring a significant threat that affects the patients&#x2019; health. According to Fernando and Wijesinghe, the traditional hospital food catering system repeats the menu over weeks, therefore results in high food wastage and patient&#x2019;s dissatisfaction8. &#xD;
&#xD;
According to an article published by The Star, hospitals are unable to support the patient&#x2019;s nutritional needs as the diet requirements of patients with different sicknesses are not the same. Based on this issue, the newspaper has interviewed an experienced nutritionist. The interviewee, consultant dietitian Lim Kwee Ean has introduced the legal standard of regular diet is consuming 1800-2000 kJ of energy formed by 50-55% of carbohydrates, 15-20% of proteins and less than 30% of fat. However, current hospital catering does not satisfy the patient needs and does not meet the legal standard of regular diet9. This made a great impact on the patient&#x2019;s process of recovery. Improvement of hospital meal needs to be made as it is the main source for the patient to optimize their protein and energy intake during hospitalization. &#xD;
&#xD;
One factor of causing malnutrition in hospital food is the cut down of budget in preparing hospital meal. To reduce cost, many hospitals decided to cut the budget used in the patient meal by replacing the ingredient with frozen ingredient and change the cooking method to reheating and serve ready-cooked food to the patients. In the year 2013, the Scottish Government has reduced the food and drink budgets to national hospitals from &#xA3;32.6million to &#xA3;29.7million. This great deduction caused the national hospitals to shut down their kitchens and began to buy in ready-made food to be served to patients10.&#xD;
&#xD;
Another article has been published in the year 2014 regarding the cut down of catering budgets from NHS hospitals. NHS hospital has cut down the spare of cost on hospital catering, resulting thousands of NHS patient were forced to eat the reheated meal that cost less than a packet of potato chips, which makes no sense that it could be nutritious. One of the patients in the NHS hospital revealed that she was served with a bowl of boiled water with an instant soup stock cube during hospitalization11. These articles have proved that many hospitals have forgotten the needs of nutritious hospital meal to the patient and they focus on the hospital profit more than the patients. There is a need to highlight the importance of hospital meal to the hospital and raise awareness regarding the importance of nutrient levels in hospital meal. 11&#xD;
&#xD;
Food nutrition is significant for patient&#x2019;s body recovery. With good guidance on food consumed, the patient&#x2019;s rate of recovery can be increased. Nutritional food is important for the patient, especially for those who need additional care. An investigation on the importance of food nutrition to patient&#x2019;s recovery is being conducted in the year of 200212.&#xA0; A group of patients with stable angina are selected as the participant of the investigation. They are given nutritional medical food enriched with the nutrient they need during the investigation period. After a month, results showed that patients have a different level of recovery and less angina onset time after consuming the nutritional food. The nutritional meal has improved the flow-mediated vasodilation and improves their vascular function. This investigation has proven that the food provided by the hospital is significant to patient recovery.&#xD;
&#xD;
A study on the quality of food and nutritional care in hospitals has been conducted in the year of 2012.37 hospitals are being assessed under two quality control corpora, the Nutritional Care Quality (NCQ) and the Hospital Food Service Quality (FSQ)13.&#xA0; However, the results of the investigation showed that both nutritional care and food services are all below standard14. Due to the financial control and the allocation of budgets, majority hospitals did not pay concern to the nutrition level of hospital meal, and not aware of the importance of providing highly nutritious food to the patients15. A survey is conducted by the Campaign for Better Hospital Food Organization to investigate the quality of hospital meal in London hospitals. The result shows that among all London hospitals, only 23% provide freshly prepared meals to the patients and 77% serves reheated airline-style food from plastic containers to their patients. More than half of the investigated hospital has failed to meet the basic standards for hydration and nutrition as the quality of the meal served to the patient are worse than those served in prisons and schools16. This investigation has shown that currently, the majority hospital does not serve fresh and tasty food to the patient. &#xD;
&#xD;
Research Towards Nutrition Information&#xD;
&#xD;
The proposed system aims to achieve in assisting the patient to customize a healthy and nutritional meal that fulfil nutritional needs for body recovery and satisfy the patient&#x2019;s dietary preference. The food consumed by the patient is important and needs to be measured. A dietary concept is proposed by the United State Department of Agriculture under one of the Nutrition Policy and Promotion of US (CNPP). The concept of MyPlate is to build healthy eating habits in our daily life and to improve the nutrition consumptions of Americans17. &#xD;
&#xD;
&#xD;
&#xD;
Figure 1 illustrates the concept of MyPlate. The image of MyPlate is a plate that divided into four sections with a circle component on the right of the plate. The image allows the user to visualize the nutrients and amount of each nutrient he or she should consume. The MyPlate shown in the diagram refers to the nutrient consumptions of a person without health issues, therefore, the portion and the needs of consuming each nutrient are varying depends on an individual&#x2019;s health conditions. In the HNMC system, the concept of MyPlate is adopted. Each patient&#x2019;s MyPlate is being customized based on their dietary restrictions and the health condition. &#xD;
&#xD;
Other than the portion of nutrient consumption, ingredients that made up a meal needs to be concerned. The food pyramid is designed by grouping the food and ingredients according to their nutrient&#x2019;s similarity. By referring to the food pyramid, people can know if they are consuming the right amount of the basic nutrients and the food to boost each nutrient. However, the normal food pyramid is only suitable for people who are healthy that has no health issues. The needs for healthy people in the diet is to maintain their body healthy and sustain their body energy. This is not suitable to be adopted by a person with a health issue as their main concern is to improve their health condition and recovery. &#xD;
&#xD;
Based on the concern, a food pyramid for the patient has been proposed by the University of Michigan Health System18. It is known as healing foods pyramid and it was built upon the needs of the patient. It emphasizes foods that nourish the body and contains healing qualities and essential nutrients that able to sustain energy over time. Apart from the normal food pyramids, it focuses on the nutrients that able to supply body energy and vitamins to boost the body recovery18. &#xD;
&#xD;
&#xD;
&#xD;
In the healing foods pyramid, the bottom of the pyramid contains water, Figure 2. Water is important as the body needs water in all the cells, tissues and organs to maintain bodily functions. It is a need for the patient to consume a larger amount of water in sustaining body condition and stay hydrated. Vegetables and fruits are in the second last of the pyramid. They are the main source of vitamins and minerals. They contain high fibre that helps to maintain the health of the gut and prevent constipation and digestion problems19. &#xD;
&#xD;
By referring to the healing foods pyramid, the nutritional food provided in the system is being selected and filtered. All fruits and vegetables contain healthful fibre, minerals and vitamins. However, some has better health benefits compared to others.20 In the system, it stores the fruits and vegetables that provide most healthful nutrients that can help in the patient&#x2019;s body recovery. &#xD;
&#xD;
Similar System&#xD;
&#xD;
Nowadays, there are a few hospital food catering system on the market. Below is Table 1 of the competitor of a nutritional menu customization system. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The nutritional menu customization system is a comprehensive patient meal service system that focuses on patient&#x2019;s dietary preference as well as their health condition. It customizes and suggests food menu for the patient based on their body health condition. It takes patients food preference, dietary restrictions and allergy ingredients into consideration and aims to generate the most suitable menu to the patient. &#xD;
&#xD;
&#xD;
&#xD;
Based on the comparison Table 2 provided, nutritional menu customization system is equipped with majority features. It is a system that allows the nutritionist to customize food menu for each patient according to their health condition to fulfil the patient&#x2019;s nutritional needs. It first collects the information about the patient, including the patient&#x2019;s allergens, body health condition and what nutrition the patient lack of. With the information, system checks for the nutritional food that is suitable for the patient. After that, it generates a list of healthy food which suits the patient. To satisfy the patient&#x2019;s preference, he or she can view and select the food from the list of generated menus as the meal of the day. Also, to prevent food wastage, the patient can choose the food portion that he or she can finish. &#xD;
&#xD;
Technical Research&#xD;
&#xD;
C# is being selected as the programming language for the Hospital Nutritional Menu customization system development. Visual Studio 2017 is selected as the IDE and entity framework is selected as the libraries and tools of the proposed system. Microsoft SQL Server is chosen as the database management system and Windows 10 is being selected as the operating system of the proposed system. Internet Information Services (IIS) is selected as the webserver and google chrome is selected as the web browser of the proposed system. Static Content Hosting is adopted as the cloud design pattern for the HNMC system development.&#xD;
&#xD;
System Development methodology refers to the framework used in structuring, planning and controlling a system development process24. Various methodologies are being identified. Among all, three methodologies are being introduced and compared in Table 3 to select the most appropriate methodology to be used in the HNMC system development. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Through comparison, Scrum methodology is being selected. Scrum methodology is the most preferred methodology for HNMC system development. It is an agile project management methodology that able to deliver a higher-quality system in a short period. Also, its iterative nature allows the system to adapt to the changes made during the development phase. It has high adaptability to change as it prevents changes from disrupting the entire project course. Scrum made the development process high in transparency as the developers can ensure what is being developed is what they are expecting. By using Scrum methodology, the developer can have a clear big picture on the project estimated time, resource and cost27. &#xD;
&#xD;
Implementation&#xD;
&#xD;
In this page, the admin needs to insert patient&#x2019;s basic information, including patient full name, Date of Birth, gender, BayID, Duration of hospitalization and religion. Admin can select patient hospitalization starting date and ending date using the calendar, Figure 3.&#xD;
&#xD;
&#xD;
&#xD;
In this page, the admin needs to insert food name, select food category and select food availability in restriction. Admin can select food category from the dropdown list and click on the food restriction checkbox to select the food availability in the restriction, Figure 4.&#xD;
&#xD;
&#xD;
&#xD;
In the patient home page, patient Bay ID and the patient name is displayed on the left of the page. Patient BMI is displayed and a BMI range and categories are shown below the patient name (shown in Figure 5). Patient&#x2019;s BMI level is highlighted with a black border around the level to indicate the patient. The patient BMI is calculated based on the weight and height inserted by the nutritionist and the patient is only allowed to view the BMI but not edit it. The patient meal schedule is displayed on the right side of the BMI range. In the patient meal schedule, it shows the patient meal schedule along with the patient meal and the portion. In the meal schedule, a carousel is used to allow the patient to change and select the meal schedule. The patient can click the left arrow to view previous meal schedule and right arrow to view the next meal schedule. Table 4 and Table 5 presents the unit test for the login and add a meal.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
There are several features that the Hospital Nutritional Menu Customization system does not involve, which is being defined as the limitation of the system. In the HNMC system, nutritionist is in charge of select nutrition food ingredients to a patient. A nutritionist can select up to 5 foods in each nutrition group to a patient, which is 25 food options in total. However, the patient might not be satisfying with the food ingredients suggested by the nutritionist. If the patient does not satisfy with all 5 food ingredients suggested by a nutritionist, he or she can only inform the nutritionist through communication externally outside of the system as the system does not provide a platform for the user to interact with each other. &#xD;
&#xD;
The second limitation is the food portion estimation. The patient can select the portion of food in a small, normal and large portion. However, there is no exact measure or ways to define the serving size of the food as the term &#x2018;normal&#x2019; is ambiguous. The patient cannot visualize the serving size of the food portion until the meal is served to him or her. Hence, despite the system allows the patient to select the meal portion and the options are provided, the patient might still have confusion on deciding the food portion. &#xD;
&#xD;
In the HNMC system, some enhancement can be achieved in future time, which is shown as below:&#xD;
&#xD;
-Private Chat between user and nutritionist&#xD;
&#xD;
Currently, the system does not support interaction between patient and nutritionist. Thus, if the patient has any question or inquiries towards his nutritional information, the patient can only consult the nutritionist outside of the system. In future enhancement, a chat function can be implemented to allow the patient to consult the nutritionist using the system. &#xD;
&#xD;
- Allow Upload Image File&#xD;
&#xD;
Currently, the system provides nutritional food without showing the image. Also, the patient might have difficulty in visualizing the food portion. In future time, enhancement can be made to allow the admin to upload image file on the portion serving size and the image of nutritional food. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
Throughout the software development, the proposed Hospital Nutritional Menu Customization system is being developed. The system involves four user types, which are admin, nutritionist, patient and food, service worker. By using the system, admin can manage user accounts and nutritional foods in the system. A nutritionist can add nutrition information for patients and suggest nutritional foods for the patient. With the system, the patient can customize the meal schedule with their desirable food portion and foods. Foodservice worker can view the meal delivery information to know the time and sickbay to deliver the meal. &#xD;
&#xD;
To achieve the project aim and objectives, the developer spent a considerable amount of time in investigating and conducting research towards the problem and solution. After studied through journals and articles related to hospital catering services, the developer collected sufficient information towards the current situation of the majority food catering system in hospitals. The developer conducted a study on the methods of resolving the realized problem and finally, the developer adopted the concept of MyPlate and healing food pyramid as the guide of patient nutrition consumption. In the system design, the developer designed the storyboard of the proposed system. The main feature of the system is to allow the patient to customize their meal. Thus, the developer spent some time designing the metal plate based on the MyPlate concept. During the development of the HNMC system, the developer created a functional meal plate using the design illustrated in storyboard and majority webpages are designed according to the storyboard of the system.&#xD;
&#xD;
For future enhancement, the developer would like to improve on the system by adding more remarks to indicate the user what to do on each page. Also, the developer would like to develop on a chat platform within the HNMC system to allow the patient to interact with the nutritionist. Other than that, the developer would like to enable admin and nutritionist in adding remarks for the patient that has special needs in future time. &#xD;
&#xD;
Acknowledgements&#xD;
&#xD;
The authors also wish to express gratitude to the management of Asia Pacific University of Technology &amp; Innovation (APU) for their support.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
The authors involved in the current study does not declare any competing conflict of interest.&#xD;
&#xD;
Funding and Sponsorship&#xD;
&#xD;
No fund or sponsorship in any form was obtained from any organization for carrying out this research work.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2991</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2991</Fulltext></URLs><References>1. Hartwell H, Edwards JS. A preliminary assessment of two hospital food service systems using parameters of food safety and consumer opinion. The journal of the Royal Society for the Promotion of Health. 2001 Dec;121(4):236-42.&#xD;
&#xD;
2. Cymru, Swyddfa Archwilio.Hospital Catering and Patient Nutrition. United Kingdom: Wales Audit Office, 2011.&#xD;
&#xD;
3. Naithani S, Whelan K, Thomas J, Gulliford MC, Morgan M. Hospital inpatients&#x2019; experiences of access to food: a qualitative interview and observational study. Health Expectations. 2008 Sep;11(3):294-303.&#xD;
&#xD;
4. Sahin B, Demir C, Celik Y, Teke AK. Factors affecting satisfaction level with the food services in a military hospital. Journal of medical systems. 2006 Oct 1;30(5):381-7.&#xD;
&#xD;
5. Watters CA, Sorensen J, Fiala A, Wismer W. Exploring patient satisfaction with foodservice through focus groups and meal rounds. Journal of the American dietetic association. 2003 Oct 1;103(10):1347-9.&#xD;
&#xD;
6. Breitmeyer, Richard. Limitation of Manual Data Entry In Hospital Catering System. [Online] 2015. [Cited: December 24, 2018.] https://klipboard.io/limitation-of-manual-data-entry-in-hospital-catering-system/.&#xD;
&#xD;
7. Azeman AR, Adenan H. Patients Satisifaction Towards Private Hospital Food Services in Melaka. Journal of Hospitality and Networks. 2018;1(1):32-6.&#xD;
&#xD;
8. Fernando GH, Wijesinghe CJ. Quality and standards of hospital food service; a critical analysis and suggestions for improvements. Galle Medical Journal. 2017 Dec 11;22(2).&#xD;
&#xD;
9. The Star Online. The art of hospital food. [Online] 2004. [Cited: October 05, 2019.] https://www.thestar.com.my/lifestyle/health/2004/01/04/the-art-of-hospital-food.&#xD;
&#xD;
10. Daily Mail. Revealed: The 89p meals that shame NHS hospitals after catering budgets slashed by up to 10%. [Online] 2014. [Cited: October 05, 2019.] https://www.dailymail.co.uk/news/article-2804476/Meals-shame-Scottish-hospitals-3million-cuts-hit-hospital-food-forcing-thousands-patients-eat-89p-dishes.html.&#xD;
&#xD;
11. Matthews, Stephen. Government launches review into food served in NHS hospitals in the wake of listeria deaths linked to pre-packaged sandwiches - and Great British Bake Off&#x2019;s Prue Leith will act as an advisor. [Online] 2019. [Cited: October 05, 2019.] https://www.dailymail.co.uk/health/article-7383527/Government-launches-review-food-served-NHS-hospitals.html.&#xD;
&#xD;
12. Maxwell AJ, Zapien MP, Pearce GL, MacCallum G, Stone PH. Randomized trial of a medical food for the dietary management of chronic, stable angina. Journal of the American College of Cardiology. 2002 Jan 2;39(1):37-45.&#xD;
&#xD;
13. Donini LM, Castellaneta E, De Guglielmi S, De Felice MR, Savina C, Coletti C, Paolini M, Cannella C. Improvement in the quality of the catering service of a rehabilitation hospital. Clinical Nutrition. 2008 Feb 1;27(1):105-14.&#xD;
&#xD;
14. Diez-Garcia RW, de Sousa AA, da Costa Proen&#xE7;a RP, Leandro-Merhi VA, Martinez EZ. Gauging food and nutritional care quality in hospitals. Nutrition Journal. 2012 Dec 1;11(1):66.&#xD;
&#xD;
15. Beck AM, Balkn UN, F&#xFC;rst P, Hasunen K, Jones L, Keller U, Melchior JC, Mikkelsen BE, Schauder P, Sivonen L, Zinck O. Food and nutritional care in hospitals: how to prevent undernutrition&#x2013;report and guidelines from the Council of Europe. Clinical Nutrition. 2001 Oct 1;20(5):455-60.&#xD;
&#xD;
16. Knapton, Sarah. Hospital food divide: doctors and nurses eat better than sick patients. [Online] 2017. [Cited: October 05, 2019.] https://www.telegraph.co.uk/science/2017/03/23/hospital-food-divide-doctors-nurses-eat-better-sick-patients/.&#xD;
&#xD;
17. USDA. ChooseMyPlate. [Online] 2020. [Cited: January 14, 2020.] https://www.choosemyplate.gov/.&#xD;
&#xD;
18. Riley M, Locke A, Skye EP. Health maintenance in school-aged children: Part II. Counseling recommendations. American family physician. 2011 Mar 15;83(6):689-94.&#xD;
&#xD;
19. NHS. WHY 5 A DAY? [Online] 2020. [Cited: January 15, 2020.] https://www.nhs.uk/live-well/eat-well/why-5-a-day/.&#xD;
&#xD;
20. Marengo, Katherine. What are the most healthful vegetables? [Online] 2018. [Cited: January 16, 2020.] https://www.medicalnewstoday.com/articles/323319.&#xD;
&#xD;
21. VersaSuite. The Food Services Solution for Facilities of All Sizes. [Online] 2019. [Cited: January 02, 2019.] https://versasuite.com/food-services/.&#xD;
&#xD;
22. Saffron. Saffron Patient Ordering. [Online] 2019. [Cited: January 02, 2019.] https://fdhospitality.com/product/saffron-patient-ordering/.&#xD;
&#xD;
23. RMS Omega HealthCare Technologies. Software Hospital Food Service Management: Manage Food Service Operations within the Hospital. [Online] 2019. [Cited: January 02, 2019.] https://rmsomega.com/healthcare/products/food-service-management/.&#xD;
&#xD;
24. Bagaro, Lodza. Systems development methodology. [Online] 2016. [Cited: October 04, 2019.] https://www.supinfo.com/articles/single/2880-systems-development-methodology.&#xD;
&#xD;
25. TutorialsPoint. SDLC - Waterfall Model. [Online] 2019. [Cited: October 06, 2019.] https://www.tutorialspoint.com/sdlc/sdlc_waterfall_model.htm.&#xD;
&#xD;
26. &#x2014;. SDLC - Spiral Model. [Online] 2019. [Cited: October 05, 2019.] https://www.tutorialspoint.com/sdlc/sdlc_spiral_model.htm.&#xD;
&#xD;
27. Guru99. Agile Vs Scrum: Know the Difference. [Online] 2019. [Cited: October 05, 2019.] https://www.guru99.com/agile-vs-scrum.html&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Clinical Case Report on Extra Pyramidal Symptoms&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>61</FirstPage><LastPage>65</LastPage><AuthorList><Author>Jaya Pranoykumar Gawai</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Extrapyramidal signs are side effects of antipsychotic medications when the patient is receiving Schizophrenia treatment. Such signs include dystonia (continuous spasms and muscle contractions), akathisia (may manifest as muscular restlessness), Parkinsonism (characteristic signs such as stiffness), bradykinesia (slow motion), tremor, and intermittent dyskinesia (irregular, jerky motion). Aim: This case report aims to identify extrapyramidal symptoms at the earliest, prevent potential harm and to provide quality of nursing care to the patients. Objectives: 1. To identify extrapyramidal symptoms by the nurses and to report immediately. 2. To take action immediately and to prevent adverse effects. Results: The patient was taking Tab. Olanzapine 20mg for 25 years, abruptly stopped the medicine without consulting to the psychiatrist and the patient started with abnormal movements of lips, head and neck for two days. The patient was treated with Tab.Pacitone12 mg, movements were minimized. Conclusion: The nurses play a vital role at the bedside and take care of psychiatric patients when they receive antipsychotic drugs.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Extrapyramidal symptoms, Dystonia, Antipsychotic drugs, Parkinsonism, Olanzapine, Haloperidol MESH TERMS Antipsychotic agents Hypokinesia Dystonia in Parkinson&#x2019;s disease Dystonia and related activity Benzadiazepines Psychomotor agitation</Keywords><Fulltext>Introduction&#xD;
&#xD;
There is evidence that Olanzapine is more effective than Divalproex, causing less nausea but more weight gain, drowsiness and movement disorders. When compared with haloperidol ineffectiveness, Olanzapine induces fewer movement disturbances, but there will be greater weight gain in the individuals treated by the above drugs.1&#xD;
&#xD;
Olanzapine increases the patient sleepiness more and if the psychiatrist prescribes the dosage of Tab. Olanzapine5mgs may be the likelihood of being reduced sleep of the patient without any harm to the patient. Whereas Tab. Olanzapine 20 mg was prescribed for this particular case, the patient had good sleep and the side effects should be more concerned. There is evidence the patient one who is taking Olanzapine with combined standard treatment might be having improved quality of life than with any one of the treatment alone and still it is not sure. &#xD;
&#xD;
Extrapyramidal side effects and dyskinesias, as well as in the ECG prolongation of QT interval, the time between the Q and T waves, the time is taken for the heart to repolarise and is corrected to take account of the heart rate. Prolongation of the QT interval may lead to sudden death due to the increased potential of malignant ventricular tachyarrhythmias.2&#xD;
&#xD;
Case history&#xD;
&#xD;
This case report has been taken DMIMS (Deemed to be University), Sawangi (Meghe), Wardha where lack of mental health services for the remote population and underprivileged population, Acharya Vinobha Bhave Rural Hospital provides mental health care services for all the needy people.&#xA0; &#xD;
&#xD;
Patient Information&#xD;
&#xD;
One of the female patient, 55 years old, got admitted in the psychiatric ward, Acharya Vinobha Bhave Rural Hospital with a known case of Schizophrenia for the past 25 years. Since then she was taking several antipsychotic drugs and regular visit to the psychiatrist. Past two years she was prescribed to take Tab.Olanzapine 20 mg and Tab. Haloperidol 5mgs by the psychiatrist. Her husband understood the cost of Tab. Olanzapine 20 mg is expensive and he stopped the medicine abruptly without consulting to the psychiatrist, continued with the only Tab. Haloperidol 5 mg for two weeks and then the patient herself skipping Tab. Haloperidol 5mgs a week before she comes to the hospital because she claims that the medications had given her chest pain, breathlessness and mouth ulcers. Patient started to develop paranoid spells, believing that her son had pinched her and her husband drained her blood and selling it secretly. She also thinks that her family members were trying to kill her for her property, suspiciousness, aggressive, sleep disturbance, irritabilities and muttering to self and abnormal movements of lips, head and neck since 2 Days. She was taken to AVBRH Psychiatric OPD by her husband and was admitted on 19/1/2020 for further evaluation.&#xD;
&#xD;
Precipitating factors&#xD;
&#xD;
According to family history, she is the only daughter and another sibling of an elder brother for their parents. Her parents had special emotional attachment towards her because she is the only daughter, after getting married she started having the symptoms of Paranoid schizophrenia and on regular treatment. Another reason one of her cousins told her that her husband is having extramarital relationships with someone in the year of 1995 since then she started doubting her husband.&#xD;
&#xD;
Perpetuating factors&#xD;
&#xD;
The patient is poor compliance to medication for the past week, developed delusional thinking towards her family.&#xD;
&#xD;
Past psychiatric history&#xD;
&#xD;
Since 1995 the first episode, she was taken to a psychiatrist and taken treatment for a while. Since then, she always develops suspiciousness towards her husband and even with her relatives when she was on medications. In 2009, after being on antipsychotics for several years, developed muscle spasms, neck rigidity, and headache and then taken to a psychiatrist, she was diagnosed as suffering from the extrapyramidal syndrome.&#xD;
&#xD;
Signs and symptoms were:&#xD;
&#xD;
This patient presented with typical symptoms of Bradykinesia, eye spasms or blinking, twisting head, protruding tongue, extended neck, physical discomfort, agitation, anxiety, shaking legs, Repetitive, involuntary facial movements, such as tongue-twisting, chewing motions and lip-smacking, cheek puffing, and grimacing. Changes in gait, jerky limb movements, or shrugging, Rigid muscles and fever, drowsiness and confusion shown in Table 1&#xD;
&#xD;
&#xD;
&#xD;
Timeline&#xD;
&#xD;
The patient was admitted for three weeks and the nursing care has been rendered along with the psychopharmacological interventions. The patient discharged from the hospital in a good condition and follow up has been taken regularly in the psychiatric OPD every week.&#xD;
&#xD;
Diagnostic Assessment&#xD;
&#xD;
Physical examination: Unstable gait, abnormal facial movements, smacking lips, abnormal neck movements.&#xD;
&#xD;
Mental status examination: Abnormal speech, inappropriate affect, delusional thought&#xD;
&#xD;
Presented with Thanatophobia and Pistanthrophobia, Obsessional compulsive phenomena, perceptional abnormalities, attention, concentration, recent and remote memory, intelligence, and judgment was found to be affected and impaired. Disturbed sleeping pattern and anorexia were present in the patient.&#xD;
&#xD;
Data extraction&#xD;
&#xD;
Data extracted from PUB MED, Medline, and Cochrane database library.&#xD;
&#xD;
&#xD;
&#xD;
Follow-up and outcomes&#xD;
&#xD;
Follow up has been taken regularly, the patient visits psychiatric OPD every week and there were no side effects have been reported.&#xD;
&#xD;
Primary Outcome&#xD;
&#xD;
The evidence of extrapyramidal symptoms was minimized by anticholinergic drugs and adjunct with other psychosocial therapies.&#xD;
&#xD;
Secondary outcome&#xD;
&#xD;
Regular follow up will prevent adverse effects of newly prescribed antipsychotic drug.&#xD;
&#xD;
Discussion&#xD;
&#xD;
Amisulprideequally effective as olanzapine and risperidone, Olanzapine induces a higher increase of glucose. There is no difference in terms of cardiac effects and extrapyramidal symptoms (EPS) compared with olanzapine, risperidone and compared with Ziprasidone.3&#xD;
&#xD;
Aripiprazole is typical antipsychotics and safer for children having Schizophrenia, this drug induces fewer occurrences of extrapyramidal symptom, and particularly akathisia. There is evidence through RCT it induces hyperprolactinaemia, lesser risk of sinus tachycardia, blurred vision but causes dizziness and nausea.4&#xD;
&#xD;
The trials compared oral Zuclopenthixol dihydrochloride to placebo, Zuclopenthixol dihydrochloride might be causing more movement disorders than Clozapine, Risperidone or perphenazine, other drug comparisons or placebo.5&#xD;
&#xD;
One of the animal studies revealed, Haloperidol was administered orally at a dose of 0.2 mg/rat/day in rats for 5 weeks and the rats developed dull chewing movements after 2 weeks but the treatment continued for 5 weeks. Motor coordination observed after 3 weeks and tolerance for the Haloperidol-induced motor impairment after 5 weeks of treatment. Motor activity observed by administration of IMI (intraperitoneally, for 5 weeks) did not have a motor activity or motor coordination.6&#xD;
&#xD;
Another trial reported Tab. Haloperidolingesting with water is recommended dose by the psychiatrist exhibited reduced exploratory activity without producing akinesia. Motor coordination was impaired at the maximum after 3 weeks treatment and tolerance were developed in the drug-induced motor impairment after 5 weeks of treatment. The intensity of vacuous chewing movements (VCMs) and tardive VCMs was greater by oral administration than intraperitoneal injections of haloperidol. The results show that oral administration of haloperidol produces constant effect thus resulting intolerance in the case of acute parkinsonian but more intensity of tardive dyskinesia. Oral Haloperidol may help alleviate tardive dyskinesia.7&#xD;
&#xD;
Tardive dyskinesia is a disturbance in the human balance between stimulation of the dopamine receptor and blockage of the dopamine receptor in the motor striatum, with hypothetically too much stimulation of the supersensitive D2 receptor resulting in "don&amp;#39;t stop" signalling for motor output.8&#xD;
&#xD;
There is evidence; dysphagia may be resulted by first- and second-generation of antipsychotics and this may be an extrapyramidal adverse reaction or related to anticholinergic effects of antipsychotics. Management of dysphagia includes discontinue the antipsychotic, reduce the dose, divide the dose, or switching to another antipsychotic drug. Dysphagia may be causing the immediate effect of airway obstruction like choking, asphyxia, aspiration pneumonia, and longer effect of weight loss, dehydration, malnutrition, and poor compliance to an oral antipsychotic drug.9&#xD;
&#xD;
There is the evidence: olanzapine induces metabolic syndrome and dyslipidemias but less risk of developing extrapyramidal syndromes (EPS) other tardive syndromes are more concern, tardive dyskinesia, tardive akathisia, and tardive dystonia are the commonest tardive syndromes, the others are less common. Tardive oculogyric crises (TOC) are an uncommon form of tardive dystonia. The present patient also had TOC with unsupervised treatment with olanzapine and no report of weight gain. In the case, the low dose of trihexyphenidyl can be started and stopping of &#xA0;Olanzapine and also aripiprazole can be initiated, the present patient also Olanzapine has stopped now.10&#xD;
&#xD;
Atypical antipsychotics are first-line treatment for schizophrenia because of less risk of EPS compared with conventional antipsychotics. EPS can occur when antipsychotic drugs are prescribed in a higher dose. A typical antipsychotics should balance with other side effects also.11 &#xD;
&#xD;
Intramuscular Midazolam found more effective sedation in agitated patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine. Olanzapine provides more effective sedation than haloperidol.12&#xD;
&#xD;
The evidence found that olanzapine treatment is associated with a normalization of brain activity in schizophrenia patients. Typical functional changes were found in the frontal cortex and cingulate cortex activity during both cognitive and emotional tasks. During emotional processing, olanzapine treatment seems to be specific it regulates the activity of the striatum and limbic system and it is called emotional brain.13&#xD;
&#xD;
Recent research evidence supports the use of olanzapine, to treat anorexia nervosa and chemotherapy-induced nausea in cancer patients. The evidence for high dose olanzapine dosages &gt;20 mg remains limited.14 &#xD;
&#xD;
There may be an incident of olanzapine-induced thrombocytopenia and neutropenia when the patient takes for the first time. One of the cases reported the patient developed biochemical neutropenia and thrombocytopenia without any clinical symptoms, the symptoms resolved after complete stoppage of the drug. Although its comparative uncommonness, case report to a growing corpus suggests that Clinicians and Psychiatrists &#xA0;should maintain keen observation of patients when they prescribe Olanzapine and regular monitoring of haematological counts to find out any abnormalities or immunosuppression.15&#xD;
&#xD;
The rise of liver enzymes is slightly more frequent with Clozapine and Olanzapine than Risperidone, Perazine and Haloperidol.16 &#xD;
&#xD;
The main complication of the anti-psychotic drug is Neuroleptic Malignant Syndrome arise from renal failure because of the presence of myoglobin in the urine produced by rhabdomyolysis; respiratory insufficiency due to aspiration pneumonia due to the promise of conscience and dysphagia; myocardial infarction which causes heart insufficiency and arrhythmias. There is evidence, Neuroleptic Malignant Syndrome can occur because of the dose of neuroleptics was increased. However, this syndrome can also be precipitated by the withdrawal of drugs, since they cause a sudden interruption of the dopamine availability in the brain.17 Olanzapine is a better choice of drug for schizophrenic patients, it causes less Extra Pyramidal Symptoms.18&#xD;
&#xD;
One of the RCT, olanzapine is statistically significant superiority to the haloperidol group on the primary analysis (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2992</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2992</Fulltext></URLs><References>&#xD;
	&#xD;
	Rendell. Olanzapine alone or in combination for acute mania. JM-2003;http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004040.[Cited 2020 May 26].&#xD;
	&#xD;
	&#xD;
	Olanzapine for the prevention and treatment of cancer- related nausea and vomiting in adults.2018;http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012555.[Cited 2020 May26].&#xD;
	&#xD;
	&#xD;
	Komossa. Amisulpride versus other atypical antipsychotics for schizophrenia. K-2010: http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006624.[Cited 2020 May26].&#xD;
	&#xD;
	&#xD;
	Bhattacharjee. Arpiprazole versus typical antipsychotic drugs for schizophrenia. J-2008; http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006617.[Cited 2020 May26].&#xD;
	&#xD;
	&#xD;
	Bryan EJ, Purcell MA, Kumar A. Zuclopenthixol dihydrochloride for schizophrenia. Cochrane Database Syst Rev [Internet]. 2017 [cited 2020 May 26] ;( 11). Available from:https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005474. &#xD;
	&#xD;
	&#xD;
	Samad N, Haleem DJ. Haloperidol-induced extrapyramidal symptoms attenuated by imipramine in rats. Pak J Pharm Sci. 2014 Sep; 27(5):1497&#x2013;501. &#xD;
	&#xD;
	&#xD;
	Qu I, Dj H. OralAdministration of Haloperidol at Clinically Recommended Doses Elicits Smaller Parkinsonian Effects but More Tardive Dyskinesia in Rats. Vol. 26, Pakistan Journal of pharmaceutical sciences. Pak J Pharm Sci; 2013 [cited 2020 May 28].&#xD;
	&#xD;
	&#xD;
	Stahl SM. Neuronal traffic signals in tardive dyskinesia: not enough &#x201C;stop&#x201D; in the motor striatum. CNS Spectr. 2017; 22(6):427&#x2013;34. &#xD;
	&#xD;
	&#xD;
	Crouse EL, Alastanos JN, Bozymski KM, Toscano RA. Dysphagia with second-generation antipsychotics: A case report and review of the literature. Ment Health Clin. 2017 Mar; 7(2):56&#x2013;64. &#xD;
	&#xD;
	&#xD;
	Bavle AD, Kumar GMN. Olanzapine-induced Tardive Oculogyric Crises. Indian J Psychol Med. 2013 Oct; 35(4):423&#x2013;4. &#xD;
	&#xD;
	&#xD;
	Jm P. Extrapyramidal Symptoms with Atypical Antipsychotics?: Incidence, Prevention and Management.Vol. 28, Drug safety. Drug Saf; 2005 [cited 2020 May 28]. &#xD;
	&#xD;
	&#xD;
	Klein LR, Driver BE, Miner JR, Martel ML, Hessel M, Collins JD, et al. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department. Ann Emerg Med. 2018; 72(4):374&#x2013;85. &#xD;
	&#xD;
	&#xD;
	LDF, GD, AD, PB. Effects of Olanzapine during Cognitive and Emotional Processing in Schizophrenia: A Review of Functional Magnetic Resonance Imaging Findings. Vol. 34, Human psychopharmacology. Hum Psychopharmacol; 2019 [cited 2020 May 28]. &#xD;
	&#xD;
	&#xD;
	AmM, ED, LC, Jt K. New Discoveries for an Old Drug: A Review of Recent Olanzapine Research. Vol. 132, Postgraduate medicine. Postgrad Med; 2020 [cited 2020 May 28].&#xD;
	&#xD;
	&#xD;
	Pang N, Thrichelvam N, Naing KO. Olanzapine-induced Pancytopenia: A Rare but Worrying Complication. East Asian Arch Psychiatry Off J Hong Kong Coll Psychiatr Dong Ya Jing Shen Ke Xue Zhi Xianggang Jing Shen Ke Yi Xue Yuan Qi Kan. 2017 Mar;27(1):35&#x2013;7. &#xD;
	&#xD;
	&#xD;
	Manceaux P, Constant E, Zdanowicz N, Jacques D, Reynaert C. Management of marked liver enzyme increase during olanzapine treatment: a case report and review of the literature. Psychiatr Danub. 2011 Sep; 23 Suppl 1:S15-17. &#xD;
	&#xD;
	&#xD;
	20-113-ENG-112-6-773500.pdf. [Cited 2020 May 28]. &#xD;
	&#xD;
	&#xD;
	Chan HY, Chang CJ, Chiang SC, Chen JJ, Chen CH, Sun HJ, et al. A randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonism. J Psychopharmacol Oxf Engl. 2010 Jan; 24(1):91&#x2013;8. &#xD;
	&#xD;
	&#xD;
	Inada T, Yagi G, Miura S. Extrapyramidal symptom profiles in Japanese patients with schizophrenia treated with olanzapine or haloperidol. Schizophr Res. 2002 Oct 1; 57(2&#x2013;3):227&#x2013;38. &#xD;
	&#xD;
	&#xD;
	Tran PV, Dellva MA, Tollefson GD, Beasley CM, Potvin JH, Kiesler GM. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. J Clin Psychiatry. 1997 May; 58(5):205&#x2013;11. &#xD;
	&#xD;
	&#xD;
	Tollefson GD, Beasley CM, Tran PV, Street JS, Krueger JA, Tamura RN, et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry. 1997 Apr; 154(4):457&#x2013;65. &#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of C Reactive Protein in Acute Appendicitis: A Cross-Sectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>66</FirstPage><LastPage>69</LastPage><AuthorList><Author>Lamture Yeshwant Ramrao</Author><AuthorLanguage>English</AuthorLanguage><Author> Varsha Gajbhiye</Author><AuthorLanguage>English</AuthorLanguage><Author> Vikram Panjabrao Vaidya</Author><AuthorLanguage>English</AuthorLanguage><Author> Md. Jawed Akther</Author><AuthorLanguage>English</AuthorLanguage><Author> Mangesh Padmawar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The diagnosis of acute appendicitis is still difficult and probably the commonest difficulty in the emergency surgical department. Raised levels of inflammatory markers like C reactive protein (CRP) in a clinically suspected case of acute appendicitis suggest early exploration. Appendicitis is an inflammatory process in the appendix. There is no confirmatory tool to detect this inflammation and its sequelae. C-reactive protein is synthesized in the liver in the response of any sort of insult to the body including inflammation lead to the rise of a level. Diagnostic accuracy of CRP is a more than ESR and leucocyte count in detecting inflammatory processes. Hence this study was conducted to know the significance of CRP to detect acute appendicitis. Material and Method: This Prospective cross-sectional study was inclusive of 100 Patients of acute appendicitis with no age bar. Subjected for appendicectomy and resected specimen for histopathological examination, CRP was measured before surgery. Result: C-reactive protein was raised in 62 out of 100 patients. The sensitivity and specificity of was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively. Higher levels of CRP more than 15/dl were suggestive of complicated appendicitis like perforation and gangrene. Conclusion: CRP is a valuable investigation in acute appendicitis. CRP is a valuable tool to rule out acute appendicitis and complications but its value to detect or diagnose acute appendicitis is low.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Inflammation, Gangrenous appendicitis, Perforation, C reactive protein, Erythrocyte sedimentation rate</Keywords><Fulltext>Introduction&#xD;
&#xD;
The typical presentation of acute appendicitis was first-time described by Reginald Haber Fitz in the late seventeenth century. From that time, it was the most frequent presentation of emergency surgery patients. Around 6 % of the peoples will be affected by acute appendicitis during their lifetime; hence, very strong efforts are already delivered for correct identification of appendicitis and its treatment. Due to this, decreases the death rate and morbidity significantly even with complications. The detection of appendicitis sometimes a hard task, hence doubtful atypical patients need admission and repeated examinations. This can lead to delay in diagnosis ultimately affect to raise the possibility of complications1.&#xD;
A negative appendectomy means a normal histopathology specimen. Various tools have been suggested to help in atypical cases to lower the negative appendectomy rates (NAR). Many scoring systems have been used to detect early acute appendicitis and its surgery. These scores are based on clinical findings and blood investigations. In all patients, but, a final diagnosis is only by histopathological examination of the appendix. Without removal, the diagnosis of acute appendicitis is not correct in most cases, and being bad in females than in males. 2.&#xD;
C-reactive protein (CRP) is quite a routine laboratory test performed, to assess and identify the inflammatory process. But, the functions of CRP in normal health is not distinctly understood but increases its level by many folds during the event of insult to the body. Hence it is used as a tool to identify inflammatory disease process3.&#xD;
Increased levels of C reactive protein (CRP) in a clinically suspected case of acute appendicitis suggest early exploration. C- reactive protein is synthesized in the liver in the response of any sort of insult to the body including inflammation lead to the rise of the level. Diagnostic accuracy of CRP is a more than ESR and leucocyte count in detecting inflammatory processes. Hence investigation like an estimation of CRP in suspected appendicitis may help to improve the diagnostic ability of clinician4.&#xD;
Many studies have proved the role of CRP in increasing the accuracy of the diagnosis of acute appendicitis5,6. It is a more specific and a good parameter of inflammation than ESR and white cell count. The CRP levels rise faster than that of ESR and decrease quickly when the inflammation subsides. A false-negative test can get usually early in infective episodes&#xD;
Birchley D in his study results stated that in suspected cases of acute appendicitis posted for surgery based on clinical examination total leucocyte count and granulocyte count differentiate acute appendicitis from normal appendices but do not suggest the presence of appendicular perforation or abscess. C-reactive protein not able to differentiate appendicitis from normal, but suggests the presence of appendicular abscess at higher levels only. A study conducted by Lateef et al.8 suggested that it is possible to get inflamed appendix even inflammatory markers not raised.&#xD;
.Looking at this confusing scenario, we undertake this study to assess the significance of this inflammatory marker, CRP in a diagnosis of acute appendicitis.&#xD;
Methodology&#xD;
&#xD;
The present study was undertaken in the department of surgery, Jawaharlal Nehru Medical College, Wardha in collaboration with Datta Meghe Medical College Hingana, Nagpur, Datta Meghe Institute of medical science (DMIMS), Sawangi, Meghe, Wardha,&#xD;
&#xA0;Maharashtra India. This study was a prospective interventional. The duration of this study was from September 2019 to June 2020. The numbers of patients were 100.&#xD;
Sample size- 100&#xD;
&#xD;
Type of study (research design): Prospective cross-sectional study.&#xD;
&#xD;
Period of study: September 2019 to June 2020&#xD;
&#xD;
Inclusion criteria:&#xD;
&#xD;
Clinically diagnosed cases of Acute Appendicitis.&#xD;
&#xD;
Exclusion criteria:&#xD;
&#xD;
&#x2022;&#xA0;&#xA0; &#xA0;Pregnancy&#xD;
&#xD;
&#x2022;&#xA0;&#xA0; &#xA0;Appendicular lump.&#xD;
&#xD;
&#x2022;&#xA0;&#xA0;&#xA0;Inflammatory Disease and connective tissue disorders like inflammatory bowel diseases or sickle cell disease&#xD;
&#x2022;&#xA0;&#xA0; &#xA0;HIV positive,&#xD;
&#xD;
&#x2022;&#xA0;&#xA0; &#xA0;Patients on corticosteroid therapy,&#xD;
&#xD;
&#x2022;&#xA0;&#xA0; &#xA0;Patient of interval appendectomy&#xD;
&#xD;
Data collection tools and process, variables, definitions, analysis plan:&#xD;
&#xD;
Informed consent was obtained before enrollment. Approval of the institutional ethical committee was sought. After careful examination and appropriate imaging and blood investigations including estimation of CRP. The diagnosis of appendicitis was confirmed by a senior consultant. An appendectomy was performed and a specimen was sent for histopathological examination.&#xD;
&#xA0;The data analysis was done by using the SPSS 17.0 statistical software, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CRP was calculated.&#xD;
Ethical approval for the study was got from the Ethics committee of DMIMS University&#xD;
&#xD;
Result:&#xD;
&#xD;
Around 100 subjects were included in the study, consists of 60 males and 40 from the female gender. All patients were operated by the laparoscopic appendicectomy method(figure 1).&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
In the present study, we found the sensitivity and specificity of C-reactive protein &#xA0;was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively ( Figure 2).&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
The present study, figure 1 &amp; 2 suggest normal appendix in 32 patients out of 100 patients, 38 patients have catarrhal appendicitis, 16, 10 and 4 patients were diagnosed suppurative, gangrenous and perforated appendicitis respectively as per of histopathological examination.&#xD;
Discussion&#xD;
&#xD;
An inflammatory marker, C-reactive protein (CRP) studied in the present research. It is an important parameter to help in detecting acute appendicitis in an early course of this disease process. If it is normal, the diagnosis of appendicitis must be reconfirmed by repeated clinical examination reinforced with ultrasonography or diagnostic laparoscopy. The typical combination of three, a history, clinical examination, and CRP has a higher accuracy power to detect appendicitis in most of the patients 9.&#xD;
In the present study, including more males than females (3:2), the sensitivity and specificity of C-reactive protein was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively (see fig. 1 and 2). In the present study, CRP was positive in 62 out of 100 patients. A study conducted by Giorgio Stefanutti et al10 proves that if CRP levels are normal in a child with even high clinical suspicion of acute&#xD;
&#xA0;&#xD;
appendicitis, the presence of an inflamed appendix is extremely rare and re-examination with appropriate investigations are required before attempting removal of the appendix. Results of a study done by Giorgio Stefanutti et al.10 are similar to the present study.&#xD;
In a present study, a high negative appendectomy rate of 32% was observed (see (figure 3) Wani et al2 also suggested a NAR of 20-40% has been documented and many surgeons consider a rate of 30% as inevitable. Removal of a normal appendix is an economic loss on both the patients and the hospital. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis2.&#xD;
The present study suggest normal appendix in 32 patients out of 100 patients, 38 patients have catarrhal appendicitis, 16, 10 and 4 patients were diagnosed suppurative, gangrenous and perforated appendicitis respectively as per of histopathological examination. All complicated appendicitis were associated with higher levels of CRP more than 15 mg /dl. Choudhary SK et al. suggested that CRP useful to correctly predict the severity of acute appendicitis. higher CRP has a high sensitivity for complications of acute appendicitis than specificity. He also suggests the cut off level at 6mg/dL requires to be used. If clinical presentations and imaging suggestive of appendicitis, a person with high CRP should undergo surgery urgently 4.&#xD;
Alvarado A6 in his review article depicts that a few inflammatory parameters, alone or combined, do well to help the detection of acute appendicitis in the late stages. But, not superior to the clinical examination of patients suspected of acute appendicitis. The duration of pain and other symptoms easily suggest that whether the inflammatory process is early or late. Hence clinical examination has a higher place to do a correct diagnosis.&#xD;
D Birchley et al.7 suggested that: &#x2018;components of the history, clinical presentation and laboratory investigation are poor identifiers of acute appendicitis. But if combined, they provide high diagnostic ability.&#x2019; Hence it is wise to say that in combination, CRP has a raised diagnostic accuracy and more effective in helping a clinical diagnosis of acute appendicitis.&#xD;
Very high levels of CRP either alone or coupled with raised TLC warrants mandatory explorations. The present study recommends that CRP should be done as a routine laboratory test in the doubtful diagnosis of acute appendicitis.&#xD;
Conclusion&#xD;
&#xD;
In conclusion, CRP is an important inflammatory marker in acute appendicitis. Because it is not specific, hence it has limitations. The simultaneous presence of other inflammatory disease processes, and the effect of non-inflammatory agents, like tobacco chewing and smoking, high body mass index, and psychological stress, decreases the correctness of CRP significantly. Because of these factors, clinical correlation with imaging is required in atypical cases., Hence CRP is a valuable tool to rule out acute appendicitis and complications but its value to detect or diagnose acute appendicitis is low.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2993</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2993</Fulltext></URLs><References>&#xD;
&#xD;
	&#xD;
	Ahmed M et al. Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi&#xA0;Medical&#xA0;&#xA0;&#xA0; Journal&#xA0; 2004; 25 (9): 1229-1231.&#xD;
	&#xD;
	&#xD;
	Wani, M et al. Usefulness Of The Alvarado Scoring System Concerning Age, Sex And Time Of Presentation, With Regression Analysis Of Individual Parameters. The Internet Journal of Surgery.2007; 11(2).&#xD;
	&#xD;
	&#xD;
	Chandrashekara S. C-reactive protein: An inflammatory marker with a specific role in physiology, pathology, and diagnosis. IJRCI. 2014;2(S1): SR3.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Khairy G. et al. acute appendicitis: Is removal of a normal appendix still existing and can we reduce its rate? Saudi J Gastroenterol 2009; 15:167-70.&#xD;
	&#xD;
	&#xD;
	Choudhary S et al. Diagnostic value of C-reactive protein as a predictor of complicated appendicitis like perforated/gangrenous appendicitis. Int Surg J 2019; 6:1761-6.&#xD;
	&#xD;
	&#xD;
	Alvarado A. In?ammatory Markers in Acute Appendicitis: Are We Still Looking for the Philosopher&#x2019;s Stone? J Surg, 2018; 02: JSUR-1104. &#xD;
	&#xD;
	&#xD;
	Birchley D, Patients with clinical acute appendicitis should have pre-operative full blood count and c-reactive protein assays, Ann R Coll Surg Engl. 2006;88(1):27-32.&#xD;
	&#xD;
	&#xD;
	Ibrahim, M et al. Ultrasonography in the Diagnosis of Clinically Equivocal Acute Appendicitis: A Prospective Study Kuwait Medical Journal 2003, 35 (3): 271-274&#xD;
	&#xD;
	&#xD;
	Lateef A et al. Role of leucocyte count in the diagnosis of acute appendicitis, Gomal Journal of Medical Sciences. 2009, 7(2): 140-142.&#xD;
	&#xD;
	&#xD;
	Stefanutti G et al. Inflammatory markers for acute appendicitis in children: Are they helpful? Journal of Paediatric Surgery. 2007; 42, 773&#x2013;776&#xD;
	&#xD;
&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Sleep Well: Mobile Application to Address Sleeping Problems&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>70</FirstPage><LastPage>74</LastPage><AuthorList><Author>Leow Jun Xian</Author><AuthorLanguage>English</AuthorLanguage><Author> Siti Sarah Binti Maidin</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Sleeping issues are associated with sleeping disorder whereby the user is having a problem to sleep and to remain sleeping. Problem: Anxiety, depression, and stress are among the identified factors which lead to a sleeping problem. Purpose: This paper presents a proposed system, &#x201C;Sleep Well,&#x201D; which is a mobile application to overcome sleeping problems. The questionnaires which were distributed to 80 people via google form has revealed the need to have an application for this purpose. Outline: The first section of this paper is an introduction and followed by a literature review. Next is data collection and continued by findings and data analysis. Finally, the paper concludes by making some recommendations.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Applications, Mobile, Sleeping, Insomnia, Sleep Well, User Acceptance Testing</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2996</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2996</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Health Communication in Digital Era: A Study of Sub-Urban City of Jaipur&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>75</FirstPage><LastPage>80</LastPage><AuthorList><Author>Maninder Kumar Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Subhash Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Health communication generally deals with the process of communicating promotional health information on personal health and hygiene and educational campaigns on public health and sanitation. In this study on health, communication pursues target audience knowledge on health issues, demonstrate healthy practices, support health services and dispel the misconceptions about health. Materials and Methods: Keeping the study objectives in view an interview schedule was developed for data collection. The questionnaire was administered through a Google form. A random sample from the target audience group was selected for the study. Results: The total one hundred and thirty-three respondents from four villages were responded to the survey. In which majority of the respondents 52% are less than 40 years of age and 53% of the respondents are male, 47% of the respondents are female. A great majority (98 %) of the respondents are aware of health and hygiene. More than 90% of the respondent had a fairly good idea about various aspects of personal hygiene. Respondents reported that updated information on social media 68% and mobile apps 55% play a vital role. On self-protection from disease, more than 90% of respondents&#x2019; state that they drink potable water, and keep the surroundings clean. In an analysis about media is creating awareness on personal health and hygiene, social media 87 % among them through awareness campaigns,television and radio 75% and mobile apps 52%. Government basic training on health and hygiene, 77 % of the respondents said such training was never given. Conclusion: The study reveals that the respondents have a fairly good knowledge of personal health and hygiene. The respondents have a very positive perception of health and hygiene and its importance to individual wellbeing.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Communication, Development, Health, Media, Strategy, Information, Digital</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Development programme in any developing society like India has two major components. One is the development input, be it agriculture, health and hygiene or social development. The other is the media, be it mass media, traditional media, interpersonal channels and digital media that is employed to carry the development input. The use of media resources for &#x2018;Development Support Communication&#x2019; is to ensure the development inputs reach the beneficiaries.&#xA0; Communication for development has three basic factors, Advocacy, Social Mobilization and Behavioural change. Health communication generally deals with the process of communicating promotional health information on personal health and hygiene and educational campaigns on public health and sanitation. Health communication pursues to increase target audience knowledge on health issues, demonstrate healthy practices, support health services and dispel the misconceptions about health and so on. To ensure that messages on health communication to reach target audiences accurately and quickly, health communication professionals must develop a health information package designed for the particular sections of the population in the society.Development Communication is the knowledge of social transformation carried out by the exploration, model, and skills in the communication to carry growth. &#xD;
&#xD;
Development communication normally refers to communication policies and principles in the underdeveloped and developing countries. Development communication is resulting from social transformation to social growth and development theories that recognized the central issues of the post-world war era in terms of a lack of progress corresponding to first and second world countries.3&#xD;
&#xD;
&#x201C;The UN General Assembly in Article 25 wherein it was clearly stated that Health is both a public and merit good. Health cannot be forced by affordability, and cannot, therefore, be left to the market. It is an understanding in which primary health and hygiene care, like primary education, qualifies as a merit good for the provision of which the state has to bear special responsibility&#x201D;.2&#xD;
&#xD;
Brief Introduction of Four Villages of Sub-Urban city of Jaipur&#xD;
&#xD;
Begas&#xD;
&#xD;
Begas is a panchayat located in Sanganer tehsil of district Jaipur in Rajasthan, India. The entire terrestrial area of the village is 1752 hectares. Begas has an overall inhabitant of 5,149 peoples with male 2,617 and female 2,532.&#xA0; Agriculture and private service are the main occupations of Bega&amp;#39;s villagers. The Total Literacy rate of the village is about 60% amongst the population of 5149 in which around 50% male and 18% female are literate.4&#xD;
&#xD;
Dahmi Kalan&#xD;
&#xD;
Dahmi Kalan is its-self gram panchayat situated under Sanganer Tehsil of Jaipur district in Rajasthan, India. The overall terrestrial land of the village is 914.16 hectares. Dahmi Kalan has approximate inhabitants of 5,850 peoples withthe males are 2950 and females are 2900 and in which around 919 houses in the village.Agriculture, business, daily wage labourer is the main occupation of the villager in the Dahmi Kalan. The Total Literacy rate of the village is about 52.6% amongst the population of 5,850 in which around 48.2% male and 17.4% female are literate.4&#xD;
&#xD;
RamsinghPura&#xD;
&#xD;
RamsinghPura is a village under the Fatehpura gram panchayat in Jaipur tehsil of Jaipur district in Rajasthan, India. The overall terrestrial area of the RamsinghPura village is 609 hectares with the population of 1,517 peoples in which 785 are male and 732 are female and approximately 217 houses. RamsinghPura&#x2019;s people the main occupation are agriculture, business, government-private services. The Total Literacy rate of the village are about 50% amongst the population of 1517 in which around 50% male and 28% female are literate.4 &#xD;
&#xD;
Theekariya&#xD;
&#xD;
Thikariya is itself a gram panchayat placed under the Sanganer Tehsil of Jaipur district in Rajasthan, India. The total terrestrial area of Thikariya village is 344.4 hectares. The village has an approximate population of 2,238 peoples in which 1137 are male and 1101 are female. With around 345 houses in Thikariya.&#xA0; Thikariya villager&#x2019;s main occupation are business, government and private services, agriculture, daily wage labourers etc. The Total Literacy rate of the village is about 53.5% amongst the population of 2238 in which around 60.8% male and 19.7% female are literate.4&#xD;
&#xD;
This study aims to know about knowledge, attitude, and practice regarding health and hygiene and role of media providing healthinformation among the people of four selected villages in the sub-urban area of Jaipur city in Rajasthan. &#xD;
&#xD;
The objective of this study:&#xD;
&#xD;
&#xD;
	&#xD;
	To ascertain the knowledge, attitude and practices on health and hygiene in rural areas&#xD;
	&#xD;
	&#xD;
	To examine the use of conventional mass media by the target audience for information on health&#xD;
	&#xD;
	&#xD;
	To assess the role and use of digital media on delivering health information &#xD;
	&#xD;
	&#xD;
	RESEARCH METHODOLOGY&#xD;
	&#xD;
&#xD;
&#xD;
The study is being conducted under Ex-Post-Facto conditions in four selected villages in the sub-urban area of Jaipur city in Rajasthan. Keeping the study objectives in view an interview schedule was developed for data collection. The questionnaire was administered through a Google form. Where ever respondents were not able to use the Google Form, the form was filled on their behalf through personal interviews. A random sample from the target audience group was selected for the study.&#xA0; A total number of 133 respondents from four villages were responded to the survey. All these responses were calculated with the help of SPSS software.&#xD;
&#xD;
ANALYSIS AND INTERPRETATION&#xD;
&#xD;
The data collected through the survey in Google form. Tables present the demography of the respondents. Majority of the respondents (52%) are less than 40 years of age. (24%) of the respondents are of 40 to 50 years of age. (12 %) of the respondents are of the age group from 51 to 62 years. Rest 12% respondent are more than 65 years of age. On the other hand, a majority (53%) of the respondents are male, (47%) of the respondents are female. &#xD;
&#xD;
&#xD;
&#xD;
The (Table 1)above shows that a great majority (98 %) of the respondents are aware of health and hygiene. This a remarkable fete in rural areas, wherein the awareness about health and hygiene always remained low. This may be because there is a greater amount of information available today and better exposure as well. &#xD;
&#xD;
&#xD;
&#xD;
To a question enquiry about the knowledge of personal hygiene, (Table 2) the data has revealed that more than 90% of the respondent had a fairly good idea about various aspects of personal hygiene. As the awareness was very high, further proving to show that personal hygiene factor-like washing hand before the food had an awareness of more than 97%. Other hygiene had its like bath daily, brushing teeth, hand washing after toilet, washing cloth had a high score of more than 90% among respondent. Even washing cloth regularly (90%) was attributed to hygiene practice. However, changing clothes daily as a hygiene practice was poor with 45%. Washing hands with soap scores a fairly good awareness of 75% among the respondent. Among the 62 women respondent, 93% of them consider protection during menstrual period as good hygiene habit. &#xD;
&#xD;
&#xD;
&#xD;
A question was asked regarding the understanding of personal health, the data has revealed that rise in body temperature (fever) and viral fever is known to more than 90% respondents. Knowledge about Blood pressure among the respondent is also high (75%) in comparison to Sugar level (54%) and Diabetic (38%). One of the reasons for better awareness about viral fever and a health condition called diabetes is due to better availability of information through mass media. However, blood pressure and increased sugar level information which are slightly more technical have not been perceived by the rural community(Table 3). &#xD;
&#xD;
&#xD;
&#xD;
In response to a question regarding falling ill more than 85% among the respondent beliefs in visiting Government Doctors in comparison to Private Doctors only 54%. The data has also revealed that more than 50% of the respondents believe in home remedy and 22% believe in God. However, visiting Seva Kendra in their village scores poorly 2.5% among respondent. The data shows that there is a need to strengthen the health facilities under the Government (Table 4).&#xD;
&#xD;
&#xD;
&#xD;
To a question on self-protection from any disease, more than 90% of respondents&#x2019; state that they drink potable water, and keep the surroundings clean. During the viral affection, more than 80% respondent had a fair idea of not to visit the affected place and person both. More than 70% of the respondent belief in taking proper diet during viral infection. Taking medicine as a precaution during by viral disease was poorly rated only 9%. This indicates that there is a greater awareness among the rural community about issues related to health and precautions need to be taken (Table 5). &#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
To a question on from where did you get information on Personal Health and Hygiene, radio and television score high more than 70% in comparison to newspaper, magazine, poster, and brochures are 30%, 1.5%, 3%, 3% respectively ( Table 6). The indication is that the audio-visual medium is more sought after for information on health and hygiene. The print media is not the sought source of information since it is a literate medium and also the coverage of information on health and hygiene is also pretty low. Surprisingly, even posters which are abundant in-display do not look atthe popular source of information. &#xD;
&#xD;
&#xD;
&#xD;
To a question about the sources of information on health programme of government, Social media including mobile apps score more than 70%. Electronic media information on health programme of the government was fairly good scores about 54% among the respondents. Print media only 12% among the respondent was the fairly poor medium of information regarding health awareness programme of government is a concern ( Fig. 1). &#xD;
&#xD;
&#xD;
&#xD;
To a question analysis on receiving information by the government about maintaining personal health and hygiene. The respondent response to this particular question mostly in the negative way of more than 85% ( Fig. 2). &#xD;
&#xD;
&#xD;
&#xD;
In an analysis about media is creating awareness on personal health and hygiene, it was found that social media is creating more awareness (87 %) among them through awareness campaigns. Through mobile apps, 52% of respondent had positively aware of health and hygiene. Information about health and hygiene awareness programme by Television and Radio scores more than 75%.&#xA0; Creating an awareness programme among respondents by newspaper and magazine was poorly about less than 19% ( fig 3).&#xD;
&#xD;
&#xD;
&#xD;
Keeping the consistency in the response, 69 % of the respondents said they depend on social media and 63 % of on mobile applications (Fig. 4). Traditional mass media like print, electronic and outdoor media has the very little role as the most preferred source of information.&#xA0; &#xD;
&#xD;
&#xD;
&#xD;
For any development message to be diffused in a community, the dispersion of the message through appropriate media is essential. The data has revealed that a host of social media platforms play a very important role in the diffusion of information. According to the study, social media platforms (66 %) have a major role, followed by mobile apps (48 %) ( Fig. No. 5). Traditional media and mass media also play an important role. The high dependency on social media platforms and mobiles apps even rural areas is because of the percolation of internet facilities. Besides, not so expensive and affordable mobile phone technology is also there. &#xD;
&#xD;
&#xD;
&#xD;
To a question on the media supporting to maintain personal health and hygiene, the respondents reported that updated information on social media (68%) and mobile apps (55%) play a vital role. Besides, the latest information provided by radio and TV (63 %) also have an important in this regard (Fig. 6). The data also reveals that print media as a source has a limited role. &#xD;
&#xD;
&#xD;
&#xD;
Considering the role and impotence of health worker in supporting health and hygiene in rural areas, a question was asked about the frequency of health worker visit or contact. A majority (68 %) of the respondents said it never happened and some 27 % said once in a way the health worker contacted for providing information on health and hygiene ( Fig. 7).&#xA0; &#xD;
&#xD;
&#xD;
&#xD;
Also a question on providing some basic training on health and hygiene, 77 % of the respondents said such training was never given (Fig. 8). However, a bit surprisingly some 19 % said at some point in time some basic training on health and hygiene was given in the villages. &#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
The study reveals that the respondents have a fairly good knowledge of personal health and hygiene. The respondents have a very positive perception of health and hygiene and its importance to individual wellbeing. In this study, &#x2018;Development Support Communication&#x2019; revealed the technology has changed the present situation in the diffusion of information to mass regarding awareness on their health and hygiene. The study also supports the advancement of technology in the field of Communication in the form of mobile applications to avail of this benefit. Media is creating awareness on various aspects of health and hygiene but the medium is changed from traditional to digital. The study revealed the government official and intuition are hardly concerned about support and training of personal health and hygiene. Seva Kendra and government health professional is a failure in providing information among these four sub-urban villages of Jaipur on personal health and hygiene. Digital media extensively used to access the information, for their health and hygiene issues. The study also reveals the use of smartphones for easy access, with constantly updated on the news apps, to save their time and money.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from villagers of Theekariya, Begas, Dahmi Kalan and RamsinghPura of Rajasthan for support to conduct the study.The authors are also grateful to authors/editors/publishers of all those ar&#xAD;ticles, journals and books from where the literature for this article has been reviewed and discussed in this manuscript.&#xD;
&#xD;
Ethical clearance- not applicable.&#xD;
&#xD;
Source of funding- self.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
&#xD;
Conflict of Interest- not applicable.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2997</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2997</Fulltext></URLs><References>&#xD;
	&#xD;
	Everett Rogers M.&#xA0; Diffusion of Innovations,The Free Press, New York, 1983: 5-37, 64-68, 84-88.&#xD;
	&#xD;
	&#xD;
	Mefalopulos Paolo.DevelopmentCommunicationSourcebook:Broadening the Boundariesof&#xA0;&#xA0;&#xA0; Communication, The World Bank Washington, D.C., 2008: 3,5 6,7.&#xD;
	&#xD;
	&#xD;
	Genevey Remi, Pachauri Rajendra K. and Tubiana Laurence. Reducing Inequalities: A Sustainable Development Challenge, AFD IDDRI TERI, 2013, 124,157,189.&#xD;
	&#xD;
	&#xD;
	List of Districts in Rajasthan [Internet] Available from the site:&#xA0; https://villageinfo.in/rajasthan.html.&#xD;
	&#xD;
	&#xD;
	Minakshi, Joshi P.C., Kumar Rahul. &#x201C;Mental Health Problems in Wake of Disaster: A Gendered Perspective.&#x201D; Rupkatha Journal on Interdisciplinary Studies in Humanities.&#x201D; Vol.12, No.1, 2020. pp. 1-12.&#xD;
	&#xD;
	&#xD;
	Gupta Rajeev Kumar, Raina Sunil Kumar, Shora N. Tajali, Sharma Renu, Hussain Shahid. &#x201C;A household Survey to Assess Community knowledge, Attitude and practice on Malaria in a Rural Population of North India.&#x201D;Journal of Family Medicine and Primary Care, Vol. 1, No.3, 2016, pp. 101-107. &#xD;
	&#xD;
	&#xD;
	KadamSuhas, AdhavAmbadas, Mote Balu, KalaskarShrikant, M. Thirumugam, KurbudeRavindra, PatilSushil. &#x201C;Knowledge, Attitude and Practices of People Towards Malaria in Tribal Communities of Jawhar, Maharashtra, India.&#x201D; International Journal of Current Research and Review, Vol.7, Issue 18, 2015, pp. 25-30.&#xD;
	&#xD;
	&#xD;
	Nandha B., Srinivasan R., Jambulingam P. &#x201C;Cutaneous Leishmaniasis: Knowledge, Attitude and Practices of the Inhabitants of the Kani Forest Tribal Settlements of Tiruvananthapuram District, Kerala, India.&#x201D; Health Education Research, Vol. 29, No.6, 2014, pp.1049-1057. &#xD;
	&#xD;
	&#xD;
	Lie Rico. Rural HIV/AIDS Communication/Intervention: From Using Model to Using Frameworks and Common Principles, one chapter in edited book by Jan Servaes, Communication for Development and Social Change, Sage publications India, 2008: 280,283,284.&#xD;
	&#xD;
	&#xD;
	Schramm Wilbur. Mass Media and National Development, East-West Communication Institute Honolulu, Hawaii U.S.A 1979: 13,14, 16.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Estimation of the Basic Reproduction Rate (R0) of the Novel Coronavirus (COVID-19)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>81</FirstPage><LastPage>86</LastPage><AuthorList><Author>See Jie</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajasvaran Logeswaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>The notorious novel coronavirus has been causing various cases of pneumonia outbreak starting in Wuhan, Hubei province in China and spreading throughout the world. This paper presents a study of the information available on the outbreak, to provide a deeper understanding of the origin, transmission and danger of this newly discovered virus. The basic reproduction rate (R0 ) is focused on to understand the transmission pattern of this virus. Results obtained from the studies conducted by various parties have been collected and compared. It is believed that this virus is highly related with the SARS-CoV and MERS-CoV that happened during 2003 and 2012, respectively, hence a lot of preliminary studies are based on these as there is lack of sufficient data specific to COVID-19. Studies reported R0 within the range of 2-5, indicating that each infected patient will transmit the virus to 2-5 other individuals.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Novel Coronavirus, COVID-19, Basic Reproduction Rate, Transmission patterns, Pandemic</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2998</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2998</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pandemic and Vaccines &#x2013; The Case of Deadly Anthrax Infection, Vaccine Development and Evolution&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>87</FirstPage><LastPage>94</LastPage><AuthorList><Author>Vinay Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Mohsin Waheed</Author><AuthorLanguage>English</AuthorLanguage><Author> Manu Pant</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Anthrax is a highly infectious, zoonotic disease occurring worldwide in domestic as well as wild herbivores. It is caused by gram-positive, rod-shaped, anaerobic and sporulating bacteria Bacillus anthracis. Humans and other secondary consumers are infected when they come in contact with contaminated animals or animal products and consume anthrax contaminated meat. The symptoms are manifested in the three forms namely cutaneous, gastrointestinal and inhalational, and result in high mortality. Objective: Timely detection and treatment of anthrax remain a big challenge for scientists and clinicians. The only way to prevent this disease is to vaccinate people living in maximum threat areas The present study is an attempt to compile available information on conventional anthrax vaccines, vaccines under development, and prospects of developing new anthrax vaccines along with their advantages and disadvantages. Conclusion: This review gives an insight into the cause and mechanism of anthrax infection, the current status of anthrax vaccines available in the market, vaccines under process and the need and future prospects of anthrax vaccine development. The need of the hour is to put in more concerted efforts towards development, testing and use of the new generation vaccines.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Anthrax, Vaccine, Anthrax toxins, Recombinant Vaccine, New generation Vaccine, Bacillus anthracis</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=2999</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=2999</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Ultrasonography Guided Fine Needle Aspiration Cytology as a Valuable Tool for Management of Solitary Thyroid Nodule&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>95</FirstPage><LastPage>97</LastPage><AuthorList><Author>Meenakshi Kekre</Author><AuthorLanguage>English</AuthorLanguage><Author> Anant Kekre</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Ultrasonography (USG) in today&#x2019;s scenario is extremely crucial for detection of the dimensions of the tumour, for the diagnosis of multinodular goitres, and more importantly the nature of the solitary thyroid nodule whether it is solid or cystic. Very rarely cystic nodule is associated with malignancy. Aims &amp; Objectives: Our study on solitary thyroid nodules will try to corroborate the pre-operative cytological diagnosis obtained by USG guided Fine Needle Aspiration Cytology with the postoperative histopathological diagnosis. Methods: We have studied 60 patients taken from a tertiary care hospital for one year. We have considered to only the patients with solitary thyroid nodule of both sexes and all age groups. The type of operation was planned as per the report of USG guided fine needle aspiration cytology (FNAC). Results: Patients were aged between 15-75 years. 83 % of the patients in our study were females. Commonly associated symptoms were of hoarseness of voice, lymph node involvement &amp; those nodes are fixed to the underlying structures &amp; all these symptoms strongly suggestive of malignancy. Conclusion: When properly done by an expert cytopathologist, we can reliably diagnose the benign cases, that can be managed reasonably by conservative approach rather than subjecting all patients to operations.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Multinodular goitre, Solitary thyroid nodule, USG, FNAC</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
A solitary thyroid nodule is the commonest presentation of thyroid carcinoma &amp; studies suggest that only 10% of them are cancerous. After doing proper examination &amp; investigation, most of them looking solitary thyroid nodules will be as a part of a multinodular goiter1-2. On radiological investigation, if the nodule turns out to be truly solitary then the chances of it being malignant rises by 20%. Hence it is extremely crucial to find out these cases so that we can plan safe &amp; effective surgical intervention. Rest of the patients can be managed by a conservative approach along with judicious follow-up so that unnecessary operations can be avoided. In the general population, the chances of having solitary thyroid nodule may be up to 3%. It may be a simple adenoma or carcinoma3-5. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Whereas if adenoma is there then simple excision will solve the purpose but if it turns out to be a carcinoma then surgical intervention differs as per the type of carcinoma. USG is very convenient and extremely proficient for the detection of the dimensions of the tumour, for the diagnosis of multinodular goitres, and more importantly the nature of the solitary thyroid nodule whether it is solid or cystic. Very rarely cystic nodule is associated with a malignancy6-7. Its accuracy of detection by USG is directly proportional to its resolution. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Similarly, if FNAC is carried out under the guidance of USG then the specificity and sensitivity of the procedure increase. Most importantly. This procedure is free from radiation exposure8-9.&#xD;
&#xD;
Aims and objectives: Our study on solitary thyroid nodules will try to corroborate the pre-operative cytological diagnosis obtained by USG guided FNAC with the postoperative histopathological diagnosis. &#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
Study type: Observational study.&#xD;
&#xD;
Study Period: one year&#xD;
&#xD;
Place of study: tertiary care hospital&#xD;
&#xD;
Sample size: We have studied 60 patients. We have considered only the patients with solitary thyroid nodule of both sexes and all age groups ( Table 1).&#xD;
&#xD;
Study design: The modules which were small, difficult to palpate and deeply seated were particularly chosen. The cases of multinodular goitres were excluded from our study. The detailed history of the patient&#x2019;s illness, any history of radiation exposure, the familial background particularly in respect of thyroid carcinoma was taken which was followed by thorough clinical examination &amp; local examination. We clinically assessed the functional status of the thyroid. Routine blood tests, chest X-Ray, urine and stool examination, ECG was done to assess the general condition of the patient. Then we proceed to the specific investigation of the disease proper. We checked the functional status of the thyroid gland by examining blood for T3, T4 and TSH. We consider the patients with a normally functioning thyroid status for our study. We then performed USG guided FNAC in all patients to detect the size of the lesion and more importantly the consistency of the nodule. The material obtained by USG guided FNAC was subjected to cytological examination to diagnose the nature of the lesion. We have done Radionuclide uptake and thyroid scan in selective patients.&#xD;
&#xD;
After a thorough evaluation, we did operative intervention under general anaesthesia whenever required, after taking consent and following the norms of medical ethics. The type of operation was according to the report of USG guided FNAC. The post-operative specimen was sent for histopathological examination. The results were compared with the pre-operative USG guided FNAC report.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
&#xD;
&#xD;
As per table no. 1, Most of our study subjects were middle-aged females.&#xD;
&#xD;
&#xD;
&#xD;
As per table no. 2, all the three associated symptoms of Hoarseness of voice, Lymph node involvement &amp; Fixation to deep structures are in favour of malignancy.&#xD;
&#xD;
&#xD;
&#xD;
As per table no. 3, on USG guided FNAC, 16 cases were diagnosed as the clear malignant lesion, out of this 14 were papillary Ca and 2 were anaplastic Carcinoma. As per table no. 4, 30 cases out of 60 were diagnosed as a colloid nodule.&#xD;
&#xD;
&#xD;
&#xD;
As per table no. 5, eight cases were managed conservatively.&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In our study, the age of the patients was between 15-75 years. According to Russel, the majority of patients with solitary thyroid nodules present in between 30-55 years and 80% are females. Watkinson noted that a solitary thyroid nodule is more likely to be malignant if the patient is male. We also noted that male patients are more prone to develop a malignant thyroid nodule10. Apart from swelling in the neck, there were symptoms such as hoarseness of voice, fixity to the deeper structures and lymph node enlargement. All the above symptoms correlate with malignancy. We have selected the cases with small thyroid nodules. Out of 60 patients in our study, 58 patients (96.6%) were clinically and biochemically euthyroid11-12. Only 2 patients were seen to have hypothyroidism on biochemical examination though they both were clinically euthyroid. We did not encounter any case of hyperthyroidism. As almost all patients of solitary thyroid nodule are euthyroid, it is not necessary to do all thyroid function tests (T3, T4 and TSH) in every patient. One parameter is enough and according to Russel, that parameter is T4. The FNAC is a very simple, rapid procedure that can be done on OPD basis and is devoid of any complication and radiation exposure. It does not require any anaesthesia and hospitalization. The procedure is economical and inflicts minimal trauma. When this procedure is done under the guidance of USG the sensitivity and specificity are increased and the chance of complications is also minimized. For better results, the aspiration should be done by the person who will interpret the result. To get adequate samples, multiple punctures at different sites should be done. The cytopathologist should have a view of all relevant clinical and radiological data. Proton magnetic resonance spectroscopy may be used on FNAC smears to help to differentiate benign from malignant follicular neoplasms13-15. In this technique, the spectral ratio of resonance from amino acid lysine and lipid is used to differentiate normal follicular cell from cancerous follicular cells in FNAC smears. In our study, we have operated 52 cases out of 60 patients and all the specimens were sent for histopathology. 8 cases of a small solitary thyroid nodule, reported as colloid goitre in USG guided FNAC, were not subjected to operation and they have been managed conservatively with regular follow up. We have operated those patients which were benign on cytology but have a strong suspicion of malignancy clinically. We also emphasized regular follow up with repeat USG guided FNAC whenever required16.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
All patients were clinically euthyroid. Among the associated symptoms there were hoarseness of voice, lymph node involvement and fixity to deeper structures go in favour of malignancy. All patients were subjected to USG guided FNAC. We found this technique very simple, safe, practically atraumatic. &#xA0;Due to low false-negative report of USG guided FNAC, it would be easy to plan the conservative management of solitary thyroid nodule. When compared with postoperative histopathology report, it can be concluded that USG guided FNAC can guide the course of management of &#x201C;Solitary Thyroid Nodule&#x201D;.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3000</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3000</Fulltext></URLs><References>&#xD;
	&#xD;
	Watkinson J et al. Tumors of the thyroid and parathyroid glands; Stell and Maran&#x2019;s Head and Neck Surgery; 4th edition:; Butterworth Heinemann: 459-485.&#xD;
	&#xD;
	&#xD;
	Taksande A et al. Study of Motor Nerve Conduction Velocity in Patients of Thyroid Dysfunction in Central India.&#x201D; Journal of Datta Meghe Institute of Medical Sciences University. 2017; 12(4): 229&#x2013;33.&#xD;
	&#xD;
	&#xD;
	C F J Russel; Recent Adv in Surg; 17th edition; 1994; 4- 16.&#xD;
	&#xD;
	&#xD;
	Raniwala A, et al. Study and Correlation of Clinical, Radiological, Cytological, and Histopathological Findings in the Diagnosis of Thyroid Swellings. Journal of Datta Meghe Institute of Medical Sciences University 2017; 12(2): 138&#x2013;42. &#xD;
	&#xD;
	&#xD;
	Abdullaeva M, et al. The Influence of Dysfunction of the Autonomic System and the Thyroid Gland on the Course of Bronchial Asthma (BA) in Children IJCRR. 2020,&#xA0; 12(14): 36-39&#xD;
	&#xD;
	&#xD;
	Robertson M, et al; Otolaryngol Head Neck Surg. 2004; 131: 596-600.&#xD;
	&#xD;
	&#xD;
	Agrawal D, et al. &#x201C;Role of Bethesda System for Reporting Thyroid Lesion and Its Correlation with Histopathological Diagnosis.&#x201D; Journal of Datta Meghe Institute of Medical Sciences University. 2019, 14(2): 74&#x2013;81&#xD;
	&#xD;
	&#xD;
	&#xA0;Russell CF, Recent Adv. In Surg; 17th ed; 1994; 4-16.&#xD;
	&#xD;
	&#xD;
	Wagh S, et al. Relationship between Hypothyroidism and Body Mass Index in Women: A Cross-Sectional Study. IJCRR. 2020;12(12): 48-51.&#xD;
	&#xD;
	&#xD;
	Sutapa D, et al. Fine Needle Aspiration Cytology of Cervical Lymph Nodes with Special Emphasis on Different Cytomorphological Presentation of Tuberculous Infection. IJCRR. 2020;12(16), 108-114.&#xD;
	&#xD;
	&#xD;
	Matheson N, The diagnosis of thyroid swelling; in Russell RCG (ed) Recent Adv in Surg; 12th ed; Ch. Livingstone; Edinburgh; 179-197.&#xD;
	&#xD;
	&#xD;
	Zajicek J, Kargar S, Basel R. Aspiration Biopsy Cytology 1 &amp; 2. 1974; 384-389.&#xD;
	&#xD;
	&#xD;
	Wong TH, et al; Ann Acad Med Singapur; 22(4); 1993.&#xD;
	&#xD;
	&#xD;
	Gulve S, et al. &#x201C;Parathyroid Adenoma: Ultrasonography, Doppler, and Elastography Imaging.&#x201D; Journal of Datta Meghe Institute of Medical Sciences University. 2019; 19(1): 47&#x2013;49.&#xD;
	&#xD;
	&#xD;
	Gurbani N, et al. To Study the Histopathological Forms of Thyroid Lesions Observed in Tertiary Care Hospital International Journal of Current Research and Review. 2020 12(14): 109-112&#xD;
	&#xD;
	&#xD;
	Ramaciotti CE et al; Diagnostic accuracy and use of aspiration biopsy in the management of thyroid nodules; Arch. Intern Med. 144(6): 1169-1640.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Depression in Teachers Due to Cyberbullying Who are Working in COVID-19 Pandemic: A CrossSectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>98</FirstPage><LastPage>102</LastPage><AuthorList><Author>Muzahid K Sheikh</Author><AuthorLanguage>English</AuthorLanguage><Author> Neha Chaudahry</Author><AuthorLanguage>English</AuthorLanguage><Author> Ajinkya Ghogare</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: During this Current pandemic situation, as we all know that the whole world is unfortunately forced to be indoor but, because of this pandemic various sectors have being affected, out of which the education sector has been affected greatly, as this corona pandemic has taken more than 6 months of the education, school, colleges and tuition teachers have started taking online classes thereby resuming the curriculum. The Educational platforms like google classroom, google meet, zoom etc. are being used more now than in the past as compared to the traditional teaching method in which teachers can interact one on one with the students. Method: Descriptive Study was conducted by providing E-Questionnaire and personal information sheet. 200 participants with the age group of 25 - 60 years both genders were selected according to the inclusion criteria. Results: Statistical analysis was done using a paired and unpaired t-test. The outcome was measured by using PHQ-9 Questionnaire and personal information form. Conclusion: The Above Conducted study Showed that there is a state of depression is present in the young teachers who are taking online lectures because of COVID-19 Pandemic situation.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> COVID-19, Depression in teachers, Work from Home, Online lectures.</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
During this Current pandemic situation, as we all know that the whole world is unfortunately forced to be indoor but, because of this pandemic various sectors have being affected, out of which the education sector has been affected greatly, as this corona pandemic has taken more than 6 months of the education, school, colleges and tuition teachers have started taking online classes thereby resuming the curriculum. The Educational platforms like google classroom, google meet, zoom etc. are being used more now than in the past as compared to the traditional teaching method in which teachers can interact one on one with the students. Which is not permissible in online teaching as teachers have reported a lack of interaction in the class. Till now no such statistical data allied to cyberbullying on teachers has been cited since the onset of this pandemic.1&#xD;
&#xD;
But, there have been multiple reviews by the teachers that, they are facing cyberbullying by the students. According to UNICEF cyberbullying is a type of harassment with the use of digital technologies which can take place via, any social media platform and education platform like google classroom, Google meet, Zoom ETC. It is a huge Disrespect to the teachers who are taking substantial efforts in teaching students even during this gloomy time of the pandemic.&#xD;
&#xD;
Bullying by the students may have an adverse effect on the teachers which may include depression, anxiety, loss of self-esteem, lack of interest and associator health issues. the myriad of scenarios leading to the oblivious conditions are screen scratching, scribbling, students create anonymous IDs to make fun of the teachers, they pass comments while switching off the cameras, they create nuisance in the group chat as well by writing gratuitous comments or by sending memes, they also make needless sounds hereby distracting the class, as the lecture link can be shared with anyone so students add there anonymous friend and create mischief in the class.2,3&#xD;
&#xD;
Since there isn&#x2019;t a way to get holdoff the students violating the class decorum, therefore the teacher has to ignore, let go and continue teaching.&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
&#xD;
Work environment stressors are a leading health and safety issue for schoolteachers.1 Stress is an evitable part of an individual&#x2019;s working life. Over the last decades, teaching has been widely conceded as a profession considering full of stress and anxiety.2 The number of teachers suffering from stress-related disorders- specifically depression and anxiety appear to be increasing. Such painful symptoms are brought about by the teacher&#x2019;s recent working state and the pressure under which they find themselves.3 According to Kyriacou, the teaching profession is one of the high-stress occupation parallels to other stressful jobs such as police, the prison service, air traffic controllers, nurses and doctors. All type of stressors are denoted as barriers appraised by the teachers that interfere with the instructional process carried out to accomplish learning principles and that would explain a high level of burn out. Schwarzer and Greenglass, 1999, Blas&#xE9;, 1982).4,5.6&#xD;
&#xD;
Stressors are not limited to a particular school, city, or state and can influence teachers in public and private elementary, middle, and high schools (Gray&#xAD;son and Alvarez, 2008; Jarvis, 2002; Rieg, Paquette, and Chen, 2007).4 The 2003-2004 U.S. Department of Education&#x2019;s School Survey on Crime and Safety reports that the schools have unsafe work environments with probably dangerous students. The prevalence of violence has not increased significantly during the past two decades, but violent and aggressive students are now considered as a problem in U.S. public school systems.&#xA0; Urban school teachers are more likely to be victims of violent crime at school than rural teachers. One or more violent crimes, such as sexual assault, aggravated assault, robbery, or rape, were described to have raised in 20% of U.S. public schools (DeVoe et al., 2004; Guerino et al., 2006).8,9&#xD;
&#xD;
A challenging workload (Class size, paperwork, lack of planning time) was a habitual stressor mentioned in the veteran and nov&#xAD;ice teachers&#x2019; work environments (Liu and Ramsey, 2008; McCann and Johannessen, 2004; O&#x2019;Donnell and Lambert, 2008; Pearson and Moomaw, 2005; Plash and Piotrowski, 2006; Rieg et al., 2007). &#xA0;Schonfeld (1990, 1996) postulated that social support may also have a direct effect on health outcomes among teachers.10&#xD;
&#xD;
Anxiety is one of the aspects of stress that affects the teacher&#x2019;s quality of teaching, which ultimately affects the learning process and fulfilment of the course objectives. It is a personalized state of internal discomfort.3 Anxiety is a normal emotion with adaptive value in which it acts as a warning system alerting a person to nearing the danger. It usually occurs without any conscious or apparent stimulus, which differentiates it from fears. It can be focused on a particular object, event or activity or it can be unfocused and demonstrated or indicated as a more general dread.3&#xD;
&#xD;
There are five major types which are as follows: Panic disorder, Obsessive-Compulsive disorder, post-traumatic stress disorder, Generalized anxiety disorder and Phobic disorder. (Anxiety Disorders of America, 2005).3 &#xD;
&#xD;
Depression is one of the most likely unfavourable psychological consequence. The variety of other feasible psychological problems include, &#x201C;burn out&#x201D;, alcohol abuse, uncleaned physical symptoms including &#x201C;absenteeism&#x201D;, chronic fatigue and accidents, sick building syndrome and repetitive strain injury. (Hotopt, Wessely, 1997).11 Rejection and sadness are the most likely and silent emotional symptoms of depression. The individual feels hopeless and unhappy. Activities that used to bring self- satisfaction becomes dull and joyless. The depressed individual slowly starts losing interest in hobbies, recreation and family activities. It is correlated with psychological, behavioural and physical symptoms too. (Cassano and Fara, 2002).12,13 The depressed individual has negative thoughts, low self- esteem and low motivation for progress. A few studies specified anxiety occurred due to fear of immediate or future threat (e.g., robbery), and depression occurred due to a loss event (e.g., the death of a significant other) (Eysenck, Payne, and Santos, 2006; Sandin, Chorot, Santed, and Valiente, 2004). Jurado, Gurpegui, Moreno, and de Dios Luna (1998) announced depression increased with years of teaching expe&#xAD;rience and teacher age.14&#xD;
&#xD;
In a study, Daniel Veronica (2011), stated that gender produces evident differences in the level of experienced anxiety. In comparison with their male counterparts, female suffered more from higher levels of anxiety and depression. It was found that female teachers suffer more from stress as compared to male teachers.15 The level of anxiety or stress is not the only difference between the two different genders. The type of stressors can also be marked between them. For example, Green glass and Burke (2003) suggested that the raised job stress of females might stock from gender differences in non-working domains, with the higher total workload and higher role conflict between work and family.16 The present study investigates the anxiety, depression and stress among the secondary school teachers working in residential and non-residential schools.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Method&#xD;
&#xD;
Research Design&#xD;
&#xD;
The research is conducted in cross-sectional study design with compliance of the survey model.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Samples of study&#xD;
&#xD;
The study is composed of teachers who are working from home and taking lectures via the internet the teachers are from higher school, tuition teachers and higher studies lecturers. The sample size of this study is 200 teachers from various institutes.&#xD;
&#xD;
Data Collection and Questionnaire.&#xD;
&#xD;
Personal Information form and PHQ-9 (Patient Health Questionnaire) is made by the researcher with the help of google form and send it to the teachers via the link, who are willing to share the personal information with the doctor. In the PHQ-9 questionnaire, there is 9 question which grades individuals depression and anxiety. We have typed those questions in the google form and made an E-questionnaire because in this pandemic it is not possible to meet the teachers personally and fill the form.&#xD;
&#xD;
In PHQ-9 Questionnaire the scores and interpretation are 0-4 (Suggests the patient may not need depression treatment.), 5-14 (Mild major depressive disorder. Physician uses clinical judgment about treatment, based on patient&#x2019;s duration of symptoms and functional impairment.), 15-19(Moderate-major depressive disorder. Warrants treatment for depression, using an antidepressant, psychotherapy, or a combination of treatment), 20 or Higher (Severe major depressive disorder. Warrants treatment with an antidepressant, with or without psychotherapy; follow frequently.) The diagnostic validity of scale having a sensitivity of 88% and a specificity of 88% for Major Depressive Disorder.16&#xD;
&#xD;
The PHQ-9 Questionnaire is the instrument commonly used for measuring the depression. In this questionnaire, there are a total of 9 questions which composed of 4 gradings respectively by which the symptoms of depression is noticed. It takes about 10-15 to read and fill the form. This scale is the same PRIME-MD screening questions to detect depressive symptoms.&#xD;
&#xD;
Procedure&#xD;
&#xD;
The PHQ-9 Questionnaire and the personal information form are the data collection instrument, were implemented by the researcher in the teachers who are willing to share the information, the teachers are informed how to answer the questionnaire during the questionnaire session it will take approx., 10-15 minutes to complete the form for each teacher after completing the e-questionnaire the participant will send the form to the researcher, the special attention is given so that form will be restricted to only one entry per participant, by enabling the option in google form setting. The number of teachers that completed the questionnaire was observed to 200.instst software programme was used for statistical analysis t-test, Mann-Whitney test, and Statistician were used.&#xD;
&#xD;
Findings&#xA0; &#xD;
&#xD;
The Data Obtained from the research was given below ( Table 1, 2).&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
5. Discussion.&#xD;
&#xD;
In this study, we have focused on the depression level on the teachers taking online Classes. The Outcome measure which we have taken is Personal Information form and PHQ-9 (Patient Health Questionnaire) taken 200 Samples in which there are 83 males and 117 females have been included who all are in the teaching profession and currently working and taking lectures via online method. according to statistical analysis,&#xD;
&#xD;
We have 88 subjects of age group 25-34 which is 44% of total sample size, 59 subjects of age group 35-44 which is 29.5% of total sample .0size, 45 subjects of age group 45-54 which is 22.5% of total sample size, 8 subjects of age group 55-60 which is 4% of total sample size. &#xD;
&#xD;
In the present study as there are both males and females has included their marital status has also been taken into consideration we have 134 subjects who are married Which 66% of the total sample and remaining 66 subjects are single which is 33% of the total sample. The marital status has considered because as subjects are working from home many problems encountered the profession that will lead to irritation and if this persists for longer duration it will affect the normal life and will lead to depression.&#xD;
&#xD;
Concerning teaching experience 78 subjects are in teaching field from 1-5 years, 74 subjects who are in teaching field from 6-10 years, 33 subjects who are in teaching field from 11-15 years, 5 subjects who are in teaching field from 16-20 years, 4 subjects who are in teaching field from 21-25 years, 6 subjects who are in teaching field from 26 years and more. As a larger number of subjects are from 1-10 years of experiences i.e total 76% of total subjects. According to this personal information form record, it is calculated that most of the teachers out there in the teaching field are the young population with many responsibilities so while handling this online classes along with responsibilities it can lead to irritation and further depression. &#xD;
&#xD;
Lastly, According to PHQ-9 Questionnaire Interpretation, 67 Subjects fall under 0-4 (Suggests the patient may not need depression treatment.) i.e. 33.5 % of total subjects, &#xD;
&#xD;
74 subjects who fall under 5-14 (Mild major depressive disorder. Physician uses clinical judgment about treatment, based on patient&#x2019;s duration of symptoms and functional impairment.) i.e. 37% of the total population &#xD;
&#xD;
33 subjects who fall under15-19(Moderate-major depressive disorder. Warrants treatment for depression, using an antidepressant, psychotherapy, or a combination of treatment) i.e. 16.5% of total subjects.&#xD;
&#xD;
26 subjects who fall under 20 or Higher (Severe major depressive disorder. Warrants treatment with an antidepressant, with or without psychotherapy; follow frequently.) i.e. 13% of the total population.&#xD;
&#xD;
Because in this situation teachers are facing many problems such as students doesn&#x2019;t respond to the command, students are making fun of teachers as their identity has not reveled or they can easily change their name while joining the class, making inappropriate Soundsas this kind of&#xA0; students disturb the whole class &#xA0;&#xA0;&#xA0;&#xA0;&#xD;
&#xD;
Conclusion.&#xD;
&#xD;
In this study, we have found out that during this present Covid pandemic the teachers who are taking online lecture are suffering from depression or some are on the verge of depression. Because the teachers who are of young age group and are married they are having high chances of getting depressed because of family responsibilities and job responsibilities as well. &#xA0;&#xD;
&#xD;
Recommendation &#xD;
&#xD;
Further Study should be conducted with larger sample size.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3001</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3001</Fulltext></URLs><References>&#xD;
	&#xD;
	Barnes L et al. Reliability generalization of scores on the Spielberger state-trait inventory. Educational and Psychological Measurements, 2002; 62(4): 603-618.&#xD;
	&#xD;
	&#xD;
	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition text revision, DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.&#xD;
	&#xD;
	&#xD;
	Anxiety Disorders of America (2005). Anxiety disorders. Retrieved October 15, 2005 from http://www.adaa.org.&#xD;
	&#xD;
	&#xD;
	Borg M, et al. Stress in teaching: A study of occupational stress and its determinants, job satisfaction and career commitment among primary school teachers. Educational Psychology, 1991; 11: 59-75.&#xD;
	&#xD;
	&#xD;
	Fontana D. Stress levels, gender and personality factors in teachers. Br J Educ Psychol. 1993; 63: 261&#x2013;270.&#xD;
	&#xD;
	&#xD;
	Beehr T, et al. Work stressors and coworker support as predictors of individual strain and job performance. Journal of Organizational Behaviour, 2000; 21, 391-405.&#xD;
	&#xD;
	&#xD;
	Beehr T. Social support and occupational stress: Talking to supervisors. Journal of Vocational Behavior, 1990; 36: 61-81.&#xD;
	&#xD;
	&#xD;
	Betoret F. Stressors, self-efficacy, coping resources, and burnout among secondary school teachers in Spain [Electronic version]. Educational Psychology, 2006; 26(4), 519-539.&#xD;
	&#xD;
	&#xD;
	Brewer, E et al. Job stress and burnout among industrial and technical teacher educators. Journal of Vocational Education Research, 2003; 28: 125-140.&#xD;
	&#xD;
	&#xD;
	Cassano P, et al. Depression and public health. An overview. Journal of Psychosom Research, 2002; 53: 849.&#xD;
	&#xD;
	&#xD;
	Cooper CL, ed (1996) Handbook of stress, medicine and health. (CRC Press, USA).&#xD;
	&#xD;
	&#xD;
	Hotopf M, Wessely S. Stress in the workplace: unfinished business. J Psychosom Res; 1997; 43(1): 1&#x2013;6.&#xD;
	&#xD;
	&#xD;
	Gurian BS, and Miner JH, Clinical presentation of anxiety in the elderly. In C. Salzman and B.D. Lebowitz (Eds), Anxiety in the elderly; Treatment and research. 1991: 31-44. New York: Springer.&#xD;
	&#xD;
	&#xD;
	Daniela Veronica, Stress and Job Satisfaction among University Teachers; International Conference of Scientific Paper AFASES, Brasov,1996: 26-28.&#xD;
	&#xD;
	&#xD;
	Green glass ER, and Burke RJ. Teacher stress. In M. F. Dollard, A. H. Wine field, and H. R. Wine field (Eds.), Occupational stress in the service professions 2003;213&#x2013;236. New York:&#xD;
	&#xD;
	&#xD;
	Kroenke K, et al. The PHQ-9: validity of a brief depression severity measure.&#xA0;Journal of General Internal Medicine, 2001;&#xA0;16(9): 606-613.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Portsmouth POSSUM System in General Surgical Practice and Identifying Risk Factors for Low Outcome&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>103</FirstPage><LastPage>108</LastPage><AuthorList><Author>R. G. Naniwadekar</Author><AuthorLanguage>English</AuthorLanguage><Author> Dilip Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> A. M. Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Harshal Bhoi</Author><AuthorLanguage>English</AuthorLanguage><Author> R. N. Sarwate</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The essential point of any surgery is to cause a decrease in grimness and death rates. Aim: This examination was embraced to evaluate the legitimacy of P-POSSUM scoring framework in patients going through significant medical procedures in our arrangement and, to attempt to dissect the reasons for low result in this high hazard groups is by looking at the effect on the unfriendly result. Methods: A total of 218 major surgical operations were studied in patients admitted in the general surgery department of Krishna Hospital, Karad. Results: A study group consisted of 76 elective, 112 emergency and 30 immediate cases. Duodenal perforation (37), Laparotomy is accounted for 175 cases, Resection anastomosis accounted for 27 cases, Amputation accounted for 12 cases, Cholecystectomy with choledochotomy accounted for 2 cases and Embolectomy accounted for 2 cases. 17 patients died among 112 emergency surgeries except for malignancy, Wound infection (56 cases, 25.92%), accounted for the majority of complications. Conclusion: This study subsequently approves P-POSSUM as a legitimate method for surveying ampleness of care given to the patient. P-POSSUM can be utilized for careful review to survey and improve the nature of careful consideration and result in better result to the patient.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Portsmouth, POSSUM, Surgical, Risk factors, Wound infection, Outcome.</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3002</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3002</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>In-silico Analysis of Deleterious Single Nucleotide Polymorphisms (SNPs) and Molecular Docking of Disease-linked Mutations in Genes Responsible for Schizophrenia&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>109</FirstPage><LastPage>133</LastPage><AuthorList><Author>Neema Tufchi</Author><AuthorLanguage>English</AuthorLanguage><Author> Kumud Pant</Author><AuthorLanguage>English</AuthorLanguage><Author> Devvret</Author><AuthorLanguage>English</AuthorLanguage><Author> Akshara Pandey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Schizophrenia (SZ) is a neurological disorder, the causative agents of which may be multiple factors like genetic, environmental factors, or co-morbidities with other diseases. The actual reason for the occurrence of this disorder is yet to be unrevealed. The genes responsible for this disorder are vulnerable to mutations at the chromosomal or protein levels. So identification of disease-associated mutations may pave the way for divulging the root cause behind the disorder. In the current study, the emphasis had been made on finding the said disease-associated mutations for the disorder through in-silico analyses. Methods: The genes and FDA approved antipsychotics were prioritized using text mining approach, which shortlists nine genes (COMT, DISC1, DAOA, NRG1, PRODH, RGS4, GRM3, DRD3 and DTNBP1) and seven antipsychotics (Haloperidol, Fluphenazine, Aripiprazole, Clozapine, Iloperidone, Lurasidone, and Risperidone). The genes were checked for deleterious or damaging mutations using SIFT and PolyPhen servers. Results: The SNPs rs6267 and rs4986871in COMT protein were found deleterious with both the servers. SNPs rs2391191 and rs9558562 were found damaging in DAOA protein. In case of DISC1 protein five SNPs (rs6675281, rs821616, rs3738400, rs34622148, and rs55795950) were found damaging. NRG1 and RGS4 protein have one deleterious mutation (rs3924999 and rs68678746 respectively) and three deleterious mutations (rs450046, rs2870984 and rs397055) were present in PRODH protein. The SNPs rs181422088 (in DRD3) and rs16876589 (in DTNBP1) were found deleterious with both the servers. The native protein and their mutated form were modelled and docked with the antipsychotics to check their binding energies. Conclusion: The results showed that the binding energies between antipsychotics and mutated proteins were lower as compared to native protein suggesting that mutated proteins bind well and were stable, so a person is prescribed antipsychotics to reduce the symptoms of the disorder. Thus, these mutations may be the reason behind the pathophysiology of the disorder.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Antipsychotics, Docking, Genes, In-silico, Mutations, Schizophrenia.</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3003</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3003</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Prediction and Forecasting of Persistent Kidney Problems Using Machine Learning Algorithms&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>134</FirstPage><LastPage>139</LastPage><AuthorList><Author>Debnath Bhattacharyya</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhanu Prakash Doppala</Author><AuthorLanguage>English</AuthorLanguage><Author> N. Thirupathi Rao</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Persistent Kidney Illness is an extremely hazardous health problem that has been spreading in addition to expanding due to diversification in lifestyle such as food routines, modifications in the environment, and so on. Aim and Objective: The field of health science generates substantial amounts of information from Electronic Wellness Records. According to the wellness data of India, 63538 cases have been registered on persistent kidney condition. The average age of male and female prone to renal problems occurs within the variety of Mid Forty and Seventy year age groups. Conclusion: This paper&#x2019;s original idea is to make a comparative study on various classification techniques and their performance.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Disease Forecasting, Kidney Diseases, Classification.</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3004</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3004</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Social Aspects of Behavioural Problems in Rural School Age Children&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>140</FirstPage><LastPage>144</LastPage><AuthorList><Author>P. M. Durgawale</Author><AuthorLanguage>English</AuthorLanguage><Author> Mrs. Supriya S. Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> R. V. Mohite</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Social problems are the result of the failure of society to adapt to its social institutional culture to its growing needs. Social problems, therefore, are man-made. They are one of the major sources of social suffering. Aim: The study was aimed to find out the prevalence of behavioural problems in rural school-age children and to study social factors associated with behavioural problems in children. Methods: A community-based cross-sectional study was conducted in a rural field practice area. All children of age 6-15 years were included in the study, Mothers were the informant. A manual for the Behaviour Checklist and Revised Child Behaviour profile was used to collect data. Data were summarized in number and percentages. Chi-square test was applied to assess association if exists between social factors and behavioural problems. Results: Total 456 children were studied from the age group of 6-15 years. Majority of the children were from the age group of 12-15 i.e. 254 (55.7%) children. Male children constituted 298 (65.35%). Majority of the children were enrolled in school 449 (98.5%), Major proportion of study group constitute children from joint families i.e. 410(89.9%) and only 46 (10.1%) were from nuclear families. There were 138(30.3%) children with behavioural problems coming from two children families. Majority of the parents were from high school grade education 158(34.6%). Occupation of the father was 264 (57.89%) farmer in the majority of the children. Prevalence of the behavioural problem were Conduct disorder 358(78.5%), Attention deficit hyperactivity disorder 309(67.8%), Anxiety disorder 415(91.8%), Oppositional defiant disorder 367(80.5%), Depressive disorder 355(77.7%), Obsessive-compulsive disorder 33(7.2%), Gender Identity Disorder 2(0.4%). Conclusion: Timely prevention and timely intervention of these behaviour problems can decrease the burden of future psychiatric morbidity or criminality on society&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Behavioural Problems, Rural Area, School Age, Conduct disorder, Attention deficit.</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3005</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3005</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Polio Vaccination at Birth: Current Status and Future Perspectives&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>145</FirstPage><LastPage>147</LastPage><AuthorList><Author>Prasanna Kumar Sahoo</Author><AuthorLanguage>English</AuthorLanguage><Author> Gangadhar Sahoo</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhagirathi Kar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: In the 1950s, Poliomyelitis was a dreaded disease which crippled millions of children all over the globe and a public health scare even in countries where the best health systems existed1 . Almost all children infected with polio developed paralytic poliomyelitis. Aim: This review aims to systematically review the published literature regarding the use of OPV and IPV at birth to determine; i) The justification for an additional dose of tOPV at birth. ii) The use of bOPV in place of tOPV. iii) The use of IPV in place of OPV. Conclusion: The lack of robust data at present does not recommend the birth dose of IPVin countries using IPV in their routine immunization schedule or any other countries.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> OPV (Oral Polio Vaccine), IPV (Inactivated Polio Vaccine), VAPP (Vaccine Associated Paralytic Poliomyelitis), cVDPV (Circulating Vaccine Derived Poliovirus)</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3006</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3006</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pre-Conception and Pre-Natal Diagnostic Techniques Act: Knowledge and Attitude of Students of Commerce College in Rajasthan&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>148</FirstPage><LastPage>151</LastPage><AuthorList><Author>Anand Ranjan</Author><AuthorLanguage>English</AuthorLanguage><Author> Dilip Kumar L</Author><AuthorLanguage>English</AuthorLanguage><Author> Pradeep P. Shinde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was first enforced in 1994 and then updated 2003 to control an age-old and insistent social problem of female foeticide in India. Aims and Objective: To assess the awareness regarding the PCPNDT Act and sex ratio, among the college&#x2019;s students and to sensitize the students regarding declining sex ratio and create awareness by education. Materials and Methods: A cross-sectional opinion study was carried out in the commerce college students of Udaipur under the jurisdiction of the urban health centre area of Pacific Medical College and Research Center. Total of 336 respondents participated with good response. Pre-tested and predesigned proforma was used to collect information under the supervision and analyzed and interpreted using statistical tools. The sensitization was done with lecture and question-answer session. Results: Majority (85.11%) were found in the age bracket of 20 to 22 years with more female respondents. Almost (91.48%) aware of the adverse sex ratio and the PCPNDT Act. The commonest source of information was mass media (82.73%) more than half (58.92%) were aware that sex determination is not permitted legally. Among them (27.97%) exactly knew the punishment profile for violators. Unavailability of brides to marry and rise in violence against women remained common future implication of female foeticide. Girls attitude towards not going for sex determination found statistically significant compared to boys. The commonplace of Male/Female discrimination for girls was outside home and institute while for boys it was in the institute. Conclusion: Although, the majority were aware of the adverse sex ratio and PCPNDT Act, knowledge about exact punishment for violators seemed to be less. Boys attitude towards not going for sex determination in future was less compared with girls. Proper guidance sessions are urged for them.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> PCPNDT act, Sex ratio, Awareness, Female foeticide</Keywords><Fulltext>&#xD;
INTRODUCTION&#xD;
&#xD;
Since antiquity, we Indian are experiencing a long history of social evils and traditions.&#xA0;The widespread social evils till the first half of the 20th century were the Sati system, female infanticide, child marriage, caste system, devadasi, purdah system, and untouchability. About these very less is known to the people.&#xD;
&#xD;
A female infanticide is an act of murdering a female infant deliberately Female infanticide and its practice were widely common in Indian families and communities of colonial India, irrespective of class and caste. Sex-selective abortion was also commonly adapted by many families. This resulted in and a significant decline in the number of girl child in India over the years.1 Sociability ratings for male and female is also likely to differ quite significantly many factors often affect sociability ratings among the youths, in general, some include youth age brackets, family, religious disposition, education, gender and cultural values.2&#xD;
&#xD;
The census 2001 reported alarming sharp fall of sex ratio of children (0-6 year) from 962 (1981), 945 (1991) to 927 in 2001. In 2011 this goes worse and reach down to 914 per 1000 males. Categorical worst performing states are Haryana (830), Punjab (846), Delhi and Chandigarh (867), Rajasthan (883) and Gujarat (886). Government of India enacted legislation in 1994, entitled Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) act to regulates and prevent misuse of technologies for sex determination. The act was implemented in 1996 and was amended in 2003 to Preconception and Prenatal Diagnostic techniques. This act provides the prohibition of sex selection before and after conception. As on September 30, 2009, 36477 bodies registered using ultrasound in the country and 431 machines closed with 603 ongoing cases in the court of law.3 Sex ratio is defined as the number of Female per thousand males.4 Female foeticide is perhaps one of the worst forms of violence against women, where women are denied for most basic &amp; fundamental right i.e. &#x201C;the right to life&#x201D; 5.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The present cross-sectional institution-based opinion study was carried out in commerce college of Udaipur under the jurisdiction of the Urban health centre of Pacific Institute of Medical Sciences and Research Centers. Informed written consent was obtained from the Head of the institute and the purpose of the study was explained to him. With the help of teachers from the same institute, a pretested and predesigned proforma was given to all the students with verbal permission from them. Those who were willing and present on the day of the visit were included in the study. In total 336 respondents participated with good response. In presence of investigators and teachers, participants fill the perform as without permitting to discuss with each other. After filling of proforma, a lecture was delivered on the same to resolve the queries if any. Strict confidentiality was maintained about the collected data and Interpreted and analyzed using appropriate statistical techniques.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Demographic representations&#xD;
&#xD;
In the present study, the majority of the students belonged in the age bracket of 20 to 22 years.&#xA0;Female were more in number than male respondents.&#xD;
&#xD;
&#xD;
&#xD;
Awareness about gender ratio and PCPNDT act&#xD;
&#xD;
Almost many respondents were aware of the adverse gender ratio and the PCPNDT Act. The difference in awareness in boys and girls was not statistically significant.&#xD;
&#xD;
&#xD;
&#xD;
Source of information about the act&#xD;
&#xD;
Majority of participants voted mass media and internet as their primary sources of information. None of the participants replied that doctors or physicians are their sources of&#xA0;information. Very few agree that family or friends are their sources of information and most were unable to answer.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Awareness about legal permission of gender detection&#xD;
&#xD;
About 58.92 % of respondents were aware that, prenatal sex determination is not legally permitted. Girls (63.63%) were more aware compared with boys (52.17%). Many participants answered that they do not this acts and whether there is a provision of legal permission to do gender detection.&#xD;
&#xD;
&#xD;
&#xD;
Awareness about punishment under PCPNDT Act&#xD;
&#xD;
There are different provisions of punishments under this act for doing illegal prenatal gender detection. This includes monetary fine, imprisonments or both, suspend or dispend form the job if a person is employed somewhere. Only 1/3rd (27.97%) was exactly aware of punishment under the PCPNDT Act. Girls were more aware compared with boys (2.61:1).&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Opinion on the future consequences&#xD;
&#xD;
Many participants (80.95%) felt that there will be an increase in crime against women followed by, a smaller number of girls to marry for boys (77.97%). About 57.14% felt that no mothers and sisters will be there in future. Few also responded that this may cause an adverse effect on female health because of repeated pregnancies and forced abortions. Possibility of inter-caste marriages, polyandry were also answered by many participants.&#xD;
&#xD;
&#xD;
&#xD;
Personal views prenatal gender detection&#xD;
&#xD;
About 2/3rd of the participants (69.05%) had a positive attitude towards not doing sex determination in future. Girls outnumbered the boys, found to be statistically highly significant.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
In life encounter with gender discrimination&#xD;
&#xD;
About 59.59 % girls &amp; 75.36 % boys never encountered male/female discrimination in life. The commonest place for discrimination for girls was outside home and institute i.e. 40.59 % while boys the place was institute i.e.14.49%.&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In the present study, Commerce undergraduates participated with the preponderance of female students agreed regarding adverse sex ratio and female foeticide (91.48%). These findings are comparable with the previous study.6 Different cross-sectional studies reported 98% of awareness on medical students in Mumbai and 58% among the general population.7,8 Mass media and the Internet remained the commonest source of information regarding PCPNDT Act awareness.&#xD;
&#xD;
Previously similar results were reported wherein, 90% agreed and vote to media as a source of knowledge.7,8 Majority of participants voted mass media and internet as their primary sources of information. None of the participants replied that doctors or physicians are their sources of information. Very few agree that family or friends are their sources of information and most were unable to answer.&#xD;
&#xD;
In our study, about 58.92 % were aware that female foeticide determination is not legally permitted. Many participants answered that they do not this acts and whether there is a provision of legal permission to do gender detection. This percentage of the respondent is less as compared to the previous report who states that 79 % of adolescent girls were aware of it. Only one third (27.97%) students were aware of the correct punishment scenario in PNDT Act, which is the more compared previous study by Murarkar and team who reported 18.33 % among adolescent girls7 but less compared with the study by Metri and team who reported 53 % among teachers of Hassan district Karnataka.8 There are different provisions of punishments under this act for doing illegal prenatal gender detection. This includes monetary fine, imprisonments or both, suspend or dispend form the job if a person is employed somewhere. Girls were more aware compared with boys (2.61:1).&#xD;
&#xD;
The present study focused increase in sexual and social crime against women as an impact of female foeticide in future (80.95%) followed by a smaller number of girls to marry (77.97%).&#xD;
&#xD;
Half of the participants also answered that there will be no mothers and sisters in future. Few also responded that this may cause an adverse effect on female health because of repeated pregnancies and forced abortions. Possibility of inter-caste marriages, polyandry was also answered by many participants. Our findings are comparable to study by Dadwani and team who compare the urban and rural population and reported that 76.5% answered the lack of bride in future from urbanities and 73.9% from rural people.6 Further 43% response to the increase in sexual and social crime is also reported.4 Commonest place of discrimination for girls was outside home and institute while for boys institute.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The study shows that most of the student are aware of sex determination and female foeticide and voted mass media and the Internet as a primary source of information. More than half were aware that sex determination is illegal and few were aware of the punishment modalities for defaulters. Crime against women may increase in future and there will be no girls to marry are the future demerits of not this social evil. We conclude that the knowledge and attitude regarding PCPNDT act need to reach to maximum sections of the community the provisions have to be implemented compulsorily.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3007</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3007</Fulltext></URLs><References>&#xD;
&#xD;
	&#xD;
	Basumatary A. The study of the institution of female infanticide in colonial India. J IntAcad Res Multidiscipl2015;3(7):26-33.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Baraskar VJ, Shinde PP. To study the gender difference in personality factor and anxiety in adolescents-sociality self-confidence ambition and Anxiety. J Evidence-Based Med Healthcare2018;5(18):123-129.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Yadav KJ, Ganapa P, Fernandes J et al. Awareness and perception regarding female foeticide among adolescents in the rural community of Nalgonda district, Telangana. IntJ Comm Med Pub Health2018;5(7):3106-3110.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Patil P, Singh V, Chavan S. Knowledge and attitude regarding PCPNDT Actamong medical undergraduate. Innovative J Medical Health Science2014;4(2):83-85.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Siddhu TK, Kumar S, Paramjit E, Kaur S. A study of knowledge and attitude regarding the PCPNDT Act among medical undergraduate regarding prenatal sex determination &amp; female foeticide. Int J Med Commu Health2011;13(3):410-417.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Dadwani RS, Thomas T. Knowledge regarding sex ratio &amp; PCPNDT Act: Across sectional study. Int J Sci Res2014;3(8)274-276.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Murarkar SK, Ghate MM, Joshi AM. A study of knowledge and attitude of adolescent girls in the rural area regarding prenatal sex determination and female foeticide. Ind J Mater Child Health2013;15(4):2-7.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Metri SS, Venktesh GM, Thejeseari HL. Awareness regarding Gender preferences female foeticide among the teachers in Hassan District, South India. J Clin Diag Res 2011;5(7):1430-1433.&#xD;
	&#xD;
&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Exploring the Connection between Problematic Pornography, Personality and Emotional Adjustment&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>173</FirstPage><LastPage>176</LastPage><AuthorList><Author>Samiksha Jain</Author><AuthorLanguage>English</AuthorLanguage><Author> Neelam Pandey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The topic of Sexually explicit materials and the discussion of sex is always a limitation to most of the developing country such as India.The study aims to understand the relationship between pornography viewing, personality and Emotional adjustment among young and unmarried Indian adults. Method: Data was collected from 96 young adults (33 males and 63 females) considering the inclusion and exclusion criteria of the study. Snowball sampling design was used to recruit the participants for the study. Statistical Analysis was done using SPSS. Result: The study found the gender difference in the use of pornography among males and females. And there exists a relationship between problematic pornography, four dimensions of personality and Emotional adjustment. Conclusion: There exists a positive and significant relationship between problematic pornography consumption and Emotional adjustment, Openness to Experience and Extraversion (significant at 0.05 level). A highly significant and positive relationship was found between problematic pornography consumption and Neuroticism (significant at 0.01 level). Also, the study found that there exists a negative correlation between problematic pornography consumption and Conscientiousness (significant at 0.01 level). There have been insignificant relationship found between pornography consumption and agreeableness.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adjustment, Consumption, Emotional, Pornography, Watching</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3011</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3011</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>12</Volume><Issue>20</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2020</Year><Month>October</Month><Day>27</Day></PubDate></Journal><ArticleType>Life Sciences</ArticleType><ArticleTitle>Potato Plant Disease Detection Using Convolution Neural Network&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>152</FirstPage><LastPage>156</LastPage><AuthorList><Author>Pitchai R</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharath Kumar G</Author><AuthorLanguage>English</AuthorLanguage><Author> Ashutosh Varma D</Author><AuthorLanguage>English</AuthorLanguage><Author> Madhu Babu CH</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: In countries like India, whose primary occupation is agriculture faces a huge loss when the crops get affected by any disease. These diseases attack the crops in various stages and destroy the entire production. Since most of the diseases are transmitted from one crop to another there is much need to detect the exact type of disease the crop has been affected so that farmers can take the required steps to the &#x201C;save the crops&#x201D; and production. But detecting the kind of disease that a crop has been affected is very difficult for farmers since there are various kinds of diseases. Method: There are so many classification techniques, such as k-Nearest Neighbor Classifier, Probabilistic Neural Network, Genetic Algorithm, Support Vector Machine, and Main Component Analysis, Artificial Neural Network, and Fuzzy Logic. It is difficult to select the best classification method as compared to other methods the system will be more reliable. This article presents a dissection of various techniques used to find the disease of the plants. Results and Observation: The developed system is capable of detecting diseases in plants and is also capable of providing treatments that can be used against them. To improve the health of the plant, we need to deal with it with sufficient knowledge of the disease and cure. The framework proposed is implemented using python and the google GPU(Graphical Processor Unit) used provided 80 % accuracy. Conclusion: The proposed model used a convolution a neural network model based on SSD mobile network for data training. Some checkpoints are created after training the model. We need to take the last Model Checkpoint to create a file that is used for testing. A particular file type with the.pb extension is created by using the checkpoint file. The model provided 80% of accuracy.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Plant Disease Detection, Neural networks, Genetic algorithm, KNN, PCA, Fuzzy Logi</Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; India is a cultivated nation that relies on farming for approximately 70% of its population. Farmers have a wide range for the option of different suitable crops and the search for effective plant pesticides. Plant disease leads to a substantial decrease in both farm goods quality and quantity. The aim of agriculture is not just to feed people but also to provide a major energy source and solution to the worldwide problem of global warming. To order to treat and monitor the disease, the diagnosis of plant disease is very important at an earlier level. Plant disease studies include analyses of visually tracked plant trends.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; During the early days, the specialist in this field was able to manually track and examine plant diseases, who would notice the light colour changes on the plant leaf, but this takes an incredibly long processing period. The image processing techniques are then used to solve this problem. Health monitoring and plant disease identification are very relevant to sustainable farming. Manually tracking plant diseases is very difficult. It needs a large amount of effort, plant disease experience and an unnecessary time for production. The analysis of photographs is also used to identify plant diseases.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Detecting diseases requires measures such as collection, preprocessing, segmentation of images, extraction of features and classifications. Within the following (Section III) the literature review provides brief details on the different methods used to detect plant diseases.&#xD;
&#xD;
Motivation &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The leaves are a delicate part of the plant; the assessment of farm harvest is of dynamic importance. The leaf&amp;#39;s texture and colour is the most significant visual property. Therefore it is important to identify leaf diseases to assess farm products, enhance the market value and comply with quality standards. This is also important to recognise and take additional measures to further spread diseases. It&amp;#39;s going to be too slow. When physical methods are used to classify and categorize the method, we also need the professionals to ensure it gets incorrect, and who&amp;#39;s less readily available.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The works are categorized according to colour, scale, etc. When such procedures are documented in an automated system by using the correct software design language, the effort becomes faster and error-free. There are two main features to be achieved, speed and precision in the methods of machine-learning for plant disease detection. Technologies such as automated detection and classification of plant diseases using floor image processing techniques are required. It proves useful for farmers and warns them at the right time before the disease spreads over a wide area.&#xD;
&#xD;
Literature Survey&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; T. Van der Zwet et al. (2002)1 developed a model of identification of plant diseases using CNN to classify 13 different types of plant diseases. Tatem and Rogers et al. (2006)2 researched the Global Transportation Networks and the transmission of infectious diseases and their effects on epidemiology in particular. J. R. Rohr et al. (2008)3 studied the relations between climate, disease transmission and declines in amphibians. Steinwart and A. Christmann et al. (2008)4 used the algorithm K -means to cluster the data set. Mrunalini R. et al. (2011)5 identified clustering of K-means and artificial intelligence in pattern recognition of crop diseases. A. New spectral indices (NSIs) developed by K. Mahlein et al. (2013)6. NSI is useful for the identification of crops of various diseases.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; H. Cartwright et al. (2015)7 identified the Artificial Neural Networks to simulate human brain model functioning. Raj Kumar et al. (2016)8 addressed Hybrid Features and Automated Leaf Disease Detection and Classification Supervised Classifier. They also built a database consisting of around 32,000 different species of plants that are pre-processed, such as image reshaping, resizing and converting to a collection. Related processing happens on the test image as well. H. Azizpour et al. (2016)9 used Convolution networks to examine many factors affecting transferability, design, training data distribution, feature extraction etc.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; J. Garcia Arnal Barbedo et al. (2018)10 used the Annotated Plant Pathology Databases for the identification and recognition of diseases based on photos. G. Zhou et al. (2019)11 suggested, using FCM-KM and Faster R-CNN fusion, a technique to resolve the various problems with rice disease detection accuracy. Adnan Mushtaq et al. (2019)12 proposed a model for plant disease detection and offers solutions using coevolutionary neural networks. Raghavendran S et al. (2019)13 addressed the categorisation of leaf disease using vector machine support technique. Sankaran et al. (2010)14 surveyed some of the advanced plant disease identification techniques.&#xD;
&#xD;
Tyr Wiesner-Hanks et al. (2019)15 outlined a two-step process for producing large quantities of high-quality training data with limited expert feedback. Liu, LOuyang, W and Wang, X et al. (2020)16 reviewed more than 300 research papers including several views on the detection of generic objects: frameworks for identification, representation of object characteristics, generation of object proposals, context modelling, training strategies, and metrics for assessment. M Pothen, E and D. M. L. Pai, (2020)17 suggested a classification system for the rice leaf disease.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The following parameters were considered: bacterial leaf blight, Leaf smut and Brown spot diseased images, and Otsu&amp;#39;s segmentation method was used. Sun et al. (2020)18 proposed the multi-scale detection of feature fusion using neural networks of convolution. J. Li et al. (2020)19 proposed a system for the identification, location and study of marine cucumber using a Faster R-CNN. W. As a new extraction design for the Rice Blast detection Chen et al. (2020)20 implemented a revolutionary spore germination method. Rasul Ruzmetov et al. (2020)21 reviewed the morphological properties of apple trees with cytosporosis disease. Anjan Kumar Payra et al. (2013)22 protein function for prediction.&#xD;
&#xD;
Methodology&#xD;
&#xD;
The basic steps of plant disease detection are shown in figure 1. The steps involved in our methodology are,&#xD;
&#xD;
&#xD;
	&#xD;
	Image Acquisition&#xD;
	&#xD;
	&#xD;
	Image Pre-processing&#xD;
	&#xD;
	&#xD;
	Image Segmentation&#xD;
	&#xD;
	&#xD;
	Feature Extraction&#xD;
	&#xD;
	&#xD;
	Classification&#xD;
	&#xD;
	&#xD;
	Image Acquisition: The initial procedure is to collect all infected or diseased plant leaf images via a camera or a source, which stores all infected plant leaf data. The first photo is in RGB type (Red, Green and Blue). In this colour transformation method, a device-independent colour-space transition is generated for an RGB leaf image and then used for the colour transformation method.&#xD;
	&#xD;
	&#xD;
	Image Pre-processing: The contaminated plant leaf in the picture produces noise. The noise here may be dust, on the leaf sand and other stuff. To get more accuracy it is important to remove the noisy data from the image. Pre-processing techniques are then used to eliminate noisy image images. There are several pre-processing techniques available some of which are Image clipping, i.e. cropping of the image of the leaf to get the area of interest. Smoothing of the image is achieved with the smoothing filter. Improvement of the picture is carried out to improve the contrast. The result it generates is dependent on any one of the techniques used.&#xD;
	&#xD;
	&#xD;
	Image Segmentation: Segmentation means partitioning the image into separate parts with the same features, or having some resemblance. The segmentation can be achieved using various approaches such as clustering k-means, converting an RGB image to HIS model etc. Here, we used the algorithm K Means. The clustering of K-means is used to classify objects based on a collection of features into the number of classes K. Object classification is achieved by minimizing the sum of the squares of the distance between the object and the cluster in the query.&#xD;
	&#xD;
	&#xD;
	Feature Extraction: Extraction of features plays a key role in detecting a plant disease. Extraction function is used in many image processing applications. Colour, texture, shape, edges etc. are the characteristics that can be used in the identification of plant diseases. Morphological results are found to provide better results than the other features. Texture means how the image is formed in colour, the roughness, the image&amp;#39;s hardness. This method collects the characteristics of tainted vegetable leaves.&#xD;
	&#xD;
	&#xD;
	Classification: After the extraction of the function is done, a classifier is created which is used to identify the plant disease. Depending on their leaves, the plant disease can be classified and is defined as healthy and unhealthy leaves. The unhealthy leaf is further graded based upon the type of disease with which it has been attacked.&#xD;
	&#xD;
&#xD;
&#xD;
Results&#xD;
&#xD;
Our system is capable of reliably detecting diseases on potato plants. We need to deal with this with ample knowledge of the disease and cure to improve the plant&amp;#39;s health. The framework implemented using python and the google GPU(Graphical Processor Unit). Figure 2 provides samples of the results of our system. Figure 2.a shows Healthy early blight potato leaf, Figure 2.b shows Healthy late blight potato leaf and Healthy potato leaf Figure 2.c. Our system delivered 80 per cent accuracy.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The input for the model is photos of potato leaf that include two disease types, one of which is early bright and the other late bright. The images input which is passed to the model is as follows. To get more accuracy for the model, the input images are preprocessed to eliminate noise data, dust, and other stuff from the images.&#xD;
&#xD;
We applied the transfer learning technique to a predefined convolutional neural network model i.e.,&#xA0; SSD mobile net for training the data. SSD_Mobilenet is a neural network algorithm which is used for object detection. SSD is a framework used for multi-box detectors and Mobilenet is used for classification. Only by combining both, it is used for object detection. The job of mobile net layers is to convert the pixels from input image to feature that defines the image and hence it is used as a feature extractor. With the help of the mobile net, we can classify the image category. The following is the procedure for training and testing the model.&#xD;
&#xD;
Initially, we collect a few hundred images that contain the required leaf images i.e., potato diseased leaf from an external source. We need to annotate the infected potato images by using a software called LabelImg because we need to draw a box around the infected region for the leaf image and must specify the class for it to train it. This Label Img software automatically will create an Extensible Markup Language (XML) file that describes the leaf image with infected region dimensions. We need to split the images data into train and test samples. The train samples are used for training the model and test samples are used for testing the model whether it is producing the required results or not. &#xD;
&#xD;
As we have discussed in the above statement LabelImg software creates an XML file but the model( SSD mobile net) does not accept the XML file for training we need to change the XML file to another file format so that we can use that file to train the model. We can convert the XML file to comma-separated values (CSV) file by using some code. After the conversion of a file from XML to CSV use the generated train.csv file to train the model. The ssd_mobilenet model uses tensor flow as a backend for object detection. It takes more time to train the model in normal systems. So we have used google open-source cloud platform i.e., Google Colaboratory which provides GPU environment and storage space up to an extent for the user. It is faster when compared to normal systems that do not have a Graphical Processor Unit (GPU) accessibility. The platform runtime is only 12 hours So we have to be careful while training the model. To train the predefined model we need to change some code in the model configuration file to our requirement and save it. &#xD;
&#xD;
While training, the model generates some checkpoint files at some interval of time so we need to save those checkpoints accordingly to start the training from that checkpoint even if the platform runtime restarts. We can start the training from a particular checkpoint by using a checkpoint file by changing some code in it. In the ssd_mobilenet configuration file, there will be something like execution steps. We need to mention a value by which the training ends whenever it reaches the specified execution step. &#xA0;The output of the model is as follows in fig 2.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Our proposed system was built taking into account the benefits of the farmers and the farming industry. The established system is capable of detecting disease in plants and also providing the remedy that can be taken against it. We will handle it by proper knowledge of the disease and the cure to improve the plant&amp;#39;s health. The framework proposed is implemented using python and gives approximately 80 % accuracy. Use Google GPU to process will improve accuracy and speed. Shortly, we will be able to train the model with more data that can cover all the diseases that are present and it should be able to suggest the precautions. It can also be implemented in drones so that the drones capture the leaves from the top and detects the kind of disease that the plant has affected and provide the necessary instructions for the farmers to take further action to stop the disease.&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
We thank our colleagues from B.V. Raju Institute of Technology, Narsapur who provided insight and expertise that greatly assisted the research, although they may not agree with all of the interpretations/conclusions of this paper. 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.&#xD;
&#xD;
Conflict of Interest: There is no conflict of interest.&#xD;
&#xD;
Financial Support: Not applicable&#xD;
&#xD;
Human or animal study Ethical clearance letter: Not Applicable&#xD;
&#xD;
Informed consent: Not Applicable&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3153</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3153</Fulltext></URLs><References>&#xD;
	&#xD;
	Van der Zwet, T. Present Worldwide Distribution Of Fire Blight. Acta Hortic, 2002; 590: 33-34. &#xD;
	&#xD;
	&#xD;
	Tatem, D. J. Rogers, and S. I. Hay et al. Global transport networks and infectious disease spread, Advances in Parasitology, 2006; 62: 293&#x2013;343.&#xD;
	&#xD;
	&#xD;
	Rohr JH, Raffel TR, Romansic JM, &#xA0;McCallum H, and P. J. Hudson et al. Evaluating the links between climate, disease spread, and amphibian declines, Proceedings of the National Academy of Sciences of the United States of America. 2008; 105(45): 17436&#x2013;17441.&#xD;
	&#xD;
	&#xD;
	Steinwart and Christmann R. Support Vector Machines, Springer Science and Business Media, New York, NY, USA, 2008.&#xD;
	&#xD;
	&#xD;
	Mrunalini R. Badnakhe. An Application of K-Means Clustering and Artificial Intelligence in Pattern Recognition for Crop Diseases, 2011 International Conference on Advancements in Information Technology With workshop of ICBMG 2011: 134-138.&#xD;
	&#xD;
	&#xD;
	Mahlein AK et al. Development of spectral indices for detecting and identifying plant diseases, Remote Sensing of Environment. 2011; 128: 21&#x2013;30. &#xD;
	&#xD;
	&#xD;
	Cartwright H, Ed., Artificial Neural Networks, Humana Press, 2015.&#xD;
	&#xD;
	&#xD;
	Raj Kumar S, Sowrirajan S. Automatic Leaf Disease Detection and Classification using Hybrid Features and Supervised Classifier, Int. J. Adv. Res. Electrical, Electronics and Instrumentation Engg. 2016; 5(6): 4556-4563. &#xD;
	&#xD;
	&#xD;
	Azizpour H et al. Factors of Transferability for a Generic ConvNet Representation, IEEE Transactions on Pattern Analysis and Machine Intelligence, 2016; 38(9): 1790-1802.&#xD;
	&#xD;
	&#xD;
	Garcia J, Arnal B. Annotated Plant Pathology Databases for Image-Based Detection and Recognition of Diseases, in&#xA0;IEEE Latin America Transactions,2018; 16(6): 1749-1757. &#xD;
	&#xD;
	&#xD;
	Zhou G, Zhang W, Chen A, He M and Ma X. Rapid Detection of Rice Disease Based on FCM-KM and Faster R-CNN Fusion, IEEE Access, 2019;7: 143190-143206. &#xD;
	&#xD;
	&#xD;
	Adnan Mushtaq et al. Plant Disease Detection using CNN &amp; Remedy, Int. J. Adv. Res. Electrical, Electronics and Instrumentation Engg. 2010; 8(3): 622-626. &#xD;
	&#xD;
	&#xD;
	Raghavendran S et al. Leaf Disease Classification using SVM Classifier in Cloud, Int. J. Innovative Techn. Exploring Engg. (IJITEE), 2019; 9(1): 4146-4149. &#xD;
	&#xD;
	&#xD;
	Sankaran S, Mishra A, Ehsani R, and Davis C et al. A review of advanced techniques for detecting plant diseases, Computers and Electronics in Agri. 2010; 72(1):1&#x2013;13,&#xD;
	&#xD;
	&#xD;
	Tyr Wiesner-Hanks et al. Millimeter-Level Plant Disease Detection From Aerial Photographs via Deep Learning and Crowdsourced Data, Tech. Adv. Plant Sci. 2019; 10: 1-11.&#xD;
	&#xD;
	&#xD;
	Liu, L., Ouyang, W., Wang, X.&#xA0;et al. Deep Learning for Generic Object Detection: A Survey.&#xA0;Int. J. Comput Vis, 2020; 128: 261&#x2013;318.&#xD;
	&#xD;
	&#xD;
	Pothen ME and Pai DM, Detection of Rice Leaf Diseases Using Image Processing,&#xA0;2020 Fourth International Conference on Computing Methodologies and Communication (ICCMC), Erode, India, 2020; &#xA0;424-430.&#xD;
	&#xD;
	&#xD;
	&#xA0;Sun J, Yang Y, He X and Wu X, Northern Maize Leaf Blight Detection Under Complex Field Environment Based on Deep Learning, in&#xA0;IEEE Access, 2020; 8: 33679-33688. &#xD;
	&#xD;
	&#xD;
	&#xA0;Li J, C. Xu L, Jiang, Y, Xiao L, Deng Z and Han Z, Detection and Analysis of Behavior Trajectory for Sea Cucumbers Based on Deep Learning,&#xA0; in&#xA0;IEEE Access, 2020; 8: 18832-18840. &#xD;
	&#xD;
	&#xD;
	Chen W, Lin Y, Ng Y, Liu C and Lin Y. Rice Talk: Rice Blast Detection Using Internet of Things and Artificial Intelligence Technologies, in&#xA0;IEEE Internet of Things Journal, 2020; 7:2: 1001-1010.&#xD;
	&#xD;
	&#xD;
	Rasul Ruzmetov, Yulduz Matyakubova, Ikram Abdullaev. Cytosporosis Diseases of Apple Trees (Reinette Simirenkomalus) and It&#x2019;s Distribution in the Lower Amudarya Region International Journal of Current Research and Review. 2020;12 (14): &#xA0;62-67.&#xD;
	&#xD;
	&#xD;
	Payra, Anjan. Function Prediction using Cluster Analysis of Unannotated Align Sequences. International Journal of Current Research. 2013; 5: 134.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet></xml>