Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Warning: Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 234
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareSpectrum of Pathogens Derived from Women Diagnosed with Urinary Tract Infections
English0206Dilfuza IsanovaEnglish Yuriy AzizovEnglish Dildora MirzakarimovaEnglish Manzura SolievaEnglish Sherzodjon AbdukodirovEnglish Avazbek KayumovEnglishIntroduction: As a result of large-scale scientific research and fundamental research carried out in the field of medicine in the world, it has been established that one of the most common bacterial infections occurring in humans is infections of the urinary system. These infections are common among populations of all ages. “the incidence of urinary tract infections among newborns is 1.0%, among school-age children 2-3% (the ratio of boys to girls is 1:10), in the elderly 20-30%.” it is known that there are various microorganisms in the lower part of the urinary tract.
Objective: Several scientific studies are being carried out around the world to achieve high efficiency in improving the diagnosis, treatment, prevention of acute and chronic urinary tract infections.
Methods: In the leading scientific and clinical centres of many countries, research work is being carried out on acute and chronic urinary tract infections, but it remains a priority to determine the degree of variability of taxonomic characteristics of urinary tract infections, the relationship of their virulence with the immunobiological state of the macroorganism, the development of criteria for determining the effectiveness of treatment, mechanisms the formation of a dysbiotic state in various biotopes of women, the creation and implementation of optimal treatment regimens.
Result: In Uzbekistan, along with the accelerated development of the medical sector, which provides high-tech enrichment of modern medical equipment, the correct system of diagnosis and treatment of chronic diseases among women of reproductive age is being introduced.
Conclusion: Fulfilling these tasks for the diagnosis of microbiological characteristics and the peculiarities of the variability of the main taxonomic signs of urinary tract infections in women of reproductive age, raising the level of modern medical care to a new level and further improving the quality of medical services will help reduce the incidence of urinary tract infections among women of reproductive age and improve health.
EnglishUrinary Tract Infections, Pathogens, Sick women, Purulent-inflammatory processes, Bacteriuria, Pyelonephritis, renal abscess, CarbuncleINTRODUCTION
The term "urinary tract infections" refers to the process of purulent-inflammatory processes in the urinary system. At present, there are pathologies of the lower (cystitis, urethritis) and upper parts of the urinary tract (pyelonephritis, renal abscess and carbuncle, apostematous pyelonephritis).1,2
The clinical significance of UTI is explained by its prevalence, the complexity of the diagnosis, the negative impact on the health and ability to work of the population, the large investment in the diagnosis and treatment of this pathology.3,4 At present, all urinary tract diseases are divided into congenital and lifelong diseases based on the International Classification of Diseases (ICD-10), which was revised 10 times in 2007.2,5,6
It is known that the human urinary system includes the kidneys (upper urinary tract), urinary organs - urinary tract, bladder (middle urinary tract), urethra (lower urinary tract). The tissues and cells of these organs perform the functions of separating urine from the blood, expelling it from the body, and expelling it.7
The literature suggests that the urinary tract of healthy women is normally sterile, free of various microorganisms, while in men, some urinary tract genital system biotope-specific normative microflora are present, albeit in small amounts.2,4,8
It has been shown that urination is a complex reflex process that occurs when at least 250-300 ml of urine accumulates in the bladder in normally healthy people. Normally, urination occurs 4-6 times a day, and in all healthy people, urine is normally sterile.3,9 There is no difference between men and women in this pathophysiological process.
Uroepithelial cells in the urinary tract produce a mucopolysaccharide substance that forms a protective layer that is a covering and antiadhesive factor and separates it on the surface of the urinary tract mucosa. The formation of this mucopolysaccharide layer is a hormone-dependent process produced in the body. While estrogens affect its synthesis, progesterone affects its release from epithelial cells.7 Normally, a low value of urinary pH has a bacteriostatic effect, characterized by high concentration and osmolarity of urea.5,9
The occurrence of bacteria of different generations and types, specific and non-specific inhibitors, A, G, secretory immunoglobulins A (IgA, IgG, sIgA) are observed in human urine.6
MATERIALS AND METHODS
To complete this dissertation, a total of 1026 women of childbearing age (18-49 years) with UTI (Main group) and healthy (control group) were involved in the article. Their urine samples were bacteriologically examined. Clinical material was obtained from sick leaves and outpatient cards.
The examined women of childbearing age (Main group, n = 986) were divided into age groups as follows:
- 18-35 years - mature reproductive age (n = 578, 58.6 ± 1.6%);
- 36-49 years - late reproductive age (n = 408, 41.4 ± 1.6%).
Healthy women of childbearing age (n = 40) included in the control group formed for comparison were also distributed by the following age groups:
- 18-35 years - mature reproductive age (n = 25, 62.5 ± 7.6%);
- 36-49 years - late reproductive age (n = 15. 37.5 ± 7.6%).
The group of women with UTI did not include women with occupational diseases that adversely affect the condition of the urinary tract, women with urinary tract infections caused by specific pathogens (tuberculosis, gonorrhoea, trauma, etc.), urinary tract tumours, chronic nephrological diseases.
The group of healthy women included women who did not have UTI, who did not have symptoms typical of such diseases in the last 2 years, whose age, lifestyle, living conditions were representative with the group of sick women.
The other control group consisted of healthy males of the same age (18–49 years) (n = 30). Their urine samples were also bacteriologically examined, as were those of women.
Andijan (sick women - n = 628, 63.7 ± 1.5%; healthy women - n = 23, 57.5 ± 7) in order to compare the results of microbiological studies to determine whether there are regional differences between UTI pathogens in relation to the location of patients , 8%) and Khorezm regions (sick women - n = 358, 36.3 ± 1.5%; healthy women - n = 17, 42.5 ± 7.8%).
Of all the women of childbearing age (18-49 years) involved in microbiological studies, 194 patients (n = 986) were diagnosed with acute UTI, 84 with chronic UTI (total n = 278) using clinical, laboratory-instrumental methods, bacteriological confirmed using methods.
RESULTS
To compare the results obtained during the study, we gave the level of detection of uroinfectious pathogens by gender. Clinically significant bacteriuria (10? CFU / ml and more) were considered urinary tract infectious pathogens isolated from the largest dilution of urine.
Clinically significant bacteriuria in 278 samples (28.2 ± 1.4%), non-clinically significant bacteriuria (less than 10?CFU / ml) in 528 samples (53.5 ± 1.6%), sterile urine samples in 180 cases ( 18.2 ± 1.2%) were detected (Figure 3.1). Advanced microbiological studies in the next phase involved sick women (n = 278) with clinically significant bacteriuria and isolated pathogens (Figure 1).
The results showed that the etiological role of gram-negative bacteria was close to each other in women of childbearing age and men of the same age (Table 1). Escherichia coli accounted for the majority (59.4 ± 2.9%, n = 165) of the 278 strains isolated from women of childbearing age UTI observed. A similar situation was observed in male patients. Other representatives of Enterobacteriaceae were characterized by the fact that Klebsiella pneumonia, Proteus Vulgaris, Enterobacterales and Citrobacter freundii were significantly less isolated than Escherichia coli (PEnglishhttp://ijcrr.com/abstract.php?article_id=3257http://ijcrr.com/article_html.php?did=32571. Abdullaev RK, Tojieva ZB. Diagnostic value of bacteriological examinations in urinary tract infections. J Theo Clin Med 2014;2:31-33.
2. Apolikhina IA, Glybochko PV, Teterina TA. Genetic predisposition to the development of uncomplicated urinary tract infections and refractory overactive bladder in women. Expt Clin Urol 2012;4:14-19.
3. Alekseenko IV, Ivanova LA. The modern view of the problem of urinary tract infections in pregnant women with type 1 diabetes. Int J App Fund Res 2016; 12:1174-1179.
4. Alekseenko IV, Ivanova LA, Arkhipov EV, Sigitova ON. Urinary tract infections in pregnant women: modern recommendations for diagnosis and treatment. Bull Mod Clin Med 2016;9(6):109-114.
5. Beloglazova IP, Troshina AA, Poteshkina NG. Urinary tract infections: part I. Gen Med 2018;1:18-24.
6. Voshchula VI, Vilyukha AI. Uncomplicated lower urinary tract infection in women and its prevention. Arsmedica 2012; 5:98-104.
7. Valyshev AV, Elagin NN, Bukharin OV. Anaerobic microflora of the female reproductive tract. Gen Med 2001;4:78-84.
8. Barkanova ON, Modern views on antibiotic therapy of uncomplicated urinary tract infections. Bull. Mod. Clin. Med .2012;4:108-113.
9. Bereznyakov IG. Features of diagnosis and treatment of lower urinary tract infections in women. Med Asp Wom Health 2006; 1: 38-43.
10. Hajiyeva ZK. Features of the approach to the diagnosis and treatment of recurrent infections of the lower urinary tract. Urology 2013;3:84-90.
11. Gadzhieva ZK, Kazilov YB. Features of the approach to the prevention of recurrent lower urinary tract infections. Urology 2016;3: 65-76.
12. Venkata NM, Debnath BD. Identification of Parasite Presence on Thin Blood Splotch Images. Int J Curr Res Rev 2020;12(19):4-08.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareProtocol for Handling and Disposal of The Dead Bodies in Covid-19
English0709Sampada V. LateEnglish Harsha KecheEnglish V. K. ChimurkarEnglish Vaibhav AnjankarEnglishCOVID 19 is an acute respiratory illness caused by COVID 19 virus that directly affects the lungs. Based on current pieces of evidence and researches, the COVID 19 virus is transmitted between peoples and communities through droplets, fomites and close contact with an infected person, with possible spread with faeces. It is not an airborne disease. As this is a new virus whose sources and disease progression are not yet totally clear. Except in cases of hemorrhagic fever such as Ebola, Marburg and cholera, dead bodies are not infectious. Only those patients having lung disease-causing pandemic influenza, if handled improperly during an autopsy, can be infectious. Otherwise, cadavers do not transmit diseases. It is a generally common myth that a person who has died from the communicable disease should be cremated, but this is not true. To date there is no evidence of a person has become infected from exposure and contact with bodies of persons who died from COVID 19. The safety and wellbeing of everyone who tends to handle the bodies should be the priority. WHO, Ministry of Health, Family welfare has given some important guidelines on handling dead bodies in hospital setups, with the standard of precautions. They also have given guidelines on the transportation of bodies, autopsy, environmental cleaning. Before contact with bodies, health care worker should ensure that necessary hand hygiene and personal protective equipment are being used. Hasty disposal of a dead from COVID 19 should be avoided.
EnglishAirborne disease, Cadaver, COVID 19, Droplets, Ministry of Health and family welfare, PPE, WHOIntroduction
All dead bodies are potentially infectious and standard precautions should be applied to every case. Although most organisms in the body are unlikely to infect a healthy person. Some infectious organism agents may be transmitted when a person is in contact with blood, body fluid or tissue of the dead body of a person with infectious disease. To minimize the risk of transmission of unknown and unspecified infectious diseases, dead bodies should be handled in such a way that worker's exposure to blood and fluid of dead bodies, body fluid, or tissue is reduced.1 A rational approach should include staff training and education about how to handle dead bodies of the infectious patient,2 a safe working environment for workers and the availability of personal protective equipment in hospitals.3
WHO, Ministry of Health, Family Welfare guidelines given in pandemic situation on handling COVID 19 patients dead bodies, transportation, autopsy, environmental cleaning, preparing and packing of dead bodies, mortuary care, etc. with standards of precaution procedure and use of PPE properly.3,4 In this pandemic situation, health workers have programs to enhance their practices in the pandemic situation and its implementation on the patient to fast recover and stop spreading infections.5
Preparing and packing the body
According to WHO guidelines on infection prevention and control of the dead body in COVID19. Preparing and packing of a dead body with a standard of precautions.4
Ensure that the health workers, mortuary staff, or the burial team, interacting with the dead body, should apply standard precautions for the safeguard.4,6
Hand hygiene should be followed before and after interacting with the dead body and surrounding environment.7
Appropriate personal protective equipment including gown and gloves should be used according to the level of contact with the dead body.
If there is risk of splashes of body fluids or secretions, the facial shields or goggles and medical masks should be used by health care or mortuary staff.
When transferring the body to the mortuary, all intravenous lines, catheter and other medical equipment or tubes should be removed.
Ensure nobody fluids are leaking from orifices.
To minimize the movement and handling of the body.
Wrap the body properly in cloth and transfer the body as soon as possible to the mortuary area.
There is no need to disinfect the body before transferring to the mortuary area.
Mortuary care
Ministry of health and family welfare has given guidelines for dead body management and Mortuary care.4
Health care staff or mortuary staff should prepare the body e.g. washing body, tidying hair, trimming nails, or shaving.
Health care staff or mortuary staff should wear appropriate PPE according to standard precaution like gloves, impermeable disposable gown, medical mask, eye protection, shield.
If the family wished to view the body of the patient and not to touch, they may do this, using standard precautions at all times including hand hygiene. Instruct the family don’t touch or kiss the body.
Embalming is not recommended to avoid excessive manipulation of the body.
Elderly people above age 60 and an immunosuppressed person should not directly interact with the body.2,7
Handling of a dead body in Mortuary
WHO and Ministry of Health gave some guidelines on how to handles dead bodies in a mortuary with a standard of precautions.6,8
Mortuary staff or mortuary workers handling COVID 19 dead bodies should handle and observe standard precautions.9
Dead bodies should be stored in the Mortuary cold chamber and maintained the temperature at 4 0C.
After removing the body from mortuary, the chamber door, handles, the floor should be clean immediately with sodium hypochlorite 1% solution.5,9
Transportation
WHO and MOH guidelines on transportation. WHO guidelines mention that no specific equipment or vehicles required for transportation of COVID 19 patient’s dead bodies.10
The body securely packed in a body bag and the exterior of which is decontaminated poses no additional risk to the staff transporting the dead bodies.
Those workers handling dead bodies during transportation may follow standard precaution equipment.
After transportation of the body to cremation or burial, staff will be decontaminated with 1% sodium hypochlorite.
Autopsy and Environmental control
WHO and Family Welfare have given clear guidelines on autopsy and environmental control. That can prevent medical staff and hospital workers from infections.10
For a diseased person with COVID-19, the protection protocol should be compatible with that used with other autopsies of people who have died of an acute respiratory disease.11
The lungs and other organs can still contain live viruses if a person dies during the infectious period of COVID-19.11
Additional respiratory protection is needed during the procedure that generates small particle aerosols, such as the use of power saws.
If a body with suspected or confirmed with COVID 19 is selected for autopsy, health care facilities must ensure that safety precaution is placed to protect those performing the autopsy.8
Performing autopsy procedure inadequately ventilated room.
Should involve minimum staff in autopsy procedure.
Appropriated PPE should be used when performing the autopsy procedures.12
Environmental cleaning and control
WHO has given specific guidelines on environmental cleaning and control in COVID 19 pandemic situation. Coronavirus can remain live on a surface for up to 9 days.13 COVID 19 viruses have been detected after up to 72 hours in experimental conditions.14 therefore, cleaning the environment is paramount.4
The mortuary must be kept clean and properly ventilated environment at all times.
Lighting in the room must be adequate.
Instruments and surface area must be disinfected and maintained between autopsies.
The instruments which will be used in autopsies that should be clean immediately after the procedure.
Environment surface and the surface area should be first cleaned with soap and water or commercially prepared detergent solution where bodies were prepared.
When preparing disinfecting solution personnel should use appropriate PPE, including respiratory and eye protection.14
Burial
According to WHO guidelines implementation. People who have died from COVID 19 can be buried or cremated.4
Following customs family and friends may view the body after it has been prepared for burial.
Do not touch or kiss the body and should wash hands thoroughly with soap or sanitizer after viewing the body.15
Those who are placing the body in the grave, on the funeral pyre, etc., should wear gloves, mask and wash hands after removal of gloves after burial is complete.
Conclusion
COVID 19 is an acute respiratory illness caused by COVID 19 virus that directly affects the lungs. As this is a new virus whose sources and disease progression are not yet totally clear. Although most organisms in the body are unlikely to infect a healthy person. Some infectious organism agents may be transmitted when a person is in contact with blood, body fluid or tissue of the dead body of a person with infectious disease. To minimize the risk of transmission of unknown and unspecified infectious diseases, dead bodies should be handled in such a way that worker's exposure to blood and fluid of dead bodies, body fluid, or tissue is reduced. WHO, Ministry of Health, Family Welfare guidelines given in pandemic situation on handling COVID 19 patients dead bodies, transportation, autopsy, environmental cleaning, preparing and packing of dead bodies, mortuary care, etc. with standards of precaution procedure and use of PPE properly.
Funding/Support: The authors are grateful for the financial support of the Datta Meghe Institute of Medical Science (Deemed to be University), Sawangi (Meghe), Wardha, India
Conflict of interest: There are no conflicts of interest in this work.
Englishhttp://ijcrr.com/abstract.php?article_id=3258http://ijcrr.com/article_html.php?did=32581. Chavez S, Long B, Koyfman A, Liang SY. Coronavirus Disease (COVID-19): A primer for emergency physicians. Am J Emerg Med 2020;S0735-6757(20):30178-9.
2. Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dental Res 2020;99(5):481-7.
3. Morgan O, Tidball-Binz M, Van Alphen D. Management of dead bodies after disasters: a field manual for first responders. Pan American Health Organization (PAHO); 2006.
4. Curran ET. Standard precautions: what is meant and what is not. J Hosp Info 2015 May;90(1):10.
5. World Health Organization. Infection prevention and control during health care when novel coronavirus ( nCoV) infection is suspected: interim guidance, 25 January 2020.
6. World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance, 19 March 2020. World Health Organization; 2020.
7. Verbyla ME, Pitol AK, Navab-Daneshmand T, Marks SJ, Julian TR. Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. Environmental Sci Tech 2019;53(5):2852-61.
8. Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Path 2020;73(5):239-42.
9. Lamontagne F, Angus DC. Toward universal deployable guidelines for the care of patients with COVID-19. JAMA 2020;323(18):1786-7.
10. Chartier Y, Pessoa-Silva CL. Natural ventilation for infection control in health-care settings. World Health Organization; 2009.
11. Ghinai I, McPherson TD, Hunter JC, Kirking HL, Christiansen D, Joshi K, et al. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020;395: 1137–44.
12. Interim US. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19): Centers for Disease Control and Prevention; 2020. Center for Disease Control and Prevention. 2020.
13. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Info 2020;104(3):246-51.
14. Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. New Engl J Med 2020;382(16):1564-7.
15. World Health Organization. Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidance, 23 April 2020. World Health Organization; 2020.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcarePrevalence of Diabetes Mellitus and Socio-demographic Survey in the Community of Western Uttar Pradesh, India in the Year 2019-2020
English1015Nadeem RaisEnglish Akash VedEnglish Rizwan AhmadEnglish Kehkashan ParveenEnglish Om PrakashEnglishIntroduction: Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. There are two types of diabetes and the most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin.
Objective: This study aimed to estimate the prevalence of diabetes mellitus (DM) and its socio-demographic profile and screen the study population of diabetic patients in Western Uttar Pradesh.
Methods: The different mode of the survey was conducted between January 2019 to January 2020. A random screening was carried out with 3989 individuals of 1000 families at various geographical regions of western Uttar Pradesh. This was a cross-sectional house to house experience study that was conducted to find out the prevalence of diabetes mellitus at the community level.
Result: A total of 287 diabetic subjects were enrolled through a simple random sampling methodology. In the collected data, the prevalence of DM was found at 07.34%. Whereas the prevalence of type-1 DM and type-2 DM amongst known diabetics was found 06.62% and 93.37% respectively.
Conclusion: Incidents of DM were found varied person to person depending on their physical activities, knowledge, and myths/misconceptions about diabetes, food habits, etc. Current findings suggest that a relatively unfavourable risk profile of the diabetic subjects who also suffered from diabetic complications.
EnglishDiabetes Mellitus, Prevalence, Community, Demographics profile, Uttar PradeshINTRODUCTION
Diabetes is a chronic problem that occurs either when the insulin production decreases from β cells of islets of Langerhans or when the pancreas cannot effectively use the insulin it produces. Insulin is a peptide hormone produced by beta cells of the pancreatic islets that regulates blood sugar level in the body. Hyperglycaemia, or raised blood sugar level, is the most common problem of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.1,2
India is currently experiencing a rapid epidemiological transition from communicable to non-communicable diseases viz. diabetes mellitus, hypertension, and ischaemic heart disease. Rapid industrialization and urbanization with a subsequent rise in standards of living, obesity, stress, sedentary lifestyle, addictions, etc. are posing a growing threat to the health of the nation. The number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken.2 A very high prevalence of DM was observed in Saudi Arabia, the U.S., Switzerland, and Austria. Researchers believe there is a 250 per cent greater incidence of DM in the Middle East, Sub-Saharan Africa, India, Asia, and Latin America.3
Over recent decades, the prevalence of diabetes mellitus has been increasing worldwide due to factors like changes in lifestyle (sedentary living and eating habits) and obesity.4,5 The World Health Organization (WHO) estimated that India will have the largest number of diabetics in the world (every fourth diabetic is an Indian) and will become the diabetic capital of the world. 6,7,8 Although it has been recognized as a major cause of death and disability, many who suffer from diabetes are unaware that they are afflicted until they experience a debilitating side effect or complication of the disease.6 It is a fact that good clinical and self-care activities can delay diabetic complications and improve the quality of life. Therefore, in this present research, we attempted to determine the prevalence of diabetes mellitus and its socio-demographic profile and screen the study population of diabetic subjects in Western Uttar Pradesh.9-13 Having diabetes increases the risk of a myocardial infarction two times and the risk of suffering a stroke two to four times and it is also a leading cause of blindness, limb amputation, and kidney failure.14-16
MATERIALS AND METHODS
Study population
This was a cross-sectional house to house experience study that was conducted to find out the prevalence of diabetes mellitus at the community level. The study was carried out in the urban, semi-urban, and rural areas of Western Uttar Pradesh, India. Some developing and developed cities viz. Ghaziabad, Meerut, Bijnor, J.P. Nagar, and Moradabad of western Uttar Pradesh were selected for the study. The survey started in January 2019 and concluded in January 2020. The research protocol was approved by independent ethics committees. A random survey was performed with a total population of 3989 individuals Ghaziabad (N1=406), Meerut (N2=603), Bijnor (N3=1123), J.P. Nagar (N4=876), and Moradabad (N5=981) from 1000 families to know whether they had diabetes or not. The family members of already registered diabetic patients under treatment (oral antidiabetic drugs/injection regimen) or discontinuation were studied consciously (excluding pregnant women). 293 diabetic patients were selected for the study while 6 diabetic patients declined to answer any queries regarding diabetes. In this context, the detailed study of present final data of 287 diabetic patients of both gender and either age were carried out.
Data collection method
Data of the total population were collected on individual Data Collection Forms1 (DCFs1) while data of diabetic patients were collected on individual Data Collection Forms2 (DCFs2) at baseline and written consent was obtained from all the patients participating in the study. DCFs1 included in the interview schedule pertained to personal information i.e. name, religion, age/gender, residence, marital alliance, and diabetic status. DCFs2 included in the interview schedule pertained to personal information, date of diagnosis of disease, patient’s medical history, knowledge and myths/ misconceptions about diabetes, diabetic complication, demography, education, occupation, antidiabetic treatment, food habits, blood glucose measurement frequency, diabetes among any family member, number of hypoglycaemic episodes, adverse drug reactions (ADRs) and lifestyle (i.e. physical activity, smoking or consumption of alcohol, etc.).17-19
Data handling and statistical analysis
All data were tabulated and descriptive statistical analyses were performed. Sub groupings were carried out where required and prevalence (%) was calculated. Values are expressed as mean±SEM (N=5) by using One-way Analysis of Variance (ANOVA) followed by Dunnett's Multiple Comparison Test P< 0.01.
RESULTS
Data Concerning the prevalence of diabetes according to gender, marital alliance, and type incidence amongst known diabetics with Prevalence of DM according to parental history is presented in Table 1.
There are 3989 individuals from 1000 families in the five zoographical regions of Ghaziabad (406), Meerut (603), Bijnor (1123), J.P. Nagar (876), and Moradabad (981)} were selected for the study. The patients taken medications by oral ant-diabetic drugs/injection regimen under the supervision of physicians and discontinuation were studied consciously (excluding pregnant women). 293 diabetics were selected for the study while 6 diabetic patients declined to answer any queries regarding diabetes. This gave a final sample of 287 diabetic patients (considered as 100%) of both gender and either age to be studied. Out of 287 diabetics, 278 were found married with a percentage of 56.09% (males) and 40.76% (females). Type-1 and Type-2 incidence amongst known diabetics were06.62% and93.37% respectively. Parental history of diabetes was detected 33.79% (either parent) and 09.05% (both parents) while 57.14% diabetics were detected without any family history of diabetes. The prevalence of diabetes was significantly different between different zoographical zones urban 51.21%, semi-urban 32.75%, and rural 16.02%. The detailed descriptions are reported in Table 2.
Diabetics in the study were distributed into 8 groups according to age (in years) from 21 to 70 plus, where we found that the age group of 21-27 was at the lowest risk (3.13%) of DM and the prevalence of diabetes increased significantly with advancing age till the age group of 42-48 (21.60%) then after this age group the prevalence of diabetes decreased significantly with advancing age (70+ years). The decreasing prevalence of DM after 54 years indicates the lethal effects of diabetes if not controlled. Detailed information is provided in Table 3.
Complications in DM were recorded and data were collected for the number of patients having one major complication, the number of patients with more than one complication, and the number of patients without any complication. The significant complications of diabetes were recorded as kidney disease, high blood pressure, neurological disorder cardiac disease, ophthalmic trouble, diabetic coma, etc, while 13.58% diabetics were reported without any complication. The detailed complications are reported in Table 4. Most of the diabetics were recorded as no exercise and sedentary work and data are 143 or 49.82%, while few diabetic peoples were aware of it and doing exercise regularly with strenuous work and data is 37 or 12.89%. Many of them accepted that physical activity plays a very important role in managing diabetes mellitus and found either doing regular exercise or strenuous work and data are 107 or 37.28%. The prevalence of DM according to lifestyles such as fast food/junk food (67.24%), smoking (35.54%), and consumption of liquor (4.52%) were recorded and detailed information is given in table5).
Out of 287 diabetics, patients are also elaborated based on literacy are having secondary school education, primary school education, college education, university/professional education, and illiterate patients and the collected data are 24.04%, 22.29%, 13.58%, 6.62%, and 18.81% respectively ( Table 6 and 7). The detailed information is reported in table 6. Out of 287 (100%) diabetics, the majority of subjects were found to have physically less active occupation like desk job (19.86%) > professional jobs (18.46%) > household work (18.11%) and further the prevalence was found gradually decreased with a physically active occupation like a businessman (15.33%) > labour (13.24%) > student (04.18%) while diabetics with other occupations were (10.80). The detailed information is given in Table 7. Because the majority of diabetics were uneducated or little educated, the prevalence of myths or misconceptions about diabetes mellitus was also at its peak. Out of 287 (100%) diabetics, 94(32.75%) subjects believed that excessive consumption of sweets is the main cause of DM. 91 (31.70%) subjects had negative faith that a diabetic lives no longer. 51 (17.77%) subjects were suggested to have relaxed. Despite this technical era, 26 (09.05%) subjects had faith in the spiritual treatment to get permanent benefit and25 (08.71%) diabetics thought that diabetes is contagious, and shown in Table 8.
Discussion
Diabetes mellitus is a leading public health problem and a major cause of morbidity and mortality worldwide. Its prevalence is on the rise in many areas of the developing world, especially in India, in response to increasing prosperity and sedentary lifestyles. In this study, the overall prevalence of diabetes in the study population was 07.34%. The prevalence of diabetes mellitus was higher among subjects with a family history of diabetes mellitus, who had a sedentary lifestyle or light grade physical activity. This community-based cross-sectional prevalence study was conducted in urban, semi-urban, and rural areas of the western Uttar Pradesh with a significant difference (51.21% urban, 32.75% semi-urban and 16.02% rural). These data provide a firm basis for further qualitative and quantitative studies to explore socio-demographic profile and many risk factors affecting the outcomes of diabetes, especially Type 2 DM, which will yield new perspectives and knowledge regarding diabetes management. To the best of our knowledge, no similar study has been conducted in Western Uttar Pradesh, India.8 The overall prevalence of diabetes in our study population was 7.34%, out of which 4.23% diabetics were males and 3.10 % diabetics were females. This is lower than earlier studies from other areas of the same state by Singh PS et al. in which prevalence was 8.03%.7 This difference could be explained, because of the change in lifestyle, and age composition of the selected population of earlier studies. The International Diabetes Federation had estimated that in 2010 the global population with diabetes between the ages of 20-79 was285 million (6.4%) and it had projected that this would grow to 439 million (7.7%) by 2030.2 However, the Diabetes Atlas, 6th edition figures show that in 2013 there are 382 million people have diabetes in the world and by 2035 this will rise to 592 million. Diabetes caused 5.1 million deaths in 2013; every six seconds a person dies from diabetes.9
Many cross-sectional studies conducted in India and other countries have shown that there is a rise in the prevalence of diabetes globally. There is a rapid increase in the prevalence of diabetes in India and other Asian countries. It has been predicted that India will be having a maximum number of diabetes cases in the year 2025.10 Many other Indian studies on diabetes like Rao et al, 2010 and Mohan et al, 2006 have seen that prevalence did not differ concerning gender; however, few studies have shown higher prevalence among the females.11-13 The prevalence of type 2 diabetes rates continues to increase with an increasing number of patients at risk of serious diabetes-related complications. In large metropolitan cities in India (Mumbai, Delhi, Calcutta, Chennai, Bangalore, and Hyderabad), the prevalence of diabetes among adults (aged ≥20 years) ranges from 8-18%.12,13,17-24
CONCLUSION
We recommend modifying the risk profile through early screening, education, awareness, and lifestyle modification strategies to improve the quality of life for diabetics. Early intervention for the prevention of complications can improve the outcome for diabetics and reduce the associated mortality and morbidity.
Funding
No funding sources
Ethical Approval and Consent to Participate The authors have no ethical conflicts to disclose. Conflicts of interest
The authors declare that there are no conflicts of interest.
Acknowledgements
Authors are thankful to Dr Tauheed Ishrat, Associate Professor, Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, TN, USA for his sustained encouragement, meticulous supervision, and valuable suggestions at all stages of completion of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=3259http://ijcrr.com/article_html.php?did=3259
Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes. June 2020.
Sicree R, Shaw J, Zimmet P. Diabetes, and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. International Diabetes Federation. 3rd ed. Belgium, 2006, pp15-103.
Ginter E, Simko V. Diabetes type2 pandemic in the 21st century. Bratis Lek Listy. 2010; 111(3):134-137.
Roman SH, Harris MI. Management of diabetes mellitus from a public health perspective. Endocrinol Metab Clin North Am 1997; 26(3):443-474.
Gruber W, Lander T, Leese B, Songer T, Williams R. The Economics of Diabetes and Diabetes Care. International Diabetes Federation. Brussels: Belgium;1998.
Mayur P, Ina MP, Yash MP, Suresh KR. Profile of the subjects with Diabetes: A hospital-based observational study from Ahmedabad, Western India. Electr Physic 2011:378-384.
Prem SS, Himanshu S, Khwaja SZ, Prafulla KS, Sudhir KY, Rajesh KG, Tony P. Prevalence of type 2 diabetes mellitus in the rural population of India- a study from Western Uttar Pradesh. Int J Res Med Sci 2017;5(4):1363.
Poulomi S, Kapil M. Study of Prevalence and Pattern of Sensorineural Hearing Impairment in Stage 5 Chronic Kidney Disease Patients on Haemodialysis- at a Tertiary Health Care Setup in India. Int J Curr Res Rev 2020;12(04):08-13.
Diabetes in South-East Asia: An update for 2013 for the IDF Diabetes Atlas, 6th edition.
International Diabetes Federation. Diabetes Atlas. 4th edition 2009. Available from URL:www.diabetesatlas.org.
Rao CR, Kamath VG, Shetty A, Kamath A. A study on the prevalence of diabetes in coastal Karnataka. Int J Diabetes 2010;30:80-85.
Mohan V, Deepa M, Deepa R, Shanthirani CS, Farooq S, Ganesan A, Datta M. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India- the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 2006;49:1175-1178.
Ramachandran A, Snehalatha C, Latha E, Vijay V, Viswanathan M. Rising prevalence of NIDDM in an urban population in India. Diabetologia. 1997; 40:232-237.
World Health Organization. Fact Sheet No.312: What is Diabetes? Available from URL:http://www.who.iny/mediacentre/factsheets/fs312/en.pdf.
International Diabetes Federation. Diabetes Atlas. 3rd ed 2006. Available from www.diabetesatlas.org.
Cubbon RM, Wheatcroft SB, Grant PJ, Gale CP, Barth JH, Sapsford RJ, Ajjan R, Kearney MT, Hall AS. Temporal trends in mortality of patients with diabetes mellitus suffering acute myocardial infarction: a comparison of over 3000 patients between 1995 and 2003. Eur Heart J 2007;28:540-545.
Iyer SR, Iyer RR, Upasani SV, Baitule MN. Diabetes mellitus in Dombivli-an urban population study. J Assoc Physicians India 2001; 49:713-716.
Misra A, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N. High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in Northern India. Int J Obes Relat Metab Disord 2001;25:1722-1729.
Prabhakaran D, Shah P, Chaturvedi V, Ramakrishnan L, Manhapra A, Reddy KS. Cardiovascular risk factor prevalence among men in a large industry of Northern India. Nat Med J India 2005;18:59-65.
Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna KKM, Nair JD. Diabetes epidemiology study group in India. High prevalence of diabetes and impaired glucose tolerance in India: national urban diabetes survey. Diabetologia 2001;44:1094-1101.
Mohan V, Shanthirani CS, Deepa R. Glucose intolerance (diabetes and IGT) in a selected South Indian population with special reference to family history, obesity and lifestyle factors- The Chennai urban population study (CUPS 14). J Assoc Physic India 2003;51:771-777.
Ramachandran A, Snehalatha C, Baskar ADS, Mary S, Kumar CKS, Selvam S, Catherine S, Vijay V. Temporal changes in the prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia 2004;47:860-865.
Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High Prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 2008;31:893-898.
Bai PV, Krishnaswami CV, Chellamariappan M. Prevalence and incidence of type-2 diabetes and impaired glucose tolerance in a selected Indian urban population. J Assoc Physic India 1999;47:1060-1064.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareDiagnosis and Management of Gestational Diabetes with Oral Glucose Tolerance Test and HBA1C
English1618Anjana ChaudharyEnglish Baljeet Kaur BhatiaEnglishIntroduction: Gestational diabetes mellitus (GDM) is a potentially serious and prevalent condition such as fetal growth abnormalities, shoulder dystocia, birth injury, prematurity and increased Caesarean section rate, which may lead to serious effects in mothers and neonates. Recently HbA1c used diagnostic criterion for diabetes (DM).
Objective: Diagnosis and Management of Gestational Diabetes with Oral Glucose Tolerance Test and Hba1c.
Methods: A total of 241 pregnant women recruited in the study. Pregnant women in prenatal care, without previous DM, were included to perform OGTT tests in the third trimester of pregnancy. written informed consent was obtained from all the patients.
Results: All the patients were between 23 and 35 years of age in the third trimester of pregnancy (gestational age = 27±5 weeks). In patients without GDM mean SBP was 110±11.8and with GDM 119±12.6 (p EnglishGestational diabetes mellitus, GDM, HbA1c, Hb, Cholesterol, Blood glucoseINTRODUCTION
Gestational diabetes mellitus (GDM) is a potentially serious and prevalent condition such as fetal growth abnormalities, shoulder dystocia, birth injury, prematurity and increased Caesarean section rate, which may lead to serious effects in mothers and neonates.[i],[ii] The risk of adverse perinatal and maternal outcomes are directly proportional to the level of hyperglycaemia, and there is a linear relationship between maternal glucose and various neonatal outcomes.3 Detection of GDM and treatment reduces the risks for the mothers as well as for the neonates.[iii]
Customarily, the OGTT has been the test of choice for this condition. It can be preceded by a screening methodology, for example, fasting glycemia (FG) or a glucose load test. But still are controversies regarding OGTT cut-offs which should be used for the diagnosis of GDM and also a recent review concluded that the evidence is insufficient to permit assessment of which strategy is best to diagnose GDM.[iv] HbA1c test as a diagnostic criterion for diabetes (DM) in the general population and was included in 2010 by the American Diabetes Association (ADA). The cut-off of HbA1c ≥48 mmol/mol (6.5%) was set up for the conclusion, and was endorsed by the World Health Organization (WHO) in 2011.[v],[vi] However weak agreement was seen in between HbA1c and glucose tests and these two tests may identify different populations of patients.[vii]
OGTT is a cumbersome test which is time-consuming, labour intensive and generally poorly tolerated by pregnant women. It is important to fasten the patient, sit for more than 2 h and have at least three venipunctures. Pregnant women are susceptible to nausea and vomiting from delayed emptying of the stomach. This may contribute to an invalid test result, combined with gestational oedema compromising venous access. Also, the recommendation for universal screening has greatly increased the research burden. HbA1c is the result of glucose's irreversible non-enzymatic binding to plasma proteins, in particular haemoglobin. (Hb).HbA1c is a single, non-fasting blood test and reflects glucose levels over the previous 4 to 8?weeks. HbA1c has been shown to have greater reliability compared to glucose monitoring. [viii],[ix]
Based on this study was carried out to analyse HbA1c test for detection of GDM based on OGTT as a reference test.
MATERIAL AND METHODS:
The present study was carried out in the department of OBGY. A total of 241 pregnant women recruited in the study. Pregnant women in prenatal care, without previous DM, were included to perform OGTT tests in the third trimester of pregnancy. written informed consent was obtained from all the patients. There have been records of the era, gestational age, obstetric background, smoking, family history of cardiovascular disease (CVD), DM, arterial hypertension (HT), alcohol intake, and drug usage. The weight and height of patients have also been reported and used to measure BMI (kg/m2) values.
Patients were excluded from the study if observed with the following conditions which are known to interfere with or lead to the misinterpretation of HbA1c results, anaemia, chronic renal disease and/or presence of haemoglobin variants. After an overnight fast, blood samples were taken to determine HbA1c levels, blood cell counts, lipid profile, creatinine and glucose concentrations. The OGTT was performed according to recommendations.
All data were entered in the Excel sheet, Data were expressed as mean and SD for normally distributed variables, and as median (range) for non-Gaussian variables. Student’s T-tests and kappa coefficients were used as appropriate.
RESULTS
A total of 241 pregnant women recruited in the study. Pregnant women in prenatal care, without previous DM, were included to perform OGTT tests in the third trimester of pregnancy and were assessed as to the presence or absence of GDM. All the patients were between 23 and 35 years of age in the third trimester of pregnancy (gestational age = 27±5 weeks) ( Table 1).
In patients without GDM mean age was 27±5.2and with GDM 33±5.4 (p Englishhttp://ijcrr.com/abstract.php?article_id=3260http://ijcrr.com/article_html.php?did=3260
Casey BM, Lucas MJ, McIntire DD. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol 1997;90:869–73.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99 2 ed, Geneva 1999.
Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159(2):123-9.
Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F, DALI Core Investigator Group. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012 Jul; 29(7):844-54.
Farrar D, Duley L, Medley N, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev 2015; 1:CD007122.
American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38:S8-S16.
Cavagnolli G, Comerlato J, Comerlato C, Renz PB, Gross JL, Camargo JL. HbA(1c) measurement for the diagnosis of diabetes: is it enough? Diabet Med 2011; 28(1):31-5.
Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care 2011; 34(2):518-23.
d'Emden M. Glycated haemoglobin for the diagnosis of diabetes. Aust Prescriber 2014;37:98–100.
Gillery P. A history of HbA1c through Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med 2013;51:65–74.
Balaji V, Madhuri BS, Ashalatha S, Sheela S, Suresh S, Seshiah V. A1C in gestational diabetes mellitus in Asian Indian women. Diabetes Care 2007; 30(7):1865-7.
Rajput R, Yogesh Yadav, Rajput M, Nanda S. Utility of HbA1c for diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract 2012; 98(1):104-7.
Hiramatsu Y, Shimizu I, Omori Y, Nakabayashi M, JGA (Japan Glycated Albumin) Study Group.Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and influencing factors during pregnancy. Endocr J 2012; 59(2):145-51.
HAPO Study Cooperative Research Group., Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358(19):1991-2002.
Rowan JA, Budden A, Sadler LC. Women with a nondiagnostic 75 g glucose tolerance test but elevated HbA1c in pregnancy: an additional group of women with gestational diabetes. Aust N Z J Obstet Gynaecol 2014; 54(2):177-80.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareComparative Analysis of Midazolam with Fentanyl Versus Midazolam with Propofol for Their Haemodynamic Stability During Regional Anesthesia
English1921Aditya KhotEnglish Aparna Girish BenareEnglishIntroduction: Many methods have been recommended for the prevention of hemodynamic instability during induction of anaesthesia.
Objectives: To study Midazolam plus Fentanyl versus Midazolam plus Propofol concerning Hemodynamic stability during regional Anaesthesia.
Methods: We have conducted a comparative study of conscious sedation using midazolam with fentanyl in group-I Vs. midazolam with propofol in group-II. This study was conducted at a tertiary care centre for one year. 120 patients of ASA Grade I, II and III, were randomly divided into two groups, 60 in each group, of between 15 to 60 years.
Results: Systolic blood pressure changes in both the groups are comparable with each other at 30 minutes after sedation but fall in blood pressure was more in group II from the baseline. Statistically pEnglishMidazolam plus Fentanyl, Midazolam plus Propofol, Hemodynamic stability, Propofol, Hypnotic agentINTRODUCTION
Propofol is very commonly given hypnotic agent of choice but having its advantages & disadvantages. Anaesthesia induction with propofol is having some effects on hemodynamics in patients more than 50 years of age in the form of fall in blood pressure.1,2 In cases with the previous history of hypotension & in those cases with American society of anesthesiologists’ physical status (ASAPS) >II, this fall in blood pressure is extremely profound. Day by day, regional analgesia is getting very important in anaesthetic practice.1,2 Its most common advantages are like avoidance of risks due to general anaesthesia. They are like aspiration pneumonia due to reflux of gastric contents, laryngeal spasm or obstruction of airways, also it gives better postoperative experience.3,4 It has also got advantages in cases with pre-existing pulmonary embolism. Midazolam is a very commonly used agent for conscious sedation for short endoscopic or dental procedures & acts as an adjunct to local as well as regional anaesthesia. Propofol is a sedative-hypnotic agent & is getting very popular for local aesthetic procedures. Its high clearance rates & extremely favourable recovery profile has added advantage over other IV sedatives & analgesics. Also, one more advantage is that sedation due to propofol can be well adjusted by manual intermittent bolus injection technique.5 Fentanyl is a very potent synthetic opiate agonist (around many folds potent than morphine).
Fentanyl is extremely lipid soluble & it enters the Central Nervous system (CNS) very rapidly which in turn leads to the rapid onset of action. Due to its higher potency for controlling pain, it is becoming the narcotic drug of choice for a range of painful procedures. But comparatively, it has got a shorter duration of action.6-8
MATERIALS AND METHODS
We have conducted a comparative study of conscious sedation using midazolam with fentanyl in group-I Vs. midazolam with propofol in group-II. This study was conducted at a tertiary care centre for one year. 120 patients of the American Society of anaesthesiologists (ASA) Grade I, II and III, were randomly divided into two groups, 60 in each group, of between 15 to 60 years of either sex, undergoing any surgery under regional anaesthesia (spinal, epidural anaesthesia or peripheral nerve blocks). Patients having any history of allergy to any of the anaesthetic agents, or any chronic opioid use or obesity are excluded. Also, those cases who are having clinically significant cardiac, hepatic, renal or pulmonary dysfunction were excluded from our study. The institutional ethics committee approved the study.
Assessment of Sedation
Table no 1 shows the sedation score of Fully awake and anxious, Drowsy or awake and comfortable, Eyes closed but responds to verbal commands, Eyes closed but responds to light physical stimulation and Unresponsive to light physical simulation
Patients were specifically asked regarding their awareness during the surgical procedure and whether they will be happy to have the same aesthetic technique again. The hemodynamic parameters like Blood pressure, Heart Rate etc. were recorded. The statistical analysis was done by SPSS 19 software.
RESULTS
Hemodynamic changes (systolic blood pressure)
Systolic blood pressure changes in both the groups are comparable with each other at 30 minutes after sedation, but blood pressure fall was more in group II from the baseline (Table 2)
Table 2b and chart II shows heart rate (HR) changes in both the groups applying the test of significant changes in heart rate seen after sedation in group-I (Midazolam + Fentanyl) compare to group II (Midazolam+ propofol) ( Table 3).
DISCUSSION
The drop in propofol-induced systemic blood pressure is greater than that evoked by a comparable dose of thiopental. These decreases in blood pressure are also accompanied by related improvements in cardiac performance and systemic vascular resistance. Propofol-induced relaxation of the smooth vascular muscles is mostly due to the inhibition of propofol, which can result from a reduction in the influx of intracellular calcium. The effect of propofol on blood pressure is reversed by stimulation provided by direct laryngoscopy and trachea intubation, although the drug is more effective than thiopental in blunting the magnitude of the pressure response. Propofol also effectively blunts the hypertensive reaction to laryngeal mask airway positioning.6-8
The blood pressure effect of propofol can be underestimated in hypovolemic patients, elderly patients, and patients with reduced left ventricular function due to coronary artery disease. Adequate hydration before rapid IV administration of propofol is advised to minimise the blood pressure effects of this drug. Adding a dose of nitrous oxide would not affect the cardiovascular effects of propofol. After a decrease in systemic blood pressure, the heart rate still stays steady. Bradycardia and asystole were identified following induction of propofol anaesthesia, resulting in the occasional suggestion that anticholinergic drugs should be administered when the vagal stimulation is likely to occur in combination with propofol administration. High doses of fentanyl are also available at 50ug / kg IV. It does not elicit the release of histamine.9-11 As a result, it is doubtful that venous capacitance vessel dilation leading to hypotension may occur. Heart rate reflex control of the carotid sinus baroreceptor is significantly depressed with fentanyl (10 ug/kg, IV) administered to neonates. Bradycardia is more common with fentanyl than with morphine and can lead to periodic drops in blood pressure and heart output. Sedation was achieved after the bolus doses and this persisted throughout the procedure in both groups. Patients were instantly sedated following bolus in the propofol category without any hypotension or bradycardia. But it took 9 to 10 minutes for sufficient sedation in the opioid group to be achieved.11,12 In 5 patients from the opioid community, there was bradycardia and in 2 patients there was hypotension, so we decreased the doses by adjusting the micro drip and by prescribing IV fluids and atropine.13-15 And they avoided further blood pressure and heart rate declines. In our study, we found that, at 30 minutes after sedation, systolic increases in blood pressure in both groups were comparable to each other, but there was a greater drop in blood pressure from the baseline in group II. Significant improvements in the heart rate observed after sedation in group I (Midazolam+ Fentanyl) compared with group II (Midazolam+ propofol) were observed in the heart rate improvements in both test groups. Statistically, pEnglishhttp://ijcrr.com/abstract.php?article_id=3261http://ijcrr.com/article_html.php?did=3261
Golzari S. Contributions of medieval Islamic physicians to the history of tracheostomy. Anesth Analg 2013; 116:1123–32.
Soleimanpour H. Effectiveness of intravenous Dexamethasone versus Propofol for pain relief in the migraine headache: A prospective double-blind randomized clinical trial. BMC Neurol 2012;12:114.
Dhungana Y. Prevention of hypotension during propofol induction: A comparison of preloading with 3.5% polymers of degraded gelatine and intravenous ephedrine. Nepal Med Coll J 2008; 10:16–9.
Taware M, Sonkusale M, Deshpande R. Ultra-Fast-Tracking in Cardiac Anesthesia ‘Our Experience’ in a Rural Setup. J Datta Meghe Inst Med Sci Uni 2017;12 (2); 110–14.
Yamaura K. Changes in left ventricular end-diastolic area, end-systolic wall stress, and fractional area change during anaesthetic induction with propofol or thiamylal. J Anesth 2000;14:138–42.
Modig J. Thromboembolism after total hip replacement: role of epidural and general anaesthesia. Anesth Anal 1983; 62: 174-80.
Freund F. ventilator reserve and level of the motor block during high spinal and epidural. Anaesthesia. Anesthesia 1967; 28: 834-7.
Rajan R, Gosavi S, Dhakate V, Ninave S. A Comparative Study of Equipotent Doses of Intrathecal Clonidine and Dexmedetomidine on Characteristics of Bupivacaine Spinal Anesthesia. J Datta Meghe Inst Med Sci Uni 2018;13(1); 4–8.
Jogren S. Respiratory changes during the continuous epidural blockade. Acta Anaesth Scandinavica 1972; 16: 27-49.
Wahba W. The cardiorespiratory effects of thoracic epidural anaesthesia. Canadian Anesth Soc J 1972:19: 8-19.
Aitkenhead A. Interaction with concurrent disease and medication. In: Henderson JJ, Nimmo WS, eds. Practical regional anaesthesia, oxford: Blackwell scientific publication, 1983, 143-62.
While P. sedative infusion during local and regional anaesthesia a comparison of midazolam and propofol. J Clin Anaesth 1991:3:32-9.
Taylor E. Midazolam in combination with propofol for sedation during local anaesthesia. J Clin Anesth 1992:4:213-6.
Seibs S. The treatment of pain the emergency department. Pediatr Clin North Am 1989:36,965-78.
Cafe CJ. Sedation for pediatric patients: A review. Pediatr Clin North Am 1994: 41; 31-58.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareQuality Attributes of Value Added Tarts Developed from Lotus (Nelumbo nucifera) Seed Powder
English2225Jyoti KumariEnglish Arivuchudar REnglishBackground: The consumer preference for snack product is on a huge rise, which is evident from the increase in revenue generated by the snack food industries. Also, the increase in nutritional awareness has posed a demand to develop nutritious snack products for bingeing. The tarts are extremely attractive and relished high-calorie snack by people of all age groups. The lotus seed with pharmaceutical properties is underutilised and hence used in this study to balance the empty calories provided by tarts.
Objective: This study is aimed at developing high-quality tarts by incorporating lotus seed powder.
Method: The lotus seed powder was substituted into the wheat flour at 0, 25, 50 and 75% to prepare tarts. All the variations of lotus seed powder incorporated tarts were analysed for physical and organoleptic attributes. The most accepted variation by the panel members was further subjected to nutrient analysis.
Results: The results showed that the nutrients like carbohydrate and protein are more in the accepted variation (75% of lotus seed powder incorporation) of value-added tart while fat was lower. The quantity of fibre was also more in 75% lotus seed powder incorporated tart compared to the control tart. The vitamins thiamine, riboflavin, niacin, vitamin B5 and B6 were more in the value-added tart and minerals, calcium, potassium, iron, magnesium and zinc were also more compared to the control tart.
Conclusion: The value addition with lotus seed powder, to the most savoured bakery products like tart,will ascertain adequate nutrition without compromising the taste of original tarts.
EnglishLotus Seed, Phytonutrients, Tart, Value AdditionINTRODUCTION
Lotus seeds obtained from lotus flowers (Nelumbo nucifera), with lots of medicinal values, have not gained popularity like that of the lotus flower. Though lotus seeds are not consumed as a dietary product, it is being used extensively in Chinese medicine. The type of lotus seeds available commercially is either brown peel or white variety. White lotus seeds which are de-shelled and de-membraned are white, while in the brown peel lotus seeds the membrane adheres to the seeds.
The nutritional and nutraceutical parameters of lotus seeds are noteworthy. Lotus seeds contribute to key nutrients namely starch, carbohydrates, protein and fat, chiefly unsaturated fatty acids.1 The nutraceutical components like asparagines, gallic acid and alkaloids such as demethylcolaurine, isoliensinine, liensinine, Lotusine, methylocrypalline, neferine, nuciferine, and pronuciferine, flavonoids like galuteolin, hyperine, rutin and minerals such as zinc, iron, calcium and magnesium are found in significant amounts in mature lotus seeds.2 The presence of these nutraceuticals help in alleviating conditions such as inflammation or infection in tissues and skin, tumours, and acts as an antidote for poison.3 Lotus seeds are also used in the treatment of hyperdipsia, halitosis, menorrhagia, leprosy and fever.4 The roasted lotus seeds can be substituted for coffee seeds and it also possesses saponins and phenolics in appreciable quantities.5
The health effects of N.nucifera seeds on animals have been studied by many researchers. Hydro-alcoholic extract from N. Nucifera seeds showed potent free-radical scavenging ability.6 Immunologic effect was observed in mice, where ethanolic lotus seed extract caused a significant increase in total and differential leukocyte and lymphocyte count.7 The neferine, an alkaloid present in the lotus seed has shown to have anti-arrhythmic action and also significantly inhibited platelet aggregation in mice.8 In animal study, the trace elements present in lotus seed play a significant role in maintaining blood glucose levels.9 By inhibiting acetylcholinesterase activity and inducing choline acetyltransferase expression, the lotus seed extract improved scopolamine-induced dementia in rats.10 Lotus seeds also possess antiviral activity. The lotus seed extract’s inhibitory effects on herpes simplex virus type 1 (HSV-1) have been reported.11 In rats on a high-fat diet, N. nucifera seeds reduced adipose tissue weights, ameliorated blood lipid profile and modulated serum leptin level.12
The lotus seeds with various potent nutrients can be used to enhance the nutritional quality of many foods which provide empty calories. Tarts being one of the favourite bakery foods is high in calories and many obese children and obese diabetic adults are deprived of eating tarts. Hence, value addition to tart by incorporating the lotus seed powder will help in improving the nutritional parameters.
MATERIALS AND METHODS
Procurement and Processing of Raw Material
Different ingredients for the development of value-added tart, like raw lotus seed, wheat flour, as well as other ingredients like butter, honey were procured from the local departmental store in Jharkhand.
Processing of Lotus Seed
Lotus seeds were purchased and checked for any infestation or damage. Lotus seeds free from damage were washed in clean water, dried under sunlight and ground to a fine powder.
Formulation of Lotus Seed Powder Incorporated Tart
The fresh lotus seed was washed in clean water, dried under the sun for 12 hours until free from moisture. The dried lotus seed was then ground in a mixer and sieved. Fine lotus seed powder and wheat flour were blended in the required proportions as given in the Table 1along with butter, and a pinch of salt. Knead all the ingredients with the required amount of water and make a stiff dough. Take a small piece of dough, roll it flat and put it in the tart maker to give the shape of the tart. Bake in the oven at 170oC for 20 minutes and the tart crust is done ( Table 1).
The lotus seed paste is made by grinding 10gms of lotus seed with water. The paste obtained is cooked with honey and butter and the tart crust is filled with lotus seed paste evenly for all variations.
Statistical Analysis
All experiments in the present analysis were conducted in triplicate, and mean values were reported.
RESULTS AND DISCUSSION
The results and discussion about the study Quality Attributes of Value Added Tarts Developed from Lotus (Nelumbo nucifera) Seed Powder is presented below.
Physical Characteristics of the Lotus Seed Powder Incorporated Tarts and Control Tart
The physical characteristics such as thickness, diameter, spread ratio and breaking strength were studied in the developed variations of lotus seed powder incorporated tarts and the results are presented in Table 2.
The above table depicts the physical characteristics of values of control and lotus seed powder incorporated tarts. Tart with desirable the quality is achieved when the spread ratio is more.13 Hardness is considered as an important characteristic which is measured as the peak force required to break the food product.14 It is observed that more the incorporation of lotus seed powder more is the spread ratio and more is the breaking strength. Breaking strength correlates with the hardness of the tart. The more spread ratio and higher breaking strength in variation 3, proves that the capacity to hold the fillings and to achieve the desirable mouth feel is favourable in variation 3, which has 75 gms of lotus seed powder incorporated.
Organoleptic Evaluation of Different Variations of Lotus Seed Powder Incorporated Tarts and Control Tart.
Five-point hedonic rating scale method was adopted to estimate the acceptance of the developed products. Totally 30 semi-trained people were used for organoleptic analysis. The sensory parameters like appearance, texture, flavour, mouthfeel, taste and overall acceptability of the value-added tart developed by incorporating lotus seed powder in various proportions was assessed.
The success of a food product formulated does not end with its preparation, rather the acceptability by the consumers determine it.15From the above figure 1 of organoleptic evaluation, it can be concluded that the variation 3, tart with lotus seed powder incorporated at 75% level scored comparatively higher in terms of all the sensory parameters like appearance, taste, texture, flavour and mouthfeel. The mean score for overall acceptability was 4.64 and also very much higher compared to the overall acceptability mean value of control tart, which was 3.3. An organoleptic study by Kaur et al. on various value-added bakery products like biscuits, muffins, bread, doughnuts and tarts by incorporating soybean flour have proved that tarts were highly acceptable.16Also, in this study based on the organoleptic evaluation, variation 3 tarts with 75% of incorporation of lotus seed flour was found to be most acceptable by the panel members and the proportion of lotus seed powder incorporation was directly proportional to the level of acceptance of the tart and this was further subjected to nutritional analysis.
Nutrient Content of the Accepted Variation of Tart
Nelumbo nuciferagaertn, belonging to the Nymphaeaceae family is an aquatic perennial widely planted in eastern Asia and cultivated for food and drink. According to folk medicine, it was traditionally used for dispersing summer heat. Numerous papers have mentioned the pharmacologically and physiologically activities of lotus seed, including antioxidant, anti-HIV and antiobesity effects.
The above table predicts that the lotus seed powder incorporation in the tart has added nutritional value to the control tart. Nutrients like carbohydrate and protein are more in the accepted variation of value-added tart viz. 66.1gms and 12.8gms, while fat (5.6gms) is lower and fibre (4.8gms) is more in lotus seed incorporated tart compared to the control tart. The vitamins thiamine, riboflavin, niacin, vitamin B5 and B6 are more in the value-added tart. The accepted variation of lotus seed powder incorporated tart contains 1.4mg of B1, 1.8mg of B2, 1.2mg of B3, 1.1 mg of B5 and B6. On comparing the mineral content, except manganese, all other minerals are more in lotus seed powder incorporated tart ( table 3). The lotus seed powder incorporated tart contains 142mg of calcium, 983mg of potassium, 1.8mg of manganese, 1.9 mg of iron, 186mg of magnesium and 0.8mg of zinc, all the nutrient values are on the higher side compared to the control tart. A similar study on lotus seed powder incorporated at 5% level in noodles was found low in fat, high in fibre, ash and phenols.17Thus, value addition improves the nutritional quality and consumable supremacy of any food product.
CONCLUSION
The health benefits of lotus seed powder is massive. Lotus seed powder improves appetite. Their low sodium and high magnesium content are effective in treating heart disease, diabetes and high blood pressure. The astringent properties help stop chronic diarrhoea. These seeds contain an anti-ageing enzyme, which repairs the damaged protein and heal the skin. The calming effects and the sedative properties of the seeds are effective in restlessness and to treat insomnia. Lotus seed consists of flavonoids like quercetin that have an anti-hemorrhagic effect and therefore can avoid excessive bleeding by improving the strength of the wall of capillaries. Nelumbo nucifera seeds contain neuroprotective flavonoids such as kaempferol, quercetin, isorhamnetin and myricetin. Polyphenols of lotus seeds are complex phenolic secondary metabolites, hence have powerful inhibitory effects on microorganisms. Hence, this study done to incorporate the wellness of lotus seeds into the most enjoyed bakery product tart, to enhance its nutritional value and to disseminate the goodness of nutrients to the tart consuming population is fruitful.
Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest
The authors declare no conflict of interest.
Financial Support
Nil
Englishhttp://ijcrr.com/abstract.php?article_id=3262http://ijcrr.com/article_html.php?did=3262
Indrayan AK, Sharma S, Durgapal D, Kumar N, Kumar M. Determination of nutritive value and analysis of mineral elements for some medicinally valued plants from Uttaranchal. Curr Sci 2005; 89: 1252–1255.
Pal I, Dey P. A Review on Lotus (Nelumbo nucifera) Seed. Int J Sci Res 2015; 4: 1659-66.
Sridhar K R, Bhat R. Lotus – A potential nutraceutical source. J Agric Technol 2007; 3(1): 143-155.
Sujitha R, Bhimba BV, Sindhu MS, Arumugham P. Phytochemical Evaluation and Antioxidant Activity of Nelumbo nucifera, Acorus calamus and Piper longum. Int J Pharm Chem Sci 2013; 2(3): 1573-78.
Ling Z.Q, Xie B.J, YangE.L. Isolation, characterization, and determination of the antioxidative activity of oligomeric procyanidins from the seedpod of Nelumbo nucifera Gaertn. J Agric Food Chem 2005; 53: 2441-2445.
Rai S, Wahile A, Mukherjee K, Saha B.P, Mukherjee P.K.Antioxidant activity of Nelumbo nucifera (sacred lotus) seeds. J Ethnopharmacol 2006;104: 322-327.
Mukherjee D, Khatua TN, Venkatesh P, Saha B.P, Mukherjee P.K.Immunomodulatory potential of rhizome and seed extracts of Nelumbo nucifera Gaertn. J Ethnopharmacol 2010; 128: 490-494.
Sugimoto Y, Furutani S, Itoh A. Effects of extracts and neferine from the embryo of Nelumbo nucifera seeds on the central nervous system. Phytomedicine 2008;15(12): 1117-1124.
Sivasankari S, Mani, Iyyam Pillai S, Subramanian SP, Kandaswamy M. Evaluation of hypoglycemic activity of inorganic constituents in N.nucifera seeds on streptozotocin-induced diabetes in rats. Biol Trace Elem Res 2010;138:226-237.
Oh JH, Choi BJ, Chang MS, Park SK. Nelumbo nucifera semen extract improves memory in rats with scopolamine-induced amnesia through the induction of choline acetyltransferase expression. Neurosci Lett 2009; 461(1): 41-44.
Kuo YC, Lin, YL, Liu CP, Tsai WJ. Herpes simplex virus types 1 propagation in HeLa cells interrupted by Nelumbo nucifera. J Biomed Sci 2005; 12:1021-1034.
You JS, Lee Y J, Kim KS, Kim SH, Chang K J. Antiobesity and hypolipidaemic effects of Nelumbo nucifera seed ethanol extract in human pre-adipocytes and rats fed a high-fat diet. J Sci Food Agric 2014;94(3):568-75.
Suriya M, Rajput R, Reddy CK, Haripriya S, Bashir M. Functional and physicochemical characteristics of cookies prepared from Amorphophallus paeoniifolius flour. J Food Sci Technol 2017;54(7):2156-2165.
Cheng YF, Bhat R. Functional, physicochemical and sensory properties of novel cookies produced by utilizing underutilized jering (Pithecellobium jiringa Jack.) legume flour. Food Biosci 2016; 14:54–61.
Aditi, Arivuchudar.R. A study on the organoleptic evaluation of unprocessed, sprouted and roasted flour mix chapattis. Int J Home Sci2018; 4(3): 88-92.
Kaur H, Kaur N. Development and sensory evaluation of value-added bakery products developed from germinated soybean (Glycine max) varieties. J Appl Nat Sci 2019; 11(1): 211-216.
Jirukkakul N, Sengkhamparn N. The Physicochemical Properties and Potential of the Lotus Seed Flour as Wheat Flour Substitute for Noodle. Songklanakarin J Sci Technol 2018;40(6):1354-1360.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareEffect of Tobacco Smoking on Salivary pH and Clinical Periodontal Indices in Indian Patients with Chronic Periodontitis
English2630Senthilkumaran MEnglish Siji Jacob TEnglish Asha JEnglish Ravivarman CEnglish Pradeep P ElangoEnglish Vijayalakshmi DEnglishIntroduction: Tobacco smoking has been known to assume the role of a robust risk factor for the progression of periodontal disease and salivary quantitation being an easily accessible tool can aid in assessing the diagnosis and prognosis of clinical parameters in smokers with chronic periodontitis.
Objective: Our study aims at the assessment of salivary pH and clinical periodontal parameters in Indian smoker patients diagnosed with chronic periodontitis.
Methods: In this study, 78 subjects between 25 years and 55 years of age were recorded. The habit history and clinical periodontal indices were recorded and subjects were divided into three groups: Group 1: 26 healthy subjects; Group 2: 26 non-smokers diagnosed with chronic periodontitis and Group 3: 26 smokers diagnosed with chronic periodontitis. The clinical periodontal indices recorded were Plaque index, Gingival Bleeding Index, Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Salivary samples were collected and centrifuged and salivary pH is measured.
Results: The results indicated that group 3 had statistically significant higher plaque score level, clinical attachment loss and probing pocket depth measurements than group 2 and group 1. Group 2 had a higher gingival bleeding score than group 1and group 3 and the mean difference is statistically significant. Smokers with periodontitis had a decreased salivary pH (acidic) when compared to non-smokers and healthy subjects.
Conclusion: Cigarette smoking may be associated with a decrease in the salivary pH and variation of the various clinical periodontal parameters. Salivary samples can be used for early diagnosis of the severity of periodontitis and thus aid ineffective treatment.
EnglishSmoking, Periodontitis, Salivary pH, Clinical periodontal parameters, Probing pocket depth, Gingival Bleeding IndexINTRODUCTION
Diseases of the periodontium continue to be one of man’s most widespread afflictions. Dental plaque is the chief etiological factor that explains the initiation and progression of gingival and periodontal disease.1 Despite plaque with pathogenic bacteria being the main aetiology, tobacco smoking assumes the role of a capable risk indicator contributing to the disease progression. Tobacco smoking greatly influences the structural and physical properties of the saliva. Also, salivary pH greatly influences the growth of oral microorganisms.2
Various studies on evaluation of salivary quantitation of pH in smokers3,4 and effect of smoking on periodontal tissues5,6 have been extensively undertaken previously, but the clinical periodontal parameters and salivary pH levels in smokers diagnosed with chronic periodontitis has been less studied. We aimed at evaluating the various clinical periodontal parameters and salivary pH in Indian smoker and non-smoker chronic periodontitis patients.
MATERIALS AND METHODS
A sample size of 78 subjects in the age group between 25 years and 55 years of age were segregated into 3 groups based on the inclusion, exclusion criteria, smoking history and clinical examination. A smoking history of 10 cigarettes per day for 2 consecutive years would sample the subject into the smokers' group. Subjects with a history of any co-morbidities
(Diabetes), chronic infections, or constant intake of any type of medication, any form of physical trauma in the last 2 weeks, or those with less than 22 permanent teeth were excluded from the study. The study also excluded patients diagnosed with aggressive periodontitis, acute periodontal conditions and patients with a history of smoking before two years.
All patients were briefly informed about the procedure and informed consent was taken. An extensive medical and smoking history (consumption and duration) was assessed by a standardized interview. Clinical examination was carried out utilizing the basic diagnostic instruments and William’s periodontal probe (Figure 1). The following clinical parameters were recorded: 1.Plaque index (Sillness and Loe 1964)7; 2. Gingival Bleeding Index (Ainamo and Bay 1975)8,9; 3. Probing Pocket Depth (PPD)9; 4. Clinical Attachment Level (CAL) (Ramfjord 1959).10
Figure 1: William's probe used for measuring the clinical periodontal parameters (Probing Pocket Depth being measured)
Smoking history and periodontal indices were taken into consideration to sort the subjects into three groups:- Group 1: included 26 systemically and periodontally healthy subjects with no loss of Clinical Attachment level and little or no Bleeding on Probing and Probing Pocket Depth less than 3mm; Group 2: Included 26 patients with no smoking history and clinically diagnosed as moderate to severe periodontitis (Clinical Attachment Loss more than 3 mm and Bleeding On Probing Probing Pocket Depth more than or equal to 5mm); Group 3: Included 26 patients with smoking history and clinically diagnosed as moderate to severe periodontitis.
Collection of Saliva sample
The saliva samples were collected in the morning on 2 hours fasting to avoid any stimulation. The subjects were restfully seated upright were and were instructed to flex their neck forward and gently spit out the saliva into the sterile test tube. The subjects were told not to spit forcibly to avoid blood contamination from an inflamed gingival tissue or an ulcerated lesion. About 5 ml of unstimulated saliva sample was collected and was centrifuged for 10 minutes at 3000 rpm.
Salivary pH estimation
A single electrode digital pH meter (ROYS instruments) was used to estimate the salivary pH levels. A pH tablet was then used for the calibration of the pH meter (pH 7 and pH 9.2). The procedure included immersing the single electrode in 0.1 N hydrochloric acid for 6 hours, followed by double distilled water. Sterile filter papers were then used to dry the electrodes before using it on the sample.11 All the data were analyzed using a software program (SPSS 11). Analysis of variance (ANOVA) and Scheffe multiple comparison tests were applied to collate the periodontal parameters among the groups.
RESULTS
Plaque Scores
Mean plaque scores in all the three groups were analyzed (Table 1). One way ANOVA test revealed that all the three groups were statistically different (p < 0.001). Scheffe multiple comparison tests have been applied to find out which of the three groups are statistically different. The results indicate that group 3 had a higher plaque score level than group 2 and group 1and the mean difference was statistically significant (p < 0.001). Group 3 had slightly higher plaque score level than group 2 and the mean difference was statistically significant (p < 0.001). In group1, mean plaque score was found to be 0.039 with a standard deviation of 0.034. In group 2, mean plaque score was found to be 1.415 with a standard deviation of 0.441. In the group 3, mean plaque score was found to be 1.913 with a standard deviation 0.571. One way ANOVA test revealed that all the three groups were statistically different (P < 0.001).
Scheffe multiple comparison test has been applied to find out which of the three groups are statistically different. The results indicate that group 3 has a higher plaque score level than group 2 and group 1 and the mean difference is statistically significant.(P < 0.001). Group 3 has slightly higher plaque score level than group 2 and the mean difference is statistically significant.( P < 0.001).
Gingival bleeding scores
One way ANOVA test and Scheffe multiple comparison test of the gingival bleeding scores (Table 2) indicated that group 2 had a higher gingival bleeding score than group 1 and group 3 and the mean difference was statistically significant (p < 0.001). However, Group 3 had slightly higher gingival bleeding score than group 1 and the mean difference was statistically insignificant (p =0.002). In group 1, mean gingival bleeding score was found to be 2.413% with a standard deviation of 1.773. In group 2, mean gingival bleeding score was found to be 89.093% with a standard deviation of 12.892. In group 3, mean gingival bleeding score was found to be 18.518% with a standard deviation of 23.924. One way ANOVA test revealed that all the three groups were statistically different (P < 0.001). Scheffe multiple comparison test has been applied to find out which of the three groups are statistically different. The results indicated that group 2 has a higher gingival bleeding score than group 1 and group 3 and the mean difference is statistically significant (P < 0.001) . Group 3 has slightly higher gingival bleeding score than group 1 and the mean difference is not statistically significant (P =0.002)
Attachment Loss values
Clinical Attachment Loss values on analysis with one way ANOVA test indicated that group 3 had a higher Clinical Attachment Loss than group 1 and group 2 and the mean difference was statistically significant. Group 3 has slightly higher Clinical Attachment Loss than group 2 and the mean difference is not statistically significant (p=0.080). In Group 1, the mean clinical attachment loss was found to be 0.00mm with a standard deviation of 0.00. In group 2, mean clinical attachment loss was found to be 5.593mm with a standard deviation of 1.070. In group 3, mean clinical attachment loss was found to be 6.078mm with a standard deviation of 0.783. One way ANOVA test revealed that all the three groups were statistically different (P < 0.001).
Scheffe multiple comparison test has been applied to find out which of the three groups are statistically different. The results indicate that group 3 has a higher clinical attachment lossthan group 1 and group 2 and the mean difference is statistically significant (P Englishhttp://ijcrr.com/abstract.php?article_id=3263http://ijcrr.com/article_html.php?did=3263
Al-Tayeb D. The effects of smoking on the periodontal condition of young adult Saudi population. Egyptian Dental J 2008;54(1):15.
Singh M, IngleNA, Kaur N, Yadav P, Ingle E. Effect of long-term smoking on salivary flow rate and salivary ph. J Ind Assoc Public Health Dent 2015;13:11-3
Ahmadi-Motamayel F, Falsafi P, Goodarzi MT, Poorolajal J. Comparison of Salivary pH, Buffering Capacity and Alkaline Phosphatase in Smokers and Healthy Non-Smokers. Sultan Qaboos Univ Med J 2016; 16(3): e317–321.
McGuire JR, McQuade MJ, Rossmann JA, Garnick JJ, Sutherland DE, Scheidt MJ. Van Dyke TE. Cotinine in Saliva and Gingival Crevicular Fluid of Smokers With Periodontal Disease. J Period 1989; 60: 176-181.
Bergström J. Tobacco smoking and chronic destructive periodontal disease. Odontology 2004; 92:1–8.
Kinane DF, Chestnutt IG. Smoking and Periodontal Disease. Crit Rev Oral Biol Med 2000; 11(3):356-365.
John J. Textbook of community dentistry. 1st edition: 2003, CBS.
Wolf HF, Rateitschak EM, Hassell TM. Color Atlas of Dental Medicine: Periodontology. 3rd edition: 2005;309-19.
Newman MG, Takei H, Klokkevold PR, Carranza FA. Clinical periodontology. 8th Edition: WB Saunders.1996.
Newman MG, Takei H, Klokkevold PR, Carranza FA. Carranza’s Clinical Periodontology. 10th edition: WB Saunders.2006.
Vasudevan DM, Shreekumari S; Vaidyanathan K. Textbook of biochemistry for medical students. 6th edition ed: 2010.
Baumert Ah MK, Johnson GK, Kaldahl WB, Patil KD, Kalkwarf KL. . The effect of smoking on the response to periodontal therapy. J Clin Periodontol 1994; 21: 91–97.
Zuabi O, Machtei EE, Ben-Aryeh H, Ardekian L, Peled M, Laufer D. The effect of smoking and periodontal treatment on salivary composition in patients with established periodontitis. J Periodontol 1999;70(10):1240-1246.
Apatzidou D A, Riggio M P. and Kinane D F. Impact of smoking on the clinical, microbiological and immunological parameters of adult patients with periodontitis. J Clin Periodont 2005;32:973–983.
Ramli J. Taiyeb Ali T B Association between smoking and periodontal disease: A review of the literature. Ann Dentist Uni Malaya. 1999; 6:21-26.
Kinane DF, Peterson M. and Stathopoulou PG. Environmental and other modifying factors of the periodontal diseases. Periodontology 2006;40:107–119.
Rajasekar S, Ramasubramanian V, Sethupathi. Assessment of Salivary EnzymesalanineAminopeptidase(Alap) and Dipeptidyl Peptidase Iv (Dpp Iv) in Patients with Chronic Periodontitis. Int J Cur Res Rev 2016; 8(19): 6-11.
Baliga S, Muglikar S, Kale R. Salivary pH: A diagnostic biomarker. J Indian Soc Periodontol 2013;17(4):461-465.
Fenoll-PalomaresC, Montagud J, Sanchiz V, Herreros B, Benages A. Unstimulated salivary flow rate, pH and buffer capacity of saliva in healthy volunteers. Revista Espanola De Enfermmedades Digestivas 2004;96(11):773-783.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareEfficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study
English3140Shamim AnsariEnglish Wajeeha BegumEnglish Kouser Fathima FirdoseEnglishIntroduction: Cervical ectopy (quruhal rahim) is a benign and common gynaecological condition. About 80-85% of women suffer from Cervical Erosion. Clinically the patient may present with vaginal discharge, low backache, contact bleeding in the form of post-coital bleeding or intermenstrual bleeding, dyspareunia, etc. Cervical erosion is diagnosed by per speculum examination. Considering these facts methi, alsi,babuna, nakhuna, Karam Kala, has been selected to evaluate the efficacy in the form of Abzan in Quruhal Rahim.
Objective: To evaluate the efficacy of Abzan in Quruhal Rahim with Unani formulation.
Methods: Clinically diagnosed patients (n=30) with Married women between the age group of 18-45yrs. Having symptoms of vaginal discharge, normal or inflammatory changes in pap smear were included and patients with malignancy, Pelvic inflammatory disease, systemic illnesses & sexually transmitted disease, oral contraceptive Pills and Intrauterine contraceptive device, pregnancy and lactation were excluded. After menses use daily one time for sitz bath for 15minuts for 21 days. Cervical ectopy by arbitrary grading scale and SF-12 for Quality of life were health-related quality of the life is measured by SF-12 Questionnaire to provide easily interpretable scales for physical and mental health.
Result: Vaginal discharge mean score before and after treatment is 2.37±0.57 and0.367±0.49 respectively with pEnglishQuruhalrahim, Cervical ectopy, Abzan, Arbitrary grading scale, SF-12 for QOL, Vaginal dischargeINTRODUCTION
Cervical erosion is also known as cervical ectopy. It is a benign lesion and a common gynaecological condition seen in outpatient departments.1,2 About 80-85% of women suffer from cervical erosion3. It is the commonest finding in routine pelvic examinations during the fertile age group11. Pathologically cervical erosion is a condition where squamous epithelium of the ectocervix is replaced by the columnar epithelium of the endocervix.3 The exposed columnar epithelium looks red because of the blood vessels just below the surface.4 A single layer of glandular cells that reside in close association with the underlying vascular cervical stroma appear. It is thin and vascularized epithelium fragile tissue. With easy access to the blood and lymphatic systems, there are decreased mucosal barriers to sexually transmitted infections (STIs), including HIV. Prior observational epidemiological studies have suggested that cervical ectopy can increase the risk of acquiring diseases like chlamydia trachomatis, human papillomavirus, and cytomegalovirus, but not Neisseria gonorrhea.5
The common causes of ectopy are trauma by multiple childbirths, tampon use of intrauterine contraceptive device chemicals, infections, hormones (oral contraceptive pills) or carcinoma etc. Cervical ectopy is more common in women of lower socioeconomic groups, poor general hygiene, early marriage and multiple pregnancies.6
Clinically, the patient may present with vaginal discharge, low backache, contact bleeding in the form of post-coital bleeding or intermenstrual bleeding, dyspareunia, etc.7 Cervical erosion is diagnosed by per speculum examination. It reveals a bright red area surrounding and extending beyond the external os in the ectocervix. The outer edge is demarcated. It may be smooth or having small papillary folds. It is neither tender nor bleeds to touch.7 It is asymptomatic and physiological then needs no treatment but when it is symptomatic and infected then the treatment is needed.3,7 Cryo cauterization, electrocoagulation and cautery with laser is the treatment of choice. Side effects like prolonged excessive mucoid discharge per vagina, seldom cervical stenosis, accidental burns, bleeding and recurrence are associated with this treatment6. In classical Unani literature which is caused by external factors such as wound due to trauma, instrumentation, a drug which is caused by external factors such as wounds due to trauma, instrumentation, drug-induced i.e use of haad drugs in the form of humool, or internal factors like difficult labour or mismanagement of labour, sometimes, it may be because of acute yellow bile causing gradual erosion of cervix due to its acute nature or inflammation and rupture of pustules.,8,9 In symptoms like backache, pelvic pain, abnormal vaginal discharge, excessive tiredness etc. Use of (relaxant) drugs is harmful while qabiz (astringent) drugs are beneficial in its treatment.8-10,
Unani system of medicine has several drugs available for healing of cervical ectopy as a local treatment in the form of sitzbath, which are safe and cost effective. In present study research drug comprises of Methi (Trigonella foenum graeceum) 5gms, alsi (Linum usitatissimum) 5gms, babuna (Matricaria chaemomilla) 3gms, nakhuna ((Trigonella uncata) 5gms, karmkalla ka dant’hal (Brassica oleracea)10gms Joshanda is prepared in 2 lots of warm water. After menses use daily one time forsitz bath for 15minuts for 21 days.11 In unani system of medicine various drugs with medicinal properties like munzij, muhallilawram (anti-inflammatory), jaali (detergent), muqawiebadan, mushil ( laxative), mujaffif, mudammilquruh, dafi-i-taffun, mullayan, mussakinetc are used locally to treat this disease.
Materials and Methods
Study design: An open observational study
Study duration: One and a half years from March 2019 to January 2020
Study centre: OBG Dept. National Institute of Unani Medicine Hospital, Bangalore.
Sample size: 30 patients
Ethical clearance No.: Ethical clearance was obtained from the institutional ethical committee vide no NIUM/ IEC/2017-18/013/ANQ/05; and CTRI registration done vide no.CTRI//2019/03/024426.
Informed consent: all participants gave written informed consent before study
Drugs Identification: was done at FRLHT Bengaluru. with an acc. No. 5510-5514
Participants
Total 60 patients were screened for the study, 10 patients refused participation and 20 patients didn’t meet the inclusion criteria, hence were excluded. 30 patients were allocated in- an open observational study.
Selection criteria
Married women between the age group of 18-45 yrs. Having symptoms of vaginal discharge, low backache, dyspareunia, post-coital bleeding, normal or inflammatory changes in pap smear were included and patients with malignancy, PID, systemic illnesses like Hypertension, diabetes mellitus & STIs, OC Pills and IUCD’s, pregnancy and lactation were excluded.
Study procedure
The patients fulfilling the inclusion criteria were enrolled after explaining the study in detail and receiving informed consent. In each patient, history was evaluated and a complete physical examination including breast, abdominal examination and per vaginal examination was performed. Personal details, history, clinical features and investigations were recorded in the Case record form structured for the study.
Criteria for selection of drug
The research drug possesses properties like muhallilewaram, mujaffif, mudammilequruh, dafi-i- ta’ffun,qabid, musakkin,12-17 properties. Moreover, pharmacological studies show that research drug exhibit antimicrobial, anti-inflammatory, antioxidant, anti-cancer, anti-ulcer, analgesic, hepatoprotective wound healing activities.13,14,18-20 Further methi, alsi, nakhoona, baboona, karamkallacontains flavonoids, saponins (glycosides), alkaloids (terpenoids, steroids) arachidonic acid, ethanol, histamine, leukotrienes, polysaccharides, saponins (glycosides), carbohydrates, tannins, triglisoraletc13,14,18 which are considered as the active principle of anti-ulcer activity. Flavonoids are a group of the polyphenolic compound having anti-ulcerogenic, anti-inflammatory, anti-bacterial, antioxidants properties4 which provide strength to the mucosal barrier & promote the ulcer to heal fast.20 The wound healing activity of Unani formulation as abzan might protect against microbial invasion by providing better tissue formation. Further, it enhances the rate of wound healing & tissue epithelization.4 Thus, research Unani formulation is anticipated to be effective in the healing of cervical ectopy and relieving the associated symptoms.
Method of preparation
The best quality of methi, alsi, babuna,nakhuna, and karmkalla was provided by the pharmacy of NIUM and was further authenticated by FRLHT Bengaluru. with an acc. No. 5510-5514. All the drugs were finely powdered. Drugs were weighed and mixed. The powdered drugs were dispatched in plastic self-lock bags. To avoid any confusion regarding dosages one lock bag was used to dispatch 28gm of the drug for a single day which was to be used daily for one measure for sitz bath. So every patient was given 7 packets of the drug for one week at each visit and continued for 3 weeks. Treatments were given locally.
Initial assessment and laboratory screening
Baseline Laboratory investigations like haemoglobin percentage, total leucocyte count, differential leucocyte count, erythrocyte sedimentation rate, Veneral Disease Research Laboratories test and random blood sugar were done to exclude general diseases. Ultrasonography of pelvis was done to exclude pelvic pathology. Pap smear was done to exclude genital malignancy in each case. Assessment of the extent of erosion was graded as 0, 1, 2 and3; as follows. Grade 0: No erosion Grade 1: covering 1/3rdof cervix Grade 2: from 1/3rd to 2/3rd area of the cervix, and Grade 3: overs 2/3rd of the cervix. The assessment was done before treatment, at .each follow up during treatment and after treatment. Patients were also enquired for any side effects during the trial. Assessment of Health-related quality of life (HRQol) was assessed by the SF-12 questionnaire. Assessment of low backache is done by using the Visual Analogue Scale (VAS). Assessment of vaginal discharge was graded from 0 to 4 grade: score: 1-No discharge; 2- Mild ( No staining or moistness of undergarments); 3-Moderate (stain on undergarments); Score:4- severe (using pads). Dyspareunia and post-coital bleeding were based on the arbitrary four-point scale (0= None,1=Mild,2= Moderate, 3= Severe ). Treatment was subsequently started in patients fulfilling the inclusion criteria.
Intervention
Joshanda of methi (Trigonella foenum graceum) 5gms, alsi (Linum usitatissium graceum) 5gms, babuna (Matricaria chaemomilla) 3gms, nakhuna (Trigonella uncata) 5gms, karmkalla ka danthal (Brassica oleracea) 10gms was prepared by soaking the drugs in 400ml of water for the whole night. Next day in the morning the soaked drugs with water was boiled until it was concentrated to 180 ml. Abzan were prepared according to the standard method of preparation. It was used for 15minuts daily for 21 days after menses. Assessment of erosion and health-related quality of life (HRQol) was done at baseline, each follow up during treatment (weekly) and after treatment (once in 15 days for a month). Patients were also enquired for any side effects during the trial. Patients were advised to maintain personal hygiene and avoid intercourse during the treatment.
Subjective parameters: Vaginal discharge, low backache, contact bleeding, dyspareunia
Objective parameters:
Changes in Cervical ectopy assessed by the arbitrary grading scale
(Direct visual assessment of the appearance of cervix, healing of erosion and vaginal discharge).
SF-12 score to assess for QOL
Outcome measures:
Primary outcome measure: changes in white discharge and low backache.
Secondary outcome measure: Improvement in cervical ectopy grading and SF-12 (12 items short-form survey) Health Questionnaire score ( Figure 1).
Statistical analysis
Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean ± SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance. The Statistical software namely SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables etc.22,23
RESULTS AND DISCUSSION
The present study entitled “Efficacy of Abzan with Unani formulation in Quruhal Rahim - An open observational study” was effective in the healing of cervical erosion and relieving the symptoms. In the present study, it was demonstrated that complete healing of cervical ectopy was achieved in 56.7% of patients with a mean of 1.7±0.66 & 0.47±.57before and after respectively. Vaginal discharge was improved in 63.3% of patients with a mean of 2.37±0.56 and 0.37±0after treatment respectively. While it persists in a mild form in 36.7%. Low backache was relieved in 90% patients, and remains 10% in a mild form, with mean of 1.93±0.37 and 0.1±0.36. Highly significant improvement in vaginal discharge and low backache was might be due to healing of cervical ectopy, which causes relief in these symptoms. No adverse effect of research Unani formulation was reported during the study.
Demographic characteristics
Age: Majority of the patients (63.3%) were in the age group of 31-40 years & remaining 30% were in 21-30 years and 6.7% in 41-50 years of age. Hashmi S et al.24and Mirza S et al25Patil P et al. 26Latafat T et al.27reported 40% and 44% in two groups in 31-35 yrs., reported 39.2% in 31-40 yrs, reported 40% &37.8% in 26-30 yrs. respectively. The result of present study correlates with the above studies. Evidence suggests that cervical ectopy is common in women of reproductive age group.4,7 Mean±SD of the age of patients was 33.93±5.37, which is by the study of Jindal M et al.2 who reported 31.32 and 33.7 in two groups, Al- Kaseer reported28 27.1 ± 5.9, Cekmez Y et al.29 reported 34.4±4.3.
Socioeconomic status: In the present study, 23.3% of patients belong to an upper-middle-class, 63.3% to lower middle class and 13% to the lower class. Hashmi S et al.24 reported 43.3% of patients in the upper-lower, 36.6% in the upper middle, 16.6% in the lower-middle and 13.3% in the lower class. Mirza S et al.25reported 42.2% of patients in the upper lower class, 40% in the lower middle, 11.1% in the upper middle & 6.7% in the upper class. Shivanna et al. 30reported 72% and 75% patients respectively from low Socioeconomic status. Gautam A et al.31 reported majority of the patients belong to lower middle class. Bengal V. B. et al.32 reported that maximum patients having cervical ectopy belong to low socioeconomic class, low literacy level, poor personal hygiene and poor health awareness. Literature report says that low socio-economic status predisposes to poor nutrition, poor personal hygiene leading to infection which may cause cervical ectopy.32,33
Literary Status: Most of the patients had low educational level i.e.; 36.7% patients had primary school education, while 13.3% were illiterate, 23% & 16.7% had education up to secondary and higher secondary school while graduate and postgraduate are 6.7% and 3.3 % respectively. Mirza S etal.25reported 20% illiterate, 33.3% had middle school education, 10% each in primary school and high school & 13.3% graduate. Hashmi S et al.24 reported44.44% illiterate, 20% had middle school education & 13.3% had education in each primary, secondary and higher secondary. Gautam A et al.31reported 40% of the patients had a high school education. Al-Kaseer et al.28 reported low educational level among patients of cervical ectopy.
Occupation: In this study housewife are more affected than the working class. Out of 30 patients, 73.3% of patients are of housewife affected with cervical erosions whereas 26.7% are working women.
Dietetic habit: In this study out of 30, 20(66.7%) patients are of mix diet. Whereas 10(33.3 %) are vegetarian. In the Unani system of medicine, importance has been given to dietetics in health and disease.34Unaniphysicians mentioned certain foods which are to be taken and to be avoided according to age, season, place, and mizaj of the person. The temperament of meat is har when consumed in excessive quantity; it causes increase production of khilte dam and can lead to amrazedamvi. As, mentioned earlier that cervical erosion with cervicitis is a damvi marz,35 it may be assessed that non-vegetarian diet has its impact on this disease as per the mizaj and akhlat theory.
Mizaj: Most of the patients, 86.7 % possessed damwimizaj, while 13.3% had balghamimizaj, none of the patients had safrawi or saudawimizaj, which agrees with the studies of Hashmi S et al.24 reported 66.67 % patients with damwimizaj, Mirza S et al.25 reported 53.3% with damwimizajMoreover, it coincides well with the theories of eminent Unani Scholars in the etiopathogenesis of quruh, who states that hararat & ratubat are an essential component of ufunat which forms an inflammatory swelling and when it get secondarily infected, it results in rupture of this swelling which in turn leads to ulcer formation.10,36.
Vaginal discharge
At baseline, all patients were complaining of vaginal discharge. During treatment, on 1st& 2nd follow up, it persists in 96.3% and was absent in 3.3% patients respectively. After treatment, it persists in 36.7% with mild discharge. & was absent in 63.3%.At baseline, vaginal discharge was mild, moderate & severe in 3.3%, 56.7% & 40% patients respectively. During treatment, on 1st follow up vaginal discharge was mild & moderate and severe in 3.3%, 70% and 26.7% patients respectively, whereas none of the patients had severe vaginal discharge; on 2nd follow up, the vaginal discharge was not present in 3.3% and 26.7% and 70% patients had mild and moderate vaginal discharge respectively. After treatment, the vaginal discharge was mild in 36.7% & absent in 63.3% of patients, though no patient had a moderate and severe vaginal discharge. After treatment, vaginal discharge with mean of 2.37±0.57 and 0.367±0.49 before and after intervention with PEnglishhttp://ijcrr.com/abstract.php?article_id=3264http://ijcrr.com/article_html.php?did=3264
Kumari R.C, Singh BK. Role of Udumbaradi Tail in the management of a vaginal discharge due to Cervical erosion: A case report. Int J Res Ayur Pharm 2013; 4(4) 631-33.
Jindal M, Kaur S, Sharma S, Gupta KB, Pandotra P. What is better: cryocautery or electrocautery for cervical erosion? Int J Reprod Contracept Obstet Gynecol 2014; 3(3):715-19.
Kamini D, Meena.P. Kampillakadighrita in Garbhashaya Greeva Gata Vrana (Cervical Erosion). IJARP 2012;3(2):203-09.
SolankiSK,Sharma S. Role of Kshara Karma in the Management of Cervical Erosion. Ayu Ayur Phram Int J Alli Sci 2016;5(6):77-82.
Kartik K,Venkatesh , Uvin S. Assessing the relationship between cervical ectopy and HIV susceptibility: implications for HIV prevention in women. Am J Reproduct Immunol 2013; 69:68-73.
Yogesh M, Hetal B, Shachi P. Effect of Udumber-Sar in GarbhashayaGrivamukhagataVrana (Cervical erosion)- A case study. Int J Appl Ayur Res 2017 Oct;3(4):781-84.
D.C.Dutta. Text Book of Gynecology 7th Edn. New Delhi: Jaypee Brothers Medical Publishers(P)LTD ;2016. Pg. 217-218.
Khan A. Al Akseer (Urdu trans. by Kabeeruddin). 1sted. New Delhi: Idarae Kitabul Shifa; 2011:788-90.
Razi ABZ. Al HawiFilTib. Vol ΙΧ. New Delhi: CCRUM; 2001:10,12,24,25,36,42 ,47,50,
IbnSina. Al QanoonFilTib (Urdu trans. by Kantoori GH).Vol ΙΙΙ. New Delhi: Idarae Kitabul Shifa; 2010:1092,125-126.
Qamari MH. Ghana Mana. 1sted. New Delhi: Markazi Council Barai Tehqeeq Tibbe Unani; 2008: 414-415.
Halim MA. MufradateAzizi. New Delhi: Central Councill Research for Unani Medicine, 2009. p.49.
Swaroop A, Jaipuriar AS, Gupta SK, Bagchi M, Kumar P, Preuss HG, Bagchi D. Efficacy of a novel fenugreek seed extract (Trigonellafoenum-graecum, Furocyst TM) in polycystic ovary syndrome (PCOS). Int J Med Sci 2015; 12 (10): 825.
Umer KH, Zeenat F, Ahmad W, Ahmad I, Khan AV. Therapeutics, phytochemistry and pharmacology of Alsi (Linumusitatissimum Linn): An important Unani drug. J Pharmacog Phytochem 2017; 6 (5):377-83.
Khan ZJ, Khan NA, Naseem I, Nami SA. Therapeutics, phytochemistry and pharmacology of Tukhm-e-Katan (Linumusitatissimum L.). Int J Adv Pharm Med Bioallied Sci 2017 Mar; V. 2017(2017):1-
Rashid N, Dar PA, Ahmad HN, Rather SA. Alsi (Linum Usitatissimum (Linn.): A potential multifaceted Unani drug. J Pharmacog Phytochem 2018; 7(5):3294-300.
Hakim A. Tajudlin. Ahmed G. Jahan N. Evaluation of anti-infllammatory activity of the pods of iklil-ul-Malik (Astraogalushamosus. Linn). Indian J Nat Prod Reso 2010; (I): 34-37.
Jabeen A, Khan AA, Alam T, Maaz M, Mohmad SH. Flaxseed/Tukhm-e-katan (Linum Usitatissimum Linn): A Review. J Pharm Sci Innov 2014 oct;3(5):401-09.
Umer KH, Zeenat F, Ahmed W, Khan VK, Theraputics phytochemistry and pharmacology of Iklilul Malik (Astragalus hamosus Linn) A natural unani remedy. Int J Herb Med 2017 May;5: 1-4.
Khan MA. Asmaul Advia (Edited hy S. Z. Rehman). Aligarh: Publication Division. AMU: 2002:45
Gur CS, Onbasilar I, Atilla P, Genc R, Cakar N, Gurhan ID et al. In vitro growth stimulatory and in vivo wound healing studies on cycloartane-type saponins of Astragalus genus. J Ethnopharmacol 2011;134: 844-50.
Bernard Rosner (2000), Fundamentals of Biostatistics, 5th Edition, Duxbury, page 80-240
Suresh K.P, Chandrasekhar S. Sample Size estimation and Power analysis for Clinical research studies. J Human Reproduction Sci 2012;5(1): 7-13.
Hashmi S, Begum W, Sultana A. Efficacy of Sphaeranthusindicus and cream of Lawsoniainermis in cervical erosion with cervicitis. Eur J Integr Med 2011Aug; 3: 183-85.
Mirza S, Naaz SA, Alim SM, Rahman A. Analgesic, anti-inflammatory and anti-microbial activities of Irsa (Irisensata): A clinical study on the patients of Iltehabe Unqur-Reham (Cervicitis). IJPPR 2015; 3(4): 66-72.
Patil P, Sharma P. Colposcopic evaluation of cervical erosion in symptomatic women. Int J Reproad Contracept Obstet Gynecol 2017 jun; 6(6): 2207-11.
Latafat T, Siddiqui MMH, Jafri SAH. A Clinical study of Marham dakhlion on chronic cervicitis and cervical erosion. Ancient Sci life. 1992;11(3-4):158-62.
Al-Kaseer EA. Epidemiological characteristics of women with cervical erosion in Al-Sader city, Baghdad, Iraq. J Fac Med Baghdad 2010; 52(2): 157-58.
Cekmez Y, Sanlikan F, Gocmen A, Vural A, Turkmen SB. Is cryotherapy friend or foe for symptomatic cervical ectopy. Med Princ Prac 2016;25: 8-11.
Shivanna BS, Shivanna L, Kulkarni P. Comparative study of the efficacy of cryosurgery and Albothyl® solution in the management of cervical erosion in a rural hospital. J Dental Med Sci 2014 Sep;13 (9):106-09.
Gautam A, Rajan S, Rajan S, Sharma E. A clinical study of Kusthadi Varti in Karnini Yonivyapada w.s.r. to cervical erosion. Int J Curr Res 2017; 9(12): 62140-143.
Bangal VB, Patil NA, Gavhane SP, Shinde KK. Colposcopy guided management of cervical erosions in Rural population. Sch J App Med Sci 2014; 2 (1):261-65.
Koteswari M, Rao N, Renuka IV, Devi CP. A study of Pap smear examination in women complaining of leucorrhea. IOSR-JDMS 2015; 14(1/IV): 37-42.
Zulkifle M, Ansari AAH, Shakir M, Kamal Z, Alam T. Management of non-healing leg ulcers in Unani system of medicine. Int Wound J 2012; 366-72.
Qadry JS. Pharmacognosy. 16thed. New Delhi: JS. Offset Printers; 2014: 170.
Ibn Rushd. Kitabul Kullyat. (Urdu trans.). New Delhi: CCRUM; 1980. p.79- 81. 84-5,286,304-310.
Gupta P, Sharma S. Clinical evaluation of the efficacy of Kashara Karma with ApamargaKashara and Jyatyaditailapichu in the management of cervical erosion (Karniniyonivyavada). WJCPMT 2015; 1(3): 43-49.
Monroy OL, Aguilar C, Lizano M, Talonia FC, Cruz RM, Zavaleta LR. Prevalanceof human papillomavirus genotypes and mucosal IgA anti-viral responses in women with cervical ectopy. J Clin Vir 2010; 47:43-48.
Anees S, Mustafa S. Clinical study for the efficacy of Unani formulation in the management of vaginal discharge associated with cervicitis (Iltehabe unqurrehm). IABCR 2017; 3(4): 127-29.
Tanvir A, Izharul H, Aisha P, Nazamuddin M, Shaista P. Hulba (Trigonella foenum graecum): The common Indian spice full of medicinal values. Int J Preclin Pharm Res 2014; 5 (1):41- 6.
Anju. Idris M. Methi (Trigonella fenum graceum): A Multifunctional Herbal Drug. JHMR 2018; 3:1-8.
Dharajiya D, Jasani H, Khatrani T, Kapuria M, Pachchigar K, Patel P. Evaluation of antibacterial and antifungal activity of fenugreek (Trigonella foenum graecum) extracts. Int J Pharm Pharm Sci 2016; 8(4): 212-17.
Miraj S, Alesaidi S. A systemic review study of the therapeutic effects of Matricaria Recutita chamomile (chamomile ). Electr Physic 2016 sep;8(9):3024
Sharma P, Sharma S, Nariyal V. A clinical study to evaluate the efficacy of Snuhi Kshara and Dhatakyadi Tail Pichu in the management of Karnini Yonivyapadw. s.r to cervical erosion. Int Ayur Med J 2016; 4 (9): 2793-98.
Hussain SM. Herbal Unani Medicine all India; Unani Tibbi Conference New Delhi 53
Kabeeruddin M. Makhzanul Mufradat. New Delhi. Aijaz publication house: 2007.
Larson CO, Schlundt D, Patel K, Hargreaves M, Beard K. Validity of the SF-12 for use in a low-income African American community-based research initiative (REACH 2010). Prev Dis Public Health Res Pract Pol 2008; 5 2(2): 01-11.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareAccuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis
English4146Mohita RayEnglish Pranita MohantyEnglish Sunil AgarwalEnglish Debahuti MohapatraEnglishIntroduction: Frozen section (FS) is an intraoperative diagnostic tool which provides the operating surgeon with a rapid diagnosis, helping him to make a timely decision which may have a significant impact on patient management & prognosis. Hence the efficiency of this technique has to be periodically reviewed to ensure that the quality of the sections and agreement between frozen section diagnosis and final diagnosis remain at an acceptable level.
Objective: To assess accuracy, sensitivity & specificity of Intra-operative frozen section in the diagnosis of a lesion & in determining the adequacy of surgical resection margins in gastrointestinal surgeries.
Methods: Total 220 cases and 521 intra-operative FS specimen during gastro-intestinal surgeries were analysed. The samples were sent for intraoperative diagnosis and margin assessment. The initial FS report was then correlated with the final histopathology report and the concordance rate & reasons for discrepancies were analysed.
Results: After the correlation of all the specimen with final histopathology, the diagnosis was conclusive in 99.2 % (215 cases) & deferred in 0.8 %(5 cases). The cases with conclusive diagnoses showed a concordance rate of 91.1% for all cases and 95.9% for all specimens (excluding deferrals). Sensitivity and specificity of FS diagnosis as compared to histopathology was found to be 89.3% and 98.4% respectively.
Conclusion: The accuracy, sensitivity, specificity of frozen section diagnosis in this study are comparable with most international quality control statistics for frozen sections. Keeping the limitations and pitfalls in mind, FS technique is very reliable in good hands.
EnglishFrozen section, Intra-operative consultation, Concordance, HistopathologyINTRODUCTION
Tissue obtained after the operation is usually assessed by histopathologists on the following day after adequate formalin fixation of the specimen. However, during certain circumstances, the surgeons require the urgent pathologic information while the patient is still on the operative table, to take an intra-operative or peri-operative decision on the treatment. Hence, they request an intra-operative consultation on a tissue that arouses doubt. FS analysis as an intra-operative consultation is a powerful tool that can help guide surgical decision making by providing quick diagnosis, tissue recognition and extent of resection necessary. Thus it helps in the making of therapeutic decisions, thereby sparing the patient from possible re-operation and reducing the length and cost of hospitalization.1,2
Further, the decision to perform a radical surgery of lymph nodes is entirely dependent on the frozen section. Frozen section help in rapid diagnosis of the lesion and intra-operative histological evaluation of tumour resection borders. This is done without prolonging the surgery and thus acts as a guide to the surgeon in making a therapeutic decision, while the patient is still on the operating table.3-5
In cases where tumour-free margins have been achieved at the time of surgery, lower local tumour recurrence rates and improved survival have been reported.6-10 Intra-operative frozen section analysis of margins is widely employed to assist in complete tumour extirpation. Frozen section diagnosis of surgically resected tumours and tissues has become a regular practice over the past 60 years.11-13 Hence it is very essential to evaluate the quality & accuracy of FS reporting.
MATERIALS AND METHODS
The current study was carried out in the department of cytology & histopathology of IMS & SUM Hospital, Bhubaneswar over 3 years from 2014 to 2017. A prospective analysis of all the intraoperative frozen sections performed during gastrointestinal surgeries was done & a total of 220 cases very studied which yielded 521 specimens. Tissue was sent from the operation theatre in normal saline to the central cytology laboratory, where the sample-receiving time & gross findings were noted, and sections were taken. Blocks were cut on LEICA CM1860 cryostat. The slides were stained with haematoxylin and eosin (H & E) stain and studied. In cases of positive margins, results were informed to surgeon over the phone and revised margins were sent which were subsequently studied & yielded final FS report. The final results were informed to the operation theatre over the phone. Frozen tissue as well as any remaining non-frozen tissue were then fixed in 10% formalin solution & sent to histopathology lab to make paraffin embed sections & H&E stained slides.
The FS report given at the time of surgery was compared to the final histopathology report of the permanent sections & the accuracy rate, sensitivity and specificity of the frozen section reporting were determined in comparison to the routine histopathology reporting. Any discrepancy was noted and all cases which were discordant as regards the benign versus malignant, and negative versus positive margins were reviewed. The review process included the re-examination of all slides with the categorization of the reasons for discordance in three categories, i.e., Interpretative errors, sampling errors & technical errors. Patients of both sex, of age group 5-85 years undergoing gastro-intestinal surgery with informed consent were included in the study. Other sampling techniques like endoscopic biopsy, fine needle aspiration, brushings, lavage, peritoneal, pancreatic or bile fluid analysis were excluded.
The study design was approved by the Research Ethics Committee of IMS & SUM Hospital, Bhubaneswar. Any discrepancy was noted and all cases which were discordant as regards the benign versus malignant, and negative versus positive margins were reviewed.
RESULTS
Age distribution of cases showed that the maximum number of cases operated was around 60 years of age (mode = 60 years). Clustering of cases was seen from 35 years of age to 70 years of age. Age of the youngest patient was 11 years old female, with clinical diagnosis Mucoepidermoid Carcinoma, whose 3rd Dimensional margin was submitted for intraoperative frozen section, which was confirmed to be free of tumour. Age of the eldest patient was 84 years male, with a clinical diagnosis of Carcinoma left buccal mucosa, whose intraoperative frozen section biopsy was submitted to establish primary malignancy, & was subsequently diagnosed to have Pseudoepitheliomatous hyperplasia. FS was done mostly in male patients (70%). A maximum number of Gastrointestinal cases sent for Intraoperative frozen section consultation were sent with a clinical diagnosis of the malignant lesion (97.27 %). In the indication –wise distribution of the 220 cases, 111 cases (111 specimens) were sent to establish/ confirm a pathology/ primary malignancy, 90 cases (372 specimens) to determine the adequacy of resection margins & 19 cases (38 specimens) to establish/confirm metastatic malignancy. Hence, most of the cases were sent with the indication to establish/confirm a pathology/primary malignancy (50%).
There were total 71 cases diagnosed as malignant on final paraffin embed sections (including diagnoses of suspicious of malignancy) which comprised of 66.98 % of the final diagnoses of the cases sent with an indication to establish/ confirm primary pathology/malignancy. Squamous cell carcinoma (oral cavity) was the most commonly diagnosed malignant lesion (33 cases, 31.1%). Most of the specimen for Intraoperative FS were submitted for surgeries of the Oral cavity (51.14 %) followed by Stomach (17.80 %), large intestine(6.78%), gall bladder(5.23%) & periampullary region(3.87%) (Figure.1).
Overall % Concordance/ Accuracy of FS in Gastrointestinal surgeries was 95.9 %. The sensitivity and specificity of FS were found to be 89.3% (95% CI: 82.9, 93.9) and 98.4% (95% CI: 96.6, 99.4) respectively. Receiver operating curve (ROC) area was found to be 0.94 (95% CI: 0.67, 0.75) thus justifying that FS can be used as a diagnostic test against the gold standard for intra-operative samples collected during surgeries of the Gastro-intestinal tract. The positive predictive value and negative predictive value for FS in detecting any pathologies were found to be 95.4% (95% CI: 90.3, 98.3) and 96.1% (93.7, 97.8) respectively. The positive likelihood ratio (LR) of FS was found to be very strong and it was 56 (95% CI: 25.2, 124). The test has very strong likelihood ratio (>10) which means that sections which are positive with Histopathology are 81 times more likely to have positive result also with FS as compared to the sections with negative Histopathology results. The negative likelihood ratio of FS was found to be 0.109 (95% CI: 0.07, 0.18). The test result was strong (near to 0.1) which means that specimen found to be negative with Histopathology are 0.1 times likely to have a negative result also with FS as compared to the positive results with Histopathology. (Table. no. 1)
In the 106 cases submitted with an indication to Establish/confirm Primary pathology/malignancy (excluding deferred cases), the FS diagnoses showed high concordance (84.9 %) with the final Permanent section diagnoses. Figure No. 2, 3, 4 show images of FS & subsequent histopathology of the specimen with concordant diagnoses. In the 372 margins submitted for evaluation, the overall accuracy of FS was 99.7 % with a sensitivity of 95.24 % & specificity of 100 %. The overall accuracy of FS in establishing/ confirming metastatic malignancy was 93.3 % with a sensitivity of 100 % & specificity of 80 %. Figure No.5 shows a colonic serosal nodule diagnosed as metastatic adenocarcinomatous deposits on FS, which was confirmed on histopathology.23-25
There were 21 discordant diagnoses (19 cases) which comprised of 4.1% of all the conclusive frozen section diagnoses. Of these 19 discordant diagnoses, false-positive were 13 & false negative were 6. Of all discordant diagnoses, 10 were due to misinterpretation (52.63 %) & 9 were due to sampling error (47.37 %).
DISCUSSION
Majority of the cases where FS specimen were sent was for confirmation of diagnosis (around 50%), followed by margin assessment and lymph node metastasis (rest 50%) which is in line with other studies.11-14 Since the majority of the resection cases were neoplastic, there was the need to ensure that entire pathology has been removed. Complete awareness of the indications for FS should be there in the operating surgeon as well as pathologists to ensure that appropriate requests are attended to. Only then errors can be reduced.15,16,17 Oral cancer was among the most common form of GI cancers encountered, which is in line with epidemiology. (figure. 1)
Our study showed a concordance rate of 91.1% for all cases and 95.9% for all specimens (excluding deferrals). This was found to be in line with other studies. (Table 2) The concordance rate has always been more than 90%, with a usual range of 94% to 97%. Mishra S et al conducted the study comparing the accuracy of FS with Histopathology and found a concordance rate of 96.2%. 18,19 Studies conducted by Chbani et al., had an accuracy rate of 95%, while that of Geramizadeh B et al. had an accuracy of 96.7%. 15, 20 If the accuracy of GIT specimens is considered, it varied depending on the number of samples. Geramizadeh B ‘et al’ had an accuracy of only 75% for GIT specimens, as there were only 4 samples (Table 2).20,21
Sensitivity and specificity of FS diagnoses as compared to Histopathology was found to be 89.3% and 98.4% respectively. Thus, FS specimens were found to be highly specific and can limit the number of false negatives to a minimum. The study conducted by Patil P et al., had higher sensitivity of 97% as compared to our study while the specificity is almost the same (98.4%). 12 However, the study does not mention 95% CI levels, which could have probably overlapped with that of ours (95% CI for sensitivity for our study: 82.9, 93.9).
In our study, the overall accuracy of FS in margin assessment was very high of 99.7 % with a sensitivity of 95.24 % & specificity of 100 % which was comparable to the findings of DiNardo ‘et al’, who analysed FS margins in head and neck cancer surgeries & reported an accuracy, sensitivity & specificity of 98.3 %, 88.8% & 98.9% respectively.22,26
CONCLUSION
The accuracy, sensitivity and specificity of FS diagnosis as compared to Histopathology was found to be 95.9%, 89.3% and 98.4% respectively which are comparable with most international quality control statistics for frozen section
Receiver operating curve (ROC) area was found to be 0.94 (95% CI: 0.67, 0.75) thus justifying that FS can be used as a diagnostic test against histopathology for intra-operative samples collected during surgeries of the Gastro-intestinal tract.
As compared to other studies, our study could even throw light on likelihood ratios, predicting chances of a slide being positive or negative in FS depending on the results of Histopathology. LR+ and LR- overall was found to be 56 and 0.109, strongly indicating that FS can be a better diagnostic test as compared to Histopathology if other steps are taken to reduce discordance (through error reduction).
Keeping the limitations and pitfalls of FS in mind, it should be noted that the FS technique is very reliable in good hands.
ACKNOWLEDGMENT
The author acknowledges the help received from Professor and Head, Department of for her guidance. I am also thankful to my Guide for her kind co-operation & meticulous supervision of the work. I would like to give my special thanks to all the technicians of Histopathology & cytology Section, for helping me while conducting the present study. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed, discussed & cited.
Conflict of interest: None
Financial support: Nil
ABBREVIATIONS
FS- Frozen section
GIT- Gastrointestinal tract
CI- Confidence interval
Figure 1: This bar diagram shows that most of the specimen for Intraoperative FS were submitted for surgeries of the Oral cavity (51.14 %) followed by Stomach (17.80 %).
Figure 2: Adenocarcinoma, Stomach (signet ring cell type) A. FS from ulcerated growth in gastric fundus reported as Adenocarcinoma, Stomach. (H&E, x100). B. Permanent sections also showing features of Adenocarcinoma Stomach (Signet ring cell type) (H&E, x400). C. PAS +ve signet ring cells. (PAS, x400)
Figure 3: Adenocarcinoma Gall bladder. A. FS from Gall bladder showing features of Adenocarcinoma, Gall Bladder. (H&E, x100). B. Deeper sections from the corresponding permanent section showing Infiltrating Adenocarcinoma, Gall Bladder. (H&E, x100)
Figure 4: Tubular Adenoma, colon. A. FS from a case of Recurrent Carcinoma Colon with multiple polyp. showing features of Tubular Adenoma with High grade Dysplasia. (H&E, x100) B. Subsequent permanent sections from the same case showing features of Tubular Adenoma with High grade Dysplasia.
(H&E, x100)
Figure. No.5. Metastatic serosal nodule. A. FS from colonic serosal nodule showing features of Metastatic Adenocarcinomatous deposits. (H&E, x100). B. Permanent section of the same showing features of Metastatic Adenocarcinomatous deposits. (H&E, x100)
Englishhttp://ijcrr.com/abstract.php?article_id=3265http://ijcrr.com/article_html.php?did=3265
Howanitz PJ1, Hoffman GG, ZarboRJ.The accuracy of frozen-section diagnoses in 34 hospitals. Arch Pathol Lab Med 1990 Apr;114(4):355-9.
Kaufman Z, Lew S, Griffel B, Dinbar A. Frozen section diagnosis in surgical pathology- A prospective analysis of 526 frozen sections. Cancer 1986;57(2): 377–379.
Bahr W, Stoll P. Intraoperative histological evaluation of tumour resection borders without prolonging surgery. Int J Oral Maxillofac Surg 1992;21(2): 90–91
Ravasz LA, Slootweg PJ, Hordijk GJ, Smit F, van der Tweel I. The status of the resection margin as a prognostic factor in the treatment of head and neck carcinoma. J Crani- Maxillofac Surg 1991;19:314–318.
Jones AS, Bin Hanafi Z, Nadapalan V, Roland NJ, Kinsella A, Helliwell TR. Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery. Br J Cancer 1996;74(1):128–132.
Chen TY, Emrich LJ, Driscoll BA. The clinical significance of pathological findings in surgically resected margins of the primary tumour in head and neck carcinoma. Int J Radiat Oncol Biol Phys 1987;13:833–837.
Cook A, Jones AS, Phillips DE, Soler Lluch E. Complications of tumour in resection margins following surgical treatment of squamous cell carcinoma of the head and neck. Clin Otolaryngol 1993;18:37–41.
Looser KG, Shah JP, Strong EW. The significance of “positive” margins in surgically resected epidermoid carcinomas. Head Neck Surg 1978;1:107–111.
MacCarty WC, The diagnostic reliability of frozen sections. Am J Pathol 1929;5(4):377–380.5.
Peters PM. Frozen section diagnosis. Br Med J 1959;1(5133):1321–1322.
Tangled A, Shrivastava V, Joshi A. Analysis of frozen section in correlation with surgical pathology diagnosis. Int J Res Med Sci 2019;7:2312-7.
Patil P, Shukla S, Bhake A, Hiwale K. Accuracy of frozen section analysis in correlation with surgical pathology diagnosis. Int J Res Med Sci 2015;3:399-404.
Chatelain D, Schildknecht H, Trouillet N, Brasseur E, Darrac I, Regimbeau JM. Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections. J ChirurgieViscérale 2012; 149(2) :146-155.
Ahmad Z, Barakzai MA, Idrees R, Bhurgri Y. Correlation of intraoperative frozen section consultation with the final diagnosis at a referral centre in Karachi, Pakistan. Ind. J Pathol Micro 2008;51:469-73
Laila Chbani, Sekal Mohamed, Tawfik Harmouch; Quality assessment of intraoperative frozen sections: An analysis of 261 consecutive cases in a resource-limited area: Morocco. Sci Res Health 2012;4: 433-435
Valerie A. White; Intraoperative Consultation/Final Diagnosis Correlation Relationship to Tissue Type and Pathologic Process; Arch Pathol Lab Med 2008;132:29–36
McIntosh ER. Frozen section: guiding the hands of surgeons? Ann Diagn Pathol 2015; 2(4): 123-6.
HasnanJaafar, Intra-Operative Frozen Section Consultation: Concepts, Applications And Limitations, Malay. J Med Sci 2006;13(1): 4-12.
Saumya Mishra et al., Qualitative Comparative Study of Frozen Section with Routine Histological Technique; Nat J Lab Med. 2016.
Bita Geramizadeh, Taghi Rezai Larijani, Seyed-Mohammad Owji; Accuracy of intra-operative frozen section consultation in the south of Iran during four years; Ind J Path Micro 2010; 53(3): 414-417
Sams SB, Wisell JA. Discordance Between Intraoperative Consultation by Frozen Section and Final Diagnosis: A Classification Model to Guide Quality Improvement.; Int J Surg Pathol. 2016; 8: 341-345.
Di N. Frozen Section Margins in Head and Neck Cancer Surgery . Laryngoscope. 2000; 110:1773–1776.
Khoo JJ1.An audit of intraoperative frozen section in Johor.Med J Malaysia. 2004 Mar;59(1):50-5.
Ferreiro JA, Myers JL, Bostwick DG. Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Mayo Clin Proc 1995;70(12):1137-1141.
Khaled A, Agrawal L, Nasir TA; Correlation of Intra-Operative Frozen Section Consultation With the Final Diagnosis At a Tertiary Referral Center in Dhaka. Pulse 2011; 5(2): 22-25.
Rafael DenadaiPigozzi Da Silva1; Luís Ricardo MartinhãoSouto, Tcbc-Sp2; Graziela De Macedo Matsushita3; Marcus De Medeiros Matsushita3. Diagnostic accuracy of frozen section tests for surgical diseases. Rev Col Bras Circ 2011; 38(3): 149-154
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareThe Effect of Different Dental Implant Thread Designs on Stress Distribution on Bone - A Systematic Review
English4751Amit NandiEnglish Nilesh S BulbuleEnglish Shalu S MondalEnglish Akansha BhandariEnglish Prerna KulkarniEnglish Amit JagtapEnglishAlmost all earlier mechanical analysis of implants presumed bone as an isotropic material while the bone is anisotropic. Clinically, an implant never attains total contact with the adjacent bone. The study aims at examining the result of three implant thread designs on stress dissipation features on the bone. We aimed to assess the result of three implant thread design on stress dissipation on the bone. An online search was made for the articles using Google Scholar, Ebscohost and PubMed. Articles published in the English language or those articles that have a detailed summary in the English language were included. Articles published between 1st January 2010 and 31st October 2019 were selected. Scientific research papers, Randomized controlled trials were included with data on the result of varying implant thread designs on stress dissipation on the bone. Out of 1234 articles that were identified through electronic database searching. 18 articles were selected. These articles were screened for duplicates and 4 articles were obtained after eliminating the duplicates. None were excluded after the screening of the duplicate articles. This review provides an understanding of the effect of various abutment connections on the loosening of the screw. Out of all the studies evaluated, 2 studies stated that Square thread design showed the least stress distribution for all degree of osseointegration while 2 other studies showed V-shaped thread design with minimum stress design.
EnglishThread design, Implant, Stress distribution, Reverse buttress, Analysis, Implant-bone interface, Implant screw looseningIntroduction
Implants have become a vital option for the replacement of the missing teeth.1 The function of dental implants is to distribute the load to the adjacent anatomical structures. Therefore, the chief functional design objective is to transfer biomechanical loads to enhance the function of the implant-supported prosthesis.2 The thread geometry of implant is a major factor in the biomechanical properties of dental implants.3 Thread geometry may vary according to pitch, depth and shape.2,4 Even though stress distribution may be affected with different thread pitch and depth, the manufacturers more commonly provide implant systems with constant pitch and depth.5 So, a superior design of threads is required for commercial implant system.5
Thread designs improve primary contact, increase surface area and facilitates the distribution of the stresses at the bone and implant surface.6 The thread designs usually used in dental implants are square, v-threads and reverse buttress.2 The success of dental implants depends on several factors. Stress dissipation at the bone-implant interface is one of the main factors.7 Compressive stress of some amount is necessary to initiate osseointegration while excess stress results in implant failure in the form of bone resorption.8 More compressive load transfer is provided on the reduction of shear loading at the interface of thread and bone which is particularly a crucial factor in D3 and D4 bone situations.2
The current study is used to examine the result of three implant thread geometry on stress dissipation properties at adjacent anatomic structures. The main focus of this study is to determine an optimum basic thread design among three thread profiles i.e square, v-threads and reverse buttress.9
MATERIALS AND METHODS
Eligibility Criteria
Inclusion Criteria
Articles between 1St Jan 2009-31st Oct 2019
Articles in English language or the articles that can be translated into English
All full-text articles
In vitro studies
Randomized controlled trial
Exclusion Criteria
Articles that are in a language other than English.
Articles with full text not available.
Review articles.
Letters to editors
Case reports.
PICOS: Table 1 shows the required component and its description
INFORMATION SOURCES
PubMed, Ebsco and Google scholar were the three databases that were used to complete the findings for all full-text articles available. Lists of the cross-reference of the chosen articles were checked for papers that might meet the suitable criteria of the study. The search was done for studies published from 1St Jan 2010 to 31st Oct 2019.
Search Strategy
The comprehensive data search was done on PubMed, Ebsco and Google scholar. Articles published from 1st Jan 2010 to 31st Oct 2019 were included. Articles in the English language were selected. Filters for full text and study designs were not applied. The keywords used for searching articles in PubMed are given in table 2.
STUDY SELECTION
All articles were searched with the help of the above-mentioned search strategy. For screening of articles, initially, titles and abstracts were used to identify full articles concerning the result of varying implant thread geometry on the stress dissipation on the bone. After the articles were identified, duplicates from the respective searches were pulled out. In the final step, these articles were subjected to exclusion and inclusion criteria for the review.10
Data were extracted independently by the first author and the data extraction was confirmed by other review authors. The difference of any opinion between the reviewers was resolved with dialogue. After this, a data extraction sheet was prepared.
DATA COLLECTION PROCESS
Significant data from the selected articles were recorded for screw loosening depending on connection design. A standard pilot form in excel sheet was used. Data extraction was first done for one of the selected articles according to the form and was evaluated by an expert and finalized. Data extraction was then done for all the remaining articles.
DATA ITEMS
Selected articles were read thoroughly and the data was segregated under the following headings in an excel sheet.
1. Study ID – Serial number.
2. Author – Author name.
3. Publication Year – When the article was published.
4. Location – Where the study was conducted.
5. Comparison Groups –Different implant thread designs
6. Sample Size of implants – Number of implants tested.
7. Brand Of Implant
8. Method of Loading – the method used for loading of the implant
9. Outcome – Amount of stress distribution to the surrounding bone
10. Results - Which implant thread design distributes minimum stress to the surrounding bone
11. Remarks - Comments of the author
12. Other Observations
STUDY SELECTION
One review author(AN) screened independently the titles and abstracts obtained by search strategy and included them to check if they met the inclusion criteria. Later full texts of all the included studies were obtained. After obtaining the full texts of the articles they were screened after reading the whole article and then decided if they met the inclusion criteria. Whenever there was any doubt regarding any study if it was eligible for inclusion, the problem was resolved via discussion with the second author(NB). Ultimately, 3 studies were included in the systematic review. All the recorded articles had been recorded with reasoning for the exclusion of each study. None of the authors was blinded to the journal titles, study or the institutions where the study was conducted ( Figure 1).
706 Records were identified through the data search using search strategy in Pub Med while 528 articles were identified through Ebsco and other search engines. The second step was screening through the titles and after the screening, 1227 articles were excluded because they were not related to the objectives of the systematic review. Some articles mentioned studies done in vitro, some focused on osseointegration while the others did no study on stress distribution. 29 articles which remained were screened for duplicates manually. Out of 29 articles, 9 articles were found to be duplicates and hence remaining 11 articles were screened through abstracts as a next step. Finally, 4 articles were screened for full text. At the end, 4 studies remained which underwent qualitative synthesis ( Table 3).
RESULTS
Out of the 4 studies, 2 studies stated that Square thread design showed the least stress distribution for all degree of osseointegration while 2 other studies showed V-shaped thread design with minimum stress design.
Some studies don’t give a definite conclusion because of the smaller sample sizes, differences in implant system used for the study, variety of groups compared, and relevant articles being available in languages other than English. The stress distribution pattern was not affected by the different use of implant thread designs and various osseointegration conditions.
DISCUSSION
Several studies have been conducted to assess the result of varying implant thread designs on stress dissipation on bone This systematic review has been endeavoured to find the best available evidence to establish which implant thread design dissipates the least force on the surrounding bone. However, it is difficult to draw inference from the articles selected as they cannot be compared directly due to the diversity of eligibility criteria’s, assessment methods and outcomes. Seven papers were identified and included.12 The consequence of varying thread geometry of implant on stress dissipation in the peri-implant bone are observed. Four different implant thread designs were compared i.e buttress, reverse buttress, square and v-shaped through finite element analysis. In conclusion, square threads exhibited the most favourable outcome.9 Eraslan et al. (2009)10 evaluated the result of thread geometry on stress dissipation in an implant. Four different implant thread-form configurations were assembled with the adjacent structure of bone. Buttress, reverse buttress, V-thread and square thread designs were reproduced. 100N fixed axial occlusal load was put vertically over the surface of the abutment to determine the dissipation of stress. The von Mises stress values showed that highest stress applications were detected at the loading areas of the implant abutments as well as for all models at the cervical cortical bone region. The current investigation presents that the application of three dissimilar thread geometry did not influence the von Mises concentration at adjacent bone form. The compressive stress concentrations however varied by varying thread profiles.
Dhatrak et al. (2017)11 evaluated the Stress dissipation of implants around Implant-Bone Interface. Square, v thread and buttress thread profiles were used in the study. 300N of the static load was applied to the top of the abutment to figure out the shear stress around the implant and bone region. The maximum value of stress is found in the model containing the reverse buttress thread profile around the apical part of the implant while minimum value was detected in the implant with V thread profile at the critical region, and is proved as the most superior thread design amidst the rest two within greatest shear stress criteria.
Nam et al. (2015)12 investigated the Stress dissipation characteristics of four implant thread designs with the force of 100 N was applied onto the top of implant abutment at 30 degrees with the implant axis. To mimic different osseointegration stages at the implant/bone interfaces, a nonlinear contact condition was used to imitate immature osseointegration and a bonding condition for mature osseointegration states. He concluded that Stress dissipation characteristics of the V-shape thread were in the middle of the four threads in both the immature and mature stages of osseointegration. This systematic review was an attempt to find the best available evidence to determine which implant thread design distributes the least force on the surrounding bone. However, it is difficult to conclude the articles selected as they cannot be compared directly due to the diversity of eligibility criteria’s, assessment methods and outcomes
CONCLUSION
The implant thread geometry is a major factor in the biomechanical properties of dental implants as they improve primary contact, enhance surface area and aids in the distribution of stresses at the interface of bone-implant. Various studies have been conducted to compare the distribution of forces on the bone by the different implant thread designs. Some studies claimed square thread design as best while some claimed V-shaped. It is difficult to draw a conclusion relating to the eligibility criteria and as the studies don’t show a significant difference in the results obtained for comparison. The stress distribution pattern was not affected by the different usage of implant thread geometry and varying osseointegration conditions. More studies are required with a bigger sample size as it is difficult to conclude at this stage.
Studies with larger sample size and long term follow up; studies about all different kinds of thread designs in the same sample may be carried out to evaluate which amongst the different implant thread designs has the least value of stress on both cortical and cancellous bones.
ACKNOWLEDGEMENTS
I place on record, my heartfelt gratitude to the HOD and professors, Department of Prosthodontics and Crown & Bridge, for their constant help and encouragement. I also thank them for their expert, sincere and valuable guidance extended to us. I appreciate the immense help gained from the scholars whose articles are cited and included in references to this manuscript. I am also thankful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: Nil
Conflict of interest: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=3266http://ijcrr.com/article_html.php?did=3266
Kulkarni SP, Bulbule SN, Kakade MD, Hakepatil VN. Radiographic Stents and Surgical Stents in Implant Placements: An Overview. Int J Curr Res Rev 2019;11(12):11-15.
English C. Dental Implant Prosthetics Carl E. Misch Implant Dent 2005;14(1):11-12.
Brunski J. In Vivo Bone Response to Biomechanical Loading at the Bone/Dental-Implant Interface. Adv Dental Res 1999;13(1): 99-119.
Geng JP. A differential mathematical model to evaluate side-surface of an Archimede implant. Shanghai Shengwu Gongcheng Yixue 1995;50:19
Geng J, Ma Q, Xu W, Tan K, Liu G. Finite element analysis of four thread-form configurations in a stepped screw implant. J Oral Rehab 2004;31(3):233-239.
Ivanoff C, Grönhahl K, Sennerby L, Bergström C, Lekholm U. Influence of variations in implant diameters: a 3- to 5-year retrospective clinical report. Int J Oral Maxillofacial Impl 1999;14:173–180.
Van Oosterwyck H, Duyck J, Vander Sloten J, Van der Perre G, De Coomans M, Lieven S et al. The influence of bone mechanical properties and implant fixation upon bone loading around oral implants. Clin Oral Impl Res 1998;9(6):407-418.
Oswal M, Amasi U, Oswal M, Bhagat A. Influence of three different implant thread designs on stress distribution: A three-dimensional finite element analysis. J Indian Prosthodontic Soc 2016;16(4):359.
Mosavar A, Ziaei A, Kadkhodaei M. The Effect of Implant Thread Design on Stress Distribution in Anisotropic Bone with Different Osseointegration Conditions: A Finite Element Analysis. Int J Oral Maxillofac Impl 2015;30(6):1317-1326.
Eraslan O, ?nan Ö. The effect of thread design on stress distribution in a solid screw implant: a 3D finite element analysis. Clin. Oral Invest. 2009;14(4):411-416.
Hatrak P, Shirsat U, Sumanth S, Deshmukh V. Finite Element Analysis and Experimental Investigations on Stress Distribution of Dental Implants around Implant-Bone Interface. Materials Today: Proceedings 2018;5(2):5641-5648.
Nam O, Yu W, Kyung H. Stress dissipation characteristics of four implant thread designs evaluated by 3D finite element modeling. J Kor Acad Prosthodont 2015;53(2):120.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareTo Study the Effects of Viral Diseases on the Human Body and Their Effective Treatment
English5255Rahmanova Sanobar SabirovnaEnglishViruses are microorganisms that multiply only in living cells and cause infections in plants, animals, and humans. In the past, the term “virus” has been used to refer to various pathogens, especially unknown agents. After the French scientist, L. Pasteur proved the role of bacteria in the origin of several diseases, the concept of the virus began to be used as a synonym for the word “microbe”. When we test viruses in the laboratory, they break down at the expense of amino acids in the cytoplasm, and it needs several amino acids. When we look at a set of virus molecules under a microscope, they look like crystals or X-cells. It is believed that their reproduction can take place around them. When we studied viruses, we found that they spread in several different ways. Studies have shown that most viruses are spread by airborne droplets. One of the main principles of combating infectious diseases is early detection and prevention of the spread of the disease. This is a very complex job and largely depends on the experience and qualifications of the specialist. In addition to the traditional methods used in other areas, some special methods are used in the detection of infectious diseases.
EnglishBacteria, Living cells, Viruses, Ecology, Infectious diseases, Vaccines, Influenza, DiagnosticsIntroduction
The virus is widespread and causes a variety of serious diseases in humans, animals and plants. They are spread by a special distributor or mechanically. Most viruses do not lose their viability over the years but become infected as soon as they are exposed to the right conditions (living cells). Some viruses lose their properties in the external environment. Often, only one virus particle can cause a viral infection. For example, from a single poliovirus molecule, billions of viruses are formed in a matter of hours. Reproduction of the virus is associated with amino acids in the cytoplasm.1 The sum of millions of virus molecules is visible under a microscope in the form of crystals or X-cells. The pathogenesis of the disease is that it is relatively small compared to other pathogens and does not develop in a normal artificial nutrient medium. Except for a few bacteriophages, they are lab. has been shown to reproduce under All viruses that can be studied in the laboratory are "measured" more accurately by various physical methods. Their diameter is 10-300 microns. It can be in the form of a stick, a ball or a string. Many virus pathogens that cause disease in plants and animals are round in shape. Wheat and alfalfa mosaic The virus looks like a bacterial rod or an arrow. The structure of the virus has been identified by electron microscopy and X-rays. They all contain an inner substance, mainly nucleic acid, which is surrounded by a protein shell. The chemical composition of only a few species of the virus has been studied. The structure of vaccines virus is probably as complex as that of ordinary bacteria. It contains nucleoproteins, carbohydrates and lipids. Nucleic acid occurs in the form of deoxyribose, and the lipid group occurs in the form of cholesterol, phospholipids, and neutral fats. Phytopathogenic VIRUS contains ribonucleic acid (RNA), while pathogenic VIRUS contains RNA or DNA (deoxyribonucleic acid). Some VIRUS is obtained in the form of purified preparations, some of which form pure true crystals (eg, VIRUS of tobacco necrosis), while others form liquid crystals (e.g., tobacco mosaic VIRUS) or shale sediments. Ultracentrifuged to separate and purify VIRUS, various physicochemical methods are used.2,3
The classification of viruses and the symbols that represent them have not yet been adopted. They are given the same species and genus names as animals and plants, folk expressions, various abbreviations, are called by the genus name of the diseased organism, numbered next to it, or grouped into seeds and families according to VIRUS morphological, chemical, and reproductive properties. The Latin name for the VIRUS genus includes the word virus (eg, enterovirus), and the family name includes the word viridae (eg, Poxviridae).
The virus enters the body in various ways, for example, the virus can enter plant cells from the outside only when they are damaged. Influenza virus and others contain enzymes that break down the cell membrane. When a virus enters the body, a latent or latent period of infection begins. Many viruses accumulate in cells and form specific components within the cell (see Viral granullosis). Plants infected with Virus usually become a source of infection throughout their lives. virus ecological, biological and bacteria. has a strong variability under the influence of factors. the virus is common in nature and has many hosts. It is mainly spread by sucking insects, canals and nematodes. Some virus is transmitted by seeds, and almost all virus-infected plants are passed on to offspring when they are asexually propagated. The pathological effects of the virus are varied, mainly due to the disruption of protein and nuclein metabolism in the host organism due to their proliferation (see Viral diseases) which is studied by virology.
INFECTIOUS DISEASES
Infectious diseases are diseases caused by pathogenic microorganisms (bacteria, viruses, the simplest animals, etc.) that multiply in humans, animals and plants and have harmful effects. Some infectious diseases (eg, measles) are transmitted by walking close to a patient, to whom the term "infectious disease" refers. Some infectious diseases (eg, malaria) are not transmitted by close contact ("contact") with the patient, which means that the term "infectious disease" is less appropriate for them.
The main symptoms of infectious diseases are the presence in the patient's body of a specific microbe that causes the disease and the fact that the disease can be transmitted from person to person. The real causes of infectious diseases were discovered in the second half of the 19th century. Some diseases (plague, diarrhoea, paratyphoid, dysentery, and other intestinal infections) are transmitted through the digestive tract (through water and food that have been excreted by patients, or through unwashed hands that have been touched by these faeces). Influenza, whooping cough, mumps, diphtheria, measles, and other diseases are caused by airborne particles (droplet infections) that are released when a patient coughs, sneezes, or talks. enters. Some diseases are transmitted by blood-sucking insects (lice, mosquitoes, fleas, mites, scabies, etc.) (malaria, rash sweating, recurrent sweating, tick-borne encephalitis, scabies fever, etc.). When walking close to the patient or his towel, dishes, etc. Infectious diseases (venereal diseases, anthrax, scabies, etc.) are a separate group. Infectious diseases can last for several days (influenza, measles, scabies) or weeks (diarrhoea, rash, etc.) or last for months or even years (tuberculosis, leprosy, ulcers). The origin of infectious diseases depends on the number of pathogenic microbes entering the body, virulence, location, age, susceptibility to infection, as well as the external environment of the microbe (in unfavourable conditions, the virulence of the microbe decreases). Social conditions (housing, diet, culture, health care) play a crucial role in the emergence and spread of infectious diseases. Depending on the interaction of these conditions, different forms of infectious diseases (typical - true, mild, etc.) appear. Infectious diseases differ in the incubation period, the period of onset and exacerbation of symptoms, the period of disease exacerbation, the period of extinction and the period of recovery. Each of the infectious diseases has the characteristics of these periods. Some infectious diseases, such as diarrhoea, cause the microbe to remain in the affected organism and be released into the environment. Immunity remains after many infectious diseases. For example, the diagnosis of infectious diseases is based on clinical signs of the disease, the results of laboratory tests and epidemiological data. Patients are treated in specially equipped infectious disease hospitals. Prevention plays a crucial role in the fight against infectious diseases.
CHARACTERISTICS OF INFECTIOUS DISEASES
To prevent the spread of infectious diseases, patients with or suspected of having such diseases are isolated in a hospital or at home. Tone (plague), plague (cholera), rash sweating (rash typhoid), diarrhoea (typhoid fever), paratyphoid, dysentery, viral hepatitis, diphtheria, etc. persons diagnosed or suspected of having the disease must be transported to the hospital in a special ambulance. Influenza, measles, pertussis, etc. In some cases, patients with infectious diseases can be isolated at home, provided they are kept in a separate room, provided with proper care and disinfection.
In sanatoriums, rest homes, children's health facilities, kindergartens and nurseries, as well as in hospitals for therapy, surgery, paediatrics, etc. (except for the infectious department) is equipped with an insulator. In particular, people who are close to patients with dangerous infections (plague, plague) should be isolated for a period equal to the incubation period of those diseases. In other infectious diseases, patients are isolated at different times
Infectious diseases have their characteristics. They include:
1. All infectious diseases can be transmitted from a patient or a carrier of bacteria to healthy people around. The probability of transmission of the disease to others depends on the type and course of the disease.
2. Infectious diseases Each disease is characterized by a specific type of pathogenic microbe. For example, diphtheria is caused by the diphtheria bacillus, measles is caused by the measles virus, and plague is caused by the plague (when the plague does not cause diphtheria or vice versa).
3. There is a certain periodicity in the course of infectious diseases. Once the pathogen enters the human body, there are no symptoms for some time. It is called the latent (incubation) period of infectious disease. The duration of this period varies in different diseases. For example, a few hours to 2 days in the flu, 2-3 weeks in diarrhoea, and so on. The next period is the period when the symptoms of the disease appear. It reveals both the general symptoms of the disease and the specific clinical symptoms of each disease. These symptoms first appear (prodromal period), develop and peak, and after a certain period go away and disappear. As the symptoms of the disease begin to subside, the patient begins to feel more normal. This marks the beginning of a period of convalescence. It often ends with a period of healing. In some cases, the disease may worsen during this period.
In infectious diseases, "complete recovery" means not only the complete cessation of symptoms but also bacteriological healing. Because when the patient is completely cured of the disease, the release of pathogenic microbes from his body must also stop. The fact that pathogenic microbes are not detected 2-3 times in the analysis (ointment or implants) performed after the formation of the patient indicates bacteriological recovery. In some diseases, such as diarrhoea or paratyphoid, pathogenic microbes are released from the body even after the patient has recovered. It is called the post-disease bacterial carrier condition. If this condition lasts for up to 3 months, it is an acute bacterial carrier, and if it lasts more than 3 months, it is a chronic bacterial carrier.
4. After infectious diseases, the patient's body develops stagnant immunity to the germs of this disease. It is an acquired immunity and the ability to defend is maintained for various periods. For example, post-influenza immunity lasts up to 3 years against this type of virus. The immunity that develops after measles and diarrhoea lasts a lifetime and a person does not get sick with these diseases again. In recent years, scientific studies have shown that immunity formed after infectious diseases largely depends on the genetic or phenotypic characteristics of the diseased organism.
5. Common infectious diseases can be prevented through vaccination. The goal of vaccinating children against several infectious diseases is to prevent them. These include vaccines against diphtheria, pertussis, measles, and polio.
In some cases, the human body is indifferent to disease germs. The immune response to the microbe does not develop. There will be no symptoms of the disease. The microbe, on the other hand, is located in a known and average organ and can only be detected by laboratory tests. For example, diphtheria bacilli or meningococci may be present in a person’s throat for some time, but may not have symptoms of the disease. This condition is called bacterial overdose. In humans, the pathogen is found only once, and if the disease is not observed, it is considered to be a transient bacterium.
In some stages of infectious disease, germs that enter the body can also enter the bloodstream. This condition is called bacteremia. In some diseases, the patient takes venous blood from the vein to look for germs, that is, to use it in diagnostics. For example, bacteremia occurs in typhoid fever. Therefore, to make a diagnosis, among other tests, blood is taken from the wrist and injected into the bile fluid. Later, the disease microbe can be found in it.
Perspective
Although infectious diseases are caused by pathogenic bacteria, viruses, and simple single-celled organisms, their occurrence cannot be considered solely as a result of the microbe’s fight against the organism. The outbreak is a complex social biological process that depends on the interaction of the microbe with the macroorganism. When a pathogenic bacterium enters, the human body undergoes pathological changes, adaptation and defence processes, i.e. the development of an infectious disease. Once a pathogenic microbe enters the body, the disease does not have to develop. The relationship between a pathogenic microbe and the human body can be different, depending on the virulence of the microbe on the one hand and the susceptibility and reactivity of the human body to the disease on the other hand.3-5
Infectious diseases differ from other diseases by the following 4 features:
1. Infectious disease is caused by a live pathogenic microbe.
2. The patient in turn becomes the source of the disease and can spread it to others.
3. Whichever infectious disease a patient suffers from, his body develops immunity against that disease and resists the re-transmission of that disease.
4. Infectious diseases develop and disappear with certain periods, i.e. cyclically.
The pathogenic microbe tries to protect itself from any opposing forces, under small conditions it begins to multiply rapidly, adapts to phagocytes (forms a capsule, produces substances such as aggression, atifagin, virulinka). the ability of a microorganism to overcome its protective mechanisms and show its harmful effects is its virulence.6,7
Epidemiology is the study of the laws of the emergence, spread, and spread of infectious diseases and the development of measures to combat them. The term epidemiology is derived from the Latin epi-many, Demas-population, meaning the spread of disease within a population. Depending on the number of people infected with the infectious disease, there are different types of epidemiological processes.
1. Sporadic diseases. People with the disease are rare.
2. An epidemic is the spread of an infectious disease in any country, province or country.
3 A pandemic is the simultaneous spread of an infectious disease (eg, cholera, influenza) on an international scale, ie in several countries and continents.
4. Endemicity - the constant occurrence of any infectious disease in a particular area.
5. Enzootia - the constant occurrence of an infectious disease (eg, plague, leishmaniasis) among animals living somewhere (for example, rodents)
6. Epizootics - the spread of any infectious disease among animals.
7. Exotic diseases - infectious diseases imported from abroad.4,6,7
Infectious diseases are divided into two groups depending on the source of infection: 1. Anthropozoonoses - these diseases occur only in humans and do not infect animals (typhoid, diarrhoea, hepatitis, AIDS). Zoonoses - these diseases are in animals and humans occurs. Infection in humans is transmitted from animals (brucellosis, plague, rabies, anthrax)
Conclusion
It is less difficult to diagnose during an infectious disease outbreak. During this period, the specific clinical symptoms of each disease are clearly expressed. In addition to the patient's life history, the history of the disease is also inquired. Whenever possible, determine when and with what symptoms the disease has started. In the following days, they are asked what symptoms were added to them and how the initial symptoms developed. The patient himself may not know what is worth noting in the anamnesis for the medical professional. Therefore, it is necessary to get the necessary information from him through questions. In particular, it is important to know when the body temperature has risen, how many degrees it has reached, and at what time of the day it is most pronounced. Headaches, sleep disturbances are not only common symptoms but also specific to some infectious diseases. It is even important to know where the head hurts. Information such as the appearance of rashes on the body, their appearance, in what order they rash, how long they persist, also helps to determine the true nature of the disease. In the diagnosis of intestinal infections, information such as abdominal pain, where it is most often felt, nausea, vomiting, diarrhoea, recurrence of these symptoms make it easier to diagnose.
Conflict of interest: none
Financial support: None
Englishhttp://ijcrr.com/abstract.php?article_id=3267http://ijcrr.com/article_html.php?did=3267
Kubanova AA, Martynov AA, Pirogova EV. Questions of Informatization in dermatovenerology. Collection of abstracts of the 10th anniversary scientific and practical conference of young scientists. Clin Expt Med 2010; 3:18-19.
Martynov AA, Pirogova EV. Telecommunication technologies in the process of providing specialized dermatovenerological care.Theses of the XIII International Congress of the interregional public organization.Society for pharmacoeconomic research. Justice Quality Economy Clin Pharmac Pharma 2010; 5:34
Morozova EV, Cartagena OB. medico-organizational measures to improve medical care on the profile of dermatovenereology in the Samara region. Mod Prob Sci Edu 2016;5:231.
Pirogova EV, Martynov AA. the current state of information infrastructure of specialized dermatovenerological institutions of the Russian Federation. Top Iss Health Org Dev 2011;136-145.
Ju Y, Yang MS. Asthma Simulation Team Experience Using Hybrid Modeling. Int J Cur Res Rev 2020;12(19):10.
Kurz H, Riedler J. An increase in allergic diseases in childhood--current hypotheses and possible prevention. Wiener medizinische Wochenschrift (1946). 2003;153(3-4):50-8.
Lapik SV, Zhmurov VA. Clinico-biochemical effectiveness of emoxpine in patients with bacterial bronchial asthma. Terapevticheskii arkhiv. 1998;70(11):72-4.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareGender Difference in Ocular Pressures Among Prehypertensive Individuals
English5658Vinitha K REnglish Sudha B SreenivasEnglishBackground: Raised intraocular pressure (IOP) and reduced ocular perfusion pressure (OPP) are significant risk factors for glaucoma. It is important to study the factors which affect IOP and OPP, to prevent the development of glaucoma. Some of the factors include age, gender, systemic blood pressure, obesity etc. Though few studies have demonstrated the gender difference in IOP in normotensive individuals as well as in glaucoma patients, the results are inconsistent. It has also been proved that hypertension is more prevalent in males. Hence the present study was taken up to explore the gender difference in IOP levels among individuals with prehypertension, a predictor of hypertension in future.
Objective: To compare and evaluate the IOP and OPP values among males and females with prehypertension.
Methods: 100 voluntary participants with prehypertension (systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 80–89 mmHg) were recruited from the ophthalmology clinic in Mysuru in the age group of 20 - 50 years. They were categorised into two groups based on their gender. Written informed consent was taken. IOP and blood pressure were recorded using rebound tonometer and sphygmomanometer respectively. Results: Males had a significantly higher IOP in both the eyes when compared to their female counterparts. There was no difference in their OPP values.
Conclusion: Since elevated IOP is seen in males than females, IOP could be a leading indicator for early diagnosis of glaucoma in males.
EnglishIntra Ocular Pressure, Ocular Perfusion Pressure, PrehypertensionIntroduction
Glaucoma is one of the commonest causes of irreversible blindness globally. Asia alone accounts for almost 60% of the world's total glaucoma cases.1 India is estimated to become the second in the world with its increasing number of glaucoma cases.2 Of the numerous risk factors attributed to glaucoma, ocular pressures such as Intra Ocular Pressure (IOP) and ocular perfusion pressure (OPP) are significant. IOP is the only proven treatable risk factor for glaucoma. Even in the absence of glaucoma, raised IOP is considered to be a cause of optic nerve damage.3 Hence it is essential to study the factors affecting IOP thus facilitating the prevention and early detection of glaucoma. Some of these factors include age, gender, race, ethnicity, genetic inheritance, systemic blood pressure, body mass index etc.4,5 Gender dissimilarity in general health exists in the literature but studies representing gender difference in IOP is not adequate.6,7
OPP is determined by IOP and blood pressure (BP). A positive correlation between BP and IOP was observed in hypertensive individuals.7 Prehypertension, which is a warning sign for hypertension, is defined as above-optimal systolic and diastolic blood pressure of 120–139 or 80–89 mmHg respectively. It includes elevated hypertension and stage I hypertension.8,9 Since prehypertension remains asymptomatic, its mechanical and vascular effects on ocular tissues is complex and poorly understood. Raised IOP levels were noted in prehypertensive individuals as well.10 It has been observed that young adult males have higher levels of blood pressure when compared to the females of same age group.11
Though few studies have demonstrated the gender difference in IOP in normotensive individuals as well as in glaucoma patients these results are inconsistent.12,13 Also, there is a lack of literature related to the gender difference in ocular pressures among prehypertensive -non-glaucomatous subjects. Hence the present study was taken up to compare and evaluate the IOP and OPP values among males and females with prehypertension.
Material and methods
100 voluntary participants with prehypertension (systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 80–89 mmHg) were recruited from the ophthalmology clinic in Mysuru in the age group of 20 - 50 years after screening for BP. They were categorised into two groups based on their gender. Subjects with conjunctivitis, h/o hypertension and diabetes mellitus, h/o smoking and alcohol consumption were excluded. Institutional ethical clearance was obtained for this cross-sectional study (IEC letter no. JSS/MC/IEC/18/1957/2015-16). After explaining the details of the procedure, informed written consent was taken. Subjects were asked to rest for 15min following which basal IOP and BP were recorded in sitting position using SW-500 rebound tonometer (Tianjin Suowei Electronic Technology Co., Ltd, Tianjin, China) and Sphygmomanometer respectively. All the recordings were done between 11 am and 1 pm to reduce the effects of diurnal variations on IOP.14
Mean arterial pressure (MAP) and Mean ocular perfusion pressure (MOPP) was calculated using the following formulas:
MAP = Diastolic BP +1/3 (Systolic BP- Diastolic BP)
MOPP = (2/3) MAP - IOP.14
Statistical Analysis
Data collected were entered in MS excel 2010 and analysed using SPSS version 23. Descriptive statistical measures like percentage, arithmetic mean and standard deviation were applied. Inferential statistical tests like independent unpaired t-test were applied. Normality of all the variables was checked before applying the statistical tests. P-value Englishhttp://ijcrr.com/abstract.php?article_id=3268http://ijcrr.com/article_html.php?did=32681. Chan EW, Li X, Tham Y, Liao J, Wong TY, Aung T et al. Glaucoma in Asia: regional prevalence variations and future projections. Br J Ophthalmol 2016;100:78-85.
2. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90(3):262–267.
3. Yassin SA, Al-Tamimi ER. Age, gender and refractive error association with intraocular pressure in healthy Saudi participants: A cross-sectional study. Saudi J Ophthalmol. 2016;30(1):44–48.
4. Ejimadu CS, Chinawa NE, Fiebai B. Age and Gender-Related Changes in Intraocular Pressure among Patients Attending a Peripheral Eye Clinic in Port Harcourt, Nigeria. Austin J Clin Ophthalmol 2018;5(2):1092.
5. McMonnies CW. Glaucoma history and risk factors. J Optom 2017;10(2):71–8.
6. Azodo CC, Unamatokpa B. Gender difference in oral health perception and practices among Medical House Officers. Russian Open Med 2012;1:0208.
7. Farnaz M, Mei YL, Stanley PA, Varma R, Los Angeles Latino Eye Study Group. Associations with intraocular pressure in Latinos: The Los Angeles Latino Eye Study. Am J Ophthalmol 2008;146:69-76.
8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 2003;42:1206 –52.
9. Whelton PK, Carey R, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Col Cardiol 2018; 71:19.
10. Sreenivas SB, Vinitha KR, Kulkarni P. A comparative study of intraocular pressure and ocular perfusion pressure changes in prehypertensive individuals. Nat J Physiol Pharm Pharmacol 2018;8(10):1396-99.
11. Everett B, Zajacova A. Gender Differences in Hypertension and Hypertension Awareness Among Young Adults. Biodemography Soc Biol 2015;61(1):1–17.
12. Baisakhiya S, Singh S, Manjhi P. Correlation between Age, Gender, Waist-Hip Ratio and Intra Ocular Pressure in Adult North Indian Population. J Clin Diagn Res 2016;10(12):CC05-08.
13. Osaiyuwu AB, Edokpa GD, Egharevba R. Gender difference in intraocular pressure among patients with primary open-angle glaucoma in Benin City, Nigeria. International J Curr Res Life Sci 2018;7(06):2341-43.
14. Robert NW, James DB, David GH, Felipe M. Intraocular pressure Consensus, series 4. Netherlands: Kugler publications;2007.
15. Lee JS, Choi YR, Lee JE, Choi HY, Lee SH, Oum BS. Relationship between intraocular pressure and systemic health parameters in a Korean population. Korean J Ophthalmology. 2002;16:13-19.
16. Shiose Y. Intraocular pressure new perspectives. Surv Ophthalmol 1990;34(6):413-35.
17. Jeelani M, Taklikar RH, Taklikar A, Itagi V, Bennal AS. Variation of intraocular pressure with age and gender. Nat J Physiol Pharm Pharmacol. 2014;4:57-60.
18. Hashemi H, Kashi AH, Fotouhi A, Mohammad K. Distribution of intraocular pressure in healthy Iranian individuals: the Tehran Eye Study. Br J Ophthalmol 2005;89(6):652-7.
19. Memarzadeh F, Ying-Lai M, Chung J, Azen SP, Varma R. Blood pressure, perfusion pressure, and open-angle glaucoma: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2010;51:2872–77.
20. Hoehn R, Mirshahi A, Hoffmann EM. Distribution of intraocular pressure and its association with ocular features and cardiovascular risk factors: The Gutenberg Health Study. Ophthalmology 2013;120:961–8.
21. Patel P, Harris A, Toris C, Tobe L, Lang M, Belamkar A, et al. Effects of Sex Hormones on Ocular Blood Flow and Intraocular Pressure in Primary Open-angle Glaucoma: A Review. J Glaucoma 2018;27(12):1037?41.
22. Gupta PD, Johar K, Sr Nagpal K, Vasavada AR. Sex hormone receptors in the human eye. Surv Ophthalmol 2005;50:274–84.
23. Nasta AM, Raghuwanshi SR, Churiwala JJ. Study of hypertension in youth and its contributory factors - across-sectional study of 600 subjects. Int J Curr Res Rev 2015;7(11):44-9.
24. Ergasheva Z, Sherzodbek B, Jurabaev B, Turgunov M, Akhmatokhunova M.Study of Cardiovascular Risk Prediction in Patients with Type 2 Diabetes with Arterial Hypertension after Combined Hypotensive Therapy of Enalapril with Moxonidine. Int J Curr Res Rev 2020;12(16):139-144.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareChildhood Urinary Tract Infection: Prevalence and Resistance Pattern of Uropathogens in a Tertiary Care Hospital
English5962Suren Kumar DasEnglish Purabi BaralEnglish Swati JainEnglish Rajashree PanigrahyEnglishBackground: Urinary tract infection is one of the most common bacterial infections encountered by paediatricians. Currently, the diagnosis and management of acute urinary tract infection and recurrent urinary tract infection in children remains controversial. Prompt diagnosis and initiation of treatment are important in preventing long-term renal scarring. However, increasing antibiotic resistance may delay the initiation of appropriate therapy. Antibiotic prophylaxis remains controversial.
Objective: To identify the bacterial pathogens involved in pediatric UTI and study their antibiogram patterns.
Methods: A total of 1492 urine samples of pediatric patients (0-14 years), clinically suspected of UTI, were processed in the Department of Microbiology for 3 years. Urine samples were collected in a sterile container and processed by inoculating on cysteine lactose electrolyte deficient agar (CLED). Antibiogram was performed by disc diffusion method as per CLSI guidelines. Gram-negative isolates were studies for expended spectrum β-lactamase (ESBL) production and S. aureus isolates were screened for methicillin-resistant S. aureus (MRSA).
Results: Out of 1492 samples, 876 (58.7%) were found to be culture positive. Gram-negative bacteria (80.4%) comprised the maximum number of isolates. E. coli (60.7%) was the most frequently isolated uropathogen, followed by K. pneumoniae (13.2%) and S. aureus (11.2%). Twenty-one per cent of E. coli and 17.4% of K. pneumoniae were ESBL producers. Among S. aureus, 32.6% were MRSA.
Conclusion: High-level antimicrobial resistance was observed in pediatric UTI. We should adopt antimicrobial use based on local epidemiological data which helps in maximizing clinical outcome.
EnglishE. Coli, ESBL, MRSA, Pediatric UTIINTRODUCTION
Urinary tract infection (UTI) is one of the leading cause of febrile illness and hospital admission in the pediatric population.1 The global prevalence of pediatric UTI is approximately 2-20%2 and up to 7% of girls and 2% of boys experience at least 1 episode of UTI before the age of 6.3 It is more common in boys (3.7%) than in girls (2%) in the first year of life4 and thereafter, it has been reported to be more prevalent in girls except for uncircumcised boys younger than age 5.5 Pediatric UTI most often presents with non-specific signs and symptoms due to which it remains under-diagnosed in many cases.6 Part of the challenge in diagnosing is because of children having difficulty expressing their symptoms7 Vesicoureteric reflux (VUR) is the most common predisposing factor for UTI in children which further leads to complications like chronic pyelonephritis and eventual renal scarring, hypertension and chronic renal failure. So, UTI itself may be the sentinel event for underlying renal abnormality.8 Hence, timely diagnosis and treatment may prevent renal damage. Currently, the American Academy of Pediatrics (AAP) recommends that UTI be considered in any infant or child between two months and two years of age presenting with fever without an identifiable source of infection.9 Older children may present with the classic symptoms of UTI, i.e., dysuria, frequency, abdominal or flank pain and fever.7 Escherichia coli, by far the most common uropathogen, is also the commonest in pediatric UTIs. Other offending pathogens include Klebsiella spp., Proteus spp., Pseudomonas aeruginosa and Enterococcus spp.10 There is a growing concern about antimicrobial resistance worldwide. Availability of scanty data of the resistance pattern of pediatric uropathogens in Eastern India prompted us to take the present study. The present study aimed to identify the bacterial pathogens involved in pediatric UTI and study their antibiogram patterns.
MATERIALS AND METHODS
This cross-sectional study was conducted in the Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, for a period of 3 years (March 2017- March 2020). A total of 1492 non-repetitive urine specimens of pediatric patients (0-14 years), clinically suspected of UTI were included in the study.
Sample collection
Urine samples were obtained by mid-stream clean catch in older children or children who were toilet trained. Nappy pad method was used for neonates, infants and toddlers. The pad was inserted into the nappy then removed as soon as the child urinated to reduce the risk of contamination. Once the nappy pad was removed, the urine was extracted with a syringe into a sterile container.11 In catheterized children, urine specimen was collected either through the catheter collection port or through puncture of the tubing with a sterile needle.12 The sample was then transported to the laboratory.
Sample processing in the laboratory
The urine samples were processed by semi-quantitative streaking method using a calibrated 1µl inoculating loop holding 0.001 ml of urine onto cysteine lactose electrolyte deficient agar (CLED). The inoculated plates were incubated at 37? for 24-48 hrs at ambient air. The isolates were identified using standard microbiological methods like colony morphology, gram stain and a set of biochemical tests. Antibacterial susceptibility test (ABST) was performed using the Kirby-Bauer disc diffusion method on Mueller Hinton agar (MHA) as per clinical laboratory standards institute (CLSI) guidelines.13
Gram-negative isolates if found resistant to third-generation cephalosporins on ABST were considered as potential extended-spectrum β-lactamases (ESBL) producers and confirmed by the combined disc test method. In this method, the suspected isolate was tested against ceftazidime alone and ceftazidime + clavulanic acid combination disc. Isolate showing the increase in the zone of inhibition of ≥ 5mm of the combination disc in comparison to that of ceftazidime alone was considered as ESBL producer.
All S. aureus isolates were screened for methicillin-resistant Staphylococcus aureus (MRSA) by using cefoxitin disc. Isolate showing a zone size of ≤ 22 mm was considered as MRSA.
Laboratory analysis
Positive urine culture was defined as ≥ 103 colonies forming unit (CFU)/ml for suprapubic specimen, ≥ 104 CFU/ml for catheterized specimen and ≥ 105 CFU/ml for clean catch specimen.
RESULTS
A total of 1492 non-repetitive urine samples were obtained from children with suspected UTI during the study period (March 2017- March 2020).
Among 1492 children, 813 (54.5%) were girls and 679 (45.5%) were boys. The maximum number of cases belonged to children of 0-5 years (638/1492, 42.8%) age group. (Table 1)
Out of 1492 children with suspected UTI, 876 (58.7%) were found to be culture-positive yielding significant bacteriuria. Gram-negative bacteria (80.4%) was more frequently isolated than Gram-positive bacteria (17.5%). Candida was recovered in 2.1% of the isolates. E. coli was the most common uropathogen isolated followed by K. pneumoniae. (Table 2)
Antimicrobial susceptibility test showed variable degree of resistance. Majority of E. coli isolates were most susceptible towards netilmicin (94.4%), amikacin (88.1%) and minocycline (77%) and least susceptible towards norfloxacin (12.6%), cotrimoxazole (21.2%) and cefixime (21.6%) as shown in graph 1. Out of 532 isolates of E. coli, 112 (21%) were ESBL producers (Figure 1).
Isolates of K. pneumoniae were most susceptible towards ceftazidime-clavulanic acid (57.4%), minocycline (54.8%) and meropenem (51.3%) and least susceptible towards amoxiclav (14.8%), cefixime (22.6%) and imipenem-cilastatin (23.5%) as shown in Graph 2. Twenty isolates (17.4%) of K. pneumoniae were ESBL producers.
Isolates of S. aureus were most susceptible towards linezolid and vancomycin (100% each) and least susceptible towards clarithromycin (10.2%), cefixime (22.4%) and moxifloxacin (27.5%) as shown in graph 3. Thirty-two (32.6%) isolates of S. aureus were MRSA.
DISCUSSION
UTI is a common health problem and an important cause of morbidity and mortality in children. In the present study, 58.7% of the total samples were positive for UTI. In contrast, studies done by Badhan et al14 and Gupta et al4 in India showed a lower culture positivity (26.7 and 35.4% respectively) whereas global estimates of pediatric UTI are much lower, i.e., 7.87% in Iran15 and 9% in the USA.16
The most common organism associated with pediatric UTI in this study was E. coli (60.7%) with K. pneumoniae being the second most common uropathogen, which is in concordance with many other studies.4,14,17 Irrespective of age, sex, community or country, E. coli is the most common uropathogen. Although Gram-negative bacteria comprise the majority of UTI cases, Gram-positive organisms have become an important cause in recent years. In this study, 11.2% of UTI cases were due to S. aureus, which was also the third most common organism isolated. This finding is consistent with other studies.18,19
In this study, we have found decreased susceptibility of uropathogens towards nitrofurantoin, cephalosporins, fluoroquinolones and carbapenems and better efficacy of aminoglycosides in vitro. Only 49.6% of E. coli were susceptible to nitrofurantoin, 21.2% to cotrimoxazole, 21.6% to cefixime and 12.6% to norfloxacin. This is the most alarming finding of our study pointing towards the prevalence of multidrug-resistant organisms (MDROs) in the pediatric population. Also, 21% of E. coli and 17.4% of K. pneumoniae were ESBL producers. Similar results were reported by Baral et al19 and Parajuli et al.20 Pediatric UTI with ESBL producing organisms pose a threat in treatment by limiting therapeutic choices.
Among Gram-positive organisms, 32.6% of S. aureus were MRSA; 22.4% were susceptible to cefixime, 27.5% to moxifloxacin and 10.2% to clarithromycin but showed fair susceptibility towards cephalosporin combination with a beta-lactamase inhibitor. Similar findings were reported by Gupta et al 4 and Looney et al.21 Previous hospitalization, long-term broad-spectrum antimicrobial therapy, co-morbidity, frequent instrumentation, catheterized patients might explain the higher antimicrobial resistance.
CONCLUSION
E. coli continues to be the predominant uropathogen causing UTI in children. MDROs, ESBL and MRSA are on the rise in the pediatric population. Also, this study highlights the better efficacy of aminoglycosides in vitro in comparison to other commonly used classes of drugs. We should adopt antimicrobial use based on local epidemiological data which helps in maximizing clinical outcome.
Acknowledgement –Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.
Conflict of interest – Nil
Source of funding - Nil
Englishhttp://ijcrr.com/abstract.php?article_id=3269http://ijcrr.com/article_html.php?did=3269
Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008;27:302-8.
Downing H, Thomas-Jones E, Gal M, Waldron CA, Sterne J, Hollingworth W, et al. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis 2012;12:158.
Mårild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 1998;87:549-52.
Gupta P, Mandal J, Krishnamurthy S, Barathi D, Pandit N. Profile of urinary tract infections in pediatric patients. Indian J Med Res 2015;141:473-7.
Dahiya A, Goldman RD. Management of asymptomatic bacteriuria in children. Canadian Fam Physic 2018;64:821-3.
Desai DJ, Gilbert B, McBride CA. Paediatric urinary tract infections: diagnosis and treatment. Aust Fam Physic 2016;45:558-63.
Bitsori M, Galanakis E. Pediatric urinary tract infections: diagnosis and treatment. Expert Rev Anti Infect Ther 2012;10:1153-64.
Aggarwal V K, Ferrier V, Jones K. Vesicoureteric reflux: screening of first degree relatives. Arch Dis Child 1989;64:1538-41.
Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Paediatrics 2011;128:595-610.
Marcus N, Ashkenazi S, Yaari A, et al. Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary centre. Pediatr Infect Dis J 2005;24:581-5.
Liaw LC, Nayar DM, Pedler SJ, Coulthard MG. Home collection of urine for culture from infants by three methods: survey of parents’ preferences and bacterial contamination rates. BMJ 2000;320:1312-3
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625-63.
CLSI. Performance standards for antimicrobial susceptibility testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017
Badhan R, Singh DV, Badhan LR, Kaur A. Evaluation of bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infection: a prospective study from a tertiary care centre. Indian J Urol 2016;32:50-6.
Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Paediatrics 2005;116:644-8.
Mirsoleymani SR, Salimi M, Shareghi Brojeni M, Ranjbar M, Mehtarpoor M. Bacterial pathogens and antimicrobial resistance patterns in pediatric urinary tract infections: a four-year surveillance study. Int J Pediatr 2014;6.
Singh SD, Madhup SK. Clinical profile and antibiotics sensitivity in childhood urinary tract infection at Dhulikhel hospital. Kathmandu Univ Med J (KUMJ). 2013;11:319-24.
Kaur N, Sharma S, Malhotra S, Madan P, Hans C. Urinary tract infection: aetiology and antimicrobial resistance pattern in infants from a tertiary care hospital in northern India. J Clin Diagn Res 2014;8:DC01-3.
Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC Res Notes 2012;5:38.
Parajuli NP, Maharjan P, Parajuli H, Joshi G, Paudel D, Sayami S, et al. High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal. Antim. Resist Infect Control 2017;6:9.
Looney AT, Redmond EJ, Davey NM, Daly PJ, Troy C, Carey BF, et al. Methicillin-resistant Staphylococcus aureus as a uropathogen in an Irish setting. Med J 2017;96(14):e4635.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareProspective Evaluation of Factors Affecting the Outcome in Cirrhotic Patients Requiring Intensive Care
English6367Rohit N. MaidurEnglish Sukanya BEnglish Raghavendra YEnglish Ajitkumar SEnglishIntroduction: The short-term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic and extrahepatic organ dysfunction.
Objective: This study intends to find the parameters that influence the outcome in cirrhotics requiring critical care.
Methods: This was a single-centre, prospective, observational study. Prognostic scores were calculated on the day of admission and day 7. The appearance of new events and length of hospital stay was documented. Follow up was done at day 30 in person or by telephone for those who had left the hospital.
Results: Out of 96 subjects 12 were lost to follow up, 84 subjects followed of which 55 expired within 30 days of admission. On multivariate analysis older age, presence of Malena, oliguria, presence of infective foci, hepatic encephalopathy, low platelet count and pH, high lactate, creatinine, bilirubin, serum ferritin were predictors of mortality. Mean serum ferritin levels were significantly higher (pEnglishCirrhosis, MELD, CLIF- SOFA, Serum FerritinIntroduction
Patients with advanced liver cirrhosis frequently require admission to the intensive care unit as they have a poor prognosis, with mortality rates ranging from 36% to 86%.1-3 The short-term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic insufficiency and by dysfunction of extrahepatic organ systems. Sepsis is the presence of cirrhosis is associated with poor prognosis; mortality rates increase with the increasing number of failing organs.5,6 Among the extrahepatic organ failures often encountered in end-stage liver disease, renal failure or dysfunction in cirrhotic patients has been the subject of extensive investigation7. Stratifying patients help differentiate those who could achieve a better outcome with aggressive treatment from those who would not benefit from admission to the intensive care unit.8
The Child-Turcott score and its subsequent modifications by Pugh are old empirical methods used to assess the degree of liver failure in candidate patients for Portosystemic shunt.9 The discriminatory power of this score relative to mortality in cirrhotic patients admitted to the ICU is inferior to that of general ICU scores like Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation (APACHE)( 10). Model for End-Stage Liver Disease (MELD) score, initially developed for cirrhotic patients treated with Transjugular Intrahepatic Portosystemic Shunt (TIPS), has been applied widely to predict mortality across a broad spectrum of liver diseases (11). MELD score has its limitations one such is its inaccuracy in predicting survival in 15–20% critically ill patients.12
A modification of SOFA, the Chronic Liver Failure-SOFA (CLIF-SOFA) score, has been proposed for patients with cirrhosis hospitalized for acute decompensation.13-15 Cirrhotic patients with other organ dysfunction showed increased mortality, increasing with the number of organs affected,14 reaching 90% in patients with three or more organ dysfunctions. Based on reliable prognostic factors, interventions like liver assist devices or plasmapheresis can be initiated for critically ill cirrhotics. Whenever patients with cirrhosis are critically ill the question of utility and/or futility of placing them in ICU arise, especially in resource-constrained settings.16,17 This is a challenging situation and needs good scoring systems which can predict the utility of ICU. The present study is intended to find the parameters that influence the outcome in cirrhotics requiring critical care so that available resources can be put to best use.
Materials and methods
The study was a single-centre, prospective, observational study conducted between January 2015 and January 2016 at Department of Medical Gastroenterology, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad after obtaining approval from Institutional Ethics Committee. Consecutive patients of liver cirrhosis requiring intensive care were recruited. The primary endpoint was a reassessment of scores at day 7 and mortality up to day 30.
Inclusion Criteria:
Consecutive patients more than 18 years of age with liver cirrhosis of any aetiology requiring intensive care were recruited.
Exclusion Criteria
Acute liver failure
Post-liver transplantation
HIV infection
Established case of hepatocellular carcinoma
Presence of severe comorbidities in the form of cerebrovascular accident, chronic kidney disease, severe cardiopulmonary insufficiency, ischemic heart disease, chronic obstructive pulmonary disease.
Post - hepatobiliary surgery
Procedure
The diagnosis of cirrhosis was based on clinical, radiological and laboratory parameters. History, physical examination, haematological and biochemical parameters, and imaging studies were done. Patient demographics and an indication of ICU admission were noted. Presence of co-morbid disease was documented. Prognostic scores were calculated on the day of admission and day 7. The appearance of new events and complications during the hospital course was noted. Length of ICU and hospital stay were documented. Standard of care was provided to all patients. Follow up was done at day 30 in person or by telephone for those discharged.
Results
Total of 96 patients was enrolled, 12 were lost to follow up. 84 patients (M/F: 77/7 completed the study. Alcohol was the most common aetiology (76.1%) followed by Hepatitis B (8.3%), Hepatitis C (4.7%) and alcohol with viral hepatitis (10.7%). 55 patients expired within 30 days of admission. Mean age amongst survivors was significantly lower than non-survivors (45 ± 9.32) vs. (50±8.067) (p Englishhttp://ijcrr.com/abstract.php?article_id=3270http://ijcrr.com/article_html.php?did=3270
Ruiz-del-Arbol L, Monescillo A, Arocena C, Valer P, Gines P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology (Baltimore, Md) 2005;42(2):439-47.
Aggarwal A, Ong JP, Younossi ZM, Nelson DR, Hoffman-Hogg L, Arroliga AC. Predictors of mortality and resource utilization in cirrhotic patients admitted to the medical ICU. Chest 2001;119(5):1489-9.
Chen YC, Tsai MH, Ho YP, Hsu CW, Lin HH, Fang JT, et al. Comparison of the severity of illness scoring systems for critically ill cirrhotic patients with renal failure. Clin Nephrol 2004 Feb;61(2):111-8.
Wehler M, Kokoska J, Reulbach U, Hahn EG, Strauss R. Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems. Hepatology (Baltimore, Md) 2001;34(2):255-61.
O'Brien AJ, Welch CA, Singer M, Harrison DA. Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients. Inten Care Med 2012 Jun;38(6):991-1000.
Arvaniti V, D'Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139(4):1246-56.
Cárdenas A, Ginès P, Uriz J, Bessa X, Salmerón JM, Mas A, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology 2001;34(4, Part 1):671-6.
Feltracco P, Brezzi M, Barbieri S, Milevoj M, Galligioni H, Cillo U, et al. Intensive care unit admission of decompensated cirrhotic patients: prognostic scoring systems. Transpl Proceedings 2011;43(4):1079-84.
Cholongitas E, Senzolo M, Patch D, Shaw S, Hui C, Burroughs AK. Review article: scoring systems for assessing prognosis in critically ill adult cirrhotics. Aliment Pharmacol Therap 2006;24(3):453-64.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology (Baltimore, Md) 2000;31(4):864-71.
Singal AK, Kamath PS. Model for End-stage Liver Disease. J Clin Exp Hepatol 2013;3(1):50-60.
Cholongitas E, Betrosian A, Senzolo M, Shaw S, Patch D, Manousou P, et al. Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission. J Gastroenterol Hepatol 2008;23(8pt1):1223-7.
Austin MJ, Shawcross DL. Outcome of patients with cirrhosis admitted to intensive care. Curr Opin Crit Care 2008;14(2):202-7.
Iliass Charif, Kaoutar Saada, Ihssane Mellouki, Mounia El Yousfi, D.Benajah, Mohamed El Abkari, et al. Predictors of Intra-Hospital Mortality in patients with Cirrhosis. J Gastroenterol 2014;4:141-148.
Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G, et al. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut 2005;54(5):718-25.
Viasus D, Garcia-Vidal C, Castellote J, Adamuz J, Verdaguer R, Dorca J, et al. Community-acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine 2011;90(2):110-8.
Alsherif A, Darwesh H, Badr M, Eldamarawy M, Shawky A, Emam A. SOFA Score as a Predictor of Mortality in Critically Ill Cirrhotic Patients. Life Sci J 2013;10(2).
Hamza RE, Villyoth MP, Peter G, Joseph D, Govindaraju C, Tank DC, et al. Risk factors of cellulitis in cirrhosis and antibiotic prophylaxis in preventing recurrence. Anna Gastroenterol 2014;2:28.
Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014;60(6):1310-24.
Maiwall R, Kumar S, Chaudhary AK, Maras J, Wani Z, Kumar C, et al. Serum ferritin predicts early mortality in patients with decompensated cirrhosis. J Hepatol 2014 Jul;61(1):43-50.
Zauner CA, Apsner RC, Kranz A, Kramer L, Madl C, Schneider B, et al. Outcome prediction for patients with cirrhosis of the liver in a medical ICU: a comparison of the APACHE scores and liver-specific scoring systems. Inten Care Med 1996;22:559-56.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction scores: a reliable descriptor of a complex
clinical outcome. Crit Care Med 1995;23:1638-1652.
Oikonomou T, Goulis I, Soulaidopoulos S, Karasmani A, Doumtsis P, Tsioni K, et al. High serum ferritin is associated with a worse outcome of patients with decompensated cirrhosis. Ann Gastroenterol 2017; 30:217-224.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcarePhysical Therapy Approach to Analyze Job and Ergonomic Risk Factor Among Petrol Pump Workers
English6869K Jothi PrasannaEnglish Nithinkumar S.English Dilip B.EnglishIntroduction: Based on existing knowledge and theory of the biomechanics and epidemiology of distal and upper extremity disorders, a semi-quantitative job analysis methodology was developed. The petrol pump workers who have the repetitive activity of upper limb by holding and keeping the nozzle at the petrol pump station. This repetitive activity increases the tension on the muscles, ligaments, and other soft tissues of the musculoskeletal system. This activity is carried out in standing posture.
Objective: The purpose of the present study is to know the prevalence of upper limb deformity in petrol pump workers.
Methods: Samples were assessed using Rapid Upper Limb Assessment (RULA) tool.
Results: 60% of the population were found to be under medium risk, 14%of the population had a higher risk of developing a deformity and 26% had negligible or at low risk.
Conclusion: Proper ergonomic care must be undertaken in the high-risk category and appropriate ergonomic advice should be given to the workers to prevent them from becoming vulnerable to upper limb deformities.
EnglishPetrol pump workers, Upperlimb disorder, Musculoskeletal disorderINTRODUCTION
Human factors and ergonomics are concerned with the “fit” between the user, equipment and environment or “fitting a job to a person”. Musculoskeletal disorders are the injuries that affect the human body’s movement or musculoskeletal system (muscle, tendon, ligament, nerve, discs, blood vessel).1,2 Poorly designed workplace promotes reduced efficiency and productivity as well.
The improper posture of upper extremity while working can cause excessive stress on the arm, forearm and wrist. The risk factors include working with arms above shoulder level and other awkward postures such as trunk flexed laterally, hand-arm vibrations, repetitive movements, pushing and pulling and carrying loads supported by the shoulder.3 All over India nearly 55,000 retail outlets of petrol bunks are working and have 15 lakhs employees, directly and indirectly, involved in this industry. As they are exposed to repetitive activities of upper extremity the purpose of this study is to address and to find out the prevalence of upper limb musculoskeletal disorder among petrol pump workers.
MATERIAL AND METHODS:
The subjects were chosen based on inclusion and exclusion criteria and a consent form was given to the participants. The entire method was explained to the subjects before the beginning of the assessment and demographic data was collected. Subjects were selected from various work cycles according to longer work period and higher workload. Around 100 samples were assessed using Rapid Upper Limb Assessment (RULA) tool at petrol pump stations in and around Chennai. RULASCALE is used to evaluate the exposure of workers to ergonomic risk factors associated with upper extremity musculoskeletal disorder which analyses body posture, force and repetition of job task then the scoring was evaluated.4 The output of the RULA assessment tool is the final RULA Score, which is a single score that represents the level of MSD risk for the job task being evaluated. The minimum RULA Score = 1, and the maximum RULA Score = 7 indicating the level of MSD risk.
RESULTS AND DISCUSSION
Results were analyzed by using IBM SPSS version22 software. 100 petrol pump workers were included in this study based on inclusion and exclusion criteria. This study showed that 60% of the subjects have a medium risk where the investigation is needed, 14% of them have very high risk and 26% have a low and negligible risk of upper limb musculoskeletal disorder. So the purpose of the present study is to know the prevalence of upper limb musculoskeletal disorder. Hiejin Noh et al (2013) on dentists used Strain index(SI) to measure the strain of muscles in wrist and arm in comparison to that our study did the assessment using Rapid Upper Limb Assessment (RULA) which measures the biomechanical and postural load on the whole upper limb.4 As of now, various researches have been done on the musculoskeletal disorder about industry and office work in which studies have only focused on shoulder pain and cardiovascular problem among petrol pump workers, hence this study focuses only upper limb musculoskeletal disorder. The objective of our study was to assess the personal and occupational factors for the onset of upper extremity disorder. After the completion of our study ergonomic advice as well as proper posture, the technique was taught to the workers to prevent the occurrence of further disorders.5 This study is done to evaluate the exposure of petrol pump workers to ergonomic risk factors associated with upper limb musculoskeletal disorders and thereby creating awareness among the petrol pump workers so that they can reduce the risk of the musculoskeletal disorder by opting the correct posture.
CONCLUSION
Musculoskeletal disorders play a major in inhibiting factors among the petrol pump workers. 60% of the subjects fell under the medium risk after the assessment was done which proves that if further measures are not taken, their condition will further deteriorate. So this study concludes that with proper ergonomic advice the medium risk population can be changed to low-risk population.
Conflict of interest there is no conflict of interest financial disclosure for the study.
Ethical Approval At the beginning of the study, the subjects were informed in detail regarding the study and their verbal and written consents to participate were obtained. The funding source had no role in any stage of the study.
Englishhttp://ijcrr.com/abstract.php?article_id=3271http://ijcrr.com/article_html.php?did=3271[1] Afroz ZS, Swati AB, Shilpa A. Prevalence of shoulder pain in petrol pump workers. J Appl Adv Res 2017; 2(3): 106–110.
[2] Devananda R, Narayana GD. The Health status of personnel, working in petrol bunks: A medico-sociological study. Int J Humanities and Soc. Sci. Res. 2016; 4(6) 191-5.
[3] Bongers PM. The cost of shoulder pain at work. BMJ 2001 Jan 13;322(7278):64-65.
[4] Noh H, Roh H. Approach of Industrial Physical Therapy to Assessment of the Musculoskeletal System and Ergonomic Risk Factors of the Dental Hygienist. J Phys Ther Sci 2013 Jul;25(7):821-6.
[5] Stevenmoore J, Arun G. The strain index: A proposed method to analyze jobs for risk of distal upper extremity disorder. J Appl Adv Res 2017;7(2): 192-6.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareFeatures of Renal Function in Women with Complicated Preeclampsia
English7074Akhmedov F.K.English Negmatullaeva M.N.English Tuksanova D.I.EnglishIntroduction: Study of features of renal function, some indicators homeostasis in women with mild preeclampsia. We have studied 50 women with physiological pregnancy, 100 pregnant women with mild PE (II group) in gestational age 30-34 weeks. The results of the data, it should be emphasized that among the numerous violations of various functions of the body of pregnant women with mild preeclampsia. The most prominent is hypovolemia due to preferential reduction of plasma volume, hypoproteinemia due to proteinuria and reduced renal perfusion parameters with the deterioration of their functional capacity.
Objective: The study of the features of the functional state of the kidneys, some indicators of homeostasis in women during pregnancy complicated by preeclampsia.
Method: We studied 50 women with physiological pregnancy, 100 pregnant women with mild PE (group I), 50 pregnant women with severe PE (group II) at a gestational age of 30-34 weeks. Clinical and laboratory studies were used, including general analysis of blood and urine, fibrinogen, time blood according to Sukharev, a study of the amount of protein in the blood, counting the amount of protein in daily urine and functional methods for assessing the condition of pregnant women.
Result: Assessing the results obtained, it can be indicated that pregnant women with severe preeclampsia have a greater tendency to hypernatremia than pregnant women with mild preeclampsia, which significantly exceeds the concentration of sodium in the plasma of healthy pregnant women. Changes from other electrolytes are not significant.
Conclusion: All this indicates that such a contingent of pregnant women poses a great danger in terms of the occurrence of various complications during pregnancy, childbirth and the postpartum period.
EnglishKidney, Renal hemodynamic, Homeostasis, Renal plasmaIntroduction
Preeclampsia is one of the most common and serious complications in the world of obstetrics, and in recent years a large number of scientific studies have focused on the possibility of preventing this pathology and identifying high-risk groups complicated by preeclampsia. According to the World Health Organization (WHO), preeclampsia is observed in developed countries in 5-15%, and in developing countries - 30-35%. Hypertension in pregnant women in different regions of our country is 15-25%. Preeclampsia is one of the main causes of maternal and perinatal death and remains one of the most acute problems of modern medicine.1-3
Preeclampsia is one of the main problems in the world leading to pathologies leading to complications during pregnancy. PE is an important interdisciplinary problem and occupies a leading position among pathologies that complicate the course of pregnancy.4,5 The relevance of studying PE is explained by the high prevalence of this complication, an adverse effect on the course of pregnancy, as well as a risk factor for the mother to develop arterial hypertension, chronic kidney diseases, endocrine disorders, and fatal cardiovascular complications.4-6
Nevertheless, based on an analysis of recent scientific studies in several countries (Norway, Ireland, Scotland, Israel), a total of 800,000 pregnancies showed a twofold increase in the risk of death in patients who underwent preeclampsia, especially in preterm birth.2,7 Studying the features of renal and systemic hemodynamic during “critical periods of pregnancy” during physiological pregnancy and with the development of PE will reveal early diagnostic signs of hypertension that has joined pregnancy.7,8
The debatability of several aspects of aetiology and pathogenesis, the heterogeneity and inconsistency of the listed risk factors for PE development, as well as the use of an exclusively anamnestic approach in identifying risk groups for the development of this complication in early pregnancy, emphasizes the need for an in-depth analysis of this problem.1,2,9,10
Materials and methods
Laboratory diagnostics included biochemical studies of renal function and determination of coagulation factors. Evaluation of the excretory function of the kidneys is important both from a clinical and a research point of view. It is known that an increase in serum creatinine, a decrease in creatinine clearance or the estimated glomerular filtration rate (GFR), microalbuminuria are independent prognostic factors of cardiovascular diseases and, in particular, hypertensive syndrome. Accurate direct measurement of GFR is methodologically difficult, therefore, until recently, elevated plasma creatinine levels and special formulas have been widely used in clinical practice. Moreover, their use is not only possible but also does not imply a significant increase in the cost of evaluating kidney function with a definite increase in the accuracy of the study.2-4
Cockcroft-Goult Formula (Cockcroft-Goult, FCG),
GFR={140- age× body mass/ serum creatinine (mg /dl)×72}×0.85
The study of the renal plasma flow was carried out after a water load (1liter of water drunk for one hour before the study). After the eve of the test, iodine was slowly (3–5 minutes) injected with 3 ml of 70% triombrost solution. It was established that such a dose of triombrast creates its concentration in the blood within 1-4 mg% for 40-60 minutes or more. Women urinated 10 minutes after the end of the introduction of triombrast, and from that time they collected urine for three 15-20 minute intervals by natural urination. In the middle of these gaps, blood was drawn from a vein to determine the concentration of triombrast in it. The study of blood and urinary triombrost was performed by the iodometric method of White, Rolf, using the formula:
DM= Ic/ Pk× V
Where DM is the coefficient of blood purification from triombrost; Ic - the concentration of triombrast in the urine; Pk is the concentration of triombrast in plasma; V - minute diuresis. The calculation of diabetes was carried out for each 15-20-minute period separately. The final result was the numbers of 2-3 periods of the study.
To calculate a renal blood flow was calculated for whole blood based on hematocrit indices using the formula:
Effective renal blood flow (RBF) = renal plasma flow (RPF)/ 1-? (Hematocrit)
The determination of KF and PP allowed us to calculate the filtration fraction (FF) - the volume of liquid that the plasma gives out during the filtration:
FF(Filtration fraction)= Glomerular filtration rate (GFR) / renal plasma flow (RPF)
Statistical processing of the results was carried out using Student's test using the Statgraf software package and Microsoft Excel version for Windows.
Results and discussion
A comprehensive study of the functional state of the kidneys and indicators of homeostasis in women during pregnancy with complicated preeclampsia in the period 30 to 34 weeks was carried out.
Many women in this group have a burdened obstetric history (bleeding, placenta previa and placental abruption, intrauterine hypoxia of the fetus, cesarean section).
Pay attention: pallor of the skin, swelling of the lower extremities, abdominal wall and lumbar region. Table No. 1 reflects the indicators of a clinical study of blood and urine in pregnant women of this group, where, for greater clarity, identical indicators of the control group are given (Table 1).
The table shows that for pregnant women with hypoproteinemia, proteinuria, a decrease in daily diuresis by almost 44.3% relative to healthy women at the same stages of pregnancy.
The table shows that women with mild PE are characterized by hypoproteinemia and severe proteinuria. Their total protein content in the blood is 14.4% lower than in the control group. A decrease in the volume of daily diuresis by 25.5% was also characteristic, relative to that in women with a normal pregnancy with an increase in the night fraction and a slight decrease in the fluctuation in the relative density of urine. Proteinuria increased by almost 18%.
A study of the functional state of the kidneys showed that during pregnancy with severe preeclampsia, GF decreases to 1.047 ± 0.048 ml/s, which is 0.704 ml/s (34.2%), (PEnglishhttp://ijcrr.com/abstract.php?article_id=3272http://ijcrr.com/article_html.php?did=32721. Vasiliev V, Tyagunova AV, Drozheva VV. Renal function and indicators of endogenous intoxication with gestosis. Obstet Gynaec 2013; 4:16-20.
2. Ivanova OI; Ponomareva MG; Gazazyan ZL. Features of central hemodynamics during pregnancy complicated by gestosis. J Obstet Female Dis 2008;7(3)4-9.
3. Alper AB, Yi Y, Weber LS.Estimation of glomerular filtration rate in preeclamptic patients. Am J Perinatol 2007;24:569.
4. Alieva TM, Abdukarimov TA. Preeclampsia factors, prerequisites, climatogeographic features. News Dermatol Reprod Health 2016; 4;50-54.
5. Akhmedov F.K. Features of renal function and some indicators of homeostasis in women with mild preeclampsia. Eur Sci Rev 2015;4(5):58-60.
6. Akhmedov FK, Avakov VE, Negmatullaeva MN. Status of cardio-hemodynamics and cardiac geomerms in women with complications with severe preeclampsia. News Dermatol Reprod Health Tashkent 2017;3(I):27-29.
7. Buchbinder A, Sibai ?, Caritis S. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynec 2002; 186(1):66-71.
8. Nishanova FP, Mustafayeva ME. Maternal mortality from preeclampsia in the Republic of Uzbekistan. Physician Bull 2009; 2:78-81.
9. Guryeva MV, Yu B, Kotov VA. Daily monitoring of blood pressure and heart rate in the diagnosis. Russ Bull Obstet Gynec 2013;3: 4-9.
10. Makarova OV, Nikolaev NN, Volkova EV. Features of central hemodynamics in pregnant women with arterial hypertension. Obstet Gynec 2003; 4:18-22 .
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareEffect of Mindful Outdoor Walking on Attention Among Independent Rural Elderly
English7579S. AnandhEnglish G. VaradharajuluEnglish Mahendra M. AlateEnglish Dhiraj Mane PatilEnglishIntroduction: Mindful walking in other words called “conscious walking “ technique which has been observed from Afghan nomads who travelled kilometres on foot quickly and effectively. This Afghan walking is a special kind of trekking called “holistic march”, the art of walking with one’s conscience. It includes a form of yoga that consciously absorbs energy from the air, synchronizing the steps with breathing pattern.
Objective: The study aims to find the influence of mindful outdoor walking on attention on independent rural elderly.
Methods: 192 subjects randomly selected into two groups (undergoing Normal & Mindful walking) were included for the study. Inclusion criteria: All independent elderly above 65yearsof both genders / Independent despite clinical diagnosis as Diabetes Mellitus, Hypertension, etc. / Post-surgical conditions like PTCS and CABG / medically stable cases excluding Medically unstable cases / Chronic illness & Life-threatening medical issue / Uncooperative, Psychiatric elderly patients / Amputation, Poliomyelitis / Hearing and vision deficit.
Results: State Mindfulness Scale for Physical activity (SMS - PA). The intervention is of 8 weeks period with regular 30 minutes of walking sessions in the morning for 6 times per week including a10 minutes warm-up sessions / and cool down the procedure for 10 minutes. Using relevant statistical measures the outcome measure had been analyzed. It was observed that the elderly had improved significantly on both state mindfulness of the mind and body of Group B who had undergone Mindful walking. It is so important for physiotherapists to be aware of these strategies and incorporate them into the management of fall prevention among the elderly.
Conclusion: The study concludes that it will have beneficial effects on the elderly individual’s instrumental activities of daily living. The study aims at formulating a self-reliant approach to the elderly and train themselves to their threshold levels of exercise capacity.
EnglishElderly, Mindfulness, Meditation, Attention, Outdoor walking, Geriatric Walking ProgramINTRODUCTION
An ageing population is a universal phenomenon experienced by all countries in the world. The global geriatric population > 60 years age group was 962 million in the year 2017 and is said to be doubled by year 2050.1 Frailty in the simplest definition is increasing vulnerability to adverse health outcomes. Several studies have already been undertaken on age-related cognitive decline in the elderly. Meditation has shown highly positive results from/of mental and physical aspects of meditators.2 Socio-demographic factors & Health status are the two categories influencing frailty. The appropriate Physical activity which, is mandatory without risk of specific utilizing efficient body mechanics, is walking. The safest mobility component is walking, which is conferred to great benefit as a modifiable factor of frailty prevention. More literature supports the favourable effects of mindfulness meditation while walking and other simple tasks on the cognitive function of the elderly.3,4 Quality attentiveness from physiotherapists towards framing the best possible physical activity is essential concerning the elderly population.
Mindful walking, in other words, called “conscious walking" technique that has been observed from Afghan nomads who travelled kilometers on foot quickly and effectively. It is a special kind of trekking called “holistic march”, the art of walking with one's conscience. It’s a form of yoga that consciously absorbs energy from the air, synchronizing the steps with breathing pattern.5-8 The first study in 2010, conducted by Li et al.6 Investigate that the psychological effects of a green environment would also have an impact on physiological outcomes. The authors concluded that walking in forest environments significantly increased human immune function among the participants of the study. In the follow-up study, the authors concluded that walking in a forest area compared to walking in an urban environment significantly reduced blood pressure. In the present study we aimed to study the influence of mindful outdoor walking on attention and Gait speed among independent rural elderly,to study the influence of normal outdoor walking on attention and gait speed among independent rural elderly and compare the influence of mindful walking versus normal outdoor walking on attention & gait speed among independent rural elderly.
MATERIALS AND METHODS
The study design is a Clinical demonstration project, in other words, Quality improvement project which is an Interventional study completed in a year conducted with a sample size of 192 elderly subjects using a random sampling method. Randomization with a 1:1 ratio was assigned to the elderly veterans' groups. The random assignment set was developed with SAS 9.2 application. The participants were collectively allotted, by an unbiased research nurse, after the signature of the notified permission form as well as completion of the sample evaluation questionnaires to the control and intervention groups.
Statistical Analysis
The analysis was intended to identify a 2-point differential variance between the intervention as well as the control groups with an intensity of 90%, which involves the drop-out rate of roughly 20%, of the main result component of the State Mindfulness scale for Physical activity (SMS – PA).
Outcome Measures
State Mindfulness scale of Physical activity (SMS - PA) with two components namely State mindfulness of the mind with a total score - 24 & State mindfulness of the body with a total score - 24.
Gait speed: 4-meter gait speed test.
Intervention Procedure
To promote an active lifestyle in older Veterans at rural Maharashtra, we developed an outpatient mindfulness intervention to promote physical activity in older Veterans. This intervention was modelled as a Geriatric Walking Program (GWP). The program was also comprehended at maintaining a specific focus to improve components of frailty and to engage older Veterans in a long-term program of regular physical activity primarily in the easiest form of walking.
We used proven strategies, such as motivational counselling, follow-up phone calls from a physiotherapist, and self-monitoring. Here we report short-term results of this program from the 8 - week follow-up with regular 20 minutes of the walking session in the morning outdoors on muddy track of 6 times per week including a 10-minute warm-up session and cool down the procedure for 10 minutes.
Further, the participating mindful walking intervention patients were motivated and instructed to continue the exercise by themselves' post 4-week research program.
Inclusion Criteria
All functionally independent elderly, above the age of 65-80 years including both genders with normal vitals were included in the study; Retired senior citizens restricted to their residence most of the time; No history of fall for the past 12 months; Ability to walk 20m without human assistance; Ability to speak/read/communicate. All elderly participants were screened for additional medical contraindications using Screening for You (EASY) criteria.
Exclusion Criteria
Medically unstable patients and Patients with Pacemaker; Chronic illness & Life-threatening medical issues; All types of disabilities including severe musculoskeletal pathology, neurological conditions, vestibular dysfunction that would affect participation; Uncooperative and Psychiatric elderly patients; Participants scored less below 23 on the MMSE; Subjects who are doing part-time work, Farm work or any other regular work are restricted from the study.
RESULTS
The outcomes of the statistical analysis of the study are given below in tabulated form (Table 1 to Table 7) with their relevant interpretations.
Table No: 01 - Scoring of State mindfulness of the Mind concerning daily experiences using State Mindfulness Scale for Physical Activity (SMS - PA): Pre - Post-test scores of Group - A (Normal Walking).
Interpretation: The Post Test scores of State mindfulness of the Mind have reduced which shows that the attention is improved significantly with reduced thoughts.
Table No: 02 - Scoring of State mindfulness of the Body concerning a day - to - day experiences using State Mindfulness Scale for Physical Activity (SMS - PA): Pre - Post-test scores of Group - A (Normal Walking)
Interpretation: The Post Test scores of State mindfulness of the Body have increased which shows that the attention is improved significantly towards physical activity.
Table No: 03 - Scoring of Gait speed using 4-metre walk duration (Normal Walking): Pre - Post-test scores of Group - A (Normal Walking)
Interpretation: The Post Test scores of Gait speed is significant which is evident with reduced duration of the test results.
Table No: 04 - Scoring of State mindfulness of the Mind with regard to day - to - day experiences using State Mindfulness Scale for Physical Activity (SMS - PA): Pre - Post test scores of Group - B (Mindful Walking)
Interpretation: The Post Test scores of State mindfulness of the Mind have reduced which shows that the attention is improved significantly with reduced thoughts in the experimental group of Mindful walking.
Table No: 05 Scoring of State mindfulness of the Body concerning a day - to - day experiences using State Mindfulness Scale for Physical Activity (SMS - PA): Pre - Post-test scores of Group - B (Mindful Walking)
Interpretation: The Post Test scores of State mindfulness of the Body have increased which shows that the attention is improved significantly towards physical activity in the experimental group of Mindful walking.
Table No: 06 Scoring of Gait speed using 4-metre walk duration (Normal Walking): Pre - Post-test scores of Group - B (Mindful Walking)
Interpretation: The Post Test scores of Gait speed is significant which is evident with reduced duration of the test results in the experimental group of Mindful walking.
Table No: 07 - The comparative Post-test scores of Conventional Group A (Normal Walking) & Experimental Group B (Mindful Walking)
Comparative results of Group A and Group B
The comparative Post-test scores of Conventional Group A (Normal Walking) & Experimental Group B (Mindful Walking) shows high significance concerning Mindful walking. The scores of Group B (experimental group) Mindful walking shows highly significant results with relation to State Mindfulness Scale of Physical Activity with relation to both Mind & Body component (SMS - PA) and Gait speed i.e., p < 0.0001
DISCUSSION
Today mindfulness training has become a widespread approach to ameliorating psychological suffering and maintaining emotional well-being. Besides, the veteran elderly were able to overcome their physical discomforts due to increased attention. The improvement in gait speed is clinically essential, as well as these improvements are supposed to lead to better performance, which would be of therapeutic importance in the long run. The elderly acknowledged better posture and positioning with regular marching, matching steps to their breath. Also, they were able to acknowledge their thoughts and getting more connected to their walking.
The elderly had improved significantly p < 0.0001 with both state mindfulness of the mind and body that have undergone Mindful walking. This proves that natural rural area outdoor walking has a positive effect on health overcoming frailty in the elderly. Besides, the study proves that walking itself was found to elicit overall good health despite introducing any variations. The sunlight exposure, muddy track and natural rural environment have a positive influence when the elderly walked in groups focusing attention towards their body motion and breath.
The additional benefits achieved by the elderly are staying motivated, managing pain and breath, increasing walking distances & speed as well as enhanced psychological benefits as per the elderly groups. The research ensures a provision of continuous and holistic care of the elderly through mindful walking. However, an optimal amount of support is conducive to preserve the functional independence of the elderly. The research further proves that there is also a need for enhancement directed towards mindful walking as per individual needs.
The strength of the study is that we have demonstrated the effect of promoting walking for exercise in a “real world" outdoor setting with regular participation in the elderly. At the same time, the study emphasizes/emphasized that walking speed as one of the frailty characteristics, which may not necessarily to reflect a global change in frailty classification (i.e., non-frail, pre-frail, or frail). The Mindful walking practice assisted them to get better connected with the earth with ease of mobility and nourished mental & physical health.
The safe execution of low intensity walking program ensures quality body mechanics and continuous dynamic motion with awareness to steps while breathing. The elderly experienced anchoring experience in the present moment and enrich the benefits of the cardiovascular system. This walking school promotes wellness for the elderly in rural communities in a safe progressive challenging manner. In conclusion, this mindful walking program proves as an emotional wellness program too.
Regarding community wellness, most elderly hesitate to ask for help since pride/ego is a barrier. This community welfare projects with elderly mobility as the prime objective have overcome the critical social determinant of health emphasizing elderly mobility daily regularly. The mission of the project is to ensure safe mobility of the elderly in rural communities and it has been found successful as local groups and champions have aroused out of the research project.
CONCLUSION
Our findings demonstrate that short duration, low-intensity mindful walking intervention improves attention, gait speed and helps in reducing mental stress. This new therapeutic paradigm can be helpful to promote regular physical activity as well as to avoid or improve feebleness in elderly people. The mindful walking program has proved enjoyable overcoming many minor obstacles and assisted the elderly inactive life patterns. Furthermore, it was found that mindfulness in natural surrounding seems to have had a significant influence on one’s wellbeing considering physical, psychological, as well as social factors. Besides that, mindful walking in natural rural surroundings is marginally preferable to mindfulness performed in non-natural environments. Fortunately, at this time we have too little knowledge about the effectiveness of various forms of cognitive mindfulness therapy, and therefore, further work is required to understand how an efficient mindfulness intervention can come in the form. Mindful walking in wild nature tends to be more helpful than in non-natural environments, however, the significance of the ecosystem requires more study.
ETHICAL ISSUE: Ethical clearance was taken from institutional ethical committee, KIMSDU, Karad.
FUNDING SOURCES: Krishna Institute of Medical Sciences Deemed To Be University, Karad.
CONFLICT OF INTEREST: Nil
ACKNOWLEDGEMENTS:
We are grateful for the support to Physiotherapy in Community health sciences and Directorate of Research office, Krishna Institute of Medical Sciences Deemed To Be University, Karad. for the constant guidance and support.
Englishhttp://ijcrr.com/abstract.php?article_id=3273http://ijcrr.com/article_html.php?did=3273United Nations, Department of Economic and Social Affairs, Population Division. World Population Aging 2017.
2. Marciniak R, Sheardova K, Cermáková P, Hude?cek D, Šumec R, Hort J. Effect of meditation on cognitive functions in the context of ageing and neurodegenerative diseases. Front Behav Neurosci 2014; 8:17.
3. Kandel ER, Schwartz JH, Jesse, TM, Siegelbaum SA, Hudspeth AJ. In, Kandel, ER (ed). Principles of Neural Sci. 5th edition. McGraw-Hill publishers; 2013;1328-52.
4. LaCaille RA, Masters KS, Heath EM. Effects of cognitive strategy and exercise setting on running performance perceived exertion, affect, and satisfaction. Psychol Sport Excel 2004;5: 461-476.
5. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. J Am Med Asso 2002; 288(21):2709-2716.
6. Li Q, Kobayashi M, Inagaki H, Hirata Y, Hirata K, Li YJ. A day trip to a forest park increases human natural killer activity and the expression of anticancer proteins in male subjects. J Bio Regul Homeost Age 2010;24:157-165.
7. Van den Berg AE, Maas J, Verheij RA,Groenewegen PP. Green space as a buffer between stressful life events and health. Soc Sci Med 2010;70(8), 1203-1210.
8. Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo, Morley W, Mead GE. Exercise for depression. Cochrane Lib 2012; 3(4): 41-5
9. Brymer S, Davids K, Malabon L. Understanding the psychological health and well-being benefits of physical activity in nature: An ecological dynamics analysis. Ecopsychology 2014;6:189-197.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareAn Anatomical Study of the Acromian Process of the Scapula and its Clinical Implications
English8083Saurjya Ranjan DasEnglish Manoj kumar DehuryEnglish B Santa KumariEnglishBackground: The acromion process of scapula projects perpendicularly from the lateral part of the spine of scapula. It is important because of its morphometric variations. It is associated with many ailments of the shoulder joint. The morphometric of acromion plays a vital role in impingement syndrome and the pathogenesis of rotator cuff disease.
Objective: The aim of the study was to measure and record the morphometric values and the morphology of the acromion process of the scapula.
Methods: The study was carried out on 72 dry adults human scapula of unknown sex and age. The acromion length, acromion breath, acromio coracoids distance, and the acromio glenoid distance was measured with the help of a digital vernier calliper. The morphology of the acromio process was also noted.
Result: The type II(curved) acromion was found to be the highest 48 cases (66.67%) followed by (hooked)type III in 15 cases (20.83 %). and the minimum is type I (flat ) in 9 cases (12.5%) The mean acromial length was 43.10±4.47 acromial width was 24.69±2.60. The mean acromio coracoids distance was 34.17±4.63 and acromio glenoid distance was 25.80±2.96.
Conclusion: The result of the present study will help the orthopaedics surgeons to treat the various pathology of the shoulder joint. It is of great interest of radiologists to interpret the MRI reports, Physiotherapists to mobilize to shoulder joint, Anthropologists to study the bipedal gait.
EnglishAcromion, Morphometry, Rotator cuff diseases coracoids, HookedIntroduction
The acromian process of scapula projects perpendicularly from the lateral end of the spine of the scapula. The acromian process has a tip medial and lateral borders with a dorsal and ventral surface. The crest of the spine of scapula becomes continues with the lateral border of the acromian. The medial end is short with a small oval facet for articulation was the lateral end of the clavicle to form acromio- clavicular synovial joint. The tip of the process gives attachment to the coroco acromial ligament. Thus the under the surface of anterior one-third of the acromial process, the coracoacromial ligaments and the coracoids process together form the coracoacromial arch which gives protection and stability to be shoulder joint.1
This arch prevents the upward dislocation of the shoulder joint and the subacromial bursa is present below this arch. The arch is fairly a non-elastic structure and the subacromial bursa, tendons of rotator cuff muscles and the long tendon of biceps passes beneath the arch.2 The rotator cuff is formed by the fusion of the tendons of the supraspinatus, sub scapularies, infraspinatus and tares minor. So when there is any pathology that causes, narrowing of the space, leads to impingement.
The study of morphometry of the acromial process is important as it is commonly involved impingement syndrome of the shoulder joint. The factor responsible for the syndrome can be classified into anatomical and functional. The anatomical cause includes the variations in shape and inclinations of the acromial and functional when there is the thickening of the rotator cuff due to chronic inflammation.3,4 Morphologically the acromial process is classified into three types by Bigliani et al.5
Type I (Flat)
Type II (Convex)
Type III (Hooked)
The morphometric knowledge of the variations of the acromian must be kept in mind during surgery of the shoulder joint. It will help the orthopaedic surgeons while doing surgical repair around the shoulder joint.6 Therefore the present study aimed to record the various dimensions and morphology of the acromial process of the scapula.
Material and Methods
The present study was carried out on 72 dry adult scapula of unknown sex and age from the medical colleges of eastern Odisha. The bones having external deformities were discarded and the bones with the intact acromial process were included. All the scapula were cleaned and labelled. The following measurement was taken with the help of digital vernier callipers and recorded in millimetres.
The maximum length of the acromial process (Anterior-Posterior distance along the long axis)
Maximum breath of acromial process (Distance between medial and lateral borders at the midpoint of acromial process)
Acromio coracoids distance (Distance between the tip of acromian and tip of the coracoid process.
Acromio glenoid distance (Distance between the tip of acromio to the supraglenoid tubercule.
The type of acromion were classified into 3 types by Bigliani et al.
Flat (Type I)-figure. 1
Curved (Type II)-figure. 2
Hooked (Type III)-figure. 3
The above data were then statistically analysed using Microsoft excels software. The mean value, percentage and standard deviation were used to analyze the data. The ‘p’ value was obtained by using unpaired’ test. The difference was considered to be statistically significant if ‘p’ value was less than 0.05.
Results
In the present study of 72 dry scapulae it was found the shape of the acromial process was maximum in 48 cases (66.67%) was type II(curved) and the minimum is the type I (flat ) in 9 cases (12.5%) and hooked type III(hooked) in 15 cases (20.83 %). All the measures were tabulated in table 1.
The average length of the acromian process in the right side is 43.52 mm and that of the left side is 37.95mm. The mean value of acromial length in total samples is 43.10 mm. The mean value of acromial breath in total samples is 24.69 mm. The average breath of acromian process in the right side is 24.36 mm and that of the left side is 25.02 mm. The acromial coracoid distance average is 34.17 mm in total samples with 33.53mm on the right side and 30.25 mm on the left side.
The mean acromial glenoid distance was found to be 25.80 mm in total samples with 25.80 mm and 25.71mm in right and left side respectively. All the measures were tabulated in table 2.
Discussion
The morphometry measurements of the acromial process were closely associated with shoulder impingement and rotator cuff tear. The variations in the morphology of the acromial process play a vital role in shoulder girdle pathology. It is believed that the hooked acromial (type II) was mostly involved in rotator cuff lesions7. This can be explained by the fact that the size of subacromial space is decreased in hooked acromial which frequently leads to impingement of the rotator cuff.2
The scapula undergoes significant change during the evolution of the upper extremity due to increased functional demands of the prehensile limb. The spine of the acromial process of the scapula is increased during the development from the pronograde to the orthograde. This change is due to the progressive distal migration of the part of the insertion of the deltoid muscle with the acquisition of a tree limb.
In the current study, the frequency of shape acromion process was highest for Type II (Curved) followed by type III (Hooked) and a very low incidence of Type I (Flat) scapulae. The findings were similar to Coskun ‘et al’.8Schetino ‘et al’.9 and Singhora ‘et al’10. However, high incidence of Type II, followed by Type I and less number of Type III acromion process was observed by El-Din et al.11, Saha et al.12 and Gosavi et al.7. All the measures were tabulated in table 3.
In the present study, we found that the mean value of acromion length, acromion width as 43.10 mm and 24.69 mm respectively which is similar to the studies done by Gosavi et al.7 where the mean length of the acromion was 43.7 mm and the mean width was 22.87 mm. and Singh et al. were the mean values of acromion length and acromion width as 46.1 mm and 23.2 mm respectively.2 Similar studies done by Coskun et al. and Singroha R et al. had reported the acromion length as 44.7 mm and 45.05mm respectively and acromion width as 23.60 mm and 25.79mm respectively.
The current findings of acromial length and breath are less than the studies done by Mansur et al13, El-Din et al11 and Paraskevas et al2 but more than the studies done by Sitha ‘et al’14.The acromio-coracoid distance and acromion glenoid distance in the current study found to be 34.17 mm and 25.80 mm respectively which is very similar to the studies done by Vinay G ‘et al’15 in which the acromio-coracoid and acromio glenoid distance was 34.05mm and 30.05mm respectively. The present study data shows lesser values compared to the studies done by Mansur ‘et al’ and Singh ‘et al’ but higher than the studies done by Gosavi ‘et al’, El-Din et al and Coskun et al. All the measures were tabulated in Table 4.
Conclusion
The acromial process plays a vital role in the stability and formation of the shoulder joint. The study of anatomical variation of the acromial process will help the surgeons to treat rotator cuff pathologies and shoulder impingement syndrome. It is also important in forensic investigations and racial determination thus helpful for forensic exports and anthropologist. It will also hold physiotherapist to mobilize the frozen shoulder and to increase its mobility.
Englishhttp://ijcrr.com/abstract.php?article_id=3274http://ijcrr.com/article_html.php?did=3274[1] Singh J, Pahuja K, Agarwal R. Morphometric parameters of the acromion process in adult human scapulae. Indian J Basic Appl Med Res 2013; 8(2): 1165-70.
[2] Paraskevas G, Tzaveas A, Papaziogas B, Kitsoulis P, Natsis K, Spanidou S. Morphological parameters of the acromion. Folia Morphologica 2008; 67(4): 255-60.
[3] Mansur DI, Khanal K, Haque MK, Sharma K. Morphometry of the acromion process of Human Scapulae and its Clinical Importance Amongst Nepalese Population. Kathmandu Univ Med J 2012; 38(2): 33-36.
[4] Edelson JG, Taitz C. Anatomy of the coraco-acromial arch. Relation to degeneration of the acromion. J Bone Joint Surg Br 1992; 74: 589–594.
[5] Bigliani LU, Morrison DS, April EW. The morphology of the acromion and rotator cuff impingement. Orthop Trans 1986; 10: 228.
[6] Gupta C, Priya A, Kalthur SG, D Souza AS. A morphometric study of the acromion process of the scapula and its clinical significance. Chrismed J Health Res 2014;1:164-9.
[7] Gosavi S, Jadhav S, Garud R. Morphometry of acromion process: A study of Indian scapulae. Int J Pharma Res Health Sci 2015;3(5):831-5.
[8] Coskun N, Karaali K, Cevikol C, Demirel BM, Sindel M. Anatomical basics and variations of the scapula in Turkish adults. Saudi Med J 2006;27(9): 1320-5.
[9] Schetino LPL, Sousa RR, Amâncio GPO, Schetino MAA, Almeida-Leite CM, Silva JH. An anatomical variation of acromions in Brazilian adult’s scapulas. J Morphol Sci 2013;30(2):98-102.
[10] Singroha R, Verma U, Malik P, Rathee SK. Morphometric study of the acromion process in scapula of the north Indian population. Int J Res Med Sci 2017;5:4965-9.
[11] El-Din WAN and Ali MHM. The patterns of the Acromion process and Glenoid cavity in Egyptian scapulae. J Clin Diag Res 2015;9(8): AC08-AC11.
[12] Saha S, Vasudeva N, Paul S, Gautam VK. Study of acromial morphology in Indian population. Rev Arg de Anat Clin 2011;3(2):84-8.
[13] Mansur DI, Khanal K, Haque MK, Sharma K. Morphometry of Acromion Process of Human Scapulae and its Clinical Importance amongst Nepalese Population. Kathmandu Univ Med J 2012;38(2):33-6.
[14] Sitha P, Nopparatn S, Aporn CD. The Scapula: Osseous Dimensions and Gender Dimorphism in Thais. Siriraj Hsop Gaz 2004;56(7):356-365.
[15] Vinay G, Sivan Sheela. Morphometric study of the acromion process of the scapula and its clinical importance in South Indian population. Int J Anat Res 2017; 5(3.3):4361–4364
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareExperiences of Creating a Pranic Energy Ball by Anganwadi Female Workers as a Road to Induce Wellbeing: A Qualitative Study
English8491Moulya REnglish Sowmya S NEnglish Srikanth N. JoisEnglish K. Nagendra PrasadEnglishIntroduction: Prana is the subtle energy and is essential to keep the body healthy and alive.
Objective: The present study was conducted to understand the experiences of creating a Pranic energy ball by Anganwadi Female workers which were felt between the hands, aimed at as a way of inducing emotional wellbeing.
Methods: Qualitative method, content analysis was used to study the written responses made by the participants (N=51).
Results: The results were analysed and eight themes were identified. To name a few, Pranic energy experience can enhance Positive feelings, Pranic ball can be created.
Conclusions: The creation of Pranic energy ball between the hands is a simple phenomenon and can be learnt easily.
EnglishBioplasma, Energy ball, Female workers, ShapeINTRODUCTION
Given the situation of health care in India, the Government of India initiated The Integrated Child Development Services (ICDS), which focuses on the enhancement of health and nutrition for children and mothers. Anganwadi is an offshoot of ICDS and shelters are in rural and underprivileged areas of the country. They provide very basic health care to mothers and children up to six years of age. An Anganwadi worker (AWW) is a woman who is selected from within the local community. AWW provide antenatal and postnatal care, immunization drives for mother and child, and, identi?cation and care for undernourished children.1
Presently, the AWWs also have to be involved in the Immunization program, house to house survey, deworming, and disease control programs that require a door to door visits beyond the working hours, which could result in stress. Performing their duties in a limited time may lead to stress and discontent among the AWWs (Anganwadi workers). More than half Anganwadi workers have severe stress and more than one-fourth have mild-to-moderate stress.2 AWWs are exposed to various factors relating to psychosocial and occupational stress which affects their physical and mental health and efficiency in discharging the duties.3 Stress may lead to dissatisfaction, poor motivation and a decreased efficiency.4 The government’s intervention to provide relief to these workers has only gone that far too physical health concerns but has largely ignored mental health aspects of wellbeing. Primary interventions have been undertaken to prevent the causal factors of stress, while the secondary interventions aim to reduce the severity or duration of symptoms, and tertiary or reactive interventions aim to provide rehabilitation and maximise functioning among those with chronic health conditions.5 Individual interventions may include stress awareness training and cognitive–behavioural therapy (CBT) for psychological and emotional stress. Organisational interventions affect groups of people at work and may include workplace adjustments or conflict management approaches in a specific organisation. Some interventions target both the individual and the organisation, for example, policies to secure a better work-life balance and peer-support groups. Hence, if Anganwadi workers, can be trained to manage their stress, it will help in successfully implementing ICDS. Among various training, one among them includes experiencing prana which has been demonstrated to have a positive psychological effect.6,7
Prana is the primaeval energy of the universe which is dispersed everywhere. It is the substratum of all life and is the vital energy responsible for keeping the body healthy and alive.8 Prana is also called the chi, ki, ruah. Three main sources of prana include the air, from which is derived air prana; the earth, from which ground prana is obtained; and the sun, from which solar prana is gained. The concept of prana or subtle energy and methods of its use for healing has been known from ancient times.9 A few subtle energy modalities are Pranic healing, Reiki, Qi gong among others.10 During healing, the healer removes contaminated energies of the subject and projects fresh prana on the energy body and then stabilizes the projected prana. Removing contaminated energies may be done by various methods. One method is by cleansing, which can be done by visualizing Pranic Energy Ball and cleaning the affected area.9,11 Tai chi has made use of energy ball, wherein carrying the ball of energy and doing the Tai chi walk, which is a set of bodily movements, has had a relaxation effect on the practitioner.12 Participants were taught to focus on their breathing and to walk slowly while simply observing the sensations of mindful walking.
Energy ball creation has been used in Pranic healing as a pre-emptive in advanced healing techniques, to direct energy after cleansing the affected chakra or area to normalising the depletion of energy.13 At other times, energy balls have been used to contain diseased energy prior disposal owing to its compactness and capacity to contain.9 Therefore the utilising of energy ball in healing related practices isn’t entirely contemporary and has existed from ancient times through various traditional practices.
With proper training and guidance, and with appropriate conditions, it has been suggested that one can experience and view prana. In a study involving adolescents, on the experiences of prana between the hands, 90% of them could see air prana and had a positive psychological experience like happiness and nice feelings.7 In another study, 98% of participants viewed air prana and experienced happiness, energized and relaxed.14 The above findings lead us to infer that prana can be felt, seen and with positive psychological benefits on the participants. The majority of the studies are related to experiencing and seeing prana, however, the creation of pranic ball between the hands has not been studied. This study aims at examining and analysing the experiences of participants while creating a pranic energy ball between the hands, and their experiences have been taken into account.
MATERIALS AND METHODS
Study Design
This study uses an exploratory design and qualitative analysis. Qualitative analysis has helped us to have more awareness about the subject and in the identification of themes.
Sample
Purposeful sampling method was utilised in this study. The socio-demographic details of the participants are provided in Table 1. The study was conducted with Anganwadi workers of a district in Southern Karnataka with permission from AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) Department, Government of Karnataka. Out of the 51 participants, 28 were from rural and 23 were from an urban background with the whole set of them being females with a mean age of 43 ranging from 27 to 60 years. The study was conducted at the meeting hall which could house the participants who were seated at a freehand distance with each other.
Inclusion and Exclusion Criteria
Anganwadi female workers, who were interested in participating and who were within the age range of 18 to 60 years were part of this study. Those with previous Pranic experience and with sensory impairment were excluded.
Procedure
After obtaining the written permission from the District AYUSH officer, the participants were chosen for this study based on the inclusion and exclusion criteria as stated earlier. The consent of the participants was sought before the commencement of the study. The participants were not given any clue about the study theme. Participants were free to opt-out of the study at any point of time in the study, at their own will and there would be no binding in the matter. Participants agreed to be part of the study unanimously. Even though there was freedom to opt-out of the study, none of them preferred to opt-out. The participants were not given any financial aid for taking part in the study.
The study was conducted by an experienced Pranic healer. The participants were handed over a questionnaire which was solely prepared for the study. In that questionnaire, the demographic details were collected. The experiment included three sessions. In each session, the participants had to answer the question.
In session 1, they were instructed, to hold the hands with palms facing each other at a distance of 10-15 cm and feel the experience. Then, they were told to write about their experience as the answer to the question: “Describe your experience between the hands.”
In session 2, they were instructed to sensitize their hands and hold them, with palms facing each other, at a distance of 10-15 cm and feel the experience. They were told to write about their experience as the answer to the question: “Describe your experience between the hands.” The next question which they had to answer was “Your hands were able to experience the energy at a distance of how many cm", which was to be answered in digits.
In session 3, they were instructed to sensitise their hands and then do Pranic breathing and hold the hands with palms facing each other at a distance of 10-15cm, bring the hands closer and move them farther and feel the experience. They were told to write about their experience as an answer to the question: “Describe your experience between the hands.”
They were instructed to create a Pranic energy ball. Thereafter, they had to gauge the approximate diameter of the ball and remember it. Then they were instructed to place the Pranic energy ball somewhere in the space around them, with an intention ‘Stay there’. This is called giving ‘Directions'. Then they were told to search the Pranic energy ball all around by scanning. When they searched for the energy ball, everywhere in the space around, they found that the Pranic energy ball was in the same place in which they had kept it. From memory, they had to answer the following question: “After creating the Pranic energy ball, the diameter of the ball was to be answered in digits.
The last question of the session was open-ended: “How do you feel about yourself now?”, which could be answered in 5-6 lines. Space was provided in the questionnaire for additional comments. The entire procedure took about 30 minutes in all. The researcher was available for any clarifications during the entire procedure.
Tools
A questionnaire was used to record the participants’ experiences. There were open- and closed-ended questions. The answers were to be within 3-4 lines for open-ended questions.
Pranic breathing: Pranic breathing enables one can absorb and project a large amount of prana. In a method of Pranic breathing called ‘Deep breathing with empty retention’, the following steps are followed. Connect the tongue to the palate, do abdominal breathing, inhale slowly and retain for one count and exhale slowly. Retain the breath for one count.9
Sensitising the hands: Place your hands 3 inches away from each other. Concentrate on the centre of your palms for about 1 minute. Inhale and exhale slowly.9 With this procedure, the hands will get sensitised to feel prana.
Scanning is a procedure of Pranic healing where the energy field is felt by the movement of the sensitised hands.9
Pranic Energy Ball Creation: Keep hands 4 inches apart, Inhale and exhale slowly for 10 pranic breathing cycles, move the hands keeping them in parallel, and visualize the pranic energy of white colour in between and shape it with the hands to form a pranic energy ball.
Data Analysis
The responses of the participants were consolidated, coded and grouped into similar expressions and analysed.
RESULTS
Table 1 has the socio-demographic particulars of the participants. In this particular study having 51 participants, all of them were female. 45% of them were urban and 55% were rural population. 9.84% practised only yoga asana/exercises regularly, 3.92% practised only pranayama/ breathing exercises regularly, while 3.92% did both, 82.4% did neither. 88.2% were married and 11.8% were single. All of them were qualified up to high school/ diploma and above.
The results were interpreted qualitatively. In session one, session two and session three, a total of 44, 153 and 132 expressions were mentioned respectively by the participants. The experiences of the participants were grouped into categories such as the physical domain, psychological domain, bioplasmic domain and additional expressions. The expressions concerning the hand descriptions and the physical descriptions of the hand like felt blood circulation’, ‘warmth’, ‘shaking of hands’, are categorized into the physical domain. The expressions concerning the emotional aspects like ‘good experience’, ‘happiness’, ‘solace’, ‘concentration’, ’peace’, ‘relaxation’, are categorized into the psychological domain. The unusual expressions like magnetic sensation, attraction, energy, tingling sensation, electric shock and the like are grouped into the bioplasmic domain.
Thematic Analysis:
Based on the qualitative analysis of the phenomenological type, the following themes have been identified:
Pranic energy experience can enhance Positive feelings
Pranic Energy ball can be created.
Pranic Energy can be focussed.
Pranic Energy can be infused through Pranic breathing.
Pranic Energy can be directed.
Pranic energy can take ball shape
Pranic Energy can be transmitted externally.
Prana has an elastic property.
Theme 1: Pranic energy experiences can enhance Positive feelings
The psychological domain experiences were feelings that were expressed in session 1, session 2 and session 3. Few experiences that the participants have cited include: they have felt happy (R3, R7, R9, R11, R14….), they could concentrate better (R24, R34, R50), experienced a feeling of enthusiasm (R6), experienced relief (R27), felt solace (R4), felt calm (R40), felt surprised (R2), had the experience of a feeling of lightness (R10, R11, R46, R49) (Table 2). Air prana is the air vitality globule. In a study on the perception of prana and its effect on psychological wellbeing, more than 98% of the participants were able to experience psychological changes after absorbing air prana. They had experiences of relaxation, happiness and better concentration.6 In another study, after viewing air and ground prana, the participants had experiences of relaxation, happiness and good feelings.7 The experiences in the psychological domain were plenty and have been positive only, in this particular study.
Theme 2: Pranic Energy ball can be created.
All the participants were able to create the pranic energy ball (Figure 1) according to the instructions given which shows that it is possible to give the desired shape to the focussed energy. They were able to express the experience about the energy ball as ‘Between my hands, there was a feeling of a ball’ (R13), “feeling of some energy between the hands and a ball playing between them’ (R24, R25), "An imagination of ball" (R29), “an experience of a whitish-green ball that was luminous” (R47).
Theme 3: Pranic Energy can be focussed.
Since all the participants were able to create the energy ball, it can be directly inferred that energy can be focussed. Focussed energy itself has many benefits as utilised in the science and art of Pranic healing. Pranic healing is used in the field of Pranic agriculture and also to heal and increase the well-being of living beings. Focusing energy is nothing but energising the subject’s energy with prana which facilitates healing.9
Theme 4: Pranic Energy can be infused through Pranic breathing.
Pranic breathing enables the practitioner to draw in a lot of pranas and facilitate the transference of prana. By doing pranic breathing, one becomes energised. This can be verified through scanning.9 When Pranic breathing was practised, the distance of the hands at which the participants were able to feel the energy was greater than before doing pranic breathing. Some of the participants have expressed that before doing pranic breathing, they were able to experience energy between their hands at 22cm and after doing pranic breathing and creating the energy ball, they were able to experience the energy between their hands at 52cm (R3). Likewise, the readings were 18cm and 50cm with (R4), the readings were 11cm and 50cm with (R20), the readings were 16cm and 55cm with (R51) (Table 3). These readings indicate that Pranic breathing could infuse more energy into the region of interest.
Theme 5: Pranic Energy can be directed.
The participants were able to create the energy ball and even place it in a location with the intention of ‘Stay there’ and later on they were able to trace the energy ball. So, it can be understood that energy can be directed to any place with the appropriate intention, meaning that energy ball follows our directions. In Pranic healing, there is a technique called the projection of prana wherein prana is transferred to the patient by the healer as per the intention of the healer to a patient locally or to the whole body.9 The Principle of Directability states that life force can be directed. Life-force follows where attention is focussed; it follows thought. Distant Pranic Healing is based on the principle of direct ability and the principle of interconnectedness. According to the Principle of Controllability, life force and diseased energy can be controlled and directed through the will or through “mind intent”. By the principle of Interconnectedness, the body of the patient and the body of the healer are interconnected with each other since they are part of the earth’s energy body. On a more subtle level, it means that we are part of the solar system and are interconnected with the whole cosmos. This principle is also called the Principle of Oneness.13
Theme 6: Pranic energy can take ball shape.
The energy between the hands after Pranic breathing was made to take the shape of a ball and it was done by the participants. Few participants have said that ‘Between my hands, there was a feeling of a ball’ (R13), "A feeling of ball-shaped energy" (R29). Since the participants were instructed to create an energy ball, they were able to create a ball of energy. So, we may conclude that Pranic energy can take any shape as directed.
Theme 7: Pranic Energy can be transmitted externally.
When Pranic breathing was done by the participants, it was found that the energy felt between the hands was more than before, which proves that energy can be transmitted externally. This is in parallel to Theme 4, where it is stated that energy can be infused through Pranic breathing. This inference is also according to the principle of projection of prana wherein energy can be transferred locally or to a whole region.9 Lifeforce or vital energy can be transmitted from one person to another person or object, or from one object to another object or a person. This is called the Principle of Transmittability.13
Theme 8: Prana has an elastic property.
One participant has said: “there was an experience of pulling rubber band between the hands” (R28), which indicates that prana has elastic property also.
DISCUSSION
It is well known that the human body emits energy. ECG, EEG, EMG, MRI, and various other interventions make use of the energetic properties of the body.15,16 Living things are known to release different quantities of energy or biophotons.17 The energy field of the body is referred to as the biofield. Energy workers contend that the energy body exists and has a direct influence on health. Physical problems can be preceded by problems with the energy body. A positive change at an energetic level can lead to physical healing. Also, in a study on the human biofield, it has been found that the quality of life of participants was positively related to the biofield.18 It has been suggested that measurement of biofields around the human body might be used as a holistic method for medical screening.19,20 This field is thought to represent the physical, mental, emotional, and the spiritual condition of the person.10,21 It is believed that energy follows the intentions of both the healer and the person receiving the healing.22
Biophotons can be consciously controlled and can be used in the transmission of information associated with intent.23,24 When the influence of energy healing called qigong, on fingertip biophoton emission was studied on 4 subjects, on one subject the light emission was found to increase significantly during intent to project external qi and decreased during relaxation.25Where the mind goes, qi (energy) flows”. Accordingly, biophotons may be a manifestation of qi, an intermediary system between mind and body.26 Levin27 also emphasises the role of intention in energy healing. For effective healing to occur, a disciplined mind is very helpful.28 The intent of the healer is the dominant factor.29 During healing, the healer with a strong field focused through intent, will provide a coherent, powerful energy-field.30 Intent of the individual can also direct energy to any place, even through the creation of a ball of energy. Tai Chi and Qigong used energy manipulation to gain self-control and empowerment, which was once initially used as a technique in martial arts.31 Creation of energy ball may as well be used as a bridge to wellness when used constructively through consistent guidance. Regular practice of energy manipulation and projection can be utilised in healing and restorative wellness.
Anganwadi workers, facing acute and chronic stress levels can resort to the use of projection and channelling of energy ball towards psychological and physical wellness. At a larger perspective, Primary health care centres can utilise the potency of such techniques to alleviate stress and promote emotional and psychological wellbeing amongst these workers.
Hence, we may deduce that energy can be directed through intent, which is tried in this simple experiment of the present study and can also further be instrumental in inducing wellbeing. Also, note that there has been an increase in the positive psychological experiences of the participants, its potential can be harnessed in the field of energy medicine.
All the participants were female and the study appeared to be gender-biased. Only qualitative aspects are studied, while quantity aspects are ignored.
CONCLUSION
We can infer that the Pranic energy ball can be made and directed also. The benefits of it could be harnessed in the field of healing and well-being of individuals. More studies similar to this one can be conducted with mixed-method research design as the basis to study these aspects both qualitatively and quantitatively. Since a lot of bioplasmic experiences have been unfolded by the participants here, more studies on these lines are needed to understand the concept of prana, and the Pranic energy ball.
Acknowledgements
We are grateful to Master Choa Kok Sui for the teachings, Trustees of World Pranic Healing Foundation, India for their encouragement and support, Dr Pushpa, District AYUSH Officer, Mandya and Anganwadi staff who took part in this study, Ms Shalini N.S for data entry and all those who have contributed to the present study directly and indirectly. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of Conflict
Nil
Funding
We would like to acknowledge the World Pranic Healing Foundation India for funding this study.
Englishhttp://ijcrr.com/abstract.php?article_id=3275http://ijcrr.com/article_html.php?did=3275
Shah QN, Pooja AD, Daniella AL, Raghu KA, Craig LK. Knowledge of and Attitudes Towards Mental Illness Among ASHA and Anganwadi Workers in Vadodara District, Gujarat State, India. Psychiatr Q. 2019; 90: 303-9.
Mannapur BS, Dorle AS, Ghattargi CH, Umesh R, Kulkarni KR, Selvan V. Psychological Stress among Grassroot Level Workers in a PHC of Bagalkot District. Ann Community Health. 2018; 6: 8-11.
Bhatnagar C, Bhadra S. Perceived stress among Anganwadi workers (AWWS) in integrated child development services (ICDS) programme. Social ION 2017; 6. (2): 30-6.
Padma M, Animesh J, Shashidhar K, Vinay NK. Are the Anganwadi workers healthy and happy? A cross-sectional study using the general health questionnaire (GHQ 12) at Mangalore, India. J Clin Diagn Res 2012; 6(7): 1151-4.
Whitehead M. A typology of actions to tackle social inequalities in health. J Epidemiol Comm Health 2007; 61: 473–8.
Jois SN, Rajani A, Lancy D, Gayathri R. The perception of prana and its effect on psychological wellbeing. Bede Athenaeum 2015; 6(1): 210-5.
Jois SN, Lancy D, Rajani A, Moulya R. Psychological and bioplasmic states of adolescents upon viewing air and ground prana. Ind. J Trad Knowl 2017; 16: 30-4.
Saraswati SN. Prana, Pranayama, Prana Vidya. Bihar, India: Bihar School of Yoga. 1994.
Sui CK. The Ancient Science and Art of Pranic Healing, 3rd edition, Institute of Inner Studies Publishing Foundation India Private Limited, India. 2004.
Rindfleisch JA. Biofield therapies: Energy medicine and primary care. Prim Care 2010; 37(1): 165-79.
Ellis ER.Vibrational energy healing. The Holistic Intuition Society, British Columbia, Canada 2008.
Robins JL, ElswickRK, McCain, N. L. The story of the evolution of a unique tai chi form: origins, philosophy, and research. J Holist Nurs 2012;30(3):134-46.
Sui CK. Advanced Pranic Healing, 13th Edition, Institute of Inner Studies Publishing Foundation India Private Limited, India 2012.
Jois SN, Manasa B, Lancy D, Prasad KN. A sensation of Pranic Energy between Hands: An Exploratory Study. Ind J Ancient Med Yoga 2017; 10: 5-11.
Russek L, Schwartz G. Energy cardiology: a dynamical energy systems approach for integrating conventional and alternative medicine. Adv Mind Body Med 1996; 12(4):4-24.
Siti ZA, Jalil M, Taib N, Abdullah H, Yunus MM. Frequency Radiation Characteristic Around the Human Body, Intl J Simulation System, SciTechnol 2005; 12(1): 34-9.
Creath K, Schwartz GE. Biophoton images of plants: revealing the light within. J Alt Comp Med 2004;10(1):23–6.
Rowold J. Validity of the Biofield Assessment Form (BAF). Eur J Int Med 2016; 8(4): 446-52.
Rubik B. The biofield hypothesis: its biophysical basis and role in medicine. J Alt Comp Med 2002; 8(6):703–17.
Lee HC, Khong PW, Ghista DN. Bioenergy based medical diagnostic application based on gas discharge visualization. Proceedings of the 2005 IEEE, Engineering in Medicine and Biology, 27th Annual Conference, Shanghai, China. 2005; 1533-6.
PrakashAC. Monitoring human health by measuring the biofield "aura": An overview. Intl J App Eng Res 2015; 10(35): 27654–8.
Ostrander S. Psychic Discoveries Behind the iron curtain, Prentice-Hall, New Jersey, USA. 1970.
Joines WT, Baumann SB, Kruth JG. Electromagnetic emission from humans during focused intent. J Parapsychol 2012; 76(2): 275-94.
Rubik B, HarryJ. Effects of intention, energy healing, and mind-body states on biophoton emission, Cosmos and History. J Nat Soc Phils 2017; 13(2): 227-47
Nakamura, H., Kokubo, H., Parkhomtchouk, D.V., Chen, W., Tanaka, M., Zhang, et al., Biophoton and temperature changes of human hand during qigong. J Intl Soc Life InfSci 2000; 18: 418-22.
Rubik B, David M, Richard H, Shamini J. Biofield Science and Healing: History, Terminology, and Concepts. Global Adv Health Med 2015; 4: 8-14.
Levin J. Energy healers: who they are and what they do. Explore (NY) 2011; 7: 13-26.
Atreya P. Prana: The Secret of Yogic Healing.York Beach, ME, USA. 1996.
Shealy CN. Sacred Healing: The Curing Power of Energy and Spirituality. Boston, USA 1999.
Gilkeson J. Energy Healing: A Pathway to Inner Growth.Marlowe & Co, New York. USA.2000.
LaForge R. Mind-body fitness: Encouraging prospects for primary and secondary prevention. J Card Nurs 1997;11(3):53–65.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareRelationship of Growth Factors with the Development of Iron Deficiency Anemia in Girls Aged 12-14 Years Old
English9297Shaira AtadjanovaEnglish Abdurayim ArzikulovEnglish Barnokhon InakovaEnglish Dilfuza PatidinovaEnglish Barnokhon RabievaEnglishIntroduction: According to the data of epidemiological studies, the prevalence of IDA, even within the same country, is not the same, and largely depends on the ecological, industrial, climatic and geographical conditions of residence. The most vulnerable contingent for the development of IDA includes adolescent children, especially women.
Objective: The main task of this article was to study the influence of growth factors in girls aged 12-14 years on the formation of iron deficiency anaemias, to determine ways to optimize their diagnosis. Methods: The intensity of the increase in length and body weight of girls, depending on the age and severity of ID is estimated. Also we measured, indicators of length and body weight of girls depending on the severity of iron deficiency and age.
Result: However, not all factors causing IDA at this age are equal. Judging by the literature data, the influence of growth factors on the ferrostatus of adolescents has been studied most poorly. Some authors believe that IDA negatively affects the anthropometry indicators of schoolchildren, increasing among them retarded (lagging) in physical and sexual development, while others indicate that increased growth and development are “guilty” of the manifestation of IDA, from - for the aggravation of the severity of latent iron deficiency – LID.
Conclusion: Solving these issues would make it possible to concretize the methods of dispensary observation of adolescents with iron deficiency and develop more effective methods of prevention and therapy for the haemoglobin recovery of schoolchildren with IDA in its early stages.
EnglishIron deficiency anaemia, Latent deficiency anaemia, Ferrostatus, Adolescence, Haemoglobin, Physical developmentINTRODUCTION
Epidemiological studies conducted in various regions of Uzbekistan have shown that the detectability of manifest ID in the form of IDA among the most vulnerable risk groups is impressive. At the same time, IDA is significantly widespread in risk groups in the regions of the Southern Aral Sea region, which is an area of ??ecological disadvantage.1,2 If we take into account that in all epidemiological studies as a screening method for detecting ID, an analysis of the haemoglobin (Hb) content in the blood is used, which allows only the manifest (explicit) ID to be identified, then it can be assumed that a large mass of the population suffering from latent (latent) forms JJ remains outside the field of vision of researchers.1,3 Therefore, it is quite clear that the true prevalence of ID is still unknown.4
The data of numerous studies on the identification of IDA among the population of Uzbekistan allow us to conclude that this region belongs to a high-risk group since the proportion of the manifest form of IDA exceeds 30% of the population, which corresponds to the critical level of the spread of the disease.5,6 These data require urgent measures to prevent IDA among the population, especially children.7 It was found that IDA is more often diagnosed in young children (up to 40%) and puberty-1/3 of adolescents.5,8 It is known that these age periods are characterized by an intensive growth rate, and adolescents - girls and even increased “loss” due to the onset of menarche.9,10 In these age periods, a large amount of iron is required, which is not always replenished by the food they consume.11,5
According to generalized world statistics, the prevalence of IDA in young children is from 8.2 to 39.5% 33, 344, in the Russian Federation (24.7-30%), and the incidence of LHD is from 22.4-41%.9,10
According to various authors, the incidence of IDA in children of our Republic varies from 17% to 62%, and there is an impression of the most widespread prevalence of this disease in Karakalpakstan, Surkhandarya, and Fergana Valley.4 In the Fergana Valley, the frequency of IDA among schoolchildren is still very high (up to 32%) and, unfortunately, does not tend to decrease.4,12 Children of senior school age, adolescents, conscripts, girls with the onset of the menstrual cycle are in a much worse situation in terms of the prevalence of IDA.
MATERIALS AND METHODS
The authors' studies indicate that in the Central Asian region in the development of IDA, the leading role belongs to unbalanced malnutrition, especially in children and adolescents, ie, during the period of increased iron intake to ensure growth and development.2
The unfavourable ecological situation is accompanied by a progressive deterioration in the state of health of the population, especially of children.2,8,11 In recent years, there have been works by domestic and foreign researchers to study the influence of anthropogenic environmental factors on the blood system.9 It has been established that each pathology has its own “elemental portrait”, reflecting the syndrome on which the given disease proceeds, and the participation of individual elements in its pathogenesis. The modern understanding of the essence of pathological processes is based on the recognition of the leading role of damage to the cell membrane.10 One of the mechanisms of damage to the cell membrane is lipid peroxidation (LPO).12 Even though LPO is currently being studied in many diseases, including anemia11, its significance in the pathogenesis of IDA is not fully understood.8 It has been shown that LPO-induced changes in the functional state of erythrocytes are characteristic of children with anaemia from regions of ecological disadvantage.13 It is emphasized that the indicators of erythrocyte viscosity (VE) and erythrocyte peroxide hemolysis (PGE), as well as an increase in LPO activity, a decrease in the antioxidant protection of erythrocyte membranes are factors in predicting the development of anaemic syndrome.2,13
The main task of this article was to study the influence of growth factors in girls aged 12-14 years on the formation of iron deficiency anaemias, to determine ways to optimize their diagnosis.
RESULTS AND DISCUSSION
Table 1 shows the main indicators of the physical development of girls aged 12-14 years, depending on the severity of iron deficiency. As can be seen from the data in Table 1, in girls aged 12-14 years with the development of LID, compared with the control group, there is an increase in body length (p Englishhttp://ijcrr.com/abstract.php?article_id=3276http://ijcrr.com/article_html.php?did=32761. Lavrisse M, Garsia-Casal MH, Mendez-Castellano H. Impact of fortification of flours with iron to reduce the prevalence of anaemia and iron deficiency among schoolchildren in Caracas, Venezuela: a Follow-up. Food Nutr Bull 2002;23(4):384-389.
2. Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353:1574–84.
3. Gordon N. Iron deficiency and intelligence. Paediatrics 2005;1:92-98.
4. Shankaran S, Laptook AR, Tyson JE, et al. Evolution of encephalopathy during whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr 2012; 160(4):567-572.e3.
5. Kara B, Cal S, Avdogan A, Sarper N. The prevalence of anaemia in adolescents: a study from Turkey. J Pediatr Hematol Oncol 2006;28(5):316-321.
6. Forman KR, Diab Y, Wong EC, Baumgart S, Luban NL, Massaro AN. Coagulopathy in newborns with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia: a retrospective case-control study. BMC Pediatr 2014;14:277.
7. Wyatt JS, Gluckman PD, Liu PY. Determinants of outcomes after head cooling for neonatal encephalopathy. Paediatrics 2007;119(5):912–21.
8. Gluckman PD, Wyatt J, Azzopardi DV, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: a multicenter randomized trial. Lancet 2005;365:663–70.
9. Zhou WH, Cheng GQ, Shao XM, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010;157:367–72.
10. Shankaran S, Pappas A, McDonald SA, et al. Predictive value of an early amplitude-integrated electroencephalogram and neurologic examination. Paediatrics 2011;128:e112–20.
11. Herbert N, Giabol MD, Suleymanova D, Gregory W, Evons MA. Anaemia in young children of the Muynak district of Karakalpakstan, Uzbekistan. Prevalence, Tyne and correlates. Am J Public Health 1998;88(5):147-148.
12. Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009;361:1349–58.
13. Felt B, Jimenez E, Smith J. Iron deficiency in infancy predicts altered serum prolactin response 10 years later. Pediatr Res 2006;60(5):513-517.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareCurrent Updates of Special Issue on Oral Cancer
English0101Prof. Dr. Sachin IngleEnglishEnglishhttp://ijcrr.com/abstract.php?article_id=3277http://ijcrr.com/article_html.php?did=3277Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareInfluence of Exercise Environment on Attentional Awareness and Emotional Changes Among Elderly
English98102S. AnandhEnglish Smita PatilEnglish G. VaradharajuluEnglish Mahendra M. AlateEnglish Dhirajkumar A. ManeEnglishIntroduction: Emotional wellbeing in the elderly is an essential track of the quality of life. The progress of any intervention for the elderly depends on mood characteristics and attention related to cognitive health which spirals further accordingly. In residential aged care and retired home-dwelling elderly attention and mood effect varies with individual and situation from time to time.
Objective: To explore the effects of exercise environment on Positive / Negative mood effect & Attention awareness among elderly without mobility limitation on Indoor versus Outdoor environment.
Methods: 102 literate elderly participants within the age group of 65 - 75 years sedentary and independent were recruited from the general public of Karad, Satara district of Maharashtra. Research environment setting: Outdoor environment was grassland with partly interspersed with trees. The indoor environment is a paved path within the walls or building pathways and not expose to greenery. Measures: Baseline and Posttest measures after 8 weeks adaptation to the exercise environment using PANAS questionnaire to record the scores of positive and negative mood effect and Mindful attention awareness scale (MAAS) to record attention awareness. The participants were made to undergo dual-task activity exercises and mindful walking in their prescribed environment during the 8 weeks of the adaptation period.
Results: The Pretest and Posttest measures have been analyzed and found that the outdoor environment has a significant influence on positive mood effect and improved attention awareness in the elderly.
Conclusion: Emotional wellbeing won’t work upon compulsion and it has to be explored to reach pleasantness.
EnglishOutdoor environment, Indoor environment, Positive mood effect, Negative mood effect, Emotional wellbeing, Mindful attention awarenessINTRODUCTION
Emotional wellbeing in the elderly is an essential track of the quality of life. The progress of any intervention depends on the mood characteristics of the participants and it spirals further accordingly. In aged elderly, it’s a major feature to be worked upon in a simple way of research. Ageing influences upon attention demands in association with cognitive function interfering with physical activity participation. It’s a common belief that a positive emotional state contributes to confidence and better physical functioning promoting well-being on the whole.1,2 Attention restoration is influenced by the individual’s adaptation to the environment as per his/her wish and positive or negative mood status gained. So, it is necessary to find out the interrelationship between attention awareness and mood status which directly influences participation in physical activity.3,4
A sensible and gradual approach whichever is suitable to the elderly will improve the quality of life. Fear of suffering cripples human beings. Any possibility of enriching happiness makes older adults smarter through positive emotions balancing personality traits. Regulation of emotions is influenced by cognitive function resulting in an optimally functional state. Emotional optimism protects older populations against permanent institutional care decreasing functional decline.5-7
Enhancing cognition maintains a balance between existential reality and psychological reality in the elderly which is possible through improving attentional awareness. Attention and Mood effect directly interferes with physical activity participation and level of performance in the elderly. Also, the personality variables of the elderly may get altered with the environmental stimulus which influences commonsense (Intelligence). The Studies on influences of mood-related life orientation and positive or negative emotion among older people on health outcomes are not common (Ble, Volpato, 2003).5 The timely mood effect and lack of attention lead to falls and injuries which is a neglected area of research. So, the purpose of this study has been designed to examine the association of Positive / Negative emotions and Mindful attention awareness in older people.
MATERIALS AND METHODS
Data was obtained from regular Screening and Counseling for Physical Activity and Mobility in Older People conducted by senior citizens survey in the area. A total of 102 physically independent elderly citizens in the age group of 65 - 75 years who were sedentary but able to move outdoors independently took part in the study. The emotion was analyzed with Positive effect and Negative effect schedule (PANAS - GEN) Questionnaire.6 Attention was assessed by the Mindful Attention Awareness Scale (MAAS).7,8 The study was carried out in Krishna Institute of Medical Sciences, Karad, (KIMS/IEC-043/2011). The study was carried out in Krishna Institute of Medical Sciences, Karad, (KIMS/IEC-043/2011). The Study design is a Pretest - Post-test design done in two groups. Group A participants have undergone mindful physical activity training in the Indoor Environment. Group B participants have undergone mindful physical activity training in the Outdoor environment. In the Outdoor exercise environment, the participants have an opportunity to expose to the green type of scenery amid trees and fields. An indoor exercise environment is a closed environment specifically not exposed to greenery.9-12
Physical activity training
Baseline and Posttest measures after 8 weeks of adaptation to the environment have been assessed and recorded as per group A and B. The participants were made to undergo dual-task activity exercises in their prescribed environment during the 8 weeks (5 days per week) of the adaptation period. Besides, they have to undergo mindful walking for 20 minutes at a comfortable pace. Dual-task activity training includes cognitive-motor task activities for 15 minutes. It includes Talking while walking for 5 minutes; following cues/light while walking for 5 minutes and Obstacle walking for 5 minutes. Warm-up and Cool down includes mindful breathing practice for 5 minutes session and free exercises of spine & extremities for 5 minutes.
RESULTS
Demographic data
A total of 102 participants were included in the study which consisted of 47 males and 57 females. Group A consisted of 23 males and 29 females. Group B consisted of 24 males and 28 females (Table 1).
The mean age in group A was 68.92±2.8 and Group B was 69.11±2.63. The unpaired t-test analysis showed that the age difference in both groups was not significant (Table 2).
Outcome Measures
The within-group analysis shows that in Group A the pre-intervention score was 27.30±3.184 and post-intervention was 29.78±3.33 which was statistically extremely significant (pEnglishhttp://ijcrr.com/abstract.php?article_id=3278http://ijcrr.com/article_html.php?did=3278
Allerhand M, Gale CR, Deary IJ. The dynamic relationship between cognitive function and positive well-being in older people: A prospective study using the English Longitudinal Study of Aging. Psychol Ageing 2014 Jun;29(2):306.
Jin C, Zheng Z, Xian W, Bai M, Jin L, Li Y, Yang X, Sheng Y, Ai W, Liu H. Gender differences in positive life orientation among the nursing home elders in China: a cross-sectional study. Arch Gerontol Geriatr 2017;72:86-90.
Cabrita M, Lamers SM, Trompetter HR, Tabak M, Vollenbroek-Hutten MM. Exploring the relation between positive emotions and the functional status of older adults living independently: a systematic review. Ageing Mental Health 2017;21(11):1121-8.
Yew SH, Lim KM, Haw YX, Gan SK. The association between perceived stress, life satisfaction, optimism, and physical health in the Singapore Asian context. Asi J Humanities Soc Sci 2015;3(1):56-66.
Barbic SP, Bartlett SJ, Mayo NE. Emotional vitality: the concept of importance for rehabilitation. Arch Phy Med Rehab 2013;94(8):1547-54.
Vera-Villarroel P, Urzua A, Jaime D, Contreras D, Zych I, Celis-Atenas K, Silva JR, Lillo S. Positive and Negative Effect Schedule (PANAS): Psychometric properties and discriminative capacity in several Chilean samples. Eval Health Prof 2019;42(4):473-97.
Schultz PP, Ryan RM. The “why, what,” and “how” of healthy self-regulation: Mindfulness and well-being from a self-determination theory perspective. In Handbook of mindfulness and self-regulation 2015 (pp. 81-94). Springer, New York, NY.
Schultz PP, Ryan RM, Niemiec CP, Legate N, Williams GC. Mindfulness, work climate, and psychological need satisfaction in employee well-being. Mindfulness 2015;6(5):971-85.
Parto M, Besharat MA. Mindfulness, psychological well-being and psychological distress in adolescents: Assessing the mediating variables and mechanisms of autonomy and self-regulation. Procedia-Social Behav Sci 2011;30:578-82.
De Vries NM, Van Ravensberg CD, Hobbelen JS, Rikkert MO, Staal JB, Nijhuis-Van der Sanden MW. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev 2012;11(1):136-49.
Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Envt Sci Tech 2011;45(5):1761-72.
Triguero-Mas M, Donaire-Gonzalez D, Seto E, Valentín A, Smith G, Martínez D, Carrasco-Turigas G, Masterson D, Van den Berg M, Ambròs A, Martínez-Íñiguez T. Living close to natural outdoor environments in four European cities: adults’ contact with the environments and physical activity. Int J Envt Res Public Health 2017;14(10):1162.
Brown DK, Barton JL, Pretty J, Gladwell VF. Walks4Work: Assessing the role of the natural environment in a workplace physical activity intervention. Scandinavian J Work Envt Health 2014;11:390-9.
Sheppard DP, Matchanova A, Sullivan KL, Kazimi SI, Woods SP. Prospective memory partially mediates the association between ageing and everyday functioning. Clin Neurops 2020;34(4):755-74.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareComparative Study of Frozen Section with Permanent Section at a Tertiary Care Centre in Southern Rajasthan
English103106Pawan NikhraEnglish Kavita GuptaEnglish Quresh BamboraEnglish Vardan MaheshwariEnglishIntroduction: Frozen section diagnosis helps the surgeon to make an intraoperative decision regarding further management. Comparison of frozen section diagnosis and final histopathology report aids in assessing the degree of diagnostic accuracy of frozen section and also helps to identify the potential pitfalls.
Objective: To assess the degree of diagnostic accuracy of frozen section in a tertiary hospital in southern Rajasthan and to identify the potential causes of the discrepancy.
Methods: In this study total 197 frozen section cases were identified in 2 years. The intraoperative consultation results were compared with final histopathology diagnosis. Data were analyzed and concordance rate, discordance rate, sensitivity and specificity were calculated.
Results: The age group of the cases received ranged from 12-80 years with a male to female ratio 1.3:1. Of the 197 cases received, the majority of intraoperative consultations were sought from the head-neck region followed by breast and ovary. The common indications for frozen sections in our hospital were margin status, primary diagnosis and lymph node status. Out of the 66 (33%) cases received for primary diagnosis, 31 (15.7%) cases were diagnosed as benign and 35 (17.7%) cases as malignant on frozen section. The frozen section report was concordant with final histopathology in 190 (96.4%) cases and was discordant in 7 (3.5%) cases with an overall diagnostic accuracy of 96.4%.
Conclusion: The frozen section diagnostic performance at our centre appears satisfactory and is comparable with most other similar studies published in the literature. Discrepancies can be prevented by acquiring prior clinical information of the cases and more accurate sampling.
EnglishFrozen section, Intraoperative consultation, Accuracy, Concordance, Permanent section, Margin assessmentIntroduction
Frozen section was first introduced by William H. Welch at John Hopkins hospital in the year 1891.1 Frozen section diagnosis has become a routine practice over the past 60 years. The principle of the frozen section is when the tissue is frozen; the water within the tissue turns into ice and acts as an embedding medium.2 Frozen section provides rapid diagnosis during surgery that allows the surgeon to make an intraoperative decision regarding further management. The intraoperative consultations are required for various reasons such as primary diagnosis (benign vs malignant), margin status, lymph node status (positive or negative for metastasis), assess adequacy for biopsy and various ancillary techniques. The frozen section should not be used for surgeon curiosity or a preliminary report to the family in the recovery room. It is important to periodically review the frozen section report and compare it with the final paraffin section report so that potential causes of error can be identified and measures can be taken to rectify them. Long term monitoring of frozen section report helps pathologist to improve the quality of reporting.
The present retrospective study aims to assess the degree of diagnostic accuracy of frozen section in a tertiary hospital in southern Rajasthan and to identify the potential causes of the discrepancy.
Materials and methods
The present study was carried out in the Department of Pathology at American International Institute of Medical Sciences, Udaipur after approval of the institutional ethical committee (AIIMSUDR/2020/IEC/03). A total of 197 cases were identified in the duration of 2 years (2017-2019). For frozen section diagnosis fresh tissue was received from operation theatre without preservative. Representative areas from the tissue were sampled and were embedded on chuck using freezing media. Sections were cut under controlled temperature in a modern cryostat machine (Yorko; YSI-121). Slides were stained by rapid haematoxylin and eosin method. The remaining tissue was fixed in 10% buffered formalin and submitted for routine paraffin sectioning. The frozen reports were compared with the final histopathology reports available. If the frozen report was in agreement with the histopathology report then was considered as concordant or else was categorised as discordant. In all the discordant cases, causes for discrepancy were noted. The number of cases deferred was also noted with the reason for deferral.
The data was then analysed using SPSS software, Version 20.0 and parameters such as accuracy, sensitivity, specificity, positive predictive value and negative predictive value were determined.
Results
In 2 years, the frozen section was performed on a total of 197 cases and was compared with the final conventional histopathology report (Figure1&2). The age group of the cases received ranged from 12 - 80 years with a male to female ratio 1.3:1. Of the 197 cases received, the majority of intraoperative consultations were sought from the head-neck region which contributed to 53.8% followed by breast (35.5%) and ovary (9.6%) (Table1). Common indications for frozen sections in our hospital were margin status (122 cases, 61.9%), primary diagnosis (66 cases, 33.5%) and lymph node status (9 cases, 4.5%). Out of the 66 (33.5%) cases received for primary diagnosis, 31(15.7%) cases were diagnosed as benign and 35 (17.7%) cases as malignant on frozen section. The frozen section report was concordant with final histopathology in 190 (96.4%) cases and was discordant in 7 (3.5%) cases (Table2) with an overall diagnostic accuracy of 96.4%. The incidence of false-positive diagnosis was 0.5% and false-negative was 3.0%. The frozen section technique in our hospital was 93.4% sensitive and 99.04 % specific with a positive predictive value of 98.8% and a negative predictive value of 94.5% (Table3). Of the two cases deferred, one was from the ovary and the other was from the oral cavity. Cause for deferral in ovary specimen was difficult interpretation due to poor morphology and freezing artefacts. Oral cavity specimen was deferred as it was sent in formalin.
Discussion
Frozen section is a well-established procedure to assist the surgeon in determining the extent of surgery. However, it is technically challenging and has sampling issues; therefore not all institutes provide the facility for the same. When done with maximum accuracy can be a boon to the surgeon. The pathologist should be aware of the limitations of frozen reporting and should not hesitate to communicate with the surgeon in case of doubt.3-5 It is better to defer reporting in a difficult situation than to commit errors. In the present study, margin status was the most common indication for frozen section followed by primary diagnosis and lymph node status. However, some studies showed that the most common indication for the frozen section was primary diagnosis.3,6,7 In our institute, we receive many head and neck malignancies in which the surgeon’s area of maximum concern is adequate margin clearance. Adequate margin clearance is necessary not only to minimise the risk of recurrence but also to decide the further radiation protocols.
The overall diagnostic accuracy in our case was 96.4% which was comparable to various other studies in which accuracy ranged from 92.0% - 98.6% (Table 4).8-10 The accuracy of frozen section in head and neck malignancies was found to be 98.1% which was equivalent to that reported by DiNardo et al(98.3%) in a series of 420 cases.11
In this study discordance rate was 3.5% in which 7 cases were incorrectly diagnosed. The false-negative diagnosis was given in 6 cases, however, one case was diagnosed false positive (Table 1). We find in literature; a discordant diagnosis rate ranging from 1.7-4.9%.12 Out of 7 discordant cases 2 were from the oral cavity, 2 were from the ovary, 2 from lymph nodes and 1 belonged to the gastrointestinal tract. The reason for discordance as either sampling error or misinterpretation (Table 2). To avoid misinterpretation, the case must be thoroughly discussed with the surgeon before surgery.11,12 The pathologist should know the clinical, biochemical and radiological parameters of the patient; so that the findings of the frozen specimen can be correlated and the correct decision can be made. In case of any discrepancy or doubt; help of co-pathologist can be sought for. To prevent sampling error more sections can be taken from the specimen. But the limitations are its effect on specimen integrity during final grossing, delay in reporting and increase in expenses. Other potential causes of error in reporting may be due to tissue sectioning and staining which depends upon the method used for freezing, type of specimens received, quality of cryostat machine used and nature of the lesion.13-15 In the present study; the prevalence of deferred diagnosis (1.0%) was comparable with other similar audits (0.09-6.7%).8 Two cases were deferred; one from oral cavity sent for margin status and other from ovary sent for primary diagnosis. The oral cavity frozen section was deferred as the specimen was sent in formalin and ovarian frozen section was deferred because of difficulty in diagnosing the nature of lesion due to poor morphology and freezing artefacts. The final paraffin diagnosis in this case was well-differentiated Sertoli Leydig cell tumour.16 Deferral rate in various centres may vary due to technical expertise, type of specimen received and diagnostic acumen of the pathologist. Other parameters such as sensitivity (93.4%), specificity (99.04%), positive predictive value (98.8%) and negative predictive value (94.5%) were consistent with similar other studies (Table3).3,16
Conclusion
Assessment of results of frozen section and final histopathology helps in monitoring the quality of the laboratory reports and also to assess the diagnostic capabilities of the pathologist. It is important to maintain the turnaround time for the frozen report which can be done by prior information of clinical details of the patient and good communication with the surgeon.
Acknowledgement:
The authors would like to thank our technicians Mr.Bhupendra Choudhary and Mr.Aziz Qureshi for good frozen sectioning and staining. The authors are also grateful to authors/editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Financial support: Nil
Conflict of interest: None declared
Englishhttp://ijcrr.com/abstract.php?article_id=3279http://ijcrr.com/article_html.php?did=3279
Phulgirkar PP, Dakhure SD. The diagnostic accuracy of frozen section compared to routine histological technique - A comparative study. Int J Sci Res 2018; 3(3):88-92.
Spencer LT, Bancroft JD. Microtomy: paraffin and frozen sections. In: Suvarna SK, Layton C, Bancroft JD. Theory and practice of histological techniques. 7th ed. Churchill Livingstone: Elsevier Health. 2012;125-138.
Hatami H, Mohsenifar ZH, Alavi SN. The diagnostic accuracy of frozen section compared to the permanent section: A single centre study in Iran. Iran J Pathol 2015; 10(4): 295-99.
Shrestha S, Lee MC, Dhakal H, Pun CB, Pradhan M, et al. Comparative study of frozen section diagnoses with histopathology. Med J NAMS 2009; 9(2):1-5.
Patil P, Shukla S, Bhake A, Hiwale K. Accuracy of frozen section analysis in correlation with surgical pathology diagnosis. Int J Res Med Sci 2015; 3:399-404.
Ackerman LV, Ramirez GA. The indications and limitations of frozen section diagnosis: A review of 1269 consecutive frozen section diagnosis. Br Med J 1959; 46(198):336-50.
Novis DA, Gephardt GN, Zarbo RJ. Inter-institutional comparison of frozen section consultation in small hospitals: a college of American Pathologists QProbes study of 18,532 frozen section consultation diagnoses in 233 small hospitals. Arch Pathol Lab Med 1996; 120(12):1087-93.
White VA, Trotter MJ. Quality assurance in anatomic pathology: Correlation of intraoperative consultation with final diagnosis in 2812 specimens. Abstract presented at the 96th annual meeting of the United States and Canadian Academy of Path. 2007.
Narang V, Goyal RC, Batta N, Garg B, Sood N. Utility of frozen section study in quality control of surgical pathology laboratory. Int J Path Res 2017; 6(2 Pt 2):467-70.
Selvakumar AS, Rajalakshmi V, Sundaram KM. Intraoperative frozen section consultation- an audit in a tertiary care hospital. Ind J Pathol Oncol 2018; 5(3):421-28.
DiNardo LJ, Lin J, Karageorge LS, Powers CN. Accuracy, utility, and cost of frozen section margins in Head and Neck cancer surgery. Laryngoscope 2000;110:1773-76.
Chbani L, Mohamed S, Harmouch T, El Fatemi H, Amarti A. Quality assessment of intraoperative frozen sections: An analysis of 261 consecutive cases in a resource-limited area: Morocco. Health Sci 2012;4(7):433-5.
Chandramouleeswari K, Yogambal M, Arunalatha P, Bose JC, Rajendran A. Frozen and paraffin sections- Comparative study highlighting the concordance and discordance rates in a tertiary care centre. J Dental Med Sci 2013; 12(5):26-30.
Mahe E, Ara S, Bishara M, Kurian A, Tauqir S, Ursani N. Intraoperative pathology consultation: error, cause and impact. Can J Surg 2013;56(3):13-8.
Patel R, Shah I, Goswami H. Correlation of Frozen section and routine histopathological findings in brain tumours. Int J Cur Res Rev 2017;9(20):35-8.
Maurya VP, Rana V, Kulhari K, Kumar P, Takkar P, Singh N. Analysis of intraoperative frozen section consultations and audit of accuracy: a two-year experience in a tertiary care multispeciality hospital in India. Int J Res Med Sci 2020;8(8):1-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareCorrelation of Body Mass Index with Lipid Profile and Estradiol in Postmenopausal Women with Type 2 Diabetes Mellitus
English107110Priya AlvaEnglish Aditi BhandaryEnglish Prajna BhandaryEnglish Pravesh HegdeEnglish Neevan D'SouzaEnglish Suchetha KumariEnglishIntroduction: The menopausal transition is a vulnerable period for developing obesity that predicts the future incident of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease. Metabolism of lipid in diabetes is affected by insulin resistance and its deficiency.
Objective: To find the correlation of body mass index with lipid profile and Estradiol in postmenopausal women with type 2 diabetes mellitus by examining the level of lipid profile and Estradiol based on BMI.
Methods: A total of 120 postmenopausal females with type 2 Diabetes Mellitus were enrolled in the study. Venous blood was taken and analysed for total cholesterol, triglycerides, HDL-C, LDL-C, fasting glucose and estradiol. The height and weight of each patient were recorded. BMI was calculated and was categorized as normal,(EnglishBMI, Estradiol, Obesity, Type 2 diabetes, Post-menopausalINTRODUCTION
Diabetes mellitus is a global leading health concern among human society associated with a higher risk of mortality and morbidity. Cardiovascular disease is known to be one of the prime sources of demise among people with diabetes because lipid metabolism in diabetes is affected both by insulin resistance and insulin deficiency resulting in dyspilidemia.1 Diabetic dyslipidemia is marked by elevated triglycerides, low-density lipoprotein, and low high-density lipoprotein. The increasing prevalence of type 2 diabetes mellitus corresponds to an increasing rate of obesity.2 According to the world health organization, obesity is defined as body mass index >30 kg/m2.3 Compared to the lean individual, epidemiological studies report that obese women (BMI200 mg/dl, high LDL-C >130 mg/dl, hypertriglyceridemia TG>150 mg/dl and HDL-C > 40 mg/dl. Total cholesterol, Triglyceride, LDL-C HDL-C Englishhttp://ijcrr.com/abstract.php?article_id=3280http://ijcrr.com/article_html.php?did=3280
Gordon L, Ragoobirsingh D, St Errol YA, Choo-Kang E, McGrowder D, Martorell E. Lipid profile of type 2 diabetic and hypertensive patients in the Jamaican population. J Lab Phys 2010; 2(1):25.
Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001 Dec;414(6865):782-7.
Heslehurst N, Sattar N, Rajasingam D, Wilkinson J, Summerbell CD, Rankin J. Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England. BMC Pregn Childbirth 2012 Dec 1;12(1):156.
Han TS, Sattar N, Lean M. Assessment of obesity and its clinical implications. BMJ 2006 Sep 28;333(7570):695-8.
Priya P, Lathif F, Raghavan V. Correlation Between Body Mass Index (BMI) and Fasting Glucose in Post-menopausal Women. Nur J Ind 2017 May 1;108(3):103.
Krauss RM, Winston M, Fletcher BJ, Grundy SM. Obesity: impact on cardiovascular disease. Circulation 1998 Oct;98(14):1472-6.
Denke MA, Sempos CT, Grundy SM. Excess body weight: an under-recognized contributor to dyslipidemia in white American women. Arch Internal Med 1994;154(4):401-10.
Who EC. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004 Jan;363(9403):157.
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health; 2002.
Dixit AK, Dey R, Suresh A, Chaudhuri S, Panda AK, Mitra A, et al. The prevalence of dyslipidemia in patients with diabetes mellitus of Ayurveda Hospital. J Diab Metab Disor 2014 Dec;13(1):58.
Hussain A, Ali I, Ijaz M, Rahim A. Correlation between hemoglobinA1c and serum lipid profile in Afghani patients with type 2 diabetes: hemoglobin A1c prognosticates dyslipidemia. Therapeutic Adv Endoc Metab 2017;8(4):51-7.
Sandhu HS, Koley S, Sandhu KS. A study of the correlation between lipid profile and body mass index (BMI) in patients with diabetes mellitus. J Hum Ecol 2008;24(3):227-9.
Omotoye FE, Fadupin GT. Effect of body mass index on the lipid profile of type 2 Diabetic patients at an urban tertiary hospital in Nigeria. IOSR-JDMS. 2016 Sep;15(9):65-70.
Shamai L, Lurix E, Shen M, Novaro GM, Szomstein S, Rosenthal R, et al. Association of body mass index and lipid profiles: evaluation of a broad spectrum of body mass index patients including the morbidly obese. Obesity Surg 2011;21(1):42-7.
Arora M, Koley S, Gupta S, Sandhu JS. A study on lipid profile and body fat in patients with diabetes mellitus. Anthropologist 2007;9(4):295-8.
Bingo B, Abebe SM, Baynes HW, Yesuf M, Alemu A, Abebe M. Correlation between serum lipid profile with anthropometric and clinical variables in patients with type 2 diabetes mellitus. Ethi J health Sci 2017;27(3):215-26.
Awa WL, Fach E, Krakow D, Welp R, Kunder J, Voll A, et al. Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120183 patients from the German/Austrian DPV database. Eur J Endocri 2012;167(2):245.
Hinge CR, Ingle SB, Adgaonkar BD. Body Mass Index, Blood Pressure and Lipid profile in type 2 diabetes-Review. Int J Cur Res Rev 2018;10(10):1.
Barton M. Obesity and aging: determinants of endothelial cell dysfunction and atherosclerosis. Pflügers Arch Eur J Phys 2010;460(5):
Judd HL, Davidson BJ, Frumar AM, Shamonki IM, Lagasse LD, Ballon SC. Serum androgens and estrogens in postmenopausal women with and without endometrial cancer. Ame J Obst and Gyne 1980;136(7):859-66.
Hankinson SE, Willett WC, Manson JE, Hunter DJ, Colditz GA, Stampfer MJ, et al. Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Nat Cancer Inst 1995;87(17):1297-302.
Mahabir S, Baer DJ, Johnson LL, Hartman TJ, Dorgan JF, Campbell WS, et al. The usefulness of body mass index as a sufficient adiposity measurement for sex hormone concentration associations in postmenopausal women. Cancer Epidemiol Prev Biomark 2006;15(12):2502-7.
Endogenous Hormones Breast Cancer Collaborative Group. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Nat Cancer Insti. 2003;95(16):1218-26.
Folkerd EJ, James VH. Aromatization of steroids in peripheral tissues. J Steroid Biochem 1983;19(1):687-90.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareHerbal Treatment Modality for Management of Leukoplakia - A Systematic Review
English111117Rakhi ChandakEnglish Vidya LoheEnglish Manoj ChandakEnglish Rahul BhowateEnglish R.S. SathawaneEnglish Romita GaikwadEnglish Dhiran TalatuleEnglish Runal BansodEnglish Pranali ThakareEnglishA systematic review was conducted using PRISMA guidelines. Studies, case series, clinical trials mentioning the treatment of leukoplakia with herbal modalities were included. Data are available on follow-ups of herbal treatment modalities for leukoplakia. 7 out of 10 studies were picked up for inclusion and were included in the systematic review. The effectiveness of various herbal treatment modalities for the management of leukoplakia was reviewed. With the help of abstracts and titles, the preliminary screening of the recovered studies was done. In studies whose results were found to be unclear, its corresponding full text was read. The studies where independently evaluated by authors and the results were discussed until a decision was made by a general agreement. 7 out of 10 studies were picked up for inclusion and were included in the systematic review. Several treatments exist for treating this “potentially malignant lesions” even including some surgical, as well as non-surgical treatment plans but the spectrum of herbal medicine surely, brings a new ray of hope. The most meritorious effect of herbal medicine is that it interacts with the specific chemical receptors within the body and has less side effect as compared to traditional medicines. Herbs are very good anti-oxidants, anti-bacterial agents, anti-inflammatory agents as well as good sedatives and anxiolytics hence play a very useful role in the treatment of oral diseases.
EnglishCurcumin, Herbal, Leukoplakia, Malignant Disorder
INTRODUCTION
Diagnosing an oral white lesion is of great skill and challenge to the Oral Health Care practitioners mainly due to the varied appearances of the white lesions. Reactive lesions, various carcinomatous lesions as well as some dysplastic lesions may play in the field of making a differential diagnosis opposite these oral white lesions. Clinicians must take great efforts in deriving a final diagnosis and to prevent time delay in treating patients with some serious lesions.1
Classi?cation of oral white lesions consisting of red-white lesions, ulcerations, pigmentations and exophytic lesions.2 Oral white lesions such as “leukoplakia, lichen planus, and proliferative verrucous leukoplakia” have a great malignant potential of as high as 0.5–100% and these white lesions constitute only 5% of all the oral white lesions.3 Therefore, the appropriate clinical diagnostic approach of the white lesion is necessary to exclude the possibility of malignancy.1 Amongst all the white lesions, oral leukoplakia secures the topper place in being the most common “potential malignant disorder” which affects the oral cavity. The etiopathogenesis of “oral leukoplakia” involves two basis - first being oral leukoplakia due to tobacco consumption while the second being of idiopathic or unknown etiopathology.3
According to literature, “oral leukoplakia” is described as a white patch or lesion that cannot be clinically or histologically attributed as a definite lesion.4,5 The prevalence rate of oral leukoplakia among the general population is reported to be 2.6% and is most commonly seen above the age of 50 years with the male predilection however a few studies do report of having a female predilection too. Approximately 16% to 62% of oral squamous carcinomas occur as a successor to a pre-existing oral leukoplakia.
Several factors such as tobacco, alcohol, sanguinary, UV radiation, trauma, betel nut use, genetic predisposition and microorganisms are known to have a strong and significant relationship with leukoplakia.5-7 Clinically it appears as a non-scrapable, irreversible and slightly raised white patch on plaque having wrinkled, leathery to having dry “Cracked mud appearance.” The “homogenous type of leukoplakia” has well-defined margins, a regular, smooth whitish surface. The “non-homogenous type of leukoplakia” occurs in various forms like nodular or erythematous, ulcerated,
erosive or verrucous exophytic component. A type of leukoplakia called the “verrucous leukoplakia” has an elevated, proliferative or a corrugated surface while the nodular type of leukoplakia develops a small polypoid enlargement or a white rounded excrescences.4,7.
The histopathologic aspects of oral leukoplakia may vary from epithelial atrophy to hyperplasia to varying degrees of epithelial dysplasia.8,9,10. High-risk lesions of oral leukoplakia are situated on the floor of the mouth, soft palate and tongue while the low-risk lesions of oral leukoplakia are situated in other areas of the oral cavity. Annual malignant transformation rate of OL has an.1% to17% .11-14 Epithelial dysplastic changes should be assessed while planning for the treatment of oral leukoplakia.
In cases of moderate or severe dysplastic changes surgery would be a treatment of choice, however lesions with a low to moderate malignant risk may or may not be removed completely but factors such as location, size, smoking habits should be taken into consideration.
Oral leukoplakia can be treated conservatively. Minimal adverse effects to patients in cases of widespread oral leukoplakia, in medically compromised patients, convenient application not requiring frequent hospital visits and low cost are some of the advantages of non-surgical modalities.8,15 Therefore this systematic review deeply describes and analyses the published data and compares the effectiveness of various herbal treatment modalities for the management of leukoplakia.
METHODOLOGY
Primary Question Of Research
Which herbal treatment modality is the most fruitful in managing leukoplakia?
GOALS
Scrutinizing the data and studies available on various herbal treatments for leukoplakia.
Extracting the most efficacious herbal treatment options for leukoplakia.
METHODS
Eligibility Criteria
Inclusion criteria
Studies, case series, clinical trials mentioning the treatment of leukoplakia with herbal modalities.
Data available on follow ups of herbal treatment modalities for leukoplakia.
Published articles from January 2005 up to 31 December 2019 searched in Pubmed.
English written literature was included. (Table 1)
Exclusion criteria
Data available in some other linguistic forms
In vitro studies, editorials, abstracts, letters, and historical reviews were excluded from the searches. (Table 1)
PICO from PICO
P – Participants: Leukoplakic participants or participants with dysplasia.
I - Intervention: Herbal treatment options.
C-Comparison between various herbal treatment options.
O - Outcomes: Decrease in the lesion size and severity of epithelial dysplasia.
Procedure
This systematic review was conducted using the PRISMA guidelines statement. All the studies were carefully chosen after reviewing all the abstracts and text as per the inclusion and exclusion criteria and are explained below. During the review process, none of the authors of the manuscript was contacted.
Search strategy
The search strategy commenced by conducting searches from PubMed / Medline, web of science and Scopus to collect and identify the studies published in English irrespective of the year of publication. Keywords such as oral leukoplakia and therapy, oral leukoplakia and herbal modality, curcumins in oral leukoplakia, oral leukoplakia and its management, oral and potentially malignant disorders were used.
RESULTS
With the help of abstracts and titles, the preliminary screening of the recovered studies was done. In studies whose results were found to be unclear, its corresponding full text was read. The studies where
independently evaluated by authors and the results were discussed until a decision was made by a general agreement. 7 out of 10 studies were picked up for inclusion and were included in the systematic review. All the details and results of the search strategy along with the efficacy of various herbal treatment modalities for the management of leukoplakia were summarised in Table 2.
DISCUSSION
Oral leukoplakia is one of the most important disorders of the oral cavity having great malignant potential. The two important etiological factors for oral leukoplakia is tobacco in smoking and smokeless form. Oral malignancy develops from “potentially malignant disorders”, so early and prompt diagnosis and treatment are required to resist their progression towards malignancy. Current non-surgical treatment modalities include cessation of tobacco chewing habit, retinoids and lycopene. Various authors have tried a variety of herbal medicines for treating oral disorders including premalignant disorders. The present study aims at analysing various herbal treatment modalities for the management of oral leukoplakia.1,2
Rai et al16 in 2010 conducted a study on 13 male patients and 12 female patients having oral leukoplakia, 11 male patients and 14 female patients having Oral Submucous Fibrosis and 13 female patients and 12 male patients having lichen planus along with 25 healthy participants who wear age between 17 years to 50 years. For the diagnosis of precancerous lesions of the oral cavity, all the Diagnostic test were thoroughly scrutinized. To ascertain the presence of systemic diseases a questionnaire-based Medical and Dental history was obtained from each subject along with the history of alcohol, smoking or drug consumption. A Caplet of 1 gm of curcumin containing curcumin (900 mg), desmethoxycurcumin (80 mg) and bisdemethoxycurcumin (20 mg ) was approved from “Sabinsa Corporation”.
Markers of oxidation like “malonaldehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), vitamin C and vitamin E” were measured in serum and saliva before the administration of curcumin, 1 week following the consumption of curcumin and once the precancerous lesions were cured clinically. It was found that the patients with “OL, oral submucous fibrosis & lichen planus” succeeding the administration of curcumin, the levels of MDA and 8-OHdG were found to be significantly decreased, while the levels of vitamin C and vitamin E were found to be increased in the saliva and serum. Statistically significant changes in the values were obtained post clinical cure of the disease and the p-value was found to be less than 0.05 (pEnglishhttp://ijcrr.com/abstract.php?article_id=3281http://ijcrr.com/article_html.php?did=3281
Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral white lesions: an updated clinical diagnostic decision tree. Dentistry J. 2019 Mar;7(1):15.
Mortazavi, H, Safi Y, Baharvand M, Rahmani S, Jafari S. Peripheral Exophytic Oral Lesions: A Clinical Decision Tree. Int. J. Dent. 2017; 9193831.
Mohammad A, Bobby J, Devipriya S. Prevalence of oral mucosal lesions in patients of the Kuwait University Dental Center. Saudi Dent J 2013; 25:111–118.
Mortazavi H, Baharvand M, Mehdipour M. Oral potentially malignant disorders: An overview of more than 20 entities. J Dent Res Dent Clin Dent Prospect 2014; 8: 6–14.
Parlatescu I, Gheorghe C, Coculescu E, Tovaru S, Oral Leukoplakia—An Update. Maedica 2014; 9: 88.
Neville B, Damm D, Allen C, Chi A. Oral and Maxillofacial Pathology, 4th ed.; Elsevier: Amsterdam, The Netherlands, 2016.
Martorell-Calatayud A, Botella-Estrada R, Bagán-Sebastián J.V, Sanmartín-Jiménez O, Guillén-Barona C. Oral leukoplakia: Clinical, histopathologic, and molecular features and therapeutic approach. Actasdermo- Sifiliográficas 2009; 100: 669–684.
Ribeiro AS, Salles PR, da Silva TA, Mesquita RA. A review of the nonsurgical treatment of oral leukoplakia. Int J Dentist 2010;21:1-10.
Van der Waal KP, Schepman EH, Van der Meij, Smeele LE. Oral leukoplakia: a clinicopathological review. Oral Oncol 1997; 33( 5): 291–301.
Neville BW, Day TA. Oral cancer and precancerous lesions. Cancer J Clin 2002;52( 4): 195–215.
Schepman KP, Van der Meij EH, Smeele LE, Van der Waal I. Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. Oral Oncol 1998;34(4):270-5.
Saito T, Sugiura C, Hirai A, Notani KI, Totsuka Y, Shindoh M, Fukuda H. Development of squamous cell carcinoma from pre-existent oral leukoplakia: concerning treatment modality. Int J Oral Maxillofac Surg 2001;30(1):49-53.
Reibel J. Prognosis of oral pre-malignant lesions: the significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med 2003;14(1):47-62.
Lodi G, Porter S. Management of potentially malignant disorders: evidence and critique. J Oral Patho Med 2008;37(2):63-9.
Epstein JB, Gorsky M, Wong FL, Millner A. Topical bleomycin for the treatment of dysplastic oral leukoplakia. Cancer: Interdisciplinary. Int J Ame Canc Soc 1998;83(4):629-34.
Rai B, Kaur J, Jacobs R, Singh J. Possible action mechanism for curcumin in pre-cancerous lesions based on serum and salivary markers of oxidative stress. J Oral Sci 2010;52(2):251-6.
Behura SS, Singh DK, Masthan KM, Babu NA, Sah S. Chemoprevention of oral cancer: a promising venture. Int J Oral Care Res 2015;3(2):80-7.
Hazzah HA, Farid RM, Nasra MM, Zakaria M, Gawish Y, El-Massik MA, Abdallah OY. A new approach for treatment of precancerous lesions with curcumin solid–lipid nanoparticle-loaded gels: in vitro and clinical evaluation. Drug Deliv 2016;23(4):1409-19.
Singh M, Bagewadi A. Comparison of effectiveness of Calendula officinalis extract gel with lycopene gel for treatment of tobacco-induced homogeneous leukoplakia: A randomized clinical trial. Int J Pharm Invest 2017;7(2):88.
Chhaparwal Y, Pai KM, Kamath MS, Carnelio S, Chhaparwal S. Efficacy and safety of tetrahydrocurcuminoid in the treatment of oral leukoplakia: a pilot study. Asian J Pharm Clin Res 2018;11(12):194-6.
Bhagat V, Arora P, Ranjan V, Rastogi T. Efficacy Of Curcumin In The Treatment Of Oral Leukoplakia-A Prospective Study. Int J Curr Med Pharm Res 2018;4(12):3959-3962.
Kapoor S, Arora P. Effect of curcumin in management of potentially Malignant disorders-A comparative study. Onkologia I Radioterapia 2019;13(1):1-4.
Patel JS, Umarji HR, Dhokar AA, Sapkal RB, Patel SG, Panda AK. Randomized controlled trial to evaluate the efficacy of oral lycopene in combination with vitamin E and selenium in the treatment of oral leukoplakia. J Indian Acad Oral Med Radiol 2014;26(4):369.
Lohe VK, Bhowate RR,. Association of Socioeconomic Risk Factor with Oral Squamous Cell Carcinoma. J Datta Meghe Inst Med Sci Uni 2016;11(2): 243-246
Lohe VK, Degwekar SS, Bhowate RR, Kadu RP, Dangore SB. Evaluation of correlation of serum lipid profile in patients with oral cancer and precancer and its association with tobacco abuse. J Oral Pathol Med 2010 Feb;39(2):141-8.
Sune RV, Indurkar AD, Bhowate RR, Degwekar SS, Lohe VK. An evaluation of field cancerization in patients with oral cancer by “Mirror Image” biopsy. Journal of Datta Meghe Institute of Medical Sciences University. 2017 Apr 1;12(2):148.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareCorrelation between Fingernail Length and Pinch Strength Among Collegiate Girls
English118120K. Jothi PrasannaEnglish S. ShivaniEnglishBackground: The effective and precise picking up of small objects is assisted by a fingernail. It plays a passive role in increasing the sensory perception at finger pulp. Pinch is a prehension pattern type. To perform a pinch involvement of two or three fingers are required where thumb plays a significant role.
Objective: The study objective was to correlate the fingernail length and pinch strength among collegiate girls.
Methods: The study design was non-experimental, study type is an observational study, the sample size is 100 subjects, college female students who are with fingernail length ranged from 0mm to 2mm were included. The subjects fingernail is measured using vernier calliper and the pinch strength is measured using pinch gauge.
Results: The result shows that there is a significant negative correlation between pinch strength and fingernail length (p< 0.01).
Conclusion: This study has concluded that the pinch strength decreases as the fingernail length increases.
EnglishFingernail length, Pinch strength, Collegiate girlsINTRODUCTION
Hand helps a person to participate and perform various activities and occupation needed for daily life.1 Hand function is done by the action of individual muscles and also by the different movements that take place in the joints. The closing, opening or cupping action of the hand in selected postures such as pinch or hook produces prehension activities.2 Pad-pad prehension, tip-tip prehension and pad-side prehension are the types of prehension handling2. To perform a pinch, the involvement of two or three fingers is required. During pinch strength, the force exerted by the fingers is measured. Thumb plays a significant role in the contribution of the pinch function of the hand. Palmar (three-point) pinch, lateral (key) pinch and tip pinch are the types of pinches. Tip pinch is a type of pinch which involves thumb and index finger. The tip of the thumb meets the tip of the index finger during tip pinch. Palmar pinch involves thumb, index and middle fingers. Lateral pinch is a type of pinch which involves thumb pad and lateral aspect of index finger.1 Average pinch strength among 20-24 years: 1.Tip pinch: right – 11.1 pounds left - 10.5 pounds 2. Lateral pinch: right – 17.6 pounds left – 16.2 pound 3.Palmar pinch: right – 17.2 pounds left – 16.3 pounds.3 Pinch strength is usually assessed using pinch gauge.1 Fingernail has a passive role to increase the perception of sensation at the pulp of the fingers when necessary counter-pressure necessary amount counter pressure is contributed for constriction of sensory end organ which is present between fingernail and palmar skin. It helps in effective and precise picking up of small objects.4,5
MATERIALS AND METHOD
Vernier calliper and pinch gauge were used in this study. Informed consent was obtained from the subjects. The subjects were selected based on the inclusion and exclusion criteria. The procedure was clearly explained to each individual. The distance from the groove present at the junction of the proximal nail fold and eponychium to the tip of the fingers is defined as the fingernail length. The length from the fingertip to the fingernail tip is considered as fingernail length and it can be ranged from 0 mm to 2 mm. The length was measured using Vernier calliper. The subjects were asked to adduct their shoulders and flex their elbow to 90 degrees and they were seated comfortably. The subjects were informed which of three pinch grip should be performed first. The distal portion of the pinch gauge was held by the subjects to maintain the steadiness. Three consecutive trials of each pinch grip were performed. The subject was given rest in between the trials for accuracy. After each trial, the score of the pinch is recorded. The averages of three scores have been recorded.
RESULTS AND DISCUSSION
The result shows that there is a significant negative correlation between pinch strength and fingernail length.(p< 0.01). Normally the pinch strength is affected by long nails, infection or fingernail due to any disease, loss of sensation due to any neuropathy and any deformities of hand and fingers caused by trauma, injuries and musculoskeletal disorders. Hence the purpose of this study is to find the correlation between fingernail length and pinch strength. Usually, long fingernails are grown by college girls. So, 100 subjects of college girls were selected to participate and their fingernail length was measured. Subjects with 0-2mm of fingernail were included in this study (Figure 1-4). Tip, palmar and lateral pinch strength were measured in these subjects. Tip pinch strength is less when compared with the other two pinches. It is due to the involvement of the tip of fingers which performs the pinch. Palmar pinch strength is less when compared with a lateral pinch as the pulp of the fingers is involved. Lateral pinch strength is more when compared with the other two pinch strength. A finger pad is involved in the performance of the pinch. The result shows a negative correlation between the fingernail length and pinch strength. As the length of the fingernail increases the pinch strength decreases. The table shows that there is a significant negative correlation between the fingernail length and pinch strength (pEnglishhttp://ijcrr.com/abstract.php?article_id=3282http://ijcrr.com/article_html.php?did=3282
Walukonis K, Beasley J, Boerema R, Powers J, Anderson K. Impact of Finger Position on Pinch Strength. Hand Ther Outcome Meas 2018;23(2):70-76.
Napier JR. The prehensile movements of the human hand. The Journal of bone and joint surgery. J Bone Joint Surg Br 1956Nov;38(4):902-13.
Levangie PK, Norkin CC. Joint Structure and function: a comprehensive analysis. 3rd. Philadelphia: FA. Davis Company. 2000.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985;66(2):69-7
Shirato R, Abe A, Tsuchiya H, Honda M. Effect of fingernail length on the hand dexterity. J Physic Ther Sci 2017;29(11):1914-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareKnowledge and Attitude About Organ Donation Among Medical Students: An Observational Study from Aurangabad, Maharashtra
English121124Savita KadamEnglish Smita ShindeEnglish Gautam ShroffEnglish Suvarna GulanikarEnglishIntroduction: Organ donation is life-saving for patients with end-organ failure but unfortunately organs are not available for transplantation due to poor knowledge, attitude, myths and misconceptions towards organ donation. Shortage of organ donation can be solved by increasing awareness regarding organ donation. The present study was conducted in M.G.M. Medical College, Aurangabad, Maharashtra to assess the knowledge and attitude of first-year medical students towards organ donation.
Objectives: To study the knowledge & attitude of first-year medical students towards organ donation. To identify the areas where knowledge was lacking & augmenting the knowledge of that area.
Methods: A cross-sectional study was conducted at M.G.M. Medical College, Aurangabad, Maharashtra by distributing the self–structured questionnaire to first-year medical students. The data was collected and analyzed statistically after the approval of the Ethics Committee for Research on Human Subjects (MGM-ECRHS/2020).
Results: 130 students had participated in this study after taking informed verbal consent. 98.46% of students knew about organ donation. 53.84% claimed the source of information about organ donation as television and internet while 70.76% claimed as discussion in medical college and 20% as radio. The awareness regarding eye, kidney, skin, heart and liver was 86.92%, 86%, 72.30%, 72.30% and 72.30% respectively.92.30% of students were aware of laws regarding organ donation.
Conclusion: Medical students had a high level of awareness and a positive attitude towards organ donation. However to have in-depth knowledge ‘organ donation and transplantation’ must be included in the medical curriculum.
EnglishAwareness, Donor, Transplantation, Dialysis, Brain deathINTRODUCTION
Organ donation is the donation of biological tissue or an organ of the human body from a leaving or dead person to a living recipient in need of transplantation.1 The transplanted organ or tissue may be obtained from patient himself (autograft) or another person (allograft) or any animal (xenograft). The organ donation rate of India is 0.26 per million is poor as compared with America 26, Sweden 35.3 and Groatia 36-5 per million. Organ transplantation is the only treatment for the patient with end-stage organ failure. Many organs of our body can be transplanted such as kidney, cornea, liver, heart, lung, skin, intestine, bone marrow, ligaments. At least seven lives can be saved if one person donates all his organs after death but unfortunately, lakhs of people die waiting for an organ in our country.2
In India, almost 500,000 people die every year due to non-availability of organs. Annually 175,000 kidney patients, 50,000 heart patients, 50,000 liver patients & 1 lakh corneal blind patients await transplant but only 5000, 30, 700 & 25,000 donors are available.3 It is estimated that 1.5 lakh brain deaths occur due to RTA (road traffic accident) & if even 20% of them able to donate, all requirements for organ transplantation in our country would be fulfilled.3 In India 9.5 million deaths occur annually, nearly 100000 deaths are mainly due to organ failure.4
In India awareness of organ donation is very less and hence many people on the transplant waiting list die before the organ is available. The major concerns causing organ shortage in the country are lack of awareness and correct knowledge among public, myths and misconception clouding organ donation due to religious and cultural barriers, etc.5
For chronic kindly disease, dialysis is optional for renal transplant therapy for a short period but liver and cardiac failure patients do not have replacement therapy. Therefore awareness of organ donation is a must. Knowledge & attitude of health care providers for organ donation plays a major role in promoting concept among the population. Medical students are our future doctors hence they are used for promotion of organ donation with correct knowledge. The present study was done to assess the knowledge and attitude of first-year medical students of our college about organ donation.
MATERIALS AND METHODS
A cross-sectional study was undertaken to ascertain the knowledge and attitude of first-year medical students of MGM Medical College. Aurangabad, Maharashtra, about organ donation after taking Ethical committee approval. A self-structured questionnaire was distributed to 130 medical students after taking informed verbal consent. The detailed explanation of all objectives was given to them. Students were also aware of maintaining anonymity and confidentiality. They were also explained that some questions have multiple choices so that they can correct more than one options.
The questionnaire was divided into three parts First part was related to demographic information of respondents. The second part was related to knowledge of respondents towards organ donation and the third part was related with the attitude of the respondent towards organ donation.
Students were strictly instructed that they should solve questionnaire without discussion among themselves. Data were collected and entered in MS Excel sheet and analyzed.
RESULTS
The study was conducted on 130 first-year students of M.G.M. Medical College, Aurangabad, Maharashtra in March 2020. The study population consisted of 70(53.84%) males and 63(46.16%) females. All of them were unmarried and between the age group of 18-21 years. Most of them were of Hindu religion. Very few students had not attempted all questions (Figure 1).
The students had multiple sources of information about organ donation like Television (53.84%), Radio (20%), internet (53.84%), and medical college (70.76%) (Figure 2).
Only 56.92% of respondents were aware that organs can be donated after the age of 18 years (Figure 3).
Most of the students (98.46%) were aware of organ donation. They were aware of possible organs to be donated and who can be a possible donor (Figure 4). They have poor knowledge about contraindications of organ donation; only 20.76% students knew that HBsAg (Blood test for active or chronic Hepatitis B diagnosis) positive patients cannot donate their organs whereas 66.92 % students were aware that HIV positive patients cannot donate their organs. 41.53% of students knew that cancer is a contraindication of organ donation. Most of them knew that consent is required for donation of organs both in living donor and after death 84.61% and 86.15% respectively. Respondents were having poor knowledge about the decision of organ donation of unclaimed bodies. According to 60.76% students, doctors from medical college can decide on organ donation of unclaimed bodies followed by a judge (26.92%), police (8.4%) and charitable organization (3.92%).
Knowledge regarding checking of compatibility between donor and recipient was fairly good (96.92%) among respondents whereas knowledge regarding the storage of harvested organ was very poor (56.15%) (Figure 7). Only 46.15 students knew about how to register for organ donation. It was very amazing finding that 73.07% of students were against displaying willingness of organ donation on driving licenses. The reason is ambiguous. 66.92% of respondents were aware of the National Network for organ donation which is present in Aurangabad, Maharashtra. 88.40% respondents also knew that a single donor can donate its organ to multiple donors and 93.20% knew that there are laws for organ donation.
We found that 98% participants had supported organ donation and 67% had a positive attitude towards organ donation and they were willing to donate their organs not only to family members but also to anybody in need. However, 92.30% of students were willing to donate organs to their family only. 88.46% of respondents were ready to motivate their family and friends (Figure 6).
DISCUSSION
Due to the poor rate of organ donation, there is the shortage of organs which limits transplantation programs especially in India where organ donation rate is very low i.e. 0.16 donor per million populations. This is because of lack of knowledge and myths and misconceptions about organ donation. This study was carried out to investigate the knowledge and attitude of medical students towards organ donation.
It was observed that awareness regarding organ donation was 98.48% in our first-year students which is almost equal (98.70%) to students of D.Y. Patil Medical College Pimpri, Pune as studied by Bharambe et al.6 From this, we can conclude that medical students have high awareness regarding organ donation. In our study, it was found that discussion at medical college about organ donation is the main source (70.76%) of organ donation followed by television (53.84%), internet (53.84%) and radio (20%) whereas, in the study done by Bilgel et al.7 only 28.1% students got information about organ donation in medical college, 34.4% from the newspaper, 40.6% from television, 11% from internet and 12.5% got information apart from these sources. Thus, it appears that knowledge of organ donation is enhanced in medical colleges and television and internet are also important sources of promotion of organ donation.
In present study, high level of awareness was observed regarding donation of eye(86.92%),kidney(85.24%),heart(72.30%),liver(72.30%)and skin(72.30%) but low levels(Englishhttp://ijcrr.com/abstract.php?article_id=3283http://ijcrr.com/article_html.php?did=3283
Giri PA, Yuvaraj BY, Kamble MG, Amarnath B. Solepure .Organ donation and transplantation: knowledge and attitude amongst
Indian undergraduate medical students. Int J Community Med Public Health 2017;4(11):4303-4306.
Shireen N, Ansari MW, Indupalli AS, Selladurai S, Reddy SS. Knowledge and Attitude about Organ Donation and Transplantation among Students of a Medical College in Kalaburagi. Int J Community Med 2018; 9(4): 278-282.
Apoorva Sindhu, T. S. Ramakrishnan, Anurag Khera, Gurpreet Singh. A Study to Assess the Knowledge of Medical Students Regarding Organ Donation in a Selected College of Western Maharashtra. Med J Dr DY Patil Uni 2017;10(4): 349-353.
Chakradhar K, Doshi D, Reddy BS, Kulkarni S, Reddy MP, Reddy SS. Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students. Int J Organ Transplant Med 2016; 7(1): 28–35.
GS Adithyan1, M Mariappan2, KB Nayana3 A study on knowledge and attitude about organ donation among medical students in Kerala. Ind J Transpl 2017;11(3):133-137.
Vaishaly K. Rathod H, Paranjape VM, Kanaskar N, Shevade S, Survase K, Arole V. Awareness regarding body and organ donation amongst the population of an urban city in India. Nitte University J Health Sci 2015;5(4): 51-57.
Bilgel H, Sadikoglu G, Bilgel N. Knowledge and Attitude about Organ Donation among Medical Students. Tx Med 2006;8:91-96.
Annadurai K, Mani K, Ramasamy J. A study of knowledge, attitude and practices about organ donation among college students in Chennai, Tamilnadu-2012. Prog Health Sci 2013;3(2): 59-65.
Prasanna Mithra1, Prithvishree Ravindra1, B Unnikrishnan1, T Rekha1, Tanuj Kanchan2, Nithin Kumar1, Mohan Papanna1, Vaman Kulkarni1, Ramesh Holla1, K Divyavaraprasad1.Perceptions and attitudes towards organ donation among people seeking healthcare in tertiary care centres of coastal south India. Ind J Palliative Care. 2013;19( 2): 83-87.
Bharambe VK, Rathod H, Angadi K. Knowledge and Attitude Regarding Organ Donation among Medical Students. BANTAO J 2016; 14(1): 34-40.
Sahana BN, Sangeeta M. Knowledge, attitude and practices of medical students regarding organ donation. Int J Curr Res Rev 2015;7(16):74-77.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareCompare Constraint-Induced Movement Therapy and Bobath to improve Hand functions in Hemiplegic Patients
English125130Sugasri Suresh KumarEnglish K. Senthil KumarEnglishIntroduction: With changes in techniques to treat hand functions in hemiplegic patients, both Constraint-Induced Movement Therapy (CIMT) where an unaffected hand is restrained from its use & Bobath where an unaffected hand is unrestrained are proved to be beneficial individually.
Objcetive: To compare both & to implement the better one for a speedy recovery.
Methods: Participants aged above 50, with Brainstorm stage of hand 2 and above were randomly divided into CIMT(n=10) and Bobath (n=10), the treatment being given for 30 min/day for the first 2 weeks, then 3 times/week for consecutive 10 weeks. Bobath includes Affected side weight-bearing, Bilateral Activity encouragement, Auto inhibition, Active wrist extension emphasizing MCP flexion, thumb abduction, Active finger extension by sweep tapping forearm dorsum, by withdrawing bottle brush from hand, transferring various shaped objects from sound to affected hand, Power grasps followed by prehension and repetition of tasks. CIMT includes the same as above but restraining the affected upper limb with a sling is worn 3 hours priorly avoiding bilateral activity. Fugl Meyer Assessment is used to measure hand functions, Functional Independence Measure (FIM) scale is used to measure ADL.
Results: Paired t-test showed an improvement, Independent t showed a difference in improvement between 2 groups. Percentage of difference between pretest (day1), posttest (day 60) showed increased improvement in hand functions and ADL in CIMT than Bobath.
Conclusion: Previous studies show CIMT & Bobath to be successful. The results of this study show CIMT is superior to Bobath in improving hand functions in Hemiplegics.
EnglishCIMT, Bobath, Hand Functions, Fugl Meyer Assessment, MCP- Metacarpophalangeal joint, ADL-Activities of daily livingINTRODUCTION
In recent years frequency of Stroke which is found to be the leading cause of disability in Society has started to decline as more is known about the causative factors and by early detection. Hence certain measures of prophylaxis are possible. In the Rehabilitation point of view, therapists expect nearly 90-95% of the recovery in the lower limb, and in upper limbs especially the hands take a longer duration to recover.1-3 Hand functions that are very much essential during the patient's everyday activities need to be emphasized. Stroke is a disabling neurological condition resulting due to disruption of blood supply to the brain. It is classified according to pathology as Thrombotic, Embolic & Hemorrhagic.4,5 It is noted that 70% of strokes are due to ischemia, 20% due to haemorrhage and 10% have an unspecified origin. Post Stroke Functional recovery is prolonged than Motor recovery.3,6,7 Hands become discarded as useless tools, unlike lower extremity which has to be activated with every step the patient takes. It could be postulated that this is the reason why sensation in the leg tends to improve, while that in hand remains more impaired.8 Distributed CIMT is a promising intervention for improving motor function and quality of life in chronic stroke patients which involves training for 3 hours/ day for 20 days and restraint of another arm for 9 hours. This intervention provides the same amount of training as provided in conventional CIMT protocol (60 hours) but distributes training time over twice the no of days.9 From the above studies, CIMT that involves restraining unaffected hand during treatment, and Bobath which doesn’t involve restraining unaffected hand are found to be effective individually. Hence the purpose of the study is to measure and compare the functional changes when treated with both CIMT and Bobath concepts and to find which one is more effective to be applied in clinical practice for the speedy recovery of hand.10,11
MATERIALS AND METHODS
Twenty participants are recruited from Kovai Medical Centre Hospital, Coimbatore. Inclusion criteria being Age group above 50 years, Within 3 months from the onset of stroke, Involvement of middle cerebral artery, Independent in ADL before the stroke, Brunstorm stage of hand 2 (or) above. Exclusion criteria being Age group less than 50 years, Patients with subluxation of shoulder, Involvement of anterior cerebral artery, Dependent in ADL before the stroke, impaired cognition. The participants are randomly divided into 2 Experimental Groups. Group I consisting of 10 participants are treated with CIMT Technique. Group II consisting of 10 participants is treated with Bobath Technique. The techniques applied are as follows.
BOBATH
Normalization of tone
a) Weight bearing over affected side: sitting in a couch with the elbow extended, wrist extended and hand placed several inches away from hip.4
b) Auto inhibition: Sitting - keeping affected hand flat on the table, the position of the hand on the table is marked with chalk and allowing to do activities in unaffected hand like writing, painting, etc.,3
c) Placing in mixture of ice3
To improve extension of wrist
a) Positioning in bed: Lying on the affected side- the hand is placed below pillow.3
b) Grip used by therapist: Sitting in stool - Shoulder abducted, elbow extended, therapist holding fingers in extension with one hand and holding thumb with other hand assisting in the extension of wrist3. Sitting - forearm held by therapist, encouraging to do the extension of the wrist with an extended elbow, then with a flexed elbow.
c) Bilateral activity encouragement: Sitting with both hands clasped together placed on a table, pushing a ball or some other object.12,13
To improve extension of wrist with flexion of MCP and abduction of thumb
a). Supine with assistance from the therapist.
b). Standing near the edge of the table with the elbow extended (actively done)2,13
To improve finger extension
Sweep tapping on the dorsum of the forearm. Give a bottle brush to hold and then withdraw.
To improve sense of discrimination
Picking up objects with sound hand and transferring to the affected side (Various sized and shaped objects)
To encourage independence in ADL
a) Facilitation of slow controlled movements- When attempting with any task patient is encouraged to do slowly) (as quick movements increase the flexor synergy in hand).
b) Encouraging easy tasks to be performed like holding a tumbler, rod, ball, etc., which involves power grasp. Later, a task involving prehension activities are encouraged by the use of a spoon, coins, etc. (Repetition of the task is emphasized).
c) Dressing, brushing, eating, etc., is encouraged only by sitting in an upright chair. (Visual stimuli to make aware of the affected limb)14
CIMT
The unaffected limb is restrained from helping the affected limb for the reduction of "Learned nonuse". The sling used to restrain the unaffected limb is worn 3 hours before the treatment session.15
Normalization of tone:
By weight-bearing over the affected side
To improve extension of wrist
Positioning in bed, grip used by Therapist
To improve wrist extension with flexion of MCP and abduction of thumb: By assistance from the therapist & actively done
To improve wrist extension of fingers: Sweep tapping on the dorsum of the forearm, Give a bottle brush to hold, and then withdraw.
Encouraging independence in ADL: Only with the affected hand.16,17
DURATION OF TREATMENT
For the first 2 weeks, treatment is given for 30 minutes daily (1 session). For the consecutive 10 weeks treatment is given for 30 minutes, thrice in one week. (1 Session) - O.P basis.
EVALUATION TOOLS
1. FUGL MEYER Assessment- To determine improvement in functions.18,19 Mass flexion, Mass extension, Grasp A - Distal finger grasp
Grasp B - Thumb adduction grasp, Grasp C - Thumb to index finger grasp,
Grasp D - Cylindrical grasp, Grasp E - Spherical grasp.
SCORES: 0 - Cannot be performed, 1 - Detail partly performed, 2 - Detail performed faultlessly.
2) FIM SCALE - To Determine improvements in ADL20
SELF SCORE: Eating, Bathing, Dressing- upper and lower body Toileting TRANSFERS: Bed, Chair, Toilet, Tub / Shower
SCORES: 1- Total assistance, 2- Maximal assistance, 3- Moderate assistance,
4-Minimal assistance, 5- Supervision, 6- Modified independence, 7- Complete independence.
Pretest-Posttest Experimental Study Design is implemented. Pretest values and Posttest values are noted on Day1 and Day60 respectively by administering Fugl Meyer Assessment and FIM Scale.21,22
STATISTICAL ANALYSIS
The changes within both groups I &II for the variables Mass Flexion, Extension, Grasps & ADL were analyzed using an Independent –t-test at a 5% level of significance, the difference among the 2 groups for the same variables are analyzed using paired-test at 5% level of significance and Rate of progression between Day1 &60 are given by
X1 – X2 x 100 X2
Where X1 and X2 are pretest and posttest mean values respectively.
RESULTS
Pre-test & Post-test values of the variables Mass Flexion, Extension, Grasps & ADL measured in Group I is shown in Table 1 & the values of the same variables measured in Group II are shown in Table 2. Improvement in the variables is shown by Table 3 & is graphically depicted in Fig.1 for Group I, by Table 4 & is graphically depicted in Fig.2 for Group II. The significant difference between both the groups by Table 5. Group I ‘s progression is given in Table 6. These values are more when compared with Group II ‘s progression given by Table 7.
DISCUSSION
The results obtained show that there is a 9% increase in the rate of progression in mass flexion and extension, a 12.2% increase in grasps, and a 2% increase in activities of daily living in group I than in group II comparatively. Bobath is found to be useful since Affolter(1981) says that the only sensory modality that can activate directly in the tactile-kinesthetic system that builds up cognitive & emotional experiences.4,8,12 Improved sensory feedback creates a shift in the balance of intracortical networks towards that particular body part that is represented by relative enlargement of cortical sensory-motor representation which is the key concept in putting into use the affected limb as seen in CIMT.16-17
RECOMMENDATIONS
This study measures improvement in hand functions in terms of mass flexion, extension, and grasps, further studies measuring the improvement in individual ROM of finger joints can be done. Measuring specific subscales of FIM like Self score or transfers could be considered.
CONCLUSION
Improvements in ADL & hand functions are evident with both techniques by Statistical analysis and comparatively, CIMT is found to be more Superior to bobath which is shown by an increased percentage of progression. Hence it can be concluded that CIMT can be incorporated to treat hemiplegic patients & bring early recovery of hand functions & to reduce their disablement and handicap in the society.
ACKNOWLEDGEMENT:
The author acknowledges her project guide Mr. Senthil Kumar who has shared his energy, time, ideas & her Research Professor Mr.G.Venugopal for letting know the intricacies of Biostatistics.
CONFLICT OF INTEREST:
None.
FINANCIAL FUNDING:
None
Englishhttp://ijcrr.com/abstract.php?article_id=3284http://ijcrr.com/article_html.php?did=32841. Asanuma C. Mapping movements within a moving motor map. Trends Neurosci 1991;14(6):217.
2. Bach-y-Rita P. Receptor plasticity and volume transmission in the brain: emerging concepts with relevance to neurologic rehabilitation. J Neurol Rehabil 1990;4(3):121-8.
3. Warlow CP. Epidemiology of stroke. Lancet 1998 Oct 1;352: S1-4.
4. Ryerson SD. Hemiplegia resulting from vascular insult or disease. Umphred DA (ed), Neurol Rehabil 1985;15:622-9.
5. Kakkad A, Rathod PV. Relationship & Comparison between Post-Stroke Motor Recovery and Functional Recovery–An Observational Study. Int J Cur Res Rev 2019; 11(01):6.
6. Black-Schaffer RM, Kirstein's AE, Harvey RL. Co-morbidities and complications. Arch Physical Rehabil 1999;80(5): S8-16.
7. Brock KA, Goldie PA, Greenwood KM. Evaluating the effectiveness of stroke rehabilitation: choosing a discriminative measure. Arch Phys Med Rehab 2002;83(1):92-9.
8. Taub E, Crago JE, Uswatte G. Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation. Rehabil Psychol 1998;43(2):152.
9. Cai Y, Zhang CS, Ouyang W, Li J, Nong W, Zhang AL, Xue CC, Wen Z. Electroacupuncture for poststroke spasticity (EAPSS): protocol for a randomized controlled trial. BMJ Open 2018;8(2).
10. Dettmers C, Teske U, Hamzei F, Uswatte G, Taub E, Weiller C. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phy Med Rehab 2005;86(2):204-9.
11. Dijkers MP, Yavuzer G. Short versions of the telephone motor Functional Independence Measure for use with persons with spinal cord injury. Arch Phy Med Rehab 1999;80(11):1477-84.
12. Meyer-Wahl R, Dettmers C. Outpatient rehabilitation—two years’ experience in the Neurological Rehabilitation Centre Hamburg. Neurol Rehabil 2002;8:128-37.
13. Goble DJ. The potential for utilizing inter-limb coupling in the rehabilitation of upper limb motor disability due to unilateral brain injury. Dis Rehab 2006;28(18):1103-8.
14. Hummelsheim H, Münch B, Bütefisch C, Neumann S. Influence of sustained stretch on late muscular responses to magnetic brain stimulation in patients with upper motor neuron lesions. Scandin J Rehabil Med 1994;26(1):3.
15. Taub E, Morris DM. Constraint-induced movement therapy to enhance recovery after stroke. Curr Ather Rep 2001;3(4):279-86.
16. Lister MJ. Contemporary management of motor control problems: proceedings of the II STEP conference. Found Physical; 1991.
17. Manning J. Facilitation of movement--the Bobath approach. Physiotherapy 1972;58(12):40.
18. Smith M. Neurological Rehabilitation: Optimising Motor Performance Physiother Can 2015 Spring; 67(2): 215–216.
19. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychological bull 1979 Mar;86(2):420.
20. Taub E, Miller NE, Novack TA, Cook EW, Fleming WC, Nepomuceno CS, et al. The technique to improve chronic motor deficit after stroke. Arch Phy Med Rehab 1993 Apr 1;74(4):347-54.
21. Winstein CJ, Miller JP, Blanton S, Taub E, Uswatte G, Morris D, et al. Methods for a multisite randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabil Neur Repair 2003 Sep;17(3):137-52.
22. Wolf SL, Lecraw DE, Barton LA, Jann BB. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Expt Neur 1989;104(2):125-32.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareHung Up Reflex, Clincher to Hypothyroidism - A Case Report
English131133Lohiya ShamEnglish Damke SachinEnglish Chaudhary RichaEnglishIntroduction: Acquired Hypothyroidism is the most common endocrine abnormality in paediatrics. Clinical features are weight gain, constipation, cold intolerance.
Case Report: 10-year-old female child presented to the out-patient department with complaints of intermittent swelling all over the body which used to subside on its own in a week.
Result: On examination, bradycardia, decreased height velocity, hung up reflex. We describe a case of hypothyroidism suspected based on hung up reflex in knee jerk.
Conclusion: From the case report, it appears that we can monitor response to treatment by observing improvement in relaxation time of deep tendon reflex in addition to pulse rate, stool frequency and general well-being.
EnglishHypothyroidism, Hung up reflex, BradycardiaIntroduction
Hypothyroidism in paediatrics is usually diagnosed by the presence of typical symptoms like decreased activity, constipation, decreasing school performance. On examination, there is bradycardia, decreased growth velocity, sometimes goitre. Hung up reflex or woltman sign is not a common presentation but a very specific one. Hung up reflex (also called as Woltman sign or, myxedema reflex) is increased relaxation time of elicited deep tendon reflex. It is generally seen in ankle jerk. It is named after Henry Woltman, an American neurologist1. Here we present a case of hypothyroidism with a complaint not corroborative with the diagnosis. It was mainly suspected based on one clinical finding of hung up reflex. Also, videos show improvement in relaxation time of deep tendon reflex after starting thyroxine.
Case report
The 10-year-old female child presented to the out-patient department with complaints of intermittent swelling all over the body which used to subside on its own in a week. There was no other complaint. On examination, she was noted to have a height of 112 cm which was less than 3rd centile on Indian Academy of Pediatrics growth chart 2015. Her pulse rate was 72 per min but was relatively low volume pulse. On further examination her skin was dry. Her systemic examination was normal except in the central nervous system, deep tendon reflexes (DTRs) examination; slow relaxation was seen i.e. hung up reflex in knee jerk. Her higher mental function and intelligence quotient (I.Q.) appeared to be normal for her age. Based on clinical examination her thyroid function test was sent which showed Thyroid-stimulating hormone (TSH) to be more than 100 µIU/ml T4 1.83µg/dl (Figure 1). The patient was started on thyroxine 5µg/kg/day. On day 4 of starting thyroxine, there was an improvement in relaxation time in DTRs.
Discussion
Hypothyroidism is the most common endocrine abnormality in the pediatric age group. From different types of hypothyroidism, congenital hypothyroidism is very crucial. Timely and appropriate therapy in congenital hypothyroidism can prevent brain damage and can salvage patient’s I.Q. Congenital hypothyroidism is common in India with the frequency of it being 1 out of 2640 neonates. It is more common in India when compared with the worldwide incidence of 1 in 3800 newborns. Hypothyroidism occurs in pediatric age group too where it is mostly secondary to thyroiditis.1,2 In a clinic-based study from Mumbai, 800 children with thyroid disease were studied. Out of these, 79% of kids had hypothyroidism. Thyroid dysgenesis, dys-hormonogenesis, and thyroiditis were common causes of hypothyroidism.2 Also, there is a high prevalence of thyroid disorders in reproductive age group.6 The presence of goitre is one of the main complaints in hypothyroidism in the pediatric age group. Signs of hypothyroidism are: dull facies, stunted growth, disproportionate short structure, relative bradycardia, excess weight gain, coarse dry skin, carotenemia, hung up reflex (though not commonly seen in pediatric age group, maybe because it is generally overlooked ), goitre formation and myxedema.
Hung up reflex (Woltman sign) can be elicited in about 75% of cases of hypothyroidism patients though incidence in pediatric patients per se is unknown. It has a high positive predictive value of 92% for hypothyroidism.1 It is best seen in ankle jerk.3 In the normal individual, the relaxation time of deep tendon reflex is 240–320 ms. Time taken for relaxation of deep tendon reflex tends to correlate with the severity of hypothyroidism. The step which affects the time for muscle relaxation is reuptake of calcium by the sarcoplasmic reticulum. This step is dependent on the calcium ATPase activity of the muscle fibre. Calcium adenyl pyrophosphatase (ATPase) activity of a fast-twitch variety of muscle fibre is decreased in hypothyroidism causing delayed relaxation, the hung up reflex.4 Hung-up Knee jerk reflex (HUKJR) is a classical clinical sign specific for Huntington’s disease that can be observed along the disease course.5
In our case, hypothyroidism was suspected based on pulse and hung up reflex only, as there were no characteristic complaints of hypothyroidism. She was already worked up for nephrotic syndrome in previous hospital visits to another hospital. Hung reflex was checked in all upper and lower limb reflexes, but was most prominent in knee jerk, which is again different from previous literature. Any particular reason for this finding is not present as per our view. Hence we want to emphasize the importance of checking DTRs in suspected hypothyroidism or for that reason in any case.6 To best of our knowledge, this is a first pediatric case report with video of hung up reflex in hypothyroidism with improvement in relaxation time with treatment as early as day 4.
Conclusion
In this case, hypothyroidism was suspected mainly based on DTRs. DTRs is generally overlooked in the pediatric examination. Hence it is recommended to do a complete physical examination irrespective of complaints. Also from case report, it appears that we can monitor response to treatment by observing improvement in relaxation time of deep tendon reflex in addition to pulse rate, stool frequency and general well-being.
Acknowledgement-
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/ editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of interest: None.
Financial support: None.
Englishhttp://ijcrr.com/abstract.php?article_id=3285http://ijcrr.com/article_html.php?did=3285
Houston CS. The diagnostic importance of the myxoedema reflex (Woltman's sign). CMAJ 1958;78:108-12.
Desai PM. Disorders of the Thyroid Gland in India. Indian J Pediatr 1997;64:11-20.
Zulewski H, Müller B, Exer P, Miserez A, Staub J. Estimation of tissue hypothyroidism by a new clinical score. Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82:771-6.
Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatr 2000;68:750-5.
Perez-Perez J, Diaz-Manera J, Pagonabarraga J, Martinez-Horta S, Carceller M, Horta A, et al. Hung up knee jerk reflex in Huntington’s disease: A clinical and neurophysiological study. Mov Disord 2017; 32.
Poonam Arora, Smita Prasad, Busi Karunanand. Hospital Based Study Of Thyroid Disorders In Rural Population Of Gurgaon, Haryana. Int J Curr Res Rev 2020;8(21):6-11.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareAyurvedic Immuno Booster: Is it Myth or Reality in COVID-19 Pandemic
English134140Ashok Kumar PandaEnglish Sarbeswar KarEnglishAyurveda Immune boosters (AIB) are Rasayana drugs which increase the number of white blood cells and train them to fight against microbes causing diseases. Some of them kill microorganisms, increase immunoglobulin, repair of DNA of an inflamed cell, increase Agni, and conditioning the gut to increase the beneficial gut microbiota. This review aimed to generate scientific evidence for Ayurveda Immune boosters (AIB) are effective to prevent and cure COVID-19 infection or it is a myth through Ayurveda and modern literature review. The properties of Rasayan are reviewed from Ayurveda Literature. The immunopharmacology, mechanism of immuno-booster and Rasayana herbs are reviewed from current medical literature for its subclinical and clinical evidence. Ayush kwatha and single herb like Guduchi (500-1000mg) extract, Aswagandha powder (3-5gm), and Haridra milk/gargling recommended as AIB by the Ministry AYUSH are safe and effective for prevention and cure of COVID-19 with sufficient preclinical and some Randomised clinical trials (RCT) evidence. So, the myth of Traditional Ayurveda herbs won’t boost our immunity to the virus is not true rather Ayurveda Medication (AIB) can boost our immunity to fight against COVID-19. More RCT evidence is required for clinical practice.
EnglishAyurveda Immuno booster (AIB), Rasayana, Ayush kwatha, Guduchi, Aswagandha, HaridraIntroduction
In the COVID-19 pandemic situation, Immuno -boosting is a matter of dialogue among common citizens and mostly appearing in social, press, and electronic media. Common people want to use it with a high expectation for prevention and cure corona virus1. Therefore, there is an increasing demand for Ayurvedic Immuno-booster (AIB) to strengthening Immuno system to prevent coronavirus infection rather than treating existing diseases. Looking at the demand in India, several initiatives have been taken to utilise the vast potential of Ayurveda in this pandemic.1,2 The Ministry of AYUSH has released a set of guidelines for boosting immunity and measures for self-care by using Ayurvedic principles. Further, the Indian Prime Minister in his address to the nation also advised using Ayurveda medicines for improving immunity against COVID-19. The demand for the AYUSH system across the country has increased and has also been put on alert for being called anytime to serve the nation.2 Unfortunately, the idea that Ayurveda pills, preparations, functional foods, or wellness yogic habits can provide a shortcut to a healthy immune system is a myth. Many authors enumerated that the concept of "boosting" your immune system doesn't hold any scientific meaning.3 But a study on 9,000 US children has shown that the administration of some complementary therapies, including chiro-practice and other shorts of alternative medicine (excluding multivitamins/multi-minerals) is related to a lower uptake of influenza vaccine.4
Immunity is a natural protective mechanism to protect from exposed harmful pathogens and environmental pollutants that affect the health status and homeostasis of an organism. This is maintained through a chain of networks of cells, tissues, organs, and biochemical mediators generated to defend the organism against any foreign invaders that threaten the integrity of the organism. One of the key features of immunity is to recognise its cell or tissues (self) and rejection of foreign protein molecule or microbes of the environment5. In the past two decades, epidemiological data have provided evidence of an increase in immunological diseases, therefore a new branch of pharmacology i.e Immuno-pharmacology developed, and a new group of molecules in immunotherapy is called Immunomodulators.5,6 Immuno-modulators are a specific group of molecules that suppress the immune response or stimulate the immune cells in immune-mediated disorders and infection. The immunosuppressive drugs are hugely used to inhibit the immune response in many immune-mediated diseases (Organ transplant and Autoimmune diseases) whereas immunostimulatory drugs are used to prevent or cure the infection. The synonyms used for immune stimulants are Immuno booster/buster. Immuno boosters are vitamins, minerals, probiotics, functional food as well as traditional medicines and approaches to stimulate the immune system to prevent and cure diseases.6,7 However, the concept of Vaccine is a well-recognized and effective way of Immuno booster to prevent infection. On the contrary, Ayurveda is a live traditional system of medicine with an unbreakable practice for 3000 years. Its principles and its approaches including oral administration of preventive drugs, herbs, formulae, decoction, indoor herbal medicine fumigation, etc. were recommended for effective prevention and treatment whenever the emergent of new disease7. Rasayana is one of the main branches of eight specialities (Astanga Ayurveda) which can enhance longevity, memory intelligence, freedom from disorder, youthfulness, the excellence of lustre, complexion, and voice, optimum of physique and sense organs, mastery over phonetics, and brilliance. These are health-promoting and rejuvenating procedures to prevent and cure diseases by enhancing physical strength (Bala), energy (Urja), Immunity (Vyadhi khamatwa), and mental power.8 Immuno boosting study was concluded to be commercially biased without scientific evidence.9 In this context, new and innovative approaches to Ayurveda Immuno boosters are to be studied for more effective prevention and treatment of infectious diseases special reference to COVID-19 as Ayurveda has vast literature that would represent some inspiration.8,9
The properties of Rasayan are reviewed from Ayurveda Literature. The immunopharmacology and Rasayana herbs are reviewed from current medical literature for its subclinical and clinical evidence.
Immuno system and its responses
The immune system is the network of cells, tissues, organs, and biochemical mediators that work together to protect the body. The immune cells are phagocytic cells and lymphocytes. Phagocytic cells are large white cells (monocytes, macrophages, mast cells, and neutrophils) are the most prevalent cells that can engulf and digest foreign organisms. The second most abundant cells are lymphocytes which are distinguished as B and T cells. Again, helper T cells are regulating the function of T cells whereas cytotoxic T cells destroy the infected cells or cancer cells. Natural killer cells destroy abnormal cells/cancer cells. The primary lymphoid organs are bone marrow and thymus and secondary lymphoid organs lymph nodes, spleen, tonsil, and payer's patches in the small intestine. Complement is also a series of proteins worked together with antibodies. The chemical messenger of the immune system is a cytokine. The cytokines that release T and B cells are Lymphokines whereas monokines are secreted from monocyte and macrophages. Cytokines encourage cell growth, promote cell activation, destroy target cells. The cytokines are Interferon, Interleukin, chemokines.10
Immuno response is traditionally classified as innate and adaptive immunity. Innate immunity is a short-term response that includes phagocytic cells, complement system, and receptors (TLRs, PPPs), whereas adaptive immunity is long term response that includes antigen-specific system mediated through memory cells and their specialised receptors. It is also known to be acquired as a specific antigen strategically used to create an immune response. Innate immunity recognises the infection and alerts the adoptive system through antigen, MHC, and cytokine. The total immune response worked through well recognised humoral and cell-mediated immune components. The moral response or antibody-mediated response starts from phagocytosis to the huge production of an antibody by plasma cells to memorize the specific antigen for quick mobilization of the system in later life. The cell-mediated immune response started with the recognition of antigen, secretion of lymphokine to stimulate T & B cell growth, enhance the macrophages to engulf and destroy the microbes.11,12
Immuno system does remarkable work to defend against diseases causing microbes, but sometimes it fails due to age, poor nutrition, environmental pollutants, organ damage/ dysfunction, and unhealthy lifestyle.13
Immuno response against COVID-19
The invasion of coronavirus and immunopathology of COVID-19 are associated with host immunity. The spike of glycol protein (S Protein) on the virus envelops binds to its receptor, angiotensin-converting enzyme 2 (ACE2), on the surface of human cells. Innate immunity is the first line of defence against virus invasion. The identification of pathogen-associated molecular patterns, such as RNA & uncapped m RNA results in subsequent cytolytic immune responses, mainly through the type I interferons (IFN) and natural killer cells. Adaptive immunity also plays a crucial role in viral clearance via activated cytotoxic T cells that destroy virus-infected cells and antibody-producing B cells that focus on virus-specific antigens. Patients with COVID-19, especially those with severe pneumonia are reported to possess significantly lower lymphocyte counts and higher levels of plasma concentrations of a variety of inflammatory cytokines like IL-6 and tumour necrosis factor (TNF). Another study reported that CD4+ T cells, CD8+ T cells, and natural killer cells were reduced in severely ill patients compared with those with mild disease symptoms. Moreover, a significant reduction of CD4+ T cell and CD8+ T cell counts in the peripheral blood was also observed in a patient who died in Covid 19 infection. The pro-inflammatory subsets of T cells, including IL-17-producing CCR4+ CCR6+ CD4+ (T-helper 17 or Th17) cells and perforin and granulysin-expressing cytotoxic T cells were remarkably increased, which could be quite responsible for the severe immune injuries in the lungs of this patient.13,16 Antiviral immune response is vital for the elimination of virus by overproduction of inflammatory cytokines which damaged the host tissues and aberrant immune-activation is called a cytokine storm. Cytokine storm is found in COVID-19 which is a serious explanation of disease progression and eventual death. They also found that increased plasma concentrations of both Th1 (e.g., IL-1β and IFNγ) and Th2 (eg. IL-10) cytokines. Patients admitted to the intensive medical unit (ICU) had higher plasma concentrations of IL-2, IL-7, IL-10, granulocyte-colony stimulating factor, IFNγ-induced protein-10 (IP-10), macrophage chemoattractant protein-1, macrophage inflammatory protein 1α, and TNF compared to those not admitted to ICU. Secondary haemophagocytic lymphohistiocytosis (sHLH) might be related to severe COVID-19 cases.17 HLH is a disease condition manifested by an uncontrolled cytokine storm and expansion of tissue macrophages or histiocytes that exhibit haemophagocytic activity. HLH can result from genetic defects in cytolytic pathways (familial or primary HLH) or other diseases like infection, malignancy, and rheumatic disease (sHLH). The proposed laboratory tests include serum ferritin, total lymphocyte or leukocyte counts, platelet counts, erythrocyte counts, and sedimentation rates that could be used to screen patients to exclude the high risk of hyper inflammation in small setup.14
Mechanism of Immuno booster
The impact of Rasayana drugs as Immuno boosters in the COVID-19 situation can be studied from the vast pharmacopoeia of Ayurveda which is also a matter of research. The mechanism of immune-boosting properties of Rasayana drugs is not established. Rasayana drugs have a profound effect on the body system so Immuno booster properties can be discussed as,
Rasayana drugs increase digestive power (Agni)
Rasayana drugs increased the enzymatic reaction to increasing digestion and assimilation, and clear the microchannels to provide adequate and appropriate nutrition for cellular function including immune cells. Further, the immune system is activated during infection which requires more nutrients for a good immunological outcome. Diminished digestive power (Agni) leads to the production of ama (undigested food) which can create a subclinical situation for the onset of infection or sopha (Chronic infection).15
Rasayana drugs conditioning the gut
Maximum immune cells in the human body are found within gut-associated lymphoid tissue (GALT), reflecting the crucial role of these immune tissues in maintaining host health. Several microbes with massive antigenic stimulation are present in ingested food, that provide us with strong protective immunity against invasive pathogen and tolerating various food proteins. GALT can produce a variety of sensing and effector immune functions to combat those foreign insults. Dendritic cells and M cells within the gut content, while plasma B cells within the lamina propria produce IgA, protecting pathogenic organisms. Peyer's patches are rich in immune cells, allow for communication networks between immune cells residing within the GALT, propagation of signals to the wider systemic immune response, and the recruitment or efflux of immune cells16. The gut microbiota will give a signal to produce antigen to interact with the systemic immune system. The human gut microbiome will provide antigens and signals with the potential to interact with resident and systemic immune cells within the gut lumen itself. Several Rasayana drug interventions have demonstrated the capacity to improve gut health or to reduce gut inflammation. Polyphenols in Rasayana drugs modulate the human gut microbiome and thereby promote the growth of beneficial Bifidobacteria and Lactobacillus while inhibiting the growth of undesirable gut microbes. The bioactive compounds of Triphala are elicited by gut microbiota to generate a variety of anti-inflammatory compounds.17,18 Again, there are more ammonia generated bacteria and lactobacillus bacterial are less in constipated patients.18 Most of the Rasayana drugs have bowel clear property.19,20
Rasayana drugs reduce chronic systemic inflammation
Chronic systemic inflammation is the key underlying feature of a wide range of chronic non-communicable disease conditions such as cardiovascular disease, stroke, and autoimmune disorders. This chronic inflammation is positively correlated with ageing. immunotolerance and reduced immune response, and other co-morbidities (e.g., obesity, cardiovascular disease, insulin resistance) which is related to bad outcomes of any infection and sepsis. A study in healthy adult found that risk factor of chronic systemic inflammation is increased with increased age irrespective other risk factors such as obesity, hypertension and blood lipids21. Histamine, bradykinin, neuropeptides, prostaglandins, thromboxane, leukotrienes, and platelet-activating factor stand out among the non-cytokine/chemokine mediators that are involved in the inflammatory response. Chronic inflammation involves the progressive changes in inflammatory cells as well as in tissue destruction and repair due to the on-going inflammatory process and loss of immune response due to the failure of h toll-like receptors (TLRs) of innate immunity.22 The active components from some of Rasayana plants that can modify inflammatory pathways are linked to chronic inflammatory diseases.23
Rasayana drugs can produce immune cells and Cytokine
Rasayana drugs are inherently non-specific as they enhance the body's resistance to infection. It acts through innate as well as adaptive immune response.24 Some of the Rasayana drugs improve phagocytic function by increasing PMN count, T helper cells, and NK cells.25,26 It also increased immunoglobulin proteins in the intestinal tract to combat foreign invaders. Rasayana also modulation of mono-amine function and reduction of stress, anxiety, and depression which increase the cytokines through psycho-neuro-Immuno mechanism.27
Rasayana drugs can target COVID-19 directly
Rasayana drugs can damage the coronavirus structure by binding the spike protein, E protein, and N protein. It can act by inhibiting virulence by binding Nsp1, Nsp 3c, and ORF7 protein. Most of the Rasayana drugs act through inhibiting RNA synthesis and replication by binding the active site of COVID-19 proteases.28,29
Potential Immuno booster from Rasayana drugs
Scientists realised the need for Ayurveda which mentioned epidemic management and defines immunity as the ability to preventing and arresting the progression of the disease to maintain homeostasis. The Ayurveda has emphasized building strength in the mind and body to cope with various environmental and biological stressors, including infection. Similar to innate and acquired immunity, the Ayurveda concept of immunity (Bala or strength) is classified as natural (Sahaja), chronobiologic (Kalaja), and acquired (Yuktikrut). Several treatment options are available in Ayurveda for enhancing immunity against respiratory illnesses, these include certain immuno-stimulant(Rasayana), local and systemic interventions.29 The Ministry of AYUSH, Government of India with an interest in health promotion in the COVID-19 outbreak situation recommended Ayush kwatha which consists of holy basil leaf, cinnamon bark, ginger rhizome, black pepper mostly used in Indian kitchen.30-32 Guduchi (500-1000mg) extract, Aswagandha powder (3-5gm), and Haridra milk/gargling are also recommended as single drug immuno-booter by Ministry AYUSH.33,34 Makardwaja is gold-containing mercurial preparation used for vigour and vitality.35 The mechanism of action of different potent Ayurveda drugs is described in Table 1.
Discussion
Ayurveda describes many drugs as Rasayana and Ojovardhak, which ae claimed to possess’ immuno-stimulatory effect. Some of the Rasayans which have been subjected to scientific studies are found to possess immunomodulatory and anti-inflammatory effects. If our immune system is working properly then it protected from all dangers caused by microbes. If not, we suffer sickness and disease.36,37 It is possible to intervene in this natural protective process to make our immune system stronger using immune boosters. Immune boosters work in many dimensions such as Ayurveda Immuno Booster can increase the number of white blood cells in the immune system, train them to fight against microbes causing diseases.38,39 Some of them are killed microorganism, increase immunoglobulin, repair of DNA of inflamed cell.40,41 The RCT’s investigation showed the potential clinical improvement of herbal medication for COVID-19 in terms of Symptom score, WBC count, Lymphocyte count and CRP.47 Ayush Kwatha and the other single herbs as advised by Ministry of AYUSH have excellent preclinical pieces of evidence (Table no-1). More research studies of Ayurveda formulations are registered for clinical trials.48 The presenting herbs and their phytochemicals, flavonoids act directly in the priming of SARS-CoV-2 attachment proteins by the host and viral enzymes, and the release of HMGB1 by host immune cells.46 The small observational study of Guduchi and Aswagandha have a good preventive effect on COVID-19. One of the therapeutic targets of anti-COVID-19 drugs is angiotensin-converting enzyme 2 (ACE2). ACE2 is the main functional receptor for CoV associated with COVID-19. Ashwagandha binds ACE2 effectively and the spike protein of CoV, thus enabling the virus to infect the epithelial cells of the host. The natural flavonoids have potential efficacy against COVID-19 through ACE2 receptor inhibition.42-45 Herbal medicines as immuno-booster can be used in the battle of COVID-19 pandemic before the inoculation of vaccine. So the myth of Traditional Ayurveda herbs won't boost your immunity to the virus is not true rather Ayurveda Medication can boost your immunity to fight against COVID-19. Ayush kwatha which is consisting of holy basil leaf, cinnamon bark, ginger rhizome, black pepper and single herb like Guduchi (500-1000mg) extract, Aswagandha powder (3-5gm) and Haridra milk /gargling recommended as immuno-booter by the Ministry AYUSH are safe and effective for prevention and cure of COVID-19.
Conclusion
Ayush kwatha and single herb like Guduchi (500-1000mg) extract, Aswagandha powder (3-5gm) and Haridra milk /gargling are recommended as immuno-booter by the Ministry AYUSH are safe and effective for prevention and cure of COVID-19. More RCT pieces of evidence are required for common clinical practices.
Conflict of Interest: None
Source of Funding: None
Englishhttp://ijcrr.com/abstract.php?article_id=3286http://ijcrr.com/article_html.php?did=3286
Wagner DN, Marcon AR, Caulfield T. Immune Boosting” in the time of COVID: selling immunity on Instagram. Allergy Asthma Clin Immunol 2010;16:76.
Ministry of AYUSH, Government of India, Ayurveda’s immunity-boosting measures for self-care during COVID 19 crisis.
Zoria Gorvett. COVID-19: can boost your immuno system protect you, BBC Future, 10th April 2020. https://www.bbc.com/future/article/20200408-covid-19-can-boosting-your-immune-system-protect-you.
Bleser WK, Elewonibi BR, Miranda PY, Belue R. Complementary and alternative medicine and influenza vaccine uptake in US children. Pediatrics 2016; 138:e20154664.
Yatim KM, Lakkis FG. A brief journey through immuno system. Clin J Am Soc Nephol 2015;10:1274-1281.
Trevor AJ, Katzung BG. Kruidering-Hall, Marieke.Masters, Susan B. Immunopharmacology, in Katzung & Trevor's pharmacology New York, McGraw-Hill Med;12th edition 2013:890-92.
Panda AK, Dixit A, Rout S, Mishra B, Purad UV, Kar S. Ayurveda Practitioners Consensus to Develop Strategies for Prevention and Treatment of Corona Virus Disease (COVID-19). J Ayurveda Integr Med Sci 2020;5(1):98-106.
Soni MK, Sharma OP, Importance of Rasayana in Immunity. World J Phar Med Res 2018;4(3):196-98.
Cassa Macedo, Oliveira A, Vilela de FA, Ghezzi, P. Boosting the immune system, from science to myth: analysis the infosphere with Google. Front Med 2019;6:165.
Yatim KM, Lakkis FG. A brief journey through the immune system. Clin J Am Soc Nephrol 2015;10:1274–1281.
Shishido SN, Varahan S, Yuan K, Li X, Fleming SD. Humoral innate immune response and disease. Clin Immunol 2012;144(2):142-158.
Josefowicz SZ, Lu LF, Rudensky AY. Regulatory T cells: Mechanisms of differentiation and function. Annu Rev Immunol 2012;30:531–564.
Lerner A, Jeremias P, Matthias T. The world incidence and prevalence of autoimmune diseases is increasing. Int J Celiac Dis 2016; 3:151–155.
Zhong J, Tang J, Ye C, Dong L. The immunology of COVID-19: is immune modulation an option for treatment? Lancet Rheumatol. 2020;2(7):e428-e436.
Kuchewar VV, Borkar MA, Nisargandha MA. Evaluation of the antioxidant potential of Rasayana drugs in healthy human volunteers. Ayurveda 2014;35(1):46-49.
Macdonald TT, Monteleone G. Immunity, inflammation, and allergy in the gut. Science 2005; 307:1920–25.
Peterson CT, Denniston K, Chopra D. Therapeutic Uses of Triphala in Ayurvedic Medicine. J Altern Complement Med 2017;23(8):607-614.
Ohkusa T, Koido S, Nishikawa Y, Sato N. Gut Microbiota and Chronic Constipation: A Review and Update. Front Med (Lausanne). 2019;6:19.
Singh SK, Rajoria K. Ayurvedic management of chronic constipation in Hirschsprung disease-A case study. J Ayurveda Integr Med. 2018;9(2):131-135.
Metri K, Bhargav H, Chowdhury P, Koka PS. Ayurveda for chemo-radiotherapy induced side effects in cancer patients. J Stem Cells 2013;8(2):115-29.
Hotamisligil, G.S. Inflammation, metaflammation and immuno-metabolic disorders. Nature 2017, 542, 177–185.
Rogero, M.M.; Calder, P.C. Obesity, Inflammation, Toll-Like Receptor 4 and Fatty Acids Nutr 2018;10:432.
Aggarwal BB, Prasad S, Reuter S, et al. Identification of novel anti-inflammatory agents from Ayurvedic medicine for prevention of chronic diseases: "reverse pharmacology" and "bedside to bench" approach. Curr Drug Targets 2011;12(11):1595-1653.
Doshi GM, Une HD, Shanbhag PP. Rasayans and non-rasayans herbs: Future immunodrug - Targets. Pharmacogn Rev 2013;7(14):92-96.
Elsayed Y, Khan N.A, Immunity-boosting spices and the novel coronavirus. ACS Chem Neurosci 2020;11(12):1696-1698,
Kumar D, Arya V, Kaur R, Bhat ZA, Gupta VK, Kumar V. A review of immunomodulators in the Indian traditional health care system.
J Microbiol Immunol Inf 2012; 45: 165-184.
Rajkumar RP. Ayurveda and COVID-19: Where psychoneuroimmunology and the meaning response meet. Brain Behav Immun 2020;1591(20):30637-1.
Hastantram M, Ramaiah S. Molecular docking analysis of selected natural products from plants for inhibition of SARS-CoV-2 main protease. Curr Sci 2020; 118(7):1087-1092.
Golechha, M. Time to realise the true potential of Ayurveda against COVID-19. Brain Behav Immun 2020;87:130–131.
Gautam S, Gautam A, Chhetri S, Bhattarai U. Immunity Against COVID-19: Potential Role of Ayush Kwath. J Ayurveda Integr Med. 2020;10:1016.
Rajlaxmi SP, Sneha V. Efficacy of Rasayana Dravya on Covid–19 –A Brief Review. Int J Res Pharm Sci 2020;11: 323-327.
Rastogi S, Pandey DN, Singh RH. COVID-19 pandemic: A pragmatic plan for Ayurveda intervention. J Ayurveda Integr Med 2020; S1(20):30019.
Shree P, Mishra P, Selvaraj C. Targeting COVID-19 (SARS-CoV-2) main protease through active phytochemicals of ayurvedic medicinal plants – Withania Somnifera (Ashwagandha), Tinospora Cordifolia (Giloy) and Ocimum sanctum (Tulsi) – a molecular docking study. J Biomol Struct Dyn 2020;15:1-14.
Sanjoy BK, Prajapati PK, Galib R, Batgiri P. A scientific review of gold-containing herbo-mineral preparation: Makaradwaja. Int J Green Pharm 2015; 9(4): 7-8.
Damanhouri ZA. A review on therapeutic potential of Piper nigrum L. (Black Pepper): the king of spices. Med Aromat Plants 2014; 3:231-5.
Aha S, Ghosh S. Tinospora Cordifolia: One plant, many roles. Anc Sci Life 2012;31(4):151-159.
Leyon PV, Kuttan G. Effect of Tinospora Cordifolia on the cytokine profile of angiogenesis-induced animals. Int Immunopharmacol 2004;4:1569–75.
More P, Pai K. In vitro NADH-oxidase, NADPH-oxidase and myeloperoxidase activity of macrophages after Tinospora Cordifolia (Guduchi) treatment. Immunopharmacol Immunotoxicol 2012;34:368–72.
Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med 2011;8(5 Suppl):208-213.
Davis L, Kuttan G. Effect of Withania Somnifera on cytokine production in normal and cyclophosphamide treated mice. Immunopharmacol Immunotoxicol 1999 Nov;21(4):695-703.
Malik F, Singh J, Khajuria A, Suri KA, Satti NK, Singh S, Kaul MK, Kumar A, Bhatia A, Qazi GN. A standardized root extract of Withania Somnifera and its major constituent withanolide-A elicit humoral and cell-mediated immune responses by up-regulation of Th1-dominant polarization in BALB/c mice. Life Sci 2007 Mar 27;80(16):1525-38.
Liu Z, Ying Y. The Inhibitory Effect of Curcumin on Virus-Induced Cytokine Storm and Its Potential Use in the Associated Severe Pneumonia. Front Cell Dev Biol. 2020;8:479.
Dhundi S, Ashok B, Ravishankar B, Patgiri B, Prajapati PK. Immunomodulataory activity of Triguna Makaradhwaja an ayurvedic compound formulation. Indian J Nat Prod Resour 2012;3: 320-7.
Greetha RV, Laxmi T, Roy A. A review on Nature’s immune-booster. Int J of Pha Sci Rev Res 2012;13(1):43-49.
Panyod S, Ho CT, Sheen LY. Dietary therapy and herbal medicine for COVID-19 prevention: A review and perspective. J Tradit Complement Med. 2020;10(4):420-427.
Ang L, Song E, Lee HW, Lee MS. Herbal Medicine for the Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2020;9(5):1583.
Boukhatem, M.N.; Setzer, W.N. Aromatic Herbs, Medicinal Plant-Derived Essential Oils, and Phytochemical Extracts as Potential Therapies for Coronaviruses: Future Perspectives. Plants 2020; 9: 800.
Wyganowska-Swiatkowska, M.; Nohawica, M.; Grocholewicz, K.; Nowak, G. Influence of Herbal Medicines on HMGB1 Release, SARS-CoV-2 Viral Attachment, Acute Respiratory Failure, and Sepsis. A Literature Review. Int J Mol Sci 2020; 21: 4639.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareMalignant Ovarian Tumours – A Clinicopathological Study for a Period of Five Years in a Tertiary Care Hospital
English141145G. SudhakarEnglish T. Rayapa ReddyEnglish P. Geetha VaniEnglish C. Padmavathi DeviEnglishIntroduction: Ovarian malignancy represents 5th most common cause of cancer death in females and they account for 2nd leading cause of death from cancer of the female genital tract. Though they are treatable and sensitive to anticancer therapies, they are usually detected when they have spread beyond the ovary.
Objective: To know the overall incidence of malignant ovarian tumours among all ovarian tumours. To report the age incidence, presentation, gross and microscopic features of various histomorphological types of malignant ovarian tumours which help the clinician in the anticipation of malignancy before its spread beyond the ovary. Methods: This is a clinicopathological retrospective study where clinical details of all ovarian tumours which were diagnosed as malignant were obtained. The regressed bits were subjected to histopathology processing and staining.
Results: In our study, we noted overall malignancy was14.70% among all ovarian tumours. Most commonly seen in the age group of 51-60 years and most commonly presented with either lump or pain in the abdomen. Grossly they are solid and 95.5 % are primary in origin. Among the primary ovarian malignant tumours, 69% were surface epithelial tumours.
Conclusion: The solid component in an ovarian tumour may represent the malignant nature of tumour with the increasing age of women. Surface epithelial malignancy was more common in the old age and germ cell tumours were seen in the younger group. Preoperative diagnosis of malignant tumours can be done by radiological, serological and clinicopathological findings which help in the reduction of mortality.
EnglishClinical nature, Histopathology, Malignant tumours, OvaryIntroduction
In recent times it has been observed that there is an increased incidence of cancers among women and ovarian cancer is one of the major contributors. Ovarian malignancy carries the highest fatality rate among all gynaecological cancer. The overall survival rate is less than 50%1-4. There is no screening test to detect in the early stage and also the cancer is not very symptomatic.3,4 The Ovarian tumours are complex and involving a variety of histological diagnosis ranging from epithelial tissues, connective tissues, specialized hormone-secreting to germinal and embryonal cells.5,6 Most of the ovarian tumours are benign and cystic. Majority of ovarian cancers are a solid or solid component in cystic tumours. Any solid ovarian tumours in older women first to rule out malignant nature of the tumour.5-8 A combined approach of radiological, clinical and cytopathological studies can help in early diagnosis of disease. So that with recently developed treatment modalities survival rate of the patient can be increased. Main risk factors for malignant ovarian tumours are increasing age, positive family history, increase the age of reproduction, and null parity.7,8 A clinicopathological study of malignant ovarian tumours is very helped full in understanding their nature, presentation, and behaviour in women of various ages.
MaterialS and Methods
A clinicopathological retrospective study to understand nature, behaviour and histology of malignant ovarian tumours were done at GGH and department of pathology, Guntur medical college, Guntur from January 2015 to December 2019 i.e. for five years. All ovarian tumours which were diagnosed as malignant were included. Benign and borderline ovarian tumours were excluded from our study. Among malignant tumours, inadequate samples were also not considered. Clinical details were obtained from previous data stored in the government general hospital and gross examination of specimens, the histopathological study of slides was done at the pathology department, Guntur Medical College. After a thorough study and gross examination, tissue sections were given where ever necessary. The regressed bits were subjected to histopathology processing and staining. In some cases where ever necessary special stains were done.
Results
A total number of 610 ovarian tumours were received during the period between January 2015 to December 2019 out of which 500 were benign, 20 were borderline and 90 were malignant tumours. The overall incidence of malignant ovarian tumours was 14.70% among all ovarian tumours (Figure 1). Maximum incidence was seen in the age group of 51-60 with 26(29%) cases and followed by 41-50 with 18 (20%) cases of malignant ovarian tumours (Figure 2), Surface epithelial malignancy was more common in the old age and germ cell tumours were seen in the younger group.
Most cases were presented with a lump in the abdomen or pain in the abdomen to the gynaecological department. In the majority of cases, investigations revealed serum elevation of tumour markers like beta HCG, AFP, and CA-125. Radiologically most of the cases revealed solid or predominantly solid ovarian masses.
Macroscopically malignant ovarian tumours are predominantly solid, some are partly solid and partly cystic. Of 90 Malignant ovarian tumours, 60( 67%) were solid and 28(31%) were predominantly solid and partly cystic. 2% were predominantly cystic (Table I). Size of the tumour varies can be range from huge mass to small lesion. Majority of cases were unilateral and metastatic tumours were bilateral.
Histologically the primary ovarian tumours were 95.5 % (86 cases) of cases, secondary or metastatic tumours were 3.4 %( 3cases) and undiagnosed with routine H&E and immune stains was1.1 %( 1 case) which was grouped under unclassified category (Figure 3). .In this study among primary tumours, the maximum number of cases were surface epithelial tumours, followed by germ cell tumours and sex cord-stromal tumours. Surface epithelial tumours account for the highest number 62(69%) among all malignant ovarian tumours and serous cystadenocarcinoma (Figure 4,5) was the most common histological type among surface epithelial cancers followed by mucinous cystadenocarcinoma (Figure 4,5) and transitional carcinoma.
Malignant germ cell tumours constitute about 15.5 %( 14 cases) of all ovarian cancers. Out of fourteen cases of germ cell tumours, seven were dysgerminoma (Figure 4,5), two were yolk sac tumours, two cases were immature malignant teratoma of which one was initially thought mature teratoma with gliomatosis person, later after extensive sampling we found immature elements in the tumour (Figure 4,5), two embryonal cell carcinoma and one case was of mixed germ cell tumour.
Among ten (11%) sex cord-stromal tumours majority (9) were adult granulose cell tumours and one was Sertoli cell tumour. Two Kruken berg tumours (Figure 4,5), one was Mets from squamous cell carcinoma of cervix accounts for three metastatic tumours in our study. One tumour was grouped as unclassified as histological picture suggestive of small carcinoma/Lymphoma of the ovary but immunological results were also not conclusive.
Discussion
Among all ovarian tumours we have noted 14.70% of malignant ovarian tumours which was nearer to Kancherla et al. who has reported 18% in their study.9 But Reta Devi et al. in their study mentioned 5.1% which was very low and Urmila singh et al. reported very high incidence malignant ovarian tumours which was 41.9%.10,12
Malignant ovarian tumours exhibit a wide spectrum of clinical, morphological, and histological features and are the cause of considerable mortality in all age group women. They occur at any age, seen in children, adolescence, and old age. In our study, the most common age group for malignant ovarian tumours was 51–60 years with 29% (26 cases) followed by age group 41–50 years with 20% (18) cases. A maximum number of malignant ovarian tumours was seen between age 41to 60 years accounts for 49 % (44) cases. The oldest women with ovarian cancer in our study were 82 years old and the youngest was a 6 years old female child. Like our study, most of the other studies found 41-60 years was the most common age group with malignant ovarian tumours. Chandanwale et al. in their study stated that the most common age group for malignant ovarian tumours was 51–60 (26%) years followed by 21–30 (22%) and the youngest case was an 8 years old female child.12
In our study, we found 34% (31 cases) of malignant ovarian tumours before age 40 years with a maximum incidence between 21-40 years and the common histological group is germ cell tumours and the type is dysgerminoma. Some studies mentioned the rarity of malignant ovarian tumours rarely before the age of 40 years. Chandanwale et al. also found the significant number of ovarian malignancies before age 40 years.12 Okugawa et al. found that mean age of malignant tumour was 51.9 year.13 Chandanwale et al. study mentioned 45.4 years was the mean age.12 In our study, it was 50.2 which were near to Okugawa et al.13 Most common clinical symptom in our study was Pain and lump in the abdomen. Similar observations were made by Chandanwale et al., Bhuvanesh et al. and Kanthikar et al.12,14,15
In our study, the majority of malignant tumours were unilateral (95%) and most of the bilateral cases were metastatic tumours. Our findings are similar to the findings of Kancherla et al., Reta Devi et al. and Chandanwale SS et al. and others.9.10,12 We did not find any markedly increased incidence in the right or left side of the ovary.
In our study, we found huge mass to the small lesion of malignant ovarian tumours. Majority of the tumours 67% (60 cases) were solid and 31% (28) were predominantly solid and partly cystic. Okugawa K et al. were found similar observations.13 Chandanwale SS et al. in their study found maximum (44%) malignant tumors were solid/cystic in nature.12 In our study most of the malignant ovarian tumours are primary in origin and accounts for 95.5% among all tumours. Among primary malignant ovarian tumours surface epithelial tumours were the highest in number 62 (69%) and serous cystadenocarcinoma was the most common histological type among surface epithelial cancers followed by mucinous cystadenocarcinoma and transitional carcinoma. Chandanwale et al., Kar et al. and Gilani et al. were made similar findings in their studies.12,16,17
Malignant germ cell tumours constitute about 15.5% (14 cases) of all ovarian cancers in our study. Chandanwale et al., Kar et al., Gilani et al. has made the incidence of malignant germ cell tumours as 18%,19.23%,17.1% respectively, which were near to findings of present study.12,16,17 Mankar et al. noted 10% of malignant gem cell tumours contrary to our study.18 Among the various histological types, we noted seven cases of dysgerminoma, two cases of yolk sac tumors, and two were immature malignant teratoma, two embryonal cell carcinoma and one case of mixed germ cell tumour. Dysgerminoma was the most common malignant germ cell tumour found in our study and similar finding was made by Kar et al. and Lalrinpuii et al.16,19. But Chandanwale et al. in their study found immature teratoma was the most common tumour12. We have noted one case of immature teratoma with gliomatosis peritonei, Wang et al. has described two cases of gliomatosis peritonei in their study.20
Malignant sex cord-stromal tumours constitute about 11% (10 cases) of total tumours. The majority (9) were adult granulose cell tumours and one was Sertoli cell tumour. Chandanwale et al. in their study found 14% (7) sex cord-stromal tumours with the majority of adult granulosa cell tumours.12. But Kar K et al. recorded low incidence of sex cord-stromal tumours 3.84% and Garg R et al. noted not even a single case in their study.16,21
In our study metastatic tumours account for 3.4% and 1.1% were grouped under unclassified. Our findings show less incidence of metastatic tumours than Chandanwale et al., Kar et al., Gilani et al. who has shown the incidence of 6%,7.69% and 6.6% respectively.12,16,17 Mankar et al., Jha et al. noted a high incidence of metastatic tumours 20% and 15.38%, respectively contrary to other studies.18,22
Conclusion
Surface epithelial malignant tumours are the most common among all malignant ovarian tumours. Their incidence is highest between 41-60 years. Germ cell malignant tumours are more common in younger age group females. Though their incidence is less, sex cord-stromal tumours were relatively seen in all age groups. Metastatic ovarian tumours were more common in older women and increases with increasing age. Macroscopically most of the malignant ovarian tumours are solid or predominantly solid. Due to the high fatality rate and worst prognosis of malignant ovarian tumours, it is very important to diagnose ovarian malignancy very early in the disease process. Most of the cases have extensive spread by the time of diagnosis and is the cause of increased death rate in ovarian cancers. For early diagnosis, a combined radiological, pathological and clinical approach with high vigilance is needed if a female patient came to the hospital with distension or pain abdomen. So that survival rate can be increased in patients suffering from ovarian malignancies.
ACKNOWLEDGEMENTS:
The authors are thankful to authors, editors, publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed
Conflict of interest: Nil
Source of Funding: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=3287http://ijcrr.com/article_html.php?did=32871. Hirschowitz L. What is ovarian carcinoma? Southwest Cancer Intell Serv J 2000;8:10-5.
2 Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.
3. Maheshwari A, Kumar N, Mahantshetty U. Gynecological cancers: A summary of published Indian data. South Asian J Cancer 2016;5:112-20.
4. Murthy NS, Shalini S, Suman G, Pruthvish S, Mathew A. Changing trends in the incidence of ovarian cancer – The Indian scenario. Asian Pac J Cancer Prev 2009;10:1025-30.
5. Prate J. Pathology of Ovarian Cancer. Barcelona: J Autonomous Uni Barcelona Dept Pathol 2000; 231.
6. Shraddha SO, Sridevi TA, Renukadein TK, Gowri R, Binayah D, Indra V. Ovarian masses: Changing histopathological trends. J Obstet Gynaecol Ind 2015;65:1:34–38.
7. Umakanthan S, Chattu VK, Kalloo S. Global epidemiology, risk factors, and histological types of ovarian cancers in Trinidad. J Family Med Prim Care 2019;8:1058-64.
8. Singh U, Solanki V, Prakash B, et al. Clinicopathological Spectrum of Ovarian Tumours in Northern India: Changing Trends Over 10 Years. Indian J Gynecol Oncolog 2020; 18(59): 210-14.
9. Kancherla J, Kalahasti R, Sekhar KPAC, Yarlagadda SB, Devi SP. Histomorphological Study of Ovarian Tumors: An Institutional Experience of 2 Years. Int J Sci Stud 2017;5(3):232-235.
10. Reeta Devi M, Keerthivasan V, Tikhak J. Histomorphological spectrum of ovarian tumours, 4 years experience in a regional institute. J Evid Based Med Health 2020; 7(4):173-176.
11. Singh U, Solanki V, Prakash B, Mehrotra S, Verma ML. Clinicopathological Spectrum of Ovarian Tumours in Northern India: Changing Trends Over 10 Years. Indian J Gynecol Oncol 2020;18(2):59.
12. Chandanwale SS, Jadhav R, Rao R, Naragude P, Bhamnikar S, Ansari JN. A clinicopathologic study of malignant ovarian tumours: A study of fifty cases. Med J DY Patil Uni 2017;10:430-7.
13. Okugawa K, Hirakawa T, Fukushima K, Kamura T, Amada S, Nakano H. Relationship between age, histological type, and size of ovarian tumours. Int J Gynaecol Obstet 2001;74:45-50.
14. Bhuvanesh U, Logambal A. Study of ovarian tumours. J Obstet Gynaecol 1978;28:271-7.
15. Kanthikar SN, Dravid NV, Deore PN, Nikumbh DB, Suryawanshi KH. Clinico-histopathological analysis of neoplastic and non-neoplastic lesions of the ovary: A 3-year prospective study in Dhule, North Maharashtra, India. J Clin Diagn Res 2014;8:4-7.
16. Kar K, Kar A, Mohapatra PC. Intra-operative cytology of ovarian tumours. J Obstet Gynecol 2005;55:345-9.
17. Gilani MM, Behnamfar F, Zamani F, Zamani N. Frequency of different types of ovarian cancer in Vali-e-Asr Hospital (Tehran University of Medical Sciences) 2001-2003. Pak J Biol Sci 2007;10:3026-8.
18. Mankar DV, Jain GK. Histopathological profile of ovarian tumours: A twelve-year institutional experience. Muller J Med Sci Res 2015;6:107-11.
19. Lalrinpuii E, Bhageerathy PS, Sebastian A, Jeyaseelan L, VinothaThomas, Thomas A, Chandy R, Peedicayil A. Ovarian Cancer in Young Women. Indian J Surg Oncol 2017 Dec;8(4) 540-547.
20. Wang J, Xu J, Zhang M, Li B. Gliomatosis peritonei with bilateral ovarian teratomas: A report of two cases. Oncol Lett 2016;12(3):2078–2080.
21. Garg R, Singh S, Rani R, Agrawal M, Rajvanshi R. A clinicopathological study of malignant ovarian tumours in India. J South Asian Fed Menopause Soc 2014;2:9-11.
22. Jha R, Karki S. Histological pattern of ovarian tumours and their age distribution. Nepal Med Coll J 2008;10:81-5.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareClassification of Diabetes Using Deep Learning and SVM Techniques
English146149K. ThaiyalnayakiEnglishBackground: Diabetes is a disease increasingly alarming affecting people worldwide. If not treated properly, it affects organs. An automatic classification of diabetes using deep learning perceptron and SVM is attempted.
Objective: To identified problem and provide automatic classification of diabetics data and the solution using deep learning perceptron and SVM for the best therapeutic management.
Method: The dataset consists of 768 instances, out of which, 500 diabetes subjects and 268 healthy people.
Results: There are 9 attributes which are used for analysis. MLP deep learning classifier with 18 parameters are utilized to correctly classify 595 Instances with a classification accuracy of 77.474 % and Incorrectly Classified are 173 Instances with 22.526 %. The comparison of MLP deep learning classifier with SVM classifier is performed where the SVM classifier Correctly Classified Instances are 500 with a classification accuracy of 65.1042 % and Incorrectly Classified Instances are 268 with 34.8958 %.
Conclusion: Deep learning perceptron classifier performs well with diabetes dataset and can be used for further automatic identification and detection analysis.
EnglishDiabetes, Deep learning, SVM, ROC, confusion matrix, RBFINTRODUCTION
Diabetes is an illness using which, blood sugar is not metabolically processed in the physique. Its frequency rates are expanding alarmingly consistently. If untreated, diabetes-related complexities in numerous imperative organs of the body may turn destructive. Diabetes is the main reason for visual impairment and visual debilitation in grown-ups in developed nations and more than one million lower appendage removals every year.1 One of the promising methods in AI is Support Vector Machine (SVM). SVM is utilized for classification of system. PCA is utilized for reducing the measurements by keeping up a lot of difference however much as could reasonably be expected. Output yield from preprocessed information is presently accomplished as the input.2 Unsupervised and supervised learning methods are utilized for sampling and structure, which are then trailed by a rule-based algorithm. Genuine diabetes dataset show that coherent SVMs give a promising tool to the forecast of diabetes, where ruleset have been produced, with a good prediction accuracy.3 The accuracy accomplished by useful classifiers such as Artificial Neural Network, Naive Bayes method, Decision Tree and Deep Learning lies within the scope of 90–98%. Then it is meaningful to build up a framework in the form of an application or a site that can utilize the method to help social healthcare authorities in the early discovery of diabetes.4 All trials are run on GPU empowered TensorFlow with Keras structure. Highlights of profound learning system are explored, based on CNN-LSTM architecture and into SVM for classification. LSTM can deal with long haul conditions in a time series data. To choose two paths of investigation, the data were run for SVM with direct and RBF part.5
MATERIALS AND METHODS
The dataset of 768 samples are from Pima Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases. There are 9 attributes Plasma glucose concentration, 2 hours in an oral glucose tolerance test, Two-hour serum insulin in mu U/ml, Diastolic blood pressure in mm Hg, Body mass index, Diabetes pedigree function, Age, triceps skinfold thickness in mm, class variable as 0 or 1. Class desirability and the number of instances are 0 for 500 instances and 1 for 268 instances. Figure 1 represents the distribution of the second attribute. A few imperatives were put on the determination of these cases from a bigger database. Specifically, all-female patients are at any 21 years of age of Pima Indian legacy. ADAP is a versatile learning schedule that produces and executes advanced analogues of perceptron like gadgets.
RESULT AND DISCUSSION
The attribute data set is trained using Multilayer perceptron deep learning architecture. XAVIER Neural network configuration is used to train it to learn. Trainable parameters are 18.The output layer consists of 8 inputs, 2 outputs with W:{8,2}, b:{1,2}. Bias Initialization is first set 0, dropout of neurons is disabled. Adam is a versatile learning rate streamlining method that has been structured explicitly for training profound neural systems. It helps to find individual learning rates for each parameter. Adams updater is chosen with learning rate as 0.001, learning rate constant schedule value as 0.001 and beta1 as 0.9, beta2 as 0.999, epsilon as 1.0e-8. Bias updater for learning is also scheduled. Batch processing is performed with seed as 0 and stochastic gradient descent optimization Algorithm is set. Weight noise is not provided, hence disabled. The loss function is minimized and gradient normalization is performed with, gradient normalization threshold as 1. 10 fold cross-validation is applied. The training process includes
Parameters Initialization
optimization algorithm
Input is propagated to the network
Cost function computation
Gradient’s of the cost concerning parameters is calculated.
Each parameter is updated using the gradients concerning optimization algorithm.
The statistical analysis of classified instances are Kappa statistic is 0.4832, Mean absolute error is 0.317, Root mean squared error is 0.3951, Relative absolute error is 69.7509% and root relative squared error is 82.8893%. The Correctly Classified Instances are 595 with a classification accuracy of 77.474 % and Incorrectly Classified Instances 173 are 22.526% (Table 1 and 2).
The lib SVM classifier is compared with the performance of deep learning architecture performance and classifier accuracy obtained for the pima dataset is 75% and the time is taken to build model is 0.13 seconds. Table 1 and 2 represents the Performance parameters and Confusion matrix of the classifier.
RBF Network
Radial Basis Function Network which constructs the hidden layer in an unsupervised procedure and RBF classifier which is entirely supervised. RBF Network makes a reality of a systematized Gaussian radial basis function network. It utilizes the k means clustering calculation to give the basis function and a linear regression is learned. Each cluster’s symmetric multivariate Gaussians are suitable for the data. On the off chance that the class is ordinary, it utilizes the given number of groups per class RBF regressor implements Gaussian radial basis function networks frameworks for regression, arranged in a coordinated way utilizing optimization class by restricting squared error with the BFGS strategy. In numerical optimization, the Broyden Fletcher Goldfarb Shanno (BFGS) system is an iterative computational procedure for taking care of unconstrained nonlinear streamlining issues.RBF architecture is shown in figure2. All traits are standardized into the [0,1] scale. It is possible to use conjugate gradient descent instead of BFGS refreshes, which is faster for cases with various boundaries, and normalized basis works as opposed to unnormalised ones.6-8
The inceptive pivot of the Gaussian radial basis functions discovered utilizing basic K Means. The ? assessed values are assigned to the maximum distance between any centre and its nearest neighbour in the set of centres.
There are various parameters in the network. The edge boundary is utilized to punish output layer weights. The number of premise functions can likewise be determined. Huge numbers produce long training times. Another alternative decides if one global sigma esteem is utilized for all units, quickest, regardless of whether one worth is utilized per unit and set as the default, or an alternate value is found out for each node mix. It is also possible to learn attribute weights for the distance function.9,10
The output shown is the squared value of the input. At long last, conjugate gradient descent can be utilized rather than BFGS updates, that is quicker for instance with numerous boundaries, and to apply standardized basis functions rather than unnormalized ones. An estimated form of the strategic function is utilized as the initiation work in the yield output layer to improve speed. Additionally, if delta esteems in the backpropagation step are inside the client described tolerance, the gradient isn't refreshed for that specific case, which spares several extra time. Parallel computation of squared error and gradient is conceivable when multiple CPU cores are available. Information is part of groups and prepared in different threads for this situation. Runtime for larger datasets is improved.
Nominal attributes are processed using the unsupervised model. Nominal To Binary filter and missing qualities are supplanted globally using replace missing values with choices. Batch size 100 is used. The seed is the random number seed to be used and set as 1.Use Normalized Basis Functions decides whether to use normalized basis functions or not. Scale optimization option gives the number of sigma parameters to use. The quantity of threads to utilize chooses a size of string pool. The attribute weights are used. decimal places concerning three positions are utilized for the output yield of model numbers. The batch size chooses the favoured number of cases to process if group prediction is being carried out. Approximately cases might be given, nevertheless allows executions to determine a favoured cluster size. The resilient parameter for the delta esteems is set as 1.0e-6. The ridge penalty factor for the output layer is decided as 0.01.poolSize is set as 1 which is the thread pool size, for instance, the CPU cores. The conjugate gradient descent is utilized which is suggested for some parameters. The number of premise functions to utilize is additionally set beforehand.8-10
The abilities are binary class, missing class esteems, nominal class, attributes are binary traits, date features, empty nominal qualities, missing values, nominal characteristics, numeric quality, unary characteristics, interfaces are randomizable, Handlers are weighted instances. Additional Minimum number of instance is set 1. There are several parameters. All parameters are set as described above. To enhance speed, a tentative form of the strategic function is utilized as the activation function in the yield layer. Likewise, if delta esteems in the backpropagation steps are inside the client indicated resilience, the gradient is not refreshed for that specific case, which spares some extra time. Equal estimation of squared error and slope is conceivable when numerous CPU centres are available. Information is part of clumps and handled in independent strings for this situation. Note this just improves runtime for bigger datasets. Nominal traits are handled utilizing the unsupervised nominal to binary channel and missing qualities are supplanted all-inclusive utilizing replace missing utility.
The 768 cases and 9 attributes of pima diabetes with 10 fold cross validation gives output weights for different classes as 0.09162112439990752 and 0.12059259597282575. Figure 3 shows the 768 samples and 9 features of pima diabetes with 10 fold cross validation gives output weights for different classes as 0.916 and 0.120 ,Unit center weights are 1.422, 3.868, 0.027, 0.453, 0.871, 1.43, 1.265, 1.146. Output weights for different cases are12.179, 1.895. Unitcenter as 0.025, 0.296, 0.570, 0.197, 0.179, 0.111, 0.123, 0.208. Bias weights for different classes as -3.790 and 3.691 and time grabed to build model: 0.23 seconds. The correctly classified instances using RBF network is 585 with accuracy 76.1719%. Incorrectly Classified Instances are 183 with 23.8281%, Kappa statistic is 0.4553, mean absolute error is 0.338, root mean squared error is 0.404, relative absolute error is 74.3694%, root relative squared error is 84.7695%. The confusion matrix is 430, 70 as tested negative and 113, 155 as b as tested positive. The distribution of all 9 attributes is given in figure 4.
TP Rate FP Rate Precision Recall F-Measure MCC ROC Area PRC Area Class
0.860 0.422 0.792 0.860 0.825 0.459 0.819 0.890 tested_negative
0.578 0.140 0.689 0.578 0.629 0.459 0.819 0.684 tested_positive
Weighted Avg. 0.762 0.323 0.756 0.762 0.756 0.459 0.819 0.818
CONCLUSION
The problem identified is the automatic classification of diabetics data and the solution using deep learning perceptron and SVM for the best is accomplished. MLP deep-learning classifier with 18 trainable parameters of correctly classified 595 Instances with a classification accuracy of 77.474 % and Incorrectly Classified Instances of 173 with 22.526% are obtained. The SVM classifier Correctly Classified Instances are 500 with 65.1042 % and Incorrectly Classified Instances are 268 with 34.8958%. The classification accuracy can further be increased by fusion of attributes and using advanced neural network classifiers. Deep learning perceptron classifier performs well with diabetes dataset and can be used for further automatic identification and detection systems. In future, the number of attributes needs to be increased and the number of training set also need to be increased with sequential classifier and deep neural networks to reduce false negatives.
Conflict of Interest: None
Source of Funding: None
Englishhttp://ijcrr.com/abstract.php?article_id=3288http://ijcrr.com/article_html.php?did=32881. Han W, Shengqi Y, Zhangqin H, Jian H, Xiaoyi W. Type 2 diabetes mellitus prediction model based on data mining, Infor Med Unlocked 2018;10:100–107.
2. Aishwarya R. A Method for Classification Using Machine Learning Technique for Diabetes, Int J Engg Tech 2013;5(3):2903-2908.
3. Nahla HB, Andrew P. Bradley, and Mohamed Nabil H. BarakatIntelligible Support Vector Machines for Diagnosis of Diabetes Mellitus, IEEE Transactions On Inform Techn. Biomed. 2010;14( 4).
4. Naz H, Ahuza S. Deep learning approach for diabetes prediction using PIMA Indian dataset. J Diab Metab Dis April 2020;19(1):391-403.
5. Swapna GVinayakumar RSoman K. Diabetes, Diabetes detection using deep learning algorithms. ICT express 2018;4:243-246
6. El-Jerjawi NS, Abu-Naser SS. Diabetes prediction using artificial neural network. Int J Adv Sci Tech 2018;121:55–64.
7. Perveen S, Shahbaz M, Keshavjee K and Guergachi A, Metabolic Syndrome and Development of Diabetes Mellitus: Predictive Modeling Based on Machine Learning Techniques. IEEE Access 2019;7: 1365-1375.
8. Sajida PN, Muhammad S. Performance Analysis of Data Mining Classification Techniques to Predict Diabetes. Procedia Comp Sci 2016; (82):115-121.
9. Barakat N, Bradley A, Barakat MN. Intelligible Support Vector Machines for Diagnosis of Diabetes Mellitus. IEEE Transactions Info Tech Biomed 2010;14(4):1114-1120.
10. AIyer S, Jeyalatha R, Ronak S, Diagnosis Of Diabetes Using Classification Mining Techniques. Int J Data Mining Knowl Man Pro 2015;5(1):1-14.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareStakeholders' Perspective Towards the Contingency Education Model During Covid 19 Pandemic
English150154Deepti SharmaEnglish Deepshikha AggarwalEnglish Archana B. SaxenaEnglishIntroduction: Covid-19 pandemic has an impact on worldwide education system. To avert the danger of human life, all school, colleges and university around the world have to be shut down. To circumvent the educational loss due to this pandemic, the educational bodies have decided to continue the teaching through online modes where instructor and students will be connected virtually.
Objective: This new model is considered as Contingency Educational Model (CEM). There are three major stakeholders in this Model: Students, Teachers and Parents. This paper is an effort to analyse the perspective of these stakeholders about this CEM. The scope of the paper is limited to the school and colleges of India Region.
Methods: To evaluate the above-mentioned aspect, the questionnaire method of survey was adopted by the authors. A questionnaire was designed keeping in mind IES (Indian Education system) and CEM (Contingency Education Model). Some of the key factors that authors considered are the usefulness of this model, skill enhancement of users, ease of use, privacy & security, and intention to use this model.
Results: Based on responses given by the respondents, these aspects are evaluated, using MS Excel & SPSS tools. The current paper has summarized the experiences of various stakeholders in the Contingency Education Model that has implemented on the recommendations of UNESCO.
Conclusion: The CEM is very much required to save the education loss that Covid-19 might generate due to all over world lockdown.
EnglishCEM (Contingency Education Model), TAM (Technology Adoption Model), Covid 19, Corona Educational Impact, word cloud, Online teaching tools and methodologyINTRODUCTION
The current scenario of universal lockdown is the first of its kind in human history. COVID 19 has an impact on all the essential sectors of our lives. This pandemic has forced us in a situation where everything else around the life has to be shut down to protect life. To sync with the title of the paper, authors are going to discuss the impact of this contagion on the education system and its stakeholders.1 All over the world countries have rightly decided to protect the future generation from this crisis and closed all the schools, college and universities as the first step.2 The worldwide lockdown has an impact on around 1.725 billion learners around the world. 98.5% of the student population is bearing the educational losses as 158 countries are implementing nationwide closure and 35 are implementing local closures.3 Now the dilemma is with the policymakers they cannot open the educational institutes and simultaneously they don’t want students to compromise on their studies. Countries very well realised that loss on education will not impact just the student, school or parents but it will lead to far-reaching economical and societal consequences. To strike a balance between these two teachings has been moved online by using some means. Even UNESCO (United Nations Educational, Scientific and Cultural Organization) has recommended continuing distance education or open education through virtual classroom.4 Authors will address this new model of education as CEM (Contingency Education Model) throughout the execution of this research piece. A CEM (Contingency Education Model) connects Students and teachers latitudes to continue studies through virtual class rooms.5 The most important requirement of this online teaching availability of internet connects and a device that connects with the internet connection. With the help of internet connection and devices these virtual classrooms can be practised through various synchronous tools like; Google Meet, Zoom Meetings, MS Teams or asynchronous tools like sending videos through Whatsapp, tv channels, youtube videos.6,7 Unlike CEM, TEM (Traditional Educational Model) connect students and teachers through a physical environment (school) where educational subjects are completed along with physical and extra-curricular activities. Although it is correct that CEM has supported education system a lot during this pandemic but before making any conclusion it is important what various stakeholders have to say about this Educational model.
DIFFERENT TOOLS/ MODES USED FOR TEACHING IN CEM
To continue teaching during coronavirus outbreak, many schools and colleges have shifted their classroom teaching to online education. During social distancing and ‘stay at home’ order, online education is the need of the hour. Although e-learning has been a catchword from last 4-5 years, covid-19 has forced the educational system to take thoughtful steps ahead8. Starting from schools and colleges to different universities like Harvard, Stanford started offering their online courses free to the students. Academic resources are being shared by the number of schools, colleges and universities via online platforms and apps. Some use apps like Microsoft Teams, Google Meet and Zoom as virtual classrooms, while others are using WebEx, Moodle, Google Classrooms, Instructables.9 There are online platforms also which are offering online courses e.g., National Programme on Technology Enhanced Learning (NPTEL), Study Webs of Active-Learning for Young Aspiring Minds (SWAYAM), Meritnation, Topper, Extramarks etc.10,11 Instead, any educator can also use personalized tools and techniques according to their teaching methodologies. Recording lectures using camera and then circulating it among students via email groups, Whatsapp, telegram app, video conferencing platforms and also teaching webs are in use.12
There is several educational websites and online platforms which are offering help to students with their courses.13 These websites have an advantage that student can learn at his own pace. BYJU’s is one example of such a website where students can learn online from anywhere and anytime. BYJU’s offers various subjects learning programs in English and Hindi for students.14 Meritnation also offer classes in a wide range of subjects including science, mathematics, English, social studies, Hindi and General Knowledge. It makes each session interactive with the help of videos, quizzes and many more. It also offers 1 and 2 years online preparatory courses for NEET and IIT-JEE. The topper is another informative platform for students from classes 5 to 12 across national and state boards.15 Students can attend live classes, online classes and mock tests using this platform. Extramarks is a learning platform through which school-going as well as graduate entrance exam students’ can work. Students can practice through different worksheets and can attend live classes for all subjects also.
Besides various online platforms, there are numerous apps also that help students to learn, attend and practice online. Google classroom is one such app for educators that help teachers to stay organized and track progress through their lesson plans. Instructables provide a platform to teachers through Do It Yourself (DIY) projects that can be included in lesson plans. This helps to reduce lesson planning significantly.16 Using Educreations app, teachers can create videos as part of lesson plans and assignments. At times, it is difficult to teach only through speaking, and this video and diagrams can help students to learn things quickly. Edmodo is designed with online teachers in mind; the app helps with digital organization of student work and lessons. Teachers can assign work, manage progress, and discuss feedback with students one on one and with parents/guardians too. Kahoot has given an excellent platform to students in the form of interactive games. Students can work towards completing game tasks and learn at the same time. Slack is a team communication tool that can be used for teacher-to-teacher, teacher-to-student, and even student-to-student messaging.TeacherKit is designed specifically for teachers that help them to track grades, attendance, and other factors.17
FACTORS CONSIDERED IN CEM
There are three major stakeholders in the Contingency Education Model (CEM). They are student, teacher and parent. The questions are designed keeping in view the concerns of all stakeholders. Some of the key factors that authors considered are the usefulness of this model, skill enhancement of users, ease of use, privacy & security, and intention to use this model, privacy & security, infrastructure support and impact on health. The questions and its description are given below in table 1. This table describes the key factors considered in Contingency model. These factors are various questions which were asked to stakeholders through the questionnaire.
MATERIALS AND METHDOS
A primary survey is done to collect the data. A questionnaire based on the questions shown in table 1 is used. The questionnaire was sent through e-mail, Facebook or WhatsApp to around 250 people. Out of those, 172 people responded. All the responses were recorded for analysis purpose. Later, all the incomplete questions from the data collected have been cleaned and information is processed using Microsoft Excel analysis.
Analysis of Data
After collecting the data, the data is analysed and the results are shown in below tables. Table 2 and Figure 1 shows the number of students, parents and teachers participated in the survey. The total number of students who participated in the survey was 46.35%, whereas parents were 33.11 and teachers were 7.2% only. The total contribution of both teachers and parents recorded was 13.2%.
Table 1 explains the participation made by different stakeholders like students, parents, teachers and both teacher and parent. Various stakeholders used to use the online learning platform before this pandemic situation also while others have started it only after the lockdown during online education. The interpretation is shown in table 3 which states the usage of online learning platform before and after lockdown.
Table 3 investigate the usage of online learning platforms by different stakeholders’ pre and post lockdown. It explains 51% of stakeholders agreed that they were using the online learning platform before lockdown also and 48% said that they started using it only after lockdown.
RESULTS
Perception of stakeholders based on various factors
Out of 172 respondents, stakeholders have provided their views based on various factors. The data was collected on a Likert scale of 1-5. Authors have eliminated the responses with values 1 to 3 for better results. The responses with value more than or equal to 4 are considered and shown in the form of percentage in Table 4. This table explains the stakeholder’s perception based on different factors. Factors are related to travel time, lifestyle, internet connection, health factors, teacher bonding, safety and usefulness are explained in table 4.
Table 4 above describes the stakeholder’s perception based on different factors like safety, usefulness, health issues, travelling time, the requirement of technical skills etc of online teaching. The observations of the respondents about these factors are described in section 4.3.
Observations of the respondents about online teaching
In the survey done by authors, the general feedback about their experience in online teaching and learning was also taken. Few respondents have posted positive effects while a few others shared negative aspects of online teaching. Some people told that online teaching enhances learning during the lockdown, interaction with teachers are better than the traditional model, safe and the interpersonal skills are improved whereas other say they are harmful to their children and offline mode is better. These views are represented in the form of a word cloud which is prepared using “R” software. The following figure shows the word cloud for the general observations of the respondents in online teaching.
Figure 1 shows the word cloud for the general observations of the respondents in online teaching. It observes keywords and the feedback given by different stakeholders through the questionnaire given to them. Few have highlighted keywords like online education, interaction with teachers and interpersonal skills. Others pointed out that they are satisfied with this teaching methodology. Other highlighted words are future skills, exposure, traditional, harmful, benefits, solution and many more.
CONCLUSION
The current paper has summarized the experiences of various stakeholders in the Contingency Education Model that has implemented on the recommendations of UNESCO. The CEM is very much required to save the education loss that Covid-19 might generate due to all over world lockdown. The correct analysis of this paper will help us in bringing the improved version of CEM. In the improved version recommendations made by stakeholders can be included as improvement points and difficulties used by these benefactors can be tried to illuminate in the next version. With these improvements, we can adopt CEM as NEM (Normal Education Model) as online teaching is the future of classroom teaching or they both can go hand in hand.
Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest: NIL
Source of funding: NIL
Englishhttp://ijcrr.com/abstract.php?article_id=3289http://ijcrr.com/article_html.php?did=3289
World Bank Education and Covid-19. https://www.worldbank.org/en/data/interactive/2020/03/24/world-bank-education-and-covid-19. Accessed on April 30, 2020.
Kasrekar DI, Wadhavane G. Impact of COVID-19 on Education system of India. Retrieved June 2020. www.latestlaws.com.
Impact of Covid-19 on Education System in India, https://www.latestlaws.com/articles/impact-of-covid-19-on-education-system-in-india/, Accessed in April 2020
Excel analysis tool pack, Retrieved June 2020, from https://www.excel-easy.com: https://www.excel-easy.com/data-analysis/analysis-Jan, 2020
Covid-19 in India: Using digital Media in Teaching, Retrieved June 2020, from https://www.brookings.edu: https://www.brookings.edu/blog/education-plus-development/2020/05/14/covid-19-in-india-education-disrupted-and-lessons-learned/, April 2020.
Education Mission Ahead, Retrieved 2020, from https://edition.cnn.com: https://edition.cnn.com/2020/04/08/tech/online-education-india-coronavirus-spc/index.html, 2020.
Online classes during Lockdown from https://www.karnataka.com: https://www.karnataka.com/education/online-classes-during-lockdown/, accessed on . (2020, March). Retrieved June 2020
UNESCO's support:Education Response to COVID-19, from www.en.unesco.org: https://en.unesco.org/covid19/educationresponse/support accessed on . (2020, March). Retrieved June 2020
Ahmet Berk Ustun MW, An effective way of designing blended learning: A three phase design-based research approach. Edu Info Tech. 2020;25:1529-1552.
Aljawarneh SA, Reviewing and exploring innovative ubiquitous learning tools in higher education. J Comp Higher Edu 2019;32(4).
Best app for teachers. (n.d.). Retrieved from https://www.digitaltrends.com/mobile/best-apps-for-teachers-education/, Accessed in May 2020.
Best apps . (n.d.). Retrieved from http://anomalouseducator.com/best-apps-for-online-teachers/, accessed in May 2020.
COVID-19, Retrieved from https://www.worldbank.org: https://www.worldbank.org/en/data/interactive/2020/03/24/world-bank-education-and-covid-19, April, 2020.
Online classes. (n.d.). Retrieved from https://www.karnataka.com/education/online-classes-during-lockdown/.
Shu-Chen YL. Learning online, offline, and in-between: comparing student academic outcomes and course satisfaction in face-to-face, online, and blended teaching modalities. Edu Info Tech 2018; 23(2):1-13.
Tools used by educators. (n.d.). Retrieved from https://www.redbytes.in/best-apps-for-teachers-and-educators/ accessed in May 2020.
Shinde SP, Deshmukh VP, Sawant BS. Web-based education in schools: a changing scenario of educational technology in India. Int J Curr Res Rev 2012;4(4):135-140.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareResults of Surgical Correction of Funnel-Shaped Deformation of the Chest Children
English155160Bakhromjon MirzakarimovEnglish Jurakul DjumabaevEnglish Karimjon YulchievEnglish Umidjon MamajonovEnglish Doniyorbek KarimovEnglish Muzaffar YuldashevEnglishIntroduction: Children have signs of chronic hypoxia, metabolic disorders. decreased appetite. Against this background, surgical treatment, which includes reconstruction of the chest, presents a certain risk. Based on these provisions, special attention was paid to the preoperative preparation of patients.
Objective: 1) Optimization of preoperative preparation and methods of surgical correction of funnel chest pectus excavatum( PE); 2) Improvement of postoperative management of sick children with funnel chest.
Method: We operated 44 sick children in our hospital who were admitted to the surgical department with a diagnosis of PE. After preliminary examination, these patients underwent surgical correction of the chest according to Bairov and Ravich-Gross.
Results: In sick children aged 3-6 years after the Ravich-Gross operation, compared with the Bairov operation, the intensity of the pain syndrome was expressed as according to the VAS scale (7.55 ± 0.24 versus 6.0 ± 0.52 points, p EnglishFunctional disorders, Funnel-shaped deformation, Marsheva’s splint, Children, Conservative treatmentINTRODUCTION
As shown in the review of the literature with the age of the child, functional disorders become more pronounced, and against the background of frequent colds, tonsillitis, enlargement of the palatine tonsils, phenomena of chronic intoxication occur.9,11 Children have signs of chronic hypoxia, metabolic disorders. decreased appetite. Against this background, surgical treatment, which includes reconstruction of the chest, presents a certain risk. Based on these provisions, special attention was paid to the preoperative preparation of patients.2,3
MATERIALS AND METHODS
It seems to us that the surgical treatment of sick children should include two components: preoperative and operational. Preoperative (conservative) treatment is carried out for a long time (within 1-2 months, on an outpatient basis), including the sanitation of chronic foci of nasopharyngeal infection, general and extended chest massage with elements of breathing exercises. When patients were admitted to the hospital, clinical and laboratory, instrumental, and X-ray examinations were necessarily carried out and were also re-examined by narrow specialists (cardiologist, paediatrician, ENT).4,5
RESULTS AND DISCUSSION
We operated 44 sick children in our hospital who were admitted to the surgical department with a diagnosis of PE. After preliminary examination, these patients underwent surgical correction of the chest according to Bairov and Ravich-Gross, the distribution of which is presented in Table 1.
As can be seen from the table, the smallest number of children - 6 (23.1%) underwent surgical intervention according to Bairov in the younger age group (3-6 years), since this method is characterized by low trauma and cosmetic properties. The Ravich-Gross operation was performed in 20 (76.9%) children aged 3-6 years and in 18 (100%) children aged 7-15 years, respectively. A characteristic feature of PEin older children is the progression of the disease, which is closely related to the growth and age of the child.
In this regard, the children of the older age group underwent the Ravich-Gross operation, taking into account the need for wide access to the SCC, additional incisions in the sternum, and ribs with the aim of effective correction and fixation of the SCC. For corrective thoracoplasty according to the Bairov and Ravich-Gross method, we used some modified versions of these operations, which will be indicated below (in the description of the operation).
These methods are based on resection of costal cartilage at the level of deformity, T-shaped sternotomy, traction for the body of the sternum using Marshev's splint. Both methods involve external fixation. The Marsheva splint is a lightweight, durable construction made of vinyl plastic and easy to sterilize. The tire is made taking into account the boundaries of the "funnel" before the operation (Figure 1).
The immediate preparation of the patient for the operation began with premedication, the purpose of which is to potentiate the action of the main narcotic substance and conduct a neuro-vegetative blockade. Premedication was achieved by intramuscular injection in 30-40 minutes. before the operation, a solution of 0.1% atropine and 1% diphenhydramine in an age-specific dosage.
All operations were performed under total intravenous anaesthesia using artificial ventilation in a controlled breathing mode using Drager EV-801 and Blease Frontline 560 anaesthesia machines. We used a 5% ketamine solution at a dose of 5-6 mg/kg as induction anaesthesia. which, to provide supportive drug therapy and infusions, a subclavian Seldinger catheter was installed in the modification of the staff of the Department of Pediatric Surgery with the course of anesthesiology at ASMI (Rational proposal No. 524 of June 14, 2005, by ASMI). For monoplegia, a 0.4% solution of pancuronium hydrobromide was used at a dose of 0.05 mg/kg. After preoxygenation of 100% O2, the patients were intubated and transferred to apparatus breathing, O2 saturation was maintained at a level of 90-100%, thereby creating a favourable condition for the surgeon to work on the chest wall. In children, we do not use gas-narcotic mixtures to maintain anaesthesia, given the functional disorders of the respiratory system, which is fraught with the development of complications in the respiratory system in the immediate postoperative period. To this end, a bolus of ketamine and an intravenous drip of propofol at a dose of 10 mg/kg was performed. As the main anaesthesia, 0.005% fentanyl was used at a dose of 1 ml/kg, followed by the introduction of half the dose after 40 minutes. Intraoperative blood loss was replenished with a high-molecular-weight plasma substitute - Refortan 40 at a dose of 10 ml/kg. After the completion of the operation and the appearance of spontaneous breathing, all patients were extubated on the operating table followed by O2 insufflation and transferred to the post-anaesthetic ward of the intensive care unit under the supervision of an anesthesiologist.
Operation technique according to Bairov
According to this method, 8 children aged 3-6 years were operated with some modifications, which are as follows:
The position of the patient on the back, a flat roller was placed under the shoulder blades. At the edge of the impression, 4 small longitudinal skin incisions (3-4 cm) were made in such a way that each wound could be processed above and below the rib. Slightly shifting the skin wound to the apex of the rib curvature and stupidly stratifying the muscles above it, trying not to damage the pleura and blood vessels, the necessary segment of the rib was resected, which was calculated on the contourogram, without affecting the growth zone (the place of transition of the bone part into the cartilaginous one) and immediately the ends of the resected ribs are sutured lavsan threads. After that (4-5 cm), an incision was made in the skin and subcutaneous tissue over the base of the xiphoid process, which, unlike the traditional method, was not cut off from the sternum. At the same time, the retrosternal ligament was revealed - a dense cord running from the posterior surface of the xiphoid process to the diaphragm. After mobilization of the retrosternal ligament, a Z-shaped excision of the latter was performed, with the calculation of the required distance (determined on the contourogram), which is equal to half this value.
Then, bluntly (with a finger) peeled off from the inner surface of the sternum adjacent sheets of the parietal pleura and pericardium. After that, we proceed to mobilize the deep section of the sternum. Above the beginning of the curvature of the sternum, a T-shaped sternotomy was performed with a thin chisel or scalpel (under the control of a finger inserted behind the sternum), and the inner plate was fractured by applying pressure from the inside. After sternotomy, the mobility of the sternocostal was checked, if tensions were noted, additional incisions were made in the tension area. Under the control of a finger, the mobilized sternum was percutaneously held with a fishing line for subsequent stretching and fixation. The previously excised retrosternal ligament was sutured end-to-end (Figure 2).
Then the wounds were sutured in layers, the withdrawn traction threads were passed through the corresponding holes of Marshev's special vinyl plastic splint and tied over gauze balls with a tension sufficient to hold the aligned part of the sternum and ribs. The splint was placed on a foam or rubber sponge, created for constant stretching and fixation, the structure was closed with a light gauze bandage on a cleola. The average duration of the operation ranged from 1 hour to 1 hour. 20 minutes. Immobilization was carried out depending on age for 20-30 days, followed by replacement of Marshev's splint with a plate.
Operation technique according to Rawicz-Gross
A transverse wave-like (submammary) incision was made for 15-20 cm. The tissues were dissected in layers and the skin and subcutaneous tissue were mobilized on both sides of the incision, within the limits of deformation after hydraulic dissection by the introduction of 0.25% Novocain. The length of the resection was established before the operation by contouring calculation. Immediately after resection, the edges of the ribs were connected with separate lavsan sutures. Then, in the region of the xiphoid process, a semilunar incision was made, mobilizing the retrosternal ligament, and a Z-shaped excision of the latter was performed. The pleura and pericardium were mobilized from the inner surface of the deformed sternum. A T-shaped sternotomy was performed with excision of the wedge at the transverse intersection of the anterior plate (we break the posterior plate) under the control of a finger. Through the body of the sternum in the middle part, 2 threads (fishing line) were passed for subsequent stretching. Z-shaped excised retrosternal ligament was sutured end to end with a nylon thread. The defect over the ligament was sutured with nylon thread. The superimposed traction threads were passed out through separate skin punctures. The wound surface was treated with an antibiotic solution. The subcutaneous tissue and skin were sutured. The withdrawn traction threads were fixed to Marshev's splint after achieving the visual correction of the breast.6,7
The two modified methods of surgical correction of funnel chest used by us are effective in cosmetic terms and in terms of eliminating cardiorespiratory disorders, are less traumatic with a low risk of intraoperative complications in the form of damage to the pleura and pericardium. To ensure less trauma in the intra-, postoperative period when performing these operations, we have optimized and modified the following points:
Firstly, when mobilizing the sternum during the operations of Bairov and Ravich-Gross, we did not resort to exfoliation of the parietal pleura and pericardium from the inner surface of the deformed ribs, but limit ourselves only to exfoliating them from the inner surface of the sternum, which prevents damage to the pleura and the occurrence of pneumothorax during the operation eliminates the need for X-ray control.
Secondly, in contrast to traditional methods, with both methods, we performed a complete resection of curved ribs along the edge of the "funnel". In our opinion, subperichondral resection may lead to further growth at the junction of the resected ribs (exostosis), caused by the infringement of the perichondrium in the attachment area. Also, children with PE have a hereditary predisposition to exostosis associated with dysplasia of connective tissue elements.
Thirdly, we immediately sew the ends of the resected ribs with lavsan threads. This stage of the operation, in our opinion, has a fundamental character, because, after the mobilization of the SCC, some displacement of the resected ribs is noted, which can lead to their erroneous stitching.
Fourthly, unlike the traditional method, the xiphoid process together with the retrosternal ligament was not cut off from the sternum. We believe that cutting off the xiphoid process together with the retrosternal ligament can lead to hypercorrection in the long-term postoperative periods; also, the retrosternal ligament helps to keep the SCC in a fixed position from the inside when pulling on Marshev's bus, which ensures the prevention of overcorrection.9,10
Fifth, after mobilization of the retrosternal ligament, a Z-shaped excision of the latter was performed, with the calculation of the required distance (determined on the contourogram), which is equal to half of this value, which was sutured end to end, which prevents hypercorrection and recurrence of deformity in the postoperative period. The average duration of the operation ranged from 1 hour 20 to 1 hour. 40 minutes.7,8
Numerous studies have shown 2, 8 that insufficient postoperative pain relief leads to negative changes in the emotional state of the child and increases the number of complications. So, hypoventilation in children after thoracoplasty is associated with the development of pain. Pain syndrome is an integral part of the postoperative illness and is often the root cause of a variety of disorders and deviations in the condition of patients. Therefore, an effective fight against pain in the postoperative period should be considered not only as a desire to alleviate the patient's physical suffering, improve his psycho-emotional state, but also as a prevention of hemodynamic, gas exchange, and metabolic disorders. Assessment of the pain factor in the postoperative period is complicated to a large extent by the fact that for a certain time the factor of post-anaesthetic depression acts, the degree of blood loss, disturbance of CBS, temperature balance, and several other factors matters. In this regard, in our clinic, to assess the intensity of acute pain, the Visual Analog Scale (VAS) and the four-digit categorical verbal scale (Verbal Rating Scale, VRS) are used, which are equally sensitive for determining acute postoperative pain.
At the same time, it was found that in sick children aged 3-6 years after the Ravich-Gross operation, compared with the Bairov operation, the intensity of the pain syndrome was expressed as according to the VAS scale (7.55 ± 0.24 versus 6.0 ± 0.52 points, p Englishhttp://ijcrr.com/abstract.php?article_id=3290http://ijcrr.com/article_html.php?did=3290
Berker AN, Yalç?n MS. Cerebral palsy: orthopaedic aspects and rehabilitation. Pediatr Clin North Am 2008;55(5):1209-25.
Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 1992;34(6):547-51.
Sankar C, Mundkur N. Cerebral palsy-definition, classification, aetiology and early diagnosis. Indian J Pediatr 2005;72(10):865-8.
Kilincaslan A, Mukaddes NM. Pervasive developmental disorders in individuals with cerebral palsy. Dev Med Child Neurol 2009;51(4):289-94.
Singhi PD, Ray M, Suri G. Clinical spectrum of cerebral palsy in North India—an analysis of 1000 cases. J Trop Paediatr 2002;48(3):162-6.
Rosen MG, Dickinson JC. The incidence of cerebral palsy. Am J Obstet Gynaecol 1992;167(2):417-23.
Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Paediatrics 2002;110(6):1220-5.
Hagberg B, Hagberg G, Zetterström R. Decreasing perinatal mortality–increase in cerebral palsy morbidity? Acta Paediatrica 1989;78(5):664-70.
Yoon BH, Jun JK, Romero R, Park KH, Gomez R, Choi JH, Kim IO. Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1β, and tumour necrosis factor-α), neonatal brain white matter lesions, and cerebral palsy. Am J Obstet Gynaecol 1997 Jul 1;177(1):19-26.
Wu YW, Colford Jr JM. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. JAMA 2000;284(11):1417-24.
Mallick S. Study On The Clinical Profile Of Patients With Cerebral Palsy (Doctoral dissertation) 2011; 52(172):127-47.
Garg SA. Chakravarti R. Singh NR, Masthi RC, Goyal GR. Jammy E. Dengue serotype-specific Seroprevalence among 5- to 10-Year-Old Children in India: A Community-Based Cross-Sectional Study. Int J Infect Dis 2017; 54:25–30.
Puri S, Fernandez SA, Puranik D, Anand A, Gaidhane Z, Quazi S, et al. Policy Content and Stakeholder Network Analysis for Infant and Young Child Feeding in India. BMC Public Health. 2017; 17:217-21.
Taksande A, Meshram R, Lohakare A. A Rare Presentation of Isolated Oculomotor Nerve Palsy Due to Multiple Sclerosis in a Child. Int J Pediatr 2017; 5(8): 5525–29.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareRole of Maternal Serum Ferritin in Gestational Diabetes Mellitus
English161164Feroz AlamEnglish Surabhi GautamEnglish Nasreen NoorEnglish Shagufta MoinEnglishIntroduction: Gestational diabetes mellitus (GDM) is one of the most common medical disorders complicating pregnancy, and it usually resolves following delivery. However, GDM can affect the immediate maternal and perinatal outcomes, besides, it can also have long-lasting health consequences for both the mother and the newborn. Evidence from experimental studies has shown that higher than normal ferritin concentrations can lead to pancreatic β cell dysfunction and impaired glucose metabolism and GDM.
Objective: Estimation of serum ferritin in early pregnancy in normal controls and women suffering from GDM.
Methods: 50 Pregnant women (24-28 weeks gestation) were divided into GDM cases (n=35) and normal controls (n=15). Blood samples were collected for estimation of HbA1c and serum ferritin and the results were analysed statistically.
Results: The values of initial DIPSI 2 hr blood glucose, and later HbA1c and serum ferritin were significantly higher (p< 0.05) in GDM cases in comparison to the control group.
Conclusion: Serum ferritin is significantly higher in patients of GDM, pointing towards a possible role of oxidative stress in GDM as well as fetal intra-uterine and postpartum well being.
EnglishIron, Gestational diabetes mellitus, FerritinINTRODUCTION
Diabetes is a global health epidemic, and India is one of the most affected countries, the prevalence of diabetes in urban India varies from 4.6%-14% and in rural India from 1.7%-13.2%. Presently, it is estimated that there are about 62 million cases of diabetes in India, and this figure will rise to 79.4 million by the year 2025. Diabetes is a major public health problem in India with prevalence rates reported to be between 4.6% and 14% in urban areas, and 1.7% and 13.2% in rural areas. India has an estimated 62 million people with Type 2 diabetes mellitus (DM), this number is expected to go up to 79.4 million by 2025.1 With this increase in diabetes prevalence, there seems to be a corresponding increase in the prevalence of Gestational Diabetes Mellitus (GDM). Gestational diabetes mellitus (GDM) is a common pregnancy complication, which in simple terms is spontaneous hyperglycemia developing during pregnancy. The American Diabetes Association (ADA) formally classifies GDM as “diabetes first diagnosed in the second or third trimester of pregnancy that is not either preexisting type 1 or types 2 diabetes”.2 GDM is said to affect approximately about 14% of pregnancies worldwide, representing approximately 18 million births annually. In India, the prevalence of gestational diabetes has been reported to range from 3.8% in Kashmir, to 6.2% in Mysore, 9.5% in Western India and 17.9% in Tamil Nadu. Also, in some recent studies using different criteria for diagnosis, prevalence rates as high as 35% from Punjab and 41% from Lucknow have been observed. These geographical differences in prevalence can be attributed to differences in age and/or socioeconomic status of pregnant women in different regions. At any given point of time, India is estimated to have 4 million pregnant females suffering from GDM.3 It is estimated that about 4 million women are affected by GDM in India, at any given time point.3 Despite, the ever-increasing risks associated with GDM, no widespread agreement exists among experts to diagnose it warranting treatment in a pregnant woman. In India, Diabetes in Pregnancy Study Group in India (DIPSI) criteria is used as the norm to diagnose GDM, especially in the community setting. The DIPSI recommends a non-fasting OGTT (Table-1) based on the belief that fasting OGTT would be logistically difficult in pregnant women in the community as it required them to return to the clinic on a separate day. The evidence basis of the DIPSI criteria is a single-centre study comparing non-fasting OGTT with World Health Organization (WHO) 1999 criteria, showing 100% sensitivity and specificity.3
Iron is stored in the body as ferritin, and measurement of ferritin in serum reflects adequately the pool of iron present in bone marrow macrophages. Ferritin is also an acute phase reactant and it is increased in many chronic diseases and inflammation. Increased cellular ferritin has been linked to insulin resistance and pancreatic β-cell dysfunction. Ferritin the major iron storage protein has a function in iron metabolism. Serum ferritin concentration displays the measure of body iron stores because it is highly correlated with bone marrow iron. High serum ferritin levels have been demonstrated in many chronic disorders and vascular inflammation. Mildly elevated body iron stores have been associated with elevations in glucose homeostasis indices. A significant correlation between higher serum ferritin levels and insulin resistance syndrome has been shown. Elevated serum ferritin levels were associated with greater than the two-fold increased risk of development of type 2 diabetes in the Finnish population. A strong association between higher serum ferritin concentration and newly diagnosed type 2 diabetes was observed among a U.S. population as well.4 Studies have suggested that raised serum ferritin levels were found in women with non-insulin-dependent diabetes as well as in women with GDM, and it was reported to be associated with glycemic control.5 It was postulated that circulating levels of ferritin, also an acute phase reactant, are not truly reflective of body iron stores but may reveal other processes such as systemic inflammation. Evidence from experimental studies demonstrated that iron overload, including from hereditary or secondary hemochromatosis, can induce pancreatic beta-cell toxicity and impaired glucose metabolism. Although the exact molecular mechanism is not clear, iron is a strong pro-oxidant, and higher than normal iron concentrations may lead to diminished insulin secretion coupled with pregnancy-induced insulin resistance, thereby predisposing to GDM.6
MATERIALS AMD METHODS
A prospective study was carried out from October 2018 to December 2019 in the Department of Obstetrics and Gynaecology and Department of Pathology JN Medical College, AMU, Aligarh. Pregnant women with gestational age from 24-28 weeks were eligible for the study, the DIPSI OGTT was performed with a single dose of 75-gram oral glucose in non-fasting state. 2 ml blood was collected after 2 hrs in sodium fluoride vial and blood sugar was measured spectrophotometrically (semi auto analyzer).
Based on DIPSI 2hr blood sugar screening results, 35 GDM patients (having sugar > 140 mg/dl) and 15 controls (having sugar < 120 mg/dl) were selected, with few exclusion criteria.
Inclusion criteria-
All patients diagnosed with GDM
Exclusion Criteria-
Women with overt diabetes.
Women with iron deficiency anaemia.
Women with acute or chronic liver disease or kidney disease.
Women with any acute or chronic inflammatory disease.
Sample Collection
Post DIPSI screening (after 1 week) the blood samples were collected from both the GDM and control groups. The HbA1C was measured with 2 ml EDTA blood using HPLC method on the same day. For serum Ferritin estimation an additional 2 ml blood samples were taken in the plane vial and serum was separated immediately and in case of any undue delay was stored refrigerated at, -20Degree Celsius till assayed and the test was performed by Ferritin ELISA kit.
Statistical Analysis
The data were analyzed using the SPSS 21 software. The data results were expressed as mean ±SD with mean differences and 95% confidence intervals. Student’s t-test was applied to compare data of cases and controls. Also, we applied Welch correction where the assumption of equal variances was violated.
RESULTS
The mean±SD of maternal age (yrs) in the participants was 27.6 ± 3.2 in GDM group and 27.3 ± 2.8 in the control group, Table 2 shows that the age (yrs) doesn't shows any statistical significance (p > 0.05) in the GDM and the control groups. The mean ±SD of initial DIPSI 2 hr blood glucose (mg/dl) was 175.9 ± 18.1 in GDM group and 84.0 ± 3.79 in the control group, Table 2 shows that the 2 hr blood glucose shows the significant higher value (pEnglishhttp://ijcrr.com/abstract.php?article_id=3291http://ijcrr.com/article_html.php?did=3291
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-India DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54 (12):3022–3027.
American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018;41(1): S13–S27.
Mithal A, Bansal B, Kalra S. Gestational diabetes in India: Science and society. Ind J Endocrinol Metabol 2015;19(6):701-702.
Ren Y, Tian H, Li X, Liang J, Zhao G. Elevated Serum Ferritin Concentrations in a Glucose-Impaired Population and Normal Glucose Tolerant First-Degree Relatives in Familial Type 2 Diabetic Pedigrees. Diabetes Care 2004; 27 (2):622-623.
Chan KK, Chan BC, Lam KF, Tam S, Lao TT. Iron supplement in pregnancy and development of gestational diabetes—a randomised placebo?controlled trial. BJOG 2009;116(6):789-797.
Bowers KA, Olsen SF, Bao W, Halldorsson TI, Strøm M, Zhang C. Plasma Concentrations of Ferritin in Early Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus in Women in the Danish National Birth Cohort. J Nutr 2016;146(9):1756-1761.
Pikee S, Sakshi M, Aruna N. Screening and Diagnosis of Gestational Diabetes Mellitus: from Controversy to Consensus. Curr Res Diabetes Obestet J 2017; 2(5): 555600.
Renz PB, Cavagnolli G, Weinert LS, Silveiro SP, Camargo JL. HbA1c Test as a Tool in the Diagnosis of Gestational Diabetes Mellitus. PLoS One 2015;10(8):e0135989.
Chauhan P, Gogoi P, Tripathi S, Naik S. Association of maternal serum ferritin level in gestational diabetes mellitus and its effect on cord blood hemoglobin. Int J Contemp Med Res 2020;7(1):1-4.
Jiang R, Manson JE, Meigs JB, Ma J, Rifai N, Hu FB. Body iron stores about the risk of type 2 diabetes in apparently healthy women. JAMA 2004;291 (6):711–717.
Lao TT, Chan PL, Tam KF. Gestational diabetes mellitus in the last trimester - a feature of maternal iron excess? Diabet Med 2001;18(3):218-223.
Ellervik C, Birgens H, Mandrup-Poulsen T. Need for reclassification of diabetes secondary to iron overload in the ADA and WHO classifications. Diabetes Care 2014;37(6):e137-e138.
Qiu C, Zhang C, Gelaye B, Enquobahrie DA, Frederick IO, Williams MA. Gestational diabetes mellitus about maternal dietary heme iron and nonheme iron intake. Diabetes Care 2011;34(7):1564-1569.
Pantham P, Aye IL, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta 2015;36(7):709-715.
Nicolas G, Chauvet C, Viatte L, et al. The gene encoding the iron regulatory peptide hepcidin is regulated by anaemia, hypoxia, and inflammation. J Clin Invest 2002;110(7):1037-1044.
Wolf M, Sandler L, Hsu K, Vossen-Smirnakis K, Ecker JL, Thadhani R. First-trimester C-reactive protein and subsequent gestational diabetes. Diabetes Care 2003;26(3):819-824.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareEffect of Dual Task Training on Balance and Gait Over Regular and Diversified Land Surfaces in Independent Elderly
English165168S. AnandhEnglish G. VaradharajuluEnglish Mahendra M. AlateEnglish Dhirajkumar A. ManeEnglishIntroduction: Although most falls involve multiple factors, causes of falling are often categorized into intrinsic (personal) and extrinsic (environmental) factors. The dual-task method, which requires participants to perform multiple tasks simultaneously, has been used to investigate the effects of cognitive tasks or additional motor task on postural control and vice versa. The perfect implementation of this intervention will give the evaluative report of functional capacity levels and safety limits in the social life of the elderly population.
Objective: To test the effects of combined dual tasking with the dual components of cognition-motor and motor-motor administered in both regular and diversified environments using the outcome parameter Tinetti balance assessment tool (Balance & Gait).
Methods: 192 subjects randomly selected into two groups (dual-tasking on even & uneven surfaces) were included for the study. Tinetti balance assessment tool was used in 3 sessions of training. A 10-minute warm-up exercises followed by dual-task activity training which includes two components. i.e., cognitive-motor and motor-motor activity.
Results: It was observed that the elderly slow down with gait parameters on diversified land surfaces and when performing a concurrent dual-task. Also, the elderly err on the side of safety and focus their anticipatory resources towards controlling balance. It is so important for physiotherapists to be aware of these strategies and incorporate them into the management of fall prevention among the elderly.
Conclusion: The Dual-task activity training administered in both environmental conditions with safe progressive incremental levels is a motivational response for the elderly and easily predicts the physical difficulty levels.
EnglishRegular land surface, Diversified land surface, Tinetti balance assessment tool, Balance, Gait, Dual-task trainingINTRODUCTION
A UN Population Fund and Help age India analysis stated that by 2026 the total quantity of the older adults will increase to 173 million. According to Population Census 2011 in India, there are nearly 104 million elderly persons (aged 60 years or above) in India(53 million females and 51 million males). Most common disability among the aged persons was found to be a locomotor disability and visual disability as per Census 2011. The probability of age-related disorders and disabilities will have a great impact on individuals, families & health care providers. Exercises developed for rehab of older adults should be sensible, safe & comfortably a gradual approach if applicable & suitable as per individual needs will improve quality of life since the fear of suffering cripples his / her life. Attention is the “magic sauce” for altering our brains. With increasing age, the act of walking demands a higher level of control processing, and gait becomes less automatic.1,2
The increase in attentional demands during walking would reduce the resources available for the performance of a concurrent dual-task interfering balance.3 This makes it imperative for further investigations in the effect of dual-tasking on gait / postural control among the elderly, given the strong link between gait disturbance and fall prediction.4 These differences are more pronounced when walking on diversified uneven surfaces challenging the elderly with confirming risk.
Geriatric wellness is a multi-dimensional, multi-disciplinary area with an assessment designed to evaluate an older person’s functional activity, physical health, cognition and mental health under various socio-environmental circumstances. The geriatric assessment differs from a typical medical evaluation by including non-medical domains; by emphasizing functional capacity and quality of life. Completing survey questions and completing similar procedures not only saves a lot of time but gives a valuable glimpse into the patients' encouragement and awareness. Traditionally, rehabilitation programs emphasize training balance under single-task conditions to improve balance and reduce the risk of falls.
Recent research suggests that older adults that perform poorly under dual-task conditions are at increased risk of falls. Falls, the leading cause of accidental death away older adults over 65 years of age, are a serious clinical problem. Non-fatal falls often lead to physical injury (e.g. fracture), reduced levels of activity, loss of confidence, and altered lifestyle in elderly people. Falls are costly and have potentially devastating physical, psychological and social consequences.
So, this study gives insight on how this incremental physiotherapy intervention involving dual-task activity training (cognitive-motor and motor-motor) under regular and diversified environmental conditions applied to both rural and urban older adults more than 65 years of age. The perfect implementation of this intervention will give the evaluative report of functional capacity levels and safety limits in the social life of the elderly population.
The study aims towards formulating a self-reliant approach for the elderly to self-assess and train themselves towards their threshold levels of exercise capacity. The Dual-task activity training administered in both environmental conditions (regular & diversified) with safe progressive incremental levels have proved to be a challenging responsibility for the elderly. The cause of fall is categorized into Intrinsic (Personal) and/or Extrinsic (Environmental) factor. Attention changes with environment inclusive of additional interference of Psycho-Social factors are more in Physical activity in the elderly. The need for higher attentional demands with environmental demands in the performance of the automatic act of walking needs to be understood. To date, the effects of dual-tasking on diversified land surfaces have received less attention. So, possible risk components on balance & gait need to be ruled out.
It is a community-based rehabilitation approach dealing with an elderly population under personal supervision and assistance. Elderly are taking care of their grandchildren and participate in IADL activities all alone for which functional enhancement is far mandatory. The whole elderly population indeed is well-bounded with many Psycho-Socio-Economic issues and lack of caretakers. So, this research will have a good response from the community-dwelling elderly.
Thus, we aimed to examine the effects of performing a dual-task activity on gait and balance in functionally independent elderly ambulating on regular and diversified land surfaces.
MATERIALS AND METHODS
The study type is Interventional study design with a sample size of 96 subjects using a random sampling method. The period of study continued for more than a year. The study was carried out in Krishna Institute of Medical Sciences, Karad, (KIMS/IEC-043/2011).
Outcome measures
Tinetti Balance Assessment Tool consisting of: Balance score: 16 / Gait score: 12 and so the total score: Balance + Gait = 28
Inclusion criteria
All functionally independent elderly, above the age of 65-75 years including both genders with normal vitals were included in the study; Retired senior citizens restricted to their residence most of the time; No history of fall for the past 12 months; Ability to walk 20m without human assistance; Ability to speak/read/communicate.
Exclusion criteria
Medically unstable patients and Patients with Pacemaker; Chronic illness &Life threatening medical issues; All types of disabilities including severe musculoskeletal pathologies, neurological conditions, vestibular dysfunction that would affect participation; Uncooperative and Psychiatric elderly patients; Participants scored less below 23 on the MMSE; Subjects who are doing part-time work, Farm work or any other regular work are restricted from the study.
Procedure
Ninety-six elderly males and females from 65 to 75 years of age community-dwelling that fulfilled involvement standards for inclusion voluntarily participated in the study. The participants recruited were orally briefed about the study procedure by the primary investigator and were told orally about the place to try, date and time of the trial. Demographics, anthropometrics and comorbidities were assessed at the baseline using a standard questionnaire. Diversified surface: A natural uneven surface under a smooth surface of natural grass with the solid muddy surface with minor ups and downs exposed to sunlight (Usually an area not exposed). Regular surface: A solid pavement area or a track (usually an area exposed prior or similar safe area).
To retain privacy, a letters and numbers token was allocated to each capable individual. To guarantee to counterbalance, all subjects were significantly changed to test procedure baskets. A randomized preference of directories (A-regular and B-diversified), wherein the ordering of testing has been random, offered a contrast.
The treatment lasted about 60 minutes. There have been sufficient rest periods when appropriate. Before the study, the participants had verbal guidance about what they were supposed to do and, if supposed, they performed no more than three practical experiments to get to know the research process.
Exercise Procedure
1. All participants are made to perform daily tasks& cognitive tasks for practice followed by free exercises of extremities and spine: 5 minutes. Personal activities (Folding Bedsheet/counting currency & Dressing self): 5 minutes. Cognitive exercises (Loud reading, Writing / Drawing while listening to music & brushing teeth with non-dominant hand): 5 minutes.
2. Dual-task activity: 15 minutes inclusive of the following: Reading / Talking while walking: 05 minutes. Follow the light/cues while walking: 05 minutes and Obstacle walking: 5 minutes
3. Followed by Balance and Gait assessment. The results recorded were considered for statistical analysis and interpretation.
RESULTS
The table shows the level of risk in the elderly as they ambulate and simultaneously performing a motor and/or a cognitive task on regular and diversified surfaces. Extremely Significant with p-Value < 0.0001 / Odds Ratio - 116.44 / 95% CI: 7.011 - 1933.8 / Chi. Square - 44.308 (Table 1).
The Table 2 shows the level of Balance (Poor & Better) in elderly as they ambulate and simultaneously performing a motor and/or a cognitive task on regular and diversified surfaces. Extremely Significant with p-Value < 0.0001 / Odds Ratio - 116.44 / 95% CI: 7.011 - 1933.8 / Chi. Square - 44.308
Table 3 shows the Gait score (Poor & Better) in the elderly as they ambulate and simultaneously performing a motor and/or a cognitive task on regular and diversified surfaces. Extremely Significant with p-Value Englishhttp://ijcrr.com/abstract.php?article_id=3292http://ijcrr.com/article_html.php?did=3292
Yogev-Seligmann G, Giladi N, Gruendlinger L, Hausdorff JM. The contribution of postural control and bilateral coordination on the impact of dual-tasking on gait. Exp Brain Res 2013 Apr 1;226(1):81-93.
Martin E, Bajcsy R. Analysis of the effect of cognitive load on gait with off-the-shelf accelerometers. Proc Cogn 2011;7:1-6.
Holtzer R, Wang C, Verghese J. The relationship between attention and gait in ageing: facts and fallacies. Motor Control 2012 Jan 1;16(1):64-80.
Verghese J, Ambrose AF, Lipton RB, Wang C. Neurological gait abnormalities and risk of falls in older adults. J Neurosci 2010 Mar 1;257(3):392-8.
LeMonda BC, Mahoney JR, Verghese J, Holtzer R. The association between high neuroticism-low extraversion and dual-task performance during walking while talking in non-demented older adults. J Int Neuropsychological Soc 2015 Aug;21(7):519.
Wrightson JG, Ross EZ, Smeeton NJ. The effect of cognitive-task type and walking speed on dual-task gait in healthy adults. Motor Control 2016;20(1):109-21.
Yogev-Seligmann G, Sprecher E, Kodesh E. The effect of the external and internal focus of attention on gait variability in older adults. J Motor Behav 2017;49(2):179-84.
Young WR, Olonilua M, Masters RS, Dimitriadis S, Williams AM. Examining links between anxiety, reinvestment and walking when talking by older adults during adaptive gait. Expt Brain Res 2016;234(1):161-72.
Wollesen B, Schulz S, Seydell L, Delbaere K. Does dual-task training improve walking performance of older adults with the concern of falling?. BMC Geriatr 2017 Dec 1;17(1):213.
Wollesen B, Mattes K, Rönnfeldt J. Influence of age, gender and test conditions on the reproducibility of dual-task walking performance. Ageing Clin Expt Res 2017 Aug;29(4):761-9.
Beurskens R, Bock O. Does the walking task matter? Influence of different walking conditions on dual-task performances in young and older persons. Human Movement Sci 2013;32(6):1456-66.
Martin KL, Blizzard L, Wood AG, Srikanth V, Thomson R, Sanders LM, Callisaya ML. Cognitive function, gait, and gait variability in older people: a population-based study. J Gerontol Series A: Biomed Sci Med Sci 2013;68(6):726-32.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareEvaluation of Laparotomy Fascial Wound Closure with Continuous Suture and Intermittent Aberdeen Knot
English169173Honeypalsinh H MaharaulEnglish Harsh PatelEnglish Darshan GajeraEnglish Ketul ShahEnglishBackground: The closure is a crucial factor in, laparotomy wound. Fascial layers provide a major tensile strength in wound closure. Poor wound, healing, and development of wound infection and, the incisional wound are the common complications of open abdominal surgery.
Objective: To evaluate abdominal wound closure in terms of the outcome of wound, infection, and wound pain.
Methods: Detailed, clinical history, clinical examination including per abdominal and per-rectal examination, routine blood investigations & chest x-ray screening was done. In all the patients undergoing laparotomy wound closure done with continuous suture and Aberdeen knot. All the patients were observed for complications after operation & followed up at 1 week, 15 days,3,6 months postoperatively.
Results: Most of the patients presented with intestinal obstruction (11) and peptic perforation (9) followed by ileal perforation (8) and appendicular perforation (6). There were 3 patients with liver abscess and Koch’s abdomen, 2 patients with incisional hernia. 1 patient each of pseudocyst, CA descending colon, Ca stomach SMA thrombosis, rectal prolapse, abdominal Trauma, obstructed inguinal hernia, GOO. The most common complication was wound infection (5) followed by chronic wound pain (3), wound dehiscence (2). 1 patient developed an incisional hernia. None of the patients had stich granuloma or suture sinus formation.
Conclusion: In laparotomy, wound closure with continuous suture and Aberdeen knot reduces the incidence of infection, wound dehiscence, incisional hernia, suture sinus formation, and stitch granuloma & chronic wound pain. Thus, this method holds the promise for a safe technique of closure with minimal complication.
EnglishAberdeen knot, Continuous suture, Midline laparotomy, Abdominal Wall, Incisional Hernia, SeromaINTRODUCTION
The closure is crucial,factor in a laparotomy wound. Fascial layers provide a major tensile strength in wound, closure. Poor wound healing and development of wound infection and incisional wound are common, complications of open abdominal surgery. Secure abdominal wound closure relies upon the repair of the musculofascial layer of the abdominal wall. The musculofascial layer of the abdominal wall comprises of external abdominal, internal abdominal, and transverse abdominal muscles and their aponeurosis. In the midline incision linea alba, right paramedian and right subcostal incision-anterior and a posterior layer of rectus, sheath of the musculofascial layers was included.
Continuous fascial closure with intermittent, Aberdeen knot normally practised and the, interrupted, closure is also practised by some surgeons with an assumption that it causes less, pain, and less wound infection. The wound is any discontinuity of tissue and for normal healing, it must be opposed with sufficient strength to allow the normal process of healing otherwise wound disruption may occur leading to complications.1 Wound complications may vary from seroma formation to hernia incidence of which is about 9-19%.2 There are various techniques of wound closure but there is no ideal technique or ideal suture material for particular closure and it all depends on surgeon’s preference. Closure technique varies for each surgeon either continuous or interrupted method, different fascial bites, variation in stitch interval.3,4 Here, we have tried to evaluate techniques of abdominal, fascial closure-continuous with intermittent Aberdeen, knot5 by using nonabsorbable polypropylene suture material in the midline, laparotomies.
The Aberdeen knot is a self-locking, knot consisting of a combination of unique throws and, turns that is used to secure, the end of a continuous suture line (Stott 2009).6 To form an Aberdeen knot, a loop is formed in the future and passed through the tissue on each side of the incision, line. A second loop is then passed through the first loop. This is termed one throw. This step can be repeated any number of times to achieve the desired, number of throws. To lock the knot, an additional, throw called the turn is performed by passing the end of the suture, through the final loop. Depending on surgeon preference, the turn can be repeated (Figure 1).
This study is designed as an evaluation of abdominal wound closure in terms of the outcome of wound, infection, and wound pain. To minimize the influence of suture materials we used the same suture, materials at similar levels of fascial closure in all the patients.
MATERIALS AND METHODS
This is a Prospective, observational, cohort, study in 50 patients aimed to evaluate the outcome of laparotomy fascial wound closure with continuous suture and intermittent Aberdeen knot. Study was conducted at Dhiraj, Hospital with approval from Ethics committee (No: SVIEC/ON/ME01/BNPG18/D19094) from the date of period of Semptember 2017 to Semptember 2019.
Inclusion criteria
Both male and female, patients
Patients older than 18 years
The study includes both elective and emergency laparotomies
All vertical abdominal, incision closures will be included
Patients who voluntarily decide to take part in this study, and give written consent.
Exclusion criteria
All Medically and Anesthetically, unfit patients
Non-compliance
Patient not willing to, study.
Procedure
All patients admitted at Dhiraj general Hospital posted for laparotomy were explained about the risk factor. If the patient agrees, then the only Patient was being operated
A detailed history will be taken and all patients will be subjected to thorough clinical examination including per abdominal and per-rectal examination. Routine lab investigations like, blood and screening of chest will be done. All patients were undergoing laparotomy wound closure with continuous suture and Aberdeen knot.
All the patients will be analysed postoperatively according to proforma prepared and other post-operative complications such as
Incisional Hernia
Wound dehiscence
Suture sinus formation
Stitch granuloma
Chronic Wound pain
Wound infection
All patients where be followed up at 1 week, 15 days,3,6 months postoperatively.
RESULTS AND DISCUSSION
Any contribution to the study and, knowledge of wound closure is important to surgical speciality and, this is a valuable contribution. Closure of abdominal incision has been greatly simplified by the realization that all incisions heal by forming a block of fibrous tissue.8
The strength of the abdominal wall depends on linea alba and anterior, rectus sheath. The technique of laparotomy wound closure is an important factor in preventing postoperative wound complications like wound infection, wound dehiscence, suture sinus formation, incisional hernia, and scar complications. However, there are many, systemic, and local factors responsible for delay in wound healing.
Systemic factors include diabetes, hypertension, anaemia. Local factors includes infection, hematoma formation. Mechanical factors such as postoperative vomiting, hiccough, explosive coughing and chest infection, gross gaseous distension.
The current study has shown that the mass closure technique for abdominal wounds, results in a lower incidence of wound infection, wound dehiscence and incisional hernia, chronic wound pain, suture sinus formation, and stitch granuloma than in layered technique.
Age Distribution
Most of the patients in the present study, as well as Rehman et al.2013 9 study, belonged to the 21-30 years age group which is the most productive age group (Table 1). India is a developing country most are labourer class population belonging to this age group who are malnourished and presents often late for their symptoms.
Sex Distribution
There was male predominance in both studies which may be attributed to the adverse sex ratio in India and the disease profile of a male patient who is working population with smoking habits and neglects their health (Table 2).
Diagnosis
Our institute is a tertiary institute hence the variety of patients presents to our surgical department which is comparable to Rehman et al., 2013 9 study (Table 3). Also, India being developing tuberculosis and malnutrition are endemic hence more patients with tuberculosis and perforation.
Comorbid conditions
India is a third-world country with most people belonging to either lower or extremely higher socioeconomic status thus anaemia and chest infection are common in the lower class and Diabetes Mellitus and Hypertension common in the Upper class (Table 4).
Complications
Wound infection
In the present study wound infection was 10% as compared to other studies. McNeill had a 3.92% wound infection with continuous closure. Khan et al., 20091 reported a 4.75% wound infection while Gurjar et al., 201413 reported a 4% wound infection. The part played by the wound, sepsis is important, as this is the major avoidable cause of wound failure. Inadequate treatment or, the immuno-compromised state may lead to serious, systemic complications like septicaemia, shock, and multi-organ failure.
The higher rate of wound infection in the present study may be attributed to the poor nutritional status of the study population, and late presentation to our centre with comorbidities like DM, Hypertension, anaemia
Wound dehiscence
In the present study wound dehiscence was 4% which is similar to Gurjar et al., 201413 (4%) while Khan et al., 20091 reported 0.94%. Wound dehiscence is a grave, complication with poor prognosis. Faulty suture
the technique is entirely responsible for early dehiscence but only partly responsible for a late, incisional hernia, the other culprit being deep wound sepsis often associated with intraperitoneal drainage. Wound dehiscence rates are higher with conventional layered closure than single-layered closure. The suture, holding capacity of the anterior rectus sheath, alone was 2.25 kg compared with 3.93 kgs after, full-thickness, musculoaponeurotic. The structures found to have the greatest suture holding capacity was the linea alba 7.93kgs as compared with,4.12kg for full-thickness without linea alba.14
In our study, the incidence of wound dehiscence is higher than Khan et al., 20091. This is because, in our study, we had a large number of patients who were elderly, had intraabdominal sepsis, and presented late. Most of these patients were anaemic, DM, Hypertension, and most of them were operated on an emergency basis and also had a higher incidence of post-operative wound infections. These predisposing factors were responsible for delayed wound healing and subsequent dehiscence as compared to the western countries where the incidence is less.
Chronic wound Pain
Chronic wound pain was present in 6% of patients in the present study as compared to 3% in Gurjar et al., 201413. This may be attributed to intermittent knotting and nerve entrapment in a knot.
Incisional hernia
The incisional hernia was 2% in the present study compared to 9.8% in McNeill and 3% in Gurjar et al., 201413 while it was similar to Khan et al., 20091 (2.35%)
Incisional develops from, the scar of a surgical incision, when a patient is examined by making him lie flat on the bed and is asked to lift his legs or to cough, any bulges in the scar is considered as, Incisional hernia. Incisional hernias are mainly due to faulty incision and faulty technique of closure, other, important determinants are sex (males more predisposed) and, age (elderly more predisposed) of the patients, chest infection, and wound infection. As age advances, breakdown of collagen fibres takes place weakening the old-healed scars, predisposing for hernia, thus indicating the need to use non-absorbable, suture material to support it, using chromic catgut in conventional, layered closure proved to be a drawback in causing incisional hernia and thus proving the advantages of using polypropylene in preventing incisional hernia by holding more tissue with, little tension for a long period after the wound heals. As in the present study closure technique involve intermittent Aberdeen knot tension gets distributed and thus chances of incisional hernia get reduced.
Stitch Granuloma and Suture Sinus Formation
It is defined as a chronic, granulating infection or micro abscess that results in a
persistent fistulous tract. The incidence of suture sinus formation is predisposed by the use of, multifilament suture material. Due to lodgement of, infective foci in the crevices of suture material. We did not have any patient with stitch granuloma or suture sinus formation as we had used monofilament suture material as compared to 3% (stitch granuloma) and 2% (Suture sinus) in Gurjar et al., 2014.13
CONCLUSION
In laparotomy, wound closure with continuous suture and Aberdeen knot reduces the incidence of infection, wound dehiscence, incisional hernia, suture sinus formation, and stitch granuloma & chronic wound pain. Thus, this method holds the promise for a safe technique of closure with minimal complication.
Conflict of interest: nil
Source of funding: nil
Acknowledgement: Immeasurable appreciation and deepest gratitude for the help and support are extended to my mentor Dr. Vipul Gurjar who in a way or other has contributed to making this study possible.
Englishhttp://ijcrr.com/abstract.php?article_id=3293http://ijcrr.com/article_html.php?did=3293
Khan NA, Almas D, Shehzad K, Chaudhry AK, Mian MA. Comparison between delayed-absorbable polydioxanone and non-absorbable (Prolene) suture material in abdominal wound closure. Pak Armed Forces Med 2009; 23(6):123-6.
Hodgson NCF, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure. Ann Surg 2000;231:436–442.
O’Dwyer PJ, Courtney CA.Educational Review: factors involved in abdominal wall closure and subsequent incisional hernia. Surg J R Coll Surg EdinbIrel 2003; 4:17–22.
Kreszinger M, Delimar D, Kos J, Jovanov N, Vnuk D, Maticic D, et al. Wound strength after midline laparotomy: a comparison of four closure techniques in rats. Vet Arhiv 2007;77:397–408.
Farquharson M, Moran B. Farquharson’s textbook of operative general surgery. Surgery of the skin and subcutaneous tissue, 9th edn. London, 2005; 12:5–7.
Mimi, Leong, Linda G. Philips. Wound Healing. Chapter 8 in Sabiston's Textbook of surgery, 17th ed, 183-207.
Kiran K Singisetti, George P Ashcroft. The Aberdeen ‘continuous interrupted’ surgical suturing technique. Ann R Coll Surg Engl 2009; 91:344–350.
Bentley PG, Owen WJ, Girolami PL, Dawson JL. Wound closure with Dexon (PGA), Ann R Col Surg Engl 1978; 60:123-127.
Zabd-Ur-Rehman AR, Naveed M, Javeed MU, Akbar A. Comparison of Wound Dehiscence in Interrupted with Continuous Closure of Laparotomy. PJMHS 2013;7(3): 828.
Rajesh KB, Tarun M, Rajeev S, Sanjay G, Simrandeep S, Kumar A, Ashok KA, Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy. Int Surg J 2019 Mar;6(3):886-891.
McNeill PM, Sugerman HJ. Continuous Absorbable vs Interrupted Nonabsorbable Fascial Closure. Arch Surg 1986;121: 45-48.
Khan MI, Khalil J, Khan MA. Internal tension sutures, a novel method of midline laparotomy closure in high-risk patients. Pak J Surg 2017; 33(3):165-169.
Vipul G, Halvadia BM, Bharaney RP, Vicky A, Shah SM, Samir R, et al. Study of Two Techniques for Midline Laparotomy Fascial Wound Closure. Indian J Surg 2014;76(2):91–94.
Leaper DJ, Pollock AV, Evans M. Abdominal wound closure, a trial of nylon, polyglycolic acid and steel sutures. Br J Surg 1977; 64: 603-606.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareA Prospective Study of Post-Operative Surgical Site Infection
English174180Ketul ShahEnglish Rohit SinghEnglish Pratik ShapariyaEnglish Honeypalsinh H MaharaulEnglishIntroduction: Procedures causing a break in the skin continuity, the natural barrier against infection, predisposes to infection. SSIs are defined as a discharge that may be serous or purulent discharge and presents within 30 days of a surgical procedure (within 1 year in case of a prosthetic implant). There is an emerging problem of SSIs due to resistant organisms.
Objective: To identify the possible risk factors related to the development of SSIs and the common pathogens encountered in the development of SSIs.
Methods: This is prospective, observational study. Patients of either gender that aged more than or equal to 18 years, who reported to the surgery department and underwent either elective or emergency surgeries and developed post-operative surgical site infections were included after taking consent. A swab was collected and sent to the microbiology department for culture and sensitivity reports.
Results: A total of 103 patients with surgical site infection were enrolled. SSIs were predominant in males (62.14%) as compared to females (37.86%). The mean age of the patients was 52.58 ± 19.77years. Maximum patients were in the age group of 58 to 77 years. SSIs were common in surgeries performed in an emergency setting rather than those performed electively. SSIs were common in a contaminated wound (45.63%) followed by dirty wounds (28.16%). History of hospitalization is positively correlated with the development of SSIs.
Conclusion: Both, patients, as well as a surgical factor, acts as the risk for its development. Each hospital must have its list of antimicrobials to be used for empirical therapy. An antimicrobial stewardship program needs to be implemented to bring this incidence of resistant SSIs down.
EnglishSurgical Site Infection, Wound, Antibiotics, Skin, PathogensINTRODUCTION
Procedures causing a break in the skin continuity, the natural barrier against infection, predisposes to infection.1 It also means that surgery, a planned breach in the skin continuity, also exposes patients to a risk of postoperative infection. These have created problems since the inception of surgery and are considered a surgeon's nightmare. The infection impairs wound healing and cause significant morbidity and sometimes mortality.2 These infections are categorized under the broad term of nosocomial infections. They are the 2nd most common cause of nosocomial infections just after urinary tract infection. It leads to prolongation in the hospital stay, which not only imposes a cost burden but also causes significant morbidity and mortality.
Grossly any purulent discharge that comes out of a closed surgical incision and is associated with signs of inflammation in the surrounding tissue should be regarded as wound infection, whether the micro-organisms can be cultured from it or not. The definition of surgical site infection was first of all provided by Horan and colleagues. This greatly helped in differentiating it from the term which was used earlier as wound infection These infections at different surgical sites were then classified into majorly 3 groups. The basis of this classification was the site and extent of infection. , These 3 groups were namely, 1. Superficial incisional SSIs, 2. Deep incisional SSIs and 3. Organ-space SSIs.3 These CDC has accepted this definition. It is also used widely across the United States of America and European nations.3
Discharge that may be serous or purulent discharge and presents within 30 days of a surgical procedure (within 1 year in case of a prosthetic implant). Superficial incisional SSI’s are limited to the skin and subcutaneous tissue at the site of incision It has at least one of the below-mentioned feature:
There is purulent drainage from the incision The purulent drainage may or may not have been confirmed in labs.
The culture of fluid/tissue which is obtained from the site of incision shows other growth of the organisms.
There is the presence of at least one of the signs or symptoms of infection. These infections may be associated with certain symptoms like pain or tenderness, local swelling, There may also be redness or heat. These superficial incisions are also intentionally left open by the surgeon.
A Surgeon or attending physician making a diagnosis of superficial incisional.
Deep incisional SSIs are kinds of infections, there is the involvement of deep tissues like fascial and muscle layers.
Organ space SSI’s- Herein the infection involves distant sites such as the organs or spaces which are not opened or manipulated during operation.
These infections are highly prevalent in low to middle-income countries, but this does not mean that developed nations are free from SSIs. Globally around 2 million cases of SSIs occur annually.4 WHO describes these as one of the major infectious diseases having a significant economic impact.5 The prevalence of SSIs varies widely from region to region to region and hospital to hospital to hospital, grossly it ranges between 5-16%. In India, per se literature reveals that the prevalence of SSI varies between 5% and 24%.
Various factors affect the susceptibility of any wound to the infection, these may be related to a patient, type of surgery, type of wound, surgical technique, surgeons experience, etc. The factors related to patients that influence the development of SSIs are as following: extremes of age, patient's immunity, comorbidities such as diabetes mellitus, malnourishment both obesity as well as undernourished and presence of anaemia, patient's lifestyle including alcohol and drug abuse, smoking and lack of exercise or sleep.6
These factors start right from the duration of the preoperative stay of the patient in the hospital. Common factors that act as risks for SSIs are shaving technique of the operative site, surgical procedure type, surgeon skills, duration of surgery, prophylactic use of antibiotics, and pre-operative use of drugs such as steroid therapy that have the potential to cause immune-suppression. With the increased use of diagnostic and treatment modalities, there is increased bacterial exposure of the patient.6
These factors are the bacterial inoculum that gets introduced into the wound either during the procedure or immediately after the procedure, the degree of virulent nature of the micro-organisms. Toxins produced by microorganisms increase their ability to invade host tissue and produce damage to the host tissue. Gram-negative bacteria are known to produce endotoxin that stimulates cytokine production. These cytokines, in turn, can trigger the systemic inflammatory response syndrome which causes significant morbidities and may even cause multiple system organ failures.7-9
The presence of necrosis, hematoma, or dead space provides a milieu for the growth of bacteria. The presence of foreign bodies inhibits local tissue resistance and allowing uninhibited bacterial growth.8 The wound microenvironment influences bacterial growth. With this, it can be seen that the incidence of infection is affected by factors that are intrinsic to the patient and factors related to the type and circumstances of surgery. Thus, as a result of exogenous or endogenous bacterial contamination of the operative procedure SSIs develop. Host – bacteria equilibrium gets disturbed and the equilibrium is one that is in the favour of bacteria. The common causative agents are gram-positive cocci and gram-negative bacilli. However, a variety of aerobic and anaerobic species of bacteria may co-exist.
The presence of these bacteria induces an inflammatory reaction that causes tissue destruction and ultimately pus formation. Bacteria involved in pus formation are labelled as "pyogenic" (pus producing). CDC Study on the Efficacy of Nosocomial Infection Control (SENIC) suggested the following four risk factors for the development of SSIs:7
1. Operation involving abdomen;
2. Operation lasting beyond 2 hours;
3. Operations that are classified as contaminated, dirty, or infected; and
4. Patient having multiple diagnoses at discharge.
With the advancement in the field of medicine, there is a possibility of prevention and control of these infections. With the discovery of anti-microbial agents even dirty surgeries can be performed without the risk of mortality. In 1964, the US National Research Council group had classified the operative wounds. This classification was done based on the degree of microbial contamination, It then proposed 4 wound classes. Each class had an increased risk of SSIs. These 4 classes were namely:
1. Clean
2. Clean and contaminated
3. Contaminated
4. Dirty10
With the progress of time and wide use and misuse of antimicrobial agents, anti-microbial, once referred to as "MAGIC BULLETS" to eradicate the infection, have seemed to fail in their purpose. The use of antimicrobial agents for the prevention of surgical site infection has become controversial and a disappointment in surgical practice, as the widespread use of antimicrobials has resulted in the problem of the emergence of resistance among micro-organisms. This had made it difficult to control, eliminate, or completely eradicate the surgical site infection.11
The advances that have been made to reduce the incidence of SSI are improvement in the operating theatre ventilation, proper sterilization methods, use of barriers, improved surgical technique, etc, but the rate of SSIs has not zeroed. On the other hand, there is an emerging problem of SSIs due to resistant organisms.4 It is a must to combine advances in the field of microbiology with the advances in the field of surgery. It is a must to understand the bacteriology and emergence of resistance patterns of bacteria properly and use the antibiotics judiciously and meticulously to deal with this menace of SSIs due to resistant organisms. Thus it is pertinent that every hospital has an overall understanding of all the aspects of surgical site infections. The present study was undertaken to identify the possible risk factors related to the development of SSIs and the common pathogens encountered in the development of SSIs. Identifying the pathogens and their antimicrobial sensitivity will ultimately help in the empirical management of SSIs.
MATERIALS AND METHODS
We conducted this prospective, observational study in the Surgical Department of Dhiraj General Hospital, Piparia. This study was conducted throughout one and a half years that is from January of 2018 to June of 2019. The patients that met all the criteria for inclusion and none of the criteria for exclusion were enrolled in the study. The study was conducted as per Institutional ethical approval no: SVIEC/ON/MEDI/BNPG17/D18034 guidelines as well as the bioethical guidelines provided by ICMR 2016 and in accordance to ICH (International Conference on Harmonization) E6 (R2) ‘Guideline for Good Clinical Practice’.
Inclusion criteria
Patients of either gender aged more than or equal to 18 years.
All patients who reported to the surgery department and underwent either elective or emergency surgeries.
Patients who developed postoperative surgical site infections.
The patient gave written informed consent.
Exclusion criteria
Patients having a history of previous surgical site infection.
Patients who received antibiotics more than a week before surgery.
Patients that underwent re-operation, except for the management of surgical site infection.
Patients who took DAMA, or did not follow up within 30 days of operation.
The patient did not want to participate in the study.
A swab was collected and sent to the microbiology department for culture and sensitivity reports. The patient was also investigated for: complete blood count, urine routine and microscopy, random blood sugar, liver function test, renal function test, ECG, chest x-ray PA view, and other special investigations like CT scan, if required.
The findings were computed and analyzed.
RESULTS AND DISCUSSION
Gender comparison
In the present study, we observed that SSI was predominant in males as compared to females, of the 103 patients were enrolled with surgical site infection 62.14% were males while 37.86% were females (Table 1). Similar findings were also observed by Chada et al., 2017 in their study the authors observed that males with SSI were 61% while 39% of females had SSIs.6 Saxena et al., 2013 also observed that the SSIs were common in males as compared to females.2 In contrast to our study, Khairy et al., 2011 observed that SSIs were common in females rather than males.12 Bandaru et al., 2012 and Kikkeri et al., 2014 also observed that SSI was common in males.10,13 One of the reasons for these gender differences could be the biological differences between the skin of men and women. Studies have shown that there is greater colonization with bacteria of the skin surrounding the insertion site of a central venous catheter in men than in women, even when controlling for baseline colonization.14 Additionally adherence to wound dressing is impacted by hair growth and shaving, and this may be responsible for the higher risk of infection among men that have thicker, coarser hair.
Age distribution
In the present study, the mean age of the patients was 52.58 ± 19.77years and maximum patients were in the age group of 58 to 77 years (Table 2). In the study by Mahesh CB et al.,2010, the incidence of SSIs increased with advanced age, the authors observed that 33.33% of patients in the age group of 61-70 yrs and 46.66% of patients in the age group of >70 yrs were infected.15 In contrast to this Khairy et al., 2011 observed that SSIs were common in the age group >12-19years.16 In the study by Kikkeri et al.,2014, the majority of the patients with SSIs were in the age group of 18-30 years, 64.44%.13 Saxena et al., 2013 observed that age > 50 years is a risk factor for the post-operative wound infections.2 This may be because of the co-morbidities, impaired immunity with advancing age, low healing rate, malnutrition, mal-absorption, and increased catabolic processes.
Comparison of SSI in Emergency vs elective surgery
In the present study, we observed that SSIs were common in surgeries performed in an emergency setting rather than those performed electively. Of the patients with SSIs, 56.31% had undergone surgeries under emergency settings while another 43.69% had undergone surgeries in an elective setting (Table 3). In the study by Chada et al.,2017, of the patients with SSIs, 56% had undergone surgeries under emergency settings while another 44% had undergone surgeries in an elective setting.6 Saxena et al., 2013 the infection rate was 16.48% in patients operated in an emergency setting while in patients operated electively the rate was 13.39%.2 Similar findings were also observed by Khairy et al. 2011 14.28% of the patients operated in emergency setting developed SSIs while only 3.37% operated in the elective setting developed SSIs (Table 3).16 Since the surgeries performed under emergency lack routine pre-op preparations such as management of co-morbidity, control of diabetes, etc. Also, the fact that emergency operations involve contaminated areas like bowel and the perianal region.
Comparison of SSI in different wounds
We observed that the rate of SSIs was common in a contaminated wound (45.63%) followed by dirty wounds (28.16%) (Table 4). We observed a lower incidence in operations labeled as dirty as compared to contaminated wounds is because we choose patients who had already developed SSIs and the overall incidence of operations labeled as dirty in that group was lower as compared to operations labeled as contaminated. This classification of operations is based on the probability of developing the SSIs following operations. The probability of contamination and thereby the chances of developing SSIs increases as the type of operation proceeds from clean to dirty. However, with proper aseptic precautions and proper use of antibiotics, the risk of SSIs can be reduced.
Correlation of SSI with hospitalization
When the history of hospitalization in the past 6 months was evaluated, it was observed that 73.79% of patients had undergone hospitalization in the past 6 months due to some or other reasons. History of hospitalization is positively correlated with the development of SSIs. Similar to our study Chada et al.,2017 observed that prior hospitalization had taken place in 74% of the study population (Table 5).6 Saxena et al., 2013 evaluated the impact of pre-operative stay on SSIs in elective surgeries and observed that there was a positive correlation between pre-operative stay and SSIs in case of elective surgeries. Various literature also suggests that there is a positive correlation between the pre-operative waiting period and the development of SSIs, Kikkeri et al., 2014 observed that SSIs developed in 9% of patients operated in less than 48 hours and in 43% of patients who waited for more than a week to undergo surgery.13 Mahesh CB et al.,2010 also observed a direct correlation between pre-operative hospitalization and the development of SSIs. 15 The reason for the higher incidence of infections with prolonged hospitalization could be the colonization of patients with nosocomial strains in the hospital. Also, longer pre-operative stay in the hospital reflects the severity of existing illness and the presence of co-morbid conditions that may have required workup and management before the operation.
Correlation of SSI with diabetes mellitus
Diabetics are at higher risk of infections; uncontrolled diabetics are at even higher risks. This is because of impaired micro-circulation and sugar-rich blood providing ideal media for bacterial growth. In the present study, we observed that SSIs occurred in 37.86% of patients with uncontrolled diabetics, 28.16% with controlled diabetics, and 33.98% without diabetics (Table 6). Thus, in the present study of the developing SSIS, 66.02% had diabetes, either controlled or uncontrolled. In the study by Chada et al., 2017, 39% of patients had uncontrolled diabetes while 27% of patients had controlled diabetes.6 Saxena et al., 2013 observed that the incidence of SSIs was 24.13% in diabetics while the same was 13.28% in non-diabetics.2 Kikkeri et al.,2014 observed that 83.33% of diabetes developed SSIs while it was observed in only 12.18% of patients without diabetes.13 Khairy et al., 2011 observed that the incidence of SSIs was 20% and 3.77% in diabetics and non-diabetics respectively.16 Cheng et al., 2015 observed that the incidence of SSIs in diabetics and nondiabetics was 14.3% and 2.5% respectively.17 Apart from diabetes various other co-morbidities impact the outcome in patients, these factors are BMI (both the extremes that are malnourishment as well as obesity), anaemia, etc.
Comparission of operative procedure and SSI
In the present study of the patients that developed SSIs, laparotomy, cholecystectomy, appendicectomy and amputations were performed in 35.92%, 23.30%, 21.36%, and 19.42% of the patients respectively (Table 7). Most of these operations are classified as clean-contaminated or dirty. In the study by Chada et al., 2017, of the patients with SSIs, 4.9% had undergone amputation, 7.1% had undergone appendicectomy and 17.6% patients had undergone laparotomy.6 In the study by Olowo-okere et al., 2018 >30% of patients that underwent exploratory laparotomy and appendicectomy developed SSIs.18 Laparotomy is a contaminated type of operation and hence at a high risk of developing SSIs, which was also observed in the present study.
Comparison of bacterial growth
In the present study of the 100 swabs collected, gram stain showed pus cells in 96.12% while bacteria were seen in 94.17% (Table 8). Bacterial growth in culture was obtained in 94 swabs (91.26%). In the study by Chada CKR et al., 2017, pus cells were seen in 92% of cases undergoing gram staining, and bacteria were seen in 94% of cases. Bacterial growth was obtained in 91% of culture cases. Bandaru et al., 2012 reported growth was seen in culture in 83% (35 out of 42) of cases. Arora et al., 1990, and colleagues (87% cases) and Masood Ahmed et al., 2007 also reported positive cultures for their SSI cases.19,20
In the present study, staphylococcus aureus (23.30%) was the commonest bacterial isolate (Table 9). Similar findings were also observed by Kownhar et al., 2008 the authors reported that of all the isolates, 37% were staphylococcus aureus of which MRSA was 27%.21 Chada et al., 2017 reported Staphylococcus aureus in 25.34% of the cases.6 The common isolates various from study to study and depend on the hospital, its location, common nosocomial organism prevalent, other physical and operational factors, etc. A literature review has shown that some authors have reported major isolates of Pseudomonas aeruginosa and Escherichia coli also in their studies. Bandaru et al., 2012 reported staphylococcus aureus (38% cases) followed by Escherichia coli as the common pathogens causing post-operative wound infections.10
Staphylococcus aureus was a major isolate across all the different type of surgeries. Chada CKR et al., 2017observed that staphylococcus aureus was a major isolate from orthopedic SSI, followed by L.S.C.S. surgeries and was common in an emergency procedure. In the study by Chada et al., 2017, MRSA was seen in 37% of S aureus isolates.6 Contradictory to our study, Chada et al., 2017, Bericon et al., 2007 and Anvikar et al.,1999 reported higher isolation of E.coli and Klebsiella pneumoniae from surgical wards.6,22,28 In the present study, of the various gram-negative organisms isolated, Escherichia coli and Pseudomonas aeruginosa were predominant. Suljagic et al., 2010 reported that E.coli was the major isolate from intestinal and abdominal surgeries.24 Staphylococcus aureus are common contaminants in various parts of the hospitals. Bedsheets, instruments, and dressing material are known to act as reservoirs for infections. Mehta et al., 2014 collected 196 swabs/pus specimens from different parts of a surgical unit, they found that Staphylococcus aureus was predominant as contaminant, which explains the predominance of Staphylococcus aureus as a causative organism for SSIs.29
We observed that isolated Staphylococcus aureus was resistant to various antibiotics such as amoxicillin, ampicillin, etc. which was also the observation in other studies.25,26 We also observed that a higher proportion of Staphylococcus aureus strains was also resistant to Amoxycillin + clavulanic acid and this has resulted in a decline in the use of this antibiotic for the treatment of SSIs with S aureus. We also observed that MRSA infection is widespread, which is also confirmed by other studies. Some strains of Staphylococcus aureus were also resistant to clindamycin. Despite resistance to various antibiotics, no resistance was not observed to vancomycin and linezolid in the present study.
CONS that were isolated in the present study showed a high degree of resistance to various antibiotics. However, none were resistant to vancomycin and linezolid. Chada et al., 2017and Cantlon et al., 2006 also reported CONS isolates that were resistant to various organisms.6,27 Rudresh et al., 201230 concluded adequate antibiotic prophylaxis is just not sufficient for the prevention of salmonella infection of the port in chronically infected gall bladder extraction. Every gallbladder should be extracted with an endo bag especially in developed countries, where the chances of chronic Salmonella infections are common.
In the present study, gram-negative isolates showed a high degree of resistance to commonly used low generation antibiotics. These were the observation in the various other studies also. One of the reasons for the emergence of resistance is the widespread empirical use of antibiotics for various infections. Most gram-negative isolates demonstrated multidrug-resistant. However, these organisms showed sensitivity to carbapenems like meropenem, imipenem, and doripenem and Piperacillin/tazobactam. Sensitivity to a higher generation of cephalosporins was also preserved by most Pseudomonas aeruginosa and 100% Proteus sp isolated. With this, it can be recommended that higher generation cephalosporins and carbapenems can be used for empirical management of SSI. Each hospital should develop its list of essential and empirical antibiotic lists and these lists should be updated periodically based on the common nosocomial infections and their resistance pattern.
CONCLUSION
It can be concluded that SSIs are quite prevalent and there is an emerging menace of multi-drug resistant organisms. Both, patients, as well as a surgical factor, acts as the risk for its development. Each hospital must have its list of antimicrobials to be used for empirical therapy, conduct regular surveillance. Empirical Use of higher antibiotics should be limited to high-risk patients.
Conflict of interest: Nil
Source of funding: Nil
Acknowledgement: Immeasurable appreciation and deepest gratitude for the help and support are extended to my mentor Dr. Rajesh P Bharaney who in a way or other has contributed to making this study possible.
Englishhttp://ijcrr.com/abstract.php?article_id=3294http://ijcrr.com/article_html.php?did=3294
Golia S. A study of superficial surgical site infections in a tertiary care hospital at Bangalore. Int J Res Med Sci 2014 May;2(2):647-652.
Saxena A. Surgical site Infection among postoperative patients of the tertiary care centre in Central India - A prospective study. Asian J Biomed Pharm Sci 2013:3(17);41-44.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271-74.
Anusha S, Vijaya LD, Pallavi K, Manna PK, Mohanta GP, Manavalan R. An Epidemiological Study of Surgical Wound Infections in a Surgical unit of Tertiary care Teaching Hospital. Indian J Pharm Pract 2010; 3(4):8-13.
Mohamed Issa Ahmed. Prevalence of Nosocomial wound Infection among Postoperative patients and Antibiotics patterns at Teaching Hospital in Sudan. North Am J Med Sci 2012; 4(1);29-34.
Chada CKR. A prospective study of surgical site infections in a tertiary care hospital. Int Surg J 2017 Jun;4(6):1945-1952.
Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121(2):206-15.
Lawal OO, Adejuyigbe O, Oluwole SF. The predictive value of bacterial contamination at operation in postoperative wound sepsis. Afr J Med Sci 1990;19(3):173-9.
Demling R, LaLonde C, Saldinger P, Knox J. Multiple-organ dysfunction in the surgical patient: pathophysiology, prevention, and treatment. Curr Probl Surg 1993;30(4):345-414.
Bandaru NR. A Prospective Study of Postoperative Wound Infections in a Teaching Hospital of Rural Setup. J Clin Diagn Res 2012;6(7):1266-71.
Leuva HL. Role of Antibiotics in Clean Surgeries: Prophylaxis V/S. Conventional. Guj Med J 2014:69(2):96-98.
Khairy GA. Surgical Site Infection in a Teaching Hospital: A Prospective Study. J Taibah Uni Med Sci 2011; 6(2): 114-120.
Kikkeri N. A study on Surgical Site Infections (SSI) and associated factors in a government tertiary care teaching hospital in Mysore, Karnataka. Int J Med Public Health 2014;4:171-5.
Cohen B. Gender Differences in Risk of Bloodstream and Surgical Site Infections. J Gen Intern Med 2013; 28(10):1318–1325.
Mahesh CB, Shivakumar S. A prospective study of surgical site infections in a teaching hospital. J Clin Diagn Res 2010;4:3114-9.
Khairy GA. Surgical Site Infection in a Teaching Hospital: A Prospective Study. J Taibah Uni Med Sci 2011; 6(2): 114-120.
Cheng K. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Pref Adher 2015:9;1171–7.
Olowo-okere A. Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study. Med Sci J 2018;6:60.
Ahmed M, Alam SN, Khan O, Manzar S. Post-operative wound infections: a surgeon’s dilemma: Pakistan J Surg 2007; 23(I):41-47.
Arora S, Prabhakar H, Garg BB, Jindal N. The anaerobic bacterial flora of wound sepsis. J Indian Med Assoc 1990 Jun;88:154-6.
Kownhar H, Shankar EM, Vignesh R, Sekar R, Velu V, Rao UA. The high isolation rate of staphylococcus aureus from surgical site infections in an Indian Hospital. J Antimicrob Chemotherap 2008;3:758-60.
Kamat U, Ferreira A, Savio R, Motghare D. Antimicrobial resistance among Nosocomial isolates in a teaching hospital in Goa. Indian J Community Med 2008;33:89-92.
Bercion R, Gaudeuille A, Mapouka PA, Behounde T, Guetahoun Y. Surgical site infection survey in the orthopaedic surgery department of the "Hospital communautaire de Bangui, Central African Republic. Bull Soc Pathol Exot 2007;100:197-200.
Suljagic V, Jevtic M, Djordjevic B, Jovelic A. Surgical site infections in a tertiary health care centre: a prospective cohort study. Surg Today 2010;40:763-41.
Andhoga J, Macharia AG, Maikuma IR, Wanyonyi ZS, Ayumba BR, Kakai R. Aerobic pathogenic bacteria in post-operative wounds at Moi Teaching and Referral Hospital. East Afr Med J 2002;79:640-4.
Anguzu JR, Olila D. Drug sensitivity patterns of bacterial isolates from septic post- operative wounds in a regional referral hospital in Uganda. Afr Health Sci 2007;7:148-54.
Cantlon CA, Stemper ME. Schwan WR, Hoffman MA, Qutaishat SS. Significant pathogens isolated from surgical site infections at a community hospital in the Midwest. Am J Infect Control 2006;34526-9.
Anvikar AR, Deshmukh A, Karyakarte RP, Damle AS, Patwardhan NS, Malik AK, et al. One-year prospective study of 3280. Surg Wounds 1999;17:129-32.
Mehta S. Nosocomial wound infection amongst post-operative patients and their antibiograms at tertiary care hospital in India. AJCEM 2014:15(2);60-68.
Rudresh H. K, Banashankari. G. S, Harsha. A. Huliyappa, Arvind Nayak, Prasannakmar Kabmle. Laparascopic Port Site Infection with Salmonella - Review of Literature. IJCRR 2012;4(14); 60-68.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareProphylactic Measures to be Taken by Oral Health Care Professionals During a Pandemic Outbreak of COVID-19
English181187Avula Kishore KumarEnglish Aluru SudheerEnglish Gujjula SravanthiEnglish Laxmi Tejaswin PolepalleEnglish Nagireddy Ravindra ReddyEnglish Firoz babu PEnglish Mannur Ismail ShaikEnglish Narasimha GollaEnglishMany viruses have been posing threat to the world from time to time and recently in this category, a novel coronavirus called COVID-19 (SARS-CoV2) was detected in December 2019 and is causing havoc all over the world. COVID-19 spreading through person-to-person transmission routes including direct transmission, like cough, sneeze, droplet inhalation and contact transmission, like contact with oral, nasal and eye mucous membranes. The operators in oral health care profession expose to great risk of COVID-19 infection due to face-to-face communication and their exposure to fluids from the conjunctiva, oral cavity, nose and also other body fluids, and handling with the sharp instruments. Oral health care professionals (dentists and dental hygienists) play a prime role in preventing the spread of COVID-19. Several dental hospitals and clinics have been completely closed or have been providing minimal treatment for emergency cases. However, prophylactic and emergency treatments are being provided in some countries and a few supporting regular dental treatment. Oral health practitioners are prone to risk as they are hardly prepared for such unexpected global outbreak. Lack of universal protocol or guidelines to control the infection and dental care provision during such a pandemic condition could be of better help. The present study fills in the missing gap with necessary recommendations comprising of preventive steps for disease/infection transmission during dental practice to block the operator-to-patient and vice-versa transmission routes in dental clinics and hospitals.
EnglishCOVID-19, Coronavirus, Dental, Precautions, Lockdown, AwarenessIntroduction
Viruses have always been challenging to mankind with their dynamicity in structure, virulence, prevalence, transmission, and potentiality to claim lives. One among those recently discovered is the Novel Coronavirus 2019. In late December 2019, Wuhan City province of China suffered through a pneumonia outbreak, which kept spreading at an exponential rate to other parts of China and neighbouring countries. Even before it became clear about its aetiology and mode of transmission, it was reported in more than 25 other countries and WHO declared it as a Public Health Emergency of International Concern on January 30, 2020.1 Within no time, Covid-19 had spread around 18 countries in which four countries reported human-to-human transmission. On February 26, 2020, the first case of this disease was recorded in the United States, which was not imported from China. As of today, April 10, 2020, COVID-19 has affected around 210 countries and territories all over the globe including, two international conveyances namely, Diamond Princess Cruise harboured at Yokohama, Japan, and Holland America's MS Zaandam Cruise as retrieved from WHO coronavirus disease situation dashboard on April 11, 2020.2,3
Distinctive features of novel coronavirus (COVID-19)
The causative organism for COVID-19 was identified as the seventh member of the coronaviruses family Coronaviridae of the order Nidovirales, possessing huge single-stranded positive RNA (+ssRNA) as genetic material. It belongs to one of the four coronavirus genera’s, namely, α, β, γ, and δ which can cause the infectious diseases among human and vertebrates, of which, α and β mostly infect the pulmonary, central nervous system (CNS) and gastrointestinal (GI) tract of human and mammals, while γ and δ primarily infect the birds.4
Aetiology
This virus is also speculated to have an animal origin with the capacity of the cross-species barrier to reach humans, similar to MERS and SARS of which SARS is believed to be originated from bats and then pass on to Himalayan palm civet, while MERS-CoV might have moved on from dromedary camel to human. Chan et al. in 2019 have proven that the genome of the human CoVs (HCoV), isolated from Wuhan returned atypical pneumonia cluster patient had 89% similarity with bat SARS-CoV and 82% identity with human SARS-CoV.5 However, it is of no certainty that a possible intermediate host may exist as a potential intermediate between human and bat is identified, and hence it could be as a result of a possible mutation in original strain.
Transmission
Initially, COVID-19 was believed to be animal to the human transmission when it was first reported in Wuhan's Huanan Seafood Wholesale Market. As there were no subsequent patients linked with exposure, it was ruled out, and human to human transmission was noticed as the route of transmission and spread of COVID-19. The possibility of asymptomatic individuals acting as carriers in transmitting the virus is observed and from the data, isolation is suggested to be the ideal way to restrict this epidemic.
The transmission is believed to occur through aerosols, which arise from respiratory droplets during sneezing or coughing. There is every possible chance of elevated aerosols due to lengthier exposure in closed spaces such as COVID-19 isolation wards. According to recent observations, the close contact between individuals is found to be necessary for transmission and hence, it is primarily limited to the family members, doctors, health care professionals, workers, and all other close contacts.
Reports out of China revealed that, the same means of transmission between close contacts and persons who attended the same social gatherings, or confined to one place such as office spaces or cruise ships or been a part of a religious gathering.6 This poses a serious threat for community transmission if left uncontained as experienced by India, where a large mass India experienced a similar incident where (Nizamuddin incident) around 2,000 people were found to be staying at Markaz Nizamuddin, New Delhi during the outbreak. Some of whom being international tourists have been asymptomatic carriers or being in latent phase might have transmitted to fellow members who later on dispersed to their native places all over India. This incident was one of the major transmissions witnessed by India.
The incubation period of COVID-19
The incubation period is the time interval between the moment of exposure to an infectious state until the signs and symptoms of the disease appear. An estimated time of 2 to 14 days of latency is reported by WHO7 and CDC.8 While China’s National Health Commission (NHC) reported 10 to 14 days of window period.9 However, a case with 27 days latency period at Hubei Province10 and a study with 19 days latency was recorded in February, 2020.11
Symptoms
Dry Cough, Fever and Fatigue were the common symptoms experienced by most of the infective persons and very few among those had difficulty in breathing, abnormal chest radiographs with invasive lesions of both lungs. Huang et al. 2020 reported that diarrhoea, headache, sputum production and hemoptysis also found in several cases.12
Angiotensin-converting enzyme 2 (ACE-2) is a cell surface receptor which is present on multiple human organs.13 As it is the functional receptor being the site for COVID-19 virus, it leads to dysfunction in multiple organs in addition to respiratory failure unlike other respiratory diseases such as the Middle East Respiratory Syndrome Coronavirus (MERS-CoV, 2012) and Severe Acute Respiratory System Coronavirus (SARS-CoV, 2002-2003).14,15
Dental Perspective
All health care professionals, including doctors, surgeons, helpers and support staff are at greater risk of disease contraction from patients as it is nearly impossible to identify COVID-19 positives from superficial observation as few may be asymptomatic being in the latent phase. Hence it is mandated to follow statutory precautions while handling patients as per the Center for Disease Control guidelines.
Possible Transmission Routes of Covid-19 in Dental Clinics
Oral health care professionals and their patients are often at risk of exposure to virulent microorganisms, including bacteria and viruses that infect the oral cavity as well as the respiratory tract. Dental procedures always posses the threat of COVID-19 transmission as it involves direct interaction with patients, and also their saliva, blood and other body fluids.
Airborne spread
The airborne spread of COVID-19 is a known fact. The literature reveals that, the possible contamination of droplets and aerosols produced during dental procedures with virus.16 Hence, the transmission of COVID-19 becomes a major concern as it’s next to impossible to avoid the patient’s saliva and blood combined aerosols and droplets in dental setups during their procedures.17
Discipline-wise safety measures to curb aerosol transmission.
Endodontics should take extra precautions during root canal treatment to minimize hand contact with inanimate surfaces around the clinic and should practice usage of a rubber dam during the procedures. Oral-maxillofacial surgeons should perform on patient-facing up in a supine posture to keep away from the patient’s breath. Periodontists should preferably use manual scalers over mechanical to minimize aerosols. However, the usage of ultrasonic instruments with vacuum pumps can also be more effective only when combined with personal protective gear.
Restorative and pediatric dentists in typical cases should practice either non-traumatic restoratives or chemo-chemical removal techniques. They are also advised to restrict the usage of rotary appliances and under obligatory situations; the practitioner might isolate the areas with rubber dams. Prosthodontists could be more prone to contagion. Hence timely usage of suction pumps and usage of aptly sized impression trays along with application oral mucosal anaesthesia before the procedure is highly recommended. For fixed partial dentures Li et. al., 200418 recommends modification treatment strategy either by the usage of split rubber dam or designing supra-gingival margin for the posterior bridge can be implemented in current situations. While for a removable partial denture or complete denture the practitioner should avoid maximum contact with inanimate surfaces after contacting the patient’s saliva. Similarly, all the instruments which were used for a patient need to be thoroughly disinfected immediately without further delay.
Spread by Contact
Oral health care or dental professional is prone to direct or indirect contact with the human fluids, including saliva and Gingival Crevicular Fluid (GCF), patient drapes, and used clinical instruments or surfaces which makes a possible route for virus transmission. In addition to that, contact with conjunctival, nasal or oral mucosa along with propelling droplets and aerosols bearing the virus from an infected patient during a dental procedure or by cough or talk poses a high risk for a dentist. Hence, stringent measures need to be taken to contain the contact spread of COVID-19.
Contaminated Surfaces Spread
Human coronaviruses like SARS-CoV, MERS-CoV, or HCoV can persist on various surfaces like metal, plastic or glass for up to few of days.19,20 Therefore, those contaminated surfaces frequently contacted in healthcare settings which are a possible source for transmission of COVID-19.
Infection Controls at Dental Practices
Dental professionals should be conversant that, how COVID-19 spread, the way to recognize COVID-19 infected patients and what are the additional protective measures should be adopted during the dental practice, to stop the COVID-19 transmission. In this study, we recommend the COVID-19 infection control measures that ought to be followed by dental professionals because of aerosols and droplets were considered to be main spread routes of COVID-19.
Individual Defensive Measures for the Dental Experts
In light of the chance of the spread of COVID-19, three-level defensive proportions of the dental experts are suggested for explicit circumstances.1 First level security (standard insurance for staff in clinical settings). Usage of a protective face shield or eye goggles, disposable latex or Nitrile gloves along with wearing an expendable working top, dispensable careful cover, and working garments (white coat) as needed.2 Second level care (propelled security for dental experts). Wearing dispensable specialist top, expendable careful cover covering mouth, protective eye goggles, face shield and working garments (apron) along with an expendable detachment dress or careful garments outside and expendable latex gloves.3 Third level protection (extra safety measures when possible contact with doubtful or affirmed COVID-19 patient). Albeit a patient with COVID-19 disease isn't relied upon to be attended at a dental facility, yet there could be an improbable occasion, which this could happen, and the dentist can't evade close contact. Instead, he/she needs an extraordinary defensive to outwear. If defensive outwear isn't accessible, working garments (white coat) with additional expendable defensive outside garments such as impervious shoe covers, face shields, protective goggles, disposable gloves, disposable top and a veil are to be worn.
Mouthrinse Before Dental Methods
It is widely accepted that a preoperational rise with an antimicrobial mouthwash will decrease most the number of oral organisms. Most of these mouth rinses contain chlorhexidine as an active ingredient which is considered to be ineffective against COVID-19. But as it’s aware that COVID-19 is helpless against oxidation, a pre-procedural mouthwash with oxidative specialists, for example, 1% hydrogen peroxide or 0.2% povidone is suggested, to diminish the salivary heap of oral microorganisms, including potential COVID-19 carriage. A pre-procedural mouth rinse would be generally valuable in situations when an elastic dam can't be utilized.
Rubber Dam Segregation
The utilization of elastic dams can essentially limit the creation of salivation and blood-sullied vaporized or splash, especially in situations when rapid air-rotor Handpieces, dental ultrasonic and piezoelectric ultrasonic scalers are utilized. Utilization of rubber dams could essentially diminish airborne particles or aerosols in the 1-meter measurement of the operational field by 70%.21 Additional high volume suction for vaporized and scatter needs to be utilized alongside normal suction when the rubber dam is applied.22 Right now, the usage of total four-hand activity is additionally fundamental. On the off chance that elastic dam disconnection is absurd at times, manual gadgets are to be opted to limit the spread of airborne infections. For instance, periodontal scaling and caries expulsion can be done using a hand scaler and caries excavator.
Anti-retraction Handpiece
During dental procedures, debris and fluids may be expelled during aspiration done with air-rotor dental handpiece without anti retraction valves. Infectious microbes can infiltrate air and contaminate water tubes of a dental unit leading to cross-contamination. According to Hu et al. (2007)23, the backflow of oral bacteria into tubes of dental setup is significantly less likely when an anti-retraction high-speed dental handpiece is used instead of handpiece without anti-retraction and hence, their utilization need to be highly discouraged during this COVID-19 pandemic.23 Hence, we are of the strong opinion that usage of specially designed valves containing anti-reflux equipment or anti-retraction dental Handpieces with valves shall be an efficient preventive step against cross-infection during pandemics.22
Sterilization of the Dental Hospitals/Work Places/ Clinics
Stringent sanitization measures have to be adopted by healthcare setups where people have the possibility of coming in contact with surfaces such as appliances, staircase railings, door handles, furniture like chairs, desks, elevator operation panel and any further. They need to follow the protocol of Management of Surface Cleaning and Disinfection of Medical Environment (WS/T 512-2016) released by the National Health Commission of the People’s Republic of China on December 27, 2016. People should be intimated to wear a mask and avoid direct contact with button panel and other surfaces in elevators despite it being cleaned regularly with disinfectants. Table 1, represents measures to contain nosocomial transmission of COVID 19 in India.
Medical Waste Management
Medical waste contains infectious or potentially infectious material. It has to be timely transported to a temporary storage unit inside the premises of the medical institute or hospital. The domestic and medical waste generated from treating COVID-19 patients or suspects thereof hereafter referred to as infectious medical waste needs to be packed in a yellow coloured double-layer medical waste package bags and secured with a gooseneck knot. These should be properly labelled and disposed of as per institutional norms of medical waste disposal. However, dental instruments and tools which are reusable need to be properly stored under the Protocol for the Disinfection and Sterilization of Dental Instrument (WS 506-2016) released by the National Health Commission of the People’s Republic of China after through pretreatment, cleaning and sterilization.
Procedures such as nebulizer therapy, open suction of respiratory tract, bronchoscopy, intubation, high-frequency oscillatory ventilation, non-invasive positive pressure ventilation, cardiopulmonary sputum induction.
Front office, outpatient wards, procedure rooms, radiology wings, waiting for spaces.
Protective clothing against liquid contamination by AMMI (Association for the Advancement of Medical Instrumentation PB70:2003) guidelines suggest Level 1 drape is used in anticipation of protection against the less amount of liquid exposure and Level 3 is used where the possibility of liquid exposure is more in quantity (Table 1).
Precautions to be taken by dental professionals after the lockdown ends
If possible, don't carry out aerosol related treatments (Airrotor and Scaler) till End of May-2020.
Strict Written informed consent, screening, and Undertaking from all patients regarding COVID and other diseases in general.
Before and after each patient’s observation, patient's dental chair, hand rests, spittoon, tray, buttons, headlight switch and door handles to be disinfected with alcohol scrub.
Ask the patient to keep their hands in their pockets and without touching anywhere to sit on the Dental Chair.
All asymptomatic treatments to be deferred.
Proper Donning and Doffing protocols if using PPE.
Any procedures generating splatter to be done with complete Disposable PPE for all operating Doctors and Assistants along with Rubber Dam isolation and preferably appointment kept at the end of the day.
Post splatters treatment, strict fumigation of Operatory need to be performed.
Routine procedures like OPD, Crown cementation, ART, can be carried out.
The water reservoir of the chair be added NaOCl 2.5% or H2O2 0.5%
Betadine throat gargles, just before any treatment is to be initiated.
Minimal follow-ups.
Dispose of the PPEs and Biomedical waste judiciously.
Fees to be encouraged to be paid by Digital routes
Before and after each session, meticulous floor mopping, handle disinfection, Dental chair, X-rays, Trays, Spittoon, Operatory, and waiting area needs to be implemented.
It is highly recommended to use single-use/disposable under dams and root canal files. Other regular instruments used for diagnosis or treatment need to be sealed and autoclaved. Soaking in Orocid like solutions before autoclaving is advised for used burs.
Scrubbing of a handpiece with a disinfectant before and after ever-patient should be practised without fail.
Intra procedure, hi-vac suction used in conjunction with saliva ejectors, should be used to minimize aerosol dissemination.
Rubber dams must be made mandatory, along with adequate training on its usage will form the best barrier to prevent aerosol formation.
Impressions should be effectively disinfected before dispatch to laboratories.
Fumigation with a quaternary ammonium compound must be performed every day, to ensure that all low contact areas are also disinfected.
Minimal use of Air Conditioners and restrict its use during Aerosol generating procedures. Also, regular cleaning of its filters and during Fumigation/Fogging should be on as the fumigant reaches the filters throughout.
Waste disposal must stringently follow biomedical waste disposal protocols as defined by the Municipal authorities.
Please convey beforehand or better put up a notice that due to added precautions, PPEs, etc. being taken, resulting in added costs, treatment for each procedure would increase by 10 to 15% minimum.
Educating people with facts enlightens them out of unnecessary fears. As a responsible doctor, you need to give them the confidence by emphasizing the facts regarding the spread and necessary precautions.
Adhering to all these practices creates a safe environment for patients and treatment providers. It creates a note of confidence among your patients seeking your service.
Thoughts for future
COVID-19 outbreak had unveiled the empty spaces in public health care internationally. Dentistry too failed to face emergencies of COVID19. This has to be considered as a learning opportunity to identify the role of the oral health care professional during health emergencies to improvise and implement better patient service along with personal protection from contagion. With serial outbreaks of SARS, MERS, Ebola, H1N1 and COVID19, it is evident that these emergencies are not rare anymore and we need to be prepared to fight them actively. Profound research into public dental health, basic dental education at all levels and appropriate clinical practices have to be implemented for a better future.
Inclusion of obligatory use of surgical masks, single-use appliances, tools, masks, gowns and other dental tools into Dental curriculum will help in the continuation of these practices during regular practice at their later stage.
Usage of chair-side rapid testing kits to identify a particular salivary sample for possible microbial contamination at the molecular level is an advisable way to early detect and protect against any communicable microbial infection, even at an asymptomatic stage. Further to identification, back-tracing the contacts can help in disease containment. These tests will also help us to identify the people who have developed pooled immunity due to infection, who can be used to extract readymade antibodies during emergencies.
Aerosol spread posses the highest threat in dental procedures for droplet borne infections like COVID-19. In such cases, negative pressure rooms prove to be most effective, which are generally used to control respiratory diseases. Dental professionals around the world need to consider this as a viable option for the future and has to be brought into practice at learning centres and government facilities.
Conclusion
Although there exists a lockdown due to epidemic, few patients still rush to emergency dental facilities and hospitals for treatment. As novel coronavirus COVID-19 is an airborne disease and can be spread via contact with contaminated surfaces, we have suggested all possible methods to contain the spread at dental clinics. We have summarized about dental procedures to be followed during diagnosis, treatment, patient evaluation, personal hygiene, equipment sanitization and protective measures for dental professionals, the right kind of equipment to be used and medical waste management as part of preventing the transmission of COVID19 at dental clinics. Fortunately, this virus is sensitive to regular disinfectants used in day to day dentistry procedures and by following stringent sanitization procedures as discussed will reduce the risk for patients and dentists. A dental professional or team will rarely get to face a COVID19 case, but if any latent or carrier visits the facility, he/ she poses a significant transmission risk to the entire team. Hence, knowledge and awareness among dental professionals are of vital importance against the virus. Its dark times for dentistry. With warnings from WHO about long-lasting persistence of COVID1924, it has become a nightmare for dentists and oral care professionals out there. However, life can’t be contained. It has to move on. Clinics can’t be shut down forever. So, with appropriate knowledge and prophylactic measures discussed above, it is viable for the reopening of dental practices globally.
Acknowledgement:
Authors acknowledge the immense support from CKS Theja Dental College, Tirupati, Andhra Pradesh, India and thank the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest and Funding Information
Authors declare no conflict of interest and state no receive any funding from any agency or institution.
Englishhttp://ijcrr.com/abstract.php?article_id=3295http://ijcrr.com/article_html.php?did=3295
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395(10223):470-73.
Worldometer. COVID-19 Coronavirus Pandemic data. https://www.worldometers.info/coronavirus/. Accessed 11/04/2020.
World Health Organization. https://who.sprinklr.com/explorer. Accessed 11/04/2020.
Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Meth Mol Biol 2015;1282:1–23.
Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, Yuen KY. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microb Infect 2020;9(1):221-36.
Juliet B, Delia E, Johan G, David LH, Chikwe I, Gary K, et al. COVID-19: towards controlling of a pandemic. Lancet 2020;395(10229):1015-8.
World Health Organization (WHO). Novel Coronavirus (2019-nCoV) Situation Report-7 – February 11, 2020. https://www.who.int/docs/default-source/searo/timor-leste/11-02-2020-tls-sitrep-7-ncov-final.pdf?sfvrsn=72720e51_2. Accessed 28/03/2020.
Centers for disease control and prevention. Symptoms of Novel Coronavirus (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html. Accessed 22/03/2020.
China’s National Health Commission news conference on coronavirus. China's National Health Commission is providing an update on coronavirus outbreak. https://www.aljazeera.com/news/2020/01/chinas-national-health-commission-news-conference-coronavirus-200126105935024.html. Accessed 22/03/2020.
Samuel Shen, Ryan Woo. Coronavirus incubation could be as long as 27 days, Chinese provincial government says. The Thomson Reuters Trust Principles. https://www.reuters.com/article/us-china-health-incubation/coronavirus-incubation-could-be-as-long-as-27-days-chinese-provincial-government-says-idUSKCN20G06W. Accessed 22/03/2020.
Yan B, Lingsheng Y, Tao W, Fei T, Dong-Yan J, Lijuan C, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 2(5):23-9.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-7.
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.
Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. The first step in understanding SARS pathogenesis. J Pathol 2004;203(2):631–37.
Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Inf Control 2016;44(9):102–8.
Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental healthcare settings: J Am Dental Assoc 2016;147(9):729–38.
Li RWK, Leung KWC, Sun FCS. Severe acute respiratory syndrome (SARS) and GDP. Part II: implications for GDPs. Br Dent J 2004;197(3):130–134.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hospital Inf 2020;104(3):246-51.
Otter JA. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. J Hospital Inf 2016;92(3):235–50.
Samaranayake LP, Reid J, Evans D. The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination. ASDC J Dentistry Children 1989;56(6):442–4.
Samaranayake LP, Peiris M. Severe acute respiratory syndrome and dentistry: a retrospective view. J Am Dental Assoc 2004;135(9):1292–302.
Hu T, Li G, Zuo Y, Zhou X. Risk of hepatitis B virus transmission via dental Handpieces and evaluation of an anti-suction device for prevention of transmission. Infect Con Hosp Epidem 2007;28(1):80–2.
Sanjay M, Md. IA, Bhoomika A, Ashish G. Use of Newer Protective and Disinfection Strategies: A Simple Tool Guide for the Dentists During the COVID-19 Pandemic. Int J Cur Res Rev 2020;12(16): 321-5.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241131EnglishN2021January5HealthcareAwareness Regarding a Anesthesia and Anesthesiologist in Patients and Attendants Coming to OPD in Dhiraj General Hospital: Observational Survey
English188192Anuja AgrawalEnglish Priya KishnaniEnglish Meet MaheshwariEnglish Darshan MunotEnglish Sejal MuthaEnglish Krinal ParikhEnglish Asit PatelEnglish Shivam MehtaEnglishIntroduction: Though the role of an Anesthesiologist is crucial, it’s knowledge to the public is limited. It is, therefore, imperative for us to ponder over why the importance of this speciality is still under the shades and also, ways to make people aware of their vital role.
Objective: The present study was conducted to assess public knowledge about the role of anesthesiologist and anaesthesia.
Methods: It was a cross-sectional study with study population from 18-60 years and a sample size of 500 patients. The allowable error is 5.77% and a confidence interval of 95%.
Results: When all people interviewed were asked if they would like to know more about Anesthesiology as a field of study and Anesthesiologist as a medical profession, majority of 60% showed their interest in knowing about it, 23% were not sure while only 17% denied knowing more about it. Among 500 people asked, 65% did not know if an anesthesiologist is a doctor while only 33% said yes.
Conclusion: The results highlight the urgent need of the awareness programs and camps to create awareness in the general population to highlight the importance of anaesthesia and the need of the anesthesiologist for their best care.
EnglishAwareness, Anesthesiologist, AnesthesiaINTRODUCTION
In ancient times, surgeries were done in barbaric form without any anaesthesia and analgesia. Anaesthesia is a state of temporary controlled loss of awareness or sensation induced for medical purposes. Study of Anesthesia is called Anesthesiology and the professional trained in Anesthesiology including preoperative medicine is called as an Anesthesiologist. First successful demonstration of the anaesthetic agent was showcased by William Thomas Green Morton in 18461, and its use has been growing since then. Anaesthesia has become one of the most advanced specialities of modern medicine. As the knowledge regarding Anesthesiologist is limited amongst the public. Thus, we should take measures to make public awareness regarding their role and speciality. 3 The study was conducted to assess public knowledge about the role of the anesthesiologist and anaesthesia in Dhiraj General Hospital, Gujarat, which is a tertiary level health care centre associated with a medical college.2 The study aimed to survey for awareness regarding anaesthesia and anesthesiologist in patients and attendants coming to OPD of Dhiraj General Hospital. The objective of the study was to assess the awareness regarding Anesthesia and to assess the awareness regarding Anesthesiologist in literates and illiterates.3,4
MATERIALS AND METHODS
It was an observational study with a study population from 18?60 years and a sample size of 500 patients. The allowable error is 5.77% and a confidence interval of 95%. The inclusion criteria included Age > 18 years < 60 years, subjects willing to sign the informed consent and patient and their attendants coming for pre-anaesthesia check?up to PAC. The exclusion criteria included subjects with loss of hearing or vision or both and subjects refusing to take part in the study. After obtaining permission from the institutional ethical committee the study was conducted in OPD of Dhiraj General Hospital, S.B.K.S.M.I.R.C. with ethical approval letter no. SVIEC/ON/Medi/SRP/19037. We studied patients and attendants coming to pre-anaesthesia check?up clinic for the duration of 2 months (20/07/2019 to1/10/2019). This is a cross?section study of nature. All the participants in the study were explained clearly about the purpose and nature of the study in the language they can understand. They were included in the study only after obtaining written informed consent. Data was collected by a personal interview with every individual. The individuals were randomly selected. Data was collected in in the pre-tested, pre-formed questionnaire as shown in table 1. Literate was defined as anyone having an education above 7th grade.
Statistical Analysis
Collected data were compiled in Microsoft office excel 2007 format. Data will be processed using EPI info statistical software. Descriptive and analytical, statistical methods were used for the preparation of results. Data is presented in graphical format.
RESULTS
The questions were asked to the patients and the attendants, out of 500 people, it was observed that 61% underwent any kind of surgical procedures. Out of these, 156 attendants were administered local anaesthesia, 58 general anaesthesia and 91 were not aware of either any of these. Amongst the people interviewed, 61% did understand the importance of the anaesthesia given and were aware of it while the 39% of them had no idea regarding the same.
The majority, that is 71% of the patients and attendants asked, was unaware about anesthesiology being an entirely different medical discipline while 29% were aware of the same (Figure 1).
Although 61% of the population had experienced anaesthesia, when asked about the method of administration of Anesthesia, most of them had no clue or the other. 50% identified with the administration of Anesthesia via injection in the back, 36% said intravenous, 11% said via gas from a mask while only 3% thought it was via an oral tablet (Figure 2).
On asking the concerned regarding the professional administrating Anesthesia, majority, that is, 44% knew that it was by a medical professional trained particularly in this field, while 29% and 14% thought it was either via a Surgeon or a Nurse respectively, while 13% did not have any idea (Figure 3). As seen from the pie chart in figure 5 of 500 people asked, 65% did not know if an anesthesiologist is a doctor while only 33% said yes. The role of an Anesthesiologist in an OT had varied answers. 53% thought it was pain management, 31% did not know their role while only 16% knew that it was to administer drugs, monitor patient throughout and manage pain post-surgery. 49% correctly identified the fact that Anesthesiologist does stay with the patient during the entire operation while 51% denied (Figure 4).
On a majority, i.e. 95%, people did identify that the Anesthesiologist was as important as the surgeons while only 5% claimed that they were not important at all. One of the questions did ask the source of information on which the patients and attendants were basing their answers on. 35% said that it was Friends and Relatives, 61% said it was the experience while only 4% said it was any other media including TV, Radio, etc. When all people interviewed were asked if they would like to know more about Anesthesiology as a field of study and Anesthesiologist as a medical profession, 60% showed their interest in knowing about it, 23% were not sure while only 17% denied knowing more about it (Figure 5).
Prevalence of awareness regarding anesthesiologist in literates and illiterates was found to be 33.96 and 10.32% respectively. (Figure 6) Similarly, the prevalence of awareness regarding anaesthesia in literates and illiterates was found to be 27% and 17.46% respectively (Figure 7).
DISCUSSION
In 2009 Mathur S K, Dube S K, and Jain S found that decisive role was played by anesthesiologists in patient management. Use of better patient monitoring, pain management, critical care and newer and safer anaesthetic drugs are the basis of present-day Anesthesiology. But these developments are not known to the general public. To assess the perception regarding the Anesthesiology and anesthesiologist among the general population, the study was carried out on 300 persons between the ages of 18 and 75 years. The study population was categorized as per their educational status and divided into 5 groups. Only 19.51% of the illiterate population, 58.57% of literates and 87.88% of the postgraduate population were aware of Anesthesiologist as a doctor. It was shocking to know that 100% of illiterates, 73.87% of up to matriculation, 64.29% of graduate and 51.52% of postgraduates did not know Anesthesiology as a separate medical discipline. The results reflect that ignorance and misconceptions about Anesthesiology and anesthesiologist are still prevalent in public in India.3
In 2016, Bhandarey et al. explained that 40% of the patients did not know that during surgery anesthesiologists are in charge of anaesthesia. Among the patients’ who had previous anaesthetic exposure, 69.4% felt that the anesthesiologist is the doctor who is in charge of anaesthesia. But, these patients knew very little about the roles of anesthesiologist inside and outside the operating room. Interestingly 51.7% of patients were interested to receive an explanation of anaesthesia preprocedural by an anesthesiologist.4
In the year 2018, Singh T, Sharma S explained that anaesthesia is one of the most advanced specialities in modern medicine. But, public awareness toward anesthesiologist and Anesthesiology is limited. Patients and attendants were assessed regarding the knowledge of anesthesiologist and Anesthesiology in this study. The study was carried out on 250 adult patients and attendants visiting OPD at a rural hospital in New Delhi. Over 3 months Interview was conducted in the pre-structured questionnaire in the local language. The participants based on their answers were divided into two groups, aware or unaware. Analysis of data was done using SPSS version 17. Though they were aware of the regional and general anaesthesia techniques, they were not aware of the role of anesthesiologists, in the OT and the postoperative period and about Anesthesiology as a separate medical discipline. 55.6% of participants had good knowledge, and it was significantly associated with age, sex, and education (P < 0.001). Active measures for educating the public and professionals are required.5
Thus, the above studies are in congress with my study and indicate widespread unawareness amongst the public about the role of anesthesiologists inside and outside the operating room. Therefore, they should educate about anaesthesia and the various roles of an anesthesiologist. The pre-anaesthetic check-up period should be used to fulfil this purpose. From the above study results, we could say that there is a lack of awareness in the general population regarding anaesthesia and anesthesiologist. It was found that the prevalence of awareness in the literate population regarding anaesthesia and anesthesiologist is only 33.96% and 27% respectively. While in the illiterate population, it was 10.32% and 17.46% respectively. The above results show that there is an insignificant difference in the prevalence regarding awareness of this medical profession in the literate and illiterates. This study also highlights that role of anesthesiologists apart from the O.T. is less known.6
However, if more time is spent with the patient in the preoperative check-up room and explaining the various modes of anaesthesia, the patients and their relatives will become more aware of anaesthesia and anesthesiologist and will also help in meeting the psychological needs of the surgical patient thus reducing the pre-operative anxiety.6
CONCLUSION
The present research investigated the awareness about the medical speciality Anesthesiology and the anesthesiologists who are continuously striving for the treatment of the patient. These results highlight the urgent need of the awareness programs and camps to create awareness in the general population to highlight the importance of anaesthesia and the need of the anesthesiologist for their best care. There is a need that the awareness programs are so designed/planned that could effectively help in making both literate and illiterate sections of the society aware about the very important roles of the anesthesiologist in healthcare and also the anesthesiology as a whole. This study was done in the pre-covid era, thus need to review the study after the Covid-19 era as the Covid-19 has brought the role of the anesthesiologist to the forefront.
Acknowledgement: Authors would like to express their gratitude towards the Department of Anesthesiology, Smt. B. K. Shah Medical College and Research Centre, Piparia, Vadodara and Hospital management for their constant support encouragement for the successful completion of the study and utilizing the facilities. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. They are also thankful to the subjects of this study for their valuable participation. Authors also grateful to IJCRR editorial team and reviewers to bring the quality of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=3296http://ijcrr.com/article_html.php?did=3296
Mittal MK, Sethi AK, Tyagi A, Mohta M. Awareness about Anesthesiologist and the scope of AnesthesiologistIn Non-Surgical Patients and their attendants. Ind J Anesth 2005;49(6):492-498.
Naithani U, Purohit D, Bajaj P. Public Awareness About Anesthesia and Anesthesiologist. Ind J Anesth 2007; 51(5):420.
Mathur SK, Dube SK, Jain S. Knowledge about Anesthesia and Anesthesiologist Amongst General Population in India. Ind J Anesth 2009 Apr; 53(2):179.
Bhandary A, Pallath NM, Ramkrishna M, Shetty SR. A survey on patients’ awareness about anesthesia and anesthesiologist. Ind J Clin Anesthesia. 2016;3(2):196.
Singh T, Sharma S, Garg S, Banerjee B. Knowledge regarding anesthesiologist and anesthesiology among patients and attendants attending a rural hospital of New Delhi. J Edu Health Prom 2018;7:12.
Gangadharan P, Assiri RAM, Assiri FAA. Evaluating the level of anxiety among pre-operative patients before elective surgery at selected hospitals in the kingdom of Saudi Arabia. Int J Curr Res Rev 2014;6(22):37.