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<?xml version="1.0"?>
<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Knowing What the COVID-19 Vaccine Does to Your Body?&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>01</LastPage><AuthorList><Author>Tomy M. Joseph</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3339</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3339</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Interaction of Correction of Lipid Peroxidation Disorders with Oxibral&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>05</LastPage><AuthorList><Author>Sharipov R. Kh.</Author><AuthorLanguage>English</AuthorLanguage><Author> Akhmedova M.M.</Author><AuthorLanguage>English</AuthorLanguage><Author> Rasulova N.A.</Author><AuthorLanguage>English</AuthorLanguage><Author>. Erbutayeva L.T.</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Cerebral pathology is leading reason of not only morbidity and death rate but also heavy disability in subsequent ontogenesis At the of aggressive free radicals, hydroperoxides that render the destructive operating on the membranes of neurons. Objective: To ground the efficiency of therapy of &#x201C;oxibral&#x201D; of pectoral children with the perinatal damages of CNS by the account of changes LPO in red corpuscles. Methods: An analysis was conducted for 70 pectoral children of age with the perinatal damages of CNS and with pathogeny of consequences of perinatal damages of the nervous system. Oxibral rendered the positive operating on the maintenance of MDA after incubation. At comparing of the indicated index it is not reduced to the norm of statistical difference. Results: The correction of &#x201C;oxibral&#x201D; of neurological violations opens the prospect of rehabilitation and assists a considerable reduction of per cent of children with the remaining phenomena of perinatal damages of CNS. Peroxide oxidation of lipids indicators in healthy infants have their characteristics, and the studies carried out can be used as controls for various pathological conditions, including perinatal CNS injuries. Conclusions: Thus, it was found that LPO indicators in healthy infants have their characteristics, and the results of the studies carried out can be used as controls for various pathological conditions, including perinatal CNS injuries.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Peroxide oxidation of lipids, Malonic dialdehyde, Degree of hemolysis of red corpuscles, The symptom of Grefe, Oxibral, Damages of CNS</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The perinatal damages of the brain make more than 60 per cent pathology of the nervous system of child&amp;#39;s age, directly participate in the development of such diseases, as child&amp;#39;s cerebral paralysis, epilepsy, minimum cerebral disfunction, that, in turn, assist the increase of recurrent respiratory diseases Presently the basic hypothesis of a pathogeny of consequences of perinatal damages of the nervous system (CPDNS) is cerebrovascular violations. In the conditions of hypoxia peroxide oxidization of lipids is violated with the accumulation of aggressive free radicals, hydroperoxides that render the destructive operating on the membranes of neurons.1&#xD;
&#xD;
In case of impaired cerebral circulation in newborns, several researchers conclude about the intensity of lipid peroxidation in this pathology based on an increase in the content of LPO products. Only with an integrated approach, i.e. using several research methods in combination, one can count on the possibility of a more complete assessment of pathological changes in plasma membranes.2&#xD;
&#xD;
As you know, LPO indicators characterize not only the severity of the pathological process but to a certain extent the effectiveness of the correction of disturbed metabolism. Consequently, according to these indicators, it is possible not only to assess the degree of pathological changes but also, most importantly, the effectiveness of the therapy.3&#xD;
&#xD;
Recently, several experimental and clinical studies have appeared, indicating the beneficial effect of the new herbal preparation oxybral on circulatory and metabolic cerebral disorders. The active ingredient of oxybral is a vinca alkaloid vincamine. Numerous studies have confirmed the presence of an active metabolic effect of oxybral on ischemic tissue. The drug helps to increase the consumption and use of oxygen and glucose by brain tissues improves and normalizes glycolysis, is well tolerated by patients. It has been proven that the drug is rapidly absorbed for any method of application, uniformly distributed in the brain tissues, metabolized and eliminated through the kidneys. A great deal of clinical experience has been accumulated confirming the selective vaso regulatory effect of vincamine on cerebral vessels.3,4&#xD;
&#xD;
However, there are no studies in which the effect of this drug in perinatal damage to the nervous system in children of the first year of life would be studied, the questions of the optimal dosage and duration of the course of using this drug are not substantiated.5,6&#xD;
&#xD;
The work aimed to substantiate the therapy with oxybral in infants with perinatal CNS injuries by taking into account changes in the processes of lipid peroxidation (LPO) in erythrocytes. We were the first to study the effect of oxybral on the state of the nervous system in CPDNS based on studying LPO processes&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
The paper analyzes the results of clinical and biochemical studies in 70 children of the first year of life. The main group consisted of 44 infants with perinatal CNS injuries. The control group included 26 children with CPDNS who have not prescribed the drug we tested. Since the processes of lipid peroxidation have age-related dynamics, we also studied the state of LPO processes in 20 healthy children.&#xD;
&#xD;
The state of lipid peroxidation in erythrocytes was assessed according to the following indicators: the degree of erythrocyte hemolysis before incubation (mechanical stability of erythrocytes) and after incubation under physiological conditions (peroxide hemolysis without incubation), the MDA content in erythrocytes, the MDA coefficient/hemolysis after incubation of MDA in the intensity of erythrocyte degradation. To determine lipid peroxidation parameters, only 170 &#x3BC;l of erythrocytes (approximately 0.7-0.8 ml of blood) were required. Determination of the activity of LPO processes in erythrocytes was studied twice: before and after treatment.7,8&#xD;
&#xD;
Results &#xD;
&#xD;
Most children with perinatal CNS damage were born to mothers suffering from chronic diseases of the cardiovascular system, endocrine system, nasopharynx, kidneys, digestive organs, and genitals. Complicated pregnancy was observed in all mothers of children with CPDNS. All children were born to mothers with a complicated course of labour.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the neurological status, the hypertensive-hydrocephalic syndrome was 42.8% and was characterized by the opening of the sagittal suture more than 0.5 cm, the large fontanelle over 3x3 cm, non-closure of the small fontanelle in most children, pronounced development of collateral veins of the head, and baldness of the head. Various ocular symptoms were found in the form of Graefe&amp;#39;s symptom, &#x201C;setting sun&#x201D;, and unstable horizontal nystagmus. The diagnosis was confirmed by ECHOEG, and upon examination of the fundus, by the detection of retinal vasospasm.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The main changes in the syndrome of vegetative-visceral dysfunctions (38.5%) were persistent regurgitation, persistent hypotrophy, respiratory rhythm disturbances, skin colouration, acrocyanosis, paroxysms of tachy, bradypnea, thermoregulation disorders, gastrointestinal dysfunction, temporal lobe hair loss.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; With the syndrome of increased neuro-reflex excitability (11.4%), against the background of normal mental and physiological development, the child reveals emotional lability, motor anxiety arising from minor changes in the environment, when exposed to visual, auditory, tactile analyzers. Such children have a periodic small-amplitude tremor, startle, difficulty falling asleep, anxious superficial, not long enough sleep.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Psychomotor development retardation syndrome (7.1%) is characterized by impaired reduction of unconditioned congenital reflexes. Children are not actively interested in toys and surrounding objects, do not react enough to the presence of their mother, humming is inactive and short-lived, manipulations with objects are delayed, there is no active attention.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the department, children of the control group received complex therapy: drugs that improve cerebral circulation (vinpocetine), piracetam was used, and syndrome therapy was performed. Depending on which clinical manifestations prevailed, they used anticonvulsants, diuretics and vitamin preparations. Parallel correction of disorders caused by underlying diseases was also carried out.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The results of the research showed that children with perinatal CNS injuries were found to have significant disorders in LPO processes, which can be characterized as a decrease, and in some cases, their imbalance. This was evidenced by a significant increase in the MDA content before and after incubation, the MDA / hemolysis ratio after incubation, an increase in erythrocyte hemolysis after incubation, and a decrease in the percentage of increase in hemolysis compared to the data.5,9,10&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In children of the control group, the hemolysis of erythrocytes before incubation, although significantly reduced compared to the data before treatment, still does not normalize. Hemolysis of erythrocytes after incubation practically did not differ from those of healthy children. Therefore, despite the increased value of erythrocyte hemolysis before incubation, the hemolysis of erythrocytes after incubation in children of this group does not differ from those of healthy children.6,11,12 In this regard, the percentage of increase in erythrocyte hemolysis in children of this group was significantly reduced in comparison with healthy children. Before incubation, the MDA content remained at high values, although there was a tendency to decrease it. In children of this group, MDA after incubation was significantly higher than the norm, however, the treatment carried out contributed to a significant decrease in this indicator compared with the data before treatment.13-14&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The MDA / hemolysis ratio after incubation was higher than in healthy children, but there was a significant decrease in comparison with the initial data. The intensity of MDA degradation significantly increased in comparison with the initial data and did not differ from the indicators of children in the healthy group. The same changes were observed in the degradation / MDA ratio.7,8&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Thus, in children with AED who received conventional therapy, there is a significant positive dynamics in the indicators of LPO processes, but most of them do not reach the norm. Positive dynamics was also noted in terms of clinical symptoms: children became calmer, their sleep returned to normal, the size of the brain ventricles gradually normalized, and the functions of internal organs stabilized. Appetite improved and, therefore, the children began to gain weight. An active interest in the environment appeared. In general, clinically significant improvement was observed between 10-15 days of therapy.15&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The presence of changes in LPO processes in children with perinatal CNS injuries, which persist despite the course of therapy, dictates the need to include new drugs in the treatment complex, the action of which is more effective. We have used a new herbal preparation oxybral, the effect of which in infants has been insufficiently studied. High efficiency, absence of side effects, as well as good tolerance, served as the basis for the appointment of Oxybral for the correction of cerebral and metabolic disorders and, indirectly, for the correction of LPO in children with perinatal CNS injuries.3,4&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Given the fact that infants were prescribed oxybral for the first time, it became necessary to scientifically substantiate the appointment of this drug, to select the dose and duration of the course of treatment based on studying the effect on LPO in erythrocytes. To determine the dose and duration of the course of treatment, initially, oxybral was prescribed at 7.5 mg/day. Complete normalization of indicators in most children was observed between 7 and 10 days. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Treatment with oxybral turned out to be most effective when applied for 10 days. For an objective assessment of the therapeutic effect of oxybral, the results of treatment of these patients were compared with the corresponding data in children of the control group. Erythrocyte hemolysis before incubation in children of the study group did not differ from the data obtained in healthy children and was significantly lower than in the control (1.4 &#xB1; 0.05% and 1.17 &#xB1; 0.12%, respectively). When comparing the hemolysis of erythrocytes after incubation in children with AED who received oxybral with the data obtained in healthy children and children of the control group, no statistically significant difference was found (2.37 &#xB1; 0.16%, 2.21 &#xB1; 0.44% and 2, 3 &#xB1; 0.03%, respectively). Due to the normalization of mechanical and peroxide hemolysis, the percentage of increase in hemolysis did not differ from the data of healthy children and was significantly higher than in the control group (99.7% and 64%, respectively).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The MDA content before incubation in children of the main group did not differ from the data obtained in the control study. That is, despite the course of therapy with oxybral, the MDA content before incubation in children with PEP remained significantly higher than in healthy children (2.7 &#xB1; 0.24 nmol/106 erythrocytes versus 0.86 &#xB1; 0.12 nmol/106 erythrocytes). However, one cannot fail to note a significant decrease in this indicator compared with the initial data (2.7 &#xB1; 0.24 nmol/106 erythrocytes versus 3.3 &#xB1; 0.33 nmol/106 erythrocytes).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Oxybral had a positive effect on the MDA content after incubation. When comparing this indicator with the norm, no statistical difference was found (1.6 &#xB1; 0.18 nmol/106 erythrocytes and 1.4 &#xB1; 0.16 nmol/106 erythrocytes). At the same time, in the children of the main group, the MDA content after incubation was significantly lower than in the control (1.6 &#xB1; 0.18 nmol/106 erythrocytes and 2.0 &#xB1; 0.17 nmol/106 erythrocytes, respectively ).5,9,10&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The MDA / hemolysis ratio after incubation when receiving oxybral did not&#xD;
&#xD;
differ from the data in the control group and was significantly higher than normal values (0.9 &#xB1; 0.2, 1.0 &#xB1; 0.07 and 0.5 &#xB1; 0.1, respectively). Clinical symptoms also had a pronounced positive trend: children became calm and active. Sleep has returned to normal. Normalization of ECHOEG parameters against the background of the use of oxybral was noted much faster (7-10 days, versus 10-15 in the control, depending on the degree of the initial change). Pulse and breathing became rhythmic, the activity of the gastrointestinal tract stabilized, the children began to gain weight. The temperature decreased or returned to normal, regardless of the use of antipyretic drugs in children with a history of unmotivated febrile conditions.&#xA0;Children began to take an active interest in their surroundings, and a tendency to develop motor skills began to appear.&#xA0;In general, a pronounced clinical effect was observed on days 6-10 of therapy (Table 1).&#xD;
&#xD;
&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Thus, it was found that LPO indicators in healthy infants have their own characteristics, and the results of the studies carried out can be used as controls for various pathological conditions, including perinatal CNS injuries.&#xA0;A scientifically substantiated approach to the appointment of oxybral for the correction of perinatal CNS injuries under the control of changes in LPO processes was carried out. Studies have shown that the appointment of children with perinatal damage to the central nervous system oxybral.&#xA0;Along with the normalization of most indicators, LPO contributes to more rapid normalization of neurological symptoms.&#xA0;The possibility of correcting neurological disorders with oxybral opens up the prospect of rehabilitation and contributes to a significant reduction in the percentage of children with residual symptoms of perinatal CNS damage.&#xD;
&#xD;
Conflict of Interest: None&#xD;
&#xD;
Source of Funding: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3340</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3340</Fulltext></URLs><References>1. Barashnev YI. Hypoxic encephalopathy: hypotheses of the pathogenesis of cerebral disorders and the search for methods of drug therapy. Russian Bull Perinatol Pediatr 2002;5(6):45-49.&#xD;
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3. Akhmedov FK. Features of renal function and some indicators of homeostasis in women with mild preeclampsia. Eur Sci Rev (Austria) 2015;4(5):58-60.&#xD;
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4. Akhmedov FK, Avakov VE, Negmatullaeva MN. Status of cardio-hemodynamics and cardiac geomerms in women with complications with severe preeclampsia.&#xA0; News&#xA0; Dermatol Reprod Health 2017;3(I):27-29.&#xD;
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5. Guryeva MV, Yu. B,&#xA0; Kotov VA.&#xA0; Daily monitoring of blood pressure and heart rate in the diagnosis. Russian Bull Obstet Gynecol 2013;3:4-9.&#xD;
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6. 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&#x2013;30. &#xD;
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7. 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&#x2013;5529. &#xD;
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8. Prusakov VF, Morozov EA, Marulina VI, Belousova MV, Utkuzova MA, Gamirova RG, Knyazeva OV. The role of perinatal damage to the nervous system in the formation of neurological pathology in childhood.Vestnik modern Clin.Med. 2016; 9(2): 65-70.&#xD;
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10. Wu YW, Colford Jr JM. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. Jama. 2000 Sep 20;284(11):1417-24.&#xD;
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11. Mallick S.&#xA0;Study On The Clinical Profile Of Patients With Cerebral Palsy&#xA0;(Doctoral dissertation) 2011. &#xD;
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13. Savchenkov Y, Soldatova O, Shilov S. Age physiology (physiological characteristics of children and adolescents).Textbook for universities 2019:182. &#xD;
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14. Dautov AA. &#xA0;HPLC determination of malonic dialdehyde in plasma and saliva. Sorption Chromatogr Proc 2018;18(1):73-82. &#xD;
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15. Williams CE, Mallard EC, Tan WKM, Gluckman PD. Pathophysiology of perinatal asphyxia. Clin Perinatol 1993;3(4):91-94&#xA0;&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Hepatoprotective Activity of Different Extract of Chromolaena Odorata Against CCL4 and Rifampicin&#x2013; Induced Hepatic Injuries in Rats: A Randomized Controlled Preclinical Trial&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>06</FirstPage><LastPage>10</LastPage><AuthorList><Author>Muthu Ramu T</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajasekaran S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Now a day&#x2019;s liver disease is a worldwide problem. Modern synthetic drugs used in the treatment of liver diseases are sometimes inadequate and can cause serious side effects. Objective: This current investigation aims to evaluate the ethanol and aqueous extracts of leaves of Chromolaena odorata (L.) R. M. King &amp; H. Rob. (Asteraceae) was investigated against carbon tetrachloride and rifampicin-induced hepatic damage. The plant of Chromolaena odorata is a perennial herb and distributed throughout the region of India, Mexico and Asia. In traditionally this plant is used in the treatment of coughs, colds, and skin diseases. Based on the present study, an effort has been made to establish the scientific validity of the hepatoprotective activity against ccl4 and rifampicin-induced hepatotoxicity. Methods: To evaluate the hepatoprotective activity by various inducing agents like carbon tetrachloride at the rate of 1 ml/kg and rifampicin 1mg/kg produced liver damage in rats. Results: The results are manifested by the significant (P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Chromolaena odorata, CCl4, Rifampicin, Transaminases, Histopathological studies</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
India is known for its traditional medicinal systems&#x2014;Ayurveda, Siddha, and Unani. Medical systems are found mentioned even in the ancient Vedas and other scriptures. The Ayurvedic concept appeared and developed between 2500 and 500&#x2009;BC in India.1,2 In India medicinal plants and traditional medicine have been the basis of traditional healthcare especially in remote areas where modern healthcare facilities are inadequate. India is the largest producer of medicinal plants is rightly called the &#x201C;The botanical garden of the world&#x201D;.3 The revival of interest in herbal medicines is due to safe, more accessible and more affordable. The plant of Chromolaena odorata&#xA0;(L.) R. M. King &amp; H. Rob. family of Asteraceae is a perennial herb and distributed throughout the region of India, Mexico and Asia.4,5 In traditionally this plant is used in the treatment of coughs, colds, and skin diseases.6 Now a day&#x2019;s liver disease is a worldwide problem. Modern synthetic drugs used in the treatment of liver diseases are sometimes inadequate and can cause serious side effects.7 On the basis of the present study, an effort has been made to establish the scientific validity of the hepatoprotective activity against CCl4 and rifampicin-induced hepatotoxicity. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Plant Material&#xD;
&#xD;
Fresh leaves of Chromolaena odorata.Were collected from kaaripatti, Salem (Dt) Tamilnadu. The plant was then authenticated by the Botanist A. Balasubramanium, consultant-central Siddha Research, Salem-Tamilnadu.&#xD;
&#xD;
Preparation of the extract/drug&#xD;
&#xD;
The fresh leaves of Chromolaena odorata dried at under shade, grind into small pieces of crude drugs with help of a mechanical grinder. The crude powder was passed through sieve no.30 and stored in a suitable container. Then the crude drugs were defatted with Ethanol 95% (75-78oC) by using soxhlet apparatus.&#xA0; Then crude drugs were then subjected to cold maceration method by using aqueous water for 72hrs. Then extracts were concentrated by using a rotary vacuum evaporator and kept aside in the desiccators. The extracts were suspended in Tween80 for the presented study. The extract obtained was subjected to various Preliminary Phytochemical Screening tests as per the procedure mentioned in the standard reference books.8,9 The extract was used for pharmacological evaluation&#xD;
&#xD;
Preliminary Phytochemical Screening&#xD;
&#xD;
The various extracts of Chromolaena odorata&#xA0;were then subjected to preliminary phytochemical analysis to assess the presence of various phytoconstituents, it revealed that the presence of alkaloids, steroids, polyphenolic constituents like flavonoids, saponins, glycosides, tannins, gums and mucilages. &#xD;
&#xD;
Procurement of experimental animals&#xD;
&#xD;
Swiss albino mice (20-25gm) and Wister rats (150-200gm) of either sex and approximate same age used in the present studies were procured from listed suppliers of Sri Venkateswara enterprises, Bangaloru, India. The animals were fed with standard pellet diet (Hindustan lever Ltd. Bangaloru) and water ad libitum. All the animals were housed in polypropylene cages. The animals were kept under the alternate cycle of 12 hours of darkness and light. The animals were acclimatized to the laboratory condition for 1 week before starting the experiment. The animals were fasted for at least 12 hours before the onset of each activity. The experimental protocols were approved by the Institutional Animal Ethics Committee (IAEC No.-60/2019/IAEC/VMCP.) after scrutinization. The animals received the drug treatment by oral gavage tube.&#xD;
&#xD;
Acute toxicity test10&#xD;
&#xD;
The ethanol and aqueous extract of Chromolaena odorata were subjected for acute toxicity, as per standard method (OECD/OCDE No: 423). Albino female mice weighing 20-28 gm were used in this present study. The animals were fed with standard pellet diet and water ad libitum. All the animals were housed in polypropylene cages. The animals were kept under the alternate cycle of 12 hours of darkness and light. The animals were acclimatized to the laboratory conditions for 1 week before starting the experiment. The dose of ethanol and aqueous extracts was prepared with suitable saline and was administered by intubations. The acute toxicity was screened up to doses of 5000mg/kg. &#xD;
&#xD;
Hepatoprotective studies &#xD;
&#xD;
Carbon tetrachloride [CCl4] induced hepatotoxicity in rat model11,12&#xD;
&#xD;
The rats were divided into 7 groups of six animals in each. Group, I served as a control, Group II administered with carbon tetrachloride (1 ml/kg) in 50% v/v olive oil every 72 hrs, Group III was pretreated with the standard drug of silymarin (100mg/kg) orally for 7 days. Simultaneously CCl4 (1ml/kg) in 50% v/v olive oil every 72 hrs Groups IV, V animals were pretreated with Ethanol extract of Chromolaena odorata (200mg/kg, 400mg/kg respectively) for 7 days. Groups VI, VII animals were pretreated with aqueous extract of Chromolaena odorata (200mg/kg, 400mg/kg respectively) for 7 days and carbon tetrachloride (1 ml/kg) intraperitoneal every72 hours for 7 days for test groups. After the experimental period, blood was collected by the retro orbital method and the serum was separated and used for the assay of Serum oxaloacetate transaminase (SGOT), Serum glutamate pyruvate transaminase(SGPT), alkaline phosphatase (ALP), total protein, total &amp;direct bilirubin were estimated respectively. The rats were sacrificed by cervical dislocation method. The liver is removed for histopathological examination &#xD;
&#xD;
Rifampicin induced model13,14&#xD;
&#xD;
The rats were divided into 7 groups of six animals in each. Group I served as a control, Group II administered with rifampicin (1gm/kg, p.o) every 72 hrs, Group III were pretreated with the standard drug of silymarin (100mg/kg) orally for 10 days. Simultaneously rifampicin (1 gm/kg) every 72 hrs, Groups IV, V animals were pretreated with Ethanol extract of Chromolaena odorata (200 mg/kg, 400mg/kg respectively) for 10 days. Groups VI, VII animals were pretreated with aqueous extract of Chromolaena odorata (200mg/kg, 400mg/kg respectively) for 10 days and rifampicin (1gm/kg) intraperitoneal every72 hours for 10 days for test groups. After the experimental period, blood was collected by the retro-orbital method and the serum was separated and used for the assay of Serum oxaloacetate transaminase (SGOT), Serum glutamate pyruvate transaminase(SGPT), alkaline phosphatase (ALP), total protein, total &amp;direct bilirubin were estimated respectively. The rats were sacrificed by cervical dislocation method. The liver is removed for histopathological examination.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
The values Mean&#xB1; standard error means [SEM] are calculated for each parameter. For determining the significant intergroup difference each parameter was analysed separately and one-way analysis of variance was carried out and the individual comparisons of the group mean values were done using Dunnet&#x2019;s test.15&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Preliminary phytochemical screening revealed the presence of Alkaloids, Steroids, polyphenolic constituents like flavonoids, Saponins, glycosides, tannins, gums and mucilages. Acute toxicity studies of the various extracts of the Chromolaena odorata did not exhibit any signs of toxicity up to 5 g/kg body weight. Since there was no mortality of the animals found at the high dose. Hence 200 and 400 mg/kg dose of the extract selected for evaluation of the hepatoprotective activity.&#xD;
&#xD;
CCl4 induced hepatotoxicity &#xD;
&#xD;
A significant reduction was (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3341</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3341</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Simultaneous Determination of Tenofovir Disoproxil Fumarate and Emtricitabine by UV Vierordt&#x2019;s and UFLC Methods&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>11</FirstPage><LastPage>15</LastPage><AuthorList><Author>AS Warokar</Author><AuthorLanguage>English</AuthorLanguage><Author> T Mankar</Author><AuthorLanguage>English</AuthorLanguage><Author> UN Mahajan</Author><AuthorLanguage>English</AuthorLanguage><Author> SM More</Author><AuthorLanguage>English</AuthorLanguage><Author> LN Barde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Analytical methods like Ultraviolet-visible spectroscopy and High-Performance Liquid Chromatography play a critical role in equivalence and risk assessment and management. Nucleotide reverse transcriptase inhibitors tenofovir disoproxil fumarate (TDF) and Emtricitabine (ETB) is clinically a potent combination against HIV and hepatitis B virus devoid of short-term irritating toxicity. Objective: The present investigation deals with the development and validation of new UV spectrophotometric Vierordt&#x2019;s and Reverse Phase Ultra-Fast Liquid Chromatography (RP-UFLC) methods for the simultaneous estimation of TDF and ETB in bulk and tablet dosage form as per the International Council for Harmonization (ICH) guidelines. Methods: Vierordt&#x2019;s method was developed on Shimadzu UV-1800 UV/Visible Spectrophotometer. Reverse phase ultra-fast liquid chromatography was developed on Shimadzu UPLC, X-Bridge C18 column equipped with a photodiode array detector. Mobile phase composed of water: methanol 62:38. The effluent was pass through the column 1.0 ml/min at 30o C and the response was recorded at 254 nm. Results: Absorption maxima of TDF and ETB were obtained at 260 nm and 281 nm respectively. The RSD of all validation parameters was lesser than 2 % indicated the accuracy of the Vierordt&#x2019;s method. In UFLC, the retention time of ETB and TDB were found to be at 3.371 and 6.850 min respectively. Purity angle and purity threshold of both peaks showed spectral homogeneity over all the peak region indicated its peak purity. Conclusion: The proposed Vierordt&#x2019;s and RP-UFLC methods found to be sensitive, rapid, accurate and economical and it can be employed for simultaneous estimation of ETB and TDB in bulk drugs and formulations.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Vierordt&#x2019;s method, RP-UFLC, Tenofovir disoproxil fumarate, Emtricitabine, UV spectroscopy, Chromatography</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Chemically, Tenofovir (TDF) is (R)-(1-(6-amino-9H-purin-9-yl)propan-2-yloxy)methyl phosphonic acid. It is a class of antiretroviral drugs known as nucleotide analogue reverse transcriptase enzyme inhibitors (NtRTIs), which blocks viral production in HIV-infected people.1 Emitricitabine (ETB) is 4-amino-5-fluoro-1-[(2R,5S)-2-(hydroxymethyl)-1,3-oxathiolan-5-yl]pyrimidin-2-one. It is also a nucleoside reverse transcriptase inhibitor which acts by inhibiting reverse transcriptase enzyme that copies human immunodeficiency virus ribonucleic acid into new viral deoxyribonucleic acid.2 Combinational antiretroviral therapy of TDF with ETB has significantly greater potency, reduced HIV-related morbidity, mortality, toxicity and offers simplified dosing convenience.3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Literature survey revealed that the various analytical methods like high-performance liquid chromatography4-9 and ultraviolet spectroscopy10,11 have been reported for simultaneous determination of TDF and ETB however none of these chromatographic methods developed on UFLC which offers better resolution, speed, sensitivity, accuracy compare to conventional liquid chromatography.12 In the reported high-performance liquid chromatography methods, effluents were not monitored by photodiode-array detector hence the interference of any impurities remained are undetected. Ultra-fast liquid chromatography equipped with photodiode array detector facilitates the accurate detection of co-eluting impurity within the analyte peak by measurement of its peak purity.13Vierordt&amp;#39;s spectrophotometric method applied for simultaneous estimation of drugs that have measurable absorbance at &#x3BB;max&#xA0;of each other.14 Vierordt&#x2019;s method has the bene?ts of being simple, rapid, direct, economic, with minimum data manipulation. It does not require sophisticated techniques or instruments.15 Therefore, the present investigation deals with development and validation of UV Spectrophotometric Vierordt&#x2019;s and UFLC methods to allow accurate, rapid, sensitive and precise determinations of TDF and ETB in bulk and tablet dosage forms.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Materials&#xD;
&#xD;
Pharmaceutical grade TDF and ETB bulk drugs were generously gifted by Hetro Drugs Ltd., Hyderabad, India. HPLC grade methanol and water were purchased from Rankem, Mumbai. Nylon membrane disc filter (0.45&#xB5;) and syringe filter procured from by mdi-Cat, Gurgaon. All other chemicals and reagents were of analytical grade. TENOF EMis the brand of the tablet manufactured by Hetero Drugs Ltd contains Emtricitabine/Tenofovir disoproxil fumarate 200 mg/300 mg respectively. Tablets were purchased from Nagpur retail pharmacy.&#xD;
&#xD;
Instruments&#xD;
&#xD;
Shimadzu prominence ultra-fast liquid chromatography (UFLC) system,&#xA0; Shim-pack GIST-HP C18&#xA0; (150 x 4.6 mm, 3 &#xB5;m) column manufactured by Shimadzu Pvt. Ltd. from high purity porous spherical silica, Pump LC 20 AD gradient system, connected with SPD-M20A PDA detector empowered with LC solution software. Shimadzu UV-1800 UV/Visible Scanning Spectrophotometer; 115 VAC, bandwidth 1.0 nm, wavelength accuracy &#xB1;0.1 nm, detector silicon photodiode. Mettler Toledo XS205D0 analytical balance.&#xD;
&#xD;
Development and validation of UV spectrophotometric Vierordt&#x2019;s method&#xA0;&#xA0;Working solutions of standard TDF and ETB were scanned separately in UV range 200&#x2013;400&#x2009;nm against water as blank for determining maximum wavelengths (&#x3BB;max). TDF and ETB displayed &#x3BB;max at 260&#x2009;nm and 281&#x2009;nm, respectively (Fig. 1. a &amp; b).&#xA0;Calibration curves was plotted over a concentration 5,10,15, 20,25 and 30&#x2009;&#xB5;g/ml for TDF and 3.5, 7, 14, 21, 28, 35 &#xB5;g/ml for ETB. The absorbance was measured in triplicate at &#x3BB;max&#xA0;260 and 281&#x2009;nm. Specific absorptivity A1%1cm of each solution was determined by dividing absorbance of drug with its concentration in gm/100ml. The amounts of the TDF and ETB in laboratory mixture were calculated by using Eq.1 and 2.&#xD;
&#xD;
Cx=A2 ay1 &#x2013; A1 ay2ax2ay1&#xA0; - ax1ay2&#xA0;&#x2026;&#x2026;&#x2026;&#x2026;Eq.1Cy=A1 ax2 - A2 ax1ax2ay1&#xA0; - ax1ay2&#xA0;&#x2026;&#x2026;&#x2026;&#x2026;Eq.2&#xD;
&#xD;
where Cx and Cy are the concentration (&#xB5;g/ml) of TDF and ETB. A1&#xA0;and&#xA0;A2&#xA0;are the absorbances of laboratory prepared mixtures (Tablet TENOF EM) at 260&#x2009;nm and 281&#x2009;nm, respectively. The&#xA0;ax1and&#xA0;ax2&#xA0;are specific absorptivity&#x2019;s of TDF at 260&#x2009;nm and 281&#x2009;nm, respectively. While,&#xA0;ay1&#xA0;and&#xA0;ay2&#xA0;are specific absorptivity&#x2019;s of ETB at 260&#x2009;nm and 281&#x2009;nm, respectively. &#xD;
&#xD;
All validation procedures of proposed Vierordt&#x2019;s method were performed following the International Conference on Harmonization ICH Q2 (R1) guideline.16 The per cent mean recovery (&#xB1;SD) and % relative standard deviations (%RSD) at two concentration levels for TDF (7 and 28 &#xB5;g/ml) ETB (10 and 25&#x2009;&#xB5;g/ml) in their pure state were calculated. The precision of the developed method was ascertained by repeatability and intermediate precision studies. In the intra-day study (repeatability) of the proposed method was performed with a minimum of three replicate measurements. The concentrations of the TDF and ETB were calculated every two hours (0, 3, and 6&#x2009;h). In inter-day (intermediate precision) studies, the concentrations of both the drugs were calculated on three consecutive days. Limit of Detection (LOD) and Limit of Quantification (LOQ) were calculated from linearity regression equations of TDF and ETB.&#xD;
&#xD;
Development and validation of UFLC Method&#xD;
&#xD;
Preparation of standard and working solution&#xD;
&#xD;
Standard TDF (15 mg) and ETB (10 mg) were accurately weighed and transferred into 50 ml volumetric flask. Then, 35 mL of the diluent (water-methanol, 50:50) was added. It was sonicated for 15 min and diluted to up to the mark with the diluent. From the above stock solution, 1 ml of the filtrate was transferred into another 20 mL volumetric flask and volume were made up to the mark with the diluent. The resultant concentration standard TDF (15 &#xB5;g/ml) and ETB (10 &#xB5;g/ml) were obtained for the development of the UFLC method.&#xD;
&#xD;
Preparation of tablet sample solution &#xD;
&#xD;
Twenty tablets were weighed and powdered finely. Powder quantity equivalent to TDF (15 mg) and ETB (10 mg) were accurately weighed and transferred into 50 ml volumetric flask. It was sonicated for 15 min and diluted to up to the mark with the diluent. From the stock solution, 1 ml of the filtrate was transferred into 20 mL volumetric flask and volume were made up to the mark with the diluent. The working solution pass through the syringe filter.&#xD;
&#xD;
Chromatographic separation was performed on UFLCC18 (150 x 4.6 mm, 3 &#xB5;m) column equipped with PDA detector. Isocratic elution was carried by mobile phase water: methanol (62:38) at flow rate 1 ml/min; column temperature 350 C. Mobile phase was sonicated, degassed and pass through 0.45&#xB5; nylon membrane disc filter. The stock solution and working standard prepared in diluents water: methanol (50:50 v/v). Injection volume was 20 &#xB5;L. Chromatographic peaks of TDF and ETB were integrated to observe its &#x3BB;max of the UV spectrum by PDA detector. Parameters like peak symmetry, peak purity, tailing factor, Rt and area under curve measured by LC solution software. System suitability parameters were analyzed to evaluate system performance reproducibility. Six replicates of the sample were injected into the column. Parameters such as resolution factor, capacity factor, tailing factor, asymmetry, retention time, number of theoretical plates (N) number of the height equivalent to theoretical plates (HETP), and peak purity was recorded by LC solution software to assess column performance and suitability of the analytical method.&#xA0;&#xD;
&#xD;
The method validation parameter such as system suitability, specificity, linearity, accuracy, precision and robustness were evaluated as per the ICH guidelines Q2B 16 and USP 17. Specificity study was performed by analyzing the standard working solution of TDF and ETB spiked with placebo (excipients) and blank (diluents). The linearity of an analytical method was evaluated over the six-concentration range of standard solutions. A minimum of six standard drug concentrations range between 5-30 &#xB5;g/ml for TDF and 3.5-35 &#xB5;g/ml for ETB were prepared and the calibration curve was constructed by plotting its peak area versus concentration. The limit of detection (LOD) and limit of quantitation (LOQ) were calculated from the calibration curve by using formulae: &#xD;
&#xD;
LOD = 3.3(SD)/S and LOQ = 10(SD)/S, &#xD;
&#xD;
where SD = standard deviation of response (peak area) and S = average of the slope of the linear curve.&#xD;
&#xD;
The accuracy of the method was determined by recovery studies. The percentage recovery was calculated by preparing standard drug concentrations of TDF (15 &#xB5;g/ml) and ETB (10 &#xB5;g/ml) with concentration levels of 50%, 100% and 150%. A known amount of the standard drug was added to the blank sample at each level. The precision was determined to ensure the closeness of the data values to each other for the number of measurements under the same analytical conditions. System precision: The system precision measured by six replicate injections of a homogeneous sample of standard MET (60 &#xB5;g/ml) and VILDA (40 &#xB5;g/ml) on the same day and consecutive days. Robustness was determined by small but deliberate change in conditions such as flow rate (1&#xB1;0.1ml/min), column temperature (35&#xB1;2&#xB0;C), and wavelength (&#x3BB;max257&#xB1;2 nm). &#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
Optimization of Vierordt&#x2019;s method&#xD;
&#xD;
The standard solutions of TDF and ETB were scanned separately in the UV range from 400-200 nm and its zero-order spectra were recorded. Maximum absorbance TDF and ETB was obtained at 260 nm and 281 nm for, respectively. The isosbestic point was recorded at 275 nm. The overlain UV absorption spectrum of TDF and ETB in distilled water has shown in (Figure 1). &#xD;
&#xD;
Calibration curves of TDF and ETB at 260 nm and 281 nm in distilled water showed high linearity. The correlation between sample concentrations and their absorbencies complied with Beer&#x2019;s law as illustrated by high values of regression coef?cients (r2 &#x2248; 0.999) and small values of intercepts have shown in (Table 1).&#xD;
&#xD;
Validation of Vierordt&#x2019;s method&#xD;
&#xD;
The % RSD values of TDF and ETB was found to be 1.11 and 0.74% for inter-day precision and 0.88 and 0.62 % for intra-day precision respectively. Relative standard deviation was less than 2 %, which indicates that the proposed method is precise. Limit of detection (LOD) for TDF and ETB were found to be 0.521 and 0.236 &#xB5;g/mL and Limit of Quantitation (LOQ) were found to be 1.873 and 0.847 &#xB5;g/mL respectively. The results showed that the method was found to be sensitive for the determination of TDF and ETB. Reliability of the proposed method was determined by accuracy by recovery studies. The % mean recovery of TDF and ETB were 99.4&#x2013;100.4, respectively, indicating the accuracy of the method. The results of recovery studies showed lesser than 2% RSD that indicates the proposed method is highly accurate. The proposed Vierordt&#x2019;s method was successfully applied for simultaneous determination of TDF and ETB in its bulk and tablet dosage form. Vierordt&#x2019;s method has the bene?ts of being simple, rapid, direct, and economic, with minimum data manipulation and not requiring sophisticated techniques or instruments.18&#xD;
&#xD;
Optimization of the UFLC method&#xD;
&#xD;
Method development: The RP-UFLC method was optimized for the accurate, precise simultaneous determination of ETB and TDF.RP-UFLC method was developed on Shimadzu UPLC, X-Bridge C18 column in mobile phase water: methanol 62:38 v/v. The effluent pass through the column at 1.0 ml/min; 30o C and monitored by PDA detector at 254 nm. During chromatographic trials, broadening of TDF peak was observed as the concentration of methanol increases beyond 35 % v/v as well as TDF peak was shifted towards higher retention time. In the proposed method, the retention time of ETB and TDB were found to be at 3.371 and 6.850 min respectively.&#xA0; &#xD;
&#xD;
The chromatogram showed in Fig. 2 indicated that both the drugs are well separated with proper symmetry of the peak. Assay of ETB and TDF showed 98.8&#xB1;0.55 and 99.5&#xB1;1.25% respectively.&#xD;
&#xD;
The system suitability parameter of the optimized chromatographic method has shown in Table 2. &#xD;
&#xD;
Height Equivalence to theoretical plates (HETP) is the measure of zone broadening; in general, the lower the HETP value, narrower is the solute peak. Separation efficiency is enhanced at a lower value of HETP and the higher number of theoretical plates (N). A high Capacity (k&amp;#39;)&#xA0;factor value indicates that the sample is highly retained and has spent a significant amount of time interacting with the stationary phase.19 Proposed method was unaffected by the presence of sample excipients. System suitability parameters indicated the proposed UFLC method has complied as per ICH and USP guidelines. &#xD;
&#xD;
Validation of optimized UFLC method&#xD;
&#xD;
The linearity of standard ETB and TDF was studied in the concentration range 3.5-35 &#xB5;g/ml and 5-30 &#xB5;g/ml respectively. The regression equation and coefficient of variance (r2) was found to be y = 222889x + 23810; r&#xB2; = 0.999 for ETB and y = 69511x + 13546; r&#xB2;= 0.9997 for TDF. The LOD and LOQ of ETB were found to be 0.040 and 0.125 &#xB5;g/ml respectively. The LOD and LOQ of TDF were found to be 0.085 and 0.150 &#xB5;g/ml respectively. Recovery of the spiked drugs was obtained within an acceptable limit at each added concentration. The mean percentage recovery of ETB and TDF was achieved between 99.50&#xB1;0.25 and 99.44&#xB1;40 % respectively, indicating that the method was accurate. The system precision was found to be precise for six replicates of standard ETB and TDF. The % RSD of ETB and TDF was 0.06% and 0.08% respectively which was well within the acceptance criteria. In intra-day (n=3) studies, % RSD of ETB and TDF were found to be 0.23% and 0.38% respectively. Inter-day precision (n=3) studies, % RSD of ETB and TDF were found to be 0.820 % and 0.98 % respectively. The results of robustness studies were expressed relative to control. The % RSD caused by deliberate variation in flow rate (1&#xB1;0.1ml/min), wavelength (257 &#xB1;2 nm) and column temperature (35&#xB1; 20C) was within the acceptable criteria (&#x2264;2%) for both the drug.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Vierordt&#x2019;s method was simple, economical and it can be applied for simultaneous determination of TDF and ETB in its bulk or pharmaceutical dosage forms without its prior separation. Statistical analysis of data revealed ultra-high performance method was more accurate and precise relative to Vierordt&#x2019;s method, however, both the method confined to ICH (Q2R1) guidelines. The proposed analytical method can be routinely employed in quality control and research and development activities.&#xD;
&#xD;
ACKNOWLEDGEMENT: The authors would like to thank Hetro Drugs Ltd., Hyderabad, India for generously gifting Emtricitabine and Tenofovir disoproxil fumarate sample for the dissertation work. &#xD;
&#xD;
CONFLICT OF INTEREST: No potential conflict of interest was reported by authors.&#xD;
&#xD;
SOURCE OF FUNDING: The entire research mentioned in this article was self-finance and no external funding obtained.&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3342</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3342</Fulltext></URLs><References>&#xD;
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	Tenofovir Disoproxil Fumarate, National Library of Medicine, [cited 2020 Dec 5]&#xD;
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	Grande F, Ioele G,&#xA0; Occhiuzzi MA,&#xA0;Luca MD, Mazzotta E,&#xA0;Ragno G,&#xA0; Garofalo A et al. Reverse Transcriptase Inhibitors Nanosystems Designed for Drug Stability and Controlled Delivery. Pharmaceutics 2019 May;11(5):197.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Review on Anti-Rheumatoid Arthritis Potential of Medicinal Plants&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>16</FirstPage><LastPage>32</LastPage><AuthorList><Author>Anjana Goel</Author><AuthorLanguage>English</AuthorLanguage><Author> Sunanda Kulshrestha</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Autoimmunity is an immunological disorder in which immune response against self-antigens is provoked. Rheumatoid arthritis (RA) is one of its kinds of chronic autoimmune disorder causing inflammation and infiltration of immune cells around the synovial membrane, which leads to destruction and degradation of cartilages. Steroidal and non-steroidal allopathic therapies available so far cannot cure or prevent the disease. Besides their severe side effects, they can only provide temporary relief by suppressing and reducing the pain in the joints. Detailed search for the related literature has been carried out using multiple searches with words &#x2018;rheumatoid arthritis&#x2019;; &#x2018;plants for rheumatoid arthritis&#x2019; etc. with the help of search engines. Pubmed, Research Gate, Google Scholar have been used for more authentic information support. Alternative medicinal approaches for the treatment of Rheumatoid arthritis, as a holistic approach, can be used in a better way for making life much better for the sufferer and restricting the progression of the disease. Some of the approaches carrying ethanotraditional and ethnobotanical importance have been discussed in the review article and tried to assemble all possible plants that show Anti-Rheumatoid Arthritis activity. These approaches are giving some hope for the treatment of RA. The experimental model for investigating the effects of drugs on RA has also been discussed. This could draw a new pathway for future researches as well.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Arthritis, Autoimmunity, Ayurveda, Immunological disorder</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Rheumatoid arthritis affects almost 0.5-1% of the population worldwide1 and in case of the Indian population, more than 20 % of the population suffers from any of the forms of arthritis.2 It is a multifunctional immune disorder with a known cause. Some factors which may influence RA are a genetic factor, age, hormones, environmental factors, smoking etc. Different strategies for the study of RA have been used. Experimental animal model, which elucidate the onset and progression of the disease as well as evaluate the drugs that can reduce or prevent the disease, can be studied. An ideal model should have close similarities with human disease pathogenesis and symptoms. The use of an ideal animal model contributes significantly to the evaluation of therapeutic molecules against RA.3&#xD;
&#xD;
Causes &#xD;
&#xD;
RA is believed to be an autoimmune disorder, although the real cause and aetiology of the disease are still unknown. The frequency of appearance is three times more in the females rather than the males.4 RA sometimes also leads to diffused inflammations in the lungs, pleura and sclera, nodular lesions, and most commonly in the subcutaneous tissue, this is the most severe type of RA. Autoimmunity is known to be the major prognostic factor behind RA and plays important role in its progression towards severity. Inflammations in synovial joints are caused by many kinds of immune-mediated compounds.5 The cause is still not clear but the destruction of articular cartilage due to inflammatory responses is the major cause of RA.6&#xD;
&#xD;
Symptoms &#xD;
&#xD;
Symptoms for the same includes, joint pain and swelling, stiffness in joints, sleeplessness, fatigue, loss of weight and having flu kind of symptoms. Abnormal antibodies IgG have been found in the blood of a person suffering from rheumatoid arthritis. They react to antigens leading to the formation of antigen-antibody complex that leads to inflammation and pain of the synovial membrane.7&#xA0; &#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Diagnosis &#xD;
&#xD;
Diagnosis for RA involves the use of clinical methods of imaging and laboratory tests. Laboratory testing methods include anaemia, presence of rheumatoid factor, antibodies against the cyclic citrullinated peptides and elevation in erythrocyte sedimentation rate. While symptomatic detection of stiffness and pain for a long time in the morning gives some clue about the disease. X-rays also help in detecting the RA but at times they can&#x2019;t differentiate in early arthritis too. MRI and ultrasounds are also done to look at the progress of the RA in the patients.&#xA0; No such highly specified test has been developed for validation of the disease.8, 9&#xD;
&#xD;
General treatment for Rheumatoid Arthritis and its limitation&#xD;
&#xD;
Management of pain, prevention of long-term damage to the joints and reduction in inflammation are major problematic area to deal with while treating RA. For these, disease-modifying anti-rheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) have been used as the major approaches to deal with the symptoms and after-effects of the disease. Other steroidal drugs that are used to treat inflammation by RA are corticosteroids, an anti-inflammatory hormone released from adrenal glands. An ideal steroid should meet the requirement of meeting the need at a low dosage and avoid side effects. Both the steroidal and non-steroidal drugs although control the symptoms but in long term, they cannot cure the disease or prevent it. Apart from all this, more severe side effects can be seen in the patients in terms of effects on kidney, liver and heart due to prolonged use to such medicines. Shortness of breath, nausea, infections and allergic reactions have also been noticed as the short-term side effects. This in turns marks the major limitation and issue while dealing with steroidal drugs for curing rheumatoid arthiritis.4, 10 They don&#x2019;t work effectively progression of the disease and cure it of its roots. They are just meant to deal with the symptoms like pain, inflammation, swelling etc. which are the main symptoms as discussed before. &#xD;
&#xD;
Ayurvedic perspective of Rheumatoid Arthritis&#xD;
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Ayurveda is one of the forms of alternative treatment of medicine. It is typically based on three dosa: Vata, pitta and Kapha. Amavata, an ayurvedic condition has similarities with RA.11,12 Amavata is associated with the production of &#x2018;Ama&#x201D; in the gut. Ama is produced due to the disturbed metabolism.13,14 It is pro-inflammatory and creates toxicity in the gut and imbalance of Vata in the body. According to Ayurveda the people with Vata dosa are more prone to develop this disorder.11 Thus it can be cured by taking the diet which is rich in grains, legumes, green leafy vegetables, buttermilk etc. Spices like ginger, garlic and turmeric aid the digestion process and anti-inflammatory, thus recommended. Lukewarm water is always preferred for the digestion in Ayurveda. Ginger roots, boiled in water, also remove toxins from the body and help in the digestion process. The commonly used plants used to treat and mitigate the symptoms of RA have been summed up in table 1.&#xD;
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Need of natural remedies &#xD;
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Since time immemorial, the natural remedies used by the population has been helpful to meet the symptoms of any diseases or even used till date by many folks, tribal and traditional medicinal practitioners for treatment. According to WHO, 80% of the population still rely on herbal treatments. Plants and herbs have been taken in form of infusion, raw or juice form and have worked efficiently as per observation in the patients. Just with the inclusion of such plants with medicinal properties in daily diet made a tremendous change in the disease while benefiting the sufferer. This directly indicates that there is a world to explore in the field of phytoconstituents of plants that have been used traditionally for curing RA. &#xD;
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Possible Mechanism of Action of Herbal Drugs &#xD;
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Many researchers have tried to elaborate a particular pathway of mechanism that the herbal drugs follow to hit the causative factors that are responsible for symptoms of RA and cure the disease from inside. As the disease progress via different mechanisms and pathways, therefore multi-pathway effects have been noticed by the herbal remedies by many researchers and some of them have been discussed below. &#xD;
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It has been observed that TLRs (toll-like receptors) play a major role in inflammation in RA and stimulate the cellular activity of NF-???????? mediated by adapter molecules like myeloid differentiation primary-response gene 88 (MyD88) at the onset of disease. The process of phosphorylation of cytoplasmic I????Bs is carried by TLR2/6, TLR4, or TLR5 agonist which in turn stimulate target cells and macrophages. After degradation of this complex, NF-???????? translocated into the nucleus where the promoter regions of inflammatory genes like iNOS, COX-2, IL-6 bind to NF-???????? for transcriptional activation. Augmentation in COX-2 and other pro-inflammatory cytokines modulate the metabolism of arachidonic acid which results in the formation of prostaglandins-E-2 and turn leads to suppression of leukocytes apoptosis and even stimulate proliferation of leukocyte which leads to the pathological condition of hyperplasia and pannus formation at the site. Therefore, it could be inferred why inhibition of NF-???????? would act as a major target for dealing with RA.15&#xD;
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Apart from this, cytokines and other pro-inflammatory factors play a protagonist progression of the disease. TNF-&#x3B1;, IL-1&#x3B2; and IL-6 are the major pro-inflammatory cytokines which activate the collagenase and other proteases to degrade the collagen thus increases the degradation of cartilage. It also leads to an increase in the infiltration of T cell, B cell and macrophages causing synovial inflammation. It implies that the herbal drug should be capable to inhibit and inactivate such pathways and complexes.16 Many herbal drugs have shown to down-regulate these proinflammatory cytokines and reduce oxidative stress. &#xD;
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In this row plants like Saraca asoca, which is a commonly used plant having traditional use in RA has shown major anti-inflammatory activities in vivo model showing the reduced level of pro-inflammatory cytokines.16 Ocimum, which already holds many therapeutic potentials to its glory also acts on RA by showing anti-inflammatory activity by inhibition of arachidonate metabolism and anti-histaminic activity. Eugenol (l-hydroxy-2-methoxy-4-allylbenzene), which is one of the most active bioactive molecules of Ocimum, is playing a major role.17 Cannabis sativum, a notorious plant is known for its addictive properties is also been tested for RA and gave results in favour of it. The cannabidiol, a major constituent of the plant is shown to act for anti-inflammatory by inhibiting COX-2 in mice model.18 Similar activity of suppression of NF-???????? pathway and COX-2 has been seen by aerial parts of Cassia plant which has also been one of the important traditional medicine for treating RA. The leaves have been found experimentally to show results for swelling, improvement in cartilage degradation and leucocyte infiltration in synovial fluid in the rat model study.19 Similar activities have been noted in Zingiber officinale which seen to possess a bioactive constituent 6-gingerol, that blocks the NF-???????? and PKC (protein kinase C) pathway and induce anti-inflammatory activity.20 Another remedy used Semecarpus Anacardium&#xA0;which is a tree from the sub-Himalayan region is seen to be effective in RA and has anti-oxidant potential proved by inhibition of ROS in the body. The flavonoids also induce anti-inflammatory action by inhibition of phospholipase A2 that reduces the production of PGE2 and also reduce the level of TNF- &#x3B1; and NO. This all helps in preventing the rupture and release of lysosomal enzyme and help in synovial erosion.21&#xD;
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Artemisia absinthium, a Persian plant is also used as a traditional plant for curing RA and is seen to suppress inflammatory diseases by following multiple pathways. It acts by reducing the release of NO and PGE2 which inhibits the iNOS expression. Also, another pathway followed includes inhibition of COX-2 expression by scoparone, a bioactive compound found in the plant. Similar multi-path action is also exhibited by A. sylvatica Maxim aerial parts.22 Experimental studies have also supported the use of Curcuma longa, a widely used spice containing curcumin. It inhibits the arachidonic acid cascade by the mode of inhibition of catalytic activities of phospholipases and blocking the catabolic effect of IL-1&#xA0;&#x3B2;&#xA0;induced upregulation of MMP-3, and IL-1&#x3B2;-induced decrease in type II collagen synthesis which is a contributing factor in RA progression.23 Other plants including Moringa oleifera&#xA0;which shows anti-inflammatory effect by lowering down serum levels of Rheumatoid Factor (RF) and levels of the cytokines, TNF-&#x3B1; and IL-124, Nyctanthes arbor-tristis which lowers down the inflammatory cytokines IL-1, TNF-&#x3B1; in blood serum in experimental set up25, Swertia chirayita, works in similar style and lowers down the pro-inflammatory cytokines IL-1&#x3B2;, TNF-&#x3B1; and IL-6 in experimental arthritis26 have been found to act effectively on RA following multiple pathways.&#xD;
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Minimal or no side effects by these remedies are the best part of the approach. After prolonged use of allopathic drugs, many side effects have been observed in the patients of RA as listed above. Hence, herbal therapies could act as effective approaches towards the treatment of such diseases. Today, uses of many phytomedicinal plants have been observed by experimental methods and are under scientific observations to develop as a natural way for healing.27 Goals of natural therapy includes a reduction in joint pains, prevention of deformity, prevention of erosion, prevention from progression, control on extra-articular manifestations while maintaining the quality of life as well.6,7,28 Medicinal plants which have been tested experimentally and proven their efficacy are represented in tabular form in table 2. Using suitable experimental protocols related to in vitro and in vivo validations of anti-inflammatory effects, positive results has been observed that supports the ethnobotanical importance of herbal remedies for dealing with rheumatoid arthritis and lays an important source for future researches as well.&#xD;
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CONCLUSION &#xD;
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Rheumatoid arthritis is an autoimmune disease and well known for causing deformities and pain due to inflammations in the joints of the sufferer. Conventionally, the allopathic approaches used to treat RA comprise on disease-modifying anti-rheumatic drugs, Non-steroidal anti-inflammatory drugs and corticosteroids, which relieve the pain and inflammation till a limited time when they are in action. They are also accountable for some side effects in the patients and never show or promise to cure the disease from within. Looking at all the perspectives, the herbal approach can be thought of as an alternative approach for the treatment of RA. Our folk and indigenous treasure of knowledge hold many secrets to cure any diseases without causing any side effects. At present herbal remedies carrying anti-arthritic activities have been developed and potentials of their phytochemicals continuously have been validated. More than 450 species of plants have been listed that promise anti-arthritic activity in humans ranging from various plant families. The article summarizes data regarding plants that could help and motivate researches in future. &#xD;
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ACKNOWLEDGEMENTS&#xD;
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Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xD;
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CONFLICT OF INTERESTS&#xD;
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No conflict of interest.&#xD;
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	</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>33</FirstPage><LastPage>42</LastPage><AuthorList><Author>Shamim Ansari</Author><AuthorLanguage>English</AuthorLanguage><Author> Wajeeha Begum</Author><AuthorLanguage>English</AuthorLanguage><Author> Kouser Fathima Firdose</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Cervical ectopy (quruhal Rahim) is a benign and common gynaecological condition in India with 19% of the total population. About 80-85% of women suffer from Cervical Erosion. Cervical erosion is diagnosed by per speculum examination. Considering these facts methi, alsi,babuna, nakhuna, karamkalla, 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: This is an open observational clinical study in clinically diagnosed woman (n=30) in the age group of 18-45 yrs having symptoms of vaginal discharge, normal or inflammatory changes in pap smear were included and patients with malignancy, Pelvic inflammatory disease, systemic illnesses &amp; Sexually transmitted disease, oral contraceptive Pills and Intrauterine contraceptive device, pregnancy and lactation were excluded. Joshanda of methi 5gms, alsi 5gms, babuna 3gms, nakhuna 5gms, karmkalla 10 gms in 2 litres of warm water. After menses use daily one time for sitz bath for 15minuts for 21 days. The primary and secondary outcome was assessed. 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. Results: Vaginal discharge mean score before and after treatment is 2.37&#xB1;0.57 and0.367&#xB1;0.49 respectively with p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Quruhalrahim, Cervical ectopy, Abzan, Arbitrary grading scale, SF-12 for QOL, Vaginal discharge</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
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 erosion.3 It is the commonest finding in routine pelvic examinations during the fertile age group 1.1 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 gonorrhoea.5&#xD;
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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.&#xA0; Side effects like prolonged excessive mucoid discharge per vagina, seldom cervical stenosis, accidental burns, bleeding and recurrence are associated with this treatment.6 In classical Unani literature which is caused by external factors such as wound due to trauma, instrumentation, the drug which is caused by external&#xA0; factors such as&#xA0; wounds&#xA0; due&#xA0; to trauma, instrumentation, drug-induced i.e use of&#xA0; haad drugs in the form of&#xA0; humool, or internal factors&#xA0; like difficult labour or mismanagement&#xA0; of labour, sometimes, it may be because of acute yellow bile causing gradual erosion of cervix due to its acute&#xA0; 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&#xA0; (astringent) drugs are beneficial in its treatment.8-10&#xD;
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Unani system of medicine has several drugs available for healing of cervical ectopy as a local treatment in the form of a sit bath, which is safe and cost-effective. In present study research drug comprises of Methi (Trigonella foenum graeceum) 5 gms, alsi (Linum usitatissimum) 5gms, babuna (Matricaria chaemomilla) 3gms, nakhuna ((Trigonella uncata) 5gms, karmkalla ka dant&#x2019;hal (Brassica oleracea)10 gms&#xA0; 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.&#xD;
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Materials and Methods&#xD;
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Study design:&#xA0; An open observational study.&#xD;
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Study duration: One and a half years from March 2019 to January 2020&#xD;
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Study centre: OBG Dept. National Institute of Unani Medicine Hospital, Bangalore. &#xD;
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Sample size:&#xA0; 30 patients&#xD;
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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.&#xD;
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Informed consent: all participants gave written informed consent before study&#xD;
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Drugs Identification: was done at FRLHT Bengaluru. with an acc. No. 5510-5514&#xD;
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Participants: Total 60 patients were screened for the study, 10 patients refused participation and 20 patients didn&#x2019;t meet the inclusion criteria, hence were excluded. 30 patients were allocated in- an open observational study.&#xD;
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Selection criteria: Married women between the age group of 18-45 yrs.&#xA0; 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 &amp; STIs, OC Pills and IUCD&#x2019;s, pregnancy and lactation were excluded.&#xD;
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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.&#xD;
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Criteria for selection of drug: the research drug possess properties like muhallilewaram, mujaffif, mudammilequruh, dafi-i- ta&#x2019;ffun,qabid, musakkin, 12-17 properties. Moreover, pharmacological studies show that research drug exhibit anti microbial, anti-inflammatory, anti oxidant, anti-cancer, anti-ulcer, analgesic, hepatoprotective wound healing activities., 13,14,18-20,&#xA0; Further methi, alsi, nakhoona, baboona, karamkallacontains flavonoids, saponins (glycosides), alkaloids (terpenoids, steroids) arachidonic acid, ethanol, histamine, leukotriens, polysaccharides, saponins (glycosides), carbohydrates, tannins, triglisoraletc; 13,14,18, which are considered as the active principle of anti-ulcer activity. Flavonoids are a group of a polyphenolic compound having anti-ulcerogenic, anti-inflammatory, anti-bacterial, antioxidants properties4 which provide strength to the mucosal barrier &amp; promote the ulcer to heal fast. 20The 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 &amp; tissue epithelization4 Thus, research Unani formulation is anticipated to be effective in the healing of cervical ectopy and relieving the associated symptoms.&#xD;
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Method of preparation&#xD;
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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.&#xD;
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Route of administration: Locally&#xD;
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Initial assessment and laboratory screening&#xD;
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	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. &#xD;
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	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.&#xD;
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	Assessment of Health-related quality of life (HRQol) was assessed by the SF-12 questionnaire.&#xD;
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	&#xA0;Assessment of low backache is done by using the Visual Analogue Scale (VAS)&#xD;
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	&#xD;
	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).&#xD;
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	Dyspareunia and post-coital bleeding were based on the arbitrary four-point scale (0= None,1=Mild,2= Moderate, 3= Severe ).&#xD;
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Treatment was subsequently started in patients fulfilling the inclusion criteria.&#xD;
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Intervention&#xD;
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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.&#xA0; 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.&#xD;
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Subjective parameters&#xD;
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Vaginal discharge, low backache, contact bleeding, dyspareunia&#xD;
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Objective parameters:&#xD;
&#xD;
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	&#xD;
	Changes in Cervical ectopy assessed by the arbitrary grading scale&#xD;
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(Direct visual assessment of the appearance of cervix, healing of erosion and vaginal discharge).&#xD;
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	SF-12&#xA0; score to assess for QOL&#xD;
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Outcome measures:&#xD;
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Primary outcome measure: changes in white discharge and low backache.&#xD;
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Secondary outcome measure: Improvement in cervical ectopy grading and SF-12 (12 items short-form survey) Health Questionnaire score ( Figure 1).&#xD;
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Statistical analysis&#xD;
&#xD;
Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean &#xB1; 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&#xD;
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RESULTS and Discussion&#xD;
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Demographic characteristics&#xD;
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Age: Majority of the patients (63.3%) were in the age group of 31-40 years &amp; remaining 30% were in 21-30 years and 6.7% in 41-50 years of age. Hashmi et al24, Mirza et al25, Patil et al 26 and Latafat et al.27 40% and 44% in two groups in 31-35 yrs, reported 39.2% in 31-40 yrs., reported 40% &amp;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&#xB1;SD of age of patients was 33.93&#xB1;5.37, which is in accordance with the study of Jindal et al.2 who reported 31.32 and 33.7 in two groups, Al- Kaseer reported28 27.1 &#xB1; 5.9, Cekmez et al.29 reported 34.4&#xB1;4.3.&#xD;
&#xD;
Socioeconomic status: In present study, 23.3% patients belongs to upper middle class, 63.3% to lower middle class; and 13% to lower class. Hashmi S et al.24 reported 43.3% patients in upper lower, 36.6% in upper middle, 16.6% in lower middle and 13.3% in lower class. Mirza et al.25 reported&#xA0; 42.2% patients in upper lower class, 40% in lower middle, 11.1% in upper middle &amp; 6.7% in upper class. Shivanna et al. 30 reported 72% and 75% patients respectively from low Socioeconomic status. Gautam et al.31 reported majority of the patients belong to lower middle class. Bengal 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 predispose to poor nutrition, poor personal hygiene leading to infection which may cause cervical ectopy.32,33&#xD;
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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% &amp; 16.7% had education up to secondary and higher secondary school while graduate and post graduate are 6.7% and 3.3 % respectively. Mirza et al.25 reported 20% illiterate, 33.3% had middle school education, 10% each in primary school and high school &amp; 13.3% graduate. Hashmi S et al.24 reported 44.44% illiterate, 20% had middle school education &amp; 13.3% had education in each primary, secondary and higher secondary. Gautam et al.31reported 40% of the patients had high school education. Al-Kaseer et al.28 reported low educational level among patients of cervical ectopy.&#xD;
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Occupation: In this study house wife are more affected than the working class. Out of 30 patients 73.3% of patients are of house wife affected with cervical erosions where as 26.7% are working women.&#xD;
&#xD;
Dietetic habit:&#xA0; In this study out of 30, 20 (66.7%) patients are of mix diet. Whereas 10 (33.3 %) are vegetarian.&#xA0; In Unani system of medicine importance has been given to dietetics in health and disease.34 Unani physicians 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&#xA0; 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.&#xD;
&#xD;
Mizaj: Most of the patients, 86.7 % possessed damwimizaj, while 13.3% had balghamimizaj, none of the patients had safrawi or saudawimizaj, which is in consonance with the studies of Hashmi et al.24 reported 66.67 % patients with damwimizaj, Mirza et al.25 reported 53.3% with damwimizaj. Moreover, it coincides well with the theories of eminent Unani Scholars in etiopathogenesis of quruh, who states that hararat and ratubat are essential component of ufunat which forms an inflammatory swelling and when it get secondarily infected, it result in rupture of this swelling which in turn leads to ulcer formation.10,36.&#xD;
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&#xD;
&#xD;
Subjective parameters&#xD;
&#xD;
Vaginal discharge: At baseline, all patients were complaining of vaginal discharge. During treatment, on 1st &amp; 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. &amp; was absent in 63.3%.At baseline, vaginal discharge was mild, moderate &amp; severe in 3.3%, 56.7% &amp; 40% patients respectively. During treatment, on 1st follow up vaginal discharge was mild &amp; moderate and severe in 3.3% , 70%&#xA0; and 26.7% patients respectively, whereas none of the patients had severe vaginal discharge; on 2nd follow up, vaginal discharge was not present in 3.3% and 26.7% and 70% patients had mild and moderate vaginal discharge respectively. After treatment, vaginal discharge was mild in 36.7% &amp; absent in 63.3% patients, though no patient had moderate and severe vaginal discharge. After treatment, vaginal discharge&#xA0; with mean of 2.37&#xB1;0.57&#xA0; and 0.367&#xB1;0.49 before and after intervention with P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3344</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3344</Fulltext></URLs><References>&#xD;
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	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 Chronic Dis Public health Res Pract Policy 2008;5(2):01-11.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Gene Expression Regulation by Epigenetic Mechanism an Emerging Way in Alcoholics&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>43</FirstPage><LastPage>49</LastPage><AuthorList><Author>Anjali Vagga</Author><AuthorLanguage>English</AuthorLanguage><Author> Ajay Meshram</Author><AuthorLanguage>English</AuthorLanguage><Author> Lata Kanyal</Author><AuthorLanguage>English</AuthorLanguage><Author> Komal Meshram</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Environmental factors can impose most of their harmful effects, including harmful substances and drugs, by modifying the usual sequence of genes, advances to unusual expression or attempting to silence the major DNA sequences and their encoded proteins. Epigenetic is the research of modifications of DNA sequences and subsequent proteins, with no modification of the nucleotide sequences, Methylation of the DNA, alteration in Histone and RNA-mediated targeting control. Many biochemical reactions influences in human cell function, a pattern of their modification occurs in alcoholics. This review is focused on the regulation of gene expression by the epigenetic mechanism in alcoholics. Chronic consumption of alcohol in humans affects the brain, bringing the modifications in the expression of genes. Chronic alcohol intake also creates the desire for alcohol, loss of control, ultimately leading to liver damage. Such changes result in the expression of gene and cell cycle disturbance, facilitating the development of cirrhosis and cancer of the liver. DNA methylation, histone modifications and miRNA are the important common epigenetic modifications used as biomarkers of alcoholic liver disorders. While we are in the early stages of understanding the complex epigenetic regulatory system, the preliminary evidence provided here indicates that we could be at the dawn of the advancement of epigenetic factors in the diagnosis of various disorders.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Epigenetic, Alcoholics, DNA methylation, DNA hypomethylation, Histone modification and MicroRNA</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Features of Alcoholic disease (ALD) includes inflammation, hepatic steatosis and deposition of fat that brings with it cirrhosis and hepatocellular carcinoma.1 Cognitive and affective states influence the pathogenesis of alcoholism which promotes the alcohol intake, might be due to different allostatic variables in multiple areas of the brain.2-4 Different researches have demonstrated the genetic and or environmental factors have played a key role in the development of alcoholism.5-7 It is proved that chronic consumption of Alcoholism is a replacing the brain disorders, chronic consumption of alcohol is characterized by loss of control while limiting alcohol intake, gets a negative emotional state while withdrawal and making the desire to seek alcohol.8,9 In animal models and humans, frequent alcohol consumption causes widespread brain changes in gene regulation. &#xD;
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Most of these contribute to cellular adaptations which at the end lead to dependence on alcohol and psychological tolerance. It is appreciated for the role of epigenetic changes in alcohol-induced modifications of expression and behaviour of genes for chronic alcoholism. e.g., chronic alcohol consumption results towards the shift in methylation of histone, DNA and Micro RNA transcription with different gene response to various brain cells types&#xA0; (e.g. glia and neurons) and proceeds to malfunction of cognitive function and plasticity of the brain involving the abuse of alcohol and dependence over it.10 Environmental conditions can impose most of their harmful effects, including harmful substances and drugs11, by modifying the usual epigenetic patterns, advancing to unusual expression or attempt to silencing the important sequences of DNA and their encoded proteins. Alcohol is quickly evolving as one of the key elements for changing the epigenome of cells and tissues from across organisms.12 &#xA0;&#xD;
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What is epigenetics?&#xD;
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The term "epigenetic" simply means "in addition to changes in the genome." The concept has expanded to include all mechanism that involves the expression of a gene without modifying the sequence of DNA and advances to alterations which can be incorporated to new nucleoli (although studies indicate that certain genetic mutations can be altered). Exactly what the word will possibly continue to be discussed. Alterations in DNA which do not modify the sequence of DNA might alter the expression of genes. Chemical substances applied to separate genes may control their functioning; these changes are called epigenetic alterations.&#xA0; The epigenome contains all the chemical blends applied to the whole of particular DNA (genome) as a form of controlling its function (about expression) of entire genes in the genome.&#xA0; The epigenome&amp;#39;s chemical blends are not a part of the particular DNA code, but are on or added to the DNA, epigenetic changes occur as cells divide, and may often be inherited through the gene. &#xD;
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Epigenetic modifications will boost to evaluate may be the genes are switched on or off, and which can impact protein synthesis in certain cells, assure that only proteins are synthesized that are required. For eg. The proteins are not synthesized in muscle cells, which help the growth of bone. Epigenetic change of pattern varies amongst individuals, growing tissues of the individual and also various cells. &#xD;
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Epigenetic modification&#xD;
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Histone modification &#xD;
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Post-translational modification of histone which involves the incorporation of phosphorus, incorporation of ubiquitin, methylation, Small Ubiquitin-like Modifier (SUMO) proteins are attached to or detached from other proteins and acetylene. The PTM formed for histones can vary gene expression by modifying the genetic makeup of chromatins or by including histone modifiers. Histone proteins work for inserting DNA into the chromosomes, DNA gets wrapped around eight histones. Histone alterations work in different biological procedures. Such as to the activation or deactivation the synthesis of mRNA, packing in the chromosome and genes repair or damage.&#xA0; Generally for most of the animal&amp;#39;s incorporation of acetic acid to histone H3 is done with lysine 9, 14, 18, 23 and 56, methylation with Arginine 2 and Lysine 4,9,36 and 79 and phosphorylation at Ser 10 and 28, Thr 3 and 11.&#xA0;&#xA0; Acetylation of Histone H4 occurs with residues of Lysine at positions 16, 8, 5, 16, methylation of the Arginine at position 3, and of the lysine at position&#xA0; 20 and Phosphorylation of the serine at position 1.&#xA0; &#xD;
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To quantify particular modification of histone may provide good information for better understanding of the epigenetic regulation, cellular mechanism and the production of enzyme-based drugs to modify Histones. &#xD;
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Acetylation and Deacetylation of Histone&#xD;
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Incorporation of acetic acid to histone is done by the addition of acetyl groups from CoA. Incorporation of acetyl groups to Histone (Figure 1) has importance in maintaining different mechanisms inside the cell involving gene expression, repair of DNA, chromatin mechanics and transcription, nuclear import, repression of neurons, apoptosis, and progression of the cell cycle, DNA replication and differentiation. Enzymes Histone acetyltransferases (HATs) carry out the incorporation of the acetyl group to&#xA0; Histones and has an important role to regulate the incorporation of acetyl groups to Histones H3 and H4. About 20 HATs are known and are categorized as five families like GNAT 1, TAFII 250, P300/CBP MYST and co-activators like ACTR for nuclear receptors.13 Histone deacetylases (HDACs) inhibition increases Histone H3 Acetylation and inhibition of cap decreases the acetylation. Hydrolytic separation of acetyl groups from lysine residue of histone is done by enzymes named Histone Deacetylases (HDACs). Cancer development and genesis of Tumor is linked with an imbalance in Histone acetylation equilibrium.&#xA0; Histone H3 acetylation of the Lysine residue analysis can confer important knowledge to identify sites or patterns of acetylation, which provides deeper lights on epigenetic regulation of activation of the genes and production of HAT based drugs. Like that of HATs, HDACs also have key roles in particular mechanisms involving Histone H3 and H4. So far four groups of HDACs have been established. 1,2,3 and 8 are included in class I HDAC, Class II HDAC include 4, 5, 6, 7, 9 and 10, Class III includes molecules like sirtuins which requires a cofactor with NAD+ and comprises of&#xA0; SIRTs 1-7 and a class IV group of enzymes includes&#xA0; HDAC 11 and has both classes I &amp; II functionality. By inhibiting HDAC gets impact on the cellular mechanisms, apoptosis and differentiation of the cancer cells. HDAC inhibitors act like anticancer agents.14 &#xD;
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Figure 1: Represent the reactions of acetylation and deacetylation. In the acetylation process relaxation of chromatin structure with which TF bind easily. Deacetylation leads to chromatin inactivation.15&#xD;
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Histone Methylation and Demethylation&#xD;
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Addition of methyl group to Histone is a phenomenon carried out by histone methyltransferases (HMTs) comprising either 1, 2 or 3&#xA0; CH3 units derived from SAM to Lys or Arg residues of Histones. Methylation of DNA is regulated by HMTs by the processes activation or repression of transcription in the chromatins. Methylation in the Histone occurring in the cell nucleus, different genes of the DNA, which are complexed with histone can be suppressed or activated16. Arginine and Lysine residues which are modified by histone methyl transferases are of different types e.g. SET 1, SET 7/9, Histone H3, ALL-1, Ash 1, ALR, MLL, SMYD3 and Trx are Histone methyltransferases which brings the transfer of methyl group to Histone H3 in mammalian cells at Lys 4 (H3-K4). &#xD;
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Enzyme Histone methyltransferases like SUV 39- h1, SUV 39- h2, Dim -5, G9a and Eu- HMT brings the transfer of CH3 group to Histone H3 in mammalian cells at Lys 9 (H3-K9). Histone methyltransferase enzymes like EZH2 and G9a brings the CH3 group transfer to Histone H3 in mammalian cells at Lys 27 (H3-K27)17.&#xA0; CH3 group transfer to H3-(K9 and K27) helps in the synthesis for heterochromatin and also plays a role in signals for silencing of gene expression over the euchromatic sites. Increase in H3-K27 methylation amount globally is also found to be associated with a pathological condition like the progression of cancer. &#xD;
&#xD;
DNA Methylation&#xD;
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The commonest form of epigenetic alteration is one, i.e. DNA methylation. There is the attachment of small molecules in DNA methylation, comprising of one carbon atom three hydrogen atoms, to DNA segments, called methyl groups.&#xA0; When a specific gene is attached by methyl group that gene is turned off or can say it is silenced, then no protein has formed that gene. DNA methylation is the so far most studied epigenetic mechanism which occurs by cytosine modification by covalent means of joining CH3 group to base at 5&#x2019; cytosine ring carbon located inside CpG dinucleotides.&#xA0; CpG dinucleotides more than 85% in number, are spread across the genome and are present in respective sequences are highly hypermethylated/ transcription silenced in the normal cells, the condition which is critical to the integrity of the structure of genome chromatin. &#xD;
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A vital role is played by DNA methylation for recombining, repairing and replication of DNA and also in controlling the activity of genes. The addition of the H3 group to the sequence of DNA at the 5&#x2019; cytosine base is necessary for the formation of CpG dinucleotide. A DNA methyltransferase (DNMTs) family brings out this process. CpG rich areas form the area generally called as the island with pieces of 200 bp and can form kilobases in length, and situated near the promoter regions of strong expressing genes, and these are the prone areas for methylation in human tumours, like prostate tumours. Islands of CpG produce the complex subunits and the processes occurring like methylation and demethylation ultimately produces activation or inactivation in nearly 55% of the cases. That is why the methylations of the CpG islands in gene promoter region can prevent or de-regulate gene product synthesis.18-20 &#xD;
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Three major forms of DNMTs like (DNMT1, DNMT3A, and DNMT3B) are identified. DNMT2 known as the fourth enzyme has previously been not a methyltransferase of DNA. A clear sequence is present in DNMT3 or TRDMT 1 similarly with 5- methylcytosine methyltransferases, but methyl group position 38 in aspartic acid transfer RNA has been shown as enzyme and doesn&#x2019;t methylated DNA. There is the belief that a small quantity of mammalian DNMT2 is referred to in recombining DNA, recognizing DNA damage and repairing mutations. DNA methylation patterns are preserved by responsible enzyme DNMT1. &#xD;
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At the replication fork, DNMT 1 is situated. Newly formed DNA gets methylated to DNMT3 A/B and cannot distinguish among unmethylated and hemimethylated CpG sites and they can&#x2019;t copy a common trend of the CH3 group transfer or help to sustain the trend of CH3 transfer.21 When the DNA gets methylated, condensation of chromatin occurs and then the complex of transcriptions is not able to bind DNA and thereby silences gene expression. This type of proteins, in effect, involves the enzymes capable for further epigenetic changes which lead to condensed chromatin state.22,23&#xD;
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DNA hypomethylation&#xD;
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Most studies have indicated different triggers for DNA hypomethylation, including lack of precursors of S-adenosylmethionine or vitamin-like folic acid in the food or defect in the gene of the metabolic pathway for the CH3 group donor. A deficit of enzyme methyltransferase can cause hypomethylation of DNA. Hypomethylation of the sites called promoter regions of the genome may result in the decrease in the stability of the genome also by increasing the expression of transposons, which remain dormant due to methylation under normal physiological conditions. Low levels of methylations may result in lower stability of chromosome and lower activation of proto-oncogene.18-20&#xD;
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Eukaryotic genomes structural and functional organization is reflected by Chromatin24,25 and it is composed of RNA, DNA and variety of protein components.24 Nucleosome comprising146 bp is the main repeat unit of chromatin; it is placed such that it wraps around core histones H2A, H2B, H3 and H4 and then forms an octamer.26 Nuclear protein Histone acyl transferases (HATs) can reverse Histone tails which contain residues of amino acids, Histone lysine methyltransferases (KMTs), Histone deacetylases (HDACs) and Kinases are examples.27-29&#xD;
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Mechanism of epigenetic &#xD;
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During development, the prediction is that pattern of CpG methylation changes. During the development of the embryo, methylation is wiped out throughout the genome and then it is restored to all but CpG bunches (genome sites with dense CpG residues). Until some of the CpG bunches are methylated otherwise they remain hypomethylated later during the development. 30,31 Transcriptional repression is associated with further transfer of CH3 group to cyt in CpG groups and other similar CpG dinucleotides,31-33 particularly when such methylated sites include promoters or some different sites of gene regulation.33 Nonetheless, transfer of methyl group to DNA could be activated if it inhibits transcriptional repressors from being bound or restricts their expression. Recent research in mammalian promoters that define the degree of methylation indicates that methylation takes place at over a small quantity in the proportion of CpG dinucleotides and transcription inhibition occurs at only small regions of genes in differentiated cells, some of the repressed lengths of genes are particular to germline2, like the pluripotency genes, indicating that methylation is a critical mechanism for the suppression of main genes during their separation.32&#xD;
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Epigenetic Modification in Alcoholics&#xD;
&#xD;
Stress and alcoholism can contribute to changes in epigenetic mechanism and that can be associated with behavioural phenotypes and synaptic remodellings like depression and anxiety.34 At the outset, we will outline the molecule that regulates the synaptic plasticity, which is known to associate with the addiction of alcohol and disorders of stress and then we will overview their regulation by an epigenetic mechanism, specifically the DNA methylation and Histone acetylation/methylation, which underlies these disorders.&#xA0; However, epidemiological findings of the effects of associated drinking and smoking, there is an indication that epigenetic processes are doubtful about alcohol consumption rather than to smoking. Heavy drinking (&gt;80 g/d) and smoking one pack per day together raises the risk of cancer of oesophagus by up to 44 times.35 An epidemiological finding clearly indicates there is a distinct toxicity process of drinking and smoking which will confer the disease risk. &#xD;
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Likewise, it is shown that the risk of cancer and other smoking-related disorders are not only due to cigarette smoking, but other the associated effects of various toxic materials found in smoke, alcohol-related risks are linked to dosage and alcohol content, with the concentration of alcohol on the higher side, confers increased risk.36 From the viewpoint of the epigenetic mechanism, looking at observations, researchers carried out the specific evaluation of both candidate genes and deeper investigations using advanced array-based analysis platforms for the evaluation of fundamental processes at hand. The utility of current alcohol biomarkers is limited to.37&#xA0; Measuring alcohol in the breath or serum will be the best bio-indicator for alcohol. Present an analysis determines the actual consumption of alcohol at present and do not differentiate acute consumption and chronic violence. Alcoholism has some biomarkers of adverse effects like specificity and sensitivity, which are not used as screening tools. Biomarkers are required, looking at the magnitude of health problems and community costs associated with drinking alcohol. &#xD;
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DNA methylation in alcoholic&#xD;
&#xD;
For DNA methylation&#xA0; S adenosyl methionine acts as a predominant methyl donor, in alcoholics, it is deficient, which leads to hyperhomocysteinemia which also occurs commonly in ALD patients.38 DNA methylation in alcoholics is also affected by reducing the amount of SAM. In the experiments over Rats, it is found that IV ingestion of alcohol diet for 9 weeks showed a drastic reduction in glutathione, SAM, Methionine and reduced methylation of DNA.39 DNA hypomethylation can advance to structural change in chromatin and expression of genes which may lead to strand breaks and DNA damage.39,40 which forms the environment for malignancy.41 In hepatocellular carcinoma, there is a strong correlation between alcohol consumption and reduced methylation of gene O6- methyl guanine DNA methyltransferase. It is shown by researchers that it is the alcohol-metabolizing enzyme, ADH1.&#xD;
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Alcoholic modifications of Histone &#xD;
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Phosphorylation, acetylation and transfer of CH3&#xD;
&#xD;
In vivo and in vitro there is research evidence that alcohol consumption brings the epigenetic changes in organs like gastrointestinal system, liver and brain.42 Alcohol consumption brings out the effect of liver Histone acetylation/ methylation and phosphorylation. Specifically, transfer of acetyl groups to Histone H3 at Lys 9 (H3AcK9) has been reported in exposed Iry rat hepatocytes which were subjected to alcohol in vitro.43 Other lys residues like H3 lys 14, lys 18 and lys 23 were not acetylated. It is observed that alcohol consumption modulates H3 acetylation by increasing HAT activity and inhibition of HDAC.44 Acetylation of Histone depends on the HAT and HDAC activities.45 In some cases, the HAT / HDAC balance controls the Histone residues which are getting acetylated and regulation of gene expression.46 Consumption of alcohol seems to alter the function of HAT and HDAC in hepatocytes.43 Hepatic cell exposure to in vitro alcohol affects the role of HDAC6 which directly affects the dynamics of the microtubules.47 Liver cells exposed to alcohol show lower levels of Class III HDAC and sirtuin 1 (SIRT1) mRNA expression.48 &#xD;
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Acetylation of Histone and methylation of DNA are involved in the transcription and/or silencing cycle of the genes in disease states.49 Generally, in target gene promoters, CpG islands having higher methylation leads to deacetylation of local histones, on the other hand, small quantities of transfer of acetyl groups to Histone appear to incite DNA for attachment of CH3 group. There is close co-operation of these two epigenetic pathways but is there any hierarchical order of the incidence is still not clear. In chronic alcoholic disorders, there is no connection between hyperacetylation of H3K9, elevated methylation of H3K4 and loss of methylation along with global DNA hypomethylation. Research carried out for interaction between epigenetic events can provide the required information for ALD mechanism.&#xA0; &#xD;
&#xD;
MicroRNA&#xD;
&#xD;
The small non-coding RNAs Micro RNAs (miRNAs) controls various physiologic and pathologic activities at the level of post- transcription by modulating gene expression. Different pieces of evidence provided the importance of miRNA in further advancement and severity of the diseases of the liver. Most of the studies analyzed the effect of miRNA on Alcoholic liver disease (ALD) and Non-alcoholic Fatty liver disease (NAFLD)50, which shares a similar underlying mechanism and pathological characteristics. &#xD;
&#xD;
In reality, all the pathological and physiological processes involve human miRNAs, including signal transduction, cell proliferation and differentiation, viral host interaction, metabolism, oncogenesis and inflammation and immune response.51-52 The expressions of a wide range of miRNAs are controlled by several factors, like cigarette smoking, alcohol and diet and some drugs.53 Now miRNA has gained importance as one of the main factors for identifying the cause of various diseases and as potential biomarker therapeutic target and for diagnosis.52 Considering the fast investigations and analysis of the role of miRNAs over the last few years, an updated overview of the subject will be looked after first, followed by a note on miRNA changes common to both Non-Alcoholic Fatty Liver Disease and Alcoholic Liver Disease. &#xD;
&#xD;
Role of micro-RNA in alcoholics&#xD;
&#xD;
The occurrence of the various types of ALD like steatosis, alcoholic hepatitis and cirrhosis comprise chronic alcoholics and heavy drinkers along with the probability of disease. The underlying pathophysiology for ALD is based on the direct cytotoxic impact of alcohol intake and the change in inflammatory response influenced by ethanol.54 Enzymes like cytochrome P4502E1 (CYP2E1) and alcohol dehydrogenase (ADH) contributes for alcohol metabolism55 which leads to oxygen free radicals, acetaldehyde and nitric oxide, which in the flow may cause cellular damage and inflammation of the liver.56 Toxicity of acetaldehyde causes an increase in bacterial lipopolysaccharide (LPS) permeability to the intestine, which joins to receptors-4 (TLR-4) and incites stellate cells and Kupfer cells via pro-inflammatory cytokines, like tumour necrosis factor &#x3B1; - (TNF).57 The transmission of the inflammatory signal is through the pathway of the nuclear factor-KB (NF-KB), which proceeds to liver damage.58 &#xD;
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Conclusion&#xD;
&#xD;
Epigenetics is the research of DNA alteration and accompanying proteins, without any change in the sequence of the gene. Many biochemical reactions are regulated by DNA methylation, histone alteration, and RNA-mediated targeting and they have the main role in cellular functioning, these are modified in alcoholic subjects.&#xA0; Alcoholism brings the changes in the expression of gene and cell cycle disturbance, facilitating the development of liver cancer like cirrhosis of the liver. DNA methylation, histone modifications and miRNA are the important common epigenetic modifications used as biomarkers of alcoholic liver disorders. While we are in the early stages of understanding the complex epigenetic regulatory system, the preliminary evidence provided here indicates that we could be at the dawn of the advancement of epigenetic factors in the diagnosis of various disorders.&#xD;
&#xD;
Acknowledgment: &#xD;
&#xD;
Nil.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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Conflict of interest:&#xD;
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Nil &#xD;
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Source of funding: &#xD;
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Nil&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of Red Cell Distribution Width and Neutrophil: Lymphocyte Ratio in Adults with Sepsis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>50</FirstPage><LastPage>53</LastPage><AuthorList><Author>Pavan MR</Author><AuthorLanguage>English</AuthorLanguage><Author> Madhav H Hande</Author><AuthorLanguage>English</AuthorLanguage><Author> JayakumarJeganathan</Author><AuthorLanguage>English</AuthorLanguage><Author> Meenakshi Shetty</Author><AuthorLanguage>English</AuthorLanguage><Author> Chakrapani M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Sepsis is a significant contributor to morbidity and mortality in admitted patients. A large number of markers have been studied as biomarkers for sepsis. Most of them are either expensive or lack good sensitivity and specificity. Objective: In this study, we want to evaluate the role of simple blood tests such as Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) in the evaluation of the severity of sepsis cases. Methods: 173 sepsis patients were included in this ICU cross-sectional study. Red cell distribution width and neutrophil-lymphocyte ration were measured at admission. Both these parameters were compared with quick sequential organ failure assessment (qSOFA) score. They were also compared with the outcome of patients. Results: The mean RDW was 14.455 and it showed a significant correlation with qSOFA score and outcome of sepsis patients. An RDW of 15.050 was found to predict the worse outcome with a sensitivity of 82.4% and specificity of 74.7%. The mean NLR was 5.1645 and it also correlated with qSOFA score in sepsis patients. An NLR of 3.22 predicted worse outcome but only with the sensitivity of 66.2% and specificity of 65.7%. Conclusion: RDW and NLR both showed good correlation with sepsis outcome. However, RDW had a better sensitivity and specificity in predicting worse outcomes in sepsis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Neutrophil lymphocyte ratio, Outcome, Red cell distribution width, Sepsis, Severity, Intensive care unit</Keywords><Fulltext>Introduction&#xD;
&#xD;
Sepsis continues to be a major cause of morbidity and mortality in Intensive Care Units (ICU) despite the better understanding of its pathophysiology in recent years. Bloodstream infections are an important cause of serious morbidity and mortality and the incidence of sepsis is reported up to 30% in patients admitted in the intensive care units.1,2 Since sepsis is a heterogenous process with various manifestations, severity levels and cellular processes involved, a definitive biomarker that could aid in the diagnosis, staging, prognosis, and response to intervention has been difficult to determine. Scores such as APACHE II score on admission are associated with high mortality.3 Researchers have proposed more than a hundred different molecules as useful biomarkers of sepsis. C?reactive protein (CRP) and Procalcitonin (PCT) have been frequently used in the evaluation of the severity of sepsis and deciding the duration of therapy in ICU patients. Nevertheless, they are expensive and have insufficient predictive value for an individual.4 Since the definition of the new criteria was published, qSOFA score and SOFA score have been used to predict severity of sepsis and related in-hospital mortality for patients in the emergency department or the ICU.5 Red cell distribution width (RDW) is routinely done as a part of the routine blood count. Various studies have shown that it may be used as a prognostic marker in hypertension, coronary artery disease, stroke, and acute kidney injury. It has also been shown to correlate with all-cause mortality and nutritional status. 6 Total White blood cell (WBC) count is recognised as an important systemic inflammation marker. Leucocytosis has also been shown to independently predict all?cause mortality. Previous studies have also shown relative lymphocytopenia and neutrophilia in patients with sepsis. In critically ill patients the &#x201C;neutrophil-lymphocyte ratio&#x201D; (NLR) is a simple, rapid and inexpensive novel marker of inflammation and stress. It has also been found to have predictive value in patients with suspected bacteraemia in medical emergencies; and also found to be associated with short-term and long-term clinical outcomes in critically ill patients.7 With this background, the current study aims to study the relationship between RDW and neutrophil: lymphocyte ratio with the severity of illness in patients admitted to medical ICUs with sepsis has been undertaken.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
The study design was a cross-sectional study. The study type was an analytical study. It was done in an ICU in a tertiary care centre in South India. Permission from the local ethics committee was obtained. Informed consent was obtained from all participants. &#xD;
&#xD;
Inclusion criteria: All participants who were more than 18 years and diagnosed to have sepsis in ICU and in whom blood sampling was done within 24hrs of admission were included in the study. &#xD;
&#xD;
Exclusion criteria: Immunosuppressed patients such as HIV infection, cancer or patients receiving immunosuppressive therapy, patients with haematological disorders and pregnancy. &#xD;
&#xD;
Sample size was estimated using the formula n= 2(Z&#x3B1; +Z&#x3B2;)2 x &#x3C3;2 / d2where Z&#x3B1; =1.96 at 95% confidence interval, Z&#x3B2; = 1.28 at 90% power, &#x3C3; = SD and d=mean difference. With 95% confidence level and 90% power the sample size came to 180. Sampling strategy followed was convenient sampling.&#xA0; Adult patients presenting to ICU diagnosed as sepsis as per 2016 Sepsis &#x2013; 3 guidelines2, were considered for the present study. Basic demographic data, comorbidities, source of a new infection, presenting vital signs were recorded as per the proforma. Patients were stratified according to Q-SOFA scoring. q-SOFA score and SOFA score were calculated on the fifth day of admission to ICU, to assess the progress of the patient. &#xD;
&#xD;
Blood samples were collected at the time of admission for the following tests: Complete blood counts with RBC indices. Blood urea, serum creatinine and serum electrolytes. Liver function test (LFT), coagulation studies (INR, aPTT), Serum glucose, Blood culture and other cultures (e.g., of sputum, stool, urine, wounds, catheters, prosthetic implants, epidural sites, pleural or peritoneal fluid). Arterial blood gas (ABG). Chest x-ray, ECG was performed as per protocol. Other investigations as appropriate were carried out such as lumbar puncture, echocardiogram&#xA0; (trans-thoracic or trans-oesophageal), ultrasound scan, CT chest or abdomen. RDW was measured at admission to ICU. The RDW is a measure of variability or red blood cells in size. It may be elevated due to ineffective production or increased destruction of red blood cells. This happens usually in inflammation and infections.&#xA0; Neutrophil to lymphocyte ratio (NLR) was determined by dividing the absolute neutrophil count by the absolute lymphocyte count.&#xA0; The patients were followed to check their condition whether SOFA score improved or worsened. The patient outcome on Day 5, including mortality, was recorded. &#xD;
&#xD;
Statistical Methods&#xD;
&#xD;
Data was entered and analyzed by using statistical software- Statistical Package for Social Sciences (SPSS) Version 17.0. Descriptive statistics like proportions, mean (standard deviation) and median (IQR) was used for expressing the results. For qualitative data Chi-square test and ANOVA was applied and P &lt; 0.05 was considered as a statistically significant association. &#xD;
&#xD;
Results&#xD;
&#xD;
A total of 173 patients were included in the study. Males formed 62.4% of the subjects. Majority of the patients with sepsis were over 50 years of age. Pulmonary infections (38.2%) were the most common source of infection in the majority of sepsis cases, followed by tropical infections (27.2%). Table 1 shows the organisms responsible for sepsis. Gram-negative sepsis was the most common cause of sepsis in the study population. Dengue fever, detected by dengue IgM positivity, was the most common individual cause of sepsis in the study population. No organisms could be isolated in around 23.7% of the cases. Hypertension (41.6%) and Diabetes (41%) were the most common co-morbidities present in this study. Outcomes on day 5: 43% of the patients improved, 39% of the patients worsened and 18% of the patients died. RDW was found to be between 14.2 and 15.2 in the majority (59%) of patients with sepsis in the study group. Most of the patients belonged to qSOFA score of 3 (41%). 36% of the patients had a qSOFA score of 2 and 23% of the patients belonged to qSOFA score of 1. As the RDW increased the qSOFA score also increased as shown in Table 2. It was statistically significant. As seen in Table 3 patients with high RDW had poorer outcome and it was statistically significant. ROC was plotted for RDW vs outcome: The area under the curve was found to be 0.834, which implied RDW was a good test to predict the outcome. An RDW of 15.050 was found to predict the worse outcome with a sensitivity of 82.4% and specificity of 74.7%. It was found in the study that as the q SOFA score increases, median NLR increases as seen in Table 4. ROC was plotted for NLR vs Outcome. The area under the curve was found to be 0.663, which showed that NLR was only a fair test to predict the outcome. An NLR of 3.22 predicted worse outcome with the sensitivity of 66.2% and specificity of 65.7%. &#xD;
&#xD;
Discussion &#xD;
&#xD;
In this study, 173 patients who were admitted to the ICU, diagnosed as sepsis as per the 2016 Sepsis &#x2013; 3 guidelines, were studied. Respiratory infections were the most common source of sepsis, and this was by previous studies.8&#xA0; However, tropical/non localised diseases such as dengue fever, leptospirosis and malaria had a much higher incidence in our study population, this might be explained by the endemicity of these diseases to this region. Hypertension and diabetes mellitus were the most common comorbidities seen in this study. In another study of sepsis in India, 28% of those patients had diabetes and 16.5% of the patients had hypertension.9 In our study mortality rate was 18%. In another study by Pandya et al. they found a mortality rate of 28% in sepsis patients.10 In our study there was a good correlation between RDW and qSOFA score. RDW correlated well with the APACHE II score in sepsis patients.11 In our study RDW correlated well with the outcomes and as the RDW increased the outcome of the patients worsened. In another study, RDW not only predicted short term mortality but also had a good correlation with the 4-year mortality rate.12 In our study an RDW greater than 15.050 predicted a worse outcome. In the study by Jandial A, they found that an RDW greater than 17.3 showed significant correlation with mortality in sepsis patients.11In our study the median NLR showed a reasonable correlation with the qSOFA score. As the median NLR increased the clinical outcome of the patient worsened. De Jager&#xA0;et al. observed NLR as a better predictor of severity and outcome in bacteremia than conventional markers.13&#xA0; In our study NLR of 3.22 predicted worse outcome in sepsis patients however it was not as strong a predictor as the RDW.&#xA0; Martins EC in their study showed that the cutoff point of 5.0&#xA0;for the NLR was associated with a high risk for sepsis.14&#xD;
&#xD;
Conclusion &#xD;
&#xD;
We found that RDW correlated well with qSOFA score in sepsis patients and offered a clinically reliable cut off for prognostication of sepsis. We determined such a cut off to be 15.050 above which the outcome was bad.&#xA0; But we found Neutrophil lymphocyte ratio to be of limited clinical value as it lacked a discernible cut off and had a weak association with clinical outcome.&#xD;
&#xD;
Ethical clearance: Taken from the institutional local ethics committee before the start of the study. (IEC KC MLR 09-17/167)&#xD;
&#xD;
Source of funding: Self&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;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.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3346</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3346</Fulltext></URLs><References>&#xD;
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	Singer M, Deutschman CS, Seymour CW. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801&#x2013;810. &#xD;
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	Anamika V, Ramavtar S, Pooja G, Mrityunjay K. Bloodstream infections in Intensive care unit patients: A single centre retrospective study of the distribution and antibiotic resistance pattern in clinical isolates. Int J Cur Res Rev 2012;4(12):154-162.&#xD;
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	Bhadade RR, DeSouza RA, Harde MJ, Prarthana P. Prospective evaluation and mortality outcome of nosocomial infections in medical intensive care unit at Tertiary care teaching centre in Mumbai. Int J Cur Res Rev 2013;5(19):26-40.&#xD;
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	Lichtenstern C, Brenner T, Bardenheuer HJ, Weigand MA. Predictors of survival in sepsis: what is the best inflammatory marker to measure? Curr Opin Infect Dis 2012;25(3):328-336.&#xD;
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	Freund Y, Lemachatti N, Krastinova E. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department.&#xA0;JAMA&#xA0;2017;317(3):301&#x2013;308. &#xD;
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	Patel KV, Ferrucci L, Ershler WB. Red blood cell distribution width and the risk of death in middle-aged and older adults.&#xA0;Arch Intern Med 2009;169(5):515&#x2013;523. &#xD;
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	Salciccioli JD, Marshall DC, Pimentel MA. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care 2015;19(1):13.&#xD;
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	Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34(2):344-353.&#xD;
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	Anand AK, Kumar N, Gambhir IS. Clinicomicrobiological profile of the Indian elderly with sepsis. Ann Trop Med Public Health 2016;9:316-320.&#xD;
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	Pandya H, Pabani N, Shah K, Yadav R, Patel P, Raninga J. Study of various prognostic factors for sepsis patients requiring intensive medical care with special emphasis on APACHE II score in prognostication. J Integr Health Sci 2015;3:14-22.&#xD;
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	Jandial A, Kumar S, Bhalla A. Elevated Red Cell Distribution Width as a Prognostic Marker in Severe Sepsis: A Prospective Observational Study.&#xA0;Indian J Crit Care Med 2017;21(9):552&#x2013;562. &#xD;
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	Han YQ, Zhang L, Yan L. Red blood cell distribution width predicts long-term outcomes in sepsis patients admitted to the intensive care unit. Clinica Chimica Acta. 2018;487:112-116.&#xD;
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	deJager CP, van Wijk PT, Mathoera RB. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit.&#xA0;Crit Care 2010;14(5):2-8.&#xD;
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	Martins EC, Silveira LDF, Viegas K. Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study. Raz&#xE3;oneutr&#xF3;filo-linf&#xF3;cito no diagn&#xF3;sticoprecoce de sepseemunidade de terapiaintensiva: um estudo de caso-controle.&#xA0;Rev Bras Ter Intensiva 2019;31(1):64&#x2013;70. &#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Additional Effect of Inspiratory Muscle Training Along with Aerobic Exercises in Overweight and Obese Individuals&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>54</FirstPage><LastPage>59</LastPage><AuthorList><Author>Ketki Ponde</Author><AuthorLanguage>English</AuthorLanguage><Author> Ronika Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Shifa Anis Chini</Author><AuthorLanguage>English</AuthorLanguage><Author> Mehzabin Mehboob Amreliwala</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Obesity is known to be a major risk of a whole range of cardiovascular, metabolic and respiratory disorders. In obese individuals, respiratory muscles cannot function efficiently due to increased load on them that they are required to overcome and also due to reduction in their capacity. Respiratory muscle fatigue is a potential mechanism for impaired exercise tolerance. Objective: The study aims to concentrate on finding whether adding Inspiratory muscle training (IMT) to their exercise protocol will be beneficial for overweight and obese individuals. Methods: Overweight and obese individuals were divided into group A (n = 30) and group B (n = 30) groups. BMI, inspiratory muscle strength and oxygen consumption (VO2max) were assessed pre and post-6-weeks of intervention. Group A performed inspiratory muscle training of 3 sets of 10 breathes followed by moderate intensity (Borg&#x2019;s RPE= 11 -13) of walking 20mins for 5 days/ week and progressing to 40mis at the end of 6 weeks. Group B performed only walking for 5 days/week for 6 weeks. Results: Group A showed statistically highly significant improvement in 6 min walk distance (p value=0.0001), PImax (p value= 0.0001) and VO2 max (p value= 0.0035). Thus showing significantly better results in Group A. whereas group B did not show any change post-intervention (p&#x2265;0.05). Conclusion: Individuals who performed IMT along with walking showed greater improvement than the individuals who performed only walking.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Inspiratory Muscle Training, Exercise performance, Obesity, Aerobic Exercise. Maximum Inspiratory Pressure</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Obesity is a complex, multifactorial condition that results from the interaction of genetic, metabolic, social, cultural and behavioural factors.1 It has been estimated that the global epidemic of overweight and obesity affects 1.7 billion people worldwide.2 In India 88 million individuals are overweight and 135 million individuals are obese.3 According to the classification of BMI for Asian population if Body Mass Index (BMI) is between 23-24.9kg/m2 the individual is considered as overweight, and if BMI is more than 25kg/m2 then they are considered as obese.4&#xD;
&#xD;
Obesity is known to be a major risk of the whole range of cardiovascular, metabolic and respiratory disorders2. Several studies have shown that there are excess metabolic perturbations and increased cardiovascular risk factors at a lower value of BMI in Asian population as compared to the white population. Hence these days multiple studies and several guidelines are focusing more on early intervention with diet and physical activity in Asian ethnic groups to prevent and manage obesity-related non-communicable diseases.4 Due to the accumulation of adipose tissues in the abdomen, the physiology of breathing gets altered and diaphragmatic fibres get overstretched. This results in length-tension disadvantage with lower cardiorespiratory endurance which in turn causes diaphragm dysfunction and leads to smaller pulmonary volumes, greater metabolic demands on the respiratory musculature and increased airway resistance resulting from a reduction in lung volumes and further increases the work of breathing. Also due to truncal fat, there is reduced chest wall compliance.2 Also, the above factor causes respiratory muscles to develop fatigue during exercises.&#xD;
&#xD;
Severely obese subjects tend to have a rapid shallow breathing pattern that results in increased oxygen cost of breathing.2 This in turn compromise leg blood flow thereby constraining oxygen uptake (VO2) and limiting exercise tolerance.5 Respiratory muscle fatigue is a potential mechanism for impaired exercise tolerance.6 Thus, dysfunction in the ventilatory muscles can lead to hyperventilation, reduced exercise tolerance; reduced lung function which results in respiratory insufficiency along with increased work of breathing. This affects the muscle strength of inspiratory muscles.7 During exercise there is increased chest loading with reduced lung volumes and increased mechanical ventilatory constraints in obese individuals. This has been suggested as a possible explanation for impaired exercise performance in the obese and morbidly obese individuals.8 Increased body fat percentage also contributes to the reduction in the functional exercise tolerance.2 This evaluates Respiratory Muscle Strength (RMS) and exercises tolerance in such individuals of great clinical importance.&#xD;
&#xD;
The strength of these ventilator muscles is analysed through measurement of maximum static mouth pressure (Maximal Inspiratory Pressure - MIP) against a closed airway. MIP is measured using a capsule sensing pressure gauze which is the easiest and non-invasive method of measuring the strength of respiratory muscles.2 Respiratory muscle training increases the strength and reduces the extent of fatigue of respiratory muscle hence improving their performance. Due to this, the metabolic requirement of inspiratory muscles during exercise decreases. This enhances VO2 dynamics resulting in improved exercise performance.6 A threshold device is a device used for the training of respiratory muscles. The threshold device contains a spring-loaded valve at one end and a mouthpiece on the other. The valve blocks airflow until the patient generates sufficient inspiratory pressure to overcome the resistance provided by the spring-loaded valve.9 Since respiratory muscles are also skeletal muscles, the more they are exercised the bigger and stronger they are expected to become.10&#xD;
&#xD;
&#xA0;Exercise performance is assessed by measuring maximal oxygen uptake (VO2max) and 6-minute walk distance using 6-minute walk test.11 Various metabolic and respiratory changes take place during aerobic exercise; it increases the capacity to mobilize and oxidize fat and increases the levels of fat mobilizing and fat metabolizing enzymes resulting in favourable changes in body composition and reducing body fat along with regulating the accumulation of visceral adipose tissue. There is an increase in alveolar ventilation causing diffusion of gases (increase in O2 uptake and excretion of the excess of CO2) across the alveolar-capillary membranes which improves functional capacity and decreases ventilatory demand and thereby improve overall pulmonary ventilation.12 Aerobic training improves contractility of the respiratory muscles thus resulting in improved respiratory muscles function &amp; strength. It may even increase respiratory muscle function as it increases Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second -FEV1.2 During exercise, abdominal muscle relaxation at the end of exhalation facilitates inspiratory muscles. This places inspiratory muscles at an improved mechanical advantage, enabling them to generate more pressure at the onset of inspiration. Overweight and obese individuals with increased visceral adiposity and therefore increased waist circumference tends to focus more on weight reduction, neglecting the respiratory muscle training in the process of aerobic training schedule.2&#xD;
&#xD;
MATERIALS AND METHOD&#xD;
&#xD;
Institutional Ethics Committee approval was taken (IEC no: MARCOPAR/05/613) for the comparative study and written informed consent was obtained from the subjects after fully explaining the nature of the study. 60 subjects with BMI 23kg/m2 to 29kg/m2 (overweight and obese according to Asian classification)4 of age 20-40 years both males and females13 and individuals with MIP value less than -80cmH2O14 were included in the study. Subjects with a known case of respiratory and cardiovascular disorders, musculoskeletal disorders about thorax and lower limbs and individuals who were involved in any physical activity or sports activity or aerobic training &gt;2days a week during past 3months 2&#xA0; &#xA0;&#xA0;were excluded from the study.&#xD;
&#xD;
Participants were randomly allocated by chit method into 2 groups- Group A (24.20&#xB1;4.11 years) and group B (22.87&#xB1;3.85 years). Group A underwent an inspiratory muscle training programme along with aerobic exercise. Group B underwent aerobic exercise training alone. Both the groups had 30 subjects each.&#xD;
&#xD;
Study Procedure&#xD;
&#xD;
Maximal inspiratory pressure (PImax) &#x2013; for obtaining respiratory muscle strength, capsule sensing pressure gauge with an operational interval of -250 to 0 cmH20 was used. The calibration of equipment was tested assuring the reliability of the data collected. Intra- rater reliability was 0.962 and inter-rater reliability was 0.922.1 MIP values were obtained by asking the subject to do inspiration from residual volume (RV). The manoeuvre was sustained at maximal force for approximately one second and the highest value was computed from a minimum of three repetitions for each manoeuvre. Measurements were performed according to standard procedures.15&#xD;
&#xD;
Exercise Performance &#x2013;exercise performance was measured by calculating VO2 max and&#xA0; 6 Minute Walk Distance by using the 6-minute walk test.16&#xD;
&#xD;
Subjects were asked to walk with comfortable loose clothing and appropriate shoes, subjects performed 6-minute walk test in a 30 m corridor according to ATS guidelines.&#xD;
&#xD;
&#xD;
	&#xD;
	The VO2 max was calculated using the following formula,16&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; VO2 max =VO2mL kg-1 min-1&#xA0; &#xA0;= (0.02 &#xD7; distance [m]) - (0.191 &#xD7;age [yr]) - (0.07 &#xD7; weight&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [kg]) + (0.09 &#xD7; height [cm]) + (0.26 RPP &#xD7;[10-3]) +2.45&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; b) 6-minute walk distance is the distance subject can walk in six minutes in their own comfortable pace without getting breathless.&#xD;
&#xD;
Exercise protocol- Group A underwent IMT and aerobic exercise training for 5 days a week for 6 weeks. First IMT was given with a pressure threshold resistive device followed by aerobic exercises. Group B underwent aerobic exercise alone.&#xD;
&#xD;
Inspirational Muscle Training (Group A)&#xD;
Instruction&#xD;
&#xD;
The subjects were in a sitting position on a chair with comfortable clothing. Nose clip was placed and subjects were asked to exhale completely and put the mouthpiece of the IMT in the mouth and inhale maximally to open the valve of the Inspiratory Muscle Trainer. &#xD;
&#xD;
Protocol&#xD;
&#xD;
IMT with a pressure threshold resistive training device was done .5 sessions weekly for 6 weeks for Group A whereas Group B didn&#x2019;t perform any inspiratory muscle training. The initial training load was attempted at 40%5 of the subject&#x2019;s baseline PImax for 7 minutes.&#xA0; Frequency of 3 sets of 10 breathes; with a rest period of 2 minutes between each set was done. After the first two weeks, PImax was increased to 60 % of baseline PImax. After 4 weeks 80% of the subject&#x2019;s baseline PImax was achieved.11,18,19 &#xD;
&#xD;
Aerobic Exercise (Group A and B )&#xD;
&#xD;
Instruction&#xD;
&#xD;
The subjects were asked to wear loose and comfortable clothing and proper footwear. Borg&#x2019;s scale (6-20) was explained to the subjects to monitor the intensity of walking. The subjects were asked to walk on the level surface ground.&#xD;
&#xD;
Protocol&#xD;
&#xD;
Subjects were told to perform warm-up exercises for 5min which consisted of all range of motion exercises (ROM) and marching for 1 minute.20&#xD;
&#xD;
Aerobic exercise (walking): A moderate intensity&#xA0;&#xA0; (Borg&#x2019;s RPE 11 -13) exercise training was performed for 5 days a week for 6 weeks, during exercise training, the intensity was controlled by measuring Rate of perceived exertion of 11 -13 using Borg (6-20) scale.2 In the first two weeks, subjects walked for 20mins. Then it was progressed for 30 minutes in 3rd and 4thweek. In the last two weeks, subjects were asked to walk for 40mins.21 Cooldown was done for 5 minutes which included stretching of all major group muscles, each stretch was held 30 counts and two repetitions.20&#xD;
&#xD;
Statistical Analysis &#xD;
&#xD;
Statistical analysis was done by using SPSS IBM version 20 (Statistical package for social sciences) All data in the study was presented as mean &#xB1; standard deviation. the p-value of &#x2264; 0.05 was considered statistically significant. Within the group, the comparison of the pre and post data was done by using paired t-test and between the two groups comparison was done using unpaired t-test. Demographic data of both the groups were comparable (p&#x2265;0.05) ( Table 1) &#xD;
&#xD;
RESULTS&#xD;
&#xD;
The Respiratory Muscle strength (PImax) and exercise performance in terms of maximum oxygen uptake (VO2 max) and 6 Minute Walk Distance (6MWD) of the participants of the group A and Group B were taken at the beginning(0 weeks)and the end of the six weeks.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Pre and post-treatment means were analyzed by performing paired t-test. There was statistically significant improvement seen in 6 min walk distance (p value=0.0335) and PI max (p value= 0.0001) whereas VO2max did not show any difference (p-value = 0.3850) (Table-2).&#xD;
&#xD;
&#xD;
&#xD;
Pre and post-treatment means were analyzed by performing paired t-test. There was no statistically significant difference in pre and post-treatment values of 6 min walk distance (p-value =0.3062), PImax (p-value = 0.2523) and VO2 Max (p-value = 0.5306) ( Table 3)&#xD;
&#xD;
&#xD;
&#xD;
Pre and post-treatment means were analyzed using unpaired t-test Group A showed statistically significant improvement in 6 min walk distance (p value=0.0001), PImax (p value= 0.0001) and VO2 max (p value= 0.0035) when compared with group B&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The purpose of this study was to compare effects of aerobic exercises along with inspiratory muscle training and aerobic exercises alone on respiratory muscle strength (PImax) and exercise performance (VO2 max and six-minute walk distance). The study was conducted on 60 subjects who were divided into two groups, group A underwent inspiratory muscle training along with aerobic exercises and group B performed only aerobic exercises for 6 weeks.&#xD;
&#xD;
Group A showed statistically significant improvement in PImax and 6-minute walk distance post-intervention as shown in table 1. Group B did not show statistically significant improvement in 6MWD, PI max and VO2max as shown in table 2. When group A and B were compared, group A showed better results than group B as shown in table 3.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Altered respiratory mechanics in overweight and obese individuals is due to the accumulation of visceral adipose tissue. As aerobic exercises were performed by both the groups, aerobic exercises might have helped in decreasing the body fat and regulating the accumulation of visceral adipose tissue, thus improving functional capacity. This may contribute to improving 6MWD and VO2 max in both the groups.2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A study conducted by Sonam Daftari2 &#x201C;Effect of aerobic exercises on respiratory muscle strength in overweight and obese individuals&#x201D; stated that in the early phase of the training period, during aerobic exercises, to fulfil the increased ventilatory and metabolic demands, the diaphragm had to work against the resistance posed by the visceral adiposity. As visceral adiposity is commonly found in obese individuals, this would overload and trigger the increase in the activity of respiratory muscles causing its conditioning and thus increasing the Respiratory Muscle Strength.2As after few weeks of aerobic exercises, visceral adiposity is considered to have decreased, the diaphragm would have worked in a mechanically advantageous position.2&#xA0;&#xA0; This might result in improved PImax seen in both groups.&#xD;
&#xD;
&#xA0;Due to aerobic exercise, there is an increase in aerobic enzyme levels and oxidative capacity of the respiratory musculature. Aerobic training also increases inspiratory muscle capacity to generate force and sustain a given level of inspiratory pressure.22 Improvement in VO2max in both groups as seen in table 1 &amp;2 &#xA0;may be due to aerobic training effect, which probably may be due to improved cardiac output, pulmonary diffusion capacity, alveolar-ventilation-to-perfusion ratio, Increase in oxygen extraction and utilization by the working muscles thus improving its efficiency, increase in capillary density, increase in muscle myoglobin content which might have increased the rate of oxygen transport and possibly the rate of oxygen diffusion to the mitochondria, increase in lactate threshold at sub-maximal workload and oxidative potential of muscles, thus improving the muscles metabolic function.2,23These could be the possible reasons for the increase in respiratory muscle strength and exercise performance after aerobic exercises in both groups in our study.&#xD;
&#xD;
Additionally group A underwent inspiratory muscle training program. Like other skeletal muscles, after training of inspiratory muscles, there is an improvement in the strength of inspiratory muscles. In obese individuals there is increased load on the diaphragm which leads to fatigue of the diaphragm, thus there is the recruitment of accessory muscles. IMT is proven to reduce fatigue of diaphragm which in turn reduces the recruitment of accessory muscles and also improves the pattern of recruitment of diaphragm muscles.11,24 This may be the possible reason for improved respiratory muscle strength in group A as shown in table 1.&#xD;
&#xD;
Some studies have reported greater quantities of type II muscle fibres and smaller quantities of type I fibres in obese individuals.25 A study conducted by Alba Ram?&#xB4;rez-Sarmiento18 demonstrated that the external intercostal muscles of patients with COPD can express structural remodelling after specific inspiratory training.&#xA0; Both the proportion of type I fibres and the size of type II fibres were found to increase after training.18 So, the possible reason for the increase in respiratory muscle strength (PImax) in our study could be the structural remodelling of type I and type II fibres of the external intercostal muscle.&#xD;
&#xD;
&#xA0;As inspiratory muscle training and aerobic exercises results in an improvement in respiratory muscle strength this also helps in improving exercise performance in three ways: A. Reduce overall exercise energy demands because of less respiratory work; B. reduce lactate production by the ventilatory muscles during intense, prolonged exercise&#x2019;s. Enhances the circulating lactate as metabolic fuel.22 A study was done by Stephen J. Bailey about the effect of IMT on pulmonary kinetics and exercise tolerance in healthy human states that fatigue of the inspiratory muscles occurs due to accumulation of fatigue-related metabolites including lactic acid which stimulates diaphragm innervating metaboreceptors. This activates meta bore flex invoking sympathetically mediated vasoconstrictor out?ow and a reduction in limb blood.6 They observed reduction in blood lactate accumulation during the ?rst 6 min of severe exercise after IMT, which may be, in part, due to the reduced inspiratory muscle fatigue.6&#xD;
&#xD;
It is hypothesized in one of the review article by A Willian Sheel that during exercise the Respiratory muscles compete with limb locomotor muscles for their share of cardiac output. When the work of breathing is reduced, blood flow to exercising legs is increased and endurance performance is increased. While inspiratory muscle training decreases the work of breathing and perception of respiratory exertion, this may contribute to improved exercise performance.26 Improving inspiratory muscle performance may improve ventilatory capacity and thus increases exercise performance in patients with chronic airflow limitation.9 Same may also be true in our study where improvement in ventilatory capacity might have resulted in better improvement in exercise performance in the group performing additional inspiratory muscle training.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; These all can be possible reasons for better improvement in exercise performance in group A as compared to group B which shows that adding inspiratory muscle training to aerobic exercises improves inspiratory muscle strength and exercise performance in overweight and obese individuals.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Adding IMT to conventional walking program improved subjects inspiratory muscle strength and their exercise performance.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;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.&#xD;
&#xD;
Conflict of Interest: NIL&#xD;
&#xD;
Financial Assistance: NIL &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3347</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3347</Fulltext></URLs><References>1. Karla L. Magnani, Antonio J. Cataneo. Respiratory muscle strength in obese individual and the influence of upper-body fat distribution. Sao Paulo Med J 2007;125(4):215-219.&#xD;
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2. Alberga&#xA0;AS, Prud&amp;#39;homme D, Sigal RJ, Goldfield GS, Hadjiyannakis S, Phillips P, et.al Effects of aerobic exercise training on respiratory muscle strength in overweight and obese individuals. Int J Ther Rehabil Res 2015; 4(5):305.&#xD;
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3. Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et.al. Prevalence of generalized &amp; abdominal obesity in&#xA0; &#xA0;urban &amp; rural India-the ICMR-INDIAB Study (Phase-I)[ICMR-INDIAB-3]. Indian J Med Res 2015;142(2):139-150.&#xD;
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4. Misra A. Ethnic-specific criteria for the classification of body mass index: a perspective for Asian Indians and American Diabetes Association Position Statement. Diabetes Tech Ther. 2015 Sep 1;17(9):667-671.&#xD;
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5. Bailey SJ, Romer LM, et.al Inspiratory muscle training enhances pulmonary O2uptake kinetics and high-intensity exercise tolerance in humans. J Appl Physiol 2010;109(2):457-468.&#xD;
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6. Villiot-Danger JC, Villiot-Danger E, Borel JC, P&#xE9;pin JL, Wuyam B, Verg&#xE8;s S. Respiratory muscle endurance training in obese patients. Int J Obes 2011;35(5):692.&#xD;
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7. Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol 2009;108(1):206-211.&#xD;
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8. Dreher M, Kabitz HJ. Impact of obesity on exercise performance and pulmonary rehabilitation. Respirology 2012;17(6):899-907.&#xD;
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9. Retharekar S, Mundada N. Effect of respiratory muscle training as an adjunct to conventional therapy in phase 1 cardiac rehabilitation for median sternotomy patients. Int J Ther Rehabil Res 2015; 4(5): 305-311.&#xD;
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10. Dassios T, Katelari A, et.al. Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis. Respir Med 2013;107(5):684-690.&#xD;
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11. Lisboa C, Villafranca C, Leiva A, Cruz E, Pertuz&#xE9; J, Borzone G. Inspiratory muscle training in chronic airflow limitation: effect on exercise performance. European Resp J 1997;10(3):537-542.&#xD;
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12. Agre S, Agrawal R, Alirajpurwala A. Screen time evaluation, association with obesity, and cardio respiratory fitness among children aged 10&#x2013;12 years. Indian J Child Health 2019:6(7):361-364. &#xD;
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13. Kalra S, Unnikrishnan AG. Obesity in India: The weight of the nation. J Med Nutr Nutrac 2012;1(1):37.&#xD;
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14. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Resp Care 2009;54(10):1348-1359.&#xD;
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14. Gosselink R, Wagenaar RC, Decramer M. Reliability of a commercially available threshold loading device in healthy subjects and in patients with chronic obstructive pulmonary disease. Thorax 1996;51(6):601-605.&#xD;
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15. Caruso P, Friedrich C, Denari SD, Ruiz SA, Deheinzelin D. The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning. Chest 1999; 115(4):1096-1101.&#xD;
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16.&#xA0; American College of Sports Medicine. ACSM&amp;#39;s guidelines for exercise testing and prescription. Lippincott Williams &amp; Wilkins; 2013 Mar 4.&#xD;
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17. Venkatesh N, Thanikachalam S, Satyanarayanamurty J, Maiya A. Six minute walk test: a literary review. Sri Ramachandra J Med 2011;4(1):30-34.&#xD;
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18. Ram&#xED;rez-Sarmiento A, Orozco-Levi M, Guell R, Barreiro E, Hernandez N, Mota S, et.al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Resp Crit Care Med 2002;166(11):1491-1497.&#xD;
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19. Enright SJ, Unnithan VB. Effect of inspiratory muscle training intensities on pulmonary function and work capacity in people who are healthy: a randomized controlled trial. Physical Ther 2011; 91(6):894-905.&#xD;
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20. Shah HJ, Kothary K. Supervised exercise versus workout videos for weight reduction in adults between age group of 20-50 years. Int J Physiother Res 2017;5(6):2534-2540.&#xD;
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21. Andersen RE, Wadden TA, et.al Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA 1999;281(4):335-340.&#xD;
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22. McArdle WD, Katch FI, Katch V. Exercise physiology: nutrition, energy, and human performance. Lippincott Williams &amp; Wilkins; 2010.&#xD;
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23. Kaufman C, Kelly AS, Kaiser DR, Steinberger J, Dengel DR. Aerobic-exercise training improves ventilatory efficiency in overweight children. Paediatr Exerc Sci 2007;19(1):82-92.&#xD;
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24. Dall&#x2019;Ago P, Chiappa GR, Guths H, Stein R, Ribeiro JP. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiovas 2006;47(4):757-763.&#xD;
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&#xA0;25. Magnani KL, Cataneo AJ. Respiratory muscle strength in obese individuals and influence of upper-body fat distribution. Sao Paulo Med J 2007;125(4):215-219.&#xD;
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26. Sheel AW. Respiratory muscle training in healthy individuals. Sports Med 2002;32(9):567-581. &#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Antibacterial Effects of ZnO NPs Synthesized by Solvothermal Method against Pseudomonas sp. Extracted from Saliva Ejector Tubing&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>60</FirstPage><LastPage>63</LastPage><AuthorList><Author>Sharmili Pisal</Author><AuthorLanguage>English</AuthorLanguage><Author> Jayant Pawar</Author><AuthorLanguage>English</AuthorLanguage><Author> S. C. Kale</Author><AuthorLanguage>English</AuthorLanguage><Author> Jayashri Nanaware</Author><AuthorLanguage>English</AuthorLanguage><Author> Rabinder Henry</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpa Ruikar</Author><AuthorLanguage>English</AuthorLanguage><Author> Snehal Masurkar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The widespread antibacterial activity of nanoparticles of zinc oxide (ZnO-NPs), specifically by using nano-technology to synthesize its nanoparticles, has had considerable attention. Objective: In the present study synthesis of ZnO-NPs by the solvothermal method and its antibacterial efficacy against Pseudomonas sp. has to be studied. Methods: The precursor 0.1M zinc sulfate and reducing agent 0.1M NaOH were used for the synthesis of ZnO-NPs. The synthesized ZnO-NPs were additionally, characterized biochemically using UV-vis Spectroscopy and X-ray diffraction (XRD) analysis. Results: The &#x3BB;max and band gap was found to be at 329 nm and 3.87 eV respectively. Bacteria found in contact oral cavities forms biofilms which makes them resistant to orthodox antimicrobial agents. Therefore, to overcome this problem, the present work was focused on the alternative approach based on nanomaterials. Antibacterial efficacy of ZnO NPs was performed against Pseudomonas sp. by Methylene blue reduction assay. Significant inhibition was observed (17 mm) at a 100 &#xB5;g/mL concentration of ZnO-NPs. Conclusion: Reactive oxygen species (e.g. H2 O2 ) was a critical influence in many events, including the lack of proton motives as well as the harmful absorption of dissolved toxic Zinc ions as a result including cell wall trauma, increased membrane permittivity, excessive uptakes of dissolved ions of Zn, etc. This contributed to mitochondrial weakening, intra-cellular discharge as well as the release of oxidative stress within the expression of genes, that resulted in inhibition of cell proliferation and cell death.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Antibacterial, Solvo-thermal Method, Oral cavities, Biofilm, Biochemical characterization, Saliva ejector tubing</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The most widely recognized clinical illness affecting immuno-compromised deceitful people is P. aeruginosa. The treatment of infectious diseases has become an emerging problem due to multi-drug resistance. Wide-ranged usage for several human bacterial infections with&#xA0;antibiotics of the broad spectrum&#xA0;also culminated in resistance to antibiotics. Advanced nano-medicine insights have been opened up recently in the area of nano-technology, allowing for the production of nano-particles.1 The new class of Antimicrobial Agents which are extremely being researched for their anti-bacterial properties, as well as its&#xA0;potential applications in food, health care and the environmental sustainability,&#xA0;is the metal oxides nano-particles like zinc oxide (ZnO), magnesium oxide (MgO), cupric oxide (CuO), calcium oxide (CaO), silver oxide (Ag2O).2-6&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Isolation and Biochemical Characterization&#xD;
&#xD;
Bacterial isolates were obtained from swabs collected from the oral cavity. The isolates were maintained on Mannitol Salt Agar medium (MSA). Random colonies were selected and their colony characteristics were recorded. Microscopic examination including Gram staining was performed. Biochemical characterization of the isolates was performed by Voges Proskauer, indole, catalase and methyl red tests. &#xD;
&#xD;
Synthesis and Characterization of Zinc Oxide Nanoparticles (ZnO-NPS) &#xD;
&#xD;
Zinc sulfate (0.1M) was dissolved in 50ml distilled water by continuous stirring on the magnetic stirrer. 0.1M NaOH solution (100 ml) was dropwise added into the reaction mixture at 90 &#xB0;C for 2 hours. The reaction mixture was centrifuged at 5000 rpm for 15 minutes. The pellet was washed three times with distilled water and air-dried at 60 &#xB0;C for 24 hours, followed by calcination at 400 &#xB0;C for 4 hours. The resultant precipitate was characterized by UV-Vis Spectroscopy and X-Ray Diffraction (XRD) analysis to obtain optical and structural information of the material. &#xD;
&#xD;
Screening&#xA0;of biofilm-forming isolates and tube check reduction using&#xA0;Red Agar Congo Test&#xD;
&#xD;
The bacterial isolate was inoculated on Congo red agar medium and incubated at 37&#xB0;C &#xB1; 2&#xB0;C for 24 hours. Biofilm production was investigated by observing dry crystalline black colonies on congo red agar plate.7&#xD;
&#xD;
Tube Assay&#xD;
&#xD;
The isolate was inoculated for 24 hours in tubes containing Trypticase Soy broth. The assay was disposed of and the sampled tubes with a phosphate buffer saline (PBS) were cleaned post-incubation. After that, 0.1% crystal violet was darkened for 5 minutes in the tubes as well as the deionized water poured overdye. Purple colour on the tube wall suggests biofilm development.8 &#xD;
&#xD;
Determining the Antibacterial activity of ZnO NP action against Pseudomonas sp. Test of Blue Methylene Removal (MBRT) &#xD;
&#xD;
For qualitative determination of cell viability of metabolically active Pseudomonas sp. cells on the exposure of ZnO NPs, methylene blue reduction test (MBRT) was performed6. Briefly, Pseudomonas sp. 1mL culture broth was blended with 1x105 CFU/mL mixed into 0.1mL (0.5%) methylene blue dye. As a consequence, a tube of 0.5mL of ZnO NPs (1mg/mL), as well as positive (containing bacterial culture and MB) including negative control (containing nutrients broth and MB) is applied as well as incubated in complete darkness under 37&#xB0;C&#xB1;2&#xB0;C for 4 hours. All experiments were performed in triplicates.&#xD;
&#xD;
The purpose of this experiment was to qualitatively determine cell viability of metabolically active B. cereus cells by MBRT in presence of CuO NPs. The antibacterial e?cacy of CuO NPs was determined by MBRT. Brie?y, 1 mL of selected bacterial culture (B. cereus)of1&#xD7;105 CFU/mL inoculated in the nutrient broth was mixed with 0.1 mL of 0.5% methylene blue in two Eppendorf tubes. Subsequently, in one tube 0.5 mL of CuO NPs (1 mg/mL) was added and kept for incubation at 37&#xB0;C &#xB1; 2&#xB0;C in the incubator for 4 h along with positive (containing bacterial culture and MB) and negative control (containing nutrient broth and MB). All reaction tubes were covered in silver foil and kept for incubation under dark conditions in closed incubator. All experiments were performed&#xD;
&#xD;
in triplicates. The purpose of this experiment was to qualitatively determine the cell viability of metabolically active B. cereus cells by MBRT in presence of CuO NPs. The antibacterial e?cacy of CuO NPs was determined by MBRT. Brie?y, 1 mL of selected bacterial culture (B. cereus)of1&#xD7;105 CFU/mL inoculated in the nutrient broth was mixed with 0.1 mL of 0.5% methylene blue in two Eppendorf tubes. Subsequently, in one tube 0.5 mL of CuO NPs (1 mg/mL) was added and kept for incubation at 37&#xB0;C &#xB1; 2&#xB0;C in the incubator for 4 h along with positive (containing bacterial culture and MB) and negative control (containing nutrient broth and MB). All reaction tubes were covered in silver foil and kept for incubation under dark conditions in closed incubator. All experiments were performed&#xD;
&#xD;
in triplicates. The purpose of this experiment was to qualitatively determine the cell viability of metabolically active B. cereus cells by MBRT in presence of CuO NPs. The antibacterial e?cacy of CuO NPs was determined by MBRT. Brie?y, 1 mL of selected bacterial culture (B. cereus)of1&#xD7;105 CFU/mL inoculated in the nutrient broth was mixed with 0.1 mL of 0.5% methylene blue in two Eppendorf tubes. Subsequently, in one tube 0.5 mL of CuO NPs (1 mg/mL) was added and kept for incubation at 37&#xB0;C &#xB1; 2&#xB0;C in the incubator for 4 h along with positive (containing bacterial culture and MB) and negative control (containing nutrient broth and MB). All reaction tubes were covered in silver foil and kept for incubation under dark conditions in closed incubator. All experiments were performed&#xA0;in triplicates.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
Isolation and Biochemical Characterization&#xD;
&#xD;
All the isolates were found to be motile Gram-negative rods. Isolate found catalase-positive gives a negative methyl red, indole and Voges Proskauer tests, but a positive catalase test. Therefore, it was tentatively identified as Pseudomonas sp.&#xD;
&#xD;
Characterization of ZnO-NPs&#xD;
&#xD;
ZnO-NPs were synthesized using solvothermal method. Figure 1 shows the absorption curve for Zn Opower. The absorption spectrum and bandgap of synthesized powder were found to be at 329 nm and 3.87 eV respectively. &#xD;
&#xD;
&#xD;
&#xD;
About the Joint Committee on Powder Diffraction Standards (JCPDS) for XRD, card number 36-1451, the diffractogram of ZnO powder shows the creation of hexane crystal structure. The extension of the top demonstrates the creation of nano-scale structures. The study of powders reveals crystalline nature at peaks (100), (002), (101), (102), (110), (103), (112) and (207) with a similar degree of crystalline nature (Figure 2). To observe synthesised ZnO-NPs, the UV-visible-spectroscopy was sonicated for around 15mins in distilled water, the UV spectrum was then noted. The amplitude of the peak absorption in the UV range is stated to be correlated to nano-particles&amp;#39; size. Therefore peak moves to a lower wavelength (blue shift) on the decrease of the particle&amp;#39;s sizes.&#xD;
&#xD;
&#xD;
&#xD;
Screening of isolate for biofilm formation and reduction after the exposure of ZnO NPs: &#xD;
&#xD;
Isolated Pseudomonas sp. were screened for biofilm formation. After 48 hours, black colonies on congo red agar medium indicated their biofilm-forming ability. The reduction of biofilm was determined by the visual appearance of the fragmented violet colour layer on the wall of the test tube through tube assay (Figure 3). &#xD;
&#xD;
&#xD;
&#xD;
The MBRT is focused on the assumption that the colour on a medium provided by the application of MBRT is diminished with bacteria as well as the colour decolouration rates&#xA0;by the amount of metabolically active bacterial cells present in it is in&#xA0;inverse proportion&#xA0;to the rate of oxygen consumed.6 Pseudomonas sp. strength. The MBRT has been calculated for ZnO NPs, which relies on the degree to which they live bacterial cells as well as the levels of oxygen in tube decoloratemethyle blue. This research deals on the concept of colour decrease and induces the decolouration of the bacterial cell membrane by reductase enzyme. &#xD;
&#xD;
The research has shown a total reduction of the incorporated&#xA0;dye&#xA0;after 4&#xA0;hours culturing in the MB dye in bacterial suspension, which includes only bacterial cells and has shown that the live cells were capable of dye reductions. In experiments involving nutrient broth, MB, bacterial cells and ZnO NPs, a drop in dye was not found, demonstrating specifically, that ZnO NPs destroy bacteria in the study such that the nutrient oxygen will not use the bacteria as a material that decreases the volume of toxicity. Thus, ZnO NPs have demonstrated against Pseudomonas sp.&#xA0;antibacterial&#xA0;activity (Figure 4). In negative tests including the nutrient broth and MB, though, no dye reduction had been seen. The degree of discolouration was found to be directly related to the&#xA0;viability cells.&#xD;
&#xD;
&#xD;
&#xD;
Figure 4: Pseudomonas sp. anti bacterium ZnO NPs activity.&#xA0;he non-coloured tube contains reduced MB,&#xA0;metabolically-active bacterial cells, as well as the coloured tube contained metabolically inactive bacterial cells that were eliminated from ZnO NPs action, before MBRT (a) and post&#xA0;4-hr&#xA0;incubation (b).&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
It is necessary to acquire important information about the behaviour of ZnO NPs and their antibacterial effects in the biological fluid, namely saliva, which faithfully reflects the oral cavity environment. We have shown that nano-particles can be regulated by such methods in their shape and scale. Exploring XRD shows the integrity of the process. The crystallite form of the synthesized nano-particles is hexagonal roots composition. UV spectroscopy shows that the borders of emission are moved to a lower wavelength with a blue change owing to a reduction in crystal size. The DEG and TEG molecule adsorbed in nanoparticles ZnO were provided by FTIR and TGA research. Both ZnOnano-particles are formulated and have antibacterial as well as antibiotic action against Pseudomonas sp. Colloidal ZnO-NPs were most efficient in eradicating all the tested oral bacteria. The antimicrobial activity including antibiofilm potency of ZnO NPs has improved as the particle size has reduced. The use of nanoparticles as antimicrobials in the treatment of oral diseases, however, is becoming increasingly significant in terms of their biocidal, anti-bacterial, antiadhesive and transmission capability. They are currently being researched as components of prothesized metal coatings, topical delivery agents including orthodontic applications. In the future, such nanoparticles with the highest antibacterial activities as well as having minimum toxic effects host are expected to be produced.&#xD;
&#xD;
ETHICAL ISSUE: Ethical clearance was taken from institutional ethical committee, KIMSDU, Karad, Maharashtra. &#xD;
&#xD;
FUNDING SOURCES:&#xA0; Krishna Institute of Medical Sciences Deemed To Be University, Karad.&#xD;
&#xD;
CONFLICT OF INTEREST:&#xA0; Nil&#xD;
&#xD;
ACKNOWLEDGEMENTS: We are grateful for the support which we received from the TERA Research Institute India Pvt. Ltd., Pune, Maharashtra, India, Directorate of Research, Krishna Institute of Medical Sciences &#x201C;Deemed to be University, Karad, Maharashtra, India, Department of Allied Sciences, Krishna Institute of Medical Sciences &#x201C;Deemed to be University, Karad, Maharashtra, India.&#xD;
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	Pawar J, Shinde M, Chaudhari R, Singh EA. Semi-solvothermal synthesis and characterization of zinc oxide nanostructures against foodborne pathogens. Int J Pharm Bio Sci 2017;8(2):311-315.&#xD;
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	Pawar J, Prakash V, Vinchurka P, Shinde M, Henry R, Mandke Y, et al. Application of Semi-Solvo Thermally Synthesized Zinc Oxide (ZnO) Nanoparticles in Food Technology and Its Characterization. Int J Nanotechnol Appl 2017;11(1):75-80.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pattern of Recurrence and Survival in TNBC - A Retrospective Study Done in a Rural Based Medical College and Hospital of West Bengal India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>64</FirstPage><LastPage>69</LastPage><AuthorList><Author>Santanu Acharya</Author><AuthorLanguage>English</AuthorLanguage><Author> Krishnangshu Bhanja Choudhury</Author><AuthorLanguage>English</AuthorLanguage><Author> Partha Dasgupta</Author><AuthorLanguage>English</AuthorLanguage><Author> Atanu Basu</Author><AuthorLanguage>English</AuthorLanguage><Author> Pinaki Bhattacharyya</Author><AuthorLanguage>English</AuthorLanguage><Author> Sree Krishna Mandal</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Triple-Negative Breast Cancer (TNBC) constitutes patients with estrogen and progesterone hormone receptors negativity, Her 2-neu negativity and variable expressions of Ki67 (proliferative marker), EGFR and CK 5/6 cytokeratins. Standard treatment protocols have failed to improve the overall prognosis and DFS in TNBC, unlike other subtypes. Objective: Our retrospective study aims to identify the TNBC patients treated at rural tertiary medical college and determine their pattern of care and survival. Methods: A single institutional retrospective study was conducted on patients with TNBC subtype, registered at tertiary rural medical college, between May 2012 and April 2017. The study population included female patients, aged 15-70 years, with histology proven carcinoma of the breast, AJCC TNM 7th edition staging I to IV, hormone (ER and PR) and HER-2neu receptors negative, who had undergone surgery, chemotherapy and radiation (curative or palliative), either in neoadjuvant or adjuvant or palliative settings. Disease-Free Survival (DFS) and Overall Survival (OS) curves were calculated using the Kaplan- Meier method. Results: A total of 284 patients were eligible for study analysis. The median age was 45 years. 63.4% of patients presented with T3 or T4 tumour. Similarly, 165 (58.1%) patients presented with nodal disease. AJCC TNM stage II and III combined accounted for 90.1% of patients. 14 individuals had metastases at the time of diagnosis with lung, liver and bones being affected. The 5 years DFS in months was 63.3% with events occurring in 100 individuals. Conclusion: TNBC is an aggressive luminal breast carcinoma with advanced disease presentation, poor outcome to standard conventional chemotherapy and radiation resulting in reduced DFS and OS.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Triple Negative Breast Cancer, HER2 mutation, Rural population</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Breast carcinoma classification has progressed a lot, from older pathological subtypes to receptor-based luminal and now to present micro DNA assay.1,2 According to luminal subtypes, major subgroups are luminal A, B, Her 2 neu enriched and Basal type, which includes Triple-Negative Breast Cancer (TNBC). TNBC constitutes patients with estrogen and progesterone hormone receptor negativity, Her 2-neu negativity and variable expressions of Ki67 (proliferative marker), EGFR and CK 5/6 cytokeratins.3 Unlike worldwide incidence of 15%, TNBC accounts for 31% (95% CI, 27% to 35%) of 7237 Indian patients in systemic review involving 17 studies.4,5 TNBC is mostly found among younger women less than 40 years or women with BRCA1 mutations. Despite being sensitive to chemotherapy, TNBC has a high propensity for early metastases to lung, brain and soft tissue. TNBC patients have a poorer prognosis compared with other molecular subtypes of breast cancer with short disease-free survival.6-10 Choice of chemotherapy has likewise evolved to overcome short disease-free survival from traditional anthracycline-taxane combination to platinum-based regimens to newer PTEN, PI3K pathway regulators.11 Suspected radioresistance in TNBC is probably related to more time available for repair of radiation-induced DNA damage in ER-negative cells.12 However radiation is still advocated on grounds of BRCA1 mutation and its lacking of double-stranded repair. So like the choice of chemotherapy, the role of postoperative radiation remains controversial. &#xD;
&#xD;
The incidence of TNBC worldwide is around 15%. Indian scenario is somewhat highly variable. Sandhu et al. detected the incidence of TNBC as high as 31% among 7,237 Indian patients. In other Indian studies, TNBC incidence varied from 14% to 19.3%. Data on demographic profile, treatment and survival pattern among TNBC patients are limited from the Indian subcontinent, especially from patients of the rural population. Our retrospective study aims to identify the TNBC patients from rural population treated at rural tertiary medical college and determine their pattern of care and survival.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
A single institutional retrospective study was conducted on patients with TNBC subtype, registered at outpatients department at tertiary rural medical college, between May 2012 and April 2017.&#xA0; The study population included female patients, aged 15-70 years, with histology proven carcinoma of the breast, AJCC TNM 7th edition staging I to IV, hormone (ER and PR) and HER-2neu receptors negative, had undergone surgery, chemotherapy and radiation (curative or palliative), either in neoadjuvant or adjuvant or palliative settings. &#xA0;Patients who did not receive any treatment and had received treatment before registration (excepting surgery) at the department were excluded from the study.&#xD;
&#xD;
Data was collected in Microsoft Office Excel spreadsheet Office 2007 after reviewing hospital records. The pattern of recurrence and survival in TNBC was determined using descriptive statistics. Disease-free survival (DFS) in months was defined as the time from completion of treatment of TNBC to first locoregional or distant metastasis or recurrence. Overall survival (OS) in months was defined as the time from diagnosis of TNBC (biopsy was taken) till death. DFS and OS curves were calculated using the Kaplan- Meier method. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
The retrospective single institutional study was conducted between 2012 and 2017.&#xA0; The total number of patients presenting as TNBC was 348, out of which 284 patients who had complete data retrieved from hospital medical records section were eligible for study analysis. The median age of our study population was 45 years, range 29-68 years (Table 1). Majority of patients were in ECOG performance status 2 (65.1%). 63.4% of patients presented with T3 or T4 tumour stage, which shows gross negligence and ignorance to seek treatment at early stages as well as the aggressiveness of the luminal subtype. Similarly, 165 (58.1%) patients presented with nodal disease. AJCC TNM stage II and III combined accounted for 90.1% of patients. At the time of diagnosis, 14 individuals had radiologically proven metastases with lung, liver and bones commonly being affected. None of the patients had synchronous or metachronous bilateral breast carcinoma over the study period. &#xD;
&#xD;
Breast-conserving surgery was possible in only 5.6% of individuals. Modified radical mastectomy was possible in 258 individuals. Toilet mastectomy was done in 4 patients with metastatic disease to relieve pain and bleeding. Neoadjuvant chemotherapy comprising of anthracyclines (doxorubicin &#x2013; cyclophosphamide, 5fluorouracil &#x2013; epirubicin &#x2013; cyclophosphamide) combination was given to 27.3%, i.e 50 out of 183 patients who had received neoadjuvant chemotherapy. Sequential doxorubicin &#x2013; cyclophosphamide followed by docetaxel or combination of Docetaxel - doxorubicin &#x2013; cyclophosphamide regimens were used in 69.4% patients. Unlike 6 patients in the neoadjuvant setting, 30 patients in adjuvant settings received platinum doublets (docetaxel &#x2013; carboplatin combination). Adjuvant radiation was administered in 247 individuals with usual dose regimens of 50Gray in 25fractions. For 14 patients who presented with metastatic disease upfront, palliative chemotherapy regimens used in curative settings were used. Palliative whole brain radiation (n=4) for brain metastases and radiation to bone metastases (n=10) were used (Table 3).&#xD;
&#xD;
Median follow-up of all patients (n=284, at time of diagnosis) was 40 months (calculated by reverse Kaplan Meier Survival analysis).&#xA0; The 5 years DFS in months was 63.0% with events occurring in 100 individuals.&#xA0; 20 patients had an only local recurrence (chest wall recurrence in 5 patients, others lymph nodal involvement). 72 patients had distant metastases. Visceral involvement (lungs, liver, soft tissue, brain) in 50 patients, bones involvement only in 7 patients and combined visceral and bone in remaining. Both locoregional and distant recurrences/metastases occurred in 8 individuals. 5 years OS among 284 patients was 69% (table 4).&#xD;
&#xD;
DISCUSSION &#xD;
&#xD;
TNBC is a diverse luminal breast carcinoma, often considered a subtype of basal variety (75% similarity)&#xA0; characterized by absence of traditional ER, PR and Her-2-neu receptors and expression of Ki67, cytokeratin CK 5,6 and EGFR.1 This had rendered TNBC treatment equally controversial. With no receptors to be blocked, the choice of chemotherapy had ranged conventional taxane &#x2013; anthracyclines to platinum doublets. Among all luminal subtypes, TNBC patients have increased incidence of distal metastases and early recurrences culminating in lower survival. The aggressiveness of TNBC has to lead to genetic studies to identify other possible pathways for carcinogenesis. The Cancer Genome Atlas (TCGA) Research Network using genomic DNA copy number arrays, DNA methylation, reverse phase protein arrays, exome sequencing,&#xA0; microRNA sequencing, and messenger RNA arrays, detected the loss of TP53, RB1 and BRCA1 genes in DNA damage repair mechanism, aberrant activations of phosphatidylinositol 3-kinase (PI3K) signalling pathways and activating mutations in&#xA0;PIK3CA.12-16 The heterogeneity in genetic configurations was also confirmed by Shah et al. who confirmed 12% of cases did not have the driver gene mutation.17 Lehman et al. detected 587 TNBC patients out of 3,247 breast cancer individuals using gene expression and classified TNBC into 6subtypes basal-like (BL1 and BL2), immunomodulatory (IM), mesenchymal (M), mesenchymal stem-like (MSL), and luminal androgen receptor (LAR).18 However, in 2015, Burstein et al. reclassified TNBC into 4 molecular subtypes: luminal-AR (LAR), mesenchymal (MES), basal-like immune-suppressed (BLIS), and basal-like immune-activated (BLIA).19&#xD;
&#xD;
While advances have been made in the detection and management of TNBC based on newer DNA microassay, the situation in Indian perspective is still dismal. A meta-analysis was done by Sandhu et al. involving 7,237 Indian patients from 17 studies on breast cancer, diagnosed between January 1, 1999, and December 31, 2015. TNBC prevalence was 31% (95% CI, 27% to 35%) which was much higher than the western data.5 Overall prevalence of TNBC was high in the south (34%) and west (31%) of the country unlike in north (28%) and east (30%). The mean age of patients ranged from 43 to 55 years across studies, with a weighted average of age 50 years. The proportion of patients with grade 3 diseases ranged from 16% to75%, with a weighted average of 57%. There was substantial heterogeneity across the studies (I2 of 91.2% [95% CI, 88% to 94%], p-value 0.001).&#xD;
&#xD;
The median age of our study population was 45 years, range 29-68 years. T3 and T4 disease were present in 63.4% of patients. Similarly, 165 (58.1%) patients presented with nodal disease. AJCC TNM stage II and III combined accounted for 90.1% of patients. Similar findings were reflected by Chintalapani et al. who studied TNBC patients in retrospective analysis between 2009 and 2014. A total of 1024 breast cancer patients, TNBC accounted for 198 (19.3%) of all breast cancers. The median age at the diagnosis was 50 years (range, 22&#x2013;78 years). Lymph node involvement in TNBC variety was strongly associated with large tumour size (P&#xA0;= 0.003) and higher tumour grade (p&#xA0;= 0.01). The median follow-up was of 48 months (range, 12&#x2013;88). The authors concluded that TNBC had high and early recurrences evident from 36 (19.1%) patients who had recurrences. Lost to follow up was pretty high at 14%. Visceral metastases were very common with lung recurrences in 52.7% individuals followed by bone (25%) and brain (11.1%). Three-year DFS and OS were 63.2% and 65.6%, respectively. Unlike univariate analysis where nodal status, size of the tumour, and lymphovascular invasion were found to have a significant impact on OS and DFS, only lymph nodal status was found to be significant for DFS and OS (p&#xA0;&lt; 0.001 and&#xA0;p&#xA0;= 0.001, respectively) on multivariate analysis.20&#xD;
&#xD;
In a 16 years long retrospective multicentric study (2002 to 2018), 100 patients out of 711 breast cancer individuals were diagnosed as TNBC. The median follows&#x2013;up time was 11.2 years. TNBC was detected at the much younger median age of 34 years. The left breast was involved in 50% of patients with 2% having bilateral disease. Metastasis was present in 10% of the TNBCs with lungs as the most affected organ (7%)by bone (3%). Majority of the patients were in stages 2 and 3. 85% received adjuvant chemotherapy and 15% received neoadjuvant chemotherapy. Modified radical mastectomy was done in 80% of the patients. Breast-conserving surgery was done in 20%. 45% received radiotherapy. The relapse rate was 5% with 6% alive with disease and 77% alive with no recurrences.21 In our study de novo metastases was detected in 4.9% of patients. The 5 years DFS in our study was 63.0% with events occurring in 100 individuals. 20 patients had an only local recurrence (chest wall recurrence in 5 patients, others lymph nodal involvement) with 72 patients had distant metastases only and others (n=8) with both locoregional recurrences and distant metastases. &#xD;
&#xD;
In a previous study from the same hospital, co-authored by us, recurrence pattern and survival among TNBC patients were analyzed from April 2010 to March 2015. The median age in 2010-2015 study was 47years (range 22-72 yr). DFS at 3 yrs was 64.43% and OS was 75.73% with 35.14% patients developing disease progression during the first 3 yrs after primary treatment. 5 yr DFS was 61.08% and OS was 71.54%.22 In our present study we had analysed 284 patients out of 348 TNBC patients. The analyzed sample population had increased from 239 in 2010-2015 to 2012-2017 study. This reflects higher pathological testing of receptors of biopsy specimens. Locally advanced disease was prevalent during both study periods, which shows ignorance persisting in our rural population in seeking early advice.&#xD;
&#xD;
Our study has several limitations like it&#x2019;s observational single institutional retrospective design, no separate markers like cytokeratin EGFR, CK5/6 or Ki67 were done in TNBC patients and many patients had sampling error where receptor analysis could not be done to ascertain the luminal subtypes.&#xD;
&#xD;
Conclusion &#xD;
&#xD;
TNBC is an aggressive heterogeneous luminal breast carcinoma with the poor outcome to standard conventional chemotherapy and radiation resulting in reduced DFS and OS. Whether modern targeted drugs linked to other markers like CK5/6 and EGFR improves the survival needs to be studied in future studies.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;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.&#xD;
&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3349</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3349</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Mental Health of Women Teachers Working in Secondary Schools of Mizoram&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>70</FirstPage><LastPage>74</LastPage><AuthorList><Author>Lokanath Mishra</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Mental health is now recognized universally as a shared problem with thought significances for the fitness and welfare of the people. But there is a small kindness paid to the delinquent for the distinct group of people, female teachers working in secondary schools of Mizoram. Objective: This paper is highlighting the status of mental health, work-family conflict and level of anxiety, depression, somatic symptoms and social dysfunction of the women teachers working in secondary schools of Mizoram. Methods: The research has followed the mixed-mode method with quantitative and qualitative approaches. Simple Random sampling procedure was used to select the sample. Five secondary schools of (3 urban and two rural) each district i.e. (5x8=40) 40 schools were selected for the study. Five female teachers who were available on the day of visit from each school i.e. 40x5=200 teachers were selected as the sample of the study. Out of 200 teachers, 100 are above 10 years of teaching experience and 100 are below 10 years of teaching experience. The Mental Health scale by S.P.Anada (2002) was used to collect the data for the above purpose. Results: The study reveals that the women teachers working in private secondary schools and teachers having less experience of Mizoram are mentally unhealthy. Government of Mizoram will take necessary steps for improving the mental health of private secondary school teachers and teachers having less experience. Conclusion: School Guidance and Counselling cell may help to solve mental, psychological and health-related problems of teachers and students. Mental health promotion related workshops, seminar, group discussions and conferences should be organized at the interschool level for promotion of mental health teachers. The government should ask the management of private schools to provide a salary to the teachers at per with government teachers.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mental health, Secondary, Gender, Management, Qualification</Keywords><Fulltext>Introduction &#xD;
&#xD;
Teaching is a human service profession; to teach effectively the teacher must possess sound mental health. The type of school management may also affect the mental health of the teachers in such a way that in a Public (Government) School the salary of teachers is much higher when compared to the salary of Private School teachers and the workload is also heavier. Adequate salary will keep the teachers free from financial worries, which will greatly promote their mental health. Inefficient school management is also responsible for the mental illness of the teachers. &#xA0;Emotionally and mentally healthy people have strategies to cope with difficult situations.1 Teaching is measured to be an appropriate profession for the female because it is considered of not possessing too much workload and at the same time it helps women to combine roles in workplace and family with such low level of conflicts.2 Furthermore, it is revealed that the teaching profession possesses certain characteristics, such as a low level of career commitment and more time available to devote to family, making it an ideal profession for women. Ironically, several studies show that most of the female teachers are not able to separate their professional role and role in family effectively.3 They feel that their role as a teacher and as a mother at the same time is not relaxed and pleasant. Even some female teachers mention that they must do four jobs at the same time. In some recent study, it was established that teachers are motivated more by intrinsic rewards like self-respect, accountability and intelligence of achievement, than by extrinsic rewards like monthly salary and other financial assistance.4-6 Mental health denotes the occupied and pleasant-sounding functioning of our total personality as well as spiritual well-being.7 Teachers&#x2019; mental health and wellbeing are important for the social and emotional wellbeing of their pupils. High levels of work-related stress are linked with a range of physical and mental health problems.8 Yet, the teaching profession is commonly reported as one of the most stressful occupations.9&#xD;
&#xD;
A &#xA0;little attention is paid to the problem of female teachers in working in secondary schools of Mizoram. Statistics showed that no of female teachers in secondary schools of Mizoram is 1541. Female teachers were playing a more and more important role in secondary schools of Mizoram. It was well accepted in Mizoramthat teacher was one of the most glorious occupations. It was necessary to analyse rationally and thought highly about their mental health of women teachers working in secondary schools of Mizoram. So, keeping in mind the importance of mental health of women teachers working in secondary schools of Mizoram the researcher is interested to take the project.&#xD;
&#xD;
Material and Methods&#xA0; &#xD;
&#xD;
The research has followed the mixed-mode method and has incorporated quantitative and qualitative methodologies to study the mental health and work-family conflicts in women secondary school teachers of Mizoram. Simple Random sampling procedure was used to select the sample. Five secondary schools of (3 urban and two rural) each district i.e. (5x8=40) 40 schools were selected for the study. Five female teachers who were available on the day of visit from each school i.e. 40x5=200 teachers were selected as the sample of the study. Out of 200 teachers, 100 are above 10 years of teaching experience and 100 are below 10 years of teaching experience. &#xD;
&#xD;
Ethical clearance has been taken by the researcher from the Departmental Research Committee. The researcher has used both the Primary and Secondary data for this piece of research. The researcher has collected both the Primary and Secondary data. As regards the secondary data, the investigator went through different research reports, journals and magazines on the mental health of secondary school teachers written by different authors for the development of the tools. The researcher visited the library of national importance. &#xD;
&#xD;
To find out the mental health of women teachers, the RCE, Mental Health Scale (MHS) was used which has highly reliable and validity.10 The tool is consisting of 60 items in Likert scale which measures six dimensions namely self-concept, the concept of life, perception of self-amongst others, perception of others, personal adjustment and record of achievement. The scoring was done as per the descriptions given in the manual of the standardized scale. The interview schedule was used to collect the data about work-family conflict of women teachers working in secondary schools of Mizoram. Five Focus Group Discussion (FGD) was also conducted for the study. The data was analysed both qualitatively and quantitatively. The descriptive as well as inferential statistics was employed for analysis of data. This study was approved by the Institutional Human Ethics Committee of Mizoram University. The data was collected with the help of the research assistants from the different secondary schools of Mizoram. The women teachers are very much cordial to the research assistants for answering the questions.&#xA0;&#xA0; &#xD;
&#xD;
Data were compiled and analysed using the statistical software Statistical package for the social sciences (SPSS version 21.0, IBM Corp, Armonk, NY, USA), and numerical variables are presented as mean, standard deviation, median, and interquartile range. Difference between mean scores was tested using the analysis of variance with t-test analysis. P &#x2264; 0.01 was considered statistically significant.&#xD;
&#xD;
Results &#xD;
&#xD;
From the analysis regarding Mental Health of Women Teachers of Secondary School of Mizoram the following observations have been made. Most of the respondents i.e. 42% were in the age group 31-45 years, 40% are in the age group of 36-40 years. Most of i.e. 92% of teachers of secondary schools are married whereas only 6% are unmarried and a negligible percentage are widows. Sixty-two percentage of secondary school women teachers having B.A/B.Sc. B.Ed. qualification whereas 26% are untrained and 12% are having trained postgraduates. Secondary school women teachers of Mizoram were mentally healthy. However, 31% of the teachers were mentally unhealthy and needed guidance and counselling for mental health. A few Women teachers have excellent mental health, 11% have very good mental health, 18 %have good mental health, 23 % are above average in mental health, 29.5% are average, 7.0% are poor, 5.5 % have very poor mental health and 1.0% have weak mental health. The Women teachers from Urban Secondary Schools of Mizoram have good mental health than the Women teachers from Rural Secondary Schools. Training does not affect the mental health of women teachers of Mizoram. The Women teachers of Government Secondary Schools have good mental health than Women Teachers of Government aided and Private Secondary Schools. Government secondary school women teacher shows mentally healthy on the concept of life. Private School women teacher has a better understanding of the concept of life. The government secondary school teachers have good mental health in the perception of other components. private school women teachers are showing more record of achievement. Women teachers having below ten years of teaching experience have more mental health on self-concept component. Women secondary school teachers having below 10 years of teaching experience are more mentally healthier than those women secondary school teachers having above 10 years of teaching experience with regards to their perception of others. Women teachers of above 10 years of teaching experience are more mentally healthier than those teachers of below 10 years of teaching experience with regards to their feelings of adjustment. Women teachers having above 10 years of teaching experience are more mentally healthier than the women teachers having below 10 years of teaching experience with regards to their perception of achievement. Most of the respondents said that the family issue creates a problem in teaching work in the school. Sometimes they show anger among the students and other teachers. Sixty-two per cent teacher said that the in-laws are not supporting overtime work in the school. Some time they teased to them so that they are feeling mentally unhealthy in the family. Eighty per cent of the teachers expressed that the conflicts in family are due to the interference of husband in the salary of the working women. Teachers working in the Government institutions are staffed public servants and they do not fear from dismissal. On the other hand, teachers working in private institutions work on contract and their contracts are renewed every year upon their performances. Thus, these teachers should work hard, be successful and improve themselves to be able to continue working in the same school. This situation caused more work-family conflicts for teachers working in private schools. The mothers of school-going children talked about the increase of the pressure from schools for parents to get involved in school activities and increase real-time engagement with their children in the class and outdoor activities. The autocratic behaviour of some of the Headmasters in private schools who behave only in an official manner and impose their orders on teachers without demonstrating an appreciation of services rendered is the cause of mentally unhealthy&#xD;
&#xD;
To accomplish the objectives of the study the t-test was applied to study significant differences of secondary school women teachers&#x2019; mental health concerning their experience and management type of schools. The results are given in the following tables. From Table 1 it was observed that there is the difference in mean scores of mental health of women teachers of private and government schools. To find out the significance of the difference component-wise analysis of scores of teachers of both the private and government was made.&#xD;
&#xD;
&#xD;
&#xD;
Table 2 indicates that there is a significant difference in respect of self-concept, perception of others and record of achievement. It was also observed that in each component government teachers show superiority as compared to their private school teachers. On perusal of the above table, it was evident that obtained value of &#x2018;t&#x2019; ratio in case of management variation which was 3.23 was greater than the tabulated value (2.60) at 0.01 level of significance. Hence the &#x2018;t&#x2019; ratio was significant.&#xD;
&#xD;
&#xD;
&#xD;
The study conformed with earlier studies done by11,12 who have shown gender as an intervening variable for the mental health of teachers. The &#x2018;t&#x2019; ratio in case of qualification variation (1.94) was lesser than the tabulated value (1.97) at 0.05 level of significance. Hence the &#x2018;t&#x2019; ratio in case of the concept of life was also not significant. &#xD;
&#xD;
&#xD;
&#xD;
Hence the &#x2018;t&#x2019; ratio in case of school type variation was significant. The above table also revealed that Government school teachers have higher mental health as compared to teachers of privately managed schools. The study conformed with earlier studies done by13-16.&#xD;
&#xD;
DISCUSSION &#xD;
&#xD;
&#xA0;As there are still many untrained women teachers in schools, teachers should be encouraged to undergo in-service training. The school management should arrange in-service training for teachers to refresh their knowledge of content and teaching methods. The school must have a School Guidance and Counselling cell which is functioning to caters to the needs of the teachers and students. The School Guidance and Counselling cell will help to solve mental, psychological and health-related problems of teachers and students. Mental health promotion related workshops, seminar, group discussions and conferences should be organized at the interschool level then only teachers can benefit. According to17 emphasized the framework for school mental health services must be promotional, preventive, conservative and curative and should include goals, objective, concrete activities and services which prevent problems from arising and through this approach promote teacher&amp;#39;s well-being. As per results revelations, government schoolteachers show better mental health inventory scoring in comparison to private school teachers.18 &#xD;
&#xD;
The importance of mental health promotion should be to focus throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood. There is an urgent need in the reduction of workload in the secondary schools of Mizoram. Not more than 33-36 periods per week should be given to a teacher to teach. Besides other duties should be equitably distributed among all the members of the staff. Secondary Schools whether run by a government or by private bodies of Mizoram should work on democratic principles. There should be no place for favouritism or flattery in schools. women teacher should keep busy themself in teaching work and should try to see they&#x2019;re on limitations and adjust themself to the environment. School authority should not assign overtime work to the women teachers. The government should try to avoid to assign general duties like census and election to women teachers. To alleviate the conflicts of teachers, individual and organisational strategies are needed. Teachers should learn how to cope with stress, pay attention to protecting physical and mental health and strike a balance between family and work life. As the head of the school, school headmaster should provide a positive working environment for women teachers, support teachers in solving the problems experienced in the working environment and also motivate them. The salary of the private school teachers must be paid by the private management as per the government rule and structure. Schools should provide the physical environment and social conditions required to encourage and help women teachers select and participate in different activities.19 &#xD;
&#xD;
There should be equitable sharing of resources in the school organisation to avoid dissatisfaction among the women teachers. Local Church, YMA should participate for counselling and giving an inspirational and motivational talk to the secondary school women teachers of Mizoram. Thus, the mental health of women teacher is essential to know their abilities, coping with normal stresses of life, can work productively and to make a contribution to the learning community. Therefore, the mental health of the women teachers should be enriched to make the students face the difficulties persisting within the society.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The present study exposes the mental health condition of our secondary school women teachers and this study have implications for school management members, policymakers, school authorities and administrators. The teachers of private schools differ significantly in mental health in comparison to government school teachers and therefore the school management and higher education authorities should look into the matter seriously and should provide necessary motivation and emphasis should be given on the development of self-confidence of teachers to stabilize their mental health. Attempts should be taken to address the difficulties of teachers working in private schools. Emphasis should be given for creating a better organizational climate which is mainly hampered due to groups, internal rivalry and narrow politics among staff in schools. School administrators and higher authorities should arrange faculty improvement programmes for teachers. Ample opportunity should be given for research work for the professional growth of teachers.&#xD;
&#xD;
Acknowledgement- The researcher acknowledged the research assistants and the women teachers of secondary schools of Mizoram who have helped a lot in the collection of data for the study. Further, the researcher acknowledged the National commission for women, New, Delhi who have financed for this project.&#xD;
&#xD;
Conflict of Interest &#x2013; The research has no conflict of interest.&#xD;
&#xD;
Source of Funding &#x2013;This project was funded by National Commission for women, government of India, New Delhi&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3350</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3350</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Knowledge, Attitude and Beliefs on Single Visit vs Multi-Visit Endodontics of Dental Practitioners&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>75</FirstPage><LastPage>77</LastPage><AuthorList><Author>Sudha Mattigatti</Author><AuthorLanguage>English</AuthorLanguage><Author> Shalini Srinivas</Author><AuthorLanguage>English</AuthorLanguage><Author> Chaitanya Shriram Metkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Tanay Kothari</Author><AuthorLanguage>English</AuthorLanguage><Author> Sagar H Mohkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Durgaraju Macha</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Along with innovations in techniques, instruments and materials, the root canal treatment has become more predictable and result oriented in endodontics, however, it almost depends on the knowledge, attitude and skills of the dentists too. Objective: To investigate the knowledge, attitude and beliefs of the dental practitioners on single vs. multiple visit endodontics in western Maharashtra. Methods: A well standard questionnaire was framed and distributed among 150 dentists practising in and around Karad city, Maharashtra (including general dental practitioners and specialists working in the private sector). The data were analyzed by the no of responses as a percentage of total responses to get the understanding of the majority opinions of participants. Results: Among the dentists many of them (64 %) prefer multiple visits, many of them consider a single visit is a speciality job (73%). One-third of them use the old technique of Working length determination, Biomechanical preparation, Obturation and radiograph method (45.3 %). Few, mostly younger generation (45 %) they adopted recent innovations and types of equipment and techniques with reduced time to do Root canal treatment and believe the success of single visit endodontics is more and predictable compared to multi-visit. Conclusion: The younger generation is keen on adopting the new techniques and materials and equipment to perform root canal treatment, preferring single visit over multiple visits. This survey also showed, continuing educations and hands-on courses play an important key role in motivating and adopting such practices among general dental practitioners.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Endodontics, Dental practitioners, Knowledge, Attitude, Beliefs, Root canal treatment</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Endodontics is one of the fastest-growing disciplines in the dentistry. Along with innovations in techniques, instruments and materials, the RCT has become more predictable and result oriented. But, it almost depends on the knowledge, attitude and skills of the dentists too. Root canal treatment is technically demanding, and it fails when treatment falls short of acceptable standards. To provide patients with the most recent and predictable treatment planning, patients must be well informed about the outcome of endodontic treatment. It is important to acknowledge that outcome of root canal treatment is dependent not only on specific factors like root canal infection, the complexity of root canal morphology, but is also very much influenced by less specific, more distinct causes such as dentist&#x2019;s skills and attitudes.1,2&#xD;
&#xD;
Studies have shown that most clinicians complete their RCT in multiple visits, hoping for less flare ups.3-5 At the same time, various researchers have been reported to advocate for single visit root canal treatment(RCT)as results are more predictable.6-9 Various studies have been done on postoperative pain analysis among single or multiple visit endodontics but none of the surveys is done in India to test the single vs. multiple visit endodontics among the dental practitioners. So, the primary purpose of this survey was to know the attitude, knowledge and believes of dentists among western Maharashtra population regarding single vs multiple visit endodontics.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Among 150 dentists includes both general dental practitioners and specialists, the survey was conducted using a questionnaire. The questionnaire was written in English, was used which involved no of visits for the root canal, preparation, technique, working length measurement, irrigation technique, radiography technique, isolation technique, obturation technique, any methods to upgrade the knowledge. Around 26 questions prepared including above-related matter and answers were recorded, the percentage was calculated depending on the number of participants and answers. The percentage was shown in table. &#xD;
&#xD;
The data were analyzed by the no of responses as a percentage of total responses to get the understanding of the majority opinions of participants.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Out of the total, 150 participants majority were males (74.66%), wherein, most of them (78%) were under the age of 45 years, rest&#xA0; (40%) were under the age of forty. A large number of dentists were seen in the younger aged group. as well as more clinically experienced group (66.67%). Most of the participants (90.6%) were general practitioner. About 34.6% of the participants read scientific journals monthly, with 18.66% doing so every week. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Most of the participants (64%) have preferred multiple visit practice. Hence, more (53.33%) failure rate according to participants is single visit endodontic. They (57.33%) felt that post-operative pain is more with single visit endodontic. About 73.33% of participants felt that single visit endodontic is the job of a specialist. Most of the participants (61.33%) used IOPA techniques of the image taken. One-third of participants used suction isolation method, while 40% used rubber dam method and remaining 26.66% asked the patients to spit every time. &#xD;
&#xD;
One-third of participants used radiographs method for length determination, while 46.66% used apex locator method and the remaining 20% used tactile method. Most of (80%) are used rotary files techniques of preparing root canal and 73.33% are used sodium hypochlorite irrigating solution. About 60% of participants used the syringe technique for irrigation. 81.33% of participants use zinc oxide eugenol sealers and remaining 16.66% use resin-based sealer. GP obturation material used by 88% and paste material by 12%.&#xA0; About 45.33% are used single cone technique of obturation and others (54.66%) are used multiple cone technique.&#xA0;&#xA0; &#xD;
&#xD;
&#xA0; About 48% of participants are confident about single visit endodontic. Most of (93.33%) preferred multi-visit endodontic in cases with the calcified canal, also 57.33% preferred patient without apical lesion. Most of the participants (46.66%) have upgraded the recent advances and techniques of the root canal by CDE programs, 28% by undergraduate curriculum and 25.33% by hands-on courses. 46.66% of participants have attended the CDE programs/ training courses for a single visit. Most of (58.66%) participants felt that for flare-up is more with multiple visits. About 82.66% of participants are preferred to refer the patient to the speciality clinic if the case is complicated.&#xA0; &#xD;
&#xD;
As there is a growing and interesting debate between single vs multiple visit endodontics, since decades, we were curious to know the results. All the participants actively participated and gave of positive response for the questioner, the topic was also one of its kind and interesting and informative and relevant. Studies have shown that most clinicians completed their RCT in multiple visits, this is in consistence with our study.9,11 General practitioners thought that multi-visit causes fewer flare-ups. But at the same time because of growing technology and techniques from last few decades more than 70% clinicians, researches have been reported to advocate the single visit RCT, as there is no difference in the outcome between the single and multiple visit.10,11 &#xD;
&#xD;
Most of the published studies shown post-operative pain and postoperative flare-ups rates being measures used for the evaluation of success or failure of RCT. most of the studies concluded there is no statistical significance between the single and multi-visit. Some studies have shown that Multi-visit post-operative pain is more compared to single visit.12.13 Postoperative pain associated with a 1-appointment root canal is generally the same as postoperative pain associated with multiple-visit treatment.14 Some studies have shown that Multi-visit postoperative pain is more compared to single visit.15 Some studies have shown that multi-visit root canal treatment protocols were more effective in reducing endotoxins than single visit root canal treatment protocols.16,17&#xD;
&#xD;
Studies have shown that single visit endodontics is better than multiple visits in comfort to patient in terms of injections, anxiety, frequent calls in terms of no of frequent dressing, no contamination, no injection. Studies have shown single visit RCT can be varied to be a viable option for patients, irrespective of age, sex and preoperative symptoms, vital or non-vital tooth, apical lesions. (pain, tenderness on percussion and periapical- radiolucency).12 Multiple visit RCT involves repetition of several stages at each visit like LA administration isolation with a rubber dam, access preparation, removal of more dentine by biomechanical preparation. Single-visit not only reduces time but also cost-effective and improve patient compliance and practice management. Only some cases where severe curvature, calcification, broken instrument, perforation, and patient with psychosomatic disorders we have to go for multiple visits. Otherwise, there is no significant difference between single and multi-visit outcomes. With the advent and innovations in technology from start like access, radio-graph, working length measurement with apex locators irrigation with endo-activator with irrigating solutions like warm sodium hypochlorite with improved technique in BMP using various rotary instruments and obturation with corresponding filling material, the endodontics is made easy and time saving.18&#xD;
&#xD;
A minimum degree of expertise and continuing education must be promoted in graduates after their time of dental education if ethical and quality clinic practices are to be strengthened. But at the same time awareness about the same is very much essential through continued education and hands-on courses and the conferences.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In the last decade, the dental practice has implemented numerous new ideas, procedures and tools. The plurality of survey questions was focused on traditional diagnosis, planning and securing approaches, reflecting a range of modern equipment and technologies. The research demonstrates the value of developing higher-quality preparation or dental preparation for clinicians. Lenses including surgical microscopy were seldom utilised during the training of dental procedures, for updating the knowledge of dental practitioners.&#xD;
&#xD;
FUNDING SOURCES:&#xA0; Krishna Institute of Medical Sciences Deemed To Be University, Karad.&#xD;
&#xD;
CONFLICT OF INTEREST:&#xA0; Nil.&#xD;
&#xD;
ACKNOWLEDGEMENT:&#xD;
&#xD;
We are grateful for the support which we received from the Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Krishna Institute of Medical Sciences Deemed To Be University, Karad, Department of Oral Medicine and Radiology, Panineeya Institute of Dental Science &amp; Hospital, Hyderabad, Department of Conservative Dentistry and Endodontics, SDK Dental College and Hospital, Nagpur, Department of Conservative Dentistry and Endodontics, M.A.Rangoonwala College of Dental Sciences and Research Centre, Pune, Department of Conservative Dentistry and Endodontics, Dr. R R K Dental College and hospital Kaneri, Akola and Department of Prosthodontics, Dr HSRSM Dental College &amp;Hospital,&#xA0; Hingoli.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3351</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3351</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Patterns of Anaemia in Elderly Patients in Relation with RBC Indices&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>78</FirstPage><LastPage>82</LastPage><AuthorList><Author>Munesh</Author><AuthorLanguage>English</AuthorLanguage><Author> Vani Mittal</Author><AuthorLanguage>English</AuthorLanguage><Author> Sunil Arora</Author><AuthorLanguage>English</AuthorLanguage><Author> Raj Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Anaemia, one of the most common manifestations seen in elderly patients is still a concern in the modern world as its prevalence increases with age. Higher mortality rates have been found in elderly who had anaemia in comparison to those who didn&#x2019;t. Anaemia greatly influences the quality of life, ability to recover from illness and functional capability. Objective: To study the patterns of anaemia in elderly patients in relation with RBC indices. Methods: An observational study of 100 elderly patients (visiting hospital including both OPD and IPD) with anaemia was done for four months in a tertiary care hospital to determine the aetiology behind the anaemia with the help of RBC indices. Results: Anaemia was categorized based on haemoglobin levels and patterns on the peripheral blood smear. It was found that in the elderly population most common pattern of anaemia was microcytic hypochromic due to deficiency of iron and high prevalence of chronic diseases. More than 50% of the patients in the study had moderate anaemia with RBC indices showing a wide range of values due to different etiological factors leading to anaemia. Conclusion: Anaemia is one of the major concerns in elderly as it accentuates morbidity and mortality and needs to be investigated thoroughly as most of the cases are treatable and only a few have unexplained anaemia. This being a hospital-based study only a few people could be evaluated, and so screening programs should be encouraged on a community level for older persons.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Anaemia, Total blood count, Red blood cells, Hematocrit</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Anaemia is defined as a decrease in the number of red blood cell (RBC) or haemoglobin (Hb) which results in lower capability of blood to carry oxygen.1 Anaemia in the geriatric age group is a great concern as it increases the risk of mortality and morbidity.2 The census report of 2011 shows the population of elderly as 8.1% of the total population in India and it is expected to increase to 19% by 2050.3 Anaemia is not related with ageing in elderly but it is associated with poor quality of life, poor performance status, dementia, depression and reduced mobility and it worsens the co-morbidities like cardiovascular disease and other conditions.4-8 The United Nations has accepted age of 60 years or above to define an &#x2018;elderly&#x2019; or older person.9 According to the World Health Organization (WHO), the prevalence of anaemia in people of age group 60 years or older was found to be 23.9% i.e. 164 million people affected across the globe.10 &#xD;
&#xD;
Anaemia is defined by WHO as a haemoglobin concentration of </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3352</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3352</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Oral Health Conception in Parents of Indian Cerebral Palsy Children: A Self administer Questionnaire Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>83</FirstPage><LastPage>87</LastPage><AuthorList><Author>Sanat Kumar Bhuyan</Author><AuthorLanguage>English</AuthorLanguage><Author> Ruchi Bhuyan</Author><AuthorLanguage>English</AuthorLanguage><Author> Sidhant Bhuyan</Author><AuthorLanguage>English</AuthorLanguage><Author> Akankshya Sahu</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Special child are at high risk of chronic physical, developmental, behavioural conditions and they necessitate more amount of oral health treatment required by normal children. Objective: To evaluate the oral health conception Amida carers of cerebral palsy(CP) children. Methods: A self-administered questionnaire study of 99 carers of CP children&#x2019;s were registered. The survey was conducted in SVNIRTAR Olatpur, Cuttack, Odisha, India. Questions based on sociodemographic and conception and attitudes of carers towards oral health care. Results: The mean age of the carers was 40 years. 57.6% were female and mothers of the CP children. 42.4% were female and 33.3% of them were fathers of the children. The major oral health issues were bad breath (62.6%), decayed (64.6%), missing (60.6%), filled (56.6%), malocclusion (70.7%), and the severity of cerebral palsy Class I-III was seen in 74.7% of the children followed by Class IV-V in 25.3%. 32.3% were communicated verbally, 64.4% were non-verbally and 3% had no effective communication. 57.6% had poor oral health followed by 36.4% had moderate and 6.1% had good. Clinical treatment need revealed was an extraction of permanent teeth (50.5%), followed by filling (30.3%), pulpotomy and sealants primary teeth were 4% each, space maintenance (3%), fluoridation (2%), extraction of primary teeth (1%), all of the above treatment (3%) and no treatment required (2%). 66.7% of carers thought their children had medical problems where 33.3% thought oral health issues. Around 89.9% of carers used a toothbrush to clean the teeth where only 2% used an electrical brush and 8.1% used their fingers. Conclusions: Creating awareness among carers about tooth brushing and other factors and to make dental treatment more accessible may help to upgrade the oral wellbeing of special care needs children.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Carers perception, Oral health, Dental treatment, CP children</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Knowledge frames the basis for most human activities and practices; and those with a better degree of information are relied upon to making more suitable conclusions and practices. Parents play a vital role in giving knowledge to their kids and the development of their habits and practices associated with good health. This is imperative in the case of mentally and physically challenged children, where parents take the maximum decision for them including both dietary habits and oral hygiene. Oral health is defined by one&#x2019;s general health, as it influences someone&#x2019;s capability to sense taste, smell, touch, chew, swallow, bite, speak, and smile.1 Child with special health care needs (CSHCN) has a high risk of chronic physical, developmental, behavioural conditions and they necessitate more amount of oral health treatment required by normal children.2 Generally CSHCN has poor oral status and dental caries, periodontal diseases, decayed teeth, missing teeth, delayed of both primary and permanent teeth, etc are frequently seen in this group of children.3&#xD;
&#xD;
Cerebral palsy (CP) is a neurodevelopmental condition including a bunch of imperishable disorders of movement and position which affects the normal activity of the developing brain of an infant.4It is a non-progressive and non-communicable disorders5to be found in around 2-2.5 per 1000 live births.6 There is a high commonness of orofacial motor dysfunction of CP, which is normally created disturbances in sensation, communication, behaviour, and perception of CP patients and also children with CP be affected by multiple issues and various probable disabilities including mental health problems, difficulties in feeding, losses hearing and weakvisualization.4&#xD;
&#xD;
Evidence is insufficient worldwide about the oral wellbeing conception in carers of CP children. In speedily changing socioeconomic situations; continuously observing and evaluating the CP carers regarding oral wellbeing conception is more essential in the present date. The objective of this survey is to assemble the most recent data on the oral wellbeing knowledge of CP patients carers and also raise awareness among their parents towards pediatric dental care and treatment.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The survey was a self-administered questionnaire and managed to gather suitable details about CP patients and their carers. The survey was conducted by inSVNIRTAR Olatpur, Cuttack, Odisha, India. Ethical clearance was obtained from the institutional ethics committee. Carers of all CP patients enrolled in the centre and each carer was given an information sheet. Awareness of dental hygiene and dental caries management and different aspect of oral and dental health would be evaluated. The data obtained were recorded in an MS Excel sheet and a comprehensive analysis was done and results were formulated. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
Demographic characteristics&#xD;
&#xD;
The study population comprised of 99 carers of CP children and the outline of involved carers is given in Table 1. The mean age of the carer was 40 years and half of the carers were in between 30-50 years. 57.6% of the carers were female where 42.4% were male and all-female were mothers of the children. Of these male parents, 33.3% were fathers of the children, 5.1% had any other relation and 4% had no family relationship with the children.&#xD;
&#xD;
Some characteristics of CP patients are described in Table 2. The most frequent oral health issues were bad breath (62.6%), decayed(64.6%), missing (60.6%), malocclusion (70.7%), and the severity of cerebral palsy i.e. Class I-III was found in 74.7% of the kids followed by Class IV-V in&#xA0; 25.3%. While 32.3% were communicated verbally, almost&#xA0; 64.4% were non-verbally and 3% had no effective communication. Non-verbal communication means communicated to the patients by some sign language, use of pictures and cards, or writing. Oral health index (OHI) of patients showed that&#xA0; 57.6%&#xA0; had poor oral health followed by 36.4% had moderate and 6.1% had good (Figure 1). &#xD;
&#xD;
Consequently, the most frequent professed clinical treatment need revealing was the extraction of permanent teeth (50.5%), followed by filling (30.3%), pulpotomy and sealants primary teeth were 4% each, space maintenance (3%), fluoridation (2%), extraction of primary teeth (1%), all of the above treatment (3%) and no treatment required (2%) (Figure 2).&#xD;
&#xD;
A greater percentage of carers considered that their CP patients had medical complications and dental problems. About 66.7% of carers thought that their children had medical problems where 33.3% thought oral health issues (Figure 3).&#xD;
&#xD;
Tooth cleaning material is the most important aspect of CP patients. Picture 4 showed that approximately 89.9% of carers used a toothbrush to clean the teeth where only 2% used an electrical brush and 8.1% used their fingers (Figure 4).&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
CSHCN needs much care than normal children. They have poor oral health index, starting from nutrition to facial esthetics and overall physical as well as mental development. They are completely dependent on carers, whose attitudes and knowledge are much important in dispensing special care. In this survey, carers were dominatingly female and this finding is similar to the results of prior investigations on knowledge of carers.7,8,9 Due to this woman are remarked as primary carers of children.10,11&#xD;
&#xD;
The major oral health problems were bad breath (44.6%) and decayed (64.6%) in this study, which is consistent with the previous study findings i.e. bad breath (44.6%) and decayed (33.6%).12 Furthermore we found 64.6% communicate non-verbally and 32.3% communicated verbally where 3% were non-communicated. A study by the Australian Research Centre for Population Oral Health reported that 21.3% communicated non-verbally while 30.3% had slight or no active communication.12&#xD;
&#xD;
Pini et al. found Class I malocclusions in 48.9% with bad oral hygiene in 53.2% which is equivalent to this study.13 In this study we found 57.6% CP children with poor oral health hygiene. In the survey of 2011-2012 US National Survey of Children&#x2019;s Health14, 84% of caregivers evaluated their children&#x2019;s well-being as generally excellent while 84% of caregivers also evaluated their children&#x2019;s well-being as generally excellent in the National Survey of Early Childhood Health.15 Another study by Daly et al. reported that 94% of parents rated their children&#x2019;s health as excellent.1Abanto et al. reported that a lesser percentage of carers weighted their children&#x2019;s oral wellbeing as super-excellent.16 In this study the Oral Health Index (OHI) of the CP children rated by their carers was found to be 57.6% as poor, 36.4% as moderate, and only 6.1% as good.&#xD;
&#xD;
CP children are hard to handle and obstinate throughout the dental treatment and administration, so it is too challenging for dentists as it comprises of apprehension, fear from the unknown, and complications in communication.17 Effective communication should take attention while handling CP patients. CP children are abnormal in position and movement, so they need special seating and positioning adjustments. The dental chair should permit proper adjustment to give the CP patient constancy and support.17 Patients with more severity may allow treating on the parent&amp;#39;s lap.18 Dentist should plan the appointment in the morning time to give enough period to CP&#x2019;s parent for an appropriate interaction.19&#xD;
&#xD;
Head position can be maintained in the midline by using Velcro straps and open mouth can be got by using mouth props.20 Steel mirror and finger guard are preferable to minimize the injury. Sharp instruments should be handled very cautiously to avoid any damage and injury.21 CP patients are face difficulties in rinsing mouth properly, so providing water spray and suction devices are necessary. If invasive procedures are needed then sedation and anaesthesia should give to patients for the treatment.22 Face or a nasal mask can be used in the mild case to prevent the nervousness and anxiety linked with IV supplement. Oxygen saturation must be checked by pulse oximetry and the airline must be guarded during procedures. Due to excessive salivation in CP patients and the use of water spray may increase the risk to swallow the dental materials used for the treatment, a throat shield must be used to defend the patient.23 The furthermost noteworthy aspect for effective treatment in CP children is the attitude and technique of dentists and the whole dental team.&#xD;
&#xD;
The lack of awareness on the significance of oral wellbeing among carers is the reason for the severity of oral health conditions in children. Oral health disease co-exists with some disabilities and it is not measured as life-threatening by most of the populations. It is important to create awareness among carers and make intensive efforts to educate them regarding the consequence of dental wellbeing and the role it represents in over-all health.&#xA0; &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The carers were not concern about the oral health problems which later affect the overall health conditions of the child and this might be due to a lack of awareness on the significance of oral wellbeing related to overall health status. The maximum number of the carers were not conscious about the deviancy in oral health and to treat it. So, creating awareness among carers about tooth brushing and other factors and making oral treatment more attainable may help to advances the oral wellbeing of CSHCN. The role of a pediatric dentist is more important to advances oral health problems and to cheer up the carers of CP children. &#xD;
&#xD;
ACKNOWLEDGEMENT: We are thankful to the director of SVNIRTAR centre for allowing us to conduct the survey and data collection. We are also thankful to all parents and children for their cooperation in the study&#xA0;&#xA0; &#xD;
&#xD;
Source of funding- None&#xD;
&#xD;
Conflict of interest &#x2013;None &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3353</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3353</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Marriage on Women with Schizophrenia&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>88</FirstPage><LastPage>93</LastPage><AuthorList><Author>Prakash B Behere</Author><AuthorLanguage>English</AuthorLanguage><Author> Akshata N Mulmule</Author><AuthorLanguage>English</AuthorLanguage><Author> Debolina Chowdhury</Author><AuthorLanguage>English</AuthorLanguage><Author> Amit B Nagdive</Author><AuthorLanguage>English</AuthorLanguage><Author> Aniruddh P Behere</Author><AuthorLanguage>English</AuthorLanguage><Author> Richa Yadav</Author><AuthorLanguage>English</AuthorLanguage><Author> Rouchelle Fernandes</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Marriage is widely believed to be a cure for many types of mental disorders including psychoses, neurosis and hysteria, among the general populace. A common question posed by patients and their relatives to the treating psychiatrist, concerning the effects of marriage, either good or bad on patients suffering from schizophrenia. Keeping in view the enormity of this problem, studies of such are crucial in providing advice to both patients as well as their caregivers. Objective: To study the effect of marriage on women with Schizophrenia in terms of demographic variables, marital characteristics and clinical outcome. Also to study and compare the severity of illness with family functioning and interaction in single and married women with Schizophrenia and to study marital adjustment in married women with schizophrenia. Methods: The participants were assessed using a semi-structured pro forma to record demographic and socioeconomic variables, Brief Psychiatric Rating Scale, Family Assessment Device, Marital Adjustment Rating Scale, Family Interaction Pattern Scale and ICD-10 Criteria for diagnosis of Schizophrenia were administered. Results: There was no significant difference between cases and controls in various sociodemographic variables except occupational background of both groups and a higher number of patients having longer (&gt;10 years) duration of illness in the control group than cases. Chances of exacerbation of illness are more after marriage. Conclusion: Marriage alone does not influence the severity of illness, family functioning and family interaction in both group and marital adjustment in married patients of schizophrenia.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Family interaction, Female, Marriage, Schizophrenia</Keywords><Fulltext>Introduction&#xD;
&#xD;
Assessment of effects of marriage on persons of either gender with schizophrenia has generally been perplexing. Although a plethora of concepts and definitions have been associated with marriage, it is essentially a social process involving two individuals, who pledge to share life on a personal and intimate basis. The physical status and psyche of a person are primarily affected by marriage. Besides satisfying the biological need for sexual gratification in the most socially acceptable way, marriage also aids in achieving a sharp level of personality maturation. In Indian households, a large number of factors like caste regulation, geographical proximity, and astrological compatibility and dowry expectations play a vital role. Marriage is treated as an alliance between two families rather than a union between two individuals. A happy marriage may provide substantial emotionalbenefits.1 Gender differences (cultural scripts and biological susceptibility) are likely to complicate matters. Females with mental illness face multiple psycho-socio-economic problems as compared to males as males dominate over females in the Indian setting.2 For a large number of Indian women, marriage is a once in a lifetime event linked mainly to social approval and glorification. Schizophrenia is a mental disorder characterized by disintegration of thought processes and emotional responsiveness along with other symptoms. It is a disorder that affects the way a person acts, thinks and have an altered perception of reality, often a significant&#xA0;loss&#xA0;of contact with reality. Marriage of a male and female schizophrenia patient is different as it is the female who leaves her family and enters a new one. Once married, the woman is expected to go to her husband&#x2019;s house and leave her parents house, where she is met with new responsibilities and new family members with different temperaments to deal with. If she is on maintenance drugs for psychoses, in-laws insist to find out the reason for medication, therefore she discontinues medications, which lead to relapse. &#xD;
&#xD;
The parental, familial and social factors could often be a disadvantage to the psychiatric patient, more than is normal, leading to difficulties in marrying or sustaining a marriage.&#xD;
&#xD;
In India, studies are scarce concerning this topic; as a result, many questions on this subject remain unanswered.3 The current study is a sincere attempt in this regard and at the closing stages of the study, we will know the influence of marriage on pre-existing mental disorders. Will be able to make out whether marriage is a boon or a bane, a curse or a blessing, to the women with schizophrenia.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A total of 40 women participants with schizophrenia from the psychiatry OPD and IPDof a tertiary care unit of Medical College Hospital in central India were selected for study over one and half year period. Participants who got married after the illness started (the decision of marriage was of either family members or the patient herself), and who fulfilled the selection criteria were approached for participation in the study. They were explained about the nature of the study and after written informed consent/assent, various tools were applied. One key relative informant of every patient was also interviewed. Ethical Clearance was taken from the Institute Ethics Committee for Research on Human Subjects and confidentiality was ensured (DMIMS(DU) /IEC /958). &#xD;
&#xD;
Inclusion Criteria&#xD;
&#xD;
Participants who got married after the illness started (the decision of marriage was of either family members or the patient herself) as Cases and never married as Controls and who fulfilled the selection criteria (ICD-10 Criteria for Research)&#xD;
&#xD;
Exclusion Criteria&#xD;
&#xD;
&#xD;
	&#xD;
	Patients or Relatives who refused consent for the study&#xD;
	&#xD;
	&#xD;
	Patients without proper key informant&#xD;
	&#xD;
	&#xD;
	Patients having co-morbid physical or other psychiatric disorders&#xD;
	&#xD;
	&#xD;
	Patients or informants who were not able to communicate verbally.&#xD;
	&#xD;
&#xD;
&#xD;
Procedures&#xD;
&#xD;
Semi-structured Proforma to record demographic, socio-economic and other variables: &#xD;
&#xD;
Proforma was used to collect socio-demographic variables of patients (both married and never married). &#xD;
&#xD;
Brief Psychiatric Rating Scale (BPRS)&#xD;
&#xD;
The&#xA0;Brief Psychiatric Rating Scale (BPRS) to measure depression, anxiety,&#xA0;hallucinations&#xA0;and unusual behaviour.3 It has 24 Items on the scale. This scale has earlier been used in India. 3, 4&#xD;
&#xD;
Family Assessment Device (FAD) &#xD;
&#xD;
FAD is a 60-item self-report questionnaire with each item scored on a four-point scale (1-4), from &#x2018;strongly agree&#x2019; to &#x2018;strongly disagree&#x2019;.5 &#xD;
&#xD;
Marital Adjustment Rating Scale (MARS)&#xD;
&#xD;
A 20-item scale that measures marital satisfaction. It is a self-administered questionnaire given to the patient developed by Locke H. J., &amp; Wallace K. M. in 1959.6 The Hindi version is used in the study. The Hindi version consists of 20 items which are answered on a variety of response scales. Score range from a minimum of 12 to a maximum of 110. The more the score the better the adjustment perceived.&#xD;
&#xD;
Family Interaction Pattern Scale&#xD;
&#xD;
A Family Interaction Patterns Scale (FIPS) consisting of 6 items about the level of interaction among family members. It is a self-reported questionnaire developed by Bhatti in 1979. 7&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Statistical analysis was done by using descriptive and inferential statistics using Chi-square test, z-test, Pearson&#x2019;s Correlation Coefficient and Odd&#x2019;s Ratio. The data was collected and entries were done using SPSS version 17 software. Graph pad Prism 5.0 and p2 exacerbation in 35% females after marriage in contrast to 82.5% of &lt; 2 exacerbations before marriage).&#xD;
&#xD;
Table 1 shows the comparison of the history of exacerbations of schizophrenia among cases and control group. It is observed that after comparing both the groups, chances of exacerbation of illness are more after marriage. The frequency of exacerbation is more in the married cohort (&gt;2 no of exacerbations in 55% of married patients) and there is an increase in frequency if the patient is off medication in either cohort. Compliance for treatment is poorer in cases than single patients. However, none of either group tends to have good compliance for drugs in long term. (&gt; 5 years duration).&#xD;
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&#xD;
&#xD;
&#xD;
&#xD;
Table 2 shows the opinion of relatives (informants who came with patients) and patients in both group on enquiring &#x201C;Whether marriage can be considered as a cure for mental illness?&#x201D; There was not much difference regarding opinion in relatives (mostly parents) in our study. With most of them considering marriage as a cure for mental illness (40-45% of relatives in both groups consider marriage as a cure for mental illness Vs 32-35% does not consider it as a cure). On the contrary, lesser patients (40%) in the control group in comparison to cases (70%) were of opinion that marriage can be considered as a cure for mental illness. Thus it is a statistically significant difference in opinion.&#xD;
&#xD;
&#xD;
&#xD;
When we compared the association between exacerbations of illness in both groups concerning their educational background, the number of exacerbations in the case group remained similar. On the contrary in control group exacerbations decreased as the level of education increased (clearly evident in the education level of HSC wherein control group &gt;2 frequency of exacerbation are lesser than 2 frequency in case group). This difference is statistically significant in comparison to the case group. (</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3354</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3354</Fulltext></URLs><References>&#xD;
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	Goel N, Behere P. Effect of marriage on clinical outcome of persons with the bipolar affective disorder: A case-control study. Int J Sci Study 2016;4:46-50.&#xD;
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	Behere PB. Effect of marriage on pre-existing psychoses. Indian J Soc Psych 2019;35:10-12.&#xD;
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	Inch R,&#xA0;Crossley M,&#xA0;Keegan D,&#xA0;Thorarinson D. Use of the Brief Psychiatric Rating Scale to measure success in a psychosocial day program. Psych Serv 1997;48(9):1195-1197.&#xD;
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	Overall JE. The Brief Psychiatric Rating Scale.&#xA0;Psychol Rep 1962;10:799&#x2013;812.&#xD;
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	Locke HJ, Wallace KM. Short marital adjustment and prediction tests: Their reliability and validity. Marriage Fam Living 1959 Aug 1;21(3):251-255.&#xD;
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	Epstein NB, Baldwin LM and Bishop DS. The McMaster Family Assessment Device. J Marital Fam Ther 1983. 9:171-180.&#xD;
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	&#xA0;&#xA0; Bhatti RS. Social Diagnosis of Neurosis. Doctoral Thesis; Submitted to Bangalore University, Karnataka. 1979.&#xD;
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	Hopper K, Wanderling J &amp; Narayanan P. To have and to hold: A cross-cultural inquiry into marital prospects after psychosis, Global Public Health: Int J Res Policy Pract 2007;2(3):257-280.&#xD;
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	Behere PB, Sathyanarayana Rao TS, Verma K. Effect of marriage on pre-existing psychoses. Ind J Psychiatry 2011;53:287-288.&#xD;
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	Thara R, Srinivasan TN. Marriage And Gender in Schizophrenia. Indian J Psych 1997;39(1):64-69.&#xD;
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	Thara R, Srinivasan TN. The outcome of marriage in schizophrenia.&#xA0;Soc Psych Psychiatr Epidemiol 1997;32:416-420&#xD;
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	Behere PB, Verma K, Nagdive AB, Mansharamani H, Behere AP, Yadav R, et al. Is Marriage Solution for Persons with Schizophrenia? Med Sci 2020;24(104):2663-2674.&#xD;
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	Akshata NM, Behere PB. Effect of marriage on women with schizophrenia: a preliminary study. J Datta Meghe Inst Med Sci Uni 2016;11(1):24&#x2013;28.&#xD;
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	Ornulv Odegard. New data on marriage and mental disease: the incidence of psychoses in the widowed and the divorced. Br J Psychiat 1953;99(417):778-785.&#xD;
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	Behere PB. Effect of marriage on pre-existing psychoses. Ind J Soc Psychiat 2019;35:10-12.&#xD;
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	Hailemariam M, Ghebrehiwet S, Baul T, Restivo JL, Shibre T, Henderson DC, et al. He can send her to her parents: The interaction between marriageability, gender and serious mental illness in rural Ethiopia. BMC Psychiat 2019;19(1):315.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Clinical Connotation of HPV and Effect of Various Treatment Modalities in Disease Free Survival for the Oropharyngeal Cancer&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>94</FirstPage><LastPage>98</LastPage><AuthorList><Author>Sachin Mohite</Author><AuthorLanguage>English</AuthorLanguage><Author> Vimal Vibhakar</Author><AuthorLanguage>English</AuthorLanguage><Author> Meenakshi Kekre</Author><AuthorLanguage>English</AuthorLanguage><Author> Manish Bhargava</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Oropharyngeal cancer incidence has been increasing all over the world in the last decades despite advances in various surgical and non-surgical therapies for carcinoma treatment. The incidence of other head and neck cancers are decreasing in the world. It is now established that HPV can be contributed as a part of that increase. Objective: The present trial was aimed to investigate if the oropharyngeal cancer incidence increases with HPV, also to evaluate if the proportion of HPV-positive oropharyngeal cancer patients continues to increase, and if different treatment therapies given to patients with HPV-positive oropharyngeal cancer affect prognosis. Methods: The study was carried out 468 cases of oropharyngeal cancer,88 biopsy samples pre-treatment were available and were analysed with the PCRfrom year 2019-2020 hospital records of various cancer tertiary care centres of the Indian continent. Cases positive for PCR and p16 by immunohistochemistry were finally included in the study. Also, the detection of E7 RNA and E6 of HPV-16 was done, as these are the oncogenes that seem necessary for the oncogenesis process and also contribute to the establishment of the fact that HPV can lead to the carcinomas of the base of the tongue and oropharyngeal base. P16 immunohistochemistry was added as the diagnostic criteria to avoid misdiagnosis/overdiagnosis. Results:66 samples were tested positive for HPV 16, one sample for HPV 33, one sample for HPV 59, and one sample for HPV 35. Three samples out of these 88 were not able to be detected for HPV. mRNA expression for E6 and E7 HPV-16 was detected in all samples except 1 sample. The 88 positive patients were treated with radiotherapy (40), chemoradiotherapy (20), or accelerated radiotherapy (28). No difference was noticed concerning the overall survival rates with the three different treatment modalities used. Conclusion: The results showed that the percentage of HPV positive patients with oropharyngeal cancer increased exponentially from one year to another in consecutive years. No difference was noticed about the overall survival rates with the three different treatment modalities used including radiotherapy, chemoradiotherapy, or accelerated radiotherapy.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Oropharyngeal Cancer, Human Papilloma Virus (HPV), Squamous Cell Carcinoma, Radiotherapy, Chemoradiotherapy, Accelerated Radiotherapy</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
A majority of oropharyngeal cancers are squamous cell carcinoma (SCC).1 In south Asian countries, oropharyngeal cancer is the most common cancer.2 The other sites include the base of the tongue, soft palate, posterior pharynx wall, and uvula. Tonsils and base of tongue are both parts of Waldeyers ring and have similarities in histological and morphological aspects with the lymphoid tissue.3 Waldeyer&#x2019;s ring containsSubepithelial and submucosal lymphatic tissues localized in the pharynx. Waldeyer&#x2019;s ring comprises of the tubal, pharyngeal, palatine, and lingual tonsils. Pharyngeal, palatine and lingual tonsils are part of the secondary immune system. They are exposed to the antigens through epithelial layers. These epitheliums are composed of squamous cells. Various microorganisms infect the tonsils including adenoviruses, Epstein-Barr virus, herpes simplex virus, parainfluenza virus, respiratory syncytial virus, and influenza A and B viruses.4,5In the past decade, human papillomaviruses (HPVs) has shown to infect the oropharyngeal epithelium. As seen in the other mucosal sites, HPV has shown malignant transformation in the oropharyngeal epithelial region.6,7&#xD;
&#xD;
Oropharyngeal Cancers are topographically classified according to their site of origin as the floor of the mouth, lip, tongue, retromolar triangle, buccal mucosa, the base of the tongue, hard palate, soft palate, oropharyngeal areas, and pharyngeal folds.8 At diagnosis, oropharyngeal carcinomas are classified on the TNM basis (2002) as the size of the primary tumour (T), presence, size, number, and localization of regional metastasis (N) and presence of distant metastasis (M). Treatment of cancers related to oropharyngeal regions is primarily done using either one or a combination of the mentioned techniques. These techniques include radiotherapy with/without chemotherapy, External radiotherapy, interstitial radiotherapy (brachytherapy), Chemotherapy, Drug treatment (Cisplatin, 5, fluorouracil, and sometimes docetaxel), concomitant chemotherapy (administered during radiotherapy using drugs like cetuximab weekly).&#xA0; Adjuvant chemotherapy is sometimes combined with radiotherapy and may consist of cetuximab or cisplatin. Historically, surgical treatment was more common 20-30 years ago and now administered when other therapies fail to respond.9&#xD;
&#xD;
Human Papilloma Virus (HPV) was first identified in 1949, using electron microscopy. In the 1970s, it was found that HPV is a virus family capable of causing different diseases. To date, more than 120 HPV types have beenidentified10 and around 15 HPV types are known as &#x201C;high risk&#x201D;, due to to their role in cancer development including oropharyngeal carcinoma. HPV infection, in tonsils, is restricted to the basal cells in the epithelial layers of the mucosa. This malignant transformation in the epithelial cells is attributed to the mutations in the p53 gene and on chromosome 9, p21-22 is lost early in carcinogenesis, this leads to the inactivity of the tumour-suppressing gene p16.11Head and neck tumours with the presence of HPV show less expression destructive type of p53 due to its inactivation by the E6 oncoprotein. Earlier palatine tonsils cancer was the most common oropharyngeal carcinoma. However, the incidence of oropharyngeal cancer has significantly decreased in many countries due to the new international classification of disease (ICD) guidelines since 1993.10,11&#xD;
&#xD;
In the early stages, the disease presents no symptoms. Clinical symptoms and signs of oropharyngeal cancer include difficulties in swallowing, pain (especially in the ear), palpable firmness, visible lesions in the tonsil, oropharyngeal asymmetry, neck mass, and unexplained weight loss.12 Patients with oropharyngeal cancer often present with unilateral sore throat or earache but can also present with a neck mass depicting nodal metastasis.10,11 The risk factors for the oropharyngeal carcinomas are smoking and alcohol also is seen in the oropharyngeal cancer patient. With the increase in oropharyngeal SCC, the frequency of smokers has declined, therefore it can be concluded that additional risk factors probably exist for oropharyngeal malignancy.13,14&#xA0;Studies during the recent past suggest that oropharyngeal SCCs may be associated with carcinogenic HPV infections.15&#xD;
&#xD;
It is shown in the literature recently that patients with HPV associated anogenital cancer had a higher risk (4.3 fold) of oropharyngeal SCC.13Also, husbands of HPV associated cervical cancer patients showed an increased risk for oropharyngeal cancer. This suggests that HPV can be involved in oropharyngeal cancer. Further, HPV associated oropharyngeal carcinomas are found in transplant recipients.16,17 The mode of HPV entry to the oropharyngeal tissue is not yet known. Oropharyngeal crypt epithelium is known to capture and process antigens, which might be an entry portal of the virus to the basal cells. Also, oropharyngeal tissue could act as a reservoir of HPV in the digestive tract. This can be attributed to the fact that oral samples collected by oral rinse show much higher HPV levels compared with the swabs. HPV persistence in oropharyngeal tissue is also seen.&#xD;
&#xD;
The present trial was aimed to investigate if the oropharyngeal cancer incidence increases with HPV, also to evaluate if the proportion of HPV-positive oropharyngeal cancer patients continues to increase, and if different treatment therapies given to patients with HPV-positive oropharyngeal cancer affect prognosis.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The study was carried out 468 cases of oropharyngeal cancer, 88 biopsy samples pre-treatment were available and were analysed with PCR from the year 2019-2020 hospital records of various cancer tertiary care centres of the Indian continent. Following data for the patients included in the study was recorded: &#xD;
&#xD;
1) Demographic Data of the patient: a number for identification of the subject, age, sex, address.&#xD;
&#xD;
2) Malignancy status data: tumour site, Diagnosis basis, diagnosis date, histological type, reporting pathology, tissue specimen.&#xD;
&#xD;
3) Follow-up record: death, cause of death.&#xD;
&#xD;
To assess the prevalence of the HPV, all the patients diagnosed with the oropharyngeal squamous cell carcinoma between the mentioned periods were identified using the hospital data. For all the included patients, pretreatment biopsy samples were collected to be analyzed with PCR, and tumour characteristics were also recorded, 88 samples were available. Out of the included 468 patients, subjects who were confirmed with the cancer diagnosis via PCR and positive for p16 by immunohistochemistry were finally included in the study. Demographic data, clinical data, and the follow-up data were then noted from the medical records.&#xD;
&#xD;
For the detection of HPV DNA, PCR analysis was done. Also, the detection of E7 RNA and E6 of HPV-16 was done, as these are the oncogenes that seem necessary for the oncogenesis process and also contribute to the establishment of the fact that HPV can lead to the carcinomas of the base of the tongue and oropharyngeal base. P16 immunohistochemistry was added as the diagnostic criteria to avoid misdiagnosis/overdiagnosis. &#xD;
&#xD;
For the detection of DNA, tumour sections were embedded in paraffin after fixing in formalin. The presence of HPV and its type in samples was detected using PCR using the manufacturer&amp;#39;s directions. All PCR samples were stained with ethidium bromide dye to aid in visualization. &#xD;
&#xD;
E6 and E7 mRNA was also analyzed to detect if HPV found was active transcriptionally. RNA extraction was done from the oropharyngeal tumour sections embedded in the paraffin using the kit for RNA isolation (as per the instructions by the kit manufacturer). Samples were tested and marked as either negative or positive for E6 and E7 mRNA. However, to detect if different treatment therapies are given to patients with HPV-positive oropharyngeal cancer affect prognosis, p16 analysis was done instead ofE6 and E7 mRNA. P16 analysis was done to determine biologically active HPV. The detection of p16 was done using the immunochemistry assay using primary monoclonal mouse anti-human p16INK4a antibody. Immunohistochemical staining was done and evaluated.&#xD;
&#xD;
The 88 positive patients were treated with either radiotherapy (40), chemoradiotherapy (20), or accelerated radiotherapy (28). The patients treated with the three different treatment modalities were in different stages of the oropharyngeal carcinoma. The patients at a higher stage were treated with chemoradiotherapy as compared to the other two treatment modalities. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
Out of these 468 patients, 88 samples were available pre-treatment for using the PCR for HPV detection using biopsy. 66 samples were tested positive for HPV 16, one sample for HPV 33, one sample for HPV 59, and one sample for HPV 35. Three samples out of these 88 were not able to be detected for HPV. mRNA expression for E6 and E7 HPV-16 was detected in all samples except 1 sample.&#xA0; &#xD;
&#xD;
The mean age of the patients detected positive for tumour were relatively younger with the mean age of 56 years whereas negative patients were within the age group of 64 years. The tumours tested positive for HPV were found poorly differentiated on examination.&#xD;
&#xD;
On comparing the data year-wise, the percentage of the patients found positive for HPV oropharyngeal cancer is depicted in Table 1&amp; Figure 1.&#xD;
&#xD;
 &#xD;
&#xD;
The results showed that the percentage of positive patients increased exponentially from one year to another from 64% to 92% of the sample number increased from one year to next year. The percentage however increased in the next year despite a decrease in the sample numbers obtained from 88 to 49. The 88 positive patients were treated with either radiotherapy (40), chemoradiotherapy (20), or accelerated radiotherapy (28). The patients treated with the three different treatment modalities were in different stages of the oropharyngeal carcinoma. The patients at a higher stage were treated with chemoradiotherapy as compared to the other two treatment modalities.&#xA0; &#xD;
&#xD;
Concerning the treatment modalities used in the patient with the oropharyngeal carcinoma, 88 patients were treated who had pre-treatment biopsy samples available for analyzing HPV. The 88 positive patients were treated with radiotherapy (40), chemoradiotherapy (20), or accelerated radiotherapy (28. The patients treated with the three different treatment modalities were in different stages of the oropharyngeal carcinoma. The patients at a higher stage were treated with chemoradiotherapy as compared to the other two treatment modalities (Table 2 &amp; Figure 2). &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
No difference was noticed concerning the overall survival rates with the three different treatment modalities used. On comparing chemotherapy against the radiotherapy group, again no significant difference was seen in either the death rate or survival rate. The study also analyzed if the subject group treated with the chemoradiotherapy had lesser distant metastases when compared to the other two treatment modalities. The result showed no significant difference in the distant metastases between the groups.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The present trial was aimed to investigate if the oropharyngeal cancer incidence increases with HPV, also to evaluate if the proportion of HPV-positive oropharyngeal cancer patients continues to increase, and if different treatment therapies given to patients with HPV-positive oropharyngeal cancer affect prognosis. &#xA0;The proportion of patients with oropharyngeal cancer with the positive presence of the HPV in the samples is increasing day by day.18 For the present study, there were differences in the age of the patients in cases with positive oropharyngeal cancer.19,20 These findings were based on the studies by Fakhry C et al and Hammarstedt L. et al. in 2006.&#xD;
&#xD;
While evaluating the Treatment outcomes with the three treatment modalities, i.e, conventionally fractionated radiotherapy, accelerated radiotherapy or chemoradiotherapy, no significant difference in the survival rates was seen with any of the three therapies. These findings can be contributed to the small sample size of the study population (n=88), and these findings need to be further evaluated. In a similar study conducted by Ang et al21 in 2010, authors found no significant difference in the survival rates for the HPV positive patients with oropharyngeal cancer, comparing standard fractionated radiotherapy with accelerated radiotherapy. However, in the study by Ang et al high dose of cisplatin was given to all the patients.&#xD;
&#xD;
The present study used HPV E6, E7 mRNA, and p16 immunohistochemistry for the analysis of HPV in the cases with oropharyngeal cancer. These methods have been. The use of oncogene HPV E6 is shown to be the gold standard when frozen biopsies are used by Smeets S.J et al22 in 2007, this supports the use of this oncogene assessment in the present study. Shi W et al23 in their 2007 study favoured the use of GP5+/6+ PCR, HPV16 E6/E7 mRNA, HPV16 in situ hybridization (ISH), and p16 immunohistochemistry (IHC) for HPV detection, favouring the present study.&#xD;
&#xD;
Various other studies by different authors including the studies by Weinberger et al.24 in the year 2006 favoured using the combination of the techniques used in the present study to detect HPV in the subjects with oropharyngeal cancer. The most feasible method should be selected considering the factors like specificity, sensitivity, cost, and reproducibility for the selected technique. Although the present study detected HPV DNA using PCR, another study by Weinberger P.M. et al in 2004 has shown that mere detection of HPV DNA has little or no prognostic value as PCR does not differentiate transcriptionally active and inactive cases.25 Hence, the present study utilized E6 and E7 mRNA in the biopsies which suggest that the detected virus is a transcriptionally active and relevant parameter to judge carcinogenesis.&#xD;
&#xD;
The present study was a retrospective study and hence limits the reliability and personal habits of the included subjects such as smoking, weight, malnutrition, and ecological environment. This warrants the conduction of more prospective studies with a longer monitoring period and sample size. This will also help in overcoming the selection bias and difference in the clinical appearance. The use of the HPV vaccine and its effect shall also be considered. Antiviral therapies targeted against HPV and not towards oropharyngeal cancer shall also be tested for their effect on HPV associated oropharyngeal cancers.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The results showed that the percentage of HPV positive patients with oropharyngeal cancer increased exponentially from one year to another in consecutive years. No difference was noticed concerning the overall survival rates with the three different treatment modalities used including radiotherapy, chemoradiotherapy, or accelerated radiotherapy. Conduction of more prospective studies with longer monitoring period and the larger sample size is required. This will also help in overcoming the selection bias and difference in the clinical appearance. The use of the HPV vaccine and its effect shall also be considered. Antiviral therapies targeted against HPV and not towards oropharyngeal cancer shall also be tested for their effect on HPV associated oropharyngeal cancers. More research is required to better define the most accurate and feasible diagnostic method for HPV diagnostics in the clinical setting.&#xD;
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	Manual of the international statistical classification of diseases, injuries, and causes of death.&#xA0;Geneva: World Health Organisation. 1979.&#xD;
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	Chaturvedi A. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011;29:4294-4301.&#xD;
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	Hammarstedt L. Human papillomavirus as a risk factor for the increase in the incidence of oropharyngeal cancer. Int J Cancer 2006;119:2620-2623.&#xD;
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	Fakhry C. Gillison ML. Clinical implications of human papillomavirus in head and neck cancers. J Clin Oncol 2006;24:2606-2611.&#xD;
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	Ang, KK. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24-35.&#xD;
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	Smeets SJ. A novel algorithm for reliable detection of human papillomavirus in paraffin-embedded head and neck cancer specimen. Int J Cancer 2007;121:2465-2472.&#xD;
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	Shi W. Comparative prognostic value of HPV16 E6 mRNA compared with in situ hybridization for human oropharyngeal squamous carcinoma. J Clin Oncol 2009;27:6213-6221.&#xD;
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	Weinberger PM. Molecular classification identifies a subset of human papillomavirus-associated oropharyngeal cancers with favourable prognosis. J Clin Oncol 2006;24:736-747.&#xD;
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	Weinberger PM, &#xA0;Prognostic significance of p16 protein levels in oropharyngeal squamous cell cancer. Clin Cancer Res 2004;10:5684-5691.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>To Assess the Effectiveness of Self-Instructional Module on a Healthy Lifestyle to Prevent Acid Peptic Disease Among Heavy Vehicle Driver in Wardha&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>99</FirstPage><LastPage>102</LastPage><AuthorList><Author>Samruddhi Gujar</Author><AuthorLanguage>English</AuthorLanguage><Author> Harsha Gandhare</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Acid peptic disease are a very common problem among professional truck drivers due to their lifestyle and job demands. In addition to Helicobacter pylori, Behavioural influences such as depression and diet were the primary causes of ulcers. There are other factors too. Objectives: To assess the existing knowledge regarding healthy lifestyle to prevent acid peptic disease among heavy vehicle driver and to evaluate the effectiveness of self-instructional module on knowledge regarding healthy lifestyle to prevent the same. Methods: In the present study, the quantitative research approach was used. One group pre-test post-test research design was used. Sampling technique was non-probability convenient sampling technique with 70 sample size. Result: The findings show that in pretest 14 (20 %) of study participants are having average knowledge, 33(47.14%) of study participants are having good knowledge, 23 (32.86%) of study participants are having very good knowledge whereas post-test 18(25.71%) were having very good knowledge, 52 (74.29%) had excellent knowledge. Conclusion: The study concluded that before intervention the heavy vehicle drivers have some knowledge regarding the prevention of acid peptic disease but after the intervention, they improve their knowledge. So the self-instructional module is proved to be improving their knowledge regarding prevention of acid peptic disease.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acid peptic disease, Heavy vehicle driver, Healthy lifestyle, Self-instructional module, Stomach ulcer</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
The gastrointestinal system is one of the systems of our body which has a relation with diet. In gastrointestinal systems this is the structural elements involve Esophagus, Stomach, Intestine, Liver, Gallbladder and Pancreas.1 Upper gastrointestinal inflammatory process is common and has a wide spectrum of causes and manifestations. Gastric disorders are commonly seen in population unless treated promptly and completely, they can continue to cause problems throughout the client&#x2019;s life. Client needs assistance to learn new eating habits to achieve, and maintain health and to make necessary lifestyle changes. This is a very important and difficult task; however, unless the client modifies behaviour, many of the gastric disorders recur. The main focus of nursing intervention is education, and modifications of the client&#x2019;s behaviour to promote a healthy lifestyle pattern.2 &#xD;
&#xD;
Gastric and duodenal ulcers are more prevalent and cause more death mostly in smokers, and there is also an increased chance of the recurrence along with the decrease in the healing of the gastric and duodenal ulcer. Peptic ulcer disease and gastritis have similar etiological factor and risk factors like cigarette smoking, consuming caffeine-containing foods and beverages, alcohol in large quantities, using no steroidal anti-inflammatory agents, irregular dietary habits &amp; spicy diet, stress, increased risk of peptic ulcers if type &#x2018;O&#x2019; blood and Helicobacter pylori infection.3 The presence of almost all risk factors and the stress of traffic in the big city by frequent heavy traffic and frequent stops have made drivers prone to get the acid peptic disease. Remarks result shown that drivers quit driving early for health reasons.4 &#xD;
&#xD;
Several studies in this region were reviewed which have direct or indirect effects on acquirement or progression of gastrointestinal diseases and conditions.5 In this study we aimed to assess the existing knowledge regarding healthy lifestyle to prevent acid peptic disease among heavy vehicle driver and evaluate the effectiveness of self-instructional module on knowledge regarding healthy lifestyle to prevent this condition. &#xD;
&#xD;
Materials and methods&#xD;
&#xD;
In the present study quantitative approach i.e. interventional research approach was used. One group pre-test post-test research design. Sampling technique was non-probability convenience sampling.&#xA0; The sample was selected from Wardha district. The study population was heavy vehicle drivers. Sample Size was seventy heavy vehicle drivers. Ethical permission was taken from (Ref. no: DMIMS (DU)/IEC/DEC-2019/8659 ON DATED 13 /12/2019.&#xD;
&#xD;
Independent variable&#xD;
&#xD;
In this study, the independent variable refers to the Self Instructional Module (SIM).&#xD;
&#xD;
Dependent variable&#xD;
&#xD;
In this study, the dependent variable refers to the knowledge of a healthy lifestyle to prevent acid peptic disease among heavy vehicle driver.&#xD;
&#xD;
Demographic variables&#xD;
&#xD;
In these study demographic variables includes age, gender, education, years of work, source of information.&#xD;
&#xD;
Source of data collection&#xD;
&#xD;
The data was collected by taking a pre test and post-test.&#xA0; Each sample required a mean time of 30 minutes to complete the pre-test through a structured questionnaire. Then the self-instructional module was intervened to the sample. The post-test through a structured questionnaire was administered after 7 days. The collection of data was performed within the stipulated time. After the data gathering process, the investigator thanked all the study samples as well as the authorities for their cooperation.&#xA0; &#xD;
&#xD;
Data collection &#xD;
&#xD;
Section A: Consist of demographic characteristics of the sample such as age, gender, education, years of work, source of information.&#xD;
&#xD;
Section B: This consists of 25 structured questions prevention acid peptic disease.&#xD;
&#xD;
Statistical Analysis &#xD;
&#xD;
The demographic data, collected in the pre-test stage, the analysis was done in terms of frequency and percentage. The paired t-test was used to compare pre and post-test knowledge scores. Chi-square test was applied to find out the association between the selected variable with practice score and post-test knowledge score. For statistical analysis, SPSS version 16.0 was used. The observational checklist used for checking.&#xD;
&#xD;
Result&#xD;
&#xD;
Section 1: Assess the pretest knowledge score regarding prevention of acid peptic disease among heavy vehicle drivers&#xD;
&#xD;
Table 1 shows that20% sample shows the average score, and 47.14% had a good level of satisfaction score and 32.86% of them had a very good level of satisfaction score. Minimum satisfaction score in was 7 and maximum satisfaction score was 19. Mean satisfaction score was 13.22&#xB1;3.357.&#xD;
&#xD;
Section 2: &#xA0;Assess post-test knowledge score regarding prevention of acid peptic disease among heavy vehicle drivers&#xD;
&#xD;
Table 2 shows that 25.71% sample that shows a very good score, and 74.29 % had an excellent level of satisfaction score. Minimum satisfaction score in was 17 and maximum satisfaction score was 24. Mean satisfaction score was 21.29&#xB1;1.598.&#xD;
&#xD;
Section 3: Significance of difference between knowledge score in pre and post-test of prevention acid peptic disease among heavy vehicle drivers&#xD;
&#xD;
Table 3 shows that there is a significant difference between pretest and post-test knowledge score interpreting effective self-instructional module on prevention of acid peptic disease among heavy vehicle drivers. Mean value of pretest is 13.79 and post-test is 21.29 and standard deviation value of pretest &#xB1;3.357and post-test &#xB1;1.598. The calculated t value is 15.763 and p-value is 0.000. Hence it statistically interpreted that the self-instructional module regarding the prevention of acid peptic disease among heavy vehicle drivers was effective.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Acid peptic disorders include a variety of illnesses whose pathophysiology is thought to arise from damage caused by acid and peptic action in gastric secretions, including gastroesophageal reflux disease ( GERD) and peptic ulcer disease, the two most severe and well-defined disease states. Peptic ulcers (gastric and duodenal) are defects that pass across the gastrointestinal mucosa.6 Peptic ulcers are sores/breaks in the inner lining of the stomach (duodenum) or upper small intestine.7Such sores occur as unnecessary digestive juices in the stomach are secreted &#x2014; which include hydrochloric acid and an enzyme called pepsin-irritate and tissue harm. Digestive juices from the stomach can also damage the oesophagus.8&#xD;
&#xD;
Peptic ulcer disorders mean the food mucosa is digested with acid peptic. Corrosive properties of acid with a proteolytic activity of pepsin are the primary factor for developing peptic ulcer disease. Duodenum and stomach are typical sources in peptic ulcer disorders.9 Peptic ulcer disorders include a break in oesophageal, gastric or duodenal mucosa cohesion. An ulcer may occur in any part of the gastrointestinal tract that comes into contact with excess gastric juices (Hydro choleric acid and pepsin). The ulcer may be found in the gastric, duodenal or jejunum after gastroenterostomy.10&#xD;
&#xD;
Nursing Education &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The result of the study can be used by the nursing teacher as an informative illustration for nursing students. It helps the nurse educator to plan and implement the topic in the nursing curriculum. It also helps the nurse educators to explain how this knowledge regarding prevention of acid peptic disease. Educators can help students, colleagues, and junior staff regarding management and prevention of level of satisfaction regarding acid peptic disease among heavy vehicle drivers. &#xD;
&#xD;
Nursing Administration&#xD;
&#xD;
Findings of the study can be used by the Nursing Administrator in creating policies and plans for preventing knowledge regarding acid peptic disease among heavy vehicle drivers. Nursing administrators should arrange staff development programs on healthy lifestyle to prevent acid peptic disease among heavy vehicle driver to update the knowledge of staff nurses. &#xD;
&#xD;
Nursing Research&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The findings of the study have added to the existing body of knowledge in nursing. Other researchers may utilize suggestions and recommendations for conducting the further study. The tool and technique used has added to the body of knowledge and can be used for further references. &#xD;
&#xD;
Recommendations &#xD;
&#xD;
&#xD;
	&#xD;
	A study can be conducted to assess knowledge and attitude regarding the prevention of acid peptic disease among heavy vehicle drivers.&#xD;
	&#xD;
	&#xD;
	A study can be conducted to assess knowledge prevention of acid peptic disease among labours.&#xD;
	&#xD;
	&#xD;
	A comparative study can be conducted in an urban and rural area on knowledge regarding prevention of acid peptic disease among labours.&#xD;
	&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
This study aimed to identify the effectiveness of self-instructional module on a healthy lifestyle to prevent acid peptic disease among heavy vehicle driver in Wardha. Information is given to the drivers of the heavy vehicles through a self-instructional module which includes various aspects like general knowledge regarding causes, sing and symptoms, types, management and healthy lifestyle to prevent acid peptic disease. The conclusion is drawn on the basic finding of the study, the pre-test finding showed that knowledge of heavy vehicles drivers regarding healthy lifestyle to prevent acid peptic disease inadequate after given the self-instructional module helped the drivers of the heavy vehicles to understand more about prevention of healthy lifestyle to prevent acid peptic disease, most of the drivers of the heavy vehicles wear having adequate knowledge after given the self-instructional module. So the self-instructional module is proved to be improving their knowledge regarding prevention of acid peptic disease.&#xD;
&#xD;
Acknowledgements: I would resembling to express my sincere thanks to all faculties of Smt. Radhikabai Meghe Memorial College of Nursing, India for smooth completion of my research work and we also thankful to our statistician Mr. Babar Sir.&#xA0; &#xD;
&#xD;
Conflict of interest &#x2013;&#xA0;&#xA0;&#xA0; Nil&#xD;
&#xD;
Source of Funding -&#xA0;&#xA0;&#xA0;&#xA0; Self &#xD;
&#xD;
Ethical clearance - Approved from Ethical Institutional Committee (IEC) of Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha.&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3356</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3356</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Naidoo J, Wills J. Foundations for Health Promotion E-Book. Elsevier Health Sciences; 2009. 329 p. &#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; National Health Service. In: Wikipedia [Internet]. 2020 [cited 2020 Jun 4]. Available from: https://en.wikipedia.org/w/index.php? &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Degavi G. Effectiveness of self instructional module (SIM) on knowledge of healthy lifestyle among sedentary bank Employees.&#xA0; Int J Adv Nurs Mgmt 2015;3(2):131-138.&#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Driver stress and road rage - Brake the road safety charity [Internet]. [cited 2020 Jun 4]. https://www.brake.org.uk/facts-resources/15-facts/487-driver-stress&#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Choudhari MS, Charan N, Sonkusale MI, Deshpande RA. Inadvertent diversion of inferior vena cava to left atrium after repair of atrial septal defect - Early diagnosis and correction of error: role of intraoperative transesophageal echocardiography. Ann Card Anaesth 2017;20(4):481&#x2013;482. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Bhinder HP, Kamble T K. The study of carotid intima-media thickness in prediabetes and its correlation with cardiovascular risk factors. J Datta Meghe Inst Med Sci Univ 2018;13:79-82. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Dong SXM, Chang CCY, Rowe KJ. A collection of the etiological theories, characteristics, and observations/phenomena of peptic ulcers in existing data. Data Brief 2018;19:1058&#x2013;1067. &#xD;
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8. Peptic Ulcer Disease: Background, Anatomy, Pathophysiology [Internet]. [cited 2020 Jun 4]. Available from: https://emedicine.medscape.com/article/181753-overview&#xD;
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9.&#xA0;Satheesh B, Veena Rm. A study of prevalence of hypertension among bus drivers in bangalore city. Int J Curr Res Rev 2013; 5(17):90-94.&#xD;
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10. Ghorbanshiroudi S, Khalatbari J, Maddahi ME, Salimi M, Keikhayfarzaneh MM, Abolghasemi F. A comparison between perceived stress in a patient with peptic ulcer and control group and determining the efficacy of stress inoculation training among primary school teachers in Amol city of Iran. 2011;3(11):13-22. &#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Incidence of Hearing Loss in COVID-19 Patients: A COVID Hospital-based Study in the Eastern Part of India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>103</FirstPage><LastPage>107</LastPage><AuthorList><Author>Santosh Kumar Swain</Author><AuthorLanguage>English</AuthorLanguage><Author> Somya Ranjan Pani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The coronavirus disease 2019(COVID-19) is an acute respiratory disease caused by a novel coronavirus(SARS CoV-2). Clinically COVID-19 presented with respiratory illness and also death is a possible outcome. Hearing loss is an interesting clinical outcome associated with COVID-19 infections. Objective: This study is designed to analyze the incidence of hearing loss in COVID-19 patients after discharge from the COVID-19 hospital. Methods: Twenty-eight patients of COVID-19 discharged from COVID hospital presenting with hearing loss participated in this study. The age ranges from 16 years to 52 years. Patients those had hearing loss before admission to COVID hospital were excluded from this study. All these patients underwent pure tone audiometry, tympanometry and Otoacoustic emission study. Results: Out of 28 patients, 18 (64.28%) were male and 10 (35.71%) were female with male to female ratio of 1.8:1. The age ranges of the participants were 16 to 52 years. Twenty-two patients presented with unilateral hearing loss and six presented with bilateral hearing loss. Out of 28 patients, 24 (85.71%) were presented with sensorineural hearing loss (SNHL) and 4 (14.28%) presented with conductive hearing loss. Out of the 28 patient 21 patients (75%) presented with unilateral hearing loss whereas 17 (60.71%) showed sudden-onset hearing loss. Conclusion: Hearing loss in COVID-19 has not received much attention by the medical professionals.COVID-19 infection could have deleterious effects on the inner ear specifically on the hair cells of the cochlea despite patients are asymptomatic. The proper understanding of the mechanisms behind hearing loss in COVID-19 infections needs further research.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Hearing loss, COVID-19, Sudden sensorineural hearing loss, Cochlear function</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Hearing loss has an important role in communication and interaction, causing an invisible handicap of the affected person and psychological solitary confinement. World health organization (WHO) has estimated that approximately 360 million people with disabling hearing loss in the world which proved that more than half of the persons with hearing loss can be prevented by early diagnosis and treatment.1 The symptomatology of the COVID-19 may appear in 2 to 14 days after the exposure.2 The clinical symptoms include cough, throat pain, fever, fatigue, loss of taste and smell and few patients also present with gastrointestinal symptoms. The elderly persons or patients with co-morbidity systemic diseases are susceptible to infections and serious outcome which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm.2,3 The link between the COVID-19 infection and hearing loss makes intuitive sense, given the neuropathic manifestations of the inner ear and auditory nerve leading to sensorineural hearing loss. Although certain viral infections cause hearing loss, there is still unknown whether COVID-19 infections lead to auditory dysfunction or not. Here this study is relating to the impact or incidence of the novel coronavirus infection on the auditory system.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This prospective study was conducted at a tertiary care teaching hospital attaching with five COVID hospital of 1200 COVID patients. The study was done during the period between March 2020 to August 2020. This study was approved by the Institutional ethical committee (IEC) with reference number IMS/SOA/23/26.02.2020. Informed consent was obtained from the patients those participated in this study. The audiological symptoms were searched from 472 patients at COVID-19 hospital. Out of the 472 patients, 28 (5.93%) were presented with hearing loss. There were suggested to consult the otolaryngology outpatient department after discharge/cure after the treatment or staying for 10 days at COVID hospital. The patients those were complaining about hearing loss after discharge from COVID hospital attended the outpatient department of the otorhinolaryngology included in this study. Patients were declared COVID-19 positive by real-time polymerase (RT-PCR) testing. All the patients those participated in this study were tested positive RT-PCR for SARS-CoV-2 before admission to the COVID hospital. COVID-19 patients with a history of ototoxic drugs like oral hydroxychloroquine and aspirin taken previously were excluded from this study. Patients those with hearing loss before SARS-CoV-2 infection were excluded from this study. Patients with a history of noise exposure, age-related hearing loss, measles, mumps, rubella, meningitis, syphilis, hypertension, thyroid diseases and kidney diseases before COVID-19 infections also were excluded from this study. Proper history taking and otological examinations including tuning fork tests were done in all the participants before audiological testing. All the participating patients underwent pure tone audiometry testing, tympanometry and Otoacoustic emissions (OAE) which were done by an audiologist in a soundproof room. The pure tone audiometry was performed with all safety protocols for COVID-19 pandemic. Pure tone audiometry findings were done with frequency at 250, 500, 100, 2000, 4000 and 8000Hz using Telephonics TDH39 earphones. The audiometric assessment was conducted in a sound-treated room, using GSI 61 clinical audiometer. The average value for the hearing threshold at 500Hz, 1000Hz and 2000Hz was calculated. The pure tone average greater than 25 decibels was considered as hearing loss. Tympanometry was carried out with help of the am plaid 775 middle ear analyzer to rule out middle ear pathology. Before performing the pure tone audiometry, tuning fork tests were done by using 256,512 and 1024 Hz. Transient evoked otoacoustic emissions (TEOAEs) were recorded in all participating patients with help of the Madsen Capella Analyzer.&#xA0; The stimuli in TEOAEs were a nonlinear click of about 80 dB peak SPL in the ear canal. The spectrum analyzer was stimulated as 4ms after the presentation of the stimuli for avoiding the ringing of the input stimuli and the temporal window was set at 20ms.&#xD;
&#xD;
RESULTS&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In this prospective study, 28 patients presented with hearing loss out of the 452 COVID-19 patients. Twenty-eight patients participated in this study for further audiological assessment at the otolaryngology department. Out of the 28 patients, 18 (64.28%) were male and 10 (35.71%) were female with male to female ratio of 1.8:1 (Table 1). The age ranges of the patients were 16 to 52 years with a mean age of 28.2 years. There were 15 patients (53.57%) were in the age range of 16 to 30 years and 13 patients (46.42%) in the age range of 31 to 52 years (Table 1).&#xA0;&#xA0; All were discharged from COVID-19 hospital and presented with the heaviness of the ear and hearing loss during six months of the study period. Out of the 28 patients, 19 (67.85%) were symptomatic and 9 (32.14%) had no symptoms except hearing loss (Table.2). Out of them, 11 patients presented with throat pain, cough, rhinorrhea, loss of smell, dysgeusia and hearing loss during the stay at the COVID hospital. Eleven patients presented with fever, cough, throat pain and hearing loss. Out of the 28 study patients, no respiratory symptoms were there but along with the presence of hearing loss. Out of the 28 patients, 22 were presented with unilateral hearing loss and 6 were presented with bilateral hearing loss.&#xA0; Out of 22 cases of unilateral hearing loss, 21 were with sensorineural hearing loss one patient presented with mild conductive hearing loss (Table.3). Out of 21 unilateral SNHL,17 (60.71%) presented with sudden onset. Out of the 17 cases of sudden sensorineural hearing loss, 11 (52.38%) were treated early and improved. Out of the 21 cases (75%) of unilateral sensorineural hearing loss, 9 cases (32.14%) presented with tinnitus and 3 (10.71%) had a history of vertigo immediately after development of the hearing loss with nausea and no vomiting. Out of 21 patients with unilateral SNHL, 13(61.90%) showed in the left ear and 8(38.09%) showed in the right ear. Out of 6 bilateral hearing loss, 3 were mild conductive and 3 were mild sensorineural hearing loss. Out of 24 cases of SNHL, 16 cases (66.67%) show high-frequency SNHL in pure tone audiometry. Tympanometry was done in all the participants. All the patients with SNHL were showing Type-A tympanogram whereas patients with conductive hearing loss showing Type-C tympanogram. Out of the 28 patients, 22 (78.57%) showed reduced amplitude of the TEOAEs. All the patients with sensorineural hearing loss were treated with oral prednisolone 1mg/kg/day in the tapering dose for three weeks along with vitamin B-complex and proton pump inhibitor daily. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
COVID-19 is a contagious disease caused by a novel virus called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). This virus is a large, encapsulated positive-strand RNA virus (Figure 1). The coronavirus is classified into 4 genera such as alpha, beta, delta and gamma. Alpha and beta are usually caused the infection to human beings.4 The first case was reported in In Wuhan, China in late December 2019, the 1st case of COVID-19 was reported and spread worldwide.5 The symptoms of the COVID-19 infection may appear after 2 to 14 days following the exposure(based on the incubation period of COVID-19 virus). The clinical presentations of the COVID-19 patients are fever, cough, fatigue, gastrointestinal symptoms, sore throat, headache, olfactory and taste dysfunctions.6 The elderly patients and the persons with co-morbid conditions or immunocompromised conditions are prone to serious outcomes such as acute respiratory syndrome (ARDS) and cytokine storm.6 Three outcomes may happen in the disease process of the COVID-19 such as some become serious with respiratory distress, some improve with treatment and rest recovers with no medical intervention.7 Sometimes the COVID-19 patients present with otological manifestations. The eustachian tube is often blocked because of the infections at the nasal cavity and nasopharynx. The blockage of the eustachian tube cause blockage sensation in the ear and also ear pain. It leads to acute otitis media and manifests severe otalgia and fever. It also results in hearing loss due to persistent eustachian dysfunction.8&#xA0;&#xA0; In this study, four patients were showing type-C tympanogram and conductive hearing loss. In COVID-19 infections, the nasopharyngeal infections lead to blockage of the eustachian tube because of the mucosal oedema of the nasopharyngeal end of the tube. It may cause negative pressure in the middle ear which may cause type-C tympanogram. Eustachian tube dysfunction often leads to glue ear formation and conductive hearing loss.9 Auditory or cochlear dysfunction in patients with coronavirus infection is little mentioned in the medical literature. The pathogenesis for COVID-19 infections leading to the hearing loss is not well established. Inner ear damage secondary to the viral infection is typically intra-cochlear but some viruses also damage auditory brainstem as well. &#xD;
&#xD;
The pathophysiology for making injury of the peripheral auditory system includes the direct viral damage to the organ of Corti, stria vascularis and spiral ganglia. The viral damage to the cochlea is mediated by the patient&#x2019;s immune system against virally expressed antigen/proteins as in cytomegalovirus and immunocompromised as in Human Immune deficiency virus and measles.10 In one report, brainstem involvement was found by a corona virus. 11 There are several reports regarding hearing loss by viral infections. Hearing loss due to viral infections can be congenital or acquired, unilateral or bilateral. Certain virus directly damages the inner ear and other induces the inflammatory responses which lead to damage of the inner ear whereas few viruses enhance the susceptibility of bacterial or fungal infections of the labyrinth, leading to hearing loss. Virus-induced hearing loss is often sensorineural, although conductive and mixed types of hearing loss may be found after infections of certain viruses. Sometimes, recovery of the hearing occurs spontaneously after viral infection.12,13 Typically viral infection causes a sensorineural type of hearing loss whereas a viral aetiology such as measles virus was documented for otosclerosis.14 The measles virus is an enveloped single-stranded RNA virus as SARS CoV-2 is transmitted through contact with respiratory secretions from the patient. Hearing loss was an important complication in measles virus infections before widespread vaccination.&#xD;
&#xD;
HIV infection can cause conductive hearing loss through fungal and bacterial infections, which become common after immunosuppression by the virus.15 Hearing loss by viral infections may be mild or severe to profound and unilateral or bilateral. The mechanism of the hearing loss by viral infections varies greatly and ranges from direct damage to the labyrinthine or inner structures such as hair cells and organ of Corti as in measles to induction of the host immune-mediated damage to the inner ear.16 Viruses are often known to cause neurological complications like anosmia, facial nerve weakness and sudden sensorineural hearing loss.17 In the past SARS outbreak, coronavirus was documented for causing loss of the smell and taste because of the nerve injury.18 In this study, 11 patients were presenting loss of smell and loss of taste/dysgeusia along with hearing loss. The viral etiological agents have been associated with SNHL are herpes simplex virus, human immunodeficiency virus, hepatitis virus, rubella virus, measles virus, mumps virus, Lassa virus and enterovirus.18 The present pandemic of the COVID-19 is associated with SNHL as in this study. In this 24 patients presented with SNHL where 17 of them presented with sudden onset of SNHL. Sudden hearing loss is usually a frightening symptom which prompts the patient for an urgent consultation tot the health care provider. In the majority of the cases with sudden sensorineural hearing loss, the aetiology is idiopathic and if it is not diagnosed early and treated promptly may lead to persistent or permanent hearing loss and even with tinnitus and decreased patient quality of life (QOL).19 Intra-tympani steroid, systemic steroid and hyperbaric oxygen are different treatment options for sudden sensorineural hearing loss.20,21 In our cases of sudden sensorineural hearing loss, oral steroids were prescribed in tapering doses. Out of the 17 cases of sudden sensorineural hearing loss, 11 patients were treated promptly and improved to normal.&#xD;
&#xD;
Tuning fork tests, pure tone audiometry, tympanometry and Otoacoustic emissions (OAE) were done to evaluate the hearing loss in our study patients with COVID-19. The type and degree of hearing loss were assessed by the tuning fork test and pure tone audiometry. In this study majority of the cases with SNHL (66.66%) show high-frequency hearing loss in pure tone audiometry. Tympanometry was done to assess the middle ear pathology. Otoacoustic emissions represent a form of energy produced from the outer hair cells of the cochlea. Otoacoustic emissions can be spontaneous (SOAEs), evoked by transient stimuli like clicks or tone bursts (TEOAEs). TEOAEs are not invasive and can be easily performed. For performing TEOAEs, the time is short, low cost and high sensitivity.22 In all the cases of SNHL, TEOAEs picked up the subtle deterioration in the outer hair cell functions of the cochlea. The high frequencies tones were also lower than normal in COVID-19 patients with SNHL. These outcomes may be attributed to the damaging effects of the SARS CoV- 2 viruses infection on the outer hair cells but the exact mechanism is still not clear. The outcome of this study also revealed that the absence of the major clinical symptoms may hide the unknown effect on the cochlea.&#xA0; Majority of the people infected with SARS CoV-2 virus with mild to moderate respiratory illness are recovered without special treatment.6 COVID-19 infections have a hazardous effect on the cochlear functions despite being the majority of the patients in this study are asymptomatic to mild symptoms. The mechanism for this deleterious effect on the cochlear hair cells requires further research. There is a large gap in the understanding of the etiopathogenesis, epidemiology, clinical presentations like hearing loss and human transmission of this disease. There should be continuous monitoring of the hearing loss and tracing of this COVID-19 is needed to ensure the detailed understanding of this inner ear pathogenesis. The most typical manifestations of chest CT were ground-glass opacities, patchy, cord-like, and nodular. Pleural thickening was found in some patients.&#xD;
&#xD;
Computed tomography (CT) scan of the lungs is significant for early diagnosis and assessment of COVID-19 infection. The most typical presentations in CT scan of the chest include ground gland opacities, patch, cord-like and nodular appearance in the lungs. The pleural thickening is seen in some cases of COVID-19 patients. The CT findings of the lungs appear earlier than clinical symptoms and these findings hanged dynamically as the progression of the disease. So, the CT scan of the chest plays an important role in revealing the disease progression and severity of the disease.23,24 However, authors only included the observational study related to the incidence of the hearing loss of COVID-19 patients and not included the infectivity of the patients about RT-PCR and CT scan of the lungs. Our study surely helps for further study of the hearing loss and infectivity about the RT-PCR and CT scan of the chest with cord score. This study has a relatively small sample size due to rarity of the clinical outcome (hearing loss) in COVID-19 infections which may limit the outcome of the above interpretation. However, the clinical outcome of auditory dysfunction in this study will surely encourage further research. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Patients with OVID-19 infections have a higher chance of the hearing loss specifically sensorineural hearing loss. The exact role for pathogenesis of the hearing loss in COVID-19 infections is not well defined. We would like to recommend routine screening of all the COVID-19 positive cases with pure tone audiometry, tympanometry and Otoacoustic emission for early diagnosis of the hearing loss and prompt treatment or rehabilitation. Awareness regarding hearing loss in COVID-19 patients is often crucial in the current pandemic. Early identification of the COVID-19 patients with isolation and early initiation of the targeted treatment for the patients helps to reduce the incidence of the SNHL. For the proper understanding of the pathogenesis of the hearing loss in COVID-19 infections, a large study is required with follow up. Hearing health care providers or clinicians are now encountering a challenge for hearing loss in COVID-19 pandemic. Development of the vaccines may reduce the incidence of hearing loss.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Funding: No Funding sources were granted or used specifically for this work.&#xD;
&#xD;
Author Contribution: SKS: Concept, data collection and data analysis; SRP: Data collection, data analysis, and drafting the manuscript. &#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3357</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3357</Fulltext></URLs><References>1. World Health Organisation fact sheet. Deaness and Hearing loss. In:World Health Fact Sheet ed. Geneva: World Health Organization; Feb. 2017. Available at www.who.int/mediacentre/factsheets/fs300/en.&#xD;
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2. Hong H, Wang Y, Chung HT, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol 2020;61(2):131-132.&#xD;
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3. Swain SK, Das S, Padhy RN. Performing tracheostomy in intensive care unit-A challenge during COVID-19&#xA0; pandemic. Siriraj Med J 2020;72(5):436-442.&#xD;
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4. de Wilde AH, Snijder EJ, Kikkert M, vanHemert MJ. Host factors in corona virus replication. Curr Top Microbiol Immun 2018;419:1-42.&#xD;
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5. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020;92(4):441-447.&#xD;
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6. Hong CZ, Tan YY, Chen SD, Jin HJ, Tan KS, Wang DY, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak &#x2013; an update on the status. Mil Med Res 2020;7:11.&#xD;
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7. Coronavirus disease 2019 (COVID-19) pandemic: Increased transmission in the EU/ EEA and the UK &#x2013; seventh update, 25 March 2020. Stockholm: ECDC; 2020. Stockholm: Europ. Centre for Disease Prevention Control 2020.&#xD;
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8. Cui C, Yao Q, Di Zhang YZ, Zhang K, Nisenbaum E, Cao P, et al. Approaching otolaryngology patients during the COVID-19 pandemic. Otolaryngol Head Neck Surg 2020;1(2):234-237.&#xD;
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9. Fisher E, Youngs R, Hussain M, Fishman J. Glue ear in adults, paediatric sleep apnoea and the nose in exercise. J. Laryngol Otol 2016;130(5):417.&#xD;
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10. Abramovich S, Prasher DK. Electrocochleography and brain-stem potentials in Ramsay Hunt syndrome. Arch Otolaryngol Head Neck Surg1986;112(9):925-928.&#xD;
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11. Wege H, Watanabe R, Ter Meulen V. Relapsing subacute demyelinating encephalomyelitis in rats during coronavirus JHM infection. J Neuroimmunol 1984;6(5):325-336.&#xD;
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12. Adler SP. Congenital cytomegalovirus screening. Pediatr Infect Dis J 2005;24(12):1105-6.&#xD;
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13. Al Muhaimeed H, Zakzouk SM. Hearing loss and herpes simplex. J Trop Pediatr 1997;43(1):20-24.&#xD;
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14. Karosi T, Konya J, Petko M, Sziklai I. Histologic otosclerosis is associated with the presence of measles virus in the stapes footplate. Otol Neurotol 2005;26(6):1128-1133.&#xD;
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15. Chandrasekhar SS, Connelly PE, Brahmbhatt SS, Shah CS, Kloser PC, Baredes S. Otologic and audiologic evaluation of human immunodeficiency virus-infected patients. Am J Otolaryngol 2000;21(1):1-9.&#xD;
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16. Budzilovich GN, Lieberman AN. Herpes zoster oticus and facial paralysis (Ramsay Hunt syndrome). Clinicopathologic study and review of the literature. J Neurol Sci 1973;20(2):149-159.&#xD;
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17. Mateer EJ, Huang C, Shehu NY, Paessler S. Lassa fever-induced sensorineural hearing loss: neglected public health and social burden. PLoS Negl Trop Dis 2018;12:e0006187.&#xD;
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18. Suzuki M, Saito K, Min WP, Vladau C, Toida K, Itoh H, et al. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope 2007;117:272-277.&#xD;
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19. Dallan I, Fortunato S, Casani AP, Bernardini E, Sellari-Franceschini S, Berrettini S, et al. Long-term follow up of sudden sensorineural hearing loss patients treated with intra-tympanic steroids: audiological and quality of life evaluation. J Laryngol Otol 2014;128:669-673.&#xD;
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20. Han X, Yin X, Du X, Sun C. Combined intratympanic and systemic use of steroids as a first-line treatment for sudden sensorineural hearing loss: a meta-analysis of randomized, controlled trials. Otol Neurotol 2017;38(4):487-495.&#xD;
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21. Swain SK, Achary S, Das SR.Vertigo in pediatric age: Often challenge to clinicians. Int J Cur Res Rev 2020;12(18):136-141.&#xD;
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22.Paludetti G, Ottaviani F, Fetoni AR, Zuppa AA, Tortorolo G. Transient evoked Otoacoustic emissions (TEOAEs) in newborns: normative data. Int J Pediatr otorhinolaryngol 1999;47(3):235-241.&#xD;
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23. Zhao W, Zhong Z, Xie X, Yu Q, Liu J.Relation between chest CT findings and clinical conditions of Coronavirus disease (COVID-19) pneumonia: a multicenter study. Am J Roentgenol 2020;214(5):1072-1077.&#xD;
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24.&#xA0; Ramasamy&#xA0; K. The War of United States of America with COVID-19. Int J Cur Res Rev 2020;12(16):18-28.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Use of a Halo - Vest for the Upper Cervical Spine Injuries&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>108</FirstPage><LastPage>112</LastPage><AuthorList><Author>Quziev Ortiqsher Ilmiddinovich</Author><AuthorLanguage>English</AuthorLanguage><Author> Ismoilova Muazzam Isroilovna</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: In the structure of the cervical spine injury, upper cervical spine injuries occupy from 5.5 to 35% and 1 to 2% of all spinal injuries. The main task in their treatment is the prevention of secondary displacements if possible elimination of deformations and ensuring reliable stabilization. Objective: Study of the effectiveness of the use of a halo - vest for the upper cervical spine injuries. Methods: The results of closed reduction and rigid stabilization with the Halo - vest in 28 patients with injuries of the upper cervical spine at the Fergana branch of the Republican research centre of emergency medicine are discussed. The average age of the patients is 31 years. The observation period of patients is 3 months or more. Result: In 4 (14.3%) patients with C1 fracture, slight neck pain persisted. Full offset correction was achieved in 44.4% of cases. In all cases, there were no secondary displacements of bone fragments. The overall rate of healing after 90 days of Halo &#x2013; vest is 89.3% traction. Complications were observed only in 1 (3.6%) patient in the form of scalp soft tissue infection. Conclusion: This method reduces the likelihood of postoperative complications due to low invasiveness, provides early verticalization and rehabilitation of patients.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> C1 and C2 fracture, Hangman&#x2019;s fracture, Odontoid fracture, Traumatic spondylolisthesis C2, Upper cervical spine injury, Use of the Halo - vest</Keywords><Fulltext>Introduction&#xD;
&#xD;
Traumatic injuries of the upper cervical spine include damage to the first two vertebrae and their ligamentous apparatus. In the structure of the cervical spine injury, these injuries occupy from 5.5 to 35% and 1 to 2% of all spinal injuries. The incidence of fractures of the odontoid process of the C2 is 4 to 25% of all injuries of the cervical spine. C2 arch fractures(Hangman&amp;#39;s fracture) occur in 4 &#x2013; 7% of cases. Multiple "bursting" fracture of the C1 (Jefferson fracture) occurs from 2 to 13% of all fractures of the cervical spine. Among the fractures of the upper cervical spine (UCS), Jefferson&amp;#39;s fracture in combination with Hangman&amp;#39;s fractures occurs in 6 - 26% of cases. Odontoid fractures are observed in 5 - 53% of cases of fractures of the craniovertebral level.1-4&#xD;
&#xD;
Among the causes of traumatic injuries of the UCS are dominated by road accidents, falling head down, falling objects on the head, overturning over the head, a blow to the cervical-occipital, frontal region, sudden rotational accelerations, etc. Until the mid-70s, the main method of treating traumatic injuries of C1-C2 was the method of immobilization of a thoracoacromial plaster cast, the imposition of which was preceded by traction with a Glisson loop, skeletal traction for the parietal tubercles, or the zygomatic arches. At the same time, it was not recommended to use forced distraction efforts, observing gradualism and caution. In unstable fractures in patients treated with this method, the incidence of post-traumatic deformities and chronic atlantoaxial dislocations reached 65%. This method did not allow for long-term rigid fixation, dosed dynamic correction of the deformity.6-10&#xD;
&#xD;
The main task in their treatment is the prevention of secondary displacements, elimination of deformations, if possible, and ensuring reliable stabilization. The problems of providing adequate care to patients with injuries of the upper cervical vertebrae are still relevant and far from a final solution. This is indicated by the divergence of views in the choice of treatment tactics of individual specialists.4,5&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
The analysis of the results of treatment of 28 patients with UCS injury for the period from 2012 to 2019 was carried out. in the emergency neurosurgical department of the Fergana branch of the Republican research centre of emergency medicine. Of these, 21 (75.0%) were men, 6 (25.0%) women. The age of the patients is from 18 to 72 years, the average age is 31 (&#xB1; 14.5) years. By the mechanism of injury, road traffic accidents prevailed - 18 (64.3%) cases, less often - falling from a height - 6 (21.4%) and diving in shallow water - 4 (14.3%).&#xD;
&#xD;
Severe pain syndrome at rest (3 points on the W.W. Downie scale), or arising during light exercise (2 points on the Downie scale) were in 46.4% and 50.0% of patients, respectively. Mild neck pain (1 point on the Downie scale) was present in only 1 (3.6%) patient with a type I odontoid fracture. Cervicalgia syndrome was more pronounced (3 points on the W.W. Downie scale - in 58.8% of patients) with odontoid fractures type II, which was due to a smaller contact area of the fragments and, accordingly, a greater tendency to displacement with the development of atlantoaxial dislocation. Less pronounced pain syndrome (2 points - in 66.7%, 3 points - in 33.3%) was typical for C1 fractures with displacement. The smallest clinical manifestations (2 points - in 80% of patients, 3 points - in 20%) were in patients with Hangman&amp;#39;s fracture.&#xD;
&#xD;
The American Spine Injury Assosiation \ International Standards for Neurological and Functional Classification of Spinal Cord Injury (ASIA\ISCSCI) scale (2015) was used to determine the functions of the spinal cord, according to international standards. In 24 (85.7%) patients, the UCS fracture was uncomplicated (grade E on the ASIA scale). Grade B on the ASIA scale was in 1 (3.6%) patient, grade C in 2 (7.1%) cases, grade D in 1 (3.6%) patient.11-14&#xD;
&#xD;
The assessment of the severity of the condition and the neurological status was carried out at the time of admission, on the day of stabilization, in the dynamics of the postoperative period and on day 90. Upon admission, all patients with fractures of the UCS have performed a plain X-ray of the cervical spine in 2 projections and targeted radiography of the UCS in a transoral position. If the fracture of the odontoid process was verified by computer tomography (CT), radiography was performed for preoperative planning.&#xD;
&#xD;
For victims of an accident or a fall from a great height (24 people - 85.7%), first of all, CT of the cervical spine was performed. CT was also performed in patients after diving in shallow water, with clinical signs of cervical vertebra fracture, victims with impaired wakefulness, unknown traumatic history and trauma on the head, as well as suspected fractures according to X-ray examination methods.&#xD;
&#xD;
In the postoperative period, radiography of the craniovertebral level was performed in all patients to control the correct placement of fixators and the degree of deposition of the dislocated atlantoaxial complex.&#xD;
&#xD;
CT was performed in all 28 (100%) patients. CT was used as a method of primary imaging in 24 (85.7%) patients, after spondylography of UCS - in 4 (14.3%) patients. X-ray examination revealed a C1 fracture in the first type in 1 (3.6%) patient, in 3 (10.7%) patients in the second type, and 2 (7.2%) patients in the third type, with a total discrepancy of the lateral masses of the atlas more than 8.1 mm relative to the lateral masses of the axis.&#xD;
&#xD;
According to the classification of injuries of the odontoid fractures according to Anderson and D&amp;#39;Alonzo (1974), type I was observed in 2 (7.1%) patients, type II - in 10 (35.7%), type III - in 5 (17.9 %). According to the X-ray classification of C2 arch fractures (according to the degree of displacement and angular deformity), the distribution was as follows:&#xD;
&#xD;
Type I - bilateral separation of the arch from the C2, without displacement and angular deformity - 1 (3.6%) patient;&#xD;
&#xD;
Type II - fracture of both roots of the arches with a displacement of more than 3 mm, with a slight angular deformation - 1 (3.6%);&#xD;
&#xD;
Type II-A - the fracture is similar to that of type II, but with the prevalence of pronounced angular deformity - 2 (7.1%);&#xD;
&#xD;
Type III - significant displacement and angular deformity of the C2 - 1 (3.6%);&#xD;
&#xD;
Type IV - posterior displacement of the C2 body - there were no patients.&#xD;
&#xD;
In 5 (17.9%) patients with type II odontoid fractures, CT verified the high location of the fracture line, and therefore the examination was supplemented with Magnetic resonance imaging (MRI)of the cervical spine. In 2 cases, signs of damage to the transverse ligament of the atlas were revealed. MRI was also performed in 4 patients with concomitant type II and III C1 injuries, of which 1 patient had an injury of the transverse portion of the cruciate ligament. The integrity of the transverse portion of the cruciate ligament was one of the most important criteria in choosing a method for stabilizing the UCS. Also, using MRI, the degree of spinal cord injury was determined in patients with complicated UCS fracture (9 people - 32.1%).&#xD;
&#xD;
In 16 (57.1%) patients, a concomitant injury was diagnosed. In 14 patients, a combination of Traumatic Brain Injury of varying severity with damage to the musculoskeletal system was revealed. Concussion or contusion of the brain and limb fractures prevailed. The hepatic rupture was verified in 1 patient, requiring surgery.&#xD;
&#xD;
In the treatment of injuries of the UCS, we set the following tasks:&#xD;
&#xD;
1) Achieving the maximum possible reconstruction of the damaged spine with the elimination of the compressing components that affect the neurovascular formations;&#xD;
&#xD;
2) Restoration of stability at the level of damage, excluding the phenomenon of redislocation of injured segments;&#xD;
&#xD;
3) The maximum preservation of the range of motion in the cervical spine after treatment;&#xD;
&#xD;
4) Prevention of possible complications that may arise during treatment or in the long term.&#xD;
&#xD;
The tasks are solved subject to the following principles of treatment:&#xD;
&#xD;
1) The principle of maximum radicalism and simultaneity;&#xD;
&#xD;
2) The principle of maximum minimally invasiveness;&#xD;
&#xD;
3) The principle of maximum shortening of the time needed to achieve the final reconstruction;&#xD;
&#xD;
4) The principle of ensuring the maximum possible comfort for the patient during treatment;&#xD;
&#xD;
5) The principle of prevention of possible complications during treatment and after its completion.&#xD;
&#xD;
Methods for the treatment of traumatic injuries of the segments of the craniovertebral junction are conventionally divided into 1) conservative - external immobilization, traction; 2) conditionally conservative - Halo - vest correction and stabilization; 3) surgical i.e. internal fixation.&#xD;
&#xD;
Halo&#x2013;vest was applied according to the standard technique, after which a dosed distraction was performed to eliminate the displacement of bone fragments.&#xD;
&#xD;
The patients were transferred to an upright position on the first day after applying the apparatus. Control radiographs of the cervical spine were taken once every 4 weeks. Fixation in the Halo - vest lasted up to 3 - 4 months. After its removal, external fixation was performed with a removable head holder for 2 - 3 months. The observation period of patients is 6 months or more.&#xD;
&#xD;
Results&#xD;
&#xD;
To determine the results of the effectiveness of Halo- vest fixation and to assess its place in the complex treatment of UCS fractures, we compared the results of treatment based on the obtained X-ray and clinical data in patients before and after halo fixation. Clinical and radiological assessment was carried out immediately after the fracture healed and immobilization was stopped, one month after the union and then every 6 months&#xD;
&#xD;
Pain syndrome at rest (3 points on the W.W. Downie scale), or arising during light physical exertion (2 points on the W.W. Downie scale) after removal of the Halo - vest was not noted. In 3 (10.7%) patients with C1fracture, mild neck pain (1 point on the W.W. Downie scale) remained (Table 1).&#xD;
&#xD;
On control X-ray examination, complete correction of the displacement was achieved in 8 (44.4%) cases, regression of displacement of varying severity - in 5 (27.8%), a significant reduction was not achieved - in 2 (11.1%), fixation in the achieved position was carried out in 3 (16.7%) patients. In all cases, there were no secondary displacements of bone fragments of the C2. &#xD;
&#xD;
All fractures of the ring and arch of the C1 were completely consolidated. With odontoid fractures type I, 100%, type II 80% and type III 100% healed. With a fracture of the C2 arch (hangman&amp;#39;s fracture), healing is 90%. The overall rate of healing after 90 days of Halo - vest is 89.3% traction.&#xD;
&#xD;
No worsening of symptoms was observed on dynamic neurological examination. In one patient with a neurological disorder according to the ASIA type B classification below the level of damage in the rehabilitation period, motor functions and muscle strength in the control groups recovered to 3 points.&#xD;
&#xD;
Complications in the form of secondary mixing, pseudarthrosis, screw perforation, and intracranial hematoma were not observed. Only 1 (3.6%) patient had an infection of the scalp soft tissues in the late period of Halo &#x2013; vest traction, the apparatus was removed and further immobilization was performed with a removable head holder.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The problem of choosing the tactics of treating patients with fractures of the UCS has still not lost its relevance and is the subject of increased attention among neurosurgeons and traumatologists. Despite a large number of messages on the topic under study, many questions remain unsolved and are still far from a final solution.1,3,20&#xD;
&#xD;
The disadvantages of the most commonly used structures for posterior occipito spondylodesis, cannulated screws for fixing the odontoid process of the axis, are an increased risk of deformity, migration of components of fixing structures, depending on the degree of activation of movements in the cervical spine, the need to immobilize 3-4 vertebrates motor segments. The number of intraoperative complications, according to some literature data, reaches 9-12%.16-18 and unsatisfactory results of surgical treatment in 18-29% of patients are due to secondary deformities with the development (aggravation) of neurological disorders due to incompetent spondylodesis, cicatricial adhesive processes, uncovertebral arthrosis.10,15&#xD;
&#xD;
In 2000, under the leadership of U. Vieweg20, a 40-year analysis of the treatment of 682 patients was carried out. The results of treatment with the help of the Halo &#x2013; vest of fractures UCS were evaluated. The healing rate of all types of C1 vertebra fractures is 83%, in our series 100%. According to the author&amp;#39;s data and in our study, recovery was noted in all types I and III odontoid fractures. When researching U. Vieweg type II fracture healing occurred 67%, according to our data 80%. Regarding the healing of fractures of the C2 arch, our data are close to those reported by U. Vieweg.2,7,8&#xD;
&#xD;
In our material, possible complications of the apparatus method of treatment, such as the development of pressure ulcers in the places of pressure of the corset, difficulty in swallowing, pain and numbness in the hands, perforation with a screw of the skull bones with the formation of an epidural hematoma were not observed. Only 3.6% of patients had soft tissue inflammation in the area of cortical screws.19,20&#xD;
&#xD;
The problem of surgical treatment of patients with complicated C1 and C2 vertebral dislocations has not been completely resolved to date. The advantage of the Halo &#x2013; vest is to provide rigid fixation of the cervical spine in combination with the possibility of dynamic correction while maintaining the patient&amp;#39;s mobility.18,19&#xD;
&#xD;
Conclusions&#xD;
&#xD;
The use of the Halo &#x2013; vest allows rationally eliminating the displacement of bone fragments, restoring anatomical relationships in the craniovertebral region with simultaneous fixation of the cervical vertebrae and allows you to start early activation and rehabilitation of victims. Bony fusion succeeded in 89.3% of patients. A halo vest can be recommended for patients with Jefferson fractures, hangman&amp;#39;s fractures and odontoid fractures with a dislocation rate.&#xD;
&#xD;
Conflict of Interest: The authors declare that there is no conflict of interest.&#xD;
&#xD;
Acknowledgement: I deeply indebted to the Dr Urinboyev Baxtiyor Karimovich chairman of Department of Emergency Neurosurgery Fergana Branch Republican Research Centre of Emergency Medicine for his support. Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors /editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3358</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3358</Fulltext></URLs><References>1. Babkin AV. Diagnostics and treatment of injuries of the upper cervical vertebrae [dissertation].&#xA0; Minsk, Belarus: 1997.&#xD;
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12. Crawford NR, Hurlbert JR. Anatomy and Biomechanics of the Craniocervical Junction. J Sem Neurosurg 2002;13;2:101-110.&#xD;
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13. Dai LY, Yuan BN., Liu HK, Jia LS, Zhao DL. Surgical treatment of non-united fractures of the odontoid process, with special reference to occipito cervical fusion for nonreducible atlantoaxial subluxation or instability. J Eur Spine 2000;9:118-122.&#xD;
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14. Dickman CA, Hadley MN, Browner C, Sonntag VK. Neurosurgical management of acute atlas-axis combination fractures: A review of 25 cases. J Neurosurg 1989;70:45&#x2013;49.&#xD;
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15. Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures: Analysis of management and outcome in 340 consecutive cases. J Spine 1997; 22:1843-1852.&#xD;
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16. Hadley MN. Isolated Fractures of the Axis in Adults. J Neurosurg 2002;50:125-139.&#xD;
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17. Imaizumi T, Sohma T, Hotta H, Teto I, Imaizumi H, Kaneko M. Associated injuries and mechanism of atlanto-occipital dislocation caused by trauma. J Neurol Med Chir (Tokyo) 1995;35:385-391.&#xD;
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18. Lennarson PJ, Mostafavi H, Traynelis VC, Walters BC. Management of type II dens fractures: A case-control study. J Spine 2000;25:1234-1237.&#xD;
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19. Pitzen T, Caspar W, Steudel WI., Barbier D. Dens fracture in elderly patients and surgical management. J Aktuelle Traumatol 1994;24:56-59.&#xD;
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20. Vieweg U, Schultheiss R. A review of halo vest treatment of upper cervical spine injuries. Arch Orthop Trauma 2001;121(1-2):50-55.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Correlation of Risk Perception with the COVID-19 Related Knowledge and Preventive Measures: A Study on Indian Pharmacy Students&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>113</FirstPage><LastPage>119</LastPage><AuthorList><Author>Deepika Purohit</Author><AuthorLanguage>English</AuthorLanguage><Author> Parijat Pandey</Author><AuthorLanguage>English</AuthorLanguage><Author> Manish Makhija</Author><AuthorLanguage>English</AuthorLanguage><Author> Deeksha Manchanda</Author><AuthorLanguage>English</AuthorLanguage><Author> Jyoti Rathi</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Ravinder Verma</Author><AuthorLanguage>English</AuthorLanguage><Author> Pawan Jalwal</Author><AuthorLanguage>English</AuthorLanguage><Author> Vineet Mittal</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Kaushik</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: A novel threat to mankind occurred in December 2019 which was an outbreak of infection caused by a novel coronavirus (SARS-CoV-2 or 2019-nCoV). The infection was first developed in Wuhan, China, and has affected more than 200 countries around the world till now. Objective: The present study aims to assess the knowledge related to coronavirus disease (COVID-19), risk perception and preventive behaviours among the Pharmacy students in a part of India approximately 3 months after the onset of this outbreak in India. Methods: This survey was conducted from 2nd to 5th of September 2020 with Indian Pharmacy students (1st to 4th year). The knowledge, self-reported preventive behaviours and risk perceptions of COVID-19 were assessed using an online questionnaire. A total of 21 questions were there in the questionnaire in which 14 questions were about knowledge related to COVID-19, 4 items regarding preventive behaviours and 3 about risk perception. Results: A total of 268 participants completed the questionnaire. The participants were under the age group of 15-30 years. A high level of disease-related knowledge was found in the participants (77.66%). On an average 96.1% of participants were practising preventive behaviours. The aggregate score of items in risk perception section was found to be in the moderate range i.e., 5.38 out of 8. A significant negative correlation was obtained between risk perception and preventive behaviours. Conclusion: The trajectory and severity of this outbreak are very high, therefore, effective treatment against this global threat is required to be developed as early as possible. In the present study, a high level of disease-related knowledge and preventive behaviours were observed among the participants with a moderate level of risk perception.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> COVID-19, Coronavirus, Outbreak, Preventive behaviours, Risk perception, SARS-CoV-2</Keywords><Fulltext>Introduction&#xD;
&#xD;
Recently, a global threat to human health has emerged in the form of Coronavirus Disease 2019 (COVID-19) which is an outbreak of the respiratory disease and recognized in December 2019. It has been reported to be caused by a novel virus, named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 or 2019-nCoV) having structural similarity with the virus causing SARS.1,2 As per the reports of World Health Organization (WHO), till 15 October 2020, the different regions of the world have reported cases of COVID-19 with 38,202,956 confirmed cases and 1,087,069 deaths globally.3&#xD;
&#xD;
Human coronaviruses (HCoVs) have been reported as a group of viruses causing multiple respiratory disorders/diseases of varying severity, such as common cold, bronchiolitis and pneumonia.4 The researchers have reported HCoVs as rapidly evolving viruses because of its high recombination and genomic nucleotide substitution rates.5 Among the six HCoVs, identi?ed so far, namely HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, middle east respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV), four HCoVs (HCoVNL63, HCoV-229E, HCoV-HKU1 and HCoV-OC43) are circulated in the human population globally and have been found to cause about one-third of the infections due to common cold in humans.6,7 When the infection gets severe, these four HCoVs can be responsible for causing life-threatening bronchiolitis and pneumonia especially in immunocompromised patients, children and elderly.8,9&#xD;
&#xD;
COVID-19 infection is spreading at a great pace globally and people are getting infected when they come in close contact with the people or surface infected with the virus. Lack of proper knowledge about the disease among people and not following proper preventive measures can increase the risk of infection along with increased levels of anxiety and stress.10 A study of COVID-19 related knowledge, risk perception and preventive behaviours needed to be carried out since COVID-19 has affected worldwide. To our knowledge, no such study has been conducted yet to assess the COVID-19 related knowledge of pharmacy students in India along with the preventive behaviours they are observing and risk perception among them. Therefore, in this survey authors aim to evaluate these parameters in some Indian Pharmacy students.&#xD;
&#xD;
Materials and methods &#xD;
&#xD;
This study was conducted on some Indian Pharmacy students for investigating their knowledge of coronavirus disease, the preventive measures they are following and the self-reported risk perception. The target population was those getting directly or indirectly affected by COVID-19 which included some Indian Pharmacy students in Delhi/NCR with an expected population of 15000. For calculating the sample size, an online calculator Calculator.net was used.11 based on the projected population proportion of 50%, the sample size required for the study was 375 with 5% margin of error and a confidence level of 95%. This study was carried out from 2nd September to 5th September 2020 through an online questionnaire in the English language following all the recommendations given by the Government during the pandemic, including touch precautions and prevention in close contacts.&#xD;
&#xD;
Measures&#xD;
&#xD;
There were 4 sections in the online questionnaire including demographic data, knowledge of people on coronavirus disease, preventive measures and risk perception reported by participants. &#xD;
&#xD;
Demographics&#xD;
&#xD;
Demographic information involved a participant&#x2019;s age, gender, occupation, and current working status. These items were designed based on published literature available online.&#xD;
&#xD;
Coronavirus disease related-knowledge&#xD;
&#xD;
The first section of the questionnaire included 14 items for assessing the knowledge of participants regarding COVID-19. These questions were framed based on studies conducted previously about Middle East Respiratory Syndrome (MERS) and a newly reported study on COVID-19.10, 12 This section included 5 questions related to basic science related to COVID-19 and the disease aetiology, 2 questions about incubation period and symptoms, 1 question about the diagnosis of the disease, 2 items about disease transmission, 2 questions on prevention, and 2 items related to treatment. The validity of items in this section was determined by some experts involving an epidemiologist, and three medical professionals. One point was assigned to each correct answer and 0 points to &#x2018;no idea&#x2019; or an incorrect answer. The total score obtained by participants was then converted into a percentage. A score &#x2264;50% was designated as low level, 50%&#x2212;75% as moderate, and &#x2265; 75% as the high level of COVID-19 related knowledge. For testing the reliability, a pilot study was conducted on 25 participants and compared with the original study through Cronbach&#x2019;s alpha calculation with alpha value = 0.85 and 0.78, respectively.&#xD;
&#xD;
Self-reported preventive behaviours&#xD;
&#xD;
The preventive behaviours of participants were determined using four items based on a previous study.12 This section involved two items about preventive measures taken during sneezing and coughing, surface disinfection and frequent hand washing and two items regarding reduced use of public places in daily life. These items were validated by four experts including an epidemiologist, and three medical professionals. The total score was in the range of 0 to 4 which was converted to a percentage. A score </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3359</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3359</Fulltext></URLs><References>&#xD;
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	Kushwaha D, Purohit D, Pandey P, Saif M, Katiyar P. A case study: The updated case history of India, with the impact of COVID-19 on the Indian economy. J Appl Biol Bioenergy 2020; 2(1):1-15.&#xD;
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	WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/. [Cited 2020 August 26].&#xD;
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	Pene F, Merlat A, Vabret A, Rozenberg F, Buzyn A, Dreyfus F. Coronavirus 229E-related pneumonia in immunocompromised patients. Clin Infect Dis 2003;37:929-932.&#xD;
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	Vijgen L, Keyaerts E, Mo&#xEB;s E, Maes P, Duson G, Van Ranst M. Development of one-step, real-time, quantitative reverse transcriptase PCR assays for absolute quantitation of human coronaviruses OC43 and 229E. J Clin Microbiol 2005;43:5452-5456.&#xD;
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	https://www.calculator.net/sample-size-calculator.html. [Cited 2020 August 29].&#xD;
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	Khan MU, Shah S, Ahmad A, Fatokun O. Knowledge and attitude of healthcare workers about Middle East respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health 2014;14:1281-1288.&#xD;
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	Gentile I, Abenavoli L. COVID-19: Perspectives on the potential novel global threat. Rev Recent Clin Trials 2020;15(2): 84-86.&#xD;
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	Nour MO, Babilghith AO, Natto HA, Al-Amin FO, Alawneh SM. Knowledge, attitude and practices of healthcare providers towards MERS-CoV infection at Makkah hospitals, KSA. Int Res J Med Med Sci 2015;3(4):103-112.&#xD;
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	IndiaFightsCorona COVID-19. https://www.mygov.in/covid-19. [Cited 2020 May 29].&#xD;
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	Purohit D, Saini M, Pathak N, Verma R, Kaushik D, Katiyar P, et al. COVID-19 &#x2018;the pandemic&#x2019;: An update on the present status of the outbreak and possible treatment options. Biomed Pharmacol 2020;13(4). &#xD;
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	Wong TW, Gao Y, Tam WWS. Anxiety among university students during the SARS epidemic in Hong Kong. Stress and Health: J Int Soc Invest Stress 2007;23(1):31-45.&#xD;
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	Cheong D, Lee C. Impact of the severe acute respiratory syndrome on anxiety levels of front-line health care workers. Hong Kong Med J 2004; 10(5):325-330.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Health Awareness and Nutritional Knowledge of the Dyslipidemia Subjects&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>120</FirstPage><LastPage>125</LastPage><AuthorList><Author>Shivakumara C.S</Author><AuthorLanguage>English</AuthorLanguage><Author> Satish A</Author><AuthorLanguage>English</AuthorLanguage><Author> Usha Devi C</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Dyslipidemia is one of the major risk factor for atherosclerosis and related cardiovascular diseases. Evaluating health behavior patterns and knowledge regarding food and nutrients after diagnosis may help improve the management of dyslipidemia. Objective: The study aimed to assess the health awareness and nutrition knowledge among Dyslipidemia subjects. Methods: The area chosen for the studies was public sector company hospitals from Bangalore region. It was the study of the cost-effectiveness of health awareness and nutritional knowledge. The random sample of 400 aged between 31-60 years was recruited from the Public sector company hospitals. The information obtained on a) socio-economic profile and b) assessment of health awareness and nutritional knowledge using a questionnaire. Awareness comprising of 14 statements and knowledge using 16 statements with &#x2018;Yes&#x2019; or &#x2018;No&#x2019; options. Results: Most of the subjects were found between 31-40 years (42.8 %), 76.5% were males and 23.5% were females. Females respondents had higher nutrition knowledge (48.9%) and health awareness (55.8%) than their male&#x2019;s counterparts (44%) and (48%) respectively. 41-50 years (64 %) had the unfavourable level of Health Awareness and inadequate level (69.6%) of nutritional knowledge. Unfavourable level of Health Awareness inadequate level of nutritional knowledge was observed irrespective of the educational and occupational status of the respondents compared to those working as a staff nurse had a moderate level of Health Awareness and nutritional knowledge. Conclusion: Health awareness and nutritional knowledge of among Dyslipidemia subjects females found higher than males however found inadequate. Creating health awareness and nutritional knowledge alone may not be an adequate amount of to progress health status in patients with dyslipidemia.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Awareness, Dyslipidemia, Food, Health, knowledge, Nutrients, Socio-economic</Keywords><Fulltext>Introduction&#xD;
&#xD;
Cardiovascular disease (CVD) is one of the biggest causes of death globally. Cardiovascular disease occurs typically due to atherosclerosis of bulky and medium-sized arteries and dyslipidemia is one of the most important causative factors. Lowering lipids through nutritional intervention or pharmacological treatment has been shown to decrease the occurrence of atherosclerotic events.1 Approximately 31.8 million peoples were living with coronary artery disease (CAD) in India alone.2 The Cardiovascular disease tends to occur at the youths in India with 52% of CVD deaths occurring under the age of 70 years and 10% of heart attacks happening in subjects with 200 or Low-Density Lipoprotein Cholesterol more than &gt;130, secondary data was selected with the help of physician and cardiologist using available medical records. The study was approved by the Nutri-Explore Ethics Committee (NEEC BU 010 Ph.D/Project/2015-16). &#xD;
&#xD;
Nutritional knowledge and Health Awareness&#xA0;&#xA0; &#xD;
&#xD;
The subjects were instructed to complete the nutritional knowledge and health awareness questionnaire. The data were recorded during the working hours of the individual employees. Nutritional knowledge and health awareness were evaluated using a validated general questionnaire. The information obtained on a) Assessment of health awareness and b) Nutritional knowledge using a questionnaire. Health Awareness comprising of 14 statements and nutrition knowledge measured using 16 statements with &amp;#39;Yes&amp;#39; or &amp;#39;No&amp;#39; options. Each response was given score namely.&#xD;
&#xD;
&#xD;
&#xD;
Based on the above score the total score for nutritional knowledge and health awareness was computed. The total score for health awareness was grouped into three categories namely unfavourable, moderate and favourable and for nutritional knowledge grouped in to inadequate, moderate and adequate (Table 2 and 3).&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Statistical Data Analysis&#xD;
&#xD;
Collected data was consolidated, classified, tabulated and analyzed using SPSS version 20 (SPSS 20&#xA0;is a comprehensive system for analyzing data) and office package windows 2010. The statistical test was used to analyze the data such as mean, standard deviation, chi-square test, and standard&#x2019; test.&#xD;
&#xD;
&#xD;
&#xD;
Results&#xD;
&#xD;
Table-1 represents higher parentages of the respondents were found in the age group of 31- 40 years (42.8%) followed by 41-50 (28.0%) and 51-60 years (28%). Majority of dyslipidemia subjects were male (75%).&#xA0; Fifty-one percentages of the patients were having two children followed by thirty-two per cent with one child. The finding reveals that majority of the respondents were Hindus (97.7) residing in the urban areas (92.0%). Nuclear family trend (91.8%) was observed among the respondents and their family income was found to be in the range of Rs20, 000 to 30,000 per month (38.5%) ( Table 4).&#xD;
&#xD;
&#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
&#xD;
From the present study, it is clear from the findings that females subjects had higher overall nutrition knowledge (48.9%) and health awareness (55.8%) than their male&amp;#39;s counterparts (44%) and (48%) respectively. The difference in overall health awareness (t=3.44*) and Nutritional knowledge (t=2.18*) between male and female found to be statistically significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3360</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3360</Fulltext></URLs><References>&#xD;
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	Shamsi Y, Kumar H. A Randomized, Double-Blind Study To Evaluate The Pharmacological Effect Of A Polyherbal Drug (Lipotab) In Managing Dyslipidemia. Int J Curr Res Rev 2012;4(6); 20-29.&#xD;
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	Gupta R. Burden of coronary heart disease in India. Indian Heart J 2005;57:632-638.&#xD;
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	World Health Organization, Diet, nutrition and the prevention of chronic diseases: Report of a Joint WHO/FAO expert consultation; WHO: Geneva, Switzerland, 200 &#xD;
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	Nicklas TA, Hayes D. Position of the American Dietetic Association: nutrition guidance for healthy children ages 2 to 11 years. J Am Diet Assoc 2008;108;1038&#x2013;1047.&#xD;
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	Joy-Telu HE, Malcolm T. Teaching/learning methods and students&#x2019; classification of food items. Health Educ 2011;111;66&#x2013;85.&#xD;
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	Kalpana CA. Development of an interactive website on metabolic syndrome and its impact on obese adolescent girls. Int J Cur Res Rev 2017;9(3);34-38.&#xD;
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	Dallongeville J, Marecaux, N. Cottel, D. Bingham, A. Amouyel, P. Association between nutrition knowledge and nutritional intake in middle-aged men from Northern France. Public Health Nutr 2001;4;27&#x2013;33.&#xD;
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	Gates G, McDonald M. Comparison of dietary risk factors for cardiovascular disease in African-American and white women. J Am Diet Assoc 1997;97;1394-1400.&#xD;
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	Paquette MC. Perceptions of healthy eating: State of knowledge and research gaps. Can J Public Health 2005;96(3);S15&#x2013;S21. &#xD;
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	Ghvanidze S, Velikova N, Dodd TH, Oldewage-Theron W. Consumers&amp;#39; environmental and ethical consciousness and the use of the related food products information: The role of perceived consumer effectiveness. Appetite 2016;107;311-322.&#xD;
	&#xD;
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	Barbosa BL, Vasconcelos SML, dos Santos Correia LO, Ferreira RC. Nutrition knowledge assessment studies in adults: a systematic review Ci&#xEA;ncia &amp; Sa&#xFA;de Coletiva. 2016; 21(2); 449-462. &#xD;
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	Chapman KM, Ham JO, Liesen P, Winter L. Applyingbehavioral models to dietary education of elderly diabetic patients. J Nutr Educ Behav 1995;27(2);75-79.&#xD;
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	Wardle J, Parmenter K and Waller J. Nutrition knowledge and food intake. Appetite. 2000;34; 269&#x2013;275.&#xD;
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	Parmenter K, Waller J and Wardle J. Demographic variation in nutrition knowledge in England. Health Educ Res 2000; 15;163&#x2013;174.&#xD;
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	Hendrie G, Coveney J and Cox D. Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample. Public Health Nutr 2008;11;1365&#x2013;1371.&#xD;
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	Eichler K, Wieser S, Brugger U.The costs of limited health literacy: a systematic review. Int J Public Health 2009;54;313&#x2013;324.&#xD;
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	Vernon JA, Trujillo A, Rosenbaum S.&#xA0; Low Health Literacy: Implications for National Health Policy. Washington, DC: Department of Health Policy, School of Public Health and Health Services, The George Washington University, 2007.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Usage Pattern of Gastroprotective Agents Among Patients Prescribed with NSAIDS in Orthopedics Department&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>126</FirstPage><LastPage>131</LastPage><AuthorList><Author>Lynel Venston Saldanha</Author><AuthorLanguage>English</AuthorLanguage><Author> Josina John</Author><AuthorLanguage>English</AuthorLanguage><Author> Abdul Javad K</Author><AuthorLanguage>English</AuthorLanguage><Author> Siddarth M. Shetty</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharad Chand</Author><AuthorLanguage>English</AuthorLanguage><Author> Juno J Joel</Author><AuthorLanguage>English</AuthorLanguage><Author> Bharath Raj KC</Author><AuthorLanguage>English</AuthorLanguage><Author> Nandakumar UP</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Gastroprotective agents are prescribed in the department of orthopaedics to prevent and to treat gastric toxicity due to analgesics including NSAIDs. Objective: The present study aimed to analyze the prescribing pattern of gastroprotective agents among patients prescribed with NSAIDs in the department of orthopaedics and to identify the most common gastroprotective agent co-administered. The study also aims to estimate the average cost of gastroprotective agents. Methods: A prospective observational study was conducted for six months among 370 inpatients of the orthopaedics department. Relevant details on the usage pattern of gastroprotective agents were collected from the case sheets of the patients and were analyzed by descriptive statistics. Results: Out of 370 subjects enrolled, 257 (69.5%) were males and 113 (30.5%) were females. The most frequently prescribed single NSAID agent was diclofenac 82 (71.3%) and the fixed-dose combination was found to be diclofenac + chymotrypsin 88 (32.1%). Among the various proton pump inhibitors and H2 receptor antagonists prescribed, pantoprazole was found to be the most commonly prescribed agent 205 (61.4%), followed by rabeprazole 96 (28.7%). The average cost spent by a patient on the gastroprotective agent during their hospital stay was found to be 65.85&#xB1;52.45 INR. Conclusion: The present study concluded that the majority of patients were prescribed with gastroprotective agents along with NSAIDs. The present study provides an insight into various healthcare professionals on the importance of rational use of medications among subjects.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Gastroprotectives, NSAIDs, Pantoprazole, Prescribing pattern, Average cost</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are the majorly used medications to ameliorate pain and inflammation. Opioids are rarely used because of their abuse potential and adverse effects including CNS and respiratory depression. This gives way to the use of NSAIDs which are organic acids involved in inhibiting cyclooxygenase-1 and cyclooxygenase-2 (COX-1 and COX-2)enzymes. Inhibition of these enzymes causes decreased production of prostaglandins.1,2 NSAIDs have antipyretic properties because of the inhibition of interleukin and tumour necrosis factor-alpha. The anti-thrombotic effects of NSAIDs are due to the inhibition of thromboxane.1 The anti-inflammatory properties of NSAIDs are because of the inhibition of COX-2 mediated prostaglandin synthesis. They can only stop a part of the inflammatory process because they do not block leukotrienes and platelet-activating factors.2 Prostaglandins are involved in gastric protection by helping in the inhibition of breakdown of gastric mucosa and thereby preventing the formation of an ulcer. However, they do not offer complete protection. Due to the ulcerogenic properties of NSAIDs, it is usually appropriate to prescribe them along with drugs that are involved in the protection of gastric mucosa to reduce pain and complications of excess bleeding.2,3 Studies conducted to analyze the usage pattern of any drugs would help to perform modifications in the pattern of its prescription, which ultimately increases the therapeutic benefit and helps in reducing the associated adverse effects.4-7 A significant price variation of drugs can create a financial burden, especially on economically backward patients.8 Hence, it is very important that the treating physicians must be made aware of the cheapest drugs out of the various brands available in India so that the patient bear the fewer burden of treatment costs. Thus, the present study was conducted to analyze the usage pattern of gastroprotective agents along with NSAIDs among in-patients of the orthopaedics department.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A prospective observational study was conducted for six months in the department of orthopaedics after obtaining approval from the Institutional Ethics Committee (REF: NGSMIPS/IEC/22/2019-20). Inpatients of either gender, aged above 18 years, prescribed with at least one NSAID in the department of orthopaedics were enrolled in the study. A total of 370 patients meeting the inclusion criteria were enrolled in the study after obtaining the voluntary informed consent from the patients. A suitable data collection form was prepared to collect and document the data including the details of patient demographics and the prescription pattern. Relevant details of the study subjects such as their age, gender, social habits, comorbidities, and diagnosis were obtained from the patient&#x2019;s case records. Data including the name and dosage of NSAIDs and gastroprotective agents prescribed, type of therapy and other co-prescribed drugs were also noted. The average cost spent on gastroprotective agents by the subjects was calculated. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Frequency and percentage were used to analyze the gender, domiciliary status, comorbidities, social habits, diagnosis, the prescription pattern of NSAIDs and gastroprotective agents. Mean and the standard deviation was used to summarize the age and average cost of gastroprotective agents spent by subjects. The average cost was expressed in Indian currency.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Demographic details of the study subjects&#xD;
&#xD;
Out of 370 subjects enrolled, 257 (69.5%) were males and 113 (30.5%) were females. The majority were found belonging to the age group of 21 to 40 years, 168 (45.4%) followed by 41-60 years, 143 (38.6%) and 61-80 years, 42 (11.35%). The mean age of the study population was found to be 42.04 &#xB1; 14.30 standard deviation. Distribution of subjects based on domiciliary status showed that 286 (77.3%) were found belonging to the rural background and 84 (22.7%) were from an urban background. &#xD;
&#xD;
Distribution of co-morbidities presented by the subjects&#xD;
&#xD;
Out of the total subjects enrolled, 38 patients reported a total of 44 co-morbidities. The most common comorbidity was found to be hypertension 24 (54.5%), followed by diabetes mellitus 16 (36.4%). The details are summarized in Table 1. &#xD;
&#xD;
Distribution of subjects based on their social habits&#xD;
&#xD;
Sixty-two (16.8%) patients were found to be present with at least one social habit. Out of which, 21 (33.8 %) were alcoholics and 21 (33.8%) were smokers. The details are summarized in table 2.&#xD;
&#xD;
Distribution of various diagnoses among the study subjects&#xD;
&#xD;
A total of 377 orthopaedic related diagnoses were made among 370 patients. The most frequently diagnosed condition among the study population was found to be joint pain 122 (32.3%), followed by fracture 83 (22.0%) The details are given in table 3.&#xD;
&#xD;
Prescribing pattern of NSAIDs among study subjects&#xD;
&#xD;
A total of 389 NSAIDs were prescribed among 370 patients. Out of which 115 were prescribed as single NSAIDs, whereas 274 were given as fixed-dose combination. Among the total single NSAIDs prescribed, Diclofenac 82 (71.3 %) was found to be the highest followed by Indomethacin 12 (10.4 %) and in fixed-dose combination, diclofenac + chymotrypsin 88 (32.1%) was highest, followed by aceclofenac + paracetamol 40 (14.6%) as depicted in table 4 and 5. Three hundred forty-eight (94%) patients were prescribed with monotherapy of NSAIDs followed by combination therapy 22 (6%).&#xD;
&#xD;
Distribution of subjects based on the prescription of gastroprotective agents.&#xD;
&#xD;
Out of 370 subjects enrolled, 334 (90.3%) were prescribed with gastroprotective in combination with NSAIDs, and 36 (9.7%) subjects were not prescribed with gastroprotective agents.&#xA0; Among 334 subjects, the most commonly prescribed agent was found to be Pantoprazole 205 (61.4%), followed by Rabeprazole 96 (28.7%). The details are summarized in Table 6.&#xD;
&#xD;
Distribution of Antibiotics prescribed among subjects&#xD;
&#xD;
A total of 169 (45.6 %) antibiotic agents were prescribed among the total subjects enrolled. The most commonly prescribed antibiotic was found to be cefuroxime 75 (44.3%). The details are summarized in table 7.&#xD;
&#xD;
Estimation of the cost spent by subjects on gastroprotective agents&#xD;
&#xD;
The mean cost spent by a patient on gastroprotective agents per day was found to be 8.71 &#xB1; 3.95 standard deviations. The per-day cost spent varied from 0.65 to 24.2 INR. The mean cost spent by a patient on gastroprotective agents during their hospital stay was found to be 65.85 &#xB1; 52.45 standard deviations. The total cost spent by the patient ranged from 2.62 to 350.40 INR.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The results obtained in gender-wise distribution was supported by other previously conducted research.9,10However, one study exhibited opposing results as females (57.6%) were the predominant subjects in this study.11 A a large number of patients who were prescribed with NSAIDs belonged to the age group 21-40 years (45.4%). Similar results were discussed in two other studies wherein, 27.7% and 41% of the study subjects belonged to the same age group of 21-40 years respectively.12,13 However, this result was not in agreement with a study done in 2018in which most of the patients could be categorised in the age group of 40-60 years (44.5%).11 The age of the study subjects ranged between 18-83 years with a mean value of 42.04&#xB1;14.3 standard deviation. This aspect was supported by the study results of Kim T J and his team.14 In the current investigation, hypertension (54.5%) was found to be the most frequent co-morbidity reported among the subjects. The results of a study performed by a group of researchers also showed hypertension (12.4%) as the most common co-morbidity among their study population.14 However, diabetes mellitus was found to be the major co-morbidity in a drug utilisation study conducted in Kerala.11While analysing the final diagnoses of the study population, the results were in contradiction with a study where the majority of the recruited participants were confirmed cases of osteoarthritis (36.1%). Comparable results were obtained in a study by Choudhury D K and his team as a predominant diagnosis of fractures (61%) was noted amongst the patient population.15,16&#xD;
&#xD;
In this current study, a large proportion (94.0%) of the subjects received monotherapy with NSAIDs whereas only 6.0% of the patients were recipients of combination therapy. Corresponding results were obtained in two other studies wherein, 55.5% and 98.9% of their patients were prescribed with NSAIDs as monotherapy.11,16 However, the results of another research conducted in 2016 were inconsistent with our report as combination therapy was preferred over monotherapy in this population.17 Diclofenac (71.3%) was found to be the most commonly prescribed NSAIDs among patients who received therapy with the single analgesic agent and this finding agreed with the study carried out by Choudhury DK and his team. However, in another study, Etoricoxib was observed to be the most commonly prescribed agent (33.34 %).11,16 The fixed-dose combination of NSAIDs prescribed in the present study was found to be inconsistent with the conclusions of Chaudhary DK and his team.16&#xD;
&#xD;
In our study, gastro-protective agents were co-prescribed with NSAIDs among 90.3% of the patients and comparable results were noted in a different study since 95% of the study population who were prescribed with NSAIDs also received co-administration of gastro-protective agents.18On analysing the prescription pattern of different gastroprotective agents, the results of a study were similar to the present study as proton pump inhibitors (73.54%) were the most frequently prescribed agents in their study. In contradiction, Ranitidine was found to be the most commonly prescribed agent in studies conducted during the years, 2015 and 2016.16,19 The judicious use of drugs reduces the economic burden on the patient significantly, especially among those who are financially backward. Hence, attempts to increase the physician&#x2019;s awareness of the pharmaco-economic aspects of medication and the various brands available in the market should be done at regular intervals. These aspects of treatment are often neglected while they remain crucial in a developing nation like India. This will directly benefit the patients and the clinical pharmacist is the most recommended professional to carry out these activities as part of their routine clinical pharmacy services.20&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The present study was conducted to assess the usage pattern of gastroprotective agents along with NSAIDs. Pantoprazole was found to be the most commonly prescribed gastroprotective drug, followed by rabeprazole. It is evident through various studies that the co-prescription of gastro-protective agents significantly reduces the gastrointestinal related adverse effects of NSAIDs but simultaneously, increases the cost of therapy. This study is a means to disseminate awareness among various healthcare professionals on the significance of rational prescription of gastroprotective agents along with NSAIDs and how a pharmacist could contribute to improving current prescribing practices in hospitals. &#xD;
&#xD;
ACKNOWLEDGEMENT: We authors are extremely thankful to NGSMIPS, Nitte (Deemed to be University), Mangaluru, Karnataka for providing us with all the necessary facilities for carrying out this work.&#xD;
&#xD;
FUNDING: Nil&#xD;
&#xD;
CONFLICT OF INTEREST: Authors declare no conflict of interest&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3361</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3361</Fulltext></URLs><References>&#xD;
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	Gonzalez FJ, Coughtrie&#xA0;M, Tukey RH. Drug Metabolism. In: Brunton LL, Chabner&#xA0;BA, KnollmannBC, editors. Goodman and Gilman&#x2019;s pharmacological basis of therapeutics. 12th&#xA0;ed. New York: McGraw-Hill Medical; 2011. p. 687-707.&#xD;
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	Tripathi KD, editor. Essentials of Medical Pharmacology. 7th ed. New Delhi: Jaypee Brothers; 2013.&#xD;
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	Ofman J, Badamgarav E, Henning J, Knight K, Laine L. Utilization of nonsteroidal anti-inflammatory drugs and antisecretory agents: a managed care claims analysis. Am J Med 2004;116(12):835-842.&#xD;
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	Chandran BK, Vaddakan K, Altaf M, Shetty V, Chand S, Vijayan A et al. A retrospective study on the prospective usage pattern of analgesics in orthopaedics department of a tertiary care hospital. IJSTR 2020;9(03):1207-1211.&#xD;
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	Gouda V, Shastry CS, Mateti UV, Subrahmanya C, Chand S. Study on steroid utilization patterns in the general medicine department. Res J Pharm Tech 2019;12(10):4771-4776.&#xD;
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	Al-Jabri MM, Shastry CS, Chand S. Assessment of drug utilization pattern in chronic kidney disease patients in a tertiary care hospital-based on WHO core drug use indicators. J Global Pharma Tech 2019;11(9):1-9.&#xD;
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	Yadav AK, Sharma N. Drug use in the medical outpatient department: A prospective study in the tertiary care teaching hospital. Int J Curr Res Rev 2012; 4(6):111-118.&#xD;
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	Paul F, Babu N, Chand S, Vinay BC, Nandakumar UP, Bharathraj KC. Drug utilization evaluation and price variability study of non-steroidal anti-inflammatory drugs in the orthopaedic department of a tertiary care hospital. Plant Arch 2020;20(Spl. 02): 1696-1701.&#xD;
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	Kumar A, Dalai C, Ghosh A, Ray M. Drug utilization study of co-administration of nonsteroidal anti-inflammatory drugs and gastroprotective agents in an orthopaedics outpatient&#x2019;s department of a tertiary care hospital in West Bengal. Int J Bio Chem Phy 2013;2(2):199-202.&#xD;
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	Bhat J, Akbar T, Faizan F, Mir N. Co-administration of nonsteroidal anti-inflammatory drugs and gastroprotective drugs in the orthopaedic out-patient department of a university hospital in Kashmir. JDMS 2016;15(09):17&#x2013;19.&#xD;
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	Rejimon G, Reghu R. Drug utilization pattern of non-steroidal anti-inflammatory drugs in patients attending the orthopaedic department of a hospital in Kerala. IJPSR 2018; 10(5):1014-1016.&#xD;
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	Shahsavani N. Assessment of prescribing pattern of proton pump inhibitor and histamine 2 receptor antagonist. J Innov Pharma Bio Sci 2016;3(3):13-22.&#xD;
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	Kumar S, Thakur P, Sowmya K, Priyanka S. Evaluation of prescribing pattern of NSAIDs in South Indian teaching hospital. J Chitwan Med College 2017;6(4):54-58.&#xD;
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	Kim T, Kim E, Hong S, Kim Y, Lee Y, Kim H et al. Effectiveness of acid suppressants and other neuroprotective agents in reducing the risk of occult gastrointestinal bleeding in nonsteroidal anti-inflammatory drug users. Sci Rep 2019; 9(1). &#xD;
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	Douglas R, Nair MK. Utilization pattern of antidepressants in psychiatry wards of a tertiary care hospital in South Kerala, India. IJBCP. 2017; 6(8): 1890.&#xD;
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	Choudhury DK, Bezbaruah BK.&#xA0; Prescribing pattern of analgesics in orthopaedic in-patient department at tertiary care hospital in Guwahati, Assam, Northeast India. Indian J Pharmacol 2016; 48(4): 377-381.&#xA0; &#xD;
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	Padmanabha TS, Bhaskara K, Manu G, Chrankantha T. Post-operative utilisation pattern of analgesic in orthopaedic department of an Indian tertiary care teaching hospital. IJCPCR 2016; 6(1): 27-31.&#xD;
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	Manohar V, Vinay M, Jayasree T, Kishan P, Ubedulla S, Dixit R. Prescribing pattern of gastroprotective agents with non-steroidal anti-inflammatory drugs. J Pharmacol Pharmacother 2013;4(1):59-60.&#xD;
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	Sukhlecha AG, Vaya S, Parmar GG, Chavda KD. The pattern of drug utilisation in surgical opd of a teaching hospital located in Western India. Int J Med Sci Public health 2015; 4(9):1291-1296.&#xD;
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	Voora L, Sah SK, Bhandari R, Chastry CS, Chand S, Rawal KB. Doctor of pharmacy: boon for the healthcare system. Drug Invention Today 2020;14(1):153-158.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>To Study the Additional Effect of Aerobic Exercises on Cognitive Behavioral Therapy in Depressed Diabetics&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>132</FirstPage><LastPage>138</LastPage><AuthorList><Author>Ronika Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Arwa Alirajpurwala</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Depression has been linked to abnormal glucose metabolism in diabetics by increasing insulin resistance. Cognitive behavioural therapy is commonly used psychotherapeutic approaches for reducing depression. It is usually time-limited, focuses on current problems and follows a structured style of intervention. Objective: To test the effectiveness of cognitive-behavioural therapy alone and along with aerobic exercises in reducing depression and to find its effect on blood sugar levels. To study the additional effect of aerobic exercises on cognitive behavioural therapy in depressed diabetics. Methods: Sixty diabetic patients were selected having a score of &gt;11 on Becks Depression Inventory (Age 35-60 years). HbA1c equal to or more than 8%, diabetic for more than two years. Patients were grouped (N=30/group) to receive cognitive behavioural therapy or cognitive behavioural therapy + aerobic exercises. The level of depression was evaluated using Becks Depression Inventory, postprandial blood sugar levels and glycated haemoglobin( HbA1c) levels were measured pre and post 6 weeks. The mood of patients was assessed using mood rating scale pre and post-intervention. Cognitive behavioural therapy was given for 6 weeks and results were analyzed. Results: A significant reduction was seen in depression, postprandial blood sugar levels and HbA1c levels in both the groups. There was also an improvement in the mood of the patients from depression to joyful over 6 weeks. Conclusion: Both aerobic exercises and cognitive behavioural therapy proved to be effective in reducing depression and thereby optimizing blood sugar levels and HbA1c levels.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Diabetes Mellitus Type II, Cognitive Behavioral Therapy, Depression, Becks Depression Inventory, Aerobic Exercises, Insulin resistance</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Diabetes mellitus is defined as a metabolic disorder of multiple aetiology, characterized&#xA0; by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both.1 Diabetes Mellitus has become one of the most common chronic diseases worldwide with an estimated prevalence of detected Diabetes Mellitus being 3 to 4% in the general population. One of the consistent findings among various studies on diabetes has been the high prevalence of depression with or without comorbid anxiety among patients of Diabetes Mellitus.2 Also it has been found that depression is consistently associated with hyperglycemia and an increase in the risk of diabetic complications.3&#xD;
&#xD;
Depression leads to deterioration of glycemic control via its effects on the neuroendocrine system.2 The presence of microvascular and macrovascular complications in diabetes is associated with a higher prevalence of depression and a lower quality of life.1 Remission of depression is often associated with an improvement in glycemic control. Various randomized trials of treatments for depression have been conducted in patients with diabetes. These interventions have successfully reduced the severity of depression and optimizing glycemic levels.1&#xD;
&#xD;
A variety of methods are adopted to deal with stressors and depression-like anger management, aversion treatment, relaxation training, social skills training, and stress management. One of these psychotherapeutic treatment includes Cognitive Behavioral Therapy (CBT)4. The first controlled outcome study of cognitive behavioural therapy for depression was conducted in 1977 and since then a great deal of research into the effectiveness of Cognitive Behavioral Therapy has been conducted.&#xA0; Currently, cognitive behavioural therapy is in common use throughout the world, within public and private health care services, and particularly in the US, Canada, UK, Australia and Northern Europe. 5&#xD;
&#xD;
Cognitive behavioural therapy is a psychological treatment that addresses the interactions between how we think, feel and behave. It is usually time-limited, focuses on current problems and follows a structured style of intervention.5 A systematic review evaluated the impact of cognitive behavioural therapy on glycemic control of people with type 2 diabetes where there was a reduction of 0.76% in HbA1c levels, thus suggesting the importance of cognitive behavioural therapy in treating depression among diabetics.1&#xD;
&#xD;
Brief cognitive behavioural therapy is the compression of cognitive-behavioural therapy material and the reduction of the average 12-20 sessions into four to six sessions. In Brief cognitive behavioural therapy, the concentration is on specific treatments for a limited number of the patient&#x2019;s problems. Time-limited therapy offers an additional incentive for patients and therapists to work efficiently and effectively. However, the exact length of treatment is determined by a host of factors involving the therapist, patient, and treatment setting. 6&#xD;
&#xD;
Cognitive behavioural therapy includes four important components.&#xD;
&#xD;
&#xD;
	&#xD;
	Progressive Muscle Relaxation Techniques: Muscle relaxation for all muscles is given.&#xD;
	&#xD;
	&#xD;
	Behavioural Activation: People are taught to engage in enjoyable activities and improve their problem-solving skills.&#xD;
	&#xD;
	&#xD;
	Mental Imagery: Patient is asked to imagine a peaceful atmosphere while watching a Relaxing video and oft music.&#xD;
	&#xD;
	&#xD;
	Deep Breathing Exercises&#xD;
	&#xD;
&#xD;
&#xD;
All these are progressively taught during each cognitive behavioural therapy session.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Exercise, along with diet and medication, plays an important role in the management of type 2 diabetes. Aerobic exercise consists of exercises of the same large muscle groups for at least 20 minutes at a time. Examples include walking, bicycling, jogging, swimming, etc When performed at sufficient intensity and frequency, this type of exercise increases cardiorespiratory fitness. Regular aerobic exercise decreases visceral fat mass and body weight without affecting muscle mass, increases insulin sensitivity, glucose and blood pressure control, lipid profile improves and reduces the cardiovascular risk. For these reasons, regular aerobic physical activity must be considered an essential component of the treatment of type II diabetes mellitus.7&#xD;
&#xD;
As we know that cognitive-behavioural therapy has proven to effective intervention for reducing depression and enhancing glycemic control, with enduring and clinically meaningful benefits in adults with type 2 diabetes and depression.8 And aerobic exercises help in increasing insulin sensitivity thus lowering high blood sugar levels.7,9 A combined effect of both aerobic exercises and cognitive behavioural therapy would thus give us an integrated approach in managing diabetics suffering from depression.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
After receiving approval from the Institutional Ethics Committee, patients were selected based on inclusion and exclusion criteria. A brief explanation of the procedure was given to each subject. Patients were asked to sign a written consent before their participation.&#xA0; Patients were then asked to fill the demoFigure ic datasheet.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Subjects in the age group 35-60 years, diabetic for at least 2 years or more, HbA1c equal to or more than 8% within the last 1-1.5 months or average blood sugar level (BSL) of at least 183 mg /dl, Becks depression inventory score10 of at least 11 or more signifying mild to borderline clinical levels of depression, subjects not participating in any exercises for last 3 months or more and subjects who could understand English were included in the study.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Subjects having cognitive dysfunctions like schizophrenia, dementia, any psychiatric illnesses, any musculoskeletal or neurological deficits were excluded. Patients were also given the mood rating scale, behavioural activation chart and a calendar for marking the days they performed the exercises.&#xD;
&#xD;
The following procedure was carried out with every patient. (each session represents a week)&#xD;
&#xD;
Session 1&#xD;
&#xD;
&#xD;
	&#xD;
	Identify her presenting problem. &#xD;
	&#xD;
	&#xD;
	Introduce cognitive behavioural therapy. &#xD;
	&#xD;
	&#xD;
	Set goals. &#xD;
	&#xD;
	&#xD;
	Introduce behavioural activation.&#xD;
	&#xD;
	&#xD;
	Introduce and practise progressive muscle relaxation.&#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
Session 2&#xD;
&#xD;
&#xD;
	&#xD;
	Check mood.&#xD;
	&#xD;
	&#xD;
	Review behavioural activation&#xD;
	&#xD;
	&#xD;
	Plan two times during the week to practice progressive muscle relaxation &amp; introduce deep breathing exercises (DBE) &amp; imagery. &#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
Session 3 &#xD;
&#xD;
&#xD;
	&#xD;
	Check mood. &#xD;
	&#xD;
	&#xD;
	Review progressive muscle relaxation, behavioural activation, DBE &amp; imagery.&#xD;
	&#xD;
	&#xD;
	Review homework. &#xD;
	&#xD;
	&#xD;
	Ask him to practice progressive muscle relaxation &amp; imagery exercise &#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
Session 4&#xD;
&#xD;
&#xD;
	&#xD;
	Check mood.&#xD;
	&#xD;
	&#xD;
	Review PMR, Behavioral activation, DBE, imagery&#xD;
	&#xD;
	&#xD;
	Review homework.&#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
Session 5&#xD;
&#xD;
&#xD;
	&#xD;
	Check mood.&#xD;
	&#xD;
	&#xD;
	Review homework. &#xD;
	&#xD;
	&#xD;
	Review PMR, behavioural activation, imagery &amp; DBE&#xD;
	&#xD;
	&#xD;
	Review the progress of treatment by 2 imagery ex&#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
Session 6&#xD;
&#xD;
&#xD;
	&#xD;
	Check mood&#xD;
	&#xD;
	&#xD;
	Review all the exercises.&#xD;
	&#xD;
	&#xD;
	Relapse prevention. &#xD;
	&#xD;
	&#xD;
	Receive feedback from the patient.&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; AEROBIC EXERCISES&#xD;
&#xD;
&#xD;
	&#xD;
	Before beginning with aerobic exercises, patients were asked to check their heart rate (radial pulse) by placing index, middle and ring finger on their wrist. &#xD;
	&#xD;
	&#xD;
	Their resting heart rate and target heart rate was calculated for using Karvonen&#x2019;s formula. &#xD;
	&#xD;
	&#xD;
	The warm-up was given by asking the patient to start walking slowly &amp; gradually increase the speed.&#xD;
	&#xD;
	&#xD;
	Frequency = 5 times a week&#xD;
	&#xD;
	&#xD;
	Intensity = For the first 2 weeks patients walked at 30% of Heart Rate (HR) max and for the remaining 4 weeks, they walked between 40% - 60% of HR max.&#xD;
	&#xD;
	&#xD;
	Time = 30 minutes&#xD;
	&#xD;
	&#xD;
	Type = Walking at a faster pace than normal&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Exercises were done by asking the patient to increase the speed of walking up to 6 weeks. Maximum heart rate (HR max) was calculated using the following formula11:&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;206.9 &#x2013; (0.7 * age)&#xD;
&#xD;
&#xD;
	&#xD;
	Target heart rate (THR) of the individual was calculated using Karvonen&#x2019;s formula12&#xD;
	&#xD;
&#xD;
&#xD;
Karvonen&#x2019;s formula (THR) = (HR max &#x2013; HR rest) 30% - 60% + HR rest &#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
A significant reduction was seen in depression, postprandial blood sugar levels and HbA1c levels in both the groups. There was also an improvement in the mood of the patients from depression to joyful over 6 weeks.&#xD;
&#xD;
This study aimed at finding the additional effect of aerobic exercises on cognitive behavioural therapy in depressed diabetics. Diabetic patients of age between 35-65 years were part of the study. Patients were selected from various residential areas including Camp, Kondhwa, Hadapsar and City areas in and around Pune. Patients who were having no cognitive dysfunctions like schizophrenia or dementia and without any innate or acquired musculoskeletal or neurological deficits were selected. &#xD;
&#xD;
In our study, we used the Becks Depression Inventory where the levels of depression in both groups ranged from 11 to 20 which indicates mild to borderline clinical levels of depression. There is a significant difference in the Becks Depression Inventory in Pre and Post-treatment score in group A thus showing a reduction in depression levels in the subjects of this group (Figure 2).&#xD;
&#xD;
In Figure &#xA0;3, the mean difference between pre and post-treatment values for Becks Depression Inventory for group A and group B are 7.60 and 7.83 respectively, with a p-value of 0.74 concluding that both forms of treatment that is, cognitive behavioural therapy alone and in combination with aerobic exercises have reduced depression levels in diabetic patients but no one group is better than other. &#xD;
&#xD;
Cognitive behavioural therapy is increasingly being identified as one of the best forms of therapy for conditions like depression, anxiety and stress which attempts to find links between the person&#x2019;s feelings and the patterns of thinking which predict their depression.4-6 Progressive muscle relaxation began from research that a psychobiological state called neuromuscular hypertension is the basis for a lot of negative emotional states. According to Jacobson relaxation of muscles will make way for a relaxation of mind &#x201C;because an emotional state fails to exist in presence of complete relaxation of peripheral parts involved&#x201D;. Progressive Muscle Relaxation helps to increase the frequency of alpha waves in the brain which are responsible for reducing stress and depression by reducing muscular tension and inducing relaxation.13&#xD;
&#xD;
Deficiency of monoamines i.e norepinephrine, serotonin and dopamine within midbrain and brainstem nuclei lead to depression. These areas of the brain are involved in regulating mood regulation and cognition. Relaxation and deep breathing exercises release monoamines and help in enhancing mood and improving mood regulation.14 Behavioural activation includes a set of procedures and techniques aimed at increasing patient activity and access to reinforcing situations that improve mood and functioning. Activation for depression generally serves to get the patient moving. Almost all behaviours that include physical activity, planning, or accomplishing tasks are a part of behavioural activation.6&#xD;
&#xD;
According to a study done in 2004 by Kimberly Goldapple et al, under the American Medical Association, functional MRI showed various changes in different parts of the brain in response to cognitive behavioural therapy15. For example, cognitive behavioural therapy helped in deactivating hippocampus, dorsolateral, medial frontal and ventral prefrontal cortex areas of the brain which are responsible for encoding and retrieval of maladaptive associate memories. There was also a reduction in both ruminations and over-processing of irrelevant information.15,16 &#xD;
&#xD;
Mental imagery helps in activating the prefrontal cortex, ventral cingulated cortex, dorsal cingulated cortex and amygdala all of which are responsible for changing the subject&#x2019;s affective state. Mental imagery reduces the amygdala-hippocampus hyperactivation which is involved in the generation of negative moods, thus reducing anxiety, depression and other abnormal behaviors.15 According to Figure &#xA0;4, the mean for pre and post-treatment values for Post Prandial (PP) blood sugar levels in group A is 264.60 and 240.73 respectively, with a p-value of 0.0018. Similarly, in Figure &#xA0;5 the mean for pre and post-treatment values for PP blood sugar levels in group B is 238.67 and 220.67 respectively, with a p-value of 0.00041 indicating a significant reduction in PP blood sugar levels post-treatment in both the groups. There is a significant difference in the PP Blood Sugar Levels in Pre and Post-treatment values in group A thus showing a reduction in Blood Sugar Levels in the subjects of this group. In Figure &#xA0;6, the mean difference in the pre and post-treatment results of PP blood sugar levels between group A and group B is 23.87 and 18 respectively with a p-value of 0.48. This showed a reduction in Blood Sugar Levels in the subjects of this group. In Figure &#xA0;7 the pre-treatment value for HbA1c is 10.49% which reduced to 10.17% post-treatment for group A. There is no difference in the Pre and Post-treatment means in both the groups and thus both forms of treatment show statistical significance. According to Figure &#xA0;8, the pre-treatment value for HbA1c in group B is 9.83% which reduced to 9.52% post-treatment. There is a significant difference in the HbA1c&#xA0; Levels in Pre and Post-treatment means in group A thus showing a reduction in HbA1c Levels in the subjects of this group.&#xD;
&#xD;
In Figure &#xA0;9 and 10 there is a mean difference of 0.01 in HbA1c in two groups with a p-value of 0.93 showing statistically insignificance between the two groups. Thus, there is a significant reduction seen in the HbA1c values for both the groups indicating that both forms of treatment show good effects. &#xD;
&#xD;
Several studies have reported common biologic substrates in diabetes and depression. Alterations in the activity of the hypothalamic-pituitary-adrenal axis such as increases in cortisol production have been observed in individuals with diabetes. Excess of cortisol leads to depression. Also, there are alterations seen in the metabolism of neurotransmitters, particularly norepinephrine and serotonin.&#xD;
&#xD;
An increase in the blood supply of the working limb causes an increase in glucose uptake thus maintaining optimum glucose levels within the muscle. Thus more the activity of the muscle, more the blood supply and more will be the increase in glucose metabolism. Exercise and insulin stimulate glucose utilization synergistically. The primary route of insulin-mediated glucose metabolism at rest and in the post-exercise state is non-oxidative metabolism. Hemodynamic adjustments cause an increase in capillary surface area in working muscle thus, increasing the availability of insulin. Exercises also increase insulin-stimulated glucose metabolism. Insulin action is also directly enhanced at working muscle by activation of post insulin receptor signalling which further helps in increasing glucose uptake.9&#xD;
&#xD;
In people with type II diabetes, physical training (aerobic exercises) increases insulin-stimulated nonoxidative glucose disposal presumably activating glycogen synthesis. The beneficial effects of regular physical activity on insulin sensitivity appear to be the final result of the sum of specific effects of exercise on glucose transporter 4 (GLUT 4) content, oxidative capacity and capillary density of skeletal muscle. Preliminary data suggest that insulin-independent glucose transport, induced by exercise, is promoted by augmented endothelial and muscle production of nitric oxide. Since impaired nitric oxide production often complicates type 2 diabetes mellitus, physical exercise might be utilized to improve as well as insulin sensitivity and endothelial dysfunction.7 Thus, blood sugar levels optimize by exercises in people with type II diabetes.&#xD;
&#xD;
Cognitive Behavioural Therapy helps in developing a relevant response to emotional and environmental stimuli and at cortical level helps in reducing the retrieval of abnormal thoughts and insignificant information, thus enhancing the mood of the patients.&#xD;
&#xD;
Behavioural Activation which is a part of Cognitive Behavioural Therapy is very useful for depressed mood. Re-introducing pleasant events (one form of behavioural activation) can serve to improve mood in many different ways - 1) reversing avoidance, 2) increasing physical activity, 3) increasing self-confidence and 4) increasing feelings of usefulness &#xD;
&#xD;
and purpose. Recent empirical evidence suggests that behavioural interventions improve mood symptoms and also reduce maladaptive thought patterns. 6 Also, Cognitive Behavioural Therapy seems to affect clinical recovery by modulating the functions of specific sites in limbic and cortical regions of the brain targeting the areas responsible for the change in mood thus acting as an antidepressant. 15&#xD;
&#xD;
Since in CBT, the patient is an active member of the intervention, he is aware of the disease process and means to control the disease. By this, we are educating the patient and making him take care of his disease. Cognitive Behavioural Therapy (CBT) is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.8&#xD;
&#xD;
A systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels.17 Diabetes self-management education&#xA0;in conjunction with primary care is effective in improving glycemic control in Hispanic adults with type 2 Diabetes Mellitus.18 CBT had better efficacy in improving depression symptoms of patients with diabetes compared with routine approaches.19 The quality of life of the middle-class Indian population as per SF-36 scoring is around 75 on 100. Mental Component Sum&#xAD;mary scores are better than Physical Component Summary scores (Table 1 and 2).20 By combining Aerobic exercise and cognitive behavioural therapy we can aspire to reach the quality of life as near to the normal population. By CBT we are working on the mental well being and with aerobic exercise, we are taking care of physical well being.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
We conclude that Cognitive Behavioural Therapy alone or in combination with aerobic exercises lead to a reduction in depression levels among diabetics and helps in reducing their postprandial blood sugar levels and HbA1c levels. Cognitive Behavioural therapy reduces depression in diabetic patients. &#xD;
&#xD;
ACKNOWLEDGEMENT: &#xA0;We thank wholeheartedly all the subjects for participating in our study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;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.&#xD;
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Conflict of Interest: Nil&#xD;
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Financial Assistance: Nil&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3362</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3362</Fulltext></URLs><References>&#xD;
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	Gonzalez JS, Esbitt SA, Schneider HE, Osborne PJ, Kupperman EG. Psychological issues in adults with type 2 diabetes. In Psychological Co-Morbidities of physical illness 2011 (pp. 73-121). Springer, New York, NY.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Does the Quadrant of Location Affect the Prognosis of Breast Lump? A Cytomorphological Study at a Tertiary Care Center&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>139</FirstPage><LastPage>143</LastPage><AuthorList><Author>Rani S. S. Sabitha</Author><AuthorLanguage>English</AuthorLanguage><Author> Vamshidhar I. S.</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The Importance of quadrant location on the prognosis of breast lesions has been investigated for many years. The results are variable. Objective: To determine the prevalence of breast lesions in various quadrants and to assess the nature of breast lumps based on their cytomorphological reports. To determine the prognosis based on their location. Methods: Clinical history, radiological imaging, and physical examination were done noting quadrant of location along with the bilateral examination of nipple, axilla &amp; lymph nodes. FNAC was done with a 22-gauge needle. Cytomorphology evaluation carried out on Hematoxylin and Eosin and Giemsa stained smears. Results: Out of the total n=73 cases n=29 Fibroadenoma cases 58.62% cases were in the Lateral upper Quadrant and 13.79% cases in the Medial Upper Quadrant and 10.34% were found in the Lateral Lower Quadrant and Central area 6.89% cases were detected. In the malignant cases, Invasive duct cell carcinoma (IDCC) was diagnosed in n=10 cases out of which 70% cases were in the Lateral upper quadrant and 30% cases in Medial Upper Quadrant. Conclusion: Among the benign lesions fibroadenoma showed the highest occurrence whereas in malignant lesions, it was IDCC and the Lateral outer quadrant showed the highest involvement for fibroadenoma among the benign lesions and IDCC among the malignant lesions. Therefore, it can be concluded that lesions occurring in the lateral upper quadrant may carry a good prognosis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Breast Lump, Prognosis, cytomorphological study, quadrant location, Fibroadenoma, Invasive duct cell carcinoma</Keywords><Fulltext>&#xD;
Introduction&#xD;
&#xD;
This glandular organ such as breasts are under the influence of hormones of females also involved in various lesions and lumps.1 The lesions can be inflammatory to benign to malignant affecting different age groups. The presence of lump and pain is one of the commonest indicators of lesions in the breast. 2 Breast cancer is the most common type of cancer in women across the world and frequency is found to be increasing in countries like India.3,4 It has been estimated that approximately 100,000 new cases are diagnosed every year in India.5 It was previously thought to affect the well affluent population of India. However, recent trends as shown increasing rural populations being affected by breast cancers. As per ICMR-PBCR (Indian Council of Medical Research-Population Based Cancer Registry of India) data, the incidence of breast cancer among women of the urban area such as Delhi, Mumbai, Ahmedabad, Kolkata, and Trivandrum are up to 30% of all cancers of females. 6 It has been found that the reported cases of breast cancer in India 50 &#x2013; 70% of cases are in advanced stages at the time of diagnosis. If left untreated the mean survival of females is only up to 3-years and a 5-year survival rate is less than 20%. 7 Therefore, early detection and diagnosis are of vital importance to prevent morbidity and mortality. One of the aspects in the study of breast cancers is the importance of quadrant location on the prognosis of breast lesions. It has been investigated for many years. Quadrant location for malignancy has been given importance in (Surveillance Epidemiology End Results) SEER Coding guidelines.8 However prognostic significance of tumour location in breast cancer remains unclear.9 Lymphatic drainage is different for each breast quadrant; therefore, the absence of axillary node positivity could misclassify high-risk lesion to low risk.10,11 Calculated risk for malignant transformation of benign lesions ranges from 3% - 17%. &#xA0;Our study focuses on this range of risk by additional consideration of the breast quadrant utilizing fine needle aspiration cytology (FNAC) as a diagnostic tool. &#xD;
&#xD;
Material and Methods&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Institutional Ethical Committee approval was obtained for the study RC No. IEC/KIMS/Pathology/2018. Written consent was obtained from all the participants of the study.&#xA0; Inclusion criteria: Successive cases with breast lesions, breast lumps referred to the Department of Pathology for cytology were included in the study. Exclusion criteria: History of prior breast lesions and treatment, Secondaries in the breast. A total of n=73 cases were identified as suitable for the study based on the inclusion and exclusion criteria. Clinical history, radiological imaging, and physical examination were done noting quadrant of location along with the bilateral examination of Nipple, Axilla &amp; Lymph Nodes. FNAC was done with a 22-gauge needle. Cytomorphology evaluation carried out on Hematoxylin and Eosin and Giemsa stained smears. Statistics were compiled and p-value calculated using IBM SPSS version 19 software.&#xD;
&#xD;
Results&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Figure 1 showing stained cytological specimens of patients. A: Fibroadenoma, B: Proliferative Breast Disease with atypia, C: Fibrocystic changes, D: Atypical Ductal Hyperplasia, E: Infiltrating Ductal Cell Carcinoma all A to E are stained with Haematoxylin and Eosin stain [H &amp; E] magnification is 40X. F: Lobar carcinoma, G: Metaplastic Carcinoma, H: Medullary Carcinoma, F to H stained with May-Grunwald Giemsa [MGG] stain. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Out of n=73 cases n=64 (87.67%) were females and n=9 (12.33%) were male cases. From the different age groups seen in the study the most commonly involved age group was 21 &#x2013; 30 years with n=24 (32.87%) cases, followed by 31 &#x2013; 40 years with n=14 (19.18%) cases the other distribution of cases age-wise is given in figure 2.&#xD;
&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The anatomical location of the lesions was carefully studied, the following observations were made in the study. The Lateral upper quadrant was the location of the highest number of lesions n=38(46.34%) cases. The Lateral Lower Quadrant had n=13(15.85%) of cases, the Medial Upper Quadrant was the location of lesions in n=24(29.27%) cases being the second-highest and Medial Lower Quadrant was involved in n=3(3.66%) least involved quadrant and Central area was involved in n=9(10.97%) cases (figure 3). &#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Out of the total n=73 cases, n=14 cases were found to malignant, n=54 cases were benign and n=5 cases were non-neoplastic lesions. Among the malignant lesions diagnosed the Invasive duct cell carcinoma was found in 71.28% of out of the total n = 14 cases of malignancy. In non-neoplastic lesions out of n=54 cases, fibroadenoma was diagnosed in 53.70% cases, followed by gynecomastia in 16.67% cases. In Non-neoplastic lesions, out of n=5 cases, chronic non-specific lesions were found in 60% and 20% each of granulomatous lesions and lipoma cases were diagnosed with details in table 1.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; From the total n=29 Fibroadenoma cases 58.62% cases were in the Lateral upper Quadrant and 13.79% cases in the Medial Upper Quadrant and 10.34% were found in the Lateral Lower Quadrant and Central area 6.89% cases were detected. In the malignant cases, Invasive duct cell carcinoma (IDCC) was diagnosed in n=10 cases out of which 70% cases were in the Lateral upper quadrant and 30% cases in Medial Upper Quadrant (Table 2). &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;A comparison of the risk factor and the location of lesions was done.&#xA0; The result showed that the presence of a lesion in the Lateral upper quadrant was positively correlated with age and post-menopausal women. It was also found the larger tumour sizes were more often located on the lateral upper quadrant and lymph node-positive status was also significantly related to the presence of lesions in the lateral upper quadrant given in table 3.&#xD;
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&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The most common location of IDCC in our study was the lateral upper quadrant with SEER coding for IDCC was 2. Nottingham histologic score BR grade to SEER code is shown in table 4.&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This study was conducted to determine the prevalence of breast lesions in the various quadrant and to assess the quadrant of location as a risk factor for breast lesions. Also, to correlate cytomorphological features of FNAC (Fine Needle Aspiration Cytology) of the spectrum of lesions encountered with the importance of quadrant of location determines the prognosis of the breast lump. The most common age group involved in our study includes females of 3rd decade.12&#xA0; &#xA0;Haque et al. have reported the 4th decade to be the most common age group of females in their study.13 &#xA0;Sixth decade was the most common age group in males in our study. In the current study, we found the Left breast involvement is more commonly found in n=26 (49.32%) in females The Right side involved in n=28 (38.36%) and bilateral involvement was found in n=9 (12.32%) cases. Prakash HM et al. 14 in their study found more common involvement of the left side. Palpable breast lesions were slightly more common on the left side in agreement with the results of the current study.15-17 However, Chandanwale S et al.18 found the right breast was more frequently involved in their cases. &#xA0;In this study, we found among all the four quadrants the upper and outer quadrants (superolateral) quadrant was involved is most involved n=38(46.34%) cases. The common occurrences of breast lesions in the superolateral quadrants have been also found in other similar studies.16-20 One of the possible explanations for the common occurrence of breast cancer in the upper and outer quadrant is due to the fact the lymphatic drainage of the breast in this region is poor because of inadequate support and a greater amount of target epithelial tissue in this region. In this study, the lump was the important presenting feature reported by 93.15% of patients, the pain was reported by 2.7% patients, and 4.11% reported of discharge. Goyal et al.21 reported that lump was the main presenting symptom in the majority (57.06%) of patients. Kumar et al.22 showed a painless mass in the breast (60.78%) followed by painful mass (13.73%) and associated features like ulceration of the skin, retraction of nipple and nipple discharge. In the current study out of the total n=29 Fibroadenoma cases 58.62% cases were in the Lateral upper Quadrant the calculated risk of fibroadenoma in the study was 3%. Selva Kumaran et al.23 also found the common presentation of fibroadenoma in the lateral upper quadrant agreeing with the results of the present study. The malignant cases Invasive duct cell carcinoma (IDCC) was diagnosed in n=10 cases out of which 70% cases were in the upper Lateral quadrant and 30% cases in Medial Upper Quadrant and the SEER score was 2. Tumour location with the upper outer quadrant has been reported with multiple populations including Chinese, Danish, the United Kingdom, and the USA.24-27 It has also been suggested the tumours in the upper outer quadrant have increased with time and the association of tumour with this location is associated with improved prognosis and data have suggested a trend to reduction in breast cancer mortality. In this study also all the malignant cases were operated, and the excised tissue was then examined histologically for confirmation of diagnosis and SEER grading. The patients were followed for 1 year and no mortality was reported with the cases. Our study demonstrated that the ability of patients to seek medical care when the location of tumours in the upper lateral quadrant was better due to the better ability of the patients to palpate the lump this could be one of the important factors in the better prognosis. The fact that the tumours located centrally are generally harder to detect and hence the patients seek the treatment after considerable progress of the tumour.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The most common age group of breast lesions was the 6th decade in males and 3rd decade in females. There was left breast predominance and the lump was the most frequent clinical symptom in both the genders. Among the benign lesion, fibroadenoma showed the highest occurrence whereas in malignant lesions, it was IDCC and the Lateral outer quadrant showed the highest involvement for fibroadenoma among the benign lesions and IDCC among the malignant lesions. Therefore, it can be concluded that lesions occurring in the lateral upper quadrant may carry a good prognosis.&#xD;
&#xD;
Acknowledgement: Authors thank the Dept of Pathology, Kakatiya Medical College and MGM Hospital, Warangal, Telangana State, India for their support in the conduction of this study. &#xD;
&#xD;
Source of support: Nil&#xD;
&#xD;
Conflict of interest: None&#xD;
&#xD;
Ethical Permission: Obtained [RC No. IEC/KIMS/Pathology/2018]&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3363</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3363</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Considerations for Orthodontic Treatment During Pregnancy: An Update&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>144</FirstPage><LastPage>148</LastPage><AuthorList><Author>Sakshi Tiwari</Author><AuthorLanguage>English</AuthorLanguage><Author> Dinesh Kumar Bagga</Author><AuthorLanguage>English</AuthorLanguage><Author> Poonam Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Madhurima Nanda</Author><AuthorLanguage>English</AuthorLanguage><Author> Aartika Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Prashant Kumar Shahi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Pregnancy is associated with the various physiological and hormonal changes in females. Orthodontic as well as any dental treatment should not be denied during pregnancy, perhaps some necessary precautions should be taken while treating a pregnant patient. This review article focuses on the hormonal changes and the prescribed drugs taken during pregnancy that affects the orthodontic treatment, the importance of communication and motivation, the precautions to be taken and the orthodontic considerations and management for the pregnant patients. This electronic search was undertaken through Google scholar and PubMed databases by utilizing the appropriate keywords. Literature was extensively reviewed to get information regarding dental and orthodontic treatment during pregnancy. Finally, the overall findings were summarized and presented in the following article. Based on the researched reviews, the orthodontists as well as other health care professionals need to realize that the orthodontic treatment is not a contraindication during pregnancy and can be performed successfully during this period by taking certain precautions. A good communication between the patient and the orthodontist must be established for the successful completion of the orthodontic treatment.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Pregnancy, Orthodontic tooth movement, Hormonal changes, Teratogens, Drugs, Periodontal health</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Recently there is a sharp rise in the number of adults especially females who have been seeking orthodontic treatment primarily for esthetics. Hence, orthodontists come across the female patients who undergo pregnancy during the mid-treatment which require special considerations during the orthodontic treatment. The following article highlights the hormonal changes and the prescribed drugs taken during pregnancy that affects the orthodontic treatment, the importance of communication and motivation, the precautions to be taken and the orthodontic considerations and management for the pregnant patients.&#xD;
&#xD;
ORTHODONTIC IMPLICATIONS OF PERIODONTAL HEALTH DURING PREGNANCY &#xD;
&#xD;
During pregnancy, the fluctuations in the hormones along with the various modifications in the immune system, have an impact on periodontal health. &#x201C;Granuloma gravidarum&#x201D; or "pregnancy tumour&#x201D; develops in 5% of pregnancies. The gingival inflammation caused by subclinical hormonal alterations and plaque accumulation leads to gingivitis.1,2 &#xA0;Fixed orthodontic treatment leads to several plaques retaining areas which demand rigorous oral hygiene measures. Moreover, various researches have shown the association between the diseases of the periodontium and higher risk of premature low birth weight babies.3,4&#xD;
&#xD;
HORMONAL CHANGES DURING PREGNANCY AFFECTING THE ORTHODONTIC TOOTH MOVEMENT&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There are certain hormones such as progesterone, estrogen and relaxin which show increased level during pregnancy which need to consider orthodontic treatment.&#xD;
&#xD;
Progesterone &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The range of progesterone levels are 100-200 ng/ml and the amount produced by placenta is about 250 mg/day.5,6 There is an association between the increased levels of progesterone and the presence of increased prostaglandin E2 in the gingival sulcus.7 He et al demonstrated the role of progesterone in the formation of alveolar bone which signifies the safety for pregnant patients undergoing the orthodontic treatment.8 Various studies mentioned that the&#xA0;long-term administration of progesterone (at ninth week) in rabbits could reduce the rate of orthodontic tooth movement (OTM).9,10&#xA0; &#xD;
&#xD;
Estrogen &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Estrogen level increases steadily during pregnancy and reaches a maximum during the third trimester. As estrogen has effects on RANKL/RANK/osteoprotegerin system and it reduces the production of pro-resorptive cytokines along with the reduction in the number of osteoclasts, therefore, it inhibits the resorption of bone and hence decreases the OTM. Increased estrogen and progesterone level during pregnancy might reduce OTM.11&#xD;
&#xD;
Relaxin &#xD;
&#xD;
Relaxin is released just before childbirth to loosen the pubic symphysis thus facilitating the parturition.&#xA0; It is documented that relaxin enhances the turnover for the fibrous connective tissues and can increase the rate of OTM by its effect on the tissues of the periodontal ligament.12&#xD;
&#xD;
DRUGS TAKEN DURING PREGNANCY AFFECTING THE ORTHODONTIC TOOTH MOVEMENT &#xD;
&#xD;
Special considerations should be undertaken while treating pregnant patients for avoiding any potential terato&#xAD;genic effects due to various drugs. Due to organogenesis occurring during the first trimester, the fetus is more susceptible to teratogenesis during this period. The classification of drugs put forward by United States Food and Drug Administration based on risks they are posing to the fetus. Drugs which are categorized as safe were put under Category A &amp; B, drugs whose benefits outweigh the risks they are posing to the fetus are categorized under Category C, the drugs that should be avoided during exceptional situations are under Category D and the drugs whose use are contraindicated during pregnancy are under Category X.&#xD;
&#xD;
NSAID &#xD;
&#xD;
NSAIDs suppress the production of prostanoids by inhibiting Cyclo-oxygenase 1 and 2 activity. Various experimental studies demonstrated that the OTM is reduced by the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) due to a reduction in the number of osteoclasts, as prostaglandins are involved in differentiation or stimulation of osteoclasts.13,14&#xD;
&#xD;
The effects of various groups of NSAIDs and their effects on OTM are described below:&#xD;
&#xD;
Salicylates &#xD;
&#xD;
Experimental studies on rats has shown that the rate of movement of lateral incisor on the application of 35 centinewtons (CN) of force significantly decreased after administration of 100 mg per kilogram acetylsalicylic acid two times a day.15 It was found that local injections of 17.5 to 35 mg per kilogram per day of copper salicylate caused the significant decrease in mesial movement of the molar in rats on the application of 50 or 100 cN of force.16&#xD;
&#xD;
Arylalkanoic acids &#xD;
&#xD;
Studies on rats have revealed the significant short-lasting inhibitory effect on the mesial movement of the molars on the application of 40 CN of force after administration of 4 mg per kilogram of indomethacin. Studies done for examining the effects of diclofenac has also demonstrated the mesial tipping of first molars after application of 50 or 100 cN of force in rats.17,18&#xD;
&#xD;
Arylpropionic acids&#xD;
&#xD;
Studies revealed the reduction in OTM, after administering 30 mg per kg of ibuprofen twice a day. However, on administering the low dosage of 10 mg per kilogram per day of flurbiprofen, no inhibitory effect was noticed on the mesial movement of first molars in rabbit with 100 CN of the force application.15&#xD;
&#xD;
Coxibs &#xD;
&#xD;
The effect of local injection of 1 mg per kilogram of rofecoxib was studied in rats at 1 and 3 days and it was seen that the force of 50 or 100 cN induces the mesial movement of first molars but no OTM was observed when the amount of force application was below 50 cN.18&#xD;
&#xD;
Paracetamol&#xD;
&#xD;
The study was conducted to evaluate the effect of 500 mg per kg per day of paracetamol on OTM in rabbits and no effect was observed when a force of 100 CN was applied.19 Another similar study done after administering 400 mg per kg per day of paracetamol in rats for 10 days, with a force of 35 CN and no effect was observed.15 Therefore, it was suggested that paracetamol can be given as an analgesic during pregnancy for the patients undergoing orthodontic treatment as it doesn&#x2019;t cause any adverse effect on OTM.&#xD;
&#xD;
Corticosteroids &#xD;
&#xD;
Glucocorticoids inhibit the synthesis of prostaglandins and leukotrienes by indirectly blocking the phospholipase A2 and suppressing the synthesis of COX-1 and COX-2. An experimental study was done to evaluate the mesial movement of first molars after administration of 1 mg per kg per day prednisolone in rats for an induction period of 12 days, followed by 12 days of the experimental period during which 30 cN of force was applied. No effect on the rate of OTM was observed in this study.20 Similar study was done to evaluate the effects of 8 mg per kg per day of methylprednisolone that revealed an increased rate of OTM. 21&#xD;
&#xD;
Vitamine D3&#xD;
&#xD;
1,25 dihydroxycholecalciferol regulates calcium and phosphate serum levels by assisting their intestinal absorption and reabsorption in kidneys, deposition of bone and by inhibiting the release of parathormone. Low supplemental administration of Vitamin D3 stimulates the bone resorption by upregulating the RANKL expression in osteoblasts that leads to the differentiation of osteoclasts through RANK/RANKL system.22 It has been proven by the experimental studies that the rate of OTM is stimulated by Vitamin D3 in a dose-dependent manner.23&#xD;
&#xD;
Diatary Calcium &#xD;
&#xD;
In an experimental study, the low and high calcium was given to the dogs for 10 weeks to study the effects of OTM and thereafter 100 cN of force was applied for 12 weeks. The group consists of a low calcium diet showed a higher rate of OTM from 8 weeks as compared to the group with a high calcium diet.24 This data supported the earlier studies conducted on bone turnover revealing that the number of osteoclasts and osteoblasts were increased by the intake of low calcium diet in the rats.25&#xD;
&#xD;
Bisphosphonates &#xD;
&#xD;
Bisphosphonates inhibit the aggregation of hydroxyapatite, dissolution and crystal formation due to their strong affinity to the solid-phase surface of calcium phosphate. They increase the intracellular calcium levels in osteoclasts thereby reduces the activity of osteoclasts, preventing the hematopoietic precursors for the development of osteoclasts and production of an osteoclast inhibitory factor. The reduction in the rate of OTM was revealed through various studies after the intake of topical or systemic bisphosphonates.26,27&#xD;
&#xD;
PHYSIOLOGICAL XEROSTOMIA DURING PREGNANCY &amp; ITS ORTHODONTIC CONSIDERATIONS&#xD;
&#xD;
Physiological xerostomia is frequently encountered during pregnancy due to the adverse effects of various drugs like anti-histamines which increases the risk for caries due to salivary dysfunction. Topical fluoride application and artificial saliva can be recommended in case of severe xerostomia.28&#xD;
&#xD;
BRUXISM DURING PREGNANCY &amp; ITS ORTHODONTIC CONSIDERATIONS:&#xD;
&#xD;
Bruxism is a common finding during pregnancy due to various physiological changes occurring in women&#x2019;s body that induce the stress resulting in habitual clenching or grinding of the teeth during this period. Various deleterious effects on teeth and their supporting structures occur due to bruxism as it causes excessive attrition of teeth and damages periodontal tissues and temporomandibular joints.29 Alongwith the breakages, the most common complaint in patients with bruxism is the tenderness in the temporomandibular joint. Various treatment modalities for bruxism are the stress reduction therapy, alteration of sleep positioning, drug therapy, biofeedback training, physical therapy and deprogramming appliances.&#xD;
&#xD;
CHANGES IN THE SALIVARY COMPOSITION DURING LATE PREGNANCY &amp; ITS ORTHODONTIC CONSIDERATIONS&#xD;
&#xD;
During late pregnancy, various changes can be observed in the salivary composition that temporarily predisposes to dental erosion and dental caries.30 Therefore, it is necessary for the orthodontist to motivate the patient for taking rigorous oral hygiene measures. &#xD;
&#xD;
EATING HABITS DURING PREGNANCY AND ITS ORTHODONTIC EFFECTS&#xD;
&#xD;
Some women experience unusual cravings for food during their pregnancy, which may increase the risk of tooth decay and caries.30 Therefore, the patients undergoing orthodontic treatment should be counselled regarding the diet and care must be taken so that the overall health of the patient and the fetus is not affected as a result of any nutritional deficiencies. &#xD;
&#xD;
ORTHODONTIC CONSIDERATIONS WHILE TREATING A PREGNANT PATIENT&#xD;
&#xD;
Oral hygiene maintenance&#xD;
&#xD;
Since gingival inflammation is a common occurrence during pregnancy due to various hormonal changes, vigorous oral hygiene procedures, interdental cleaning aids, constant reinforcement, monitoring the patients periodically and the frequent discussions with the patient are crucial to maintaining the oral health during the orthodontic therapy. Various researches have shown the association between the diseases of the periodontium and higher risk of premature low birth weight babies along with the pre-eclampsia during pregnancy.3,4&#xD;
&#xD;
Timing of Treatment&#xD;
&#xD;
As most of the patients during pregnancy feel nausea during morning time therefore orthodontists should avoid giving the appointments during the morning hours to avoid vomiting episodes during the appointments. The appointments should be kept for a shorter duration to avoid any discomfort to the patients. As organogenesis is completed by the first trimester, therefore it is preferred to conduct the routine procedures during the second and third trimester.31&#xD;
&#xD;
It is recommended to postpone the extensive elective procedures until the delivery.&#xD;
&#xD;
Posture of the patient&#xD;
&#xD;
Pregnant patients often experience the postural hypotension due to various cardiovascular changes that include lightheadedness, weakness, sweating, pallor, unconsciousness and convulsions. Therefore, patients should be advised to change their positions slowly and/or lean towards the left side while in the dental chair.32 The supine position leads to the development of &#x201C;supine hypotensive syndrome&#x201D; that causes a decrease in the cardiac output which results in hypotension, syncope and the decrease in uteroplacental perfusion. The ideal position during pregnancy is the left lateral decubitus position with the right buttock and hip elevated by15&#xB0;.33&#xD;
&#xD;
Radiographic imaging&#xD;
&#xD;
Radiographs should only be taken in cases of utmost importance during pregnancy. Dental radiography should preferably be taken during the second trimester and the patients should be asked to wear lead aprons.31,34 The dose of the radiograph and the gestational timing are the important factors. According to the American Dental Association, all precautions are recommended to minimize the risk of radiation during pregnancy. Various animal and human studies have supported the data that there is no increase in the gross congenital anomaly that can occur due to radiographic exposure of less than 0.05 to 0.1Gy during pregnancy and the amount of radiation used in dentistry are within this threshold range. &#xD;
&#xD;
Simple and realistic approach&#xD;
&#xD;
It is important to plan a simple and realistic treatment for pregnant patients. If the patient is willing to undergo orthodontic therapy primarily for frontal aesthetics, it should be established from the beginning and the limited treatment should only be performed. If it is possible to treat the patient by the removable appliances, then it should be preferred over the fixed appliances as with removable appliances it is easy to maintain the oral hygiene as well as the health of gingival tissues. Patient&#x2019;s cooperation is important while delivering a removable appliance and therefore patient&#x2019;s selection along with the proper counselling is a crucial component especially during the period of pregnancy.&#xD;
&#xD;
Prefer non-extraction over-extraction&#xD;
&#xD;
Preference should always be given to the non-extraction approach over-extraction if possible in pregnant patients as the treatment time is reduced by taking a former approach, but it is important that the diagnosis and treatment planning is proper and the treatment outcome should neither worsen the patient&#x2019;s profile nor should cause any other harm to the patient.&#xD;
&#xD;
Avoid invasive procedures&#xD;
&#xD;
The invasive procedures such as the placement of temporary anchorage devices and any kind of surgical procedures should be avoided during pregnancy.&#xD;
&#xD;
Force&#xD;
&#xD;
Light and continuous force should be applied as during pregnancy the periodontium is more susceptible to breakdown with heavy forces.&#xD;
&#xD;
Steel ligatures versus elastomeric modules: &#xD;
&#xD;
Steel ligatures are preferred over elastomeric modules because elastomeric modules are a source of plaque accumulation and therefore less hygienic as compared to the steel ligatures.35&#xD;
&#xD;
Medications:&#xD;
&#xD;
Since various drugs can affect the maternal cardiorespiratory functions or can have a teratogenic effect by crossing the placenta, therefore it is essential to consult the gynaecologist before prescribing any medications. 31&#xD;
&#xD;
Diet&#xD;
&#xD;
Proper maintenance of balanced diet along with the restrictions of certain food during orthodontic treatment should be balanced by proper communication as well as taking in account the various nutritional deficiencies and the hormonal alterations that can occur during pregnancy. The intake of healthy snacks and plenty of water is recommended for pregnant patients one hour before the appointments to avoid nausea during dental procedures.&#xD;
&#xD;
Co-ordination with gynaecologist&#xD;
&#xD;
It is beneficial to take the gynaecological opinion for pregnant patients if any known complications are expected. As various drugs can affect the rate of OTM, therefore it is important to know the history of medications that are advised to the patients by the gynaecologists.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The orthodontists, as well as other health care professionals, need to realize that the orthodontic treatment is not a contraindication during the pregnancy and can be performed successfully during this period by taking certain precautions and in collaboration with the gynaecologist. Good communication between the patient and the orthodontist must be established for the successful completion of the orthodontic treatment. The detailed history of the patient along with the proper examination of the oral cavity and thorough assessment of patient&#x2019;s expectations as well as the compliance enables the orthodontists to aim for the successful orthodontic therapy in a pregnant patient.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;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.&#xD;
&#xD;
Conflict of interest: NIL&#xD;
&#xD;
Source of funding: NIL &#xD;
&#xD;
Individual author&#x2019;s contribution: &#xD;
&#xD;
&#xD;
	&#xD;
	Study conception and design: Dr. Sakshi Tiwari&#xD;
	&#xD;
	&#xD;
	Acquisition of data: Dr. Dinesh Kumar Bagga&#xD;
	&#xD;
	&#xD;
	Analysis and interpretation of data: Dr. Madhurima Nanda&#xD;
	&#xD;
	&#xD;
	Drafting of the manuscript: Dr. Aartika Singh&#xD;
	&#xD;
	&#xD;
	Critical revision: Dr. Prashant Kumar Shahi, Dr. Poonam Agrawal &#xD;
	&#xD;
&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Spatio-Temporal Distribution of Diseases and Healthcare Facilities in Sonitpur District of Assam&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>149</FirstPage><LastPage>153</LastPage><AuthorList><Author>Sameer Baruah</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The environmental factors of Sonitpur district are highly responsible for the frequent occurrence of diseases like Malaria, Japanese Encephalitis, Diarrhea, Viral Hepatitis, Dysentery, Enteric Fever and the like. The district witnessed the frequent occurrence of such diseases from time to time. Within the district, there has been a spatial distribution of such diseases from one health block to another. Moreover, the distribution of health institutions or medical facilities like Hospitals, CHCs, PHCs and Health Sub-Centers is not uniform throughout the region. Some parts of the region have more health institutions, while some others have less number of the same. Objectives: The main intention of the study is to examine the spread of diseases and associated factors. The work also takes care to co-relate the spread of diseases and inadequacy of medical facilities in the Sonitpur district of Assam. Methods: The whole study is mainly based on secondary data. In a few cases, internet links are also taken into consideration for detail analytical study. The study will explain the trend of certain diseases and associated factors in the region. Moreover, an analysis of the existing health care facilities will give an idea about the availability and adequacy or otherwise of the same in the district. Results: The study revealed that health blocks with less number of health institutions are characterized by the higher frequency of diseases like Diarrhea, Hepatitis etc. The health institutions of the same are also facing high population pressure due to the deficiency of health institutions. Conclusion: The entire study has given an idea about the disease pattern in different health blocks of the region. The study also reflects the adequacy as well as deficiency of health infrastructure in the study area. The study will help the Medical Geographers as well as other health experts to take crucial steps for better health planning in the region.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Endemic diseases, Frequency of occurrence, Spatial distribution, Health infrastructure</Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Geography, generally, concerned with the relationship between man and environment, and in the recent time, a new branch of study known as &#x2018;Medical Geography&#x2019; has been emerged into the discipline of geography which particularly deals with all the aspects of human health inclusive of the distribution pattern of diseases, nutrition and health services. Medical geography is a study of the relationship between the pathological factors which cause disease and the geographical factors which give rise to that pathological factors.1 Medical geography sometimes referred to as &#x2018;Geography of Health&#x2019;. Geography of health is concerned with the distribution and comparison of various indices of disease in the human population and the interrelation with other elements of the physical, biological and cultural environment in space. The environment may be taken as a place of risk where the man may be passively experiencing some kinds of health hazards.2,3&#xD;
&#xD;
The World Health Organization has defined health as a state of collating physical, mental and social well-being and not merely the absence of disease or infirmity.4 According to some geographers, the geography of health is also the study of spatial distribution or extension of health care facilities i.e. health institutions in an area. Medical geography studies the changes in health conditions and variation of diseases and associated factors. The W.H.O. definition of health projects three different dimensions of health. Physical, Mental and Social well-being is closely related to one another. The fourth dimension has also been suggested which is &#x2018;Spiritual&#x2019; health.1,5,6&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Assam, the most populous state of North-East India, is endemic for diseases like Malaria, Japanese Encephalitis, Diarrhea, Viral Hepatitis, Dysentery, Enteric Fever etc. The climate of Assam which is sub-tropical humid provides favourable conditions for the occurrence of such diseases. Malnutrition and deficiency diseases are one of the major health problems of today.7&#xD;
&#xD;
The district of Sonitpur in question represents the study with such diseases for further discourse concerning its environment. The natural environment in which people live and settle becomes the major aspect for a pattern of disease from which they suffer. Thus the systematic study of the spatial distribution of disease concerning the environment in which the affected person lives forms the main concept of the study of medical geography.5&#xA0; &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; That the peculiar environment, occupation and living condition of the people of Assam is responsible for their vulnerability towards malaria attack has been recounted by M&#x2019;Cosh in his book Topography of Assam as early as 1837.4,6 The environmental factors of the district are highly responsible for the frequent occurrence of all these diseases.2 Moreover, the distribution of health institutions or medical facilities is not uniform throughout the region. Some parts of the region have more health institutions, while some others have less number of the same. Therefore, an attempt is made here to examine the spread of diseases and associated factors. The work also takes care to co-relate the spread of diseases and inadequacy of medical facilities in the Sonitpur district of Assam.9 The study will formulate a better plan for better health, and will also be helpful for the health department to improve health services in the region by finding a suitable location for health institutions.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
In the study, only secondary data are used. To collect relevant data many sources have been taken into consideration. Data concerned with the spatial distribution of various diseases in the study area have been collected from the Office of the Health &amp; Family Welfare (IDSP), Sonitpur District, Assam. Data about the distribution of health care facilities or health institutions in the study area have been collected from the National Health Mission (NHM) office, Sonitpur District, Assam. Moreover, books, as well as journals related to Medical Geography, are also taken for detail analytical study. In a few cases, internet links have also been taken into consideration for further study.&#xD;
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In the study, the spatial distribution of some selected diseases along with the distribution of health care facilities are proposed to be analyzed at the block level of the Sonitpur District. The study is carried out by taking seven health blocks with certain specific diseases. Analysis has been done with absolute data on the incidence of diseases. The collected data have been systematically tabulated to show the temporal as well as the spatial variation of the incidence of diseases in all the health blocks of the district. Taking into consideration of the above methods, the proposed study has been done properly.&#xD;
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Results&#xD;
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Temporal Distribution of Diseases&#xD;
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Sonitpur district is characterized by a wide range of disease variation within its territory. Various diseases have been found to be occurring in different parts of the district. Certain areas of the district are attributed to some specific types of diseases because the factors associated with various diseases are found to be varying from one part to another in the district. Besides environmental conditions, man&#x2019;s habits are also responsible for the distribution of diseases in any place.1 Among the diseases Diarrhea, Dysentery, Viral Hepatitis, Malaria, Japanese Encephalitis, Enteric Fever etc. is found to be quite frequent in different parts of the area. However, the incidence of Dengue is also diagnosed in a few areas of the district. Table 1 and Table 2 are based particularly on the data collected from different reliable sources and hospital records:&#xD;
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Source: Office of the Health &amp; Family Welfare (IDSP), Sonitpur&#xD;
&#xD;
Source: Office of the Health &amp; Family Welfare (IDSP), Sonitpur&#xD;
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Spatial Distribution of Healthcare Facilities&#xD;
&#xD;
The distribution of health care facilities may be explained in terms of the population or community for whom they serve. These health care services are considered as an essential part of a health system and it reflects an important response to health concern and the needs of the health.3&#xD;
&#xD;
The followings are the availability of healthcare facilities in different health blocks of the district:&#xD;
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Sub-Centres&#xD;
&#xD;
In the study area, the numbers of sub-centre are very high compared to the numbers of all the health care institutions. The total number of sub-centre in the study area is significantly 275. The average number of sub-centre per health block of the study area is about 39, which is satisfactory. From this perspective, sub-centres are well-developed in the study area. Table 3 shows the BPHC-wise number of Sub-Centre (SC) and the persons served by a single Sub-Centre in the study area.&#xD;
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Source: Office of the NHM, Sonitpur, Assam&#xD;
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Primary Health Centre (PHC)&#xD;
&#xD;
In Sonitpur district the total number of PHC including the MPHC (Mini Primary Health centre) and Riverine PHC is only 35. The average number of PHC per health blocks of the district is only 5, and the persons served by a single PHC in the study area are 55,700. Table 4 shows the BPHC-wise number of PHCs and the persons served by a single PHC in the study area.&#xD;
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&#xD;
Source: Office of the NHM, Sonitpur, Assam&#xD;
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Community Health Centre (CHC)&#xD;
&#xD;
In the study area, the total number of CHC is very less i.e. only 9. These nine CHCs are almost uniformly distributed among the health blocks of the study area. The average number of CHC per health block hardly cross 1, which is significantly much lower than average number of PHC per health block in the study area. Hence, CHCs are also not well-developed in the study area. The table 5 shows the BPHC-wise number of CHC and also the persons served by a single CHC in the study area. &#xD;
&#xD;
&#xD;
&#xD;
Source: Office of the NHM, Sonitpur, Assam&#xD;
&#xD;
Hospitals&#xD;
&#xD;
In the study area, hospitals are found to be well-developed. In Sonitpur district most of the hospitals belong to tea gardens which are run by private tea companies. There are many big tea gardens located in Sonitpur district, and therefore, tea garden hospitals have been established by the concerned tea company to provide health care services to the local communities. The table 6 and table 7 show the number of tea garden hospitals and private hospitals in the district.&#xD;
&#xD;
&#xD;
&#xD;
Source: Office of the NHM, Sonitpur, Assam&#xD;
&#xD;
Discussion&#xD;
&#xD;
The study, undertaken here, mainly deals with the health aspects of human beings in Sonitpur district to explain the spatial distribution of some selected diseases and extension of health institutions in the seven health blocks. The entire study is consists of selected four diseases namely Diarrhea, Viral Hepatitis, Malaria and Dengue. The temporal distribution of selected four diseases in the Sonitpur district of Assam shows remarkable findings. The whole study is based on BPHC wise distribution of diseases as well as health institutions in the district and the population pressure on the health institutions.&#xD;
&#xD;
The study has found that almost all the health blocks of the study area are deprived of health services. Gohpur BPHC is the only health block that is somehow well-served by medical institutions. What is needed for other health blocks is proper and careful health planning. Systematic as well as careful health planning by the Government should be made in the deprived health blocks to improve the health status. Efforts should also be made to control Diarrhea, Hepatitis, and Malaria properly. Health institutions like PHC as well as CHC should be increased in almost all the health blocks of the district. The specialized well-equipped hospitals should be started in the deficient health blocks. The extensive health education should be spread for personal as well as public hygiene, distribution of well-equipped required medical services in proportion to the populations, and special health check-up camps especially in the deficient or suffered health blocks would solve much of the health problems of the Sonitpur District.7,8,9&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Disease pattern and health infrastructure are related to one another as the disease pattern is largely determined by the expansion of health facilities. In the study area, it has been found that the area characterized by the sufficient number of a health institution is affected by a particular disease in less number. It has also been found that population pressure on health institution is more where there is the insufficient number of the same. Thus, there must be sufficient health infrastructure in the deficient area to stop the spread of disease and also to stop population pressure on the same.&#xD;
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Acknowledgement:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The present article is a part of my M. Phil Dissertation and hence, I would like to express my deep gratitude to my Research Supervisor Prof. Nishamani Kar, Department of Geography, Rajiv Gandhi University, Arunachal Pradesh for his constant support and help, encouragement and proper guidance, without which the current article would have not been possible. &#xA0;I am thankful to Mr. Sanjib Kumar Rajkhowa, DDM cum DNM &amp; e-Officer, NHM (National Health Mission), Sonitpur District for providing me necessary data about health care institutions. I am also thankful to the Health and Family Welfare Department (IDSP), Sonitpur District for providing me required data related to various diseases and their spatial distribution in the district.&#xD;
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Conflict of Interest: Nil&#xD;
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Source of Funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3365</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3365</Fulltext></URLs><References>&#xD;
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				Bagchi M. Mosquito-Borne Diseases and Problems of Health Management in Dibrugarh District. Assam: A Study in Medical Geography. Unpublished PhD Thesis. Department of Geography. 2010. Gauhati University. Guwahati. pp. 2-5.&#xD;
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				M&#x2019;Cosh J. Topography of Assam 1837. Logos Press, New Delhi. &#xD;
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				Sen G. Preventive and Social Medicine. Current Publisher, Calcutta. 1st ed. pp 15-16.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Community-based Study on Breastfeeding Practices in the Urban Area of Meerut, Uttar Pradesh&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>154</FirstPage><LastPage>158</LastPage><AuthorList><Author>Deepak Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Pawan Parashar</Author><AuthorLanguage>English</AuthorLanguage><Author> Rahul Bansal</Author><AuthorLanguage>English</AuthorLanguage><Author> Saurabh Sharma</Author><AuthorLanguage>English</AuthorLanguage><Author> Kaynat Nasser</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Exclusive breastfeeding is very helpful in the reduction of infant mortality and it is also helpful in protecting infants against infectious and non-infectious diseases. Exclusive breastfeeding can play important role in the reduction in infant mortality and can help in achieving health-related sustainable development goals. Various initiatives of health education and social mobilization have been taken by the department of community medicine of a private medical college of Meerut in its urban field practice area. Objective: To find out the prevalence and associated factors of exclusive breastfeeding in urban areas of Meerut. Methods: A cross-sectional study was conducted in the field practice area of the urban health training centre (UHTC) among 179 lactating mothers. The data collection was done by predesigned and pre-validated questionnaire. Descriptive statistics and Fisher Exact test were used for statistical analysis. Results: The study findings revealed the initiation of breastfeeding within an hour was practised by 63.7% of mothers. The exclusive breastfeeding was practised by 134 (74.9%) mothers. Pre lacteal feeds &amp; colostrum was given to 22.3% and 78.8% of the children respectively. The complementary feeding at 6 months was started by 76 (42.5%) mothers. Conclusion: The practices of breastfeeding like early initialization of breastfeeding, colostrum feeding, exclusive breastfeeding till 6 months and complementary feeding from 6 months are comparatively better in the study area as compared to breastfeeding practices in Uttar Pradesh. The prevalence of exclusive breastfeeding was comparatively lesser in population belonging to upper lower socioeconomic classification.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Colostrum, Complementary feeding, Exclusive Breastfeeding, Pre lacteal feeds</Keywords><Fulltext>Introduction&#xD;
&#xD;
Breast milk is the natural and complete first food for babies. It fulfils all nutritional requirements of infants for the first six months of life, and it also provides one-third of nutritional requirements during the second year of life. Breast milk promotes the mental and behavioural development of the infant and it protects the infant against infectious and non-infectious diseases. Breastfeeding promotes the health and well-being of mothers as breastfeeding decreases the risk of ovarian cancer and breast cancer. Breastfeeding is also helpful in family planning.1&#xD;
&#xD;
In exclusive breastfeeding, no foods or drinks other than breast milk are given for the first 6 months to the babies.2 Exclusive breastfeeding decreases the chances of infant mortality due to childhood illnesses such as diarrhoea, pneumonia.3.4 Exclusive breastfeeding (EBF) is estimated to prevent approximately one-tenth of child deaths. It can also play an important role in the reduction of the infant mortality rate of the country and can help achieve sustainable development goal 3.5 The benefits of EBF are enormous, but, the prevalence of exclusive breastfeeding practices in India remains low.6&#xD;
&#xD;
According to national-level household and facility survey (NFHS-4), the overall prevalence of exclusive breastfeeding in India has increased from 46.0% to 55.0% between 2005 and 2016.7 In contrast; six states i.e. Uttar Pradesh, West Bengal, Chhattisgarh, Karnataka, Arunachal Pradesh, and Kerala had shown a decline in the prevalence of exclusive breastfeeding. Uttar Pradesh has shown a maximum decline of 9.7% (from 51.3% in 2005 to 41.6%in 2016). The prevalence of exclusive breastfeeding is even worse in the urban area of Uttar Pradesh as compared to rural areas.7 However; various initiatives of health education and social mobilization have been taken by the department of community medicine of Subharti Medical College, Meerut for improving exclusive breastfeeding and complementary feeding practices in its urban field practice area. Therefore; the present study was conducted to find out the prevalence of exclusive breastfeeding in Multanagar, urban field practice area of Urban Health training centre, Subharti medical college, Meerut, Uttar Pradesh.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
A community-based cross-sectional study was conducted from December 2019 to April 2020 after taking permission from the Institutional Ethical committee. Mothers of age 18 to 45 years who had the youngest child between 6 months to 2 years were included in the study. &#xD;
&#xD;
The study was conducted in the field practice area of UHTC of a Subharti medical college, Meerut. There were approximate 3300 families and 20000 people in the study area. The study area had a total of 17 colonies and 3 slum areas. Most of the area lacks basic legal approval and facilities.&#xD;
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In the study area, 10 colonies were randomly selected. From each colony, 20 eligible mothers were selected for the interview. In case, there was a problem in finding 20 lactating mothers in the colony, then the lactating mothers were selected from the adjacent colony. Exclusive Breastfeeding was defined as only breast milk was given to the infants until the age of six months. The lactating mothers were interviewed by using a pretested, pre-validated semi-structured interview schedule. The modified Kuppuswamy scale of 2019 was used for determining the socio-economic status of mothers.8&#xD;
&#xD;
As per national-level household and facility survey 4 (NFHS 4), the prevalence of EBF in urban areas of Uttar Pradesh was 35.1 % in infants of age 0-6 months.7For 95% C.I. and 0.07 absolute precision, the minimum sample size came out to be178 as per Epi Info 2000 software. In the present study, we had used the prevalence of exclusive breastfeeding (EBF) among lactating mothers as the outcome variable whereas the independent variables included demographic and socioeconomic characteristics of mothers like mother education, mother occupation, socioeconomic classification, religion, and caste, etc. Data were analyzed by using SPSS 21 version. Descriptive statistics were used to show percentages. Fisher exact test was used as a test of significance.&#xA0; P-value of &lt; 0.05 was considered significant. &#xD;
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Results &#xD;
&#xD;
The study was conducted among 179 lactating mothers having children age less than 2 years. 76 (42.4%) mothers were educated up to senior secondary and 42 (23.5%) mothers were graduate/postgraduate. Most of the mothers (97.2%) were housewives. 78 (43.6%) females belonged to upper lower socioeconomic classification whereas 79 (44.1%) females belonged to lower medium socioeconomic classification based on Kuppuswamy socioeconomic classification. The majority (96.6%) of lactating were Hindu by religion.&#xD;
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Table 1 depicted that 63.7% of mothers started breastfeeding within the first hour of birth of their child. 88.8% of the deliveries were institutional. It was observed that 141 (78.8%) mothers gave colostrum to their babies whereas Pre lacteal feed was given by 40 (22.3%) of the mothers. Gutty (33) was the most common form of pre-lacteal feed followed by honey (5). The pre-lacteal feed was mostly given by the advice of relatives/family members (34). The feeding on demand was practised by130 (72.6%) mothers whereas 49 (27.4%) mothers fed on a regular interval.&#xD;
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Table 2 showed that 134 (74.9%) females exclusively breastfed where 45 (25.1%) did not exclusively breastfeed their babies. There was a significant association between exclusive breastfeeding and socioeconomic status and caste of mothers (p-value 0.014, 0.031 respectively). However, there was no significant association between exclusive breastfeeding and mother education, occupation, and religion (p-value 0.990, 0.492, 0.347 respectively).&#xD;
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Table 3 described that 45 (25.1%) of mothers did not breastfeed their babies exclusively.&#xA0;&#xA0; Social factors (57.7%) were the main reasons for discontinuing exclusive breastfeeding. Whereas 12 (26.7%) females told that they discontinued breastfeeding due to child illness and 7 (15.6%) females discontinued breastfeeding due to maternal illness.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
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Table 4 described that 19 (10.6%) mothers started complementary feeding before completion of 6 months whereas 76 (42.5%) mothers initiated complementary feeding after 6 months whereas the majority (46.9%) initiated complementary feeding beyond 7 months or more. The Daliya, daal, and khichri were the most commonly used food items during complementary feeding.&#xD;
&#xD;
Discussion&#xD;
&#xD;
In the current study, it was found that only 63.7 % of mothers initiated breastfeeding within 1 hour of birth which was similar to 61.6% reported by another study done in rural Wardha.9 In contrast, in various other studies, observed the early initiation of breastfeeding in the fewer number of mothers (38.1%, 36.6%, respectively).10,11 The increase in early initiation of breastfeeding might be due to the sensitization and training of health workers by the community medicine department in the study area. Secondly, it might be due to institutional deliveries in most study subjects.&#xD;
&#xD;
In our study, 78.8% of babies were fed colostrum which matched well with the findings of various other studies.12,13In contrast to our findings, only 11.8% of the women gave colostrum to their infants in Uttar Pradesh &amp; only 22.7% of mothers had given colostrum to their baby in a study done in M.P.14,15 The variation in colostrum feeding practices across various studies could be due to different customs regarding colostrum across India. Regarding pre-lacteal feeds, the prevalence of pre-lacteal feeding was lower (22.3%) than in other studies.16-18 The most important reason regarding pre-lacteal feed cited among various studies was family customs and relative&amp;#39;s advice. In the current study, the reduction in pre-lacteal feeding might be due to the participatory approach of health education by health workers.&#xD;
&#xD;
The prevalence of exclusive breastfeeding was 74.9% in this study. According to NFHS 4 data, 41.6% children under age 6 months were exclusively breastfed in U.P.7 The higher prevalence of exclusive breastfeeding in the study area was due to extensive health awareness activities in form of role plays by medical students and health workers regarding the benefits of breastfeeding among the lactating mothers of the area. The breastfeeding day was celebrated regularly to increase awareness in society by the health workers in the study area. The current study showed a significant association of exclusive breastfeeding with socioeconomic status and caste of study subjects. However, another study reported exclusive breastfeeding practices were impacted by the educational status of mothers.19&#xD;
&#xD;
WHO/UNICEF has recognized feeding on-demand as an important step for successful breast-feeding. In the current study, feeding on demand was found in the majority (72.6%) of mothers. Similarly, 84.1% of mothers fed their babies on demand in a study in Bengal.20 In another study, feeding on demand was found to be only 38%.21 In the present study, the initiation of complementary feeding at 6 months was done in 42.5 % children which is slightly higher than the results of various other studies.7,22,23 &#xD;
&#xD;
Conclusion&#xD;
&#xD;
In the current study, practices of breastfeeding like early initialization of breastfeeding, colostrum feeding, exclusive breastfeeding till 6 months, complementary feeding from 6 months are comparatively better in the study area as compared to breastfeeding practices in Uttar Pradesh. The higher prevalence of breastfeeding practices was due to awareness campaigns and social mobilization by health workers in the study area. However, the prevalence of exclusive breastfeeding was comparatively lesser in population belonging to upper lower socioeconomic classification. Therefore, we recommend that more health awareness activities should be planned in population belonging to the upper-lower socioeconomic status. We should also encourage lactating mothers to initiate complementary feeding of infants at the right time so that we can achieve the goals of reduction in child mortality.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
The Authors acknowledge the respondents who had truly given their views regarding breastfeeding and participated in the study. The authors also acknowledge the efforts of health workers, medical and nursing students, interns posted at UHTC who played important role in the awareness campaign regarding exclusive breastfeeding in the community.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3366</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3366</Fulltext></URLs><References>1. World Health Organization. Maternal, New Born, Child and adolescent health. Available at:http://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/ [Accessed Oct 10, 2020].&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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15. Taneja PV, Gupta N. Feeding practices and malnutrition in infants of Bhil tribe in Jhalva district of M.P. Indian J Nutr Diet 2001;38:160.&#xD;
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16. Shaili V, Sharma P, Kandpal SD, Semwal J, Srivastava A, Nautiyal V: A community-based study on breastfeeding practices in a rural area of Uttarakhand. Natl J Community Med 2012;3(2):283-287.&#xD;
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17.&#xA0; Parashar P, Gupta K, Chattopadhyay S, Shukla AK, Ahmad S. Effects of socio-demographic factors on prelacteal feeding practices among the lactating mothers in&#xA0; Meerut city. Indian J Public Health Res Dev 2018,9(7):122-127.&#xA0; &#xD;
&#xD;
18. Punj A, Goel SP, Shukla AK, Ahmad S. Differential of residence in practices of feeding pattern of children in Meerut. Int J Contemp Med 2016;4(2):31-36. &#xD;
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19. GuptaSK, Goel PK, Kishore S, Singh AB. Social determinants of exclusive breastfeeding practices. Indian J Community Health 2006;18:13-17.&#xD;
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20. Bandyopadhyay SK, Chaudhary N, Mukopadhyaya BB. Breast Feeding Practices in rural areas of West Bengal. Indian J Public Health 2000;44:137-138. &#xD;
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21. Srivastava A, Srivastava P, Shrotriya VP, Martolia DS. Breastfeeding Practices in Women from Urban and Rural Areas &#x2013;A Comparative Study. Ind J Matern Child Health 2010;12(2):2-10.&#xD;
&#xD;
22. Singhal P, Garg SK, Chopra H, Jain S, Bajpai SK, Kumar A. Status of Infant and Young Child Feeding Practices with Special Emphasis on Breast Feeding in an Urban Area of Meerut. J Dent Med Sci 2013;7(4):7-11. &#xD;
&#xD;
23. Das S, Das N, Mundle M, Das P. A study on Infant and Young Child Feeding (IYCF) practices among mothers attending a Tertiary Health Care Institution, Kolkata. Al Ameen J Med Sci 2018;11(3):172-177.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Effect of Internet Addiction on the Sleep Pattern and Quality of Life Among Medical Students&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>159</FirstPage><LastPage>164</LastPage><AuthorList><Author>Sana Bano Usmani</Author><AuthorLanguage>English</AuthorLanguage><Author> Poonam Bharti</Author><AuthorLanguage>English</AuthorLanguage><Author>Karun Bhatti</Author><AuthorLanguage>English</AuthorLanguage><Author> Priya Jindal</Author><AuthorLanguage>English</AuthorLanguage><Author> Aman Bharti</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Medical students are at an increased risk of internet addiction and its effect on their sleep pattern and quality of life. Objective: To assess the prevalence of internet addiction in medical students and its association with their sleep quality and quality of life. Methods: A cross-sectional study was done in a tertiary level care institute Maharishi Markhandeshwar University, Mullana. A total of 592 students of various disciplines were enrolled they were provided questionnaire including Internet Addiction Test(IAT), Physical sleep Quality Index (PSQI) and Quality of Life-10 (QoL-10). The data was collected and statistical analysis was done on SPSS v21.0. Result: Prevalence of internet addiction was 13.5% and 1.5% for moderate and severe addiction respectively. From this study, the severity of internet addiction was significantly associated with poor sleep as well as decreased quality of life (P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Internet Addiction (IA), Quality of Life (QoL), Sleep Quality, Prevalence, Medical Students, Screen Time, Somatic Symptoms</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The Internet has become one of the most pivotal elements in the life of people nowadays. It is used for a variety of purposes, like communication, education and entertainment. Despite its various advantages, the dark side of internet overuse has been emerging slowly but progressively1, 54.4% of the world&#x2019;s population has internet access.2 A multinational meta-analysis showed that 6% of the population worldwide has internet addiction; it also gave the first rank to the Middle East with 11% and the lowest rank to Northern and Western Europe with 3%.3&#xD;
&#xD;
Internet Addiction (IA) is now considered as a new type of addiction and mental disorder just like already established addictions such as gambling and alcoholism.4 IA is an impulse control problem and characterized by the inability to inhibit/decrease inter, net use, which consequently leads to the adverse effect on an individual&#x2019;s life.5 Increased use of internet use has been associated with depression6 significant mood changes, poor quality of sleep, deteriorated health outcomes like obesity and poor self-esteem.7 IA has been described as over-use or poorly controlled behaviour regarding internet access which leads to impairment or distress.8 Increased internet use tends to disturb the quality of sleep, which leads to poor quality of life.9&#xD;
&#xD;
Sleep is an essential requirement for humankind, which is important for good quality of life (QoL) and health for all ages. Multiple factors are associated with quality of sleep which includes social life, general health status and environmental factors.10,11 Guideline&#x2019;s advocate 8.5 to 9.5 hours of sleep every night for age group 10-17 years old, and 7 to 9 hours of age above 18 years.12 Sleep deprivation can have fatal outcomes like a reduced coping mechanism, increased risk of motor accidents and poor academic performance.13Literature has shown the influence of IA on disturbed sleep and insomnia, a high rate of insomnia was found among 3% heavy internet users.14&#xD;
&#xD;
The literature further shows there has been a negative impact of internet misuses such as physical, behavioural, psychological and interpersonal problems and work issues.15 It has also been observed that although internet use has increased a person&#x2019;s performance in regards to information and communication technologies, on the contrary, it has led to reduced self-capability, memory and confidence with increased dependency on internet.16&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This cross-sectional study was done in tertiary level care institute Maharishi Markhandeshwar Institute of Medical Sciences in Northern India to assess the prevalence of internet addiction and it&#x2019;s the association with quality of sleep and QoL among the medical students including bachelors, postgraduates, dental, nursing, and physiotherapy students. This study was conducted over one month between January and February 2020. A total of 592 subjects were included. The subjects were included if aged&gt;18 years, either sex, using the internet since last year, well-versed with Hindi and English language, and agreed to participate in the study. Students who had been using the internet for less than one year and those who unwilling to participate in the study were excluded.&#xD;
&#xD;
The consent for participation was obtained after explaining the research purpose, design, and voluntary nature of participation. Ethical clearance was taken from institutional ethical committee vide Project no.- 121E dated 14/12/19.&#xD;
&#xD;
Internet Addiction Test of Young (IAT)&#xD;
&#xD;
Internet use was assessed by the Internet Addiction Test of Young (IAT), a 20-item 5-point Likert Scale that measures the severity of self-reported habitual use of the internet. The total internet addiction score is the sum of 20 items ranging between 20 and 100. The severity of addiction was classified into 3 categories 20-49, 50-79 and 80-100 scores as normal, moderate and severe respectively.&#xD;
&#xD;
Pittsburg Sleep Quality Index (PSQI)&#xD;
&#xD;
Pittsburg Sleep Quality Index (PSQI)was used to assess sleep quality and quantity with verified levels of reliability, consistency and validity. It contains 19 items generating 7 components that evaluate sleep duration, disturbance, latency, daytime dysfunction due to sleepiness, sleep efficiency, overall sleep quality and sleep medication use. The score ranges from 0-3 for each component. A global score resulting from the summation of all components ranges from 0-21. Students with score &gt;5 were categorized as good sleepers and those with a score </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3367</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3367</Fulltext></URLs><References>&#xD;
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	Cheng C, Li AY. Internet addiction prevalence and quality of (real) life: A meta-analysis of 31 nations across seven world regions. Cyberpsychology, Behav Social Networ 2014 Dec;17(12):755-760.&#xD;
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	Gradisar M, Wolfson AR, Harvey AG, Hale L, Rosenberg R, Czeisler CA. The sleep and technology use of Americans: findings from the National Sleep Foundation&amp;#39;s 2011 Sleep in America poll. J Clin Sleep Med 2013;9(12):1291-1299.&#xD;
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	Young KS. Internet addiction: The emergence of a new clinical disorder. Cyberpsychol Behav 1998;1(3):237-244.&#xD;
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	Lai CM, Mak KK, Watanabe H, Jeong J, Kim D, Bahar N, et al. The mediating role of Internet addiction in depression, social anxiety, and psychosocial well-being among adolescents in six Asian countries: a structural equation modelling approach. Public Health 2015;129(9):1224-1236.&#xD;
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	Kim JH, Lau CH, Cheuk KK, Kan P, Hui HL, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviours among Hong Kong university students. J Adolescence 2010;33(1):215-220.&#xD;
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	Shaw M, Black DW. Internet addiction: definition, assessment, epidemiology and clinical management. CNS Drugs. 2008;22(5):353-65. &#xD;
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	Gupta S, Maurya VP, Singh AP, Patel AK. Internet Addiction and Quality of Life among Young Adults: An Exploratory Study. Int J Indian Psychol 2018:2348-2396.&#xD;
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	Khayat MA, Qari MH, Almutairi BS, Shuaib BH, Rambo MZ, Alrogi MJ, Alkhattabi SZ, Alqarni DA. Sleep Quality and Internet Addiction Level among University Students. Egyptian J Hospital Med 2018;73(7):7042-7047.&#xD;
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	Wang W, Zhou DD, Ai M, Chen XR, Lv Z, Huang Y, et al. Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China Peer J 2019;7:e7357.&#xD;
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	Fatehi F, Monajemi A, Sadeghi A, Mojtahedzadeh R, Mirzazadeh A. Quality of life in medical students with internet addiction. Acta Medica Iranica 2016:662-666.&#xD;
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	Siu MY. Association between use of internet and quality of life (qol) among young people in Hong Kong. Nurs Pract Health Care 2019;1(1):103&#xD;
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	Tingting GA, Xiang YT, Zeying QI, Yueyang HU, Songli ME. Internet Addiction and Quality of Life in College Students: A Multiple Mediation Analysis. Iranian J Public Health 2019;48(11):2094-2096.&#xD;
	&#xD;
	&#xD;
	Dave R, Irani A, Neekhra V. Effect of Musculoskeletal Disorders on Health-Related Quality of Life of Light Engineering Maintenance Personnel. Int J Cur Res Rev 2020;12(15):110.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Current Trend in Urology Practice During COVID-19 Pandemic: Our Experience&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>165</FirstPage><LastPage>167</LastPage><AuthorList><Author>Debashis Routray</Author><AuthorLanguage>English</AuthorLanguage><Author> Debabrata Sabat</Author><AuthorLanguage>English</AuthorLanguage><Author> Suren Kumar Das</Author><AuthorLanguage>English</AuthorLanguage><Author> Pranab Pattanaik</Author><AuthorLanguage>English</AuthorLanguage><Author> Rahul Pradhan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: COVID-19 caused a large number of mortality, morbidity and impact on the socioeconomic status of the various countries including India. Over the time COVID-19 affected number of body systems critically including urinary system and related organs. Objective: To evaluate the changing scenario in urology in the present pandemic situation arising due to coronavirus disease-19. Methods: A database of a total number of 160 patients during the period of April to July 2020 were recorded. Symptom-based questionnaires were made for the screening of the patients. The cases were divided based on the severity and emergency of the procedure and tabulated accordingly. The various safety and precautionary measures in this pandemic of COVID-19 are discussed and various emergency procedure undertaken is reviewed. Results: The patients were prioritized based on malignant and non-malignant conditions in elective surgical procedures. The priorities in case of emergency surgical procedures involved haematuria, urosepsis, urological trauma, obstructive uropathy, urinary retention due to urethral strictures etc. Conclusion: During the pandemic covid 19 situations, our centre being the covid referral centre, we have operated 160 patients with various guidelines prepared by the institute from time to time and we have safely operated and discharged all our patients..&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>COVID 19, Pandemic, Mortality, Haematuria</Keywords><Fulltext>Introduction&#xD;
&#xD;
The ongoing pandemic of COVID-19 has shaken the world with a large number of mortality, morbidity and impact on the socioeconomic status of the various countries.1 The current situation COVID-19 cases in the whole world, (confirmed cases-17,106,007 and deaths-668,910 on 31st July 2020). India being in 3rd position with confirmed cases-1,638,870, death -35,747 on 31st July 2020.2 Odisha has made achievements with less number of mortality rate and the higher number of recovered cases in comparison to other states of India. As on 31st July 2020 in Odisha, confirmed cases-33,479 and recovered cases -20,000 and death-187.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Our centre being a tertiary care centre as well as COVID hospital in Odisha, our institution is involved in formulating and implementing strategies for optimizing health care outcomes.3,4 The outcome of the current pandemic situation can be monitored by the fact that repeated attempts of lockdown, shutdown, containment and curfew have been implemented for the control of the spread of the disease.5,6 This has impacted various urological illnesses in our community simultaneously.2&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
During the initial phases of lockdown, patients visiting our OPD or emergency being screened in the flu clinic using a symptom-based questionnaire (Table 1) and were initially stratified into the suspected case or not. The suspected cases were sent for reverse transcriptase-polymerase chain reaction (RT-PCR).7,8&#xD;
&#xD;
As soon as lockdown is eased, there is the rush of patients in our OPD. Hence, we have prepared with full proof action plan to prioritize and triage these patients to manage the current situation and manage these urological illnesses according to guidelines prepared by our institution and also according to guidelines prepared by a world health organization, the urological society of India as well.9,10&#xD;
&#xD;
During the initial month of April 2020, due to less availability of RT-PCR kit in our institution, we used to triage the patient and provide treatment according to priorities.11,12 But in the latter part of April 2020, due to surplus amount of RT-PCR kit and PPE kit in our institution and also new guidelines prepared for the COVID -19, our centre used to send all indoor patients to isolation ward till the covid report turns negative. In this phase, we advocate continued use of symptom-based screening and RT-PCR test before embarking on the elective procedure to save the treating team from cross-infection. Covid-19 rapid antigen test was available in July 2020 in our institution. So we started following the symptom-based screening and RT-PCR test followed by rapid antigen test on the day of surgery. By the end of July 2020, our institution had the highest number of COVID bed availability reaching 900 beds for the separate dedicated covid hospital block with OT, ICU unit, wards and in-house investigation laboratories and imaging facilities with haemodialysis unit.&#xD;
&#xD;
RESULT AND DISCUSSION&#xD;
&#xD;
Based on the above protocol, we have operated 160 patients from April to July 2020. 2 patients were COVID positive detected preoperatively. Rest of these patients did not develop symptoms of COVID-19 following surgery.&#xD;
&#xD;
&#xD;
&#xD;
Emergency urology surgical procedures:&#xD;
&#xD;
Since the beginning of lockdown and as recommended by all guidelines, only emergency procedures are being operated. The rationale for this is to conserve the already strained health care resources. The priorities of our emergency services involved malignancies, haematuria and urosepsis and urological trauma, obstructive uropathy due to stone diseases or strictures.&#xA0; Urinary retention caused by a prostatic enlargement or urethral strictures (Table 2).&#xD;
&#xD;
&#xD;
&#xD;
Elective urology surgical procedure&#xD;
&#xD;
We have prioritized our patients with malignant and non-malignant conditions.&#xA0; We have followed above mentioned guidelines for the surgical procedures (Table 3) and types of urological surgeries operated in the covid era (Table 4).&#xD;
&#xD;
&#xD;
&#xD;
Anesthesia Consideration&#xD;
&#xD;
General anaesthesia leads to aerosol generations and therefore poses the highest chance of transmission to OT staffs. Hence, wherever feasible, regional anaesthesia considered. Patient under regional anaesthesia wears an N95 mask. During regional anaesthesia, anaesthetist used PPE kit (Table 5).&#xD;
&#xD;
&#xD;
&#xD;
General Surgical Consideration&#xD;
&#xD;
Staffs were asked to wear N95 mask and minimum staffs were allowed in OT. Hand hygiene was strictly followed. Donning and doffing procedures were strictly followed. OT was well ventilated with negative pressure ventilation and high-efficiency particulate air (HEPA) filters. Surgeons, anaesthetists and OT staffs were using face shields with N95 mask. Only a few cases of laparoscopy and open surgery, or patients who were having fever, PPE kit were used. All the patients were routinely screened preoperatively for covid 19 and no patients were developed covid 19 symptoms postoperatively and at the time of discharge.&#xD;
&#xD;
2 patients with ureteric colicky with ureteric calculus were covid 19 positives during routine RT-PCR test. Since these patients requiring surgical intervention, so these patients were posted in covid 19 dedicated OT. All the team members of the OT were quarantined after the procedure. No staffs got covid 19 symptoms after the quarantine period. &#xD;
&#xD;
Endourology procedures&#xD;
&#xD;
While viral RNA has been identified in the urine samples of 6.9% of patients who had recovered from COVID 19, others have reported that virus shedding in urine is absent. To decrease the chance of contaminations, the entire operating team had taken precaution with using impervious drapes, closed drainage of returning irrigation fluids. In most of our patients of PCNL and URSL, DJ stenting was avoided where ever applicable and tubeless PCNL were achieved. In the post-operative period, these patients did well and discharged satisfactorily. Most of our cases for stone surgery, regional anaesthesia protocol in the form of spinal anaesthesia was administered.&#xD;
&#xD;
Laparoscopic Procedures&#xD;
&#xD;
Due to the risk of transmission of the virus in the smoke due to electrocautery and aerosol due to co2 pneumoperitoneum, we had followed all precautionary measures. Appropriate size port incisions were given to prevent air leak. Electrocautery was used judiciously. Suction and irrigation system was used to prevent aerosol transmission. In our centre, laparoscopy was done for patients who were surgically fit candidate for laparoscopy.&#xD;
&#xD;
Open Surgical Procedures&#xD;
&#xD;
Adequate measures to minimize the generation of aerosol were followed. Most of our patients had given regional anaesthesia and general anaesthesia was restricted. Substitution urethroplasty was done with preferred healthy local flaps (inner preputial graft, vaginal flaps) and for unhealthy local flaps, buccal mucosal grafts were preferred.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
During the pandemic covid 19 situations, our centre being the covid referral centre, we have operated 160 patients with various guidelines prepared by the institute from time to time and we have safely operated and discharged all our patients.&#xD;
&#xD;
Conflict of Interest: None&#xD;
&#xD;
Source of Funding: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3368</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3368</Fulltext></URLs><References>&#xD;
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	Kumar A. Corona Virus Disease USI Information Centre. Available from: https://usi.org.in/New/Spe_pdf/USI%20Corona%20advise%20edited.pdf. Al-Muharraqi MA. Testing recommendation for COVID-19 (SARSCoV- 2) in patients planned for surgery - continuing the service and &amp;#39;suppressing&amp;#39; the pandemic. Br J Oral Maxillofac Surg 2020; S0266-4356:30164-9. &#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparison of Effectiveness of Diode Laser with Er: Yag Laser on Fluoride Uptake of Enamel Surface Using Acidic and Neutral Topical Fluorides: An In-Vitro Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>168</FirstPage><LastPage>174</LastPage><AuthorList><Author>Rutika Baid</Author><AuthorLanguage>English</AuthorLanguage><Author> Nilesh Rathi</Author><AuthorLanguage>English</AuthorLanguage><Author> Shreyans Aditya Jain</Author><AuthorLanguage>English</AuthorLanguage><Author> Nilima Thosar</Author><AuthorLanguage>English</AuthorLanguage><Author> Sudhindra Baliga</Author><AuthorLanguage>English</AuthorLanguage><Author> Jayati Mehta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Topical fluoride plays a vital role in the prevention of dental caries. Fluoride reduces enamel dissolution during acid attack.Laser irradiation also an adjunct to conventional caries prevention techniques. Objective: To compare &#x201C;the effectiveness of&#x201D; diode &#x201C;laser with&#x201D;Er:YAG laser on fluoride uptake of enamel surface using acidic and neutral topical fluorides. Methods: Enamel of each halved tooth specimens were painted with nail polish &#x201C;varnish leaving a window&#x201D; of 5x5 mm of exposed enamel. One half of the sectioned tooth was taken as the control group, (n=40) and it&#x2019;s corresponding half as the experimental group (n=40). These two groups were further subdivided into 4 subgroups of 10 samples each depending upon the pH of topical fluoride and wavelength of the laser used. &#x201C;Group A, Group B, Group C and Group D&#x201D; were marked as control groups and Group E, Group F, Group G and Group H marked as the experimental groups. Results: Fluoride ion-selective electrode and potentiometric analysis was used to calculate the mean fluoride uptake on the enamel surface of teeth. Er: YAG laser and diode laser after fluoride application on teeth demonstrated higher uptake of fluoride not only on enamel surface but also into the deeper structures. But, Er: YAG laser showed better results than diode laser for the incorporation of fluoride in teeth. Conclusion: APF-Er: YAG laser combination is most effective in the incorporation of fluoride in the teeth followed by NaF-Er: YAG, APF-Diode and NaF-Diode combination being the least.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Topical Fluoride, Diode Laser, Er: Yag Laser</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dental caries caused by excessive consumption of fermentable sugar, inadequate consumption of fluoride, improper oral hygiene and various systemic and oral conditions. Prevention is mandatory to identify patients with caries high risk and should be given individualized prophylactic and preventive support.1&#xD;
&#xD;
Topical fluoride plays a vital role in the prevention of dental caries. Fluoride reduces enamel dissolution during the acid attack.2 Topical fluoride treatment is one of the most widely accepted treatment regimens which helps in reducing demineralization of the hard dental tissues.3,4 Various forms are used for topical application of fluoride such as fluoridated kinds of toothpaste, gels, mouthwash contains fluoride preparation and varnishes. &#xD;
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Laser irradiation also is as an adjunct to conventional caries prevention techniques.5 Application of lasers on dental hard tissues creates certain morphological and structural changes, resulting in an increase in &#x201C;the acid resistance of the lased enamel and altering resistance to acid and permeability. These changes are attributed to various characteristics of the laser such as wavelength, exposure time, laser irradiation emission and various optical characteristics of each lased tissue. Diode lasers are soft tissue lasers and Er: YAG lasers are hard tissue lasers. The diode laser has several unique characteristics for its use in dentistry such as low cost compared to other lasers, smaller size and easy application in the mouth because of the optic fibres. Er:YAGemit light at 2940 nm wavelength, this coincides with the peak absorption of water and hydroxyapatite and can also ablate enamel, dentin, and carious tissues effectively than other lasers.7 The combination of topical fluoridation and laser has been used by various researchers but there is no study comparing both diode lasers and Er: YAG lasers with acidic and neutral fluorides.&#xD;
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So, the present study aimed to compare the effectiveness of diode laser with Er: YAG laser on fluoride uptake of enamel surface using acidic and neutral topical fluorides.&#xD;
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MATERIALS AND METHOD&#xD;
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A sample of forty extracted human premolar teeth, not older than 1 month were collected and stored at 4&#xBA;C in 0.1% thymol solution at room temperature until the experimental procedure was initiated. Non-carious intact teeth, teeth extracted for orthodontic or periodontal purposes or free from any visible developmental defects were selected. All teeth were sectioned into two halves longitudinally (mesiodistally) using a diamond disc to obtain a total of 80 specimens. These specimens were mounted on acrylic blocks formed in moulds of size 2&#xD7;2 cm individually. The enamel of each halved tooth specimens was painted with nail polish varnish leaving a window of 5x5 mm of exposed enamel. One half of the sectioned tooth was taken as the control group, (n=40) and it&amp;#39;s corresponding half as the experimental group (n=40). These two groups were further subdivided into 4 subgroups of 10 samples each depending upon the pH of topical fluoride and wavelength of the laser used. Group A, Group B, Group C and Group D were marked as control groups and Group E, Group F, Group G and Group H marked as the experimental groups.&#xD;
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In Group A, 1.23% APF gel was applied, in Group B, 2% NaF gel was applied, in Group C, 1.23% APF gel was applied and in Group D, 2% NaF gel was applied for 4 minutes each. Similarly, in Group E, 1.23% APF gel application was followed by diode laser irradiation, in Group F, 2% NaF gel application was followed by diode laser irradiation, in Group G, 1.23% APF gel application was followed by Er: YAG laser irradiation and in Group H, 2% NaF gel application was followed by Er: YAG laser irradiation, for 4 minutes each.&#xD;
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Teeth were lased from a standard distance of 4 mm each. Two treatments of irradiation were given for 20 seconds each of diode laser (power- 2 W) and Er: YAG laser (power- 0.3 W) in respective groups. After treatment, both control and experimental specimens were stored at 100% humidity in a humidifier at room temperature for 24 hours. Tooth specimen of each group containing 10 samples were further divided into subgroups of 5 samples for analysis of fluoride uptake on the enamel surface and subsurface in teeth using Fluoride ion-selective electrode and potentiometric analysis respectively.&#xD;
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Statistical analysis:&#xD;
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Statistical analysis of the data was done by using descriptive and inferential statistics both using SPSS 17.0 software and p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3369</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3369</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0; Raina R, Kumar V., Krishna M. A comparison of antibacterial efficacy of 0.5% sodium fluoride impregnated miswak and plain miswak sticks on streptococcus mutants-A randomized controlled trial. J Clin Diagn Res 2017;11:2.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Structural and Antimicrobial Analysis of Methanolic Extract of Punica granatum PEEL&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>175</FirstPage><LastPage>184</LastPage><AuthorList><Author>A. Chithra</Author><AuthorLanguage>English</AuthorLanguage><Author> Dharanyshri R</Author><AuthorLanguage>English</AuthorLanguage><Author> Arunava Das</Author><AuthorLanguage>English</AuthorLanguage><Author> Bindhu J</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The ancient fruit Punica granatum, native to Iran is gaining significant attention from contemporary researchers due to its manifold therapeutic and pharmacological properties. It is well known for antibacterial, antifungal, anti-inflammatory, immunomodulatory and antioxidant activity since time immemorial. Besides, recent studies are revealing its potent anti-cancerous properties with evident anti-metastatic, anti-proliferative and anti-invasive effects on numerous cancer cell lines. Anti-acne property and using Punica as a functional food supplement is an active research area. Objective: The study mainly focuses on identifying the rich diversity of phytochemicals and bioactive compounds present in the methanolic extract of pomegranate fruit peel. Methods: Pomegranate peel powder was soxhelation with 75% methanol to obtain peel extract. Preliminary phytochemical analysis was performed for quantification of phytochemicals. The antimicrobial assay was carried out against 3-gram positive and 3-gram negative bacteria using well diffusion method, with varying concentrations (25%, 50%, 75%, 100%) of Punica peel extract. FTIR, GC-MS analysis and DPPH assay were performed to identify the functional group, chemical composition and to quantify the antioxidant scavenging activity. Results: Presence of tannins, saponins, flavonoids, alkaloids, terpenoids, phenols, steroids, and cardiac glycosides were confirmed by various phytochemical tests. The peel extract exhibited a significant zone of inhibition against 3-gram positive (Bacillus subtilis, Listeria monocytogenes, Streptococcus aureus) and 3-gram negative (Escherichia coli, Klebsiella aerogenes, Klebsiella oxytoca) bacteria. GC-MS revealed the presence of compounds like Ethyl Acetate, Pentanoic Acid, Succinamic Acid and FTIR confirmed functional groups like O-H, C=O, S=O. Conclusion: This culminates the promising pharmacological and medicinal characteristics of Punica granatum. Its high antioxidant activity favours efficient utilization for cancer studies.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Punica granatum, Phytochemicals, GC-MS analysis, FTIR analysis, DPPH assay</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3370</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3370</Fulltext></URLs></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>3</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>3</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Structural Analysis and Evaluation of Antimicrobial Activity of Camellia sinensis Aqueous Extract&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>185</FirstPage><LastPage>191</LastPage><AuthorList><Author>Devadharshini R</Author><AuthorLanguage>English</AuthorLanguage><Author> Charulatha S</Author><AuthorLanguage>English</AuthorLanguage><Author> Arunava Das</Author><AuthorLanguage>English</AuthorLanguage><Author> J. Bindhu</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The study is focused to determine the properties (antimicrobial, antioxidant, anticancer and phytochemical) of the Camellia sinensis. In this study the extract of Camellia sinensis performed to assess the antimicrobial potential against skin associated microorganisms. Antioxidant activity performed in the plant Camellia sinensis play a protective major role in different types of cancer, heart diseases and stroke. Objective: To identify the rich components present in green tea leaves aqueous extract by phytochemical methods and then it is useful as drug for various human effects and problems. Methods: The tea leaves extract was subjected to phytochemical tests, Gas chromatography-mass spectroscopy (GC-MS), Fourier transform infrared spectroscopy (FTIR) analysis and antimicrobial test. Phytochemical analysis of Green tea leaves (Camellia sinensis) was performed and the result showed that the presence of phenolic compounds (alkaloids, flavonoids, steroids, triterpenoids and tannins). Antimicrobial property was performed with two different gram-positive and gram-negative bacteria. Result: Laboratory studies shows that herbs like Camellia sinensis (green tea leaves) can be effectively used in curing bleeding, mental health, regulate body temperature, healing wounds, and to aid digestion. It also shows positive impact on types of cancer such as breast cancer, bladder cancer, ovarian cancer, skin cancer and so on. Conclusion: Camellia sinensis are rich in flavonoids, caffeine and catechins. The tea leaves extract possesses an excellent antimicrobial, antioxidant property which can be used as an alternative drug of choice due to its lower side-effects to human.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Camellia Sinensis, Leaves Extract, GC-MS, FTIR, Cancer</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3371</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3371</Fulltext></URLs></Article></ArticleSet></xml>