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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>02</LastPage><AuthorList><Author>Shaliga Bhatnagar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3372</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3372</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Occupational Needlestick Injuries Studies of a Tertiary Care Institute&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>03</FirstPage><LastPage>03</LastPage><AuthorList><Author>Debasish Kar Mahapatra</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3373</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3373</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effects of Abiotic Factors on the Ecophysiology of Cotton Plant&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>04</FirstPage><LastPage>07</LastPage><AuthorList><Author>Kholliyev Askar Ergashovich</Author><AuthorLanguage>English</AuthorLanguage><Author> Norboyeva Umida Toshtemirovna</Author><AuthorLanguage>English</AuthorLanguage><Author> Kholov Yokub Davronovich</Author><AuthorLanguage>English</AuthorLanguage><Author> Boltayeva Zarina Azamatovna</Author><AuthorLanguage>English</AuthorLanguage><Author> Adizova Khamida Raximovna</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: During the experiments, medium-fibre cotton varieties Bukhara-8, Omad and S-4727, as well as different types of saline meadows - alluvial, red-brown and desert-sandy soil types were used. Objective: To verify the scientific substantiation and production of physiological and ecological features of the Bukhara oasis in different saline meadows as alluvial, grey-brown and desert-sandy soil types, reflecting the effect of salinity and moisture levels on the valuable characteristics of cotton varieties are considered as the aim of the investigation. Method: The experiments were carried out in the fields of meadow-alluvial, red-brown and desert-sand types. Along with several indicators that determine the growth and development of cotton, depending on soil types and salinity levels, an increase in total water content in leaves, respiration rate, cell sap density, plant water deficit, and protoplasmic viscosity was found. Result: Growth in height, expansion of leaf surface, number of joints, joint length, yield, fibre yield, fibre length, decrease in weight of 1000 seeds were detected. Recommendations for the production of scientifically based ecophysiological features of the impact of salinity and moisture levels on the valuable traits of cotton varieties Bukhara-8, Omad and S-4727 in the conditions of saline meadows of all levels of the Bukhara oasis - alluvial, grey-brown and desert-sandy soils. Conclusion: Based on the data obtained, it was noted that all indicators of Bukhara-8 variety are higher than S-4727 and Omad varieties.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Abiotic factors, Cotton varieties, S?il salinity, Respiration, Photosynthesis rate, Protoplasmic viscosity, Water deficiency, Pure productivity of photosynthesis, Adaptation</Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The main tasks of land reclamation in the world are to increase soil fertility by reducing salinity, to obtain high and quality crops from crops and to develop protected lands. Systems of reclamation measures are different for regions with different natural conditions, which requires the development of science-based measures and in-depth study of soil properties.&#xB9;,&#xB2; The rational and efficient use of land in the field of agriculture has always been a major issue in the world. This is especially due to the steady increase in population and demand for food. The search for non-traditional methods and sources of increasing water resources, irrigation of crops grown in the irrigated area from planned water resources, timely and proper implementation of saline soils and other agro-ameliorative methods, scientific-practical bases of water use, norms and technologies are being created.&#xB3;,?&#xD;
&#xD;
&#xA0;In Uzbekistan, it is important to accelerate agricultural production gradually, rational use of land resources, development of solutions to problems related to increasing the productivity of plants per hectare of irrigated land, and its economic efficiency as well. In this regard, one of the important tasks is to maintain soil fertility and to increase it regularly from year to year.?,?&#xD;
&#xD;
It has a great scientific and practical substantiation of the issues against saline soils, improvement of the ameliorative and ecological condition of irrigated lands, as well as scientific substantiation of physiological and ecological features of the Bukhara oasis, reflecting the effect of salinity and moisture levels on valuable traits of cotton varieties in soil salinity and different soil types.?,?&#xD;
&#xD;
As a result of salinization processes observed in different regions of the country and different soils, leading to disruption of the agronomic structure of soils, the yield and quality of cotton is being declined. Therefore, &#xA0;nowadays one of the demanding direction is the creation of a scientific basis for the efficient use of water in the conditions of soil salinity and water scarcity.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Subjects of the research&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Bukhara-8, Omad and C-4727 medium-fibre cotton varieties, as well as alluvial, grey-brown and desert-sandy soil types with different levels of salinity were used during the research.&#xD;
&#xD;
Procedure&#xD;
&#xD;
The experiments were conducted in the scientific laboratory and training field of Bukhara State University and the fields of farms of Karakul and Jondor districts. The experiments were carried out in meadow-alluvial, red-brown and desert-sandy fields. The depth of groundwater was 2-3 meters. Based on the pre-irrigation soil moisture, volumetric weight, and moisture capacity, the degree of moisture depletion in the soil was determined and irrigation standards were set.&#xD;
&#xD;
In all field experiments, soil water deficit was studied and irrigation was carried out by determining soil moisture before irrigation, its volumetric weight and field moisture capacity. All experiments were performed under 70 per cent humidity conditions where soil moisture was moderate. In some experiments, soil moisture was kept at 70-75-70, 65-70-65, 60-65-60 per cent of the total moisture capacity. Seeds were planted in rows at 60 cm intervals.&#xD;
&#xD;
During our research, salt regimes were studied in the Bukhara oasis, taking into account the formation of medium, strongly saline soils and the specificity of the processes of salt accumulation in saline soils. Also, during the experiments, agrochemical, agrophysical properties and other indicators of meadow-alluvial, grey-brown and desert-sandy soils, which are widespread in the Bukhara oasis, were identified. Soil salinity levels were also taken into account during field experiments.&#xD;
&#xD;
The influence of agro-ecological factors on the growth and development of certain physiological parameters, growth and development of cotton varieties was determined using generally accepted methods in the field of plant physiology and biochemistry and soil science. Phenological observations, calculations and research on plant growth and development were carried out following the methods of UzPITI.&#xD;
&#xD;
Determination of all physiological parameters and phenological observations were carried out in the experiments during the stages of budding, flowering and germination of cotton. A fourth leaf developed from the third part of the main stem was used for the study. In the laboratory, the valuable economic characteristics of each variety of plants as fibre yield, fibre length, the weight of a thousand seeds and other indicators were determined.&#xD;
&#xD;
In the Bukhara oasis, the mechanical composition, salinity and other indicators of the most common and varying degrees of salinity meadow-alluvial, grey-brown and desert-sandy soil types were determined.&#xD;
&#xD;
RESULTS &#xD;
&#xD;
Salinization processes in soils with different mechanical composition, distributed in irrigated micro and nano relief forms were observed in the form of seasonal staining and permanent staining, as well as total salt content (dry residue), HCO3--,&#xA0; Cl-,&#xA0; SO4-- ions, Ca++, Mg++ + and Na+ &#xA0;cations and easily soluble salts (MgSO4, Na2SO4, NaCl), formed from their compounds, differ in composition and amount. The pH indication of soils has low-alkaline, fluctuating around 7.21&#x2013;7.43 on the soil horizon. The total amount of carbonates in the soil profile was 6.78&#x2013;9.67%.&#xD;
&#xD;
In former irrigated meadow-alluvial soils, humus content in the topsoil is 1.09-1.39%, and in the middle and lower horizons the quantity does not exceed than 0.93-0.47%. The amount of nitrogen in the soil profile was also 0.098-0.044% and it was noted that the amount of humus gradually decreased from the upper layer to the lower horizon. An increase in total water content was found in all three varieties studied with increasing salinity in the environment. The value of this indicator peaked, especially in strongly saline conditions.&#xD;
&#xD;
The experiments were carried out in three different soil conditions, as meadow-alluvial, red-brown and desert-sandy soils during the budding and flowering stages of cotton varieties. It was found that the value of this indicator varies depending on the soil type. It was observed that the total amount of water in all three varieties increased from the stage of flowering to the stage of flowering. It was noted that the total amount of water in cotton varieties grown in meadow-alluvial soil conditions is higher than in cotton varieties grown in brown and desert-sandy soils.2,3&#xD;
&#xD;
&#xA0;The rate of photosynthesis is one of the most important physiological processes, and plant growth and development, total photosynthetic productivity, biological and economic yield, and yield and it&amp;#39;s quality depend on the value of this process. From the data obtained during the experiments, it was found that soil salinity has a negative effect on the rate of photosynthesis. The effect of soil salinity levels on the rate of photosynthesis was studied in three different soil conditions during the mowing and flowering stages of cotton varieties. With the increase in salinity levels, a decrease in the value of this indicator was also observed during the flowering and flowering stages of the three varieties. It was noted during the experiments that the value of this indicator has the lowest value in strongly saline soils compared to non-saline soils.4,6,7&#xD;
&#xD;
&#xA0;The rate of photosynthesis in Bukhara-8 cultivars grown in meadow-alluvial soils is 1.33 g in non-saline soils, 1.45 g in the flowering stage, 1.28 g in weakly saline soils, 1.37 g in flowering, 1.21 g in moderately saline soils, 1.33 in flowering, &#xA0;1.12 g during mowing in strongly saline soils, and 1.24 g during flowering. The rate of photosynthesis of Omad cultivar grown in meadow-alluvial soils is 1.15 g in non-saline soil during mowing, 1.25 g in the flowering stage, 1.06 g in low salinity soil, 1.18 g in flowering, 1.00 g in medium saline soil, 1.10 g in flowering, in strongly saline soils it was 0.65 g during mowing and 0.86 g during flowering. The rate of photosynthesis of ?-4727 cultivated in meadow-alluvial soils is 1.24 g in non-saline soils during mowing, 1.34 during flowering, 1.17 g in low salinity soils, 1.28 g in flowering, 1.10 g in medium saline soils, 1.22&#xA0; in flowering, and it was 0.90 g at the time of mowing in strongly saline soils and 1.10 g at the stage of flowering.&#xD;
&#xD;
A similar correlation was observed in the red-brown and desert-sandy soils. However, the photosynthesis rate of cotton varieties grown in meadow-alluvial soils was higher in all three varieties than in these soils. Experiments have shown that the rate of photosynthesis of cotton varieties grown on light brown soils is higher than the rate of photosynthesis of cotton varieties grown on desert-sandy soils. In the non-saline variants of desert-sandy soils, the net productivity of photosynthesis at the mating stage of Bukhara-8 variety was 6.9, at the flowering stage 8.3, at the mowing stage of Omad variety 5.6, at the flowering stage 6.6, at the mowing stage C-4727 was 5.8, and flowering was 7.1 at the stage. Similar correlations were found in weak, moderate, and strongly saline conditions of meadow-alluvial, grey-brown, and desert-sandy soils, but it was noted that the value of the net productivity of photosynthesis was higher in meadow-alluvial soils. In our study, it was found that the net productivity of photosynthesis in all three species decreases with increasing salinity compared to non-saline variants. A sharp decrease in the value of this indicator was observed in all varieties, especially those grown in strongly saline desert-sandy soils. Luckily, a sharp decline in the pure productivity of photosynthesis was noted.&#xD;
&#xD;
&#xA0;During the field research, the effect of soil moisture levels and soil types on the yield of cotton varieties was studied. It was noted that the yield of cotton varieties studied was higher than the variants grown in meadow-alluvial soils, grey-brown and desert-sandy soils, depending on soil types and soil moisture level and salinity. A decrease in yield weight was observed following the decrease in moisture level. Especially in the variants with soil moisture 60-65-60, a sharp decrease in yield was noted. Yield in all varieties was high in 70-75-70 percent humidity. The lowest results in terms of yield of cotton varieties were recorded in the conditions of humidity of 60-65-60% of desert-sandy soils.&#xD;
&#xD;
In pasture-alluvial soils, the yield of Bukhara-8 cotton variety ranges from 39.2 to 37.6 with a decrease in moisture levels; the Omad variety 36.0-34.0; the C-4727 weighed 37.4-35.5 quintals. Yields of Bukhara-8 cotton variety in red-brown soils range from 38.2 to 35.9 with a decrease in moisture levels; the Omad variety 35.3-33.2; the C-4727 weighed 36.6-34.3 quintals. In desert-sandy soils, the yield of Bukhara-8 cotton variety is 36.9-33.0 with a decrease in moisture levels; the Omad variety 33.5-31.2; the C-4727 weighed 34.8-32.9 quintals. Under moderately saline conditions, the yield of all cotton varieties decreased to varying degrees depending on moisture levels.8&#xD;
&#xD;
At different levels of humidity with moderate soil salinity, crop quality indicators were higher in meadow-alluvial soils than in brown and desert-sandy soils. In the above three different soil types, high results on this indicator were recorded in cotton varieties Bukhara-8 and C-4727.&#xD;
&#xD;
Discussion&#xD;
&#xD;
Moderate leaching of strongly saline soils has led to a sharp reduction in the amount of dry residue, Cl- and SO-- ions in the soil layer and groundwater, according to the study. As a result, toxic salts such as Na?l, Na2SO4&#xA0; and &#xA0;MgSO4 &#xA0;in strongly saline soils were washed away to groundwater and the area of saline soils distributed in the field experimental plots was reduced by 80-90%. The salinity of Bukhara-8, Omad and C-4727 cultivars studied in different saline soils of the Bukhara oasis, as well as the level of growth and development, the amount of dry residue, is 0.35-0.50%, ?l- ion 0.007-0.015% and SO4-- a decrease of 0.010&#x2013;0.550% was observed.&#xD;
&#xD;
The effect of soil types and salinity levels on some ecophysiological characteristics of cotton varieties studied in different saline soils was found to vary within varieties. It was noted that depending on soil types and salinity levels, the total amount of water in the leaves, the rate of respiration, the density of cell sap, the lack of water in plants, an increase in protoplasmic viscosity. The value of all indicators studied was found to be higher in all (weak, moderate, strong) saline options compared to the non-saline options. Variations in the value of physiological parameters to varying degrees depending on the biological characteristics of the varieties have been scientifically substantiated.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Soil salinity levels in all studied varieties led to a slowdown in photosynthesis intensity and photosynthesis net productivity value depending on soil types. It was observed that the value of the studied physiological parameters of cotton varieties differs in the cross-section of varieties depending on soil types, soil salinity levels and stages of development. Based on the data, it was noted that all physiological parameters of Bukhara-8 variety are higher than C-4727 and Omad varieties. In the Bukhara oasis irrigated meadow-alluvial, red-brown and desert-sandy soils, the valuable features of cotton varieties studied in different salinity soils differ in height, growth, leaf surface expansion, the number of joints, joint length, yield, fibre yield, fibre length, 1000 seed weights were found to vary depending on soil salinity and moisture level.&#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=3374</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3374</Fulltext></URLs><References>1. Kholliyev AE. Features of resistance of plants to adverse abiotic factors. Bukhara: Bukhara Publishing House. 2019;124.&#xD;
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2. Norboyeva UT, Kholliyev AE. Ecophysiological basis of the effect of salinity on cotton and other crops. Bukhara: Bukhara Publishing House. 2019;132.&#xD;
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3. Kholliyev AE, Norboyeva UT. Ecophysiological basis of drought effects on cotton and other crops. Bukhara: Bukhara Publishing House. 2019;152. &#xD;
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4. Norboyeva UT, Kholliyev ?E. Physiology, Productivity and Cotton Plant Adaptation under the Conditions of Soil Salinity. Int J Rec Tech Engg 2019; 8(2):1611-1613.&#xD;
&#xD;
5. Norboyeva UT, Kholliyev ?E. Regulation of the water balance of the cotton varieties under salting conditions. Int Multidisc Res J 2019;8:5-9. &#xD;
&#xD;
6. Kholliyev ?E, Norboyeva UT, Adizova KR., Fayziyeva FA. Effects of Microelements on Drought Resistance of Cotton Plant. Int J Psychosoc Rehabil 2020;24(2):643-648. &#xD;
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7. Kholliyev AE, Kholov YD, Norboyeva UT, Boltayeva ZA. Effect of soil types, salinity and moisture levels on cotton productivity. J Crit Rev 2020;7(9):240-243. &#xD;
&#xD;
8. Kholov YD, Kholliyev AE. Growing of cotton varieties and hybrid to the height under the ecological conditions of soil salinity and washed soil salinity. Asian J Multidimen Res 2019;8(9):84-89.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Impact of Laparoscopic Versus Open Ovarian Cystectomy on Ovarian reserve&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>08</FirstPage><LastPage>12</LastPage><AuthorList><Author>Ahmed L Aboul Nasr</Author><AuthorLanguage>English</AuthorLanguage><Author> Ahmed Soliman Nasr</Author><AuthorLanguage>English</AuthorLanguage><Author> Amr H Wahba</Author><AuthorLanguage>English</AuthorLanguage><Author> Reham Zeyada</Author><AuthorLanguage>English</AuthorLanguage><Author> Nadia M Helmy</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Ovarian cysts are a frequent finding in reproductive-aged women. Compared to laparotomy, laparoscopic cystectomy is increasingly gaining acceptance for ovarian cystectomy1 , but there is still no consensus on which approach is better regarding ovarian reserve2 . Objective: To determine and compare the impact of the approach of ovarian cystectomy whether laparoscopic or open on ovarian reserve parameters. Methodology: This prospective randomized study was conducted on 40 patients of reproductive age (range, 18&#x2013;35 years) with benign ovarian cysts who underwent either laparoscopic ovarian cystectomy (n=20) or open ovarian cystectomy(n=20). Serum anti-M&#xFC;llerian hormone (AMH), antral follicle count (AFC), and follicular stimulating hormone (FSH)were measured preoperatively and 3 months postoperatively in all patients. Results: Serum AMH decreased significantly at 3 months postoperatively in both laparoscopic and open ovarian cystectomy groups. The AFC increased significantly at 3 months postoperatively in both laparoscopic and open ovarian cystectomy groups. On the other hand, no significant difference in FSH was found between the preoperative and 3 months postoperative levels in both groups. Conclusion: No significant difference was found between both approaches of ovarian cystectomy whether laparoscopic or open regarding the change in ovarian reserve parameters postoperatively.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Anti-M&#xFC;llerian hormone, Antral follicular count,Laparoscopy, Ovarian cystectomy, Ovarian cysts, Ovarian reserve</Keywords><Fulltext>Introduction &#xD;
&#xD;
Benign ovarian cysts such as endometriomas, mature cystic teratomas, serous or mucinous cystadenomas are a common finding in young women in their reproductive age. It is assumed that about 7% of women worldwide experience asymptomatic cyst during their lifetime.1 Functional or simple ovarian cysts measuring less than 5 cm maximum diameter mostly resolve over 2&#x2013;3 menstrual cycles without the need for intervention.2 Minimally invasive techniques of ovarian cystectomy whether laparoscopic such as fenestration and drain&#xAD;age of the cyst and stripping of the cyst wall, or mini-laparotomy have become increasingly common approaches for the surgical removal of benign ovarian cysts. However, the safety of these techniques in terms of ovarian damage to the operated ovary has been questioned.3&#xD;
&#xD;
Ovarian reserve refers to the functional potential of the ovary, which is determined by the number and quality of the remaining primordial follicles at any given time. A great variety of tests and markers for ovarian reserve are available, none of which has yet been shown to be ideal.4 A large body of evidence has demonstrated greater clinical value of AMH and AFC compared to FSH. They have been used as the best predictors for ovarian response before proceeding with ovarian stimulation in assisted reproductive technologies (ARTs).5&#xD;
&#xD;
The anti-Mullerian hormone is produced by the granulosa cells of primary, preantral and small antral follicles. AMH level represents a reliable and useful marker of ovarian reserves supported by its gradual decline with increasing age preceding changes in AFC, FSH, or estradiol. It is also menstrual cycle-independent unlike FSH and is unaffected by the use of oral contraceptive pills or gonad&#xAD;otropin-releasing hormone agonists.6 Compared to laparotomy, laparoscopic cystectomy is increasingly gaining acceptance for ovarian cystectomy6, but there is still no consensus on which approach is better regarding ovarian reserve.7&#xD;
&#xD;
This study aimed to determine and compare the impact of the approach of ovarian cystectomy whether laparoscopic or open on ovarian reserve parameters including anti-mullerian hormone, antral follicular count and follicular stimulating hormone. &#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
This prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Kasr El-Ainy Hospital, Cairo University, in the period from April 2016 to August 2018. Forty patients with benign ovarian cysts were recruited from the gynaecology clinic. Informed written consent was taken from each participant before enrollment in the study. Women aged from 20-35 years with benign ovarian cysts, were randomized into 2 groups; group A in which patients underwent laparoscopic cystectomy(n=20)and group B(n=20) in which patients underwent open cystectomy through laparotomy. Randomization was done using computer-generated random numbers and sealed envelopes.&#xD;
&#xD;
Inclusion criteria included unilateral ovarian cyst(&#x2265;5 cm), with no clinical signs or ultrasound evidence suspicious of ovarian malignancy. Patients included had regular menstrual cycles (cycle length between 21 and 35 days). Patients on hormonal therapy or using oral contraception in the past 3 cycles, with endocrine diseases e.g. thyroid disease or hyperprolactinemia, with history of previous ovarian surgery or evidence of premature ovarian failure or premature menopause were excluded.&#xD;
&#xD;
For all patients, full history was taken followed by complete physical examination &amp; laboratory investigations in form of (AMH, FSH&amp; routine preoperative investigations). Each patient underwent transvaginal ultrasonography using the 7.5 MHz vaginal probes of the X6 ultrasound machine (Medison X6, Korea) preoperatively on day 2 of the menstrual cycle to determine the size of the ovarian cyst, its location; and the AFC, which was defined as the total number of 2 to 10 mm antral follicles in the affected ovary.&#xD;
&#xD;
Serum FSH was assayed on day 2 of the menses on IMMULITE 2000 Automated Immunoassay Analyzer. Serum AMH was assayed using AMH Gen II enzyme-linked immunosorbent assay(ELISA) kits purchased from Beckman Coulter, Inc., the USA with expected values: 0.9&#x2013;9.5 ng/ml. The ovarian reserve was reassessed (AMH, FSH and day 2 AFC) 3 months following the cystectomy. The initial pre-operative and post-operative ultrasounds were done by a single investigator.&#xD;
&#xD;
Twenty patients underwent laparoscopic ovarian cystectomy by use of a stripping technique. It was performed by the incision of the ovarian cyst using cold scissors, identification of the cystic wall, and then stripping off the cyst wall from the surrounding healthy ovarian tissue was achieved using traction and counter traction with two atraumatic grasping forceps. After excision of the cyst wall, selective coagulation was done using bipolar diathermy for hemostasis and the residual ovarian tissue was not sutured. Ovarian cystectomy by laparotomy through Pfannenstiel incision was performed on 20 patients. Cleavage plane was developed by using microsurgical techniques and instruments. After excision of the cyst wall, meticulous reconstruction and hemostasis of the ovarian tissue were achieved by the use of 2&#x2013;0 polyglactin sutures (Vicryl; Ethicon Endo-Surgery, Cincinnati, OH, USA). All specimens obtained were sent for histopathological examination.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Data were coded and entered using the statistical package SPSS version 25. Data were summarized using mean and standard deviation for normally distributed quantitative variables or median and interquartile range for non-normally distributed quantitative variables and frequencies (number of cases) and relative frequencies (percentages) for categorical variables. Comparisons between groups were done using one-way ANOVA or unpaired t-test in normally distributed quantitative variables while Kruskal-Wallis and Mann-Whitney tests were used for non-normally distributed quantitative variables. Comparison between before and after in each group was done using paired t-test. For comparing categorical data, Chi-square (c2) test was performed. Exact test was used instead when the expected frequency is less than 5. P-values ?0.05 were considered as statistically significant.&#xD;
&#xD;
Results &#xD;
&#xD;
Of the 40 patients included in the study, 20 women were allocated to undergo laparoscopic ovarian cystectomy and 20 women were allocated to undergo open laparotomy. Both groups were comparable in age, BMI, parity and cyst size. The cysts were classified as simple serous cysts, mature cystic teratomas, endometriomas, hemorrhagic, and mucinous with each cyst type occurring at the comparable frequency in the 2 groups. Preoperative serum FSH, AMH and AFC were normal and comparable in both groups (Table 1).&#xD;
&#xD;
Both the laparoscopic and open ovarian cystectomy groups showed a significant drop of AMH (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3375</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3375</Fulltext></URLs><References>&#xD;
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	Owczarek D, Malinowski A, Wilczy?ski M. Ovarian reserve evaluation after laparoscopic cyst enucleation, depending on applied haemostasis technique and with particular consideration of endometrial cysts. Prz Menopauzalny 2018 Mar;17(1): 22&#x2013;27.&#xD;
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	Georgievska J, Sapunov S, Cekovska S, Vasilevska K. Effect of Two Laparoscopic Techniques for Treatment of Ovarian Endometrioma on Ovarian Reserve. Med Arch 2015 Apr; 69(2): 88&#x2013;90.&#xD;
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	Saliho?lu KN, Dilbaz B, C?r?k DA, Ozelci R, Ozkaya E, Mollamahmuto?lu L. Short-Term Impact of Laparoscopic Cystectomy on Ovarian Reserve Tests in Bilateral and Unilateral Endometriotic and Nonendometriotic Cysts. J Min Invas Gynecol 2016;23(5):719-725.&#xD;
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	Candiani M, Ottolina J, Posadzka E, Ferrari S, Castellano LM, Tandoi I, et al. Assessment of ovarian reserve after cystectomy versus &amp;#39;one-step&amp;#39; laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial. Hum Reprod 2018;33(12):2205-2211.&#xD;
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	Kitajima M, Dolmans MM, Donnez O, Masuzaki H, Soares M, Donnez J. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril 2014 Apr;101(4):1031&#x2013;1037.&#xD;
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	Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, et al. One-year follow-up of serum antimullerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve. Fertil Steril 2013 Aug;100(2):516&#x2013;22.&#xD;
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	Abdel&#x2013;Maksoud MD, Samy N, Hashim M, Elkhayal A, Fathy H, Gomaa I. Assessment of Ovarian Reserve After Ovarian Cystectomy by Laparotomy Versus Laparoscopy. Int J Pharm Clin Res 2015; 7(1): 23-28.&#xD;
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	Chun S, Cho HJ, Ji YI. Comparison of the early postoperative decline of serum antiMullerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis. Taiwan J Obstet Gynecol 2016 Oct;55(5):641&#x2013;645.&#xD;
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	Shaltout MF, Elsheikhah A, Maged AM, Elsherbini MM, Zaki SS, Dahab S, et al. A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve. J Ovarian Res 2019;12(1):66.&#xD;
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	Mircea O, Puscasiu L, Resch B, Lucas J, Collinet P, von Theobald P, et al. Fertility Outcomes After Ablation Using Plasma Energy Versus Cystectomy in Infertile Women with Ovarian Endometrioma: A Multicentric Comparative Study. J Min Invas Gynecol 2016;23(7):1138-1145.&#xD;
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	Urman B, Alper E, Yakin K, Oktem O, Aksoy S, Alatas C, et al. Removal of unilateral endometriomas is associated with an immediate and sustained reduction in ovarian reserve. Reprod Biomed Online 2013 Aug;27(2):212-6.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Incidence of Subcutaneous Emphysema in the Head, Neck and Thoracic Region of Intubated COVID-19 Patients: Our Experiences&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>19</FirstPage><LastPage>24</LastPage><AuthorList><Author>Santosh Kumar Swain</Author><AuthorLanguage>English</AuthorLanguage><Author> Ishwar Chandra Behera</Author><AuthorLanguage>English</AuthorLanguage><Author> Saurjya Ranjan Das</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The current global pandemic of the coronavirus disease 2019(COVID-19) is a threat to the lives of the millions of people worldwide. A high number of patients with COVID-19 infections lead to pneumonia or respiratory compromise and followed by undergoing invasive mechanical ventilation. The invasive ventilation may cause barotrauma and further cause pneumothorax, pneumomediastinum and subcutaneous emphysema in the head, neck and chest region. Objective: To assess the surgical emphysema in the head, neck and thoracic region of the intubated COVID-19 patients. Methods: In this retrospective study, clinical and imaging data of the COVID-19 patients with invasive ventilation and development of the subcutaneous emphysema were studied between March 2020 and September 2020. There were 262 patients files were evaluated those were under mechanical ventilation at the intensive care unit (ICU) of COVID-19 hospital. Results: A total of 262 patients with COVID-19 patients underwent invasive mechanical ventilation. Out of them, 38 patients presented with surgical emphysema in the head, neck and chest region. The mean age of the participating patient was 62 year &#xB1;14 (standard deviation). Out of the 38 patients, 26(68.42%) were male and 12 female (31.57%) with male to female ratio of 2.16:1. Conclusion: Patients with COVID-19 infections with invasive mechanical ventilation have a high chance of the barotrauma. The development of the barotrauma in the lungs may lead to pneumothorax and surgical emphysema in the head, neck and chest region.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>COVID-19 patients, Acute respiratory distress syndrome, Surgical emphysema, Pneumomediastinum</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The coronavirus disease 2019(COVID-19)&#xA0; is a dreaded viral disease caused by a novel virus called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)&#xA0; and has been called as a pandemic by the World Health Organization(WHO) with more than&#xA0; 4.8 million confirmed patients and 300 thousand death globally.1 Acute respiratory distress syndrome (ARDS) and hypoxemic respiratory failure are found in COVID-19 infections and considered as feared complications of this disease.2 These patients require intensive care admission and mechanical ventilation.&#xA0; In current COVID-19 pandemic, there is the rising number of patients requiring orotracheal intubation or tracheostomy for ventilation. One study from the USA, 22% of the hospitalized COVID-19 patients requires invasive mechanical ventilation.3 These patients are developing a life-threatening condition called as pneumomediastinum or pneumothorax where the air is present in the mediastinum or pleural space respectively. These manifestations often lead to subcutaneous emphysema in the head and neck region.4 Clinical practice during non-COVID-19 time showed the development of the subcutaneous emphysema and pneumomediastinum as uncommon entities which often result from air leak from the lungs or other luminal organs.5 It is commonly associated with injuries of the tracheobronchial tree, lungs or pleural space and trauma to the oesophagus. In the last few months, there is the increasing number of the pneumomediastinum and subcutaneous emphysema in the head, neck and chest region following orotracheal intubation and ventilation in confirmed COVID-19 patients. This is a novel clinical finding among the intubated COVID-19 patients, which carries high morbidity and mortality. We found many COVID-19 patients with invasive ventilation at the COVID hospital ICU presenting with pneumothorax, pneumomediastinum and subcutaneous emphysema at the head. Neck and chest region. On this observation, we hypothesized that barotrauma related to invasive mechanical ventilation can cause subcutaneous emphysema in COVID-19 patients. Numerous publications are documenting the clinical presentations and outcome of the COVID-19 infection. However, there are very few or no studies done in these rare complications like pneumothorax, pneumomediastinum and subcutaneous emphysema in this region. Here, this study aims to evaluate the details of the subcutaneous emphysema in the head, neck and chest region in COVID-19 patients under invasive mechanical ventilation.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This retrospective study was conducted at a COVID-19 hospital with an intensive care unit (ICU) attached to a tertiary care teaching hospital. This study was done between March 2020 to September 2020. This study was approved by the institutional ethical committee (IEC) of our medical college with reference number IEC/SOA/IMS/34/12.02.2020.&#xA0; The institutional review board made waiver of authorized consent by the patients or patient relatives because of the urgent pandemic situation. There were 262 patients under mechanical ventilation at the ICU who participated in this study. All the participating patients were COVID-19 patients confirmed based on real-time reverse transcription-polymerase chain reaction assays. The clinical features including age, sex, date of admission, date of invasive mechanical ventilation(IVM), date of development of the subcutaneous emphysema and date of death (if applicable)&#xA0; were documented. The patient outcomes were evaluated. Chest X-ray was done in all the participating patients. The inclusion criteria of this study were age older than 18 years, COVID-19 patients with ARDS at the ICU and with invasive mechanical ventilation. Patients admitted until September 30, 2020, were included in the study. All the data and variables were collected from the electronic patient registry. The diagnosis of the pneumothorax and subcutaneous emphysema were confirmed by the chest X-ray or CT scan. All these 38 patients were invasively ventilated for respiratory compromise with severe hypoxemia. We documented details of the co-morbidities, ventilation, signs and symptoms associated with pneumomediastinum and the management. The patients with a previous history of lung surgery or thoracotomy before the diagnosis of the COVID-19 were excluded from this study. The details of the ventilator settings were not documented as these were outside the scope of this observational study. In this study, all the data were recorded and analyzed by using Statistical Package for Social Science (SPSS) software, v20.&#xD;
&#xD;
RESULT&#xD;
&#xD;
There were 38 patients (14.50%) developed subcutaneous emphysema in the head, neck and thoracic region out of the 262 intubated patients at the ICU of the COVID hospital. The age ranges were 18 years to 84 years with a mean age of 61&#xB1;14 years. Barotrauma was found in 64 cases (24.24%) and confirmed in chest X-ray and CT scan of the thorax. Out of 64 cases with barotrauma, 42 showed pneumothorax (Figure 1), 38 showed subcutaneous emphysema and 32 with pneumomediastinum. Out of the 38 patients with emphysema in the head, neck and chest region (Figure 2), 26 were male and 12 female with male to female ration is 2.16:1. All these 38 patients were also diagnosed with pneumothorax. The majority of the patients had underlying comorbidities such as hypertension in 22 patients (57.89%) and diabetes mellitus in 18 patients (47.36%) (Table 1). Out of 38 patients, 11 (28.94%) were suffered from obesity and had body mass index (BMI) above 30. There were 7 patients with a previous history of COPD (18.42%). Out of 38 patients, 24 were intubated by using direct laryngoscopy and by video laryngoscopy in 14 patients. No bougies or stylets were used at the time of intubations in all of the cases. On average, COVID-19 patients were hospitalized for 4.8 days before invasive mechanical ventilation (range 1 to 22 days). Time to develop subcutaneous emphysema after tracheal intubation ranged from 5 hours to 16 days with a mean duration of 5.3 days. All these 38 patients were managed with lung protective strategies. Out of the 38 patients, 16(42.10%) showed evidence of severe ARDS at the time of the barotrauma (PaO2/FiO2</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3376</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3376</Fulltext></URLs><References>1. Johns Hopkins University. The COVID-19 United States Cases 2020, May 14; Available from https://coronavirus.jhu.edu/us-map.&#xD;
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2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. J Am Med Assoc 2020; 323(13): 1239-1242.&#xD;
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3. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: a prospective cohort study. Br Med J 2020;369:m1966.&#xD;
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4. Swain SK, Behera IC. Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic-A real challenge to the clinicians. Ind J Child Health 2020;7(9):357-362.&#xD;
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5. Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla and pneumothorax developed during COVID-19 pneumonia. Korean J Radio &#xA0;2020;21(5):541.&#xD;
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6. Swain SK, Acharya S, Sahajan N. Otorhinolaryngological manifestations in COVID-19 infections: An early indicator for isolating the positive cases. J Sci Soc 2020;47(2):63.&#xD;
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7. Chu CM, Leung YY, Hui JY, Hung IF, Chan VL, Leung WS, et al. Spontaneous pneumomediastinum in patients with the severe acute respiratory syndrome. Eur Resp J 2004;23(6):802-804.&#xD;
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&#xA0;8. Gu J, Korteweg C. Pathology and pathogenesis of the severe acute respiratory syndrome. Am J Pathol 2007;170(4):1136-1147.&#xD;
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9. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, Liu S, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Resp Med 2020; 8(4):420-422.&#xD;
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10. Zantah M, Castillo ED, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease-incidence and clinical characteristics. Resp Res 2020;21(1):1-9.&#xD;
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11. Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, et al.&#xA0; Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore) 2018;97(17):e0487. &#xD;
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12. Badaoui R, Thiel V, Perret C, Popov I, Dupont H. Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy. Ann Fr Anesth Reanim 2013;32:718&#x2013;720.&#xD;
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13. Sonobe S, Inoue S, Nishiwada T, Egawa J, Kawaguchi M. A case of subcutaneous emphysema/mediastinal emphysema during the use of a humidified high-flow nasal cannula. J Am Clin Rep 2019;5(1):1-3.&#xD;
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14. Swain SK, Agrawal R. Mastoid surgery: a high risk aerosol-generating surgical procedure in COVID-19 pandemic. Int J Otorhinolaryngol Head Neck Surg 2020;6(10):1941.&#xD;
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15. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-513.&#xD;
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16. Banki F, Estrera AL, Harrison RG, Miller III CC, Leake SS, Mitchell KG, et al. Pneumomediastinum: aetiology and a guide to diagnosis and treatment. Am J Surg 2013;206(6):1001-1006.&#xD;
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17. Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. North Am J Med Sci 2013;5(8):460-464.&#xD;
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18. Wintermark M, Schnyder P. The Macklin effect: a frequent aetiology for pneumomediastinum in severe blunt chest trauma. Chest 2001;120(2):543-547.&#xD;
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19. Dehours E, Vall&#xE9; B, Bounes V, Lauque D. A pneumomediastinum with diffuse subcutaneous emphysema. J Emergency Med 2013;44(1):81-82.&#xD;
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20. Chu CM, Leung YY, Hui JY, Hung IF, Chan VL, Leung WS, et al.&#xA0; Spontaneous pneumomediastinum in patients with the severe acute respiratory syndrome. Eur Resp J 2004;23(6):802-804.&#xD;
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21. Eisner MD, Thompson BT, Schoenfeld D, Anzueto A, Matthay MA, Acute Respiratory Distress Syndrome Network. Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome. Am J Resp Crit Care Med 2002;165(7):978-982.&#xD;
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22. Zhou C, Gao C, Xu M. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis 2020;20(4):510.&#xD;
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23. Janssen J, Kamps MJ, Joosten TM, Barten DG. Spontaneous Pneumomediastinum in a male adult with COVID-19 pneumonia. Am J Emer Med 2020. doi: 10.1016/j.ajem.2020.07.066 [Epub ahead of print]&#xD;
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24. Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia&#x2014;Literature Review.&#xA0; Am J Trop Med Hygiene 2020;103(3):1170-1176.&#xD;
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25. Wang J, Su&#xA0; X, Zhang T, Zheng C.Spontaneous pneumomediastinum:a probable unusual complication of coronavirus disease 2019(COVID-19) pneumonia. Korean J Radiol 2020;21:627-628.&#xD;
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26. Simon M, Braune S, Laqmani A, Metschke M, Berliner C, Kalsow M, et al.&#xA0; Value of computed tomography of the chest in subjects with ARDS: a retrospective observational study. Resp Care 2016;61(3):316-323.&#xD;
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27. Fosi S, Giuricin V, Girardi V, Di Caprera E, Costanzo E, Di Trapani R, et al. Subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and pneumoscrotum: unusual complications of acute perforated diverticulitis. Case Rep Radiol 2014;2014:1-5.&#xD;
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28. Dahlawi H. Changes in Haematological Parameters among COVID-19 Patients. &#xA0;Int J Cur Res Rev 2020;12(18):2-4. &#xD;
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29. 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;
</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Anterior Resection (AR) versus Abdominoperineal Resection (APR) Technique in Patients Undergoing Oncogenic Resection of the Rectum for Quality of Life (QOL) Assessment: A Retrospective, SingleCentre, Observational Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>13</FirstPage><LastPage>18</LastPage><AuthorList><Author>Quresh Bambora</Author><AuthorLanguage>English</AuthorLanguage><Author> Mangesh Shingade</Author><AuthorLanguage>English</AuthorLanguage><Author> Aarti Gupta</Author><AuthorLanguage>English</AuthorLanguage><Author> Aditya Agarwal</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The prevalence of rectal cancer is very high and it is the third most common cancer in male and second in women. Objective: The present study aimed to compare Quality of life (QOL) parameters in patients who had undergone oncogenic resection of the rectum with three different surgical techniques i.e., Abdominoperineal Resection (APR), High Anterior Resection (HAR) and Low Anterior Resection (LAR) of the rectum. Methods: Patients were given the Short Form 36 (SF-36), The European Organization for Research and Treatment of CancerQuality of Life Questionnaire (EORTC QLQ)- C30 and C29 to fill at three-time points in their treatment (before surgery, 3 months and 6 months following surgery). The prospectively collected questionnaires were analyzed retrospectively. Results: On comparing the SF-36 questionnaire, there was no significant difference between patients who underwent all three types of surgeries except for general health which was better in patients undergoing APR and HAR. While comparing EORTC-30 questionnaire, patient undergone APR did well in terms of physical functioning and emotional well-being, while those undergone HAR did well in terms of GI-related complaints. On Comparing EORTC-29 questionnaire, micturition complaints and perception of body image were worst for the patient undergoing APR as compared to LAR. Conclusion: Quality of life as against assumption to be better in patients who had undergone AR, but after overcoming the trauma of surgery and its immediate implications, patients who underwent APR behaved almost equivalent to patients who underwent AR.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Quality of Life (QOL), Rectal Cancer, High Anterior Resection (HAR), Low Anterior Resection (LAR), Abdominoperineal Resection (APR)</Keywords><Fulltext>Introduction&#xD;
&#xD;
Carcinoma of the rectum is one among the quite common malignancies worldwide and it continues to be a major health-related concern in both the western world and the developing nations. Amongst them, the prevalence of rectal cancer is very high and it is the third most common cancer in male and second in women.1 The main treatment option available is surgery with or without radiotherapy. From quite a long-time surgery had been one of the main constituents of the multi-modality approach of the disease. Among surgical techniques, anterior resection (AR) and Abdominoperineal Resection (APR) are the two standard procedures followed worldwide.&#xD;
&#xD;
Surgeons have to consider not only the surgical methods for treating low rectal cancer but also the QoL after surgery. The main factors determining the patient quality of life seems to be an operation technique, the level of resection, the presence of a stoma following surgery and whether the stoma is temporary or permanent. Injury to the nerves controlling bladder, bowel, and sexual organs, is a major concern during resection of rectal cancer. In addition to endpoints of cancer such as survival and complications, comparison of QOL measurements are not widely used in clinical practice and the effect of different methods of surgery on the quality of life is not known.&#xD;
&#xD;
A large number of studies had been performed so far looking into issues regarding the quality of life in patients operated for rectal cancer using standard techniques of AR and APR, however, the comparison between different surgical methods from QOL perspective is hardy available.2 In addition to helping patients evolve realistic expectations, it will help clinicians identify those for whom these interventions may be appropriate.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
The present study planned with the primary objective of a retrospective analysis of a prospectively collected Quality of Life questionnaires to compare Quality of Life (QOL) in patients who have undergone oncologic resection of the rectum with Low Anterior Resection (LAR), High Anterior Resection (HAR) and Abdominoperineal Resection (APR) surgical methods.&#xD;
&#xD;
After taking prior approval from Institutional Ethics Committee, patients undergoing surgery for rectal cancer at Tata Memorial Hospital (TMH) between September 2010 to September 2012 were asked to enrol in the study. The patient was informed about the study details and those who were willing to participate in the study were given the Short Form 36 (SF-36),3 the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-C29 questionnaires4 to fill at three-time points in their treatment (before surgery, 3 months and 6 months following surgery). The forms were submitted and collected prospectively during the hospital stay and subsequently at each follow-up visit. The collected questionnaires were retrospectively audited. The questionnaires were self-administered in three languages &#x2013; Hindi, Marathi and English.&#xD;
&#xD;
The analysis of QOL data included all patients with localized non-metastatic rectal cancer who were operated either upfront or post-neo-adjuvant chemoradiation at TMH. The excluded patients were who had two or more uncontrolled co-morbidities falling into the American Society of Anesthesiologists (ASA)5 category 3 or 4, patients whose disease was invading other pelvic or abdominal organs even after completion of neoadjuvant therapy (T4 tumours), patients who underwent simultaneous resection of metastatic disease, patients who were not able to fulfil regular follow-up schedule, patients undergoing surgery for recurrent disease and illiterate patients who were not able to read and understand the questionnaires.&#xD;
&#xD;
The main outcome will be quality of life was assessed using the questionnaires of quality of life analysis - European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ &#x2013; C 29 and QLQ SF-36 questionnaire for comparison of study for improvement in physical, intellectual/cognitive, emotional, and social domains scores.&#xD;
&#xD;
Scales computed for each domain score were presented as mean (S.D), median. Group comparisons Low Anterior Resection (LAR), High Anterior Resection (HAR) and Abdominoperineal Resection (APR) for rectal cancer were made using Analysis of variance or Kruskal Wallis test as per the distribution of the data. Change in scores from baseline to follow up visit were compared using Paired T-test or Wilcoxon signed rank-sum test as per the distribution of data. Categorical variables were analyzed using the Chi-square test or Fisher&#x2019;s exact test. P-value &lt; 0.05 was considered statistically significant.&#xD;
&#xD;
Results&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; During the study period of two years, a total of 176 patients were operated in TMH for carcinoma rectum of which QOL questionnaires filled by 75 patients were retrospectively audited, wherein mean age of patients who had undergone APR was 49, LAR was 54 and HAR were 55. Male to female ratio on an average for all the arms was around 3-4 (Table-1).&#xD;
&#xD;
Out of 25 patients in APR arm, 84% were stage 3 and 16% stage 2. In LAR arm, 76% were stage 3 and 24% stage 2 and in the HAR arm 92% were stage 3 and 8% were stage 2. Thus, on an average of 75 to 90% of patients belonged to stage 3 and 10 to 25% to stage 2. Mean follow up of patients was around 13 months. In the LAR arm, 16% of patient underwent pre-op stoma, 36% of patients had a stoma at first and 20% at the second visit. In the HAR arm, 4% had a pre-op stoma and 20% had a stoma at first and 12% second visit.&#xD;
&#xD;
SF 36 Questionnaire was divided into 8 health domains, each domain containing a certain number of questions and a two-step statistical analysis was done with the calculation of P-value. An intergroup comparison was done at the first and second visit. At the first visit, there was a significant difference between physical functioning, patients who underwent low AR showing better results than who underwent APR and high AR, while at second visit there was no significant difference between patients who underwent all three types of surgeries except for general health which was better in patients undergoing APR and high AR. (Table 2 and 3).&#xD;
&#xD;
EORTC-30 questionnaire was evaluated with 17 domains, again each containing a certain number of questions and P-value was calculated. An intergroup comparison was done from first to the second visit. At the first visit, a significant difference was found for patients performing strenuous activities and taking part in social activities which were both better in patients undergoing APR. There was also a significant difference in GI manifestations like appetite loss, constipation and diarrhoea, with better appetite and less GI upset in patients undergoing APR. At second visit again patient has undergone APR did well in terms of physical functioning and emotional well-being, while those undergone HAR did well in terms of GI-related complaints like constipation and diarrhoea (Table 4 and 5).&#xD;
&#xD;
EORTC-29 questionnaire was divided into 4 domains, with 15 questions considered as single items. Out of single items, 7 questions were specific for complications regarding stoma and two regarding sexual dysfunction. Again, intergroup comparison at the first and second visit. While doing intergroup comparison at the first visit, micturition complaints were worst for the patient undergoing APR, while patients undergoing LAR complained least. Similarly, patients undergoing APR had the worst perception of body image and those undergoing LAR had best. Similar results were observed in the second visit as in first (Table 6 and 7).&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Quality of life analysis following rectal cancer surgery is a sensitive issue among patients because of the implications of treatment on the physical, sexual and psychological status of patients. Though all patients were offered to fill the QOL forms, the compliance rate was 42%. This probably is due to the lack of better understanding by the patients regarding the value of such an audit or shyness on the part of the patient for not giving answers to certain questions related to sexual problems. &#xD;
&#xD;
Quite a few patients were unwilling to discuss issues regarding their financial and social problems. Particularly questions regarding sexual dysfunction were largely avoided, however low response rates to sexual questions, have also been observed elsewhere6,7 for rest of the questionnaire patient didn&#x2019;t find much difficulty filling the questionnaire.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A study performed by Tsunoda et al. 8 on Quality of life after low anterior resection and temporary loop ileostomy concluded that patient&#x2019;s scores on the QOL questionnaires generally well improved after HAR; however, for the patients in whom LAR was performed, the physical and role functioning scores before ileostomy closure were worse than the preoperative scores and generally improved after the closure of an ileostomy.&#xD;
&#xD;
A study by Gervaz P et al. 9 stated that after one year of surgery, APR patients showed significant improvement QOL as well as tumour-related symptoms; however, the body image remained significantly altered. The treatment-related side effects didn&#x2019;t improve in the period considered. A meta-analysis was done by Cornish JA et al.10 of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer concluded that when comparing APR with AR, there were no differences in general QOL following the procedures. Individualization of care for rectal cancer patients is essential, but a policy of avoidance of APR cannot currently be justified on the grounds of QOL alone. A study by Guren MG et al.11 concluded that although the rectal function was impaired in patients with low anastomosis, patients who had undergone AR had better QOL than patients who had undergone APR. A study by Gurumann et al.12&#xA0; concluded that patients undergoing APR have better QOL than patients undergoing AR and patients undergoing LAR have a lower QOL than those undergoing APR. Surgeons should pay close attention to QOL concerns of patients undergoing LAR.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Quality of life as against assumption to be better in patients who had undergone Anterior Resection, in the domains of physical and social functioning, but the effect was diluted when such patients faced more problems regarding gastrointestinal upset. At further follow-up, after overcoming the trauma of surgery and its immediate implications, patients who underwent Abdominoperineal Resection were adjusted to their perception as a social outcast and behaved almost equivalent to patients who underwent Anterior Resection.&#xD;
&#xD;
Acknowledgements:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; We are very thankful to the hospital administration; fellow collogues and all the patient participants who willingly gave consent for the participation in the study. &#xD;
&#xD;
Source of Funding: None&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3377</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3377</Fulltext></URLs><References>&#xD;
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	GLOBOCAN 2008. http://globocan.iarc.fr/factsheets/cancers/colorectal.asp. Accessed September 2020.&#xD;
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	Jitender S, Mahajan R, Rathore V, Choudhary R. Quality of life of cancer patients. J Exp Ther Oncol 2018;12(3):217-221.&#xD;
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	Vanessa Burholt, Paul Nash. Short Form 36 (SF-36) Health Survey Questionnaire: normative data for Wales. J Public Health 2010;33(4):587&#x2013;603.&#xD;
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	European Organisation for the Research and Treatment of Cancer. Questionnaires: cores. Undated. https://qol.eortc.org/core. Accessed September 2020.&#xD;
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	Doyle DJ, Goyal A, Bansal P, et al. American Society of Anesthesiologists Classification (ASA Class) In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. &#xD;
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	Koller M, Lorenz W. Quality of life research in patients with rectal cancer: traditional approaches versus a problem-solving oriented perspective. Langenbecks Arch Surg 1998 Dec;383(6):427-36. &#xD;
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	Sprangers MAG, Te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). Eur J Cancer 1999; 35:238&#x2013;247. &#xD;
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	Tsunoda A, Tsunoda Y, Narita K, Watanabe M, Nakao K, Kusano M. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum 2008 Feb;51(2):218-222.&#xD;
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	Gervaz P, Bucher P, Konrad B, Morel P, Beyeler S, Lataillade L, Allal A. A Prospective longitudinal evaluation of quality of life after abdominoperineal resection. J Surg Oncol 2008;97(1):14-19&#xD;
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	Cornish JA, Tilney HS, Heriot AG, Lavery IC, Fazio VW, Tekkis PP. A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Surg Oncol 2007;4(2):24-29. &#xD;
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	Guren MG, Eriksen MT, Wiig JN, Carlsen E, Nesbakken A, Sigurdsson HK, Wibe A, Tveit KM; Norwegian Rectal Cancer Group. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 2005;31(7):735-742.&#xD;
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	Grumann MM, Noack EM, Hoffmann IA, Schlag PM. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 2001;233(2):149-156.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Neuropathy in Newly Diagnosed Hyperthyroid Patients: A Case-Control Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>25</FirstPage><LastPage>28</LastPage><AuthorList><Author>Ahmad Faraz</Author><AuthorLanguage>English</AuthorLanguage><Author> Sangeeta Singhal</Author><AuthorLanguage>English</AuthorLanguage><Author> M. Mobarak Hossain</Author><AuthorLanguage>English</AuthorLanguage><Author> S. S. Siddiqui</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Hyperthyroidism is a common endocrinologic disorder affecting many organ systems. Several neurological diseases like acute and chronic myopathy, periodic paralysis, ophthalmoplegia, and rarely myasthenia gravis are known associations of thyrotoxicosis. However, neuropathy in hyperthyroidism is not frequently reported. Objective: To evaluate the occurrence of neuropathy in hyperthyroid patients. Methods: 60 patients of hyperthyroidism were included in the study, detailed history and clinical examination was performed. 60 normal subjects were included as a control. Nerve Conduction Studies were performed in neurophysiology lab of Physiology dept of JNMC Aligarh. Result: While comparing motor conduction parameters of hyperthyroid patients with the control group, NCV and Latencies do not show a significant difference, while the Amplitude of the Median Nerve in both the limbs shows a significant decrease. On comparing Sensory conduction parameters of hyperthyroid patients with the control group, the amplitude of the Median Nerve, Sural Nerve shows a significant decrease, while latencies of Median Nerve and Sural Nerve is increased in hyperthyroid patients. Conclusion: Our study indicates predominant sensorimotor axonal neuropathy in newly diagnosed hyperthyroid patients. We suggest neurological investigation should be included at the time of diagnosis in these patients.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Hyperthyroidism, Neurophysiology, Nerve Conduction Velocity, Neuropathy, Sensorimotor Neuropathy, Sensory Nerve Conduction Velocity, Motor Nerve Conduction Velocity</Keywords><Fulltext>Introduction&#xD;
&#xD;
The thyroid hormone is required by cells and tissues for basic metabolism for their normal functioning. The thyroid hormone has profound impacts on prenatal and even during postnatal life on the developing brain.1,2 The thyroid hormone also plays an important part in the growth of the brain and spinal cord and myelination of neurons in adults. Prevalence of Hyperthyroidism is increased in urban population and the highest prevalence is found in the age group of 30 &#x2013; 49 years.3 Hyperthyroidism is characterized by heat intolerance, sweating, increased pulse pressure, a fine tremor of the outstretched fingers, tachycardia, atrial fibrillation in the elderly, hyperreflexia, hyperactivity, irritability, muscle weakness, proximal myopathy.4 Musculoskeletal and neurological involvement often manifests as fatigue, muscle weakness, and paralysis. Thyrotoxicosis is associated with various neurological diseases like acute and chronic myopathy, periodic paralysis, ophthalmoplegia, and rarely myasthenia gravis. Neuromuscular association and primary muscle disorder are associated with hyperthyroidism.5 However, neuropathy in hyperthyroidism is not frequently reported. Our study aims to find out the effect of hyperthyroidism in neuropathy.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
Ethical clearance was taken from the ethical committee of J.N. Medical College. Patients attending the Rajiv Gandhi Centre for diabetes and Endocrinology were evaluated for inclusion and exclusion criteria. Patients who gave valid written and informed consent were included in the study. &#xD;
&#xD;
Study population &#xD;
&#xD;
Sixty patients of newly diagnosed hyperthyroidism defined by decreased Thyroid Stimulating Hormone (TSH) and raised FT4 were taken from Rajiv Gandhi Centre of Diabetes and Endocrinology. Patients with overt hyperthyroidism were included in the study. Patients having Diabetes Mellitus, Hypertension, and Renal failure, alcoholic hepatitis, vitamin B12 deficiency, patients taking steroids, neuropathies associated with malnutrition, toxic agents e.g. metal or drugs, and neuropathy from other conditions were excluded from the study. Sixty normal subjects who gave informed consent and are willing to participate in the study were included in our study.&#xD;
&#xD;
Clinical Evaluation&#xD;
&#xD;
Patients included in the study were screened for neuromuscular symptoms such as weakness, tiredness, myalgia, stiffness, cramps, numbness, tingling, pain, and paraesthesia. Neurological examination for motor and the sensory system was done, it includes Pin-prick, light touch, and vibration sensation evaluation of cranial nerves, motor power, and reflexes. &#xD;
&#xD;
Nerve Conduction Studies&#xD;
&#xD;
MNCV&#xD;
&#xD;
NCS was carried out according to standardized protocols for the bilateral median, ulnar, and common peroneal nerve. The negative end of the stimulator was positioned near to the active electrode. The surface recording electrodes were used and placed in belly tendon montage; the active electrode is placed adjacent to the motor point and reference near to tendon. A ground electrode has been positioned between the stimulating and the recording electrodes. Stimulation intensity was slowly raised and the value at which the amplitude did not increase was calculated as the supramaximal strength. This stimulation intensity was used to record a Compound Muscle Action Potential (CMAP). At two points along its path, motor or mixed nerve was stimulated. Distance has been calculated in mm between two points of stimulation, Motor Nerve Conduction Velocity (MNCV) was calculated by dividing distance and latency difference between the proximal and the distal latencies (ms). The nerve conduction velocity is expressed as m/s and amplitude in mv.6&#xD;
&#xD;
SNCV&#xD;
&#xD;
In our study sensory nerves were tested by antidromic recording. In an antidromic conduction study, the proximal point of a nerve is stimulated and distally, Sensory Nerve Action Potential (SNAP) is recorded. In Sensory Conduction study averaging of signal enhancement is required. The averaged signal enhancement is directly proportional to the square root of the no. of trials. The latency of potential is calculated from the stimulus artefact to the initial positive peak. SNCV unlike MNCV is measured by stimulating at a single stimulation site since sensory nerve conduction does not include neuromuscular transmission time and muscle propagation time. Thus, the SNCV was calculated by dividing the distance (mm) between the stimulating and recording sites by the latency (ms). The nerve conduction velocity is expressed as m/s.5&#xD;
&#xD;
Statistical analyses&#xA0;&#xD;
&#xD;
Analyses were done using SPSS 21.0. Data were expressed as mean &#xB1; SD, the normalcy of data was assessed by the Kolmogorov Smirnoff test. Unpaired t-tests were used for comparison between quantitative variables. Chi-square tests were used to compare differences in the categorical variables. The con?dence interval (CI) was set at 95%.&#xD;
&#xD;
Results&#xD;
&#xD;
We evaluated 85 patients of hyperthyroidism and they were assessed for inclusion and exclusion criteria. 60 subjects were included in the study who gave valid consent and were newly diagnosed hyperthyroid patients and met with inclusion criteria. and 60 normal subjects. The mean age of hyperthyroid patients was 33.2&#xB1;3.58 and that of control is 32.1&#xB1;3.81 and is statistically non-significant. 18 patients (30 %) presented with a tingling sensation in lower limbs, 20 (33.3%) patients complain of numbness, 6 patients presented with pain. TSH level of Hyperthyroid patients is less than 0.02 mU/l and FT4 is 50.6 &#xB1; 3.4.&#xD;
&#xD;
On comparing motor conduction parameters in hyperthyroid patients with a control group, NCV and Latencies do not show a significant difference, while Amplitude of Median Nerve in both the limbs (Rt median: 9.41 &#xB1; 3.2, Lt Median: 10.12 &#xB1; 4.5) shows a significant decrease (Table 1). &#xD;
&#xD;
While comparing Sensory conduction parameters in hyperthyroid patients with a control group, the amplitude of Median Nerve (Rt Median Nerve: 26.71 &#xB1; 5.9, Lt Median Nerve: 28.32&#xB1; 6.2), Sural Nerve (Rt Sural Nerve: 22.80 &#xB1; 2.6, Lt Sural Nerve: 21.73 &#xB1; 3.6) shows a significant decrease, while latencies of Median Nerve (Rt Median Nerve: 3.69 &#xB1; .69, Lt Median Nerve: 3.43 &#xB1; .80) and Sural Nerve (Rt Sural Nerve: 3.31 &#xB1; .62, Lt Sural Nerve:3.29 &#xB1; .59) is increased in hyperthyroid patients when compared with control (Table 2).&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
In the present study, our results showed that the amplitude of the median and sural nerve in hyperthyroid patients is significantly decreased as compared to the control group. The latency of the sural nerve is increased, while the Nerve Conduction Velocity of these nerves showed no significant results. Duyff et al7 in their study concluded that 20 % of Hyperthyroid patients present with sensorimotor axonal polyneuropathy, they also pointed a very good response to neuropathy by anti-thyroid treatment. MNCV of the median nerve, ulnar nerve, and common peroneal nerve in the hyperthyroid subject is not decreased.13 Y&#xFC;ksel et al8 shows increased latency of sural nerve in hyperthyroid patients.&#xD;
&#xD;
A comparison of the SNCV does not show a significant decrease in the conduction velocity of the median, ulnar, and common peroneal nerve in hyperthyroid subjects as compared to the SNCV of these nerves in the control subjects. But sensory latency of the Sural nerve is increased bilaterally in hyperthyroid subjects as compared to control subjects. In hyperthyroid cases latency of sural nerve is increased when compared with normal subjects. Feibel and Campa concluded that their patient of hyperthyroidism presented with a latent sensorimotor polyneuropathy.9 Ludin et al. (1969) show neuropathic involvement in hyperthyroidism, they hypothesized that their patients had a subclinical polyneuropathy.10 Roquer et al., (1993) in their prospective study, found Carpal Tunnel Syndrome (CTS)in 5% of hyperthyroid patients in the initial survey. They concluded that CTS should be considered another peripheral neurological manifestation associated with hyperthyroidism.11 S&#xF6;zay et al., (1994) show a decrease in the amplitude of sensory nerves. The SNCV of the sural nerve is decreased by 35.5%. They concluded that electrophysiological studies can be an important diagnostic tool for asymptomatic hyperthyroid patients.12 Sweed et al., (2007) conducted their study on hyperthyroidism in geriatric patients, they revealed evidence of motor neuropathy in the upper limb of axonal type. The prevalence of affection in the hyperthyroid group was found in 25% of cases. Also, entrapment neuropathy of the median nerve has been observed in 25% of hyperthyroid patients.13 A case report on the hyperthyroid patient reveals acute polyneuropathy in hyperthyroidism.14 Ajeena, (2013) concluded that in hyperthyroid patients, nerve conduction parameters were not significant when compared with that of the control group. But they also said that there were 10 (32.2%) hyperthyroid patients, where the sural nerve was the most commonly involved, and 10 (32.2%) of them had CTS.15 Although the reason for neuropathy in hyperthyroid patients is still known, it has been hypothesized to be either a direct effect of increased thyroid hormones, immune-mediated or due to a hypermetabolic state reducing these essential nutrients of nerves.16 Further studies are required to ascertain the exact cause. Various studies suggest myopathy as a predominant manifestation of hyperthyroidism, but we cannot deny the fact that neuropathy is also associated with hyperthyroidism. The amplitude of the Median nerve and the Sural nerve is decreased which suggests that there is sensorimotor axonal neuropathy. Further several studies pointed in this direction. The exact pathogenesis is still not known.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Neuropathy in hyperthyroidism is an underdiagnosed condition, most studies correlate myopathy with hyperthyroidism. But our study indicates predominant sensorimotor axonal neuropathy in newly diagnosed hyperthyroid patients. We suggest neurological investigation should be included at the time of diagnosis in these patients. Further studies should be done to find out the pathogenesis of neuropathy in hyperthyroidism. &#xD;
&#xD;
Acknowledgment: We would like to acknowledge the support provided by Aley Mustafa. We would like to thank the Department of Physiology and Rajiv Gandhi Centre for Diabetes and Endocrinology for the smooth running of the study.&#xD;
&#xD;
Conflict of interest: None of the authors declared any conflict of interest&#xD;
&#xD;
Funding: The Study was self-financed.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3378</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3378</Fulltext></URLs><References>&#xD;
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	Bernal J. Iodine and brain development. Biofactors 1999;10:271&#x2013;276.&#xD;
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	Oppenheimer JH, Schwartz HL. Molecular basis of thyroid hormone-dependent brain development. Endocr Rev 1997; 18: 462&#x2013;475.&#xD;
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	Deokar PG, Nagdeote AN, Lanje MJ, Basutkar DG. Prevalence of Thyroid Disorders in A Tertiary Care Center. Int J Cur Res Rev 2016; 8(9):26- 30.&#xD;
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	Tonner DR, Schlechte JA. Neurological complications of the thyroid and parathyroid disease. Med Clin North Am 1993;77:251-263.&#xD;
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	Fisher M, Matell JE, Ullrich I, Gutrecht JA. Pyramidal tract de?cits and poly-neuropathy in hyperthyroidism. Am J Med 1985;78:1041&#x2013;1044.&#xD;
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	Mishra UK, Kalita J. Clinical Neurophysiology 2nd ed.New Delhi: Elsevier; 2006.&#xD;
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	Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 2000 Jun;68(6):750-755.&#xD;
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	Y&#xFC;ksel G, Karlikaya G, Tanrida? T, Us &#xD6;, Aky&#xFC;z G.Nerve Conduction Studies, SEP and Blink Reflex Studies in Recently Diagnosed, Untreated Thyroid Disease Patients. J Neurological Sci [Turkish] 2007;24(1):10:7-15.&#xD;
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	Feibel JH,&#xA0; Campa JF.Thyrotoxic neuropathy (Basedow&#x2019;s paraplegia). J Neurol Neurosurg Psychiatry 1976;39(5):491&#x2013;497.&#xD;
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	Ludin HP, Spiess H, Koenig MP. Neuromuscular dysfunction associated with thyrotoxicosis. Eur Neurol 1969;2:269-278.&#xD;
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	Roquer J, Cano JF. Carpal tunnel syndrome and hyperthyroidism. A prospective study. Acta Neurol Scand 1983;88:149&#x2013;152.&#xD;
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	S&#xF6;zay S, G&#xF6;k&#xE7;e-Kutsal Y, Celiker R, Erbas T, Ba?g&#xF6;ze O. Neuroelectrophysiological evaluation of untreated hyperthyroid patients. Thyroidology 1994; 6(2): 55&#x2013;59.&#xD;
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	Sweed HS, Nasser AA, Khalil S, Bayomi I.Cognitive and Neuromuscular Assessment in Geriatric Patients with Thyroid Dysfunction. Egypt J Neurol Psychiat Neurosurg 2007;44(1): 235-237.&#xD;
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	Al-Wahaibi AK, Kumar S, Al-Risi A, Wali F. Thyrotoxic Neuropathy: A rare cause of acute flaccid paraplegia. Sultan Qaboos Univ Med J 2017;17(4):e460-e463.&#xD;
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	Ajeena IM. Prevalence of Neuromuscular Abnormalities in Newly Diagnosed Patients with Thyroid Dysfunction. Am J Res Comm 2013;1(3):79&#x2013;88.&#xD;
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	&#xD;
	Al-Wahaibi AK, Kumar S, Al-Risi A, Wali F. Thyrotoxic Neuropathy: A rare cause of acute flaccid paraplegia. Sultan Qaboos Univ Med J 2017;17(4):e460-e463.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Novel Method of Mass Disinfection for the Prevention of Covid-19&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>29</FirstPage><LastPage>32</LastPage><AuthorList><Author>Nikhil Raj</Author><AuthorLanguage>English</AuthorLanguage><Author> Ankit Dasgotra</Author><AuthorLanguage>English</AuthorLanguage><Author> Vishal Kumar Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Surajit Mondal</Author><AuthorLanguage>English</AuthorLanguage><Author> Abhishek Sharma</Author><AuthorLanguage>English</AuthorLanguage><Author> Jitendra K Pandey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The lockdown amid COVID-19 across various countries, the sealed borders and immobilize public is a danger to the economy. Objective: In the static scenario of the economy, it is of utmost priority to get the economy moving. Methods: To mitigate the spread of coronavirus disinfection is a technology solution by using a secondary form of Ultraviolet &#x2013;C (UVC) light exposure along with disinfectant spray. Results: The taken consideration is not harming the human being and may be an effective way to prevent the further spread of the COVID-19. Conclusion: In this paper we aim to represent that using UVC along with disinfectant spray is one of the effective solution for humans.This paper represents the way to do the same by using a secondary form of Ultra Violet - C (UVC) light exposure along with disinfectant spray measures.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Prevention, Smart technology, UVC Light, Disinfecting technique, COVID-19</Keywords><Fulltext>Introduction&#xD;
&#xD;
With the origin of coronavirus disease (COVID- 19) in China in December 2019 and after observing the rate of the impact, the WHO declared this disease as pandemic on March 11, 2020. Since then this disease has spread globally with spontaneous transmission rate and infected more than 24.36 million confirmed cases and over 0.83 million fatalities all over the globe.1,2 In Inda the lockdown was implemented by the government on March 23 with little over 100 cases. Since then the lockdown had continued for 3 months and then the reopening was done in phases but the cases have gradually increased. The spread of the disease has the emerging cases of coronavirus in India are depicted in figure 1 which and the numbers are still growing even after the mitigation measures taken by the government to prevent the spread. The major impact has been seen in Lifestyles of people and eduction patterns has been impacted the most.3 Due to this, people got more concerned about safety.&#xD;
&#xD;
The ultraviolet (UV) radiation are well known for its inactivation approach on various types of microorganisms, virus and UVC whose wavelength ranged from 200-280 nm can be used in several medical applications and due to its highly effective antimicrobial and antiviral properties it is being used in the decontamination process.4,5 A low-pressure mercury vapour arc lamp is used with a conventional UV lamp to emit wavelength within the range of UVC.6 The UVC radiation does not generate any human health risks in comparison to the conventional UV light.7&#xD;
&#xD;
COVID-19 is a pandemic situation nowadays so many researchers are focusing on this emerging topic and contributing their part in their respective field. Interdisciplinary research is highly encouraged in this emerging situation resulting in the proposal of new concepts, theories and methods towards the construction of healthy cities. In this article, we are proposing an advanced preventive method for mass disinfection using UVC scattering with disinfectant. This methodology can be applied as an infection controlling techniques inbuilt and transportation environments, such as offices, hospitals, shopping malls, airline cabins, trains, buses, cruise ships etc.&#xD;
&#xD;
The paper is structured in four segments. The first segment describes the technological background of innovation. The second segment describes the actual methodology for the operation of the proposed system and its characteristics. The last segment describes the conclusion of the proposed methodology. &#xD;
&#xD;
Methods of Prevention&#xD;
&#xD;
The exponential increase in the number of COVID-19 cases can be only controlled employing prevention, as there is no direct treatment available to cure the disease. There is a various advisory issued by the government to prevent the spread of the virus. The entire economy of the country is paused. As per the economists, a lethal impact and recession is on its way to hit us and may result in more deadly impacts in coming future. To reduce the impact of the same the mass need to mobilize while protecting and preserving themselves from the COVID-19. This is possible if we start integrating the technological advancements in daily life instead of immobilizing the nation and make them still. One of the key technology resources may be UV radiation.&#xD;
&#xD;
UV rays are considered an effective disinfectant. For dis-infection UV light of short wavelength is used.8,9 The wavelength ranges between 200 and 280 nanometres.10 The process of disinfection is accomplished by ultraviolet germicidal irradiation.11,12 Which either inactivate or destroys the microorganism by attacking the base level, i.e. either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA).13 The base-level attack acts disabling the microorganism to perform any further evolution by high-frequency UV light. &#xD;
&#xD;
Although the UV rays are not safe for direct exposure to the human, body but then also can be utilized in its secondary form for large mass UV bathing. UV rays may be exposed to the large gathering in secondary form. Mercury vapour lamps can be an alternative to safe exposure of UV rays to the human body.14 It is a two-bulb assembly, where the inner bulb generates the UV light and outer bulb filters the same to make it usable for human needs in daily life. It produces UVC radiation, whose absorption length is so small that it does not penetrate the inner layer of human skin, rather kills the microorganism and dead cells on the skin surface.15 The graph of figure 2 shows the penetration length with increasing wavelength. As the wavelength decreases the scattering increases, which results in reduced penetration.&#xD;
&#xD;
System Working Methodology&#xD;
&#xD;
Sensor networking plays an important role in processing as the presence of individual or obstruction has to be detected via scattering range. Figure 3 represents the sensor arrangement with its scattering range that detects the human presence at its entry-level. Passive Infrared (PIR) sensor shall be used to detect human motion. Sensor range can be scattered in a circular pyramid shape, covering major pass by gate area. &#xD;
&#xD;
Two mercury-vapour or gas discharge lamps are installed as shown in figure 4.&#xA0; These lamps produce ultraviolet C radiation having a wavelength of 253 nm, flashed for a duration of 3.4 milliseconds. The UVC shutter shall be operated at a speed of 1/290 s. The wavelength and flash timing is so selected that it does not penetrate the human skin. The angular positioning of lamps is proposed as it maximizes the area covered. &#xD;
&#xD;
Disinfecting sprayers turns on automatically after lamp operation. Specific pressure shall be operated in installed nozzles. That further reduces the possibility of any left out the virus and thus transmission chances may be reduced largely. Figure 5 shows nozzle spraying operation and its installation. It also covers maximum range same as mercury-vapour lamps. The preferable disinfecting solution can be ethanol having a maximum alcohol content of 70% and pressure is set in a range of 4-8 bar. The single spray will consume approximately 12 ml of disinfectant collectively. &#xD;
&#xD;
In case, crowd entrance took place in form of human or obstacles (i.e. vehicles, etc.) then there is the possibility that networking can have the irregular operation but our proposed work can work effetely in these conditions too as shown in figure 6.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The proposed method of disinfection is applied to all the places where the people need to enter in mass and exist in mass, for example, shopping malls, factories, schools, and colleges etc. The arrangement can be done at the entrance of large institutions and factories to give a UVC treated bath and kill the microorganism of the mass simultaneously. The steps can prevent the further spread of coronavirus on the mass level. The system can make the economy going by operating the industries and other institution by reducing the spread of the virus. The methodology is designed keeping in mind the dense crowd of Indian economy but is not limited to any region. The same can be applied universally.&#xD;
&#xD;
Acknowledgements &#xD;
&#xD;
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3379</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3379</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Coronavirus Disease (COVID-19) Situation Reports. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Published in 2020. Accessed December 1, 2020.&#xD;
&#xD;
2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; COVID-19 pandemic in India. https://en.wikipedia.org/wiki/Template:COVID 19_pandemic_data/India_medical_cases_chart. Published 2020.&#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mukhtar M, Mukhtar S. Impact of Coronavirus Outbreak on Changing Educational Patterns of Student and Teachers at Onaizah and Buraydah Private Colleges in Saudi Arabia - A Cross-Sectional Study. Int J Curr Res Rev 2020;12(22):41-47. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Erkan M, Wang CY, Krizek DT. UV-C irradiation reduces microbial populations and deterioration in Cucurbita pepo fruit tissue. Environ Exp Bot 2001;45(1):1-9. &#xD;
&#xD;
5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kowalski W, Kowalski W. Introduction. In: Ultraviolet Germicidal Irradiation Handbook. Springer Berlin Heidelberg 2009:1-16. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Naunovic Z, Lim S, Blatchley ER. Investigation of microbial inactivation efficiency of a UV disinfection system employing an excimer lamp. Water Res 2008;42(19):4838-4846. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ponnaiya B, Buonanno M, Welch D, Shuryak I, Randers-Pehrson G, Brenner DJ. Far-UVC light prevents MRSA infection of superficial wounds in vivo. PLoS One 2018;13(2):e0192053. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Downes A, Blunt TP. Proceedings of the Royal Society of London. In: Proceedings of the Royal Society of London 1878:28 (190-195). &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Wengraitis S, McCubbin P, Wade MM, Pulsed UV-C Disinfection of Escherichia coli With Light-Emitting Diodes, Emitted at Various Repetition Rates and Duty Cycles. Photochem Photobiol 2013;89(1):127-131. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Everything We&#x2019;ve Written About Preparing for the Coronavirus Outbreak. https://nymag.com/strategist/article/how-to-prepare-for-coronavirus-outbreak.html. Published in 2020.&#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Memarzadeh F, Olmsted RN, Bartley JM. Applications of ultraviolet germicidal irradiation disinfection in health care facilities: Effective adjunct, but not stand-alone technology. Am J Infect Control 2010;38(5 SUPPL.): S13-S24. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Ascione F, De Masi RF, Mastellone M, Vanoli GP. The design of safe classrooms of educational buildings for facing contagions and transmission of diseases: A novel approach combining audits, calibrated energy models, building performance (BPS) and computational fluid dynamic (CFD) simulations. Energy Build 2021;230:110533. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Cheng N, Moe P. Inactivation of Enveloped Viruses ( Coronavirus, H5N1 Virus ) and Disinfection of the Air with Legionella-X 100 Via Ultraviolet Germicidal Irradiation (UVGI ). 2020.&#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Mercury Vapor Lamps (Mercury Vapor Light Bulbs) | FDA. https://www.fda.gov/radiation-emitting-products/home-business-and-entertainment-products/mercury-vapor-lamps-mercury-vapor-light-bulbs. Accessed July 3, 2020.&#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Is UVC Safe? UV Light and Health Effects - Klaran. https://www.klaran.com/is-uvc-safe. Accessed July 3, 2020.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>33</FirstPage><LastPage>38</LastPage><AuthorList><Author>Anu</Author><AuthorLanguage>English</AuthorLanguage><Author> Sweta</Author><AuthorLanguage>English</AuthorLanguage><Author> Uma Sharma</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Fine needle aspiration cytology (FNAC) is a rapid and inexpensive technique for the diagnosis of breast lesions. Various cytological grading systems are being used for categorisation. For better advancement of categorization and management of breast lesions Modified Masood scoring system has been proposed. Objective: To study the effectiveness and accuracy of Modified Masood Scoring Index (MMSI) and Robinson&#x2019;s cytological grading for evaluation of breast lesions with their histopathological correlation. Methods: A prospective study was conducted in a tertiary care hospital from September 2019 to February 2020. A total of 73 cases were included in the study which had undergone FNAC and had histopathological samples as excision biopsy and mastectomy. The cytological smears were categorised by using MMSI, Robinson&#x2019;s cytological grading system and were compared with the histological findings (the four categories of MMSI) and for carcinoma, cases modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system was used. Results: The sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and diagnostic accuracy of MMSI were 76.4%, 100%, 100%, 93.3% and 94.5% respectively. The Robinson&#x2019;s grading had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 88.2%, 100%, 100%, 96.5% and 97.2% respectively. Conclusion: Robinson&#x2019;s cytological grading had good sensitivity for evaluation of malignant lesions whereas MMSI can be used for the categorization of both benign and malignant breast lesions with good sensitivity.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Biopsy, Breast aspiration cytology, May Grunwald-Giemsa stain, Modified Masood scoring index, Robinson&#x2019;s grading system</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Fine needle aspiration cytology (FNAC) is a simple rapid, minimally invasive, cost-effective technique for evaluation of palpable breast lesions. It is a safe technique to distinguish non-neoplastic breast lesions from neoplastic lesions. Breast carcinoma is the second most common cancer in women in developing countries. FNAC is an important part of Triple test which is used for assessment of breast lesions.1 Despite good diagnostic accuracy, the cytological scoring systems are not used in many tertiary care centres. There are various cytological grading systems which can be used for evaluation of breast lesions which helps the surgeons to decide the treatment.2 The Bethesda System of reporting breast FNAC to categorise the breast lesions based on morphology and arrangement of cells, nuclear features, mitotic figures and the background of smear into 5 categories (Table 1). unsatisfactory, benign lesions, atypical or intermediate, suspicious for malignancy and malignant lesions.3 The Robinson scoring system is the most commonly used cytological grading system. This grading is based on cellular dissociation, cell uniformity, nuclear size, nuclear margin, nucleoli and chromatin pattern.4 Before Robinson&#x2019;s grading system, Masood Scoring Index (MSI) was developed in 1990 for breast aspiration cytology. Despite its diagnostic accuracy this is not commonly used by cytopathologists. This grading was based on cellular arrangement, cellular anisonucleosis and pleomorphism, the myoepithelial cells, presence of nucleoli and the chromatin pattern. For each criterion, 1-4 scores were given and the total score was calculated by adding all numbers. The final score was ranging from a minimum of 6 to a maximum of 24 scores. Based on scores further, categorisation was done into non-proliferative breast lesions (6-10), proliferative breast lesion without atypia (11-14), proliferative breast lesion with atypia (15-18) and carcinoma (19-24).5 Nandini el al. further modifies the MSI scoring of non-proliferative breast lesion from 6-10 to 6-8 score and proliferative breast disease without atypia from 11-14 to 9-14 (Table 2). This was named as Modified Masood scoring Index (MMSI). After this change, the diagnostic accuracy was significantly improved.6 &#xD;
&#xD;
Considering this change in diagnostic accuracy the MMSI system was used in our study to evaluate the cytological breast aspirate for the categorisation of lesions along with Robinson&#x2019;s scoring system. The sensitivity, specificity, positive predictive value, negative predictive value and the diagnostic accuracy was calculated by comparing with the histopathological findings and modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system for carcinomas. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The prospective cross-sectional study was conducted on the patient who presented with palpable breast lump in the Department of Surgery referred to the Department of Pathology, Shree Guru Gobind Singh Tricentenary Medical College during the period of 6 months, from September 2019 to February 2020. The inadequate aspirate and cases without histopathology specimen were excluded from the study. The ethical clearance number was SGT/FMHS/F/1/9/20-3. For the adequacy of smear, the minimum four clusters of ductal epithelial cells with each cluster having five to six cells were taken.&#xD;
&#xD;
After explaining the procedure of Fine needle aspiration cytology (FNAC) to the patient written consent was taken from every patient. The detailed history was taken from the patient with USG findings if available. After locating and fixing the lesion FNAC was carried out under strict aseptic precautions with 22 gauge needle and 10 ml syringes. The slides were prepared and air-dried for May-Grunwald-Giemsa (MGG) staining. The stained smears were then categorised by using MMSI (Table 2) and Robinson&#x2019;s scoring (Table 3).&#xD;
&#xD;
The breast tissue after excision biopsy and mastectomy were sent from the Surgery Department fixed in formalin. The tissue sections were prepared and stained with Haematoxylin and Eosin. The sections were categorised into four histopathological categories on basis of modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system (Table 4) to compare with MMSI and Robinson&#x2019;s scoring for carcinomas. The cytological and histopathological findings were correlated. &#xD;
&#xD;
The categorical type of data was collected and the statistics of all data were shown in the form of proportions and or percentages. The diagnostic accuracy of MMSI and Robinson&#x2019;s cytological scoring was calculated. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by comparing with the gold standard histopathological findings. To assess the agreement between the MMSI cytological scoring, Robinson&#x2019;s scoring with their histopathological findings and modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system, Cohen&#x2019;s kappa coefficient was calculated.&#xD;
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RESULTS&#xD;
&#xD;
During six months, out of 153 breast FNAC cases, 73 were included in our study as the histological specimens were available of only these cases in form of Tru-cut biopsy, lumpectomy or mastectomy. Other breast FNAC cases without histological specimens or with inadequate material were excluded from the study.&#xD;
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The mean age of female was 35.6 years with the range from 16-75 years. The maximum of cases was in the age group of 31-40 years. Most of the cases were presented with unilateral breast swelling.&#xD;
&#xD;
As per MMSI, the concordance between cytopathological and histopathological diagnosis for non-proliferative breast disease was 100% and for proliferative breast disease without atypia (Figure 1A &amp; 2A) was 92.5% with histopathology (Figure 1B &amp; 2B) and 7.5% of cases were confirmed as malignant on histopathology. For proliferative breast disease with atypia, concordance was 75% whereas category 4 of carcinoma-in-situ (CIS) and carcinoma (Figure 3A) showed 100% concordance with histopathology (Figure 3B, Table 5).&#xD;
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As per the result obtained with MMSI a 2x2 table was made and the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated (Table 6). The diagnostic accuracy was 94.5% with a sensitivity of 76.4%, specificity of 100%. The PPV and NPV were 100% and 93.3% respectively.&#xD;
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As per Robinson&#x2019;s scoring for carcinoma (Figure 3A) 15 cases out of 73 were diagnosed as carcinoma which was then graded with the modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system of histopathology (Figure 3B). In grade 1, there was 100% concordance with histopathology grading whereas, in grade 2, four cases out of nine showed discrepancy, on histopathological grading three cases were of grade 3. Five cases were categorised as grade 3 on cytological scoring, out of them one was of grade 2 on histopathology (Table 7).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; As per the result obtained a 2x2 table was made and the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated (Table 8). The diagnostic accuracy was 97.2% with a sensitivity of 88.2%, specificity of 100%. The PPV and NPV were 100% and 96.5% respectively (Table 9).&#xD;
&#xD;
Based on the overall presence or absence of carcinoma, Cohen&#x2019;s kappa coefficient was calculated to assess the MMSI and Robinson&#x2019;s cytological scoring with their histopathological diagnosis, which was 0.828 (approximately 83%) and 0.916 (approximately 92%) respectively.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
FNAC plays an important role in the assessment of breast lumps and helps the surgeon to further decide the management. Various cytological scoring systems are used to categorize breast lesions. In Masood scoring index, total score from 6 to 24 was given based on cytological category. Proliferative breast disease (PBD) increases the risk of development of breast carcinoma. The risk of breast carcinoma increases by 1.3 folds in PBD without atypia and 4.3 folds in PBD with atypia.1 In non-PBD, cells are arranged in monolayer with no cytological abnormalities. In PBD without atypia, the cells are arranged in sheets with nuclear overlapping and overcrowding at places. In PBD with atypia, tightly packed clusters of cells are present with marked nuclear overlapping and prominent nucleoli. In malignant lesions, the cells are loosely arranged with marked nuclear pleomorphism with irregular nuclear membrane, coarsely clumped chromatin and prominent macronuclei. Myoepithelial cells are absent in malignant lesions. To differentiate the benign lesions from malignant lesions myoepithelial cells played an important role.5&#xD;
&#xD;
Nandini et al. 2011 conducted a study on 100 cases and observed that the diagnostic accuracy was increased when 9 and 10 scores were shifted from category 1 of non-proliferative breast disease to category 2 of proliferative breast disease without atypia. This change was important as category 2 and category 1 have different prognostic value.1 Robinson&#x2019;s scoring system is used for the categorisation of carcinoma cases this scoring system is based on the cellular arrangement, cellular morphology and the nuclear details.4 The modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring system of histopathology is based on the tubular formation, nuclear pleomorphism and the number of mitotic figures. All these have features have prognostic values. &#xD;
&#xD;
So in our study, we used both MMSI and Robinson&#x2019;s scoring system to assess the accuracy whether this can be used for assessment of the risk of developing breast carcinoma in palpable breast lump and calculate the concordance by comparing with the histopathological diagnosis. From our result this was found that with MMSI, the maximum concordance of 100% was observed in category 1 of non proliferative breast disease and category 4 of carcinoma in-situ/carcinoma followed by category 2 of proliferative breast disease without atypia and minimum concordance of 75% was observed in category 3 of proliferative breast disease with atypia.&#xD;
&#xD;
The sensitivity and specificity of MMSI was 76.47% and 100% respectively with 100% positive predictive value and 93.33% negative predictive value with a diagnostic accuracy of 94.5%, similar results were found previously.2 Out of 73 cases, 15 were diagnosed as carcinoma on cytology and were categorized by using Robinson&#x2019;s grading system. Out of 15, one case was graded as grade 1 which was confirmed by using modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring. Nine cases were graded under grade 2, out of which three cases were graded under grade 3 on modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring and 1 was invasive lobular carcinoma. Five cases were graded as grade 3 on Robinson&#x2019;s out of which three were confirmed as grade 3, one was grade 2 on modified Scarff&#x2013;Bloom&#x2013;Richardson&#x2019;s scoring and one case were diagnosed as invasive papillary carcinoma. So the overall concordance was 60%. Robinson et al. had 57% of concordance whereas similar studies had 71.2%, 64%, 77.19%, 72.2% and 63.3%&#xA0; of concordance.4,12-15&#xD;
&#xD;
Further slides with more number of cases should be done to standardize the categorical grading system which helps in categorizing benign and malignant breast lesion. This will help the surgeons to plan the treatment and to predict the prognosis of the disease. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Our study concluded that cytological scoring systems must be used for the evaluation of all breast FNAC cases. The MMSI for categorisation of benign and malignant lesions and Robinson&#x2019;s for grading of breast carcinoma cases. These cytological scoring systems have good sensitivity, specificity, PPV and NPV with the good concordance with histopathological diagnosis. &#xD;
&#xD;
Acknowledgement- None&#xD;
&#xD;
Conflicting Interest- There are no conflicts of interest.&#xD;
&#xD;
Financial Support and Sponsorship- Nil&#xD;
&#xD;
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Figure 1: A. Monomorphic ductal epithelial cells in the cluster with many scattered myoepithelial cells (MGG, 400x), B- Corresponding histopathological lesion diagnosed as Fibroadenoma (H&amp;E,40x)&#xD;
&#xD;
&#xD;
&#xD;
Figure 2: A- Tightly cohesive ductal epithelial cells with spindle shaped myoepithelial cells with stroma (MGG,40x) B- Corresponding histopathological lesion diagnosed as Phyllodes (H&amp;E,40x)&#xD;
&#xD;
&#xD;
&#xD;
Figure 3: A- Loosely cohesive pleomorphic ductal epithelial cells with high N: C ratio (MGG 100x) B- Corresponding histopathological lesion diagnosed as Invasive ductal carcinoma with &gt;75% tubule formation (H&amp;E,40x)&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3380</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3380</Fulltext></URLs><References>1. Nandini NM, Rekha TS, Manjunath GV. Evaluation of scoring system in cytological diagnosis and management of breast lesion with the review of the literature. Indian J Cancer&#xA0; 2011;48:240&#x2013;245.&#xD;
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2. Raju K, Rajanna VS. A comparative study of three scoring systems on palpable breast aspirates at a tertiary health-care centre. A cross-sectional study. J Nat Sci Biol Med&#xA0; 2020;11:21-26.&#xD;
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3. Bansal C, Pujani M, Sharma KL, Srivastava AN, Singh US. Grading systems in the cytological diagnosis of breast cancer: a review. J Cancer Res Ther 2014;10(4):839-845.&#xD;
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4. Robinson IA, McKee G, Nicholson A, D&amp;#39;Arcy J, Jackson PA, Cook MG&#xA0;et al.&#xA0;Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet &#xA0;1994;343:947-949.&#xD;
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6. Cherath SK, Chithrabhanu SM. Evaluation of Masood&amp;#39;s and Modified Masood&amp;#39;s Scoring Systems in the Cytological Diagnosis of Palpable Breast Lump Aspirates.&#xA0;J Clin Diagn Res 2017;11(4): EC06-EC10.&#xD;
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7. Masood S, Frykberg ER, McLellan GL, Scalapino MC, Mitchum DG, Bullard JB. Prospective evaluation of radiologically directed fine-needle aspiration biopsy of nonpalpable breast lesions. Cancer 1990;66:1480-1487.&#xA0;&#xD;
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8. Masood S, Frykberg ER, McLellan GL, Dee S, Bullard JB. Cytologic differentiation between proliferative and non-proliferative breast disease in mammographically guided fine-needle aspirates. Diagn Cytopathol 1991;7:581-590.&#xD;
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10. Rekha TS, Nandini N, Dhar M. Expansion of Masood&amp;#39;s Cytologic Index for breast carcinoma and its validity. J Cytol 2013;30:233-236.&#xD;
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11. Das AK, Kapila K, Dinda AK, Verma K. Comparative evaluation of grading of breast carcinomas in fine-needle aspirates by two methods. Indian J Med Res 2003;118:247-250.&#xD;
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12. Lingegowda JB, MuddeGowda PH, Ramakantha CK, Chandrasekar HR. Cytohistological correlation of grading in breast carcinoma. Diagn Cytopathol 2011;39:251-257.&#xD;
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13. Saha K, Raychaudhuri G, Chattopadhyay BK, Das I. Comparative evaluation of six cytological grading systems in breast carcinoma. J Cytol 2013;30:87-93.&#xD;
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14. Phukan JP, Sinha A, Deka JP. Cytological grading of breast carcinoma on fine-needle aspirates and its relation with histological grading. South Asian J Cancer 2015;4:32-34.&#xD;
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15. Srivastava P, Kumar B, Joshi U, Bano M. To evaluate the applicability of parameters of cytological grading systems on aspirates of breast carcinoma. J Cytol 2018;35:15-21.&#xD;
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16. Dawande P, Bhatt N, Noman O, Bahadure S, Bhake A. Correlation between cytological and histological grading of breast cancer and its utility in patient&#x2019;s management. Int J Curr Res Rev 2020;12(14):71-76.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Detection of Methicillin-resistant Staphylococcus aureus using Chromogenic Agar and their Antimicrobial Susceptibility Pattern&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>39</FirstPage><LastPage>43</LastPage><AuthorList><Author>Priyadarshini Bhoi</Author><AuthorLanguage>English</AuthorLanguage><Author> Bichitrananda Swain</Author><AuthorLanguage>English</AuthorLanguage><Author> Sarita Otta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Methicillin-resistant S. aureus (MRSA), a major nosocomial pathogen is a challenge in treatment as it is ineffective to most antibiotics. So quick and accurate detection of MRSA is essential to avoid treatment failure and to contain the spread of this organism. Objective: This study aims to compare the conventional cefoxitin disc diffusion method with MRSA Chrom agar method for detection of MRSA and to note the resistance pattern of the organisms. Methods: In this prospective study S.aureus identified using conventional methods for the pus, nasal swabs and blood samples as a part of surveillance by hospital infection control unit. All S.aureus were screened for methicillin resistance by cefoxitin disk diffusion, MIC (by Vitek 2) and MRSA Chromagar.S.aureus ATCC strains were used for quality control. Antibiotic sensitivity was done by Kirby Bauer&#x2019;s disc diffusion method using CLSI guidelines. Data maintained in Microsoft office Excel was analyzed with statistical tools such as the Chi Square test for significance. Results: Out of 125 S. aureus isolated, 48 (38.4%) were MRSA. By cefoxitin disk diffusion method the sensitivity and specificity were 100% and 100% respectively when compared with Vitek2 MIC while, the sensitivity and specificity of Chromagar-MRSA were93.75% and 97.36%, respectively. The earliest turnaround time for MRSA identification with the conventional method was 48 hours (37.5%) only while by Chrom agar detection 91.11% were identified in the first 24 hours itself. All MRSA isolated were susceptible to Vancomycin, Linezolid and resistant to commonly used antibiotics. Conclusions: Cefoxitin disk diffusion method is having higher sensitivity and specificity for MRSA detection than the Chrom agar MRSA method. As the later is having good sensitivity, specificity and can detect the majority of MRSA with a significantly less TAT, it can be used for screening of MRSA.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cefoxitin resistant, S. aureus, MeReSachrom agar, MRSA, Vitek</Keywords><Fulltext>Introduction&#xD;
&#xD;
Staphylococcus aureus is a common human commensal well as a pathogen causing widespread infections.1 Infection caused by S. aureus specially Methicillin resistantS.aureus(MRSA) is associated with significant morbidity and mortality.2 The incidence of nosocomial as well as community-acquired infections caused by MRSA&#xA0; is increasing worldwide.3 This further promotes to the overuse of anti-MRSA drugs which has led to the emergence of vancomycin-resistant and intermediateS. aureus.4 Preventive strategies include hand hygiene practices properly with cleaning and disinfection and timely identification and isolation of MRSA from colonized or infected patients.5 So MRSA screening is important for epidemiologic and therapeutic reasons. To identify these strains in clinical samples, screening methods should have high sensitivity and specificity and early reporting is of paramount importance to reduce its further spread. A solution for this is by use of selective media and chromogenic agar media containing cefoxitin which can be useful for identification ofStaphyloccus aureus and MRSA in one step from clinical samples.6So this study was designed to know the best method for early MRSA detection and its prevalence by comparison of chromogenic agar (MeReSa chrome agar) with other conventional detection methods. One of the MRSA preventive strategies is also proper &amp; effective treatment of MRSA infected patients. So to choose the appropriate antibiotic or for empiric therapy knowledge of the resistance, the pattern is of utmost importance.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Sample collection&#xD;
&#xD;
This prospective study was performed in the Microbiology Department of IMS and SUM hospital from January to June 2020. The samples included were the surveillance culture of the hospital infection team which consisted of blood, pus or wound swabs and nasal swabs of indoor patients with septicemic or pyogenic infection. In the study period, 414 total samples i.e. 299 pus samples, 45 blood culture and 70 nasal swabs were received by the hospital infection control unit.&#xD;
&#xD;
Isolation of S. aureus &#xD;
&#xD;
Nasal swab &amp;pus samples were cultured on 5%sheep blood agar (BA), MacConkey&#x2019;s agar(MCA). Blood sample collected in blood culture bottles was cultured by the automated blood culture system (BacT/Alert, Bio Merieux). The specimen signalling growth were subcultured on above media and incubated at 35&#xB0;C in 5%CO2for 18-24 hours. Opaque, beta haemolytic colonies having positive for catalase, slide &amp; tube coagulase test, growth on mannitol salt agar and Gram-positive cocci on microscopy, were identified as S.aureus.&#xD;
&#xD;
Detection of MRSA by cefoxitin disc method&#xD;
&#xD;
On Mueller&#x2013;Hinton agar plates all strains of S. aureus with a suspension of 0.5 McFarland were tested with 30 &#xB5;g cefoxitin discs (Hi-Media). After 16&#x2013;18 h of incubation at 37&#xBA;C it was interpreted according to CLSI (2017) criteria as per the size of the zone of inhibition; susceptible if &gt;22 mm and resistant if it is </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3381</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3381</Fulltext></URLs><References>&#xD;
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	Anand KB, Agrawal P, Kumar S, Kapila K. Comparison of cefoxitin disc diffusion test, oxacillin screen agar, and PCR for mecA gene for detection of MRSA. Indian J Med Microbiol 2009;27(1):27-29.&#xD;
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	Sharma S, Srivastava P, Kulshrestha A, Abbas A.Evaluation of different phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus and antimicrobial susceptibility pattern of MRSA. &#xA0;Int J Community Med Public Health 2017;4(9):3297-3301.&#xD;
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	Poojary AA, Bhandarkar LD. Rapid identification of Meticillin Resistant Staphylococcus aureus (MRSA) using chromogenic media (BBL CHROM agar MRSA) compared with conventional methods. Int J Curr Microbiol App Sci 2015;4(4):939-947.&#xD;
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	Anupurba S, Sen MR, Nath G, Sharma BM, Gulati AK, Mohapatra TM. Prevalence of methicillin-resistant Staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiol 2003;21:49&#x2013;51. &#xD;
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	Datta P, Gulati N, Singla N, Butta H. Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns. Department of Microbiology, Government Medical College Hospital, Chandigarh, India. J Med Microbiol 2011;60:1613&#x2013;16 &#xD;
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Kalayadav ML, Panicker GJ. Prevalence and antibiogram of methicillin-resistant Staphylococcus aureus isolated in a&#xA0;tertiary care hospital in Bangalore, South India. Int J Curr Res Rev 2014; 17(6) :37-40.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Aquasomes: A Self-Assembled Nano-Particulate Carrier System&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>44</FirstPage><LastPage>52</LastPage><AuthorList><Author>Ajay Kumar Gupta</Author><AuthorLanguage>English</AuthorLanguage><Author> Diptee Gupta</Author><AuthorLanguage>English</AuthorLanguage><Author> Vedant Gupta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>In the last few decades, nanobiotechnology emerged as a novel approach for those drugs that face challenges to deliver in conventional dosage forms. Nanoparticles, liposomes, niosomes, quantum dots and aquasomes are some major different type of nano-biotechnologically developed carrier system. The aquasomesare one of the emerging approach and ideal choice of drug delivery comprises of the nano-particulate self-assembled carrier system. In the development of ceramic nanoparticles, aquasomes proved as a significant drug delivery system. Aquasomes are the three-layered structure, fabricated from the solid crystalline core, coated with carbohydrates on to which biologically active drug molecules are adsorbed. The solid core confers the structural stability, whereas the polyhydroxy oligomer coating protects against dehydration and confers stability to active drug molecules. Formulations of aquasomes are mainly administered by parenteral route but new studies suggest that it could also be administered by other routes. Aquasomes delivers their bioactive molecules via a combination of special targeting molecular shielding and sustained release process. Hydroxyapatite core-based aquasomes are broadly used for the preparation of implants. Aquasomes possess properties of maintaining conformational integrity, and a high degree of surface exposure, which is successfully targeted for the delivery of peptide molecules such as insulin, haemoglobin; enzymes like serratiopeptidase and also aid in targeting vaccine and gene to specific sites. The present article is an attempt to focus on the possible revolutionary applications of aquasomes.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Nanobiotechnology, Aquasomes, Carrier system, Novel drug delivery</Keywords><Fulltext>&#xD;
INTRODUCTION&#xD;
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Aquasomes are nano-particulate carrier system but instead of being simple nanoparticles, these are three-layered self-assembled structures, comprised of a solid phase nano-crystalline core coated with an oligomeric film to which biochemically active molecules are adsorbed with or without modification.1 So &#x201C;aquasomes&#x201D; are carbohydrate stabilized nanoparticles of the core which was first developed by NirKossovsky in 1995. Alternatively, aquasomes are termed as &#x201C;Bodies of Water&#x201D;, their water like properties support and sustain fragile biological molecules such as polypeptide and proteins. The function of preserving confirmative integrity and a high degree of surface exposure is used to target and deliver bioactive molecules such as peptides and protein hormones, antigens and genes to specific locations where the action is required.2&#xD;
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The aquasomes made up of ceramic core are stabilized by carbohydrates and by using methods like co-polymerization, diffusion or adsorption; the pharmacologically active molecules are incorporated on to the carbohydrate surfaces of preformed nanoparticles.3 Aquasomes composed of three-layered structure: solid crystalline core, carbohydrate coat and the active drug which are self-assembled by non-covalent bonds (Figure 1). The core is coated with polyhydroxy oligomers onto which bioactive molecules are adsorbed. The solid core provides structural ability while carbohydrate coating plays an important role and acts like a natural stabilizer which protects against dehydration and stabilizes the biochemically active molecules.4&#xD;
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Figure 1: Schematic diagram of Aquasome. It has 3 layers. 1. Solid Crystalline Core 2. Polyhydroxy oligomer coat 3. Bioactive molecules.&#xD;
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Aquasomes are spherical 60&#x2013;300 nm particles. Mainly three types of core materials are used for developing aquasomes i.e. Tin oxide, Nanocrystalline carbon ceramics (diamonds) and Brushite (calcium phosphate dihydrate).&#xA0; Aquasomes offer an attractive mode of delivery for drugs which are having problems such as route of delivery, physical as well as chemical instability, poor bioavailability and potent side effects.5 The discovery of aquasomes include &#xA0;concept from food chemistry, microbiology, biophysics and frequent discoveries including solid-phase synthesis, supramolecular chemistry, molecular shape change and self-assembly.6&#xD;
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&#xA0;PROPERTIES OF AQUASOMES&#xD;
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	Aquasomes prevent clearance via the reticuloendothelial system or degradation by other environmental problems because of their size and structural stability.&#xD;
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	Due to its large size and active surface, Aquasomes can be loaded with adequate amounts of agents via non-covalent, ionic bonds, van der Waals and entropic forces successfully.7&#xD;
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	The mechanism of action of aquasomes is governed by their surface chemistry.&#xD;
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	The combination of various processes like specific targeting, molecular shielding, and slow and sustained release processes involved in the delivery of the active drug via aquasomes.8&#xD;
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	Water like properties of aquasomes provides a platform for preserving the conformational integrity and biochemical stability of bio-active.7&#xD;
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	Aquasomes as a carrier also protects the drug/antigen/protein from harsh pH conditions and enzymatic degradation, thus requiring lower doses.6&#xD;
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PRINCIPLE OF SELF-ASSEMBLY&#xD;
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Self-assembly means that in two or three-dimensional space, the constituent parts of any final product assume the spontaneously prescribed structural orientations. The three-layered structure are self-assembled by non-covalent bonds.7Self-assembly in the aqueous environment of macromolecules have the virtue to design itself in smart nanostructured materials, which is primarily governed by three physicochemical processes;&#xD;
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	Interaction between charged groups: Interactions of charged groups such as amino, carboxyl, sulphate, and phosphate-groups, facilitate the long-range approach of self-assembling subunits. From the biological environment, the intrinsic chemical groups or adsorbed ions impart a polarity charge to biological and synthetic surfaces. Most biochemically related molecules are amphoteric molecules.9For the first phase of self-assembly, the long-range interaction of constituent subunits begins at an intermolecular distance of around 15 nm. Long-range forces can extend to 25 nm in the case of hydrophobic structures. Charged groups also play a part in the stabilisation of folded protein tertiary structures.&#xD;
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	Hydrogen bonding and dehydration effect: Hydrogen bond plays an important role in base pair matching and help to stabilize the secondary protein structure such as alpha helices and beta sheets. Hydrophilic molecules that form hydrogen bonds, provides the surrounding water molecules with a significant degree of organisation. Whereas hydrophobic molecules unable to form hydrogen bonds, having the ability to repel water molecules from their surroundings to organize the moiety. Organized water decreases the entropy of the surrounding environment. Since it is thermodynamically unfavourable, the molecule dehydrates and get self-assembled.10&#xD;
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	Structural stability: In the biological environment, structural stability of protein determined by the interaction between charged group and hydrogen bonds largely external to the molecule and by Van der Waals forces which responsible for hardness and softness of molecule and maintenance of internal secondary structures, provides sufficient softness, allows maintenance of conformation during self-assembly.9Van der Waals forces often experienced by the relatively hydrophobic molecular regions that are shielded from water, play a subtle but critical role in maintaining molecular conformation during self-assembly.11&#xD;
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In the case of aquasomes, sugars help in molecular plasticization.12 Van der Waals forces also play a small but measurable role in the interaction of polypeptides with carbohydrates and related polyhydroxy-oligomers. When molecules change their shape considerably following an interaction, the energy minima assumed upon conformational denaturation tend to block reversal.10&#xD;
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OBJECTIVES OF AQUASOMES&#xD;
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	The main objective of preparing aquasomes is to protect bio-actives.&#xD;
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	Aquasomes maintain molecular conformation and optimum pharmacological activity.9&#xD;
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	Many other delivery systems like pro-drugs, liposomes are prone to destructive interactions between drug and carrier while aquasomes have carbohydrate coating prevents destructive denaturing interaction between drug and solid carriers.13&#xD;
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	Aquasomes with natural stabilizers like various polyhydroxy sugars act as dehydroprotectant, help in maintaining water-like state and preserves molecules in dry solid-state, protecting from the change in aqueous state, pH, temperature, solvent, salt causing denaturation.8,14&#xD;
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	An active molecule has characteristics such as unique three-dimensional conformation, freedom of internal molecular rearrangement caused by the freedom of bulk motion molecular interactions, but protein initiates irreversible denaturation when desiccated, even unstable in an aqueous state.10, 14&#xD;
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STRATEGIES USED IN THE CHEMICAL SYNTHESIS OF AQUASOMES&#xD;
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Aquasomes are self-assembled three-layered nanostructure molecules. Hence the strategies involved in chemical synthesis of these nanostructures discussed below.&#xD;
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	Sequential covalent synthesis: This strategy is used to produce arrays of covalently linked atoms with well-defined composition, connectivity and shape such as Vitamin B12, it can produce the structures that are distant from the thermodynamic minimum for collection of atoms.15&#xD;
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Covalent polymerization: This strategy is used to prepare molecules with high molecular weight. Low weight substances are permitted to react with itself to yield molecules, including many covalently associated monomers.15 Such as Formation of polyethene from ethylene. Covalent polymerization indirectly provides synthetic routes to stable nanostructures and phase-separated polymers.3&#xD;
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Self-organizing synthesis: This strategy depends on weaker and less directional bonds such as hydrogen, ionic and Van der Waals interactions to assemble atoms, ions or molecules into structures.8 The different types of formulation are prepared by the use of this strategy include molecular crystals, ligand crystals, emulsions, colloids, micelles, self-assembled monolayers and phase-separated polymers. The ion or molecules adjust their position to reach the thermodynamic minimum and get self-organize, during formulation.16&#xD;
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Molecular self-assembly: Self-assembly is a process in which a disorganized structure with pre-existing components forms an organized structure or design. Aquasomes self-assembly has various interesting applications in nanoscience and nanotechnology formulation development.15,16&#xD;
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COMPOSITION OF AQUASOMES&#xD;
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	Core material: Widely used core materials are ceramic and polymers. Ceramics such as diamond particles, brushite (calcium phosphate) and tin oxide are crystalline easy to manufacture, biodegradable in nature, low cost and biocompatible. It provides a high degree of order and structural regularity. Due to the high degree of order, higher surface energy yields which leads to efficacious binding of carbohydrate onto it. These properties making it a good candidate for aquasome formulation.17 Polymers such as albumin, gelatin or acrylate are used.18&#xD;
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	Coating material: Cellobiose, pyridoxal 5 phosphate, sucrose, trehalose, chitosan, citrate etc. are widely used coating materials. As a natural stabilizer, carbohydrate plays a crucial role and it is preferred mostly. Carbohydrates are adsorbed as a glassy film in nanometre size range coating the preformed ceramic-nanoparticles and self-assembled calcium phosphate dihydrate particles (colloidal precipitation).19The carbohydrate used this purpose are as&#xD;
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	Cellobiose: It is 4-O-beta-D-glucopyranosyl-D-glucopyranose reducing sugar. It is acquired from the partial hydrolysis of cellulose. It protects the drug molecule against the dehydration.20&#xD;
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	Trehalose: It is an alpha-D-glucopuyranosyl-alpha-D-glucopyranoside non-reducing sugar. Trehalose also shields the drug molecule against dehydration and denaturation. It is observed more effective than cellobiose.20It shown to be tolerant of stress in fungi, bacteria, insects, yeast and some plants. Trehalose acts by protecting proteins and membranes within plant cell during the desiccation process and thus preserves cell structures, inherent flavours, colours and texture.21&#xD;
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Disaccharides like sucrose, trehalose contain a large number of hydroxyl groups and help to replace the water with polar protein residues. Thus it maintains their integrity in the absence of water. Experimental studies done with Calcium transporting microsomes isolated from rabbit muscles and lobster muscles showed that the structure and function of cellular components could be protected by sugar during lyophilisation.22The rehydrated vesicles displays drastically decreased calcium-uptake and uncoupled activity of ATPase when Calcium transporting microsomes are lyophilized without stabilizer sugar. Lyophilized vesicles are morphologically distinct from newly prepared vesicles in presence of as little as 0.3 g of trehalose per g. membrane upon rehydration.21, 23&#xD;
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	Bio-active molecules: Drugs which have the property of interacting with the film via non-covalent and ionic interactions proved a good candidate for aquasomes.22&#xD;
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Among three layers of aquasomes, carbohydrate fulfils the objective of aquasomes. The hydroxyl groups on carbohydrate interact with polar and charged groups of proteins, in the same way as with water thus preserve the aqueous structure of proteins on dehydration.23&#xD;
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&#xA0;METHOD OF PREPARATION OF AQUASOMES&#xD;
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Aquasomes preparation is a very simple and effortless process which require minimum solvent usage and no homogenization steps. By using the principle of self-assembly, the aquasomes are prepared in three steps, i.e., Formation of the core, coating of the core, and immobilization of drug molecule (Figure 2).4 &#xD;
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Formation of core material: The first step in the formulation of aquasomes is the development of the ceramic core. The method of ceramic core preparation depends on the choice of core materials. These ceramic cores can be built by various processes such as colloidal precipitation, sonication, inverted magnetron sputtering, and plasma condensation etc.24 In the preparation of core, the most regular material preferred which is ceramic. Two ceramic cores that are generally used diamond and calcium phosphate.&#xD;
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Figure 2: Method of preparation of aquasomes. It involves three steps- a) Ceramic core is prepared first by a different process such as colloidal precipitation, sonication etc. b) In 2nd step ceramic core is coated by polyhydroxy compound c) In 3rd step loading of the drug is done by partial adsorption.&#xD;
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a) &#xA0;Synthesis of Nanocrystalline tin oxide core&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; It can be synthesized by direct current reactive magnetron sputtering. Under a high-pressure mixture of argon and oxygen, the high purity tin is blown from a diameter of 3 inches. Ultrafine particles deposited on a copper tube in a gaseous phase and cooled to 77 K with the flow of nitrogen.3&#xD;
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b) Self-assembled Nanocrystalline brushite (calcium phosphate dihydrate)&#xD;
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It can be synthesized by various processes such as co-precipitation, self-precipitation, sonication and PAMAM methods.&#xD;
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(i) Co-precipitation: Diammonium hydrogen phosphate solution is added dropwise to calcium nitrate solution with continuous stirring. The temperature is maintained at 75&#xB0;C in a flask bearing a charge funnel, a thermometer, a reflux condenser fitted with a carbon dioxide trap.24, 25The pH of calcium nitrate is maintained 8-10 using the concentrated aqueous ammonia solution. Under the above-mentioned condition, the mixture is magnetically stirred. The precipitates are then filtered, washed and finally dried overnight. In an electric furnace, the powder was sintered by heating to 800&#x2013;900&#xB0;C26.&#xD;
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(ii) Sonication: Using ultrasonic bath, the solutions of disodium hydrogen phosphate and calcium chloride were mixed and sonicated. Equivalent moles of both reagents are used. For 2 hrs, the temperature was maintained at 4 &#xB0;C. The ceramic core is separated by centrifugation and then washed, resuspended in distilled water and filtered. The core material retained on filter paper is collected and dried appropriately.&#xD;
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(iii) Poly (Amidoamine) PAMAM: PAMAM was dissolved in the simulated body fluid of pH 7.4 and placed it for 1 week at 37 &#xB0;C to induce nucleation and crystal growth. By the addition of the NaOH solution, the pH of the solution was adjusted. The precipitate formed was washed multiple times with deionized water. Then it was filtered and dried overnight.28&#xD;
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c) Nanocrystalline carbon ceramic, diamond particle: These ceramic may also be used for the core synthesis after ultra-cleansing and sonication. The main property of these core is crystalline.3&#xD;
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d) Coating of the core with polyhydroxy oligomer&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Commonly used coating materials are cellobiose, citrate, pyridoxal 5 phosphate, trehalose and sucrose. It is the second step in which ceramic cores are coated with carbohydrates. By the addition of carbohydrate into an aqueous dispersion of the cores under sonication, the coating is carried out. These are then subjected to lyophilization which provides irreversible adsorption of carbohydrate onto the ceramic surface. The unadsorbed carbohydrate is removed by centrifugation.26&#xD;
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e) Immobilization of drug molecule&#xD;
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Loading of the drug to coated particles by partial adsorption is the final step for the preparation of aquasomes. A solution of known concentration of the drug is prepared at suitable pH buffer. Coated particles are dispersed and at low temperature, dispersion is kept at overnight for drug loading or lyophilized.27After sometime drug-loaded formulation obtained, then characterized using various techniques.&#xD;
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FATE OF AQUASOME&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Self-assembled aquasomes are biodegradable nanoparticles that accumulate more in liver and muscles.21 The drug&#x2019;s pharmacological or biological activity can be accomplished instantly as it is detected without any surface alteration on the surface of the system and cannot find any difficulty in identifying receptor on the active site.29&#xD;
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In vivo studies predict, biodegradation of ceramic is achieved by monocytes and multicellular cells called osteoclasts because they intervene first at the biomaterial implantation site during an inflammatory reaction.30 Two types of phagocytosis process were observed-when cells come in contact with biomaterial; either calcium phosphate crystals were taken up alone and then dissolved in the cytoplasm after the disappearance of the phagosome membrane or dissolution after the formation of the hetero phagosome.31 Phagocytosis of calcium phosphate coincided with autophagy and the deposition of residual bodies in the cell.&#xD;
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EVALUATION PARAMETER OF AQUASOMES&#xD;
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Aquasomes mainly evaluated and characterized by their various morphological and structural property of their core and polyhydroxy oligomer coating structure.&#xD;
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	&#xA0;Evaluation parameter for core material&#xD;
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Size distribution&#xD;
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Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) techniques are used for particle size distribution and morphological analysis.25To determine the particle size, samples were placed on the surface of a specimen stub coated with gold using double-sided adhesive tape in SEM while in case of TEM, particle size is determined after negative staining with phosphotungstic acid.31Coated core, as well as drug-loaded aquasomes are also analysed by these techniques.&#xD;
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Characterization (FTIR)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Fourier transform infrared spectroscopy (FT-IR) spectroscopy used for determining structural analysis. Potassium bromide sample disk method is used.32 Both the core and coated core can be analyzed by recording their IR spectra in the wavenumber range 4000 - 400 cm1.The characteristic peaks are observed and tally with reference peaks.33Stability of the drug in the formulation can be also determined by this technique.&#xD;
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X-ray diffraction&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To study crystalline or amorphous nature of a material X-ray diffraction study is performed. The hydroxyapatite ceramic core is analysed by exposing the core to copper (Cu), potassium (K) radiation in a wide-angle X-ray diffractometer.30 After that the x-ray diffraction pattern of the sample is compared with the standard diffractogram, based on which the interpretations are made.32In a study, it was observed that calcium phosphate core, lactose individually gave identical sharp peaks for crystalline peaks but when carbohydrate coated cores were observed, peaks represented an amorphous structure.34 It may be the reason for the coating technique (solubilization of carbohydrate insolvent and subsequent drying by lyophilization) and saturation of the surface of the core with carbohydrate (Figure 3).35&#xD;
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Figure 3: Evaluation parameter of aquasomes. Aquasomes consist of 3 layers and all 3 layers are evaluated for evaluation of aquasomes. In the figure, all methods for evaluation of each layer is enlisted.&#xD;
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Evaluation parameter for coated core&#xD;
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Carbohydrate coating: Coating of sugar over the ceramic core can be confirmed by Concanavalin A-induced aggregation method, Anthrone reaction and Phenol sulphuric acid method. In table 1 these methods are described.&#xD;
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Zeta potential measurement&#xD;
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The adsorption of sugar over the core and the prediction of storage stability determined by the measurement of zeta potential. Some studies indicated that with the increase in the saturation process by carbohydrate on to the hydroxyapatite core, the more decrease in zeta potential value.33&#xD;
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Glass transition temperature&#xD;
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Differential Scanning Calorimetry (DSC) studied used to analyse the glass transition temperature of carbohydrates and protein. DSC used to study the effect of carbohydrate on the drug-loaded to aquasomes.34The transition from glass to rubber state can be measured using a DSC analyser as a change in temperature upon melting of glass.&#xD;
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	Evaluation parameter of drug-loaded aquasomes&#xD;
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&#xA0;Drug loading efficiency&#xD;
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It is done to evaluate the amount of drug which is bound on the surface of aquasomes. The drug loading can be determined by incubating the aquasome formulation without the drug in a known concentration of the drug solution for 24 hrs at 4&#xB0;C.29 After that supernatant is separated by high-speed centrifugation for 1 hrs at low temperature in a refrigerated centrifuge.37Then the clear extractive supernatant is filtered and analyzed free drug content by UV spectrophotometer. The drug payload/drug loading is calculated by the following formula-&#xD;
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% Drug loading=(Weight of total added drug-weight of the unentrapped drug )/(Weight of aquasomes)&#xD7;100&#xD;
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&#xA0;In vitro drug release studies&#xD;
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The in vitro release kinetics of the loaded drug is done to study the release pattern of the drug from the aquasomes. Incubate a known quantity of drug-loaded aquasomes in a buffer of suitable pH at 37&#xB0;C with continuous stirring.35 Samples are extracted from time to time and centrifuged for some periods at high speeds. After each withdrawal, equivalent medium volumes must be substituted. Then supernatants are analyzed to estimate the amount of released drug.38&#xD;
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	In-process stability studies&#xD;
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SDS-PAGE (sodium dodecyl sulphate polyacrylamide gel electrophoresis) can be used to assess the stability and integrity of protein during the formulation of the aquasomes.36&#xD;
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ADVANTAGE OF AQUASOMES&#xD;
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	Aquasomes systems act as a reservoir to release the molecules either in a continuous or a pulsatile manner, avoiding a multiple-injection schedule.39&#xD;
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	Aquasomes based vaccines offer many advantages as a vaccine delivery system. Cellular and humoral immune responses can be elicited to antigens adsorbed on to aquasomes.36&#xD;
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	Aquasomes improves the pharmaceutically active agent&#x2019;s therapeutic effectiveness and defends the medication from phagocytosis and degradation.36&#xD;
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	These nanoparticles offer a favourable environment for proteins thereby avoiding their denaturalization.&#xD;
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	Enzyme activity and molecular conformation sensitivity have made aquasome a novel carrier for enzymes such as DNaseand pigment/dyes.&#xD;
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	Multi-layered aquasomes conjugated with biorecognition molecules such as antibodies, nucleic acid, peptides which are known as biological labels can be used for various imaging tests.39&#xD;
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APPLICATION OF AQUASOMES&#xD;
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	Oral delivery of acid-labile enzyme&#xD;
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Rawat et al developed a nanosized ceramic core-based system for oral administration of the acid-labile enzyme serratiopeptidase, prepared by colloidal precipitation under sonication at room temperature coated with chitosan under constant stirring. By further encapsulating the enzyme-loaded core into an alginate gel, the enzyme was secured. The TEM images of particles showed them with a spherical shape and an average diameter of 925 nm.40 Particle enzyme-loading was found to be approximately 46%. Both stability and integrity of enzyme during formulation steps was evaluated by in vitro proteolytic activity. The results revealed these aquasomes protect the structural integrity of enzymes, resulting in a more potent therapeutic effect.31&#xD;
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	Insulin and Insulinomimetics delivery&#xD;
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The parenteral delivery of insulin, via aquasomes, done by Cherian et a.l using a calcium phosphate ceramic core. Several disaccharides such as trehalose, cellobiose, and pyridoxal-5-phosphate used for coating the core. The drug loading to the coated cores performed via adsorption process.32The in vivo activity of aquasome formulations of insulin assessed by using albino rats. Pyridoxal-5-phosphate-coated particles found more effective in reducing blood glucose levels as compared to particles coated with Trehalose or Cellobiose. The prolonged activity as a result of the slow release of drug from the carrier as well as the structural stability of the peptide.41&#xD;
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Insulinomimetics aquasomes formulated by colloidal precipitation. Disodium hydrogen phosphate and calcium chloride solution sonicated at low temperature and then cores were coated with disaccharides and immediately loaded with polypeptide- k. In vivo activity evaluated by using albino Wistar rats.42Studies indicated that trehalose coated aquasomes released polypeptide- k faster than cellobiose coated aquasomes. It also reported that polypeptide- k oral delivery did not cause any significant change in serum glucose level.43&#xD;
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	Delivery of antigens &#xD;
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The adjuvants usually used to boost the antigen immunity appear either to modify antigen confirmation by surface adsorption or to shield the functional groups. The effectiveness of a new adapted ceramic antigen delivery vehicle is thereby formulated and evaluated by Kossovskyet al. These particles were diamond substrate wrappedin an aqueous dispersion with a glassy carbohydrate (cellobiose) layer and immunologically active surface molecule.38These aquasomes having size range 5&#x2013;300nm provided both conformational stabilization and a high degree of surface exposure to protein antigen.42 Due to high surface energy, the diamond was the first choice for adsorption and adhesion of cellobiose. It provided a colloidal surface which is capable of hydrogen bonding to the proteinaceous antigen.40 The disaccharide helps to minimize the surface-induced denaturation of adsorbed antigens (muscle adhesive protein, MAP).42&#xD;
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In other studies, BSA (Bovine serum albumin) loaded aquasomes formulated by self-assembling of hydroxyapatite using the co-precipitation method. Trehalose and cellobiose have been used as coating materials. The antigen-loading efficiency was found to be about 20-30%. This BSA loaded aquasomes showed more potent immunological activity compared to that of plain bovine serum albumin, after SC injection.21, 36Aquasomes of malarial merozoite surface protein 119 (MSP-119) were formulated by co-precipitation method using hydroxyapatite nano-ceramic carriers. The small size and large surface area of the prepared hydroxyapatite showed good absorption immunogens efficiency. Slower in vitro antigen release and slower biodegradability activity were also seen in prepared nanoceramic formulations, which may lead to prolonged exposure to antigen-presenting cells and lymphocytes.40,43&#xD;
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d. As oxygen transporter&#xD;
&#xD;
In one study, hydroxyapatite core was prepared by Khopade et a.l using carboxylic acid-terminated half-generation poly (amidoamine) dendrimers, covered with trehalose trailed by adsorption of haemoglobin.44,45 The particle size, drug loading capacity and oxygen-binding properties of formulation were studied. In vivo studies carried out in rats demonstrated that aquasomes</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3382</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3382</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Efficacy of Orthotic Management in Haemophilia: A Narrative Review of Clinical Implication and Scope of Improvement&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>53</FirstPage><LastPage>58</LastPage><AuthorList><Author>Akshay Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Vinita</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>The patients with haemophilia disorder of blood clotting system characterized by excessive bleeding at the site of trauma and surgery and bleeding into soft tissue and joints, which may result in disability due to changing bony structure and cartilage destruction. Both haemarthrosis and hemophilic arthropathy (HA) badly affect the gait pattern and ultimately quality of life of a hemophilic patient. The objective is to conduct the narrative review and synthesis of published literature to highlight the current trends of treatment in hemophilic haemarthrosis and arthropathy and narrate the need of future trends and demand to uplift the user&#x2019;s experience and quality of life. A cross-sectional randomized literature search in PubMed, Wiley, Research Gate, Google Scholar, etc done and articles synthesized to extract the line of orthotic treatment in haemophilia and its efficacy. Although there is limited literature about the orthotic treatment in hemophilic patients are available, the results of various orthosis implication in hemarthrosis and arthropathy are encouraging. Despite the complication like synovitis and arthropathy in haemophilia are manageable today, there is a need to look into the changes in orthotic practice consideration, policy development, and further research development targeting the inclusive well-being of a hemophilic patient.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Haemophilia A, Blood coagulation disorders, Orthotic devices, Foot orthoses, Rehabilitation, Joint diseases</Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Haemophilia is an X-linked genetic disorder of the blood clotting system characterized by excessive bleeding at the site of trauma and surgery and bleeding into soft tissue and joints, causing synovial inflammation, iron deposition, cartilage destruction, and bony changes. These arthritic changes cause pain and alter the activity of daily living-altering the movement. In individuals with arthropathy, reported changes from controls to include increases in swing time, stance time, double support, single support, and base of support. Decreases from controls include step length and normalized velocity.1 Haemophilia can be categorized into three types namely Haemophilia A (factor VIII deficiency), Haemophilia B or Christmas disease (factor IX deficiency), and Haemophilia C or Rosenthal syndrome (low levels of factor XI. However, Haemophilia C differs from Haemophilia A &amp;B in the pattern of bleed tendency and the cause.2 &#xD;
&#xD;
Haemophilia, an inherited single X gene disorder arises in the individual through spontaneous /auto mutations or through the known risk of family, gene disorder is assumed to affect 1per 10,000 birth. The birth prevalence of genetic disorders is likely to be high in India due to due to the high birthrate of 21.8 and the largest birth cohort globally3. A meta-analysis study on the incidence of haemophilia recently done indicate that more than 1,125,000 individual across the world is having a bleeding disorder of inheritance. However, in the past, it was considered only around 400,000 only. The expectancy of life for those having haemophilia is significantly less than a normal person, especially in less resource setting areas and countries, where lack of inclusive treatment and rehabilitation leads to chronic joint disorders and organ bleeding result in death and disability. Also, it weakens individual and family, psychologically, and economically.4,5 As per the 2011 census of India, according to population data, the prevalence of haemophilia A is recorded 4 per 1, 00,000. Nearly 70,000 patients with haemophilia are estimated with 48,407 with Haemophilia A. Intervention of medical and rehabilitation approach is indicated to improve the quality of life of hemophilic to decrease the burden of family and society.3 Haemophilia is included among the 21 types of disabilities categorized by govt. of India under Rights of Persons with Disabilities (RPwD), Act 2016, which gives them equal rights and opportunities as others.6 &#xA0;The review is aimed to communicate the best clinical orthotic treatment available to hemophilic patients with evidence. Also, focusing on future perspectives and effective approaches for inclusive care to accomplish the quality of life.&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
An online literature search was conducted through&#xA0; PubMed, Wiley,&#xA0; Research Gate, Google Scholar, Internet searches, etc using the keywords and headings related to haemophilia and orthotic intervention in the ankle, knee, hip, elbow, etc. The PubMed central mesh word search strategy followed to meet the required literature search. Language restrictions were not applied while searching the articles. These included conference proceedings, organizational reports, newsletters, media stories, and information from websites found via internet searches. Besides, the cited references in the reviewed articles were investigated. All the articles synthesized to extract the line of orthotic treatment in haemophilia and its efficacy.&#xD;
&#xD;
Anatomical joint Structure&#xD;
&#xD;
Bleeding, Joint disease of arthritis caused by frequent or inadequately treated bleeding into&#xA0;joints, heart disease, and renal disease are common in a cohort of males with haemophilia7,8. Spontaneous joint bleeding and repeated hemarthroses cause hemophilic arthropathy with a severe impact on the quality of life and movement. Joint damage through bleeding targets joints, especially the knee, ankle, hip, and elbow, and shoulder due to weight wearing and/or movement required to perform the activities by the concerned limbs9. Iron release from joint bleeding induces a chronic inflammation, which is mediated by cytokinins and pro-angiogenic factors lead to articular cartilage damage. However, articular cartilage damage by both the inflammatory and degenerative mechanisms may occur independently. Inflammation in synovial tissue is characterized by hypertrophy, a high degree of neo-angiogenesis, and migration of inflammatory cells known as synovitis.10&#x2013;12&#xD;
&#xD;
An orthopaedic manifestation occurs like;&#xD;
&#xD;
&#xD;
	&#xD;
	Hemophilic arthropathy may lead to synovitis, cartilage destruction, joint deformity, pseudotumor, articular destruction&#xD;
	&#xD;
	&#xD;
	Intramuscular hematoma evident due to swelling, pain, local warmth, and bruising that typically appear in the overlying skin may lead to nerve compression&#xD;
	&#xD;
	&#xD;
	Iliacus hematoma can compress the femoral nerve with paresthesias in the L4 destruction&#xD;
	&#xD;
	&#xD;
	Epiphyseal overgrowth may lead to LLD (Leg Length Discrepancy) and flexion contracture, valgus deviation caused by asymmetrical growth of the epiphyses, Perthes&#x2019; disease, osteophytes, and subchondral cysts&#xD;
	&#xD;
	&#xD;
	Fracture and pain due to osteopenia13,14&#xD;
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&#xD;
In patients with haemophilia, acute haemorrhage is the most frequent, and lack of proper treatment can lead to pathological changes within the joins like pain and arthropathy, which may cause disability.15&#xD;
&#xD;
Biomechanical Principals&#xD;
&#xD;
Pain, arthropathy, and muscle bleed can often result in biomechanical deficit and affect normal neuromusculoskeletal function. In the rehabilitation process orthoses play an important role to correct, align, support, or prevent a deformity and restore function16,17. Orthoses work basically on the principle of pressure distribution, equilibrium, and lever arm. In pressure principle efficacy achieved through distributing pressure over the greater surface area to achieve minimal pressure per unit area (P=F/A), Where F is Force and A is an area of the force application. Equilibrium means the sum of the forces acting on the body through the orthotic device must be equal to zero and more comfortable and effective orthosis can be ensured by the moment arm and sufficient lever arm length18. &#xD;
&#xD;
In conjunction with other modalities orthotic devices are used for the following purpose;&#xD;
&#xD;
&#xD;
	&#xD;
	To prevent post-surgical deformity or deformity in chronic bleeding joints&#xD;
	&#xD;
	&#xD;
	To immobilize painful or bleeding joints&#xD;
	&#xD;
	&#xD;
	To correct contracture if joint deformity or contracture is there&#xD;
	&#xD;
	&#xD;
	To improve joint function maintaining Joint Range of Motion (ROM)&#xD;
	&#xD;
	&#xD;
	To provide support to weak muscles or unstable joint19&#xD;
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&#xD;
&#xD;
The lower limb is categorized for ambulation, weight support. However, the upper limb is mainly used as a functional unit utilized for prehension and fine motor movement to perform daily activities.20,21 Orthosis biomechanics is relevant to understanding joint complications, pressures problems on the limb, and altered gait deviation. A combination of forces applies through orthoses to the human body to align the postural structure and improve function.22 The main aim of orthotic management is to provide enough stability, offload, movement, and support to come closer to a near-normal gait.23 The investigation from many researchers found that orthotic implication helps reducing pain, abnormal position of body parts along with correction as an external device.24&#xD;
&#xD;
During running and walking foot orthosis users felt reduced knee pain with load transfer from the tibia to the foot during various phases of the gait cycle.25 In haemophilia, the characteristics of the orthotic device vary as per the condition of the individual joint to be treated based on the need for mobilization or immobilization. Devices are used to manage and prevent the bleeds and its counter effect on the musculoskeletal system. The main goal of orthosis intervention in such cases is to mobilize, immobilize, or offload the affected body parts to assist in ambulation and gain stability during gait.26 In modern time orthosis play a crucial role in aiming protection and correction of affected articulation in a hemophilic patient using a variety of orthotic material available worldwide. The knee joint is the most frequently affected due to the complex structure and crucial function ambulation.27&#xD;
&#xD;
Review of literature&#xD;
&#xD;
Orthotic device treatments to the body or joint to which they are applied vary according to need of implication to the individual in haemophilia to manage or prevent the bleed in the joint and muscle. The lower limb is used in ambulation; however upper limb helps in fine movement, achieving different prehension patterns and purposeful hold of an object. In hemophilic, joints need to be immobilized, stabilize,&#xA0; protect, and assist the affected joint.28,29&#xD;
&#xD;
Lower limb&#xD;
&#xD;
In the US haemophilia population, the prevalence of hip dysfunction that affects the ROM of an individual is 16.7%, respectively lower in this cohort for both ankles (45%) and Knee (42%).30 To favour early, conservative, and smooth mobilization joints need to be rested in a functional position. In a study on animals, joints indicated the weight-bearing on a bleeding joint can damage the cartilage matrix worsted as compared to the non-weight-bearing side.31 Therefore, it is recommended to use the weight relieving orthosis (KAFO, cane, crutch) to avoid weight-bearing during ambulation in the early days.32 And with modern technique in orthotic intervention as weight relieving orthosis, which transfers the body weight to the ground with an offload mechanism the hemophilic significantly improve their joint function and management of arthropathy.33&#xD;
&#xD;
Till the coagulation factor availability in a hemophilic patient, the knee joint articulation is at high risk of being affected due to complex nature and an eminent/main joint at risk of trauma or injury due to the high impact of activity or body weight during the activity of daily living. In the recent era of orthoses, intervention plays an effective role in protecting, preventing, and facilitating the desired Range of Motion (ROM) in the treatment of knee hemarthroses caused by chronic synovitis aims at normalizing the Activity of Daily Living (ADL). Quality and nature of Material also play an important role in the treatment process according to the availability of clotting factors.34&#xD;
&#xD;
In patients with haemophilia, the ankle is among the frequent site of arthropathy, and orthotic devices as foot orthosis and footwear can help relieve this pain and achieving near-normal ADL. Lightweight, strong and cushioning materials like carbon fibre and silicone may be used to improve the efficiency of the device to absorb the shear stress and torsional forces during walking. These orthoses generally provide gait patterns with offload mechanisms or restrict ankle range of motion to minimize the pain. Also, the studies favour the implication of various kinds of orthotic intervention in hemophilic arthropathy joint to improve in relief to pain, stiffness, difficulty, activity limitation, and social and emotional outcomes.35,36 A significant improvement in activity and reduction in pain found in the study done on the 16 hemophilic patients with a level of 1-5 stage of joint damage in haemophilia A. The foot pain disability measures indicated a reduction in the level of ankle hemarthrosis (bleeds) and improvement in the quality of life in all the patients using functional foot orthosis over 6 weeks period.37 &#xD;
&#xD;
Evidence found that ankle joint power generation is higher during footwear waking contrast to barefoot walking in hemophilic patients having severe ankle arthropathy (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3383</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3383</Fulltext></URLs><References>1. Jeffrey C. Miller, David Paschon EJR. The United States Patent Applications Status. https://patentimages.storage.googleapis.com/67/01/f4/7e437239d18804/US20190345208A1.pdf&#xD;
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2. &#xA0;&#xA0;&#xA0;Haemophilia A, B &amp; C: The Three Different Clotting Factor Deficiencies. (IHTC), The Indiana Haemophilia and Thrombosis Center. https://www.ihtc.org/types-of-haemophilia/&#xD;
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3.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; Kar A, Phadnis S, Dharmarajan S, Nakade J. Epidemiology &amp; social costs of haemophilia in India.&#xA0; Indian J Med Res 2014;140: 19&#x2013;31&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Profile of Pediatric Lymphadenopathy- A Cytomorphological Analysis in a Tertiary Care Center of Eastern India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>59</FirstPage><LastPage>64</LastPage><AuthorList><Author>Anasuya Lenka</Author><AuthorLanguage>English</AuthorLanguage><Author> Mohita Ray</Author><AuthorLanguage>English</AuthorLanguage><Author> Sukanya Patra</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Lymph node enlargement in the pediatric age group is multifactorial in aetiology and careful assessment of patients combining the clinico-demographic, radiological as well as pathological findings can bring light on various local and systemic diseases which can have trivial effects to even life-threatening consequences for the patients. An easy, rapid and fairly accurate method of Fine needle aspiration cytology (FNAC) is very valuable in giving preliminary diagnosis and guiding further treatment plan for the patient. Objective: To assess the diagnostic role and efficacy of FNAC in the pediatric Lymphadenopathy (LAP) cases. Methods: Data form 235 cytology reports from patients &#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Lymphadenopathy, Pediatric, Fine needle aspiration cytology</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
In the pediatric age group, lymph node (LN) enlargement is a common finding, owing to exposure of children to a wide variety of infectious agents. Majority of the children have benign self-limiting reactive enlargement of the lymph node. Lymphadenopathy (LAP) also occurs in a small percentage in this age group due to other entities like neoplastic conditions, storage disorders, histiocytosis and sarcoidosis.1,2,3 &#xD;
&#xD;
The geographic variation of the disease prevalence and pattern of lymph node involvement is valuable in suggesting the diagnosis. In most of the cases, the diagnosis can be clinched by proper elicitation of history, clinical examination, ancillary laboratory tests and imaging.4,5In cases where the aetiology remains unexplained for the clinician, or a suspected aetiology needs to be confirmed,&#xA0; Fine needle aspiration cytology (FNAC) is preferred over excisional biopsy, as it is a rapid, minimally invasive and cost-effective procedure, that can be performed on an OPD basis, giving a preliminary diagnosis which can help in triaging the patients.6 Excisional biopsy is an invasive procedure done under anaesthesia and has a risk of complications.&#xD;
&#xD;
This present study is a retrospective analysis of the diagnostic role and efficacy of FNAC performed in the pediatric LAP cases.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This was a retrospective study carried out in the department of cytology of a tertiary care centre of eastern India, conducted over 2 years from August 2108 to August 2020. All the patients belonging to the pediatric age group (&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Total of 235 pediatric cases presented to the cytology department with lymphadenopathy for FNAC. Out of these FNA procedures could not be done in case of 6 uncooperative patients. Hence FNA results of 229 patients were analyzed. Age of the patients ranged from 8 months to 18 years with a mean age of presentation being 11 years. On analysis of the age-wise distribution of cases, maximum no of cases was found to be in the age group of 11-15 years. (Figure1) There were 144 male and 85 female patients, with the male/female ratio being 1.69:1. The most common presentation was cervical lymphadenopathy seen in 202 cases (88.2%), followed by 9 cases of axillary LAP, 6 cases of inguinal LAP, 6 cases of generalized LAP, 5 cases of intra-abdominal LAP and 1 case of intra-mammary LAP which was present in the peri-areolar region. (Figure 2) Patients predominantly presented with multiple, non-tender lymph nodes in 145 casesand67 cases had a bilateral presentation. 84 cases presented with solitary lymphadenopathy. Tenderness was frequently observed in cases of suppurative lymphadenitis (LAN), which were also associated with tense swelling and erythema in the surrounding area. Multiple matted lymph nodes were seen in 11 cases, 3 of which had discharging skin sinuses. &#xA0;Commonly associated symptoms were fever, cough and sore throat. Other less common symptoms were loss of appetite, weight loss as in cases of Tuberculosis and malignancies. The size of the lymph nodes examined varied from 0.5 to 5 cm. The duration of presentation ranged from short duration of 2-3 days to long-standing LAP present for over 10 years. USG guided FNA was performed in 11 cases of deep-seated LAP, which posed with difficulty in approach during plain FNA. These included 6 cases with deep-seated cervical lymph nodes, 4 cases with mesenteric LAP and 1 case of external iliac LAP.&#xD;
&#xD;
The FNA diagnoses were conclusive in 223 cases and in the rest 6 cases, the diagnoses were deferred due to inadequate material. The conclusive FNA diagnoses were broadly categorized into &#x2013; benign and malignant. There were 217 benign diagnoses (97.3%) and 6 malignant diagnoses (2.7%). The benign diagnoses were further subdivided into- reactive LAN, necrotizing/granulomatous LAN, suppurative LAN and special reactive conditions like Rosai Dorfmann disease. The most common benign diagnosis was reactive hyperplasia (131), followed by necrotizing/granulomatous LAN (48), suppurative LAN (36) and Rosai Dorfmann disease (2). Malignant diagnoses included 4 cases of Hodgkin&#x2019;s lymphoma, 1 case of metastatic Nasopharyngeal carcinoma and 1 case of metastatic Small round cell tumour. (Figure 3) The age-wise distribution of the cases according to FNA diagnoses was done. In the age groups of 0-5, 6-10 and 11-15 years, most common diagnosis was reactive hyperplasia whereas, in the age group 16-18 years, the commonest diagnosis was necrotizing/granulomatous LAN. (Figure 4)&#xD;
&#xD;
In most cases of benign diagnoses, a biopsy was not performed, except for the 2 cases of Rosai Dorfman disease and2 cases of florid reactive hyperplasia. The biopsy was performed in all the 6 cases of malignancies. On the correlation of the FNA diagnoses with histopathology of 10 cases in which subsequent LN biopsy was performed, the results were concordant in 9 cases and discordant in 1 case, which was a false positive. Hence, accuracy was 90%, sensitivity was 100%, specificity was 80%, PPV was 83.33% and NPV was 100%&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In our study, a male preponderance was noted with a male-to-female ratio of 1.2:1and the most common site of the presentation was the cervical region, which correlated with other studies.4,6 Benign disorders were more common than malignant disorders (13.67%) in the present study and the most common cause of lymphadenopathy was reactive hyperplasia followed by granulomatous LAN, which was comparable to the findings of other studies in cases LAP in all age groups done by Malhotra et al and in cases of pediatric LAP done by Lee et al, Sharma et al and Annam et al.4-7Our study showed that in 15 years age group. Many other studies from India, Pakistan, and Sudan, also reported tuberculosis as the most common cause of lymphadenopathy.8-12&#xD;
&#xD;
In our study done on pediatric LAP cases also found results varying from benign to malignant. Though as per local demographic patterns, most cases belong to reactive hyperplasia followed by granulomatous LAN, few cases also showed malignant diagnosis, where FNA served as a simple, rapid and highly effective for diagnosis and further patient management.&#xD;
&#xD;
Reactive Hyperplasia&#xD;
&#xD;
FNA diagnosis of Reactive hyperplasia was given in 131 cases (58.74%) of which Florid reactive hyperplasia was seen in 5 cases. The lymph nodes were firm inconsistency with the average size of lymph nodes being 1.2 cm. The key cytological features that were seen in cases of reactive hyperplasia were a mixed population of lymphoid cells in different stages of maturation, comprised of mature lymphocytes, centrocytes, centroblasts, immunoblasts in a logical proportion along with the presence of plasma cells, histiocytes, tingible body macrophages and lympho-glandular bodies. (Figure 5A) 5 cases showed Florid reactive hyperplasia, 4 in cervical region and1 in the inguinal region, wherein the size of the lymph nodes varied between 1.5 to 3 cm and were advised to stay in follow up. Repeat FNA/Biopsy was advised in case the swelling did not reduce in size after a course of antibiotic therapy. Also seen in some cases were immunoblastic proliferation, may be attributable to viral infections. &#xD;
&#xD;
Necrotizing/Granulomatous LAN&#xD;
&#xD;
There were 52 FNA diagnoses (23.31%) of necrotizing/granulomatous LAN, of which epithelioid granulomas were seen in 20 cases, only necrosis was seen in 12 cases and both were seen in 15 cases. The average size of the lymph node at presentation was 1.5 cm, most of which had multiple and matted presentations. The key cytological feature looked for was the presence of epithelioid cell granulomas (figure 5B), histiocytes over a background of reactive lymphoid cells, with/without the presence of necrosis and multinucleated giant cells. When only necrosis has seen reactive lymphoid cells, a diagnosis of Necrotising LAN was given. (Figure5C) ZN stain for AFB was done in all the cases of granulomatous/necrotising LAN and5 cases of suppurative LAN (total 57 cases). ZN stain was positive for AFB in 17 cases in which case a diagnosis of Tubercular LAN was given. In the other AFB negative cases, the advice was given to investigate the patients in the line of tuberculosis with ancillary investigations including culture, CBNAAT and TB-PCR.&#xD;
&#xD;
Suppurative LAN&#xD;
&#xD;
There were 32cases (14.35%), which were given FNA diagnosis of suppurative LAN. The average size of the lymph node at presentation was 2 cm and the most commonly presented as a tense, tender or sometimes soft, cystic swelling. Local erythema and rise in temperature. Was also encountered in some cases. Commonly purulent material was aspirated. The cytological feature that clinched the diagnosis was a predominant population of polymorphs, admixed with lymphoid cells, degenerated cells and macrophages over a necrotic background. Slides were thoroughly scanned to look for the presence of epithelioid granulomas, in which case it would point towards granulomatous LAN with superadded suppuration. In such cases, ZN stain for AFB was performed to rule out tubercular aetiology. In other cases suggestion for culture correlation and follow-up was advised.&#xD;
&#xD;
Rosai Dorfmann Disease&#xD;
&#xD;
In our study, we found 2 cases &#xA0;(0.90%) of Rosai Dorman disease one of which was a 4-year male presenting with multiple bilateral cervical lymphadenopathies since 7 days, and other cases was a 15-year female presenting with single tender right axillary lymph node, noticed since 15 days. The average size of the lymph node was 3cm. In both cases, the FNA smears showed features of Reactive hyperplasia with the presence of the good number of macrophages, evidence of emperipolesis and plasma cells favouring the diagnosis of Rosai Dorfman disease. The biopsy was done in both the cases and histopathology gave a concordant diagnosis. (Figure5D)&#xD;
&#xD;
Malignancies&#xD;
&#xD;
A total of 6 malignancies were diagnosed by FNA during this period. These included 4 cases of Hodgkin&#x2019;s lymphoma (1.80%), 1 case of metastatic nasopharyngeal carcinoma (0.45%) and 1 case of metastatic Small round cell tumour (0.45%).&#xD;
&#xD;
All the 4 cases of Hodgkin&#x2019;s lymphoma presented with bilateral cervical LAN, which were firm, rubbery inconsistency, and the average size was 3.5 cm. the age of these patients ranged from 13-18 years of age. The classical cytological features that clinched the diagnosis were the presence of large atypical mononuclear to multinucleate cells and multilobulated cells, with prominent nucleoli, resembling RS cells, on a background of reactive lymphoid cells, eosinophils, plasma cells and histiocytes. (Figure6A, 6B) All 4 of these cases underwent biopsy of which 3 showed concordance and 1 case was false positive, in which an FNA diagnosis of Lymphoproliferative disorder with associated granulomatous reaction was given and in-toto lymph nodal excisional biopsy was advised to rule out the possibility of Hodgkin&#x2019;s lymphoma. The cause of suspicion was the presence of a few large cells with bi-nucleation at places, prominent nucleoli and abundant cytoplasm, along with the presence of occasional eosinophils. But on histopathology, a final diagnosis of Granulomatous LAN was given, rendering a false positive discordant diagnosis. Immunohistochemistry was done in the concordant cases with lymphoma panel.&#xA0; 2 cases were given the final histopathological diagnosis of Hodgkin&#x2019;s lymphoma, mixed cellularity type, and 1 case was given the final histopathological diagnosis of Lymphocyte rich Hodgkin&#x2019;s lymphoma.&#xD;
&#xD;
A 12-year female presented with bilateral cervical LAN, largest measuring 3x2.5 cm right post-auricular region for 11 months. A previous FNA done outside had given a diagnosis of granulomatous LAN, possibly tubercular and the patient had completed ATT for 6 months. On doing FNA from bilateral cervical lymph nodes in our institute, we saw large neoplastic cells with high N: C ratio and prominent nucleoli, arranged in fibrous strands and occasional acini. (Figure6C, 6D) A diagnosis of Metastatic Nasopharyngeal carcinoma was given which was later confirmed with a biopsy.&#xD;
&#xD;
A 1-year-old male child presented with a 1.5 cm left posterior cervical lymph node which on FNA yielded richly cellular smears showing monotonous round cells in singles, sheets and fragments with focal rosettoid arrangement. These cells had high N: C ratio, finely granular chromatin, mild nuclear irregularity and scant cytoplasm. An FNA diagnosis of Small round cell tumour was given. On biopsy, we received a lymph node, which on subsequent histopathology showed near-total replacement of the LN by tumour tissue comprised of round to polygonal neoplastic cells arranged in an alveolar pattern and after Immunohistochemical positivity with Myo-D1, the final histopathological diagnosis of Alveolar Rhabdomyosarcoma was given. (Figure 6E, 6F)&#xD;
&#xD;
On comparison with final histopathology of the LN biopsies in the 10 cases in our study, we observed that FNAC had an accuracy of 90%, sensitivity of100%, the specificity of 80%, PPV of 83.33% and NPV of 100%which was comparable with the findings of&#xA0; Lee et al, who reported an accuracy of 94.5%, the sensitivity of 100%, PPV of 93.3%, for pediatric cervical lymphadenopathy.4 In a study on the profile of lymphadenopathy by FNAC, Malhotra et al reported accuracy of 91.15%, the sensitivity of 94.49%, PPV of 96.26%.5 Hafez et al reported an overall diagnostic accuracy of 82.2%, the sensitivity of 90.9%, the specificity of 67.2%, PPV 82.6% and NPV of 81.3% in FNAC of cervical lymph nodes.13&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
LAP can be a manifestation of a myriad of underlying local or systemic diseases. Being mostly superficial and well localized, it is very approachable for simple procedures like FNAC, thus making it a widely used practice for initial evaluation of cases. FNAC is a simple, cost-effective, minimally invasive and reliable technique to provide a rapid diagnosis in the majority of cases of pediatric LAP and helps in the screening of the cases to allows the clinicians to take the timely decision on the course of action. Thus it helps to avoid unnecessary invasive procedures like excisional biopsy in pediatric age group, which is associated with its complications. LAP in the pediatric population in our study is mainly due to reactive hyperplasia, most of which responded to therapy, and did not require repeat FNAC/biopsy. Granulomatous/necrotizing LAN also accounted for a large number of cases and were the 2nd most common cause of pediatric LAP, owing to the increased prevalence of Tuberculosis. Amongst the malignancies causing LAP, Hodgkin&#x2019;s Lymphoma was the most common cause. However, some rare cases of metastasis of Nasopharyngeal carcinoma and Alveolar Rhabdomyosarcoma also accounted for LAP in 1 case each. In the cases where the biopsy was performed, in comparison to histopathology, the FNAC results were very accurate. With an adequate correlation of clinical-radiological and other laboratory findings, FNAC is a very reliable screening and diagnostic tool in the cases of Pediatric LAN. However, considering the broad spectrum of etiologies a high degree of suspicion, along with adequate history needs to be kept in mind, while dealing with cases of pediatric LAP.&#xD;
&#xD;
Conflict of interest: Nil.&#xD;
&#xD;
Financial support : Nil.&#xD;
&#xD;
Authors&#x2019; Contribution: AL-concept, design, manuscript writing, editing, final approval, literature search. MR- concept, design, manuscript writing, editing, literature search, drafting, data acquisition. SP- clinical studies, data acquisition.&#xD;
&#xD;
ACKNOWLEDGMENT: The author acknowledges the help received from Professor and Head, Department of for her guidance. I am also thankful to my colleagues and postgraduates for their kind co-operation. I would like to give my special thanks to all the technicians and staff of cytology and histopathology section, for helping me while conducting the present study. The author is also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed, discussed and cited.&#xD;
&#xD;
ABBREVIATIONS&#xD;
&#xD;
AFB- Acid-fast bacilli&#xD;
&#xD;
DQ- Diff quick&#xD;
&#xD;
FNA- Fine needle aspiration&#xD;
&#xD;
FNAC- Fine needle aspiration cytology&#xD;
&#xD;
HE- Hematoxylin and eosin&#xD;
&#xD;
LAP- Lymphadenopathy&#xD;
&#xD;
LAN- Lymphadenitis&#xD;
&#xD;
LN- Lymph Node&#xD;
&#xD;
ZN- Ziehl Neelsen&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Figure 5: A. Reactive hyperplasia, showing lymphoid cells in different stages of maturation in logical proportion. (DQ, x400); B. Granulomatous lymphadenitis, showing epithelioid granuloma. (DQ, x400); C. Necrotising Lymphadenitis, showing areas of necrosis. (DQ, x400); D. Rosai Dorman&#x2019;s Disease, Histiocytes showing emperipolesis. (DQ, x400)&#xD;
&#xD;
&#xD;
&#xD;
Figure 6. A. Hodgkin&#x2019;s Lymphoma, showing RS cells. (DQ, x400); B. Hodgkin&#x2019;s Lymphoma, showing RS cells. (DQ, x400); C. Metastatic Nasopharyngeal Carcinoma, showing tumor fragments. (HE, x400); D. Metastatic Nasopharyngeal Carcinoma, showing acini. (DQ, x400); E. Metastatic small round cell tumor, showing tumor cells in singles, fragments and sheets. (DQ, x100); F. Metastatic small round cell tumor, high power showing high N:C ratio, granular chromatin, scant cytoplasm. (DQ, x400)&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Histomorphometry of Pretransverse Segment of Vertebral Artery and its Clinical Significance - A Cadaveric Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>65</FirstPage><LastPage>69</LastPage><AuthorList><Author>Prabavathy G</Author><AuthorLanguage>English</AuthorLanguage><Author> Sadeesh T</Author><AuthorLanguage>English</AuthorLanguage><Author> Arthi G</Author><AuthorLanguage>English</AuthorLanguage><Author> Anbalagan J</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Multiple variations in the origin of the vertebral artery have been reported in the literature. Objective: To study the variability in the origin and course of the vertebral arteries on both sides in both sexes and also to compare its microstructure. Methods: The vertebral artery was studied from 60 adult human cadavers on both sides. The origin and point of entry into foramen transversarium were studied and the dimensions of the artery were measured and tabulated. Results: In all 60 cadavers, the right vertebral artery (RVA) originated from the posterosuperior aspect of the first part of the subclavian artery. The left vertebral (LVA) originated from the first part of the left subclavian artery in 52 cadavers (87%). In 8 male cadavers (13%), the left vertebral artery originated directly from the arch of the aorta. The anomalous origin of LVA was longer than the right and the diameter was smaller than that of RVA. Amongst the 8 cadavers, one case appeared hypoplastic with wider close to the origin, constricted, and narrow in the middle part. In remaining cases of the normal origin of the vertebral artery, there was a significant increase in length and diameter of the vertebral artery in males compared to females on both sides. There is a predominantly increase in the length and diameter of the right vertebral artery when comparing both sexes. Conclusion: A thorough understanding of anomalous vertebral arteries is paramount when performing both diagnostic and interventional angiography.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Vertebral artery, Aortic arch, Cervical vertebra, Variation, Development, Morphometry</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Vertebral artery shows multiple variations in its origin and course. The vertebral arteries originate from the posterior superior aspect of the first part of the subclavian artery.1 The vessels take a vertical posterior course to enter into the foramen transversarium of the sixth cervical vertebra. The segment of the artery from its origin at the subclavian artery to its respective transverse foramen is termed as pre-transverse or prevertebral segment.2 The second part passes through foramen transversarium of sixth cervical vertebra (C6) to the first cervical vertebra (C1). The third part curves medially behind the lateral mass of the atlas. It passes through foramen magnum as fourth part and at the lower border of pons; two vertebral systems unite to form the basilar artery. The vertebral arteries form the vertebrobasilar vascular system and supply blood to the upper spinal cord, cerebellum, and posterior part of the brain stem. Topographically, the vertebral artery is divided into four parts: cervical or prevertebral, vertebral, sub-occipital, and intracranial part.3&#xD;
&#xD;
Origin of the abnormal vertebral artery has been noted incidentally during anatomic postmortem and angiographic examinations, because, they are clinically asymptomatic in most cases.&#xA0; However, such types of abnormalities are of diagnostic importance either before vascular surgery in the neck or in intravascular diseases such as arteriovenous malformations or cerebral aneurysms.4 Anatomical knowledge of vascular variations may help to avoid wrong interpretation of the non-opacification of the vertebral artery, as blockage or stenosis. Nizanowski et al.5 studied the course and variations of the left vertebral artery (LVA). The clinical importance of such variations in cerebrovascular disorders, head and neck surgery, angiography and arterial dissection has been cited in the literature.6,7 The prevalence of the left vertebral artery arising from the aortic arch is reported to be 2.4-5.8%. LVA arising from the arch of aorta reported entering the foramen transversarium of fourth or fifth cervical vertebra instead of the sixth cervical vertebra.8 Variations in the abnormal origin of the vertebral artery may cause cerebral disorders. &#xD;
&#xD;
A case of bilateral vertebral arteries originating from the aortic arch proximal to the left subclavian artery has been reported.9 Lemke et al.4 reported nine cases of right vertebral artery (RVA) arising from the aortic arch. Preeti et al.10 reported that they observed a common stem for left subclavian artery and left vertebral artery, arising from the arch of the aorta with the incidence of&#xA0; 2.5% of 40 cases studied. Anatomical knowledge of anomalous origin and dimensions of supra-aortic arteries are important in emergency patients undergoing four-vessel angiography. A review of the literature showed insufficient data on the morphometric and histological comparison of both normal and anomalous origin of the vertebral artery. The present work is aimed to study the variability in the origin, course and dimensions of the vertebral arteries on both sides in both sexes and also to compare its microstructure.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The vertebral artery was studied in 60 dissected adult cadavers on both sides collected from the Department of Anatomy, Mahatma Gandhi Medical College, Sri Balaji Vidyapeeth, Puducherry, after the completion of neck dissection by undergraduate students. The sample included 30 male and 30 female cadavers in the age group of 60 - 70 years. In all the cadavers the scale no-vertebral region was dissected to expose the prevertebral segment of the vertebral artery on both sides. The superior mediastinum was dissected to expose the arch of the aorta with its branches. The following parameters were considered for the present study. 1. Site of origin of the vertebral artery on the left and right side 2. Length of vertebral artery from its point of origin to the entry at foramen transversarium of the cervical vertebra using digital Vernier calliper and a thread. 3. The diameter of vertebral arteries at its origin and entry at the foramen transversarium were measured using digital vernier calliper 4. The level of entrance of the vertebral artery at foramen transversarium 5. Variations in its origin, topographic and morphological variations were recorded.&#xD;
&#xD;
For the histological study, a small segment of the artery was cut at its origin and the entry into foramen transversarium. The tissue was subjected to routine histological procedures and sections were stained with Haematoxylin and Eosin, and observed under the microscope. The thickness of the arterial wall, arrangement of smooth muscle, and elastic fibres were recorded. &#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
The data were analyzed using software SPSS 20. A comparison of the length of the vertebral artery in males and females on both sides was analyzed using Student &#x2018;t&#x2019; test. The diameter of the vertebral artery at the proximal and distal part was done using the Mann-Whitney U test. P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3385</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3385</Fulltext></URLs><References>&#xD;
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	Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th Ed., Philadelphia-Baltimore-New Aires-Hong Kong-Sydney-Tokyo: Lippincott Williams &amp; Wilkins; 1999:893&#x2013;94.&#xD;
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	Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT. The course of the prevertebral segment of the vertebral artery: Anatomy and clinical significance. Surg Neurol 1997; 48:125-131.&#xD;
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	Hollinshead WH. Arteries: The Neck. In: Anatomy for Surgeons. Vol. I, The Head &amp; Neck. New York: Paul B Hoeber, Inc, Medical Book Department of Harpers &amp; Brothers; 1954:467&#x2013;74.&#xD;
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	Lemke AJ, Benndorf&#xA0; G, Liebig T, Felix R.&#xA0;Anomalous origin of the right vertebral artery: a review of the literature and case report of right vertebral artery origin distal to the left subclavian artery.&#xA0;Am J Neuroradiol&#xA0;1999; 20:1318&#x2013;1321.&#xD;
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	Nizanowski C, Noczynski L, Suder E. Variability of the origin of ramifications of the subclavian artery in humans. Folia Morphol 1982;41:281&#x2013;294.&#xD;
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	Vicko, G, Goran I, Damjan M, and Sanja P. Anomalous origin of both vertebral arteries. Clin Anat 1999; 12: 281-284. &#xD;
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	Komiyana M, Morikawa T, Nakajiman H, Nishikawa M, and Yasui T. High incidence of arterial dissection associated with the left vertebral artery of aortic origin. Neurol Med Chir (Tokyo) 2001;41(1):8-11.&#xD;
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	Schwarzacher SW, Krammer EB.&#xA0;Complex anomalies of the human aortic arch system: a unique case with both vertebral arteries as additional branches of the aortic arch. Anat Rec&#xA0;1989; 225(3):246-250.&#xD;
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	Albayram S,&#xA0;Gailloud P, Wasserman BA. Bilateral Arch Origin of the Vertebral Arteries. Am J Neuroradiol 2002;23(3):455-458.&#xD;
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	Preeti S, Vasanti A, Rieshav A. Study of variations in the origin and course of vertebral artery. Int J Cur Res Rev 2015;7(14):85-90.&#xD;
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	Vorster W, Du Plooy PT, Meiring JH. Abnormal origin of internal thoracic and vertebral arteries. Clin Anat 1998;11:33&#x2013;37.&#xD;
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	Panicker HK, Tarnekar A, Dhawane V, Ghosh SK. Anomalous origin of left vertebral artery &#x2013; embryological basis and applied aspects &#x2013; A case report. J Anat Soc India 2002; 51:234&#x2013;235.&#xD;
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	Fayza A, Abd El Gawad, Mohamed H, Shaaban DM, Shuaib HM. Anatomical variations of the vertebral artery and its relation to the atlas vertebra - Radiological and dry bone study. Eur J Anat 2019;23(1):49-58.&#xD;
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	Bruneau M, Cornelius JF, George B. Anterolateral approach to the V3 segment of the vertebral artery. Neurosurgery 2006; 58:29-35.&#xD;
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	Sikka A, Jain A. Bilateral variation in the origin and course of the vertebral artery. Anatomy Research International. Hindawi Publishing Corporation. 2012:1-3.&#xD;
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	&#xA0;Imre N, Yalcin B, Ozan H. Unusual origin of the left vertebral artery. Int J Anat Variat 2010;3:80-82.&#xA0;&#xD;
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	Dodevski A, Lazareska M, Tosovska-Lazarova D, Zhivadinovik J, Aliji V. Morphological characteristics of the first part of the vertebral artery.&#xA0;Prilozi&#xA0;2011;32(1):173&#x2013;188.&#xA0;&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Neurorespiratology: Respiratory Signal Analysis for Objective Assessment of Anxiety&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>70</FirstPage><LastPage>75</LastPage><AuthorList><Author>H. Haritha</Author><AuthorLanguage>English</AuthorLanguage><Author> R. Sarath Menon</Author><AuthorLanguage>English</AuthorLanguage><Author> A. Anand Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> C. Santhosh Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The physiology of respiration is modulated by autonomic efferent neurons and circulating hormones. Objective: We aim to compare the respiratory patterns in normal individuals, regular meditators and individuals with anxiety spectrum disorders, in an effort to automate the anxiety detection (AnD). Methods: Prospective cross sectional study which included 52 subjects, 20 normal population, 16 regular meditators and 16 subjects with anxiety disorders, was held at the Department of Neurology, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India (IEC: AIMS/2013/18). A 24 hours ambulatory monitoring of each subject was done during the sleep-wake cycle using the respiratory inductance plethysmography (RIP). We evaluated Respiratory Rate Variability (RRV), Thoraco-abdominal ratio (TAR%) and low frequency-high frequency ratio (LF/HF) for its effectiveness in AnD using p-values. Results: It was observed that RRV was lowest, TAR% and LF/HF ratios were highest in anxiety group compared to the meditation group (p=</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Respiratory Signal Analysis, Respiratory Rate Variability, Ambulatory Respiratory Monitor, Coherent Breathing, Anxiety Detection System</Keywords><Fulltext>Introduction&#xD;
&#xD;
Manual measurements of RR and subjective assessment are the current standards of care for monitoring the respiratory status. However, these methods are highly inconsistent, depending on the clinician&amp;#39;s level of expertise.1&#xA0; Respiratory&#xA0;Rate measurement alone cannot guide us for early intervention in&#xA0;respiratory compromise.2 Hence it is necessary to validate a normal respiratory pattern which includes other respiratory parameters like RRV, TAR and LF/HF ratio, in non-intubated patients which would quantify adequacy of ventilation.3,4 No current technologies meet this requirement of noninvasively and accurately measuring and reporting the respiratory patterns. Such a device helps us for timely&#xA0;pickup and interventions during respiratory compromise with minimal complications, better safety profile and reduce healthcare cost.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
Participants&#xD;
&#xD;
The study was conducted over 2 years (October 2016 to October 2018) jointly by the Departments of Neurology &amp; Psychiatry, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India and Machine Intelligence Research Lab, Amrita Vishwa Vidyapeetham, Coimbatore, India. The prospective cross-sectional study which included 52 subjects - 20 normal population, 16 regular meditators and 16 subjects with anxiety disorders diagnosed based on DSM V criteria. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The sex distribution and the age distribution of normal, meditation and anxiety groups are shown in Table 1 and Table 2 respectively.&#xD;
&#xD;
&#xD;
&#xD;
All the subjects were evaluated based on their history and clinical examination and were grouped into 3 classes. Group 1 included normal individuals, who did not meet the criteria for any current psychiatric disorder and did not practice any meditation techniques. The subjects included in Group 2 (meditation group) were selected randomly from people who involved in mindfulness meditation technique (the combination of yoga and relaxation techniques), practising daily for 20 minutes for more than 6 months. The group 3 considered subjects with anxiety spectrum disorders, whose diagnosis was made based on DSM V (Diagnostic and Statistical Manual for Mental Disorders-V5 criteria by Department of Psychiatry, AIMS, Kochi, Kerala, India. 16 patients with anxiety spectrum disorders fitting to the inclusion criteria were included after psychiatric assessment, which comprised of 6 with a generalized anxiety disorder (GAD), 8 with panic disorders (PD), 1 patient with social phobia, 1 patient with GAD and Obsessive-Compulsive Disorder (OCD) traits.6&#xD;
&#xD;
Procedure&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Written consent of all individuals was taken and the ethical issues were considered (IEC: AIMS/2013/18). No interventions or invasive procedures were carried out. After the diagnostic interview, participants received an individual appointment for a non-invasive set-up procedure in the informal environment of the Neurophysiology Lab at the Department of Neurology, AIMS, Kochi, Kerala, India starting at 8.00 AM. All the subjects were given a proforma to record all the activities carried out during 24 hours of study. The overall procedural setup of continuous ambulatory respiratory monitoring (CARM) is shown in Figure 1.&#xD;
&#xD;
&#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;
Feature Extraction&#xD;
&#xD;
Respiratory Rate Variability (RRV)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; RRV is the absolute value of the difference of successive periods of T1 and T2 i.e, absolute (T1-T2). Since units of the period are milliseconds, RRV also has units of milliseconds. Figure 2 shows the computation of RRV.&#xD;
&#xD;
Respiratory Rate Variability (RRV%) = T2-T1T1 x 100&#xD;
&#xD;
&#xD;
&#xD;
Horaco-abdominal Ratio (TAR)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; TAR% gives a measure of relative expansion and contraction of Thorax to that of Abdomen. Figure 3 shows the computation of TAR.&#xD;
&#xD;
&#xD;
&#xD;
LF/HF Ratio&#xD;
&#xD;
Autonomic synergy and coherence suggest both the parasympathetic nervous system (PNS) and Sympathetic nervous system (SNS) competitively regulate respiration, where increased SNS activity is paired with decreased PNS activity and vice versa. The ratio of LF to HF power is called the LF/HF ratio. It is known that a low and high LF/HF ratio reflects greater parasympathetic activity and higher sympathetic activity, respectively. Hence the LF/HF ratio is also considered a marker for autonomic balance or adaptability7. The method that is adopted in this work for frequency domain analysis is Fast Lomb method. &#xD;
&#xD;
Activity Calibration&#xD;
&#xD;
Using events recorded by the subjects and the activity information provided by the device, three different levels of activity were defined: No Activity (Rest), Low Activity, High Activity. Figure 5 shows part of the recording from 7 PM to 7.30 AM. The activity level between 1 and 2 is considered as low activity, below 1 and above 2 is considered as low and high activity, respectively. The defined activity threshold is indicated by green. The plot in red shows the activity information captured by the device. &#xD;
&#xD;
&#xA0;&#xD;
&#xD;
The different activity levels are defined in table 3.&#xD;
&#xD;
&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The values of the study variables were expressed as mean and standard deviation (SD). To test the statistical significance of differences in values of variables, on an average, between two groups, Mann Whitney U test and among three groups, Kruskal-Wallis one way analysis of variance (ANOVA) followed by Bon-ferronis Multiple Comparison tests, were applied. To test the statistical significance of the differences in values of variables between two activities of the same individual, Wilcoxons Signed Rank test was applied. To test the statistical significance of the association of gender with the groups, the Chi-Square test was applied. The p-value bilaterally &lt; 0.05 was significant.&#xD;
&#xD;
Anxiety Detection (AnD) System Description&#xD;
&#xD;
Encouraged by the analysis of the respiratory signal, we then developed an AnD system using a respiratory signal as its input. Time and frequency domain statistical features8 derived from RRV is input to a support vector machine (SVM) backend classier.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The methodology for the baseline system of AnD is shown in figure 5. It may be noted that for classification using SVM, either the features that match the kernel or the kernel that matches the features should be selected for optimum performance. Often, this process is very difficult, owing to the difficulty in identifying a matching kernel. Alternatively, we may transform the feature vectors to a higher dimensional linear space, and then use SVM with a linear kernel.9 We then explored several machine learning algorithms over the baseline system to improve the performance of AnD system. Any input feature vector can be refined using dimensionality reduction and feature transformation techniques. Hence, we used principal component analysis (PCA) for dimensionality reduction and hence to find the dimensions with significant information. It may be noted that there exist patient-specific variations in the feature vectors that affect the performance of the system adversely.&#xD;
&#xD;
To make the feature space linearly separable, we experimented with a feature mapping technique using Fisher vector encoding (FVE). By using FVE to map input features to a higher dimension feature vector, we express every input feature vector in terms of parameters of a Gaussian mixture model (GMM) trained patient independently9.&#xA0; Further, the correlation between the features is reduced on using covariance normalization (CVN) which assumes that there exists an intrinsic relationship between the features. Subsequently, the feature mapping and feature normalization were combined and hence we obtained the expert system accuracy of 92.30% for FVE-CVN system.8&#xD;
&#xD;
&#xD;
&#xD;
Results&#xD;
&#xD;
In our study, the normal group had 55% of males and 45% females. The meditation group and anxiety groups had 68.8% males and 31.2% females. The differences were not statistically significant (p=0.605), the mean age of normal individuals, meditators and anxiety group were 32.2 years, 31.69 years, 34.38 years, respectively. This difference was not statistically significant (p=0.691).&#xD;
&#xD;
RRV &#xD;
&#xD;
The study showed mean RRV during sleep in normal, meditation, anxiety groups were 36.34%, 43.60%, 23.51% respectively. The difference seen in the normal group compared to meditation and anxiety groups and meditation group to anxiety group during sleep were statistically significant (p=0.013, </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3386</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3386</Fulltext></URLs><References>[1] Hong W, Earnest A, Sultana P, Koh Z, Shahidah N, Ong ME. How accurate are vital signs in predicting clinical outcomes in critically ill emergency department patients? Eur J Emerg Med 2013;20(1):27-32.&#xD;
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[2] Ragnarsd&#xF3;ttir M, Kristinsd&#xF3;ttir EK. Breathing movements and breathing patterns among healthy men and women 20&#x2013;69 years of age. Respiration 2006;73(1):48-54.&#xD;
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[3] Simoes EA, Roark R, Berman S, Esler LL, Murphy J. Respiratory rate: measurement of variability over time and accuracy at different counting periods. Arch Dis Childhood 1991;66(10):1199-1203.&#xD;
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[4] Vandana B, Vaidyanathan K, Saraswathy LA, Sundaram KR, Kumar H. Impact of integrated amrita meditation technique on adrenaline and cortisol levels in healthy volunteers. Evidence-Based Comple Altern Med 2011;2011.&#xD;
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[5] Vahia VN. Diagnostic and statistical manual of mental disorders: DSM-5. Indian J Psychiatry 2013;55(3): 220&#x2013;223.&#xD;
&#xD;
[6] Hoehn-Saric R, McLeod DR, Funderburk F, Kowalski P. Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: An ambulatory monitor study. Arch Gen Psychiatry 2004;61(9):913-921.&#xD;
&#xD;
[7] Badra LJ, Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, et al. Respiratory modulation of human autonomic rhythms. Am J Physiol Heart Circ Physiol 2001;280(6): H2674-2688.&#xD;
&#xD;
[8] Haritha H, Negi S, Menon RS, Kumar AA, Kumar CS. Automating anxiety detection using respiratory signal analysis. In2017 IEEE Region 10 Symposium (TENSYMP) 2017 Jul 14 (pp. 1-5).&#xD;
&#xD;
[9] Kumar CS, Ramachandran KI, Kumar AA. Vital sign normalisation for improving the performance of multi-parameter patient monitors. Electr Lett 2015;51(25):2089-2090.&#xD;
&#xD;
[10] Martinez JM, Papp LA, Coplan JD, Anderson DE, Mueller CM, Klein DF, et al. Ambulatory monitoring of respiration in anxiety. Anxiety 1996;2(6):296-302.&#xD;
&#xD;
[11] Liu H, Allen J, Zheng D, Chen F. Recent development of respiratory rate measurement technologies. Physiol Measur 2019;40(7):07TR01.&#xD;
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[12] Pfaltz MC, Michael T, Grossman P, Blechert J, Wilhelm FH. Respiratory pathophysiology of panic disorder: an ambulatory monitoring study. Psychosom Med 2009;71(8):869-876.&#xD;
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[13] Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH. Physical activity and respiratory behaviour in the daily life of patients with panic disorder and healthy controls. Int J Psychophysiol 2010;78(1):42-49.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Screening and Production of Lovastatin Producing Endophytic Fungus from Phyllanthus reticulatus using Oyster Mushroom Extract&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>76</FirstPage><LastPage>82</LastPage><AuthorList><Author>Senthamarai Manogaran</Author><AuthorLanguage>English</AuthorLanguage><Author> Kovilloo Packiam Kannan</Author><AuthorLanguage>English</AuthorLanguage><Author> Kowsalya Rathinasamy</Author><AuthorLanguage>English</AuthorLanguage><Author> Harish Ranganathan</Author><AuthorLanguage>English</AuthorLanguage><Author> Govardthni Gurusamy</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Endophytic fungi are most commonly found in plants. They are present inside the plants and supporting plants to survive and produce many bioactive metabolites. Lovastatin is one of the secondary metabolites produced by the endophytic fungi. It is used in the treatment of high blood cholesterol and reduces the risk of cardiovascular diseases. Objective: Screening and Production of Lovastatin Producing Endophytic Fungus from Phyllanthus reticulatus using Oyster Mushroom Extract. Methods: In our study, we have isolated endophytic fungi from the leaves and stem of phyllanthus reticulatus. Biodiversity of the endophytic fungi was calculated. Neurospora crassa bioassay was performed to identify the best producer of lovastatin. Their Lovastatin production potential was investigated with two different mediums such as potato dextrose and the mushroom extract. After completion of the fermentation process, the broth was extracted by a simple distillation method and then analyzed for the presence of Lovastatin using UV-Visible spectrophotometer and HPLC. Results: One of the positive and dominant endophytic fungi, Curvularia sp was isolated and chosen for this study. Its Lovastatin producing potential in PDA and mushroom extract medium was investigated and confirmed. Conclusion: Curvularia sp was identified as a better Lovastatin producer when compared to other endophytic fungi isolated from Phyllanthus reticulatus. From the results of the UV and HPLC, the presence of lovastatin is confirmed.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Endophytic fungi, Lovastatin, Bioassay, UV Spectrometry, High-performance liquid chromatography</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Endophytic fungi are the probable alternative sources for the development of novel biotechnological products like antibiotics, antimycotics, immunosuppressants and anti-cancer compounds. Such microorganisms live in the plant&amp;#39;s internal tissue which supports the plant cells growth and metabolism. Fungal endophytes have been recognized as an excellent source for new compounds of enormous value in agriculture, industry and medicine.1,2 &#xA0;They were the potential sources for the discovery of new and useful compounds or new platforms for the organic synthesis of such compounds for human benefit. Unlike organic synthetics, there is a clear need for endophytic sources of antimicrobials for their biological and chemical safety effects due to health and environmental problems.1,3,4&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lovastatin is one of such secondary metabolites having huge medicinal properties and also naturally produced by certain higher fungi, such as Pleurotus ostreatus (oyster mushroom) and closely related Pleurotus sp.5 Chemical synthesis of Lovastatin strictly involves synthetic methods. It was the first statin drug which was patented5 &#xA0;and approved by the United States Food and Drug Administration (FDA) in 1987.6-9 The cost of production is too high for commercialization purposes and other commercially viable chemical processes only yield poor quality production and involve complicated production steps.10-13 Hence, biotechnology has opened a new avenue through simple biotechnological methods to produce high quality and cost-effective Lovastatin and it is summarized in Table 1.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Phyllanthus reticulatus belongs to the family of Euphorbiaceae, usually a dense deciduous shrub which contains lots of medicinal properties. The different parts of this plant such as leaves, dried bark, fruits, aerial parts are to treat various diseases. In the pharmacological view, it has various activities like antidiabetic, antispasmodic, hypocholesterolemic, antimicrobial, cytotoxic, hepatoprotective anti-hyperglycemic, etc.14-19&#xD;
&#xD;
MATERIALS AND METHODOLOGY&#xD;
&#xD;
Collection of Plant&#xD;
&#xD;
&#xA0;&#xA0; Healthy leaf, stem and root of Phyllanthus reticulates (Poir)&#xA0; was collected&#xA0; from the Theravada regions of Sathyamangalam Taluk in a sterile ziplock bag and processed within 24 hours at the Endophytic Fungal Metabolite Research Laboratory, Department of Biotechnology, Bannari Amman Institute of Technology. 20,21&#xD;
&#xD;
Isolation and Identification of endophytic fungi &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All the plant specimens were washed thoroughly with sterile water and endophytic fungi were isolated. 22,23 &#xA0;The surface sterile leaves, stem and petiole were dissected under sterilized conditions into small segments of 0.5 cm x 0.5 cm using a sterile scalpel and dried in blotting paper. They were placed equidistantly (10 segments per plate per specimen) on the freshly prepared Potato Dextrose Agar plates (PDA) amended with Chloramphenicol (50 &#x3BC;gmL-1, Sigma Aldrich) and streptomycin sulphate (250 &#x3BC;gmL-1 Sigma Aldrich) and incubated at 25&#xB0;C&#xB1;1&#xB0;C.24,25 &#xD;
&#xD;
Identification of Endophytic fungi was carried out using microscopic and morphological characteristics. Isolated pure endophytic fungal cultures were stained using lactophenol cotton blue staining method and viewed under the microscope and were shown in Figures 2,3 and 4.&#xD;
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Among the group of endophytic fungi isolated from the plant, best fungal isolate (Table 2) was chosen based on the highest colonization frequency and zone of inhibition in a bioassay.&#xD;
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Biostatistics for Species Diversity&#xD;
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Colonization Frequency Percentage (CF %) &#xD;
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The density of colonization of single endophytes species was calculated &#xA0;and was equal to the number of colonized segments divided by the total number of segments observed x 100.&#xD;
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Endophytic Infection Rate (EIR %) &#xD;
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Endophytic Infection Rate was determined as the number of infected plant segments divided by the total number of plant segments screened x 100.26-30&#xD;
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Screening by Neurospora crassa Bioassay&#xD;
&#xD;
This screening was based upon the use of biological responses as a detection system for biologically active substances. Neurospora crassa (MTCC 790) was sensitive to &#x3B2; hydroxyl acid of Lovastatin 19 and hence, Lovastatin producing isolates create a zone of inhibition by suppressing the growth of this organism. Thus, using this principle, selected 10 endophytic fungal species were screened to identify their Lovastatin producing capabilities.26,27&#xD;
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Batch fermentation&#xD;
&#xD;
Highly positive endophytic fungi obtained through screening was chosen for the further fermentation process. Hence, Fully grown mycelial culture (1cm x 1cm) of Curvularia sp from the agar plate was inoculated in 100 mL of two different media M1 and M2 (Table 3) at pH 6 in triplicates under sterile condition. All the flasks were incubated in a shaker incubator at 28&#xB0;C and 180 rpm for 10 days.6,14,16&#xD;
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Extraction and confirmation of Lovastatin production&#xD;
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After 8 days of fermentation, the culture broth was separated by sterilized filter cloth. The culture filtrate was adjusted from pH 6 to pH 2 and was kept in a rotary shaker with an equal volume of ethyl acetate at 100 rpm for 2hrs at room temperature. After the extraction process, the broth was centrifuged at 1500 rpm for 20 min and filtered using Whatman filter paper No.1 to separate the biomass and filtrate. The filtrate was concentrated to 20 ml using rotary evaporator .23,24,25&#xD;
&#xD;
The presence of Lovastatin in the fermentation broth was confirmed at the maximum absorbance by UV spectrophotometry at 238nm. Further, the sample was analyzed using HPLC with a C18 column as a stationary phase and acetonitrile and water (65:35 v/v) as mobile phase.2&#xD;
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RESULTS&#xD;
&#xD;
Biostatistics for Species Diversity&#xD;
&#xD;
The colonization frequency percentage of the endophytic fungal species were shown in table 4 and the endophytic fungal infection rate percentage of Phyllanthus reticulatus was shown in figure 5.&#xD;
&#xD;
Screening by Neurospora crassa Bioassay&#xD;
&#xD;
The zone of inhibition formed by the endophytic fungi against Neurospora crassa is shown in table 5. Among these, the Curvularia sp shows higher zones of inhibition up to 0.6cm when compared to the other organisms. Further studies were carried out using the Curvularia sp.&#xD;
&#xD;
Batch fermentation&#xD;
&#xD;
Fermentation of Curvularia was carried out in both PDB and mushroom extract medium. Every 2 days, biomass was collected, filtered using pre-weighed sterilized filter cloth and dried at 60 ?C. Maximum OD of 0.826 in mushroom medium and 0.878 in PDB medium were observed at 238nm under UV spectrophotometer. The HPLC results of both the medium show that the peaks are closer enough to the standard lovastatin. It confirms the lovastatin production by Curvularia sp. The fermented biomass samples were shown in figure 6 and the HPLC results were shown in figure 7.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
This study revealed that the endophytic infection rate was high in the stem segment of the selected plant and the Curvularia sp were more abundant in the leaves of the selected plant in terms of colonization frequency compared to other endophytic fungi isolated from the same plant.28,29 This may be due to the environmental suitability and interaction of Curvularia sp within the plant. This fungus has also shown a good inhibitory effect against Neurospora crassa which is one of the confirmatory tests for the production of lovastatin. Thus, this dominant fungus was chosen for the investigation of lovastatin production in a shaker flask level. The production of lovastatin by Curvularia sp in the mushroom extract and PDB medium was confirmed by UV and the HPLC. The Rf value of lovastatin&#xA0; in the mushroom extract was 2.135 which is close to the hydroxyl form of standard lovastatin.30-32&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The research findings of this study conclude that Curvularia sp may be used as one of the fungal isolates for the production of lovastatin in mushroom extract medium. This novel method of using these fungi for lovastatin was reported the first time and further studies may be done to enhance productivity.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
We wish to express sincere gratitude to Fungal Biodiversity and BioResources Research Laboratory at Bannari Amman Institute of Technology for providing facilities for the successful completion of research work.&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
MS - Batch fermentation, recovery of the product, report writing and edition&#xD;
&#xD;
KPK - Biostatistics for Species Diversity and report writing&#xD;
&#xD;
KR, &#xA0;HR and GG &#x2013;Screening, report writing.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3387</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3387</Fulltext></URLs><References>&#xD;
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	Kumar MS, Jana SK, Senthil V, Shashanka V, Kumar SV, Sadhukhan AK. Repeated Fed-Batch Process for Improving Lovastatin Production. Proc Biochem 2000; 36(1):363-368.&#xD;
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	Kumar MS, Kumar PM, Sarnaik HM, Sadhukhan AK. A rapid technique for screening of lovastatin-producing strains of Aspergillus terreus by agar plug and Neurospora crassa bioassay. J Microbiol Meth 2000;40(1):99-104.&#xD;
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	Luthra U, Singh N, Tripathi A, Vora S, Bhosle V. Media Optimization for Lovastatin&#xA0;&#xA0;&#xA0; Production by Statistical Approach using Aspergillus terreus by Submerged Fermentation. Int J &#xA0;Res Med Sci 2015;3(2): 4520-4528.&#xD;
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	Parija SC, Shivaprakash MR, Jayakeerthi SR.Evaluation of Lacto-phenol cotton blue (LPCB) for detection of Cryptosporidium, Cyclospora and Isospora in the wet mount preparation of stool. Acta Trop 2003;85(3):349-354.&#xD;
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	Senthamarai M, Kannan KP.Optimization of lovastatin production by Fusarium nectrioides (MH173849) using response surface methodology and fuzzy logic system. J Environ Biol 2019;40(5):1036-1044.&#xD;
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	Samiee SM, Moazami N, Haghighi S, Mohseni FA, Mirdamadi S, Bakhtiari MR. Screening of Lovastatin Production by Filamentous Fungi. Iran Biomed J 2003;7(1):29-33.&#xD;
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	Sharma S, Kumar S. Phyllanthus reticulatus&#xA0;Poir. &#x2013; An important medicinal plant: A review of its Phytochemistry, Traditional uses and Pharmacological properties.&#xA0;Int J Pharm Sci Res&#xA0;2013:4(7);2528-2534.&#xD;
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	Su YC, Wang JJ, Lin TT, Pan TM. Production of the secondary metabolites &#x3B3;-aminobutyric acid and monacolin K by Monascus. J. Ind Microbiol Biotech 2003;30(1):41-46.&#xD;
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	Suryanarayanan TS, Kumaresa V and&#xA0; Johnson JA. Foliar fungal endophytes from two species of the mangrove Rhizophora. Can J Microbiol 1998;44(10):1003-1006.&#xD;
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	Vagelos PR, Galambol L. Medicine, Science and Merck. Cambridge University Press, Cambridge, United Kingdom.2004;211-301.&#xD;
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	Wang&#xA0; F W., Jiao R H., Cheng A B, Tan S H, Song Y C.&#xA0;Antimicrobial potentials of endophytic fungi residing in&#xA0;Quercus variabilis&#xA0;and brefeldin A obtained from&#xA0;Cladosporium&#xA0;sp.&#xA0;World J Microbiol Biotech 2007;23:79&#x2013;83.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Progressive Insights into the Pharmacological Importance of Isoquinoline Derivatives in Modern Therapeutics&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>83</FirstPage><LastPage>90</LastPage><AuthorList><Author>Kishor R. Danao</Author><AuthorLanguage>English</AuthorLanguage><Author> Pooja M. Malghade</Author><AuthorLanguage>English</AuthorLanguage><Author> Debarshi Kar Mahapatra</Author><AuthorLanguage>English</AuthorLanguage><Author> Meha N. Motiwala</Author><AuthorLanguage>English</AuthorLanguage><Author> Ujwala N. Mahajan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Isoquinoline (ISOQ) is a heterocyclic aromatic organic compound composed of a benzene ring fused to a pyridine ring, referred to as benzopyridines. The chemical formula is C9H7N with a molar mass of 129.162 g/mol. This ISOQ ring derives from the natural aromatic amino acid tyrosine. It is weak alkaline in nature but is more basic than quinoline. It appears as a yellowish oily liquid, having an unpleasant odour, hygroscopic when solid, has a density of 1.099 g/cm3, a melting point of 26&#xB0;C to 28&#xB0;C (79&#xB0;F to 82&#xB0;F), the boiling point of 242&#xB0;C (468&#xB0;F), and dipole moment of 2.49. In the preparation of this review article, a widespread examination of the published literature in varied pharmaceutical and medical databases such as PubMed, Google Scholar, etc. was fruitfully carried out and categorized consequently. The imperative review revealed the less known biological (anti-fungal, anti-Parkinsonism, anti-tubercular, anti-tumour, anti-glaucoma, anti-Alzheimer&#x2019;s disease, anti-viral, anti-bacterial, anti-diabetic, anti-malarial, etc.) potentials of ISOQ (an important class of chemical compounds) and their synthetic derivatives. This knowledge will serve as a ready reference for the global researchers and will be very helpful or inspiring for the medicinal chemists or associated investigators in developing novel low-molecular-weight (LMW) inhibitors for pharmacotherapeutic applications.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Isoquinoline, Derivatives, Pharmacology, Therapeutics, Targets, Inhibitors</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Isoquinoline (ISOQ) is a heterocyclic aromatic organic compound composed of a benzene ring fused to a pyridine ring, referred to as benzopyridines (Figure 1).1 The chemical formula is C9H7N with a molar mass of 129.162 g/mol.2 It is a structural isomer of quinoline where the nitrogen atom is present on 2nd position of the benzene ring.3 This ISOQ ring derives from the natural aromatic amino acid tyrosine.4 It is weak alkaline in nature but is more basic than quinoline.5 It appears as a yellowish oily liquid, having an unpleasant odour, hygroscopic when solid, has a density of 1.099 g/cm3, a melting point of 26&#xB0;C to 28&#xB0;C (79&#xB0;F to 82&#xB0;F), the boiling point of 242&#xB0;C (468&#xB0;F), and dipole moment of 2.49.6-8 The dissolution of ISOQ is well in acetone, diethyl ether, carbon disulfide, and various organic solvents but is less soluble in water. Several studies have found that ISOQ is also soluble in dilute acids.9&#xD;
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&#xD;
&#xD;
SYNTHETIC APPROACHES&#xD;
&#xD;
Various synthesis protocols were reviewed regarding the development of ISOQ derivatives such as the Bischler-Napieralski reaction (Figure 2), Pictet-Spengler reaction, and Pomeranz-Fritsch reaction whereas several new methodology and modification has been reported time to time.10,11 Overall, Pomeranz-Fritsch reaction is found to be the most efficient method for the compound preparation where amino acetoaldehyde diethyl acetal and benzaldehyde are made to react in acid medium.12 In contrast, the Schlittler-Muller synthesis involves the reaction of benzylamine with glyoxal acetal. Bischler-Napieralski reaction and Pictet-Spengler reaction are now taken into consideration by chemists for the production of substituted products.13,14 The substituted isoquinolines were generated by these methods such as dihydroisoquinolines and tetrahydroisoquinolines, which are produced in their oxidized analogues.15&#xD;
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&#xD;
PHARMACOLOGICAL POTENTIALS&#xD;
&#xD;
ISOQ and their derivatives occur in various natural products and are considered pharmacologically active owing to their potentials in expressing a large number of biological activities like anti-malarial, anti-HIV, anti-tumour, anti-fungal, anti-fungal, anti-tubercular, anti-glaucoma, anti-bacterial, anti-Parkinson&#x2019;s disease, etc (Figure 3).16-18 They are used in the manufacture of paints, dyes, and insecticides.19 They are employed as a solvent for the extraction of resin and terpenes.20&#xD;
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Anti-fungal Activity&#xD;
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The fungal infections are life-threatening opportunistic infections that are an increasingly important cause of illness in patients, principally individuals having weak immune power or hospitalized with stern fundamental ailments.21,22 The majority of these infections are caused by Candida spp., with over 50 % due to Candida albicans, a diploid fungus that grows both on yeast and filamentous.23 These fungi are responsible for various forms of the disease, ranging from superficial infections of the mucosal surfaces or skin to systemic infections, in most cases which is life-threatening.24 Siwek et al. synthesized and evaluated in vitro anti-fungal potency of 4-arylthiosemicarbazides series. Two different mechanisms of anti-fungal activity related to thiosemicarbazide derivatives have been documented. The most potent candidates were found to be ortho-methoxy or ortho-methyl group at the phenyl ring.25 Antimycotic drugs can be also be resisted by various fungal species. Surikova et al. synthesized a series of (2,2-dimethyl-1,2,3,4-tetrahydro-benzo[f]isoquinolin-4-yl)thioacetic acid which showed remarkable anti-fungal activity.26&#xD;
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Cantrell et al. synthesized two agrochemical agents; sanguinarine (Compound 1) and chelerythrine (Compound 2) and investigated the in vitro antifungal potential against Rhizoctonia solani. These alkaloids demonstrated potent fungicidal activity with sanguinarine as the most effective candidate.27&#xD;
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&#xA0;Anti-Parkinson&#x2019;s Activity&#xD;
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In this disease, substantia nigra includes progressive degeneration of dopaminergic neurons.28 The derivatives of 1,2,3,4-tetrahydroisoquinoline (TIQ) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) are employed in Parkinsonism disorder in an animal model owing to the structural similarities with an endogenous neurotoxin that have been studied for symptoms.29 Several TIQ derivatives like 1-methyl-TIQ, (R)-1,2-dimethyl-5,6-dihydroxy-TIQ [(R)-N-methyl-salsolinol)], etc. have been into applications against behavioural abnormalities.30&#xD;
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The ISOQ are homologs with MPTP and have linkage with dopaminergic cell death in Parkinson&#x2019;s disease.31 The known defects in the patients such as MAO and &#x3B1;-ketoglutarate are inhibited by TIQs and dihydroisoquinolines which are members of ISOQ derivatives.32 Natural substances of plants and several foods such as cheese, milk, banana, and cocoa also come under TIQ derivatives.33,34 Therefore, these TIQ derivatives are considered to prevent Parkinson&#x2019;s disease.&#xD;
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Anti-tubercular Activity&#xD;
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Mycobacterium tuberculosis is a bacterium that is responsible for a contagious disease, an infection called tuberculosis (TB).35 This disease has a high rate of mortality in the world where about 3 million people die every year and 8 million new cases are estimated each year in 95% of developing nations.36 The current therapy includes the combination (Isoniazid, Rifampin, or Pyrazinamide) for 2 months, followed by 4 months of follow-up therapy with isoniazid and rifampin.37 However, due to the arising of multidrug-resistant (MDR)-TB, the development of new therapeutic agents with a unique mechanism of action are required for treating these MDR forms.38,39&#xD;
&#xD;
Benzo[g]isoquinoline-5,10-diones were synthesized from 2-methyl-1,4-naphthoquinone and screened against virulent strain where higher anti-tubercular potency was observed for derivatives having position-3 substitution. The minimal inhibition concentrations (MICs) of these compounds lie in the range of 1.05 &#x3BC;M to 28.92 &#x3BC;M, respectively along with acute cytotoxic concentrations of &gt;128 &#x3BC;M.40&#xD;
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Anti-tumour Activity&#xD;
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ISOQ has been identified as bioactive ingredients in natural products-based therapeutics. ISOQs exhibit potential anti-cancer activity which makes them an important basis for treating cellular proliferation.41 Liu et al. evaluated the anti-neoplastic activity of various substituted isoquinoline-1-carboxyaldhyde thiosemicarbazones (Compound 3) where 4-amino and 4-(methylamino) have been identified as potential candidates.42,43 &#xD;
&#xD;
Current chemotherapies for cancer are mostly cytotoxics with serious side-effects and high incidence of drug resistance which escalated the need for new anti-tumour agents with reduced toxicity, excellent stability, significant anticancer activity, and increased efficacy.44,45 Because of the ability of human transferrin to undergo receptor-mediated endocytosis, it has been used previously for targeting the LP&#x2019;s.46 &#xD;
&#xD;
Derivatives of isoquinoline and &#x3B1;-methylene-&#x3B3;-butyrolactones were screened using the 3-(4,5-dimethylthi-azol-2-yl)-2,5-diphenyltetrazolium bromide (Compound 4) which was identified as the most potent anti-cancer agent.47 There are several kinds of biological activities such as an anti-Trypanosoma cruzi, an antibiotic tryptanthrin, and a cytotoxic luotonin which comprised of benzimidazoisoquinoline structure.48,49&#xD;
&#xD;
The anti-cancer potential of [1,2,4]-triazolo[3,4-a]isoquinolines and pyrrolo[2,1a]isoquinolines have been identified in the past few years. For the synthesis of some anti-tumour (anti-leukemic, tubulin polymerization properties) alkaloids like lamellarins and crysrinepyrrolo, [2,1-a]isoquinoline serves as an intermediate.50 For the inhibition of estrogen (ER) receptors, acetoxysubstituted 5,6-dihydropyrrolo[2,1-a]isoquinoline (Compound 5) serves a major role.51 Also, isoquinoline derivatives like Lamellarin D act as a potent topoisomerase-I inhibitor and induce apoptosis through the mitochondria-mediated pathway towards cancer cell lines.52&#xD;
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Tamoxifen, the selective estrogen receptor modulators (SERMs) is employed for treating breast cancer that works by preventing the binding of estrogen to the estrogen receptors and thereby slowing down the estrogen-induced cellular proliferation.53,54 Newly introduced pyrrolo[2,1-a]-isoquinoline derivatives and 1,2-diaryl-5,6-dihydropyrolo[2,1a]-isoquinoline derivatives (Compound 6) have shown better suppression of breast cancer as compared to the standard tamoxifen.55&#xD;
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Anti-glaucoma&#xD;
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Most of the surveys on glaucoma have reported that after cataract, it is the second leading cause of blindness worldwide.56 ISOQ sulphonamides-based moderate Rho-kinase Inhibitors; Fasudil (Compound 7) has been successfully evaluated for clinical studies.57,58 It is oxidized in vivo to hydroxyfasudil (Compound 8) which is slightly more active than the corresponding drug. Further, optimizations (methyl substituents at 4-position and 2-position in the ISOQ scaffold) of the compound led to the development of a compound with improved potency; dimethylfasudil (Compound 9).59,60 By varying the position of the methyl group the effect of methylation on the homopiperazine ring was studied. Compound 10 with an unsubstituted homopiperazine ring and compounds (Compounds 11-13) with homopiperazine ring substituted with a methyl group at 3-position, 5-position, and 6-position exhibited a very low potency towards Rho-kinase II. Methylation at 7-position of the ring (Compound 14) showed potent inhibition against Rho-kinase II. However, methyl substitution at 2-position of the homopiperazine ring was found to be most ideal in terms of selectivity as well as potency.61,62&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xA0; &#xA0; &#xA0; &#xA0; &#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Anti-Alzheimer&#x2019;s Disease&#xD;
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Alzheimer&#x2019;s disease (AD) is an age-related, progressive, neurodegenerative disorder, with onset usually in later ages (65 years to 85 years).63 AD has two characteristic pathological hallmarks; extracellular accumulation of &#x3B2;-amyloid peptide (amyloid plaques), and intraneuronal formation of hyperphosphorylated &#x3C4;-protein filaments leading to progressive loss of neurons and disintegration of the neural circuits, particularly in the cerebral cortex.64 Use of the currently available drugs in AD correlate with dementia severity and mostly relies on the cholinergic hypothesis that decreases in cholinergic transmission in the neocortex and hippocampus.65,66&#xD;
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Various NMDA blockers and cholinesterase inhibitors (ChEIs) are under clinical trials.67 The United States Food and Drug Administration (USFDA) has approved donepezil, galanthamine, and rivastigmine to treat the symptoms of Alzheimer&#x2019;s disease.68 Galanthamine and donepezil are taken as selective AChE inhibitors, while rivastigmine is a dual inhibitor of cholinesterases.69 As discussed above, both AChE and BChE are responsible for the breakdown of ACh in the synapses. Therefore, the inhibition of both enzymes represents a beneficial approach in AD treatment.70,71 Laudanosine (Compound 15), Protopine (Compound 16), Allocryptopine (Compound 17), Argemonine (Compound 18), Platycerine (Compound 19), Munitagine (Compound 20), and Norargemonine (Compound 21) have been identified as potential ISOQ and ISOQ-based derivatives with potential anti-Alzheimer&#x2019;s disease.&#xD;
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Anti-viral Activity&#xD;
&#xD;
Bedard et al. demonstrated anti-viral activity of 1,6-naphthyridine ISOQ derivatives against human cytomegalovirus (HCMV) where excellent results have been observed.72 The selected compounds were characterized by the presence of a 1,6-naphthyridine (Compound 22) or a dihydroisoquinoline (Compounds 23-24).73 Compound 2 with a dihydroisoquinoline scaffold was found to be less potent than ganciclovir (GCV) whereas Compound 3 was 3-times to 9-times more active than GCV. The naphthyridine derivative (Compound 22) was found to have the highest HCMV activity with an IC50 of 39-fold to 223-fold lower than GCV.74&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Anti-bacterial Activity&#xD;
&#xD;
There are ISOQ alkaloids with potent anti-microbial activities which encouraged the synthesis new antimicrobial compounds such as 1-pentyl-6,7-dimethoxy-1,2,3,4-tetrahydroisoquinolines (THIQs) with dihyroisoquinolinium salts, chlorobenzoates, methyl pentanoate-THIQ, fluorophenylpropanoate/chlorophenylpropanoate ester, phenethyl/chlorophenethyl carbamates, halogenated phenyls, 1-pentanol-THIQ, and carbamates derivatives have been developed for bactericidal and fungicidal activities.75-77 &#xD;
&#xD;
Nord et al. isolated new anti-bacterial secondary metabolites; 6,7-dihydroxy-5,10-dihydropyrrolo[1,2-b]isoquinoline-3-carboxylic acid, Spathullin A (Compound 25) and 5,10-dihydropyrrolo[1,2-b]isoquinoline-6,7-diol, Spathullin B (2) from culture broths of Penicillium spathulatum and screened against both Gram-negative and Gram-positive species like E. coli., A. baumannii, E. cloacae, K. pneumonia, P. aeruginosa, and S. aureus. Compound 25 was identified as less potent but more cytotoxic than Compound 26. The biosynthesis of Compound 25 was suggested to proceed from cysteine, tyrosine, and methionine via an enzyme that is a non-ribosomal peptide synthetase.79&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Anti-diabetic Activity&#xD;
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Type-2 diabetes mellitus (T2DM) morbidity and mortality is increasing worldwide and is the rising form of DM.80 The biggest challenge in the modern era is the management or treatment and healing the complication associated with T2DM. Berberine (BBR) is an ISOQ-based natural product extracted from Coptis chinensis known to have glucose reducing properties by mitochondrial respiratory chain complex-I suppression mechanism (via activation of the AMPK signalling pathway), which simultaneously stimulates glycolysis (decreases the rate of protons pumped from matrix to inner membrane space) and consumption of glucose (consequently lowers the mitochondrial membrane potential).81 &#xD;
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BBR derivatives were created by Zhang et al. and were evaluated for glucose-lowering potentials (promoting glucose consumption) where derivatives pos&#xAD;sessing amide bond and amidogen at 9-position better potency than parent BBR.82 Recently, accumulating evidence has indicated that BBR synthetic analogues have displayed high anti-diabetic activities and anti-hyperlipidemic activities which lead to an enhanced interest in their applications.83,84 Ren et al. discovered that dihydroberberine (dhBBR) (Compound 27) had better in vivo hypoglycemic efficacy in high-fat-fed rodents, enhanced oral bioavailability, and analogous potency compared with BBR by similar pathway.85 Cheng et al. designed and synthesized 8,8-dimethyldihydroberberine (Compound 28) which showed improved bioavailability and oral efficacy as compared to dhBBR via analogous mechanism.86&#xD;
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Anti-malarial Activity&#xD;
&#xD;
Angustureine (Compound 29), galipeine (Compound 30), cuspareine (Compound 31), and galipinine (Compound 32), obtained from the bark extract of Galipea Officinalis, commonly known as &#x201C;angostura&#x201D;, belongs to the group of 2-alkyl-1-methyl-1,2,3,4-tetrahydroquinoline naturally occurring alkaloid.87,88 Due to the stereogenic centre at position-2, they are chiral active molecules. Among the 20 species of Galipea genus, the shrub G. Officinalis is known ethnobotanically for treating dyspepsia, dysentery, chronic diarrhoea, and mainly shows anti-malarial activity.89&#xD;
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CONCLUSION&#xD;
&#xD;
The imperative review revealed the less known biological (anti-fungal, anti-Parkinsonism, anti-tubercular, anti-tumour, anti-glaucoma, anti-Alzheimer&#x2019;s disease, anti-viral, anti-bacterial, anti-diabetic, anti-malarial, etc.) potentials of ISOQ (an important class of chemical compounds) and their synthetic derivatives. This knowledge will serve as a ready reference for the global researchers and will be very helpful or inspiring for the medicinal chemists or associated investigators in developing novel low-molecular-weight (LMW) inhibitors for pharmacotherapeutic applications.&#xD;
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CONFLICT OF INTEREST&#xD;
&#xD;
Authors declare no conflict of interest regarding the publication of this article.&#xD;
&#xD;
FUNDING INFORMATION&#xD;
&#xD;
No funding agency or sources acknowledged.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
The authors acknowledge the college management for kind support and research aids. &#xD;
&#xD;
AUTHORS CONTRIBUTION&#xD;
&#xD;
KRD: Physically authored the whole manuscript&#xD;
&#xD;
PMM: Complete literature survey performed&#xD;
&#xD;
DKM: Made all Figures, Wrote Structured Abstract, Drawn Graphical Abstract, Set References&#xD;
&#xD;
MNM: Final reviewing of this manuscript&#xD;
&#xD;
UNM: Provided suggestions and corrected few errors&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comprehensive Analysis on the Efficient Mechanisms to Detect Obstructive Sleep Apnea Using AI and Heuristic Algorithms&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>91</FirstPage><LastPage>96</LastPage><AuthorList><Author>Jayit Saha</Author><AuthorLanguage>English</AuthorLanguage><Author> Ishita Dasgupta</Author><AuthorLanguage>English</AuthorLanguage><Author> G. Malathi</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajkumar Murugesan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Obstructive sleep apnea is a common problem arising in adults and children nowadays, determined by abnormalities in breathing gaps or incapability of air intake capacity during sleeping results in a decrease in oxygen level in blood. The brain detects this sudden decrease in the level of oxygen and sends a signal to wake the person up. Studies revealed the breathing stops for almost 10 seconds during a sleep apnea episode. There is no restriction on who can develop Obstructive Sleep Apnea(OSA), it can affect adults as well as infants. Our research primarily aims at assessing the various recent developments and studies made as a solution to this alarming problem. Their methodology and techniques have been studied and accuracy and sensitivity rates compared. A comprehensive and detailed study has been conducted on several research papers and studies done in the field of predicting sleep apnea. Sleep Apnea and classification of apneic signals have been mentioned in our study. The related researches have been studied extensively and compiled in our research work. The various techniques used by the researchers have been studied and tabulated along with the algorithm accuracies. It is observed that signal measurement along with AI algorithms has made significant advancements in OSA prediction. It is observed that Self Developed Algorithm on VAD showed the highest accuracy of 97%. PPG signal analysis and binary classification algorithm showed good accuracies of 86.67% and 86% respectively. AdaBoost, Decision Table and Bagging REPTree and SVM classifier also showed good accuracy of around 83% in the detection of Sleep Apnea episodes. The study highlighted the research works done to combat the rising problem of Obstructive Sleep Apnea. This comprehensive study of existing methods will help researchers to identify their drawbacks and find out more efficient solutions to them, which will help the humanity less prone to risks due to this alarming issue of sleep apnea.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Obstructive Sleep Apnea, Polysomnography(PSG), FFT(Fast Fourier Transform), Sleep Apnea-Hypopnea Syndrome(SAHS), Frequency Modulated Continuous Wave(FMCW), piezoelectric, Heart Rate Variability(HRV), photoplethysmography (PPG)</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Obstructive Sleep Apnea is curable but very often the suffering person is unaware of this situation. If undetected, it may even drive a person into a coma or even death. Due to the seriousness of the issue, several researchers are coming up with ideas to find a solution to this problem.&#xA0; An extensive amount of study done in this field in the past decade reflects the need to assess this problem seriously and aim at deriving accurate solutions for the same. The prior research has been based on medical facilities based approaches. There is a deficit in remote healthcare approaches. In this paper, we aim to elucidate on this topic by giving various review on past papers. We intend to give a thorough analysis, including all the methods involved and the different techniques used in their respective papers. We also investigate the advantages and disadvantages involved in the methodologies. Sleep apnea is mistakenly taken lightly. The magnanimity of this disorder is sometimes life-taking. The main agenda is to spread the awareness, cause and cure of this disorder.&#xA0; The main indication of OSA is depicted by typical snoring at short intervals. Also, there happens to be a sense of fatigue and tiredness the following day.&#xD;
&#xD;
SLEEP APNEA&#xD;
&#xD;
This disorder is estimated to be prevalent among a population count of 200 million people.1 In a study, there was an estimation that 4 per cent of men and 2 per cent of women in their middle-age life are more prone to this sleep apnea syndrome.2 To avoid the time-consuming, expensive and strictly confined to limited professional work-force in the field of medical detection of sleep apnea through polysomnography; there have been several automated sleep apnea classification techniques devised in the past decade.&#xD;
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MEASUREMENT OF APNEIC SIGNALS&#xD;
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Apneic intervals were evaluated by extracting features by studying the pattern in the phase of the respiratory signals and also the magnitude of the same, along with phase-locking value (PLV).3 PLV is a measurement that can be used to study the abnormalities or changes in long-range synchronization of neural activity from Electroencephalogram(EEG) data. EEG is extensively used to detect wave patterns of the electrical performances of the brain which proved to be an important metric in OSA detection study. Data extraction involved the polysomnographic data of 100 subjects and oxygen saturation signals and Electrocardiogram (which is a mechanism to record electrical signals which are transmitted from the heart to electrodes, which efficiently allows measuring the signals produced by a heartbeat ) signals for the whole night. Hilbert transform is used to determine the phases between two respiratory signals which is used to find the PLV between the two signals. This is followed by extraction of RR intervals, that is the time between continuous R-waves, from ECG signals and computation of Power Spectral Density using 256-point FFT, the two types of powers in Low-Frequency(LF), High-Frequency(HF), and Very-Low-Frequency (VLF) bands and Low-High Frequency power Ratio(LHR) (which is the ratio of LF over HF). Finally, SVM classifier has been used for OSA recognition; for specific features namely HRV, oxygen saturation using linear and second-order polynomial functions as kernels with&#xA0; C values such as (C=0.1,1,5,10). The overall accuracy was around 80%. But observation has been made by the authors that the accuracy goes up as C increases and the highest accuracy achieved at C = 5 or 10. However, it was not the same for linear classification of oxygen-saturation where accuracy decreased with increased C. The combined-signal classifier, implementing a second-order polynomial kernel with C = 5 yielded the maximum accuracy of 82.4% and sensitivity of 69.9%. Thus, it was concluded the combined-signal classifier proved to exhibit a higher accuracy than separate signal classifiers. Since second-order polynomial kernels provided higher accuracy, further accuracy improvement might be possible if higher-order polynomials are analyzed for optimum kernel selection. PLV has its disadvantage as it takes care of the second-order degree dependence between the vectors only. Kullback&#x2013;Leibler divergence or the Kolmogorov&#x2013;Smirnov test can be the alternatives. Moreover, The SVM has its disadvantage of long training time and added to its extraction of signals after 1 whole-night monitoring of a subject is also time-consuming and might seem unnecessary for several subjects.&#xD;
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TECHNIQUES TO CLASSIFY OSA&#xD;
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To automatically classify the respiratory signal to detect OSA, has elucidated on a self-developed algorithm.4 Voice Activity Detection(VAD) has been used for classification of respiratory signals into positive or negative sleep apnea by checking for the apneic interval of fifteen seconds or more. Cepstral coefficient, spectral entropy, average magnitude difference function and signal energy are some of the important features of this algorithm. But there is an assumption that spectral of speech changes over short periods. After filtration of respiratory signal, the power with FFT is calculated for a signal after filtration followed by energy calculation in two window frames for all n/l frames where n is the number of sample in research and l is the window size. This technique compares every frame of signal energy to the threshold to determine whether an episode of silence is a sleep apnea episode or non-sleep apnea episode. For testing on various samples of breathing signals, volunteers were asked to before and after the 20 breathing cycles and the audio was recorded using a microphone. However, the quality and sound capturing capability of the microphone comes into consideration. There might be better and high-quality microphones which might prove to have better audio capturing feature. Again, determining the silence interval and checking if it is more than 15 seconds is commendable as it is a primary identifying feature of a sleep apnea episode. The accuracy is decently high being 97% as compared to other paper but needs to be improved and calibrated more efficiently.3&#xD;
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An efficient contactless technique for determining sleep apnea is developed where the abdomen and chest convulsions are tracked on mobiles and obstructive apnea, hypopnea and central apnea and also provides an estimation of the apnea-hypopnea value index is detected5. The contactless technique is extremely useful nowadays because the clinical polysomnography test can often be very irritable and complex to many individuals. The use of various sensors, chest and abdomen belt, movement sensors, and 5 EEG sensors is both labour and time-intensive. In the mobile application proposed in this study, the smartphone is transformed into an active sonar system to track chest and abdomen movements using Frequency Modulated Continuous Wave (FMCW). The biggest disadvantage is that the specific target range cannot be determined as there is a deficit in the marking of time which is imperative to enable the system to time with precision the transmission and recipient and transform them into range, in continuous basic wave radar-based devices in the absence of frequency modulation. This is primarily overcome by FMCW. The phone transmits FMCW signals which are then processed to detect the breathing. The distance to the human is first found out and then the breathing movements are tracked by performing in a shorter FFT and the reflected signals are monitored. Unlike papers3,4, this study also aims at detecting types of apneic intervals occurring in a subject. Threshold values are used in this study namely threshold on the minimum distance between two consecutive peaks and minimum amplitude at which a peak can be detected. If the distance between consecutive peaks is greater than a time interval of 10 seconds, an event of central apnea is detected, while if the value of peak goes beyond the threshold maintaining its periodicity, it is marked as hypopnea event. In the cardiac chest movement signals, sudden fluctuation spikes are studied to identify the obstructive sleep apnea events when the peaks&#x2019; amplitude grows by half. Accuracy being good, this study has a negative side which is the important requirement of a stable amplitude for the microphone. This requirement is very critical as amplitude changes are used to detect apnea events occurrence. But their study also revealed that the microphone experienced some unpredictable variations while transmitting and receiving signals. This can also result in improper predictions of sleep apnea events which can be misleading. However, this issue may be resolved by using an external microphone which can be connected to the smartphone via the cloud. Breathing pattern detection namely fine chest and abdomen movements due to breathing have given this study a better and stronger prediction of apnea event as compared to others.3-5 Wearable chest bands having sensors fitted. These physiological signals can be monitored, thus being an important work in this particular domain. &#xD;
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The system described in a computer-based diagnosis of sleep apnea involves the processing of the thoracic and abdominal excursion signals.6 These signals can help detect obstructive and central sleep apnea attacks and syndromes. The most important contribution to this paper is that in between the two respiration signals, there exists a phase difference. These contribute to the identification and detection of sleep apnea and the grade of the same. Lessor no respiratory movements identify central sleep apnea. The novelty in the methodology involves on-line implementation of the whole system, thus playing a major role in clinical application. An innovative method is provided which classifies the signal system which has the capability of distinguishing between people inflicted with sleep laden disorders and people without them based on EEG and pupil size with an emphasis on the fact that pupil movements indicate alertness towards a situation.7&#xD;
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The thoracic and abdominal excursions&#x2019; phase differences are estimated, a very important factor in detection, as it indicates the rank of airway hindrance.6 A common phase between abdominal and thoracic indicates normal breathing whereas a counter phase indicates airway blockage. It is noted that identical frequency modulation is observed in the excursion signals of the thoracic and abdominal cavity, but they are found in a different phase. An on-line process is required where there is a low respiration rate is involved. In this process, the abdominal and thoracic breathing cycles&#x2019; phase is determined discretely. It incorporated the channels used in PSG signals for thorax and abdomen, hence not utilizing the other available channels. The main reason for not selecting other signal channels was because the outputs of the signals are delayed by a chunk of seconds. A major reason is also that if the cardiovascular signals were included, they tend to superimpose with the other phenomena. Time-domain phase difference analysis methodology is used here, requires a greater number of signal periods. This would result in longer processing delay which would be not feasible for on-line signal analysis. When the extreme points of the two respiration signals are determined, the next objective is to find out the relation between them. If a common phase is detected between two periodic signals having identical frequencies, then it is found that the local extreme indexes are at the same time location.&#xA0; The period between these set of points is roughly around 50% of the time frame if the signals are found to be in their counter phase position. &#xD;
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An experiment is conducted on untreated OSA people, narcoleptic personalities and some healthy subjects7. An image sensor processes the pupil images via small infrared cameras. The image processor detects the pupil and has an output current is directly proportional to the pupil diameter. It also focuses on data pre-processing as a primary objective as the data comes with noise, i.e. such as eye and blinking movements. An algorithm was designed to remove the noise and to construct a continuum series, linear interpolation was used to position data in their resulting time spaces. A case of an anomaly in data is considered when the two adjacent time frame locus&#x2019;s change excessively or when the diameters of the pupil tend to zero. Theta Wave activity has been recorded to grow during sleep apnea episode attacks. Accordingly, the energy was calculated in an interval of 2s. They have also used ART2 NN&#x2019;s to recognize QRS waves. A sequence of ART2 NN&#x2019;s is imperative to derive the categorized output with utmost precision to achieve grouping of similar individuals in conjunction and to reduce the consequences of input order. It is to be noticed that ART2 NN&#x2019;s can enhance the precision of categorization over the individual ART2 network.&#xD;
&#xD;
A study provided that in a good piecewise linearization method the tightness properties must be considered6. They include sharpness and locally ideal placements. To enhance computational efficiency selection strategies and effective breakpoints are immensely important. Thus, more work should be done to study the optimal positioning of the breakpoints. Thus, there is a high chance of diminishing the accuracy, as Piecewise Linear Approximation (PLA) was the initial phase. Moreover, the process is time-consuming which fails to serve the actual purpose. Thus a more dynamic and flexible method be applied. Whereas in another paper the drawback came as the experiment was done on a very small amount of individuals.7 The less the number of data in a dataset the higher is a chance is to achieve maximum accuracy. Moreover, the algorithm developed by the researchers is a success to eradicate the noise in the pupil size data. But there can be a possibility of errors and it is cited that a lot of assumptions been taken to device the methodology. There might be an overlap with the user data and the unused data, hence removing the required data. Also, the time frame is not continuous and the preprocessing involves masking the actual data with a dummy to force it into continuous time interval. On the positive side, the ART2 NN&#x2019;s learns and adapts to an unstable domain with rapidity and solidity, unsupervised learning of priority behaviour, also determining the manifold of groups autonomously. Thus, as paper7 uses an automated approach, whereas paper6 is more prone to human errors. Thus to some extent, paper7 is preferred. &#xD;
&#xD;
The discomforts and inconvenience of the PSG procedure which is the traditional method for sleep apnea detection, and hence aims at an easily available, comfortable, and trustworthy alternative to the traditional methods are studied.8 Real-time detection of sleep apnea and hypopnea using ECG and Spo2 signals has been developed by the researchers in the paper. Sleep apnea/hypopnea syndrome(SAHS) detection has been carried out several ways: once by only ECG signal and only SpO2 signal, the other time using both, by ECG and SpO2 uses feature selection and another time using classifier combination. The features extracted are compared via different Machine Learning Algorithms to improve accuracy and sensitivity. Cost-sensitive weighting approach is also followed in this methodology. The ECG and SpO2 signals are broken down into1minute segments, which is an efficient introductory approach to deal with the problem. Matrix Laboratory (MATLAB) is used for processing the signals and label a minute as apneic or non-apneic episode based on 5 seconds of apneic event occurrence. Basic statistical methods like mean, median and variance were calculated and used for further processing. The ODI index; the oxygen de-saturation index counts the number of times SpO2 value drops below the fixed value which is between 2 to 5. TSA indicated the accumulative time SpO2 stays dropped. Feature sets of the signals are monitored by an open-source software called WEKA. Several machine learning algorithms and classifiers namely, SVM, KNN, Decision Table and Decision Tree, multilayer perceptron, REPtree, FT trees have experimented within this study. Moreover, AdaBoost and ADtree have also been incorporated. Tenfold cross-validation approach has been used in the database and the 3 common evaluation metrics of specificity, accuracy and sensitivity have been used. To take care of computational overload, feature selection has been used. Comparison between different algorithms and classifiers result in some having higher sensitivity and accuracy over others. Hence, the classifier combination concept has been brought into this study for improvement in the overall performance. Results showed combined ECG and SpO2 feature set had higher accuracy as compared to the signals tested individually with their feature sets. For real-time detection, AdaBoost performed efficiently as compared to SVM and combining AdaBoost, Decision Table and Bagging REPTree gave the highest accuracy of 83.61. Further combinations can be explored from the comparisons provided in the paper, to have overall better accuracy and sensitivity. &#xD;
&#xD;
Itinerant detection of the obstructive sleep apnea syndrome (OSAS) has been brought to light in a research paper whose study is based on pulse photoplethysmographic (PPG) signal.9 A proposal is there that decrease in variations in the amplitude of the can prove to be an OSAS discriminator. Heart rate variability (HRV) analysis can be thus used to detect the apneic event. HRV needs electrocardiogram as an additional requirement. It is a disadvantage because of discomfort due to sensors over the patient. It can disrupt normal sleeping habits. Hence, Pulse rate variability is more focussed on in this study as opposed to HRV in paper.8 The amplitude fluctuations are known as DAP which is used in this study to detect apneic episodes.DAP detection on the database involved the preprocessing stage of suppression of mean by RMS method and the concept of the threshold. Linear and adaptive are the 2 divisions of pulse detector. Filtering is done to avoid false detection of abnormal hikes in PPG pulses as regular pulses with the help of an adaptive threshold. Clustering of DAP events into apneic and non-apneic based on SaO2 decrease and airflow decrease for a specific time interval of 5 seconds is done. Feature selection using the wrapper method approach was performed to work with the one giving the most accuracy. Classification with an accuracy of 86.67% is commendable however use of the only SaO2 is not only sufficient for apneic episode detection.&#xD;
&#xD;
Several studies on sleep apnea detection involve methods primarily include determining a list of applicable attributes and developing a classification model to fit the features to perform an automatic diagnosis. Measuring signal strength in wireless networks to monitor breathing and a device called BodyBeat uses microphones having piezoelectric mechanism on the surface of the body, which is used in monitoring sounds of food intake, respiration, etc. in the body are some of the latest trends developed to monitor sleep apnea10,11. The medication used in this cited paper, states that it acts as a promoter of consciousness, thus not letting the body achieve full Rapid eye movement sleep. The consciousness of the body increases the inherent capability of detecting any choking and thus, saving from the effects of sleep apnea and other choking nasal disorders like narcolepsy13. Classification models in use include k-Nearest Neighbour (KNN), Support Vector Machine (SVM), SVM and smartphone-based auto-adjustable pillow system, neural network and NN with the amount of oxygen being carried by the RBC cells, and linear discriminant analysis (LDA).1,3,12,14 There have been several sensors, signal analysis to predict sleep apnea. Choi et al. used thoracic and piezoelectric sensors and data from 179 polysomnographic recordings and used convolutional neural networks (CNN).15 In another study, the abdominal and chest motions from 5804 recordings were selected and analysed.16 Respiration signals obtained from ECG were also utilized in many studies. A combination of AdaBoost with Decision Stump and Bagging along with features gathered from ECG and SpO2 signals and SVM with feature extraction from heart-beat signals have been used to detect OSA.8,17 In another study, the subject is handed over a mobile sensor and an ECG sensor to wear and be monitored every night at the place of stay of the individual. The sensor collects the data and mobile records it.18 Binary classification is implemented on the annotations to detect positive or negative apneic intervals. The model used a multilayer model for better monitoring. Data, Decision and Action together determine the apnea episodes if any. Classification is accomplished using DEREx tool and gives an accuracy of around 86% which is fair. However, if the hardware part can be thought of by replacing with an alternative, then this application can be reaching out to subjects on a wider scale. And, DEREx proves to have higher accuracy as compared to AdaBoost or Bagging and SVM in this study comparison. In the last 10 years, apnea monitoring using Heart Rate Variability (HRV) based on ECG has been developed extensively.19&#xD;
&#xD;
METHODOLOGY TO ANALYZE SLEEP APNEA SIGNALS&#xD;
&#xD;
As discussed, different papers had their approach towards targeting this serious issue of sleep apnea. Use of sensors, signal analysis, classifiers, FFT analysis, HRV monitoring, AI techniques has been in recent use as alternatives of the traditional PSG. The methodology used in different papers in our study have been tabulated in Table 1:&#xD;
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&#xD;
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&#xD;
Table 1 depicts the algorithms which have been implemented in various papers, successfully predicted sleep apnea with a high accuracy rate. In algorithms used in 1, 3, 4, 12, primarily used machine learning algorithms with proper hyperparameter tuning. 4, a self-developed algorithm provided with the highest accuracy rate. 7, 12, 14, 15 algorithms used complex deep learning methodologies and had good results. Also, 5, 6, 17, 19 are primarily the electrical methodologies used to calculate and predict sleep apnea using Fourier analysis on Heart Beat signals, snoring, ECG signals.&#xD;
&#xD;
Comphension on the Results &#xD;
&#xD;
The key findings of our paper throw light upon all the existing methods that have been extensively researched and deployed to detect sleep apnea. Applications of AI, as we have found, are gradually replacing the traditional OSA detection techniques. Researchers are making use of several complex analytical algorithms as we have seen in our study, to find alternatives to the existing treatments. Some show higher accuracy using ensemble methods, while some use primarily signal analysis and result in impressive outcomes, while again some combine sensors and AI to yield better results. However, in general, it can be observed signal analysis along with AI algorithms has higher accuracy in OSA prediction. The comparison of the different methods used in our studied papers and their accuracy obtained is illustrated in Table 2:&#xD;
&#xD;
&#xD;
&#xD;
As depicted from the above table (Table 2), it is observed that Self Developed Algorithm on VAD used in paper 4, showed the highest accuracy of 97%. The VAD design includes processing of the input signal followed by feature extraction and final VAD computational decision. Paper 9 using PPG signal analysis and paper 18 using a Binary Classification algorithm showed impressive accuracies of 86.67% and 86% respectively.&#xA0; AdaBoost, Decision Table and Bagging REPTree in paper 8 and SVM classifier in paper 3 also showed good accuracy of around 83% in the detection of Sleep Apnea episodes.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The existing methods have enhanced the possibility of detection of sleep apnea and therefore reduce life-risk of an individual. Using different kinds of Machine learning and deep learning algorithms, IOT devices, sensors and signals have opened new doors to discover more and develop more accurate and better solutions to add on to the existing methods. A comprehensive study of existing methods will help researchers to identify their drawbacks and find out more efficient solutions to them, which will help humanity less prone to risks due to this rising problem.&#xD;
&#xD;
ETHICS: The study was conducted as per protocol and there were no variations from the approved protocol valid at the date on which the study was conducted. Informed consent was obtained from all participants before the focus groups. There were no withdrawals of consent.&#xD;
&#xD;
AUTHORSHIP STATEMENT: All persons who meet authorship criteria are listed as authors and have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. All authors revised and gave final approval for the version submitted.&#xD;
&#xD;
CONFLICT OF INTEREST: The authors declare that they have no conflicts of interest.&#xD;
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&#xA0;FINANCIAL SUPPORT: This work was not supported by any external funding.&#xD;
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PROVENANCE AND PEER REVIEW: Not commissioned; externally peer reviewed.&#xD;
&#xD;
ACKNOWLEDGEMENT: We take this opportunity to thank our management of Vellore Institute of Technology for their continuous support and encouragement. We are indebted to the reviewers for their valuable suggestions for improvement. 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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19. Khandoker A, Gubbi J, Palaniswami M. Automated Scoring of Obstructive Sleep Apnea and Hypopnea Events Using Short-Term Electrocardiogram Recordings. Transac Infor Tech Biomed 2009;13(6):1057-1067.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Mental Health and Lifestyle of University Students During Lockdown Period of COVID-19 Pandemic&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>97</FirstPage><LastPage>102</LastPage><AuthorList><Author>Lokanath Mishra</Author><AuthorLanguage>English</AuthorLanguage><Author> N. Pramoda Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The flare-up of Covid-19 in India caused an open frenzy and emotional wellbeing pressure. At first, it was about the course finishing later the issues have been moved to assessment. This scourge expands the mental issues, stress, dissatisfaction, sorrow and nervousness. Objective: The main objective of this study was assessing the mental health and lifestyle of Mizoram University students during Covid-19 lockdown period. Methods: This study was a cross-sectional investigation and a snowball method was utilized for an assortment of information from the students. Results: There was 65.2 per cent of members who revealed that they were giving more consideration to their emotional wellbeing during the pandemic. Most of the members revealed that they got expanded social and family support and they were giving more consideration to their psychological wellbeing, investing more time, resting and practising after the beginning of the pandemic. Majority of the participants expressed that they have expanded worry of learning, worry for conclusive university assessment, career stress and upset during the lockdown time. Very fewer members expressed that they were giving more consideration to their psychological wellness, investing more time, resting and practising after the beginning of the pandemic. Conclusion: These positive effects on psychological wellbeing may have helped the students adapt to other negative effects on emotional wellbeing, and expanded pressure. This pandemic impact will probably be engraved on every individual included.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Academics, Lifestyle, Mental health, Pandemic, Stress</Keywords><Fulltext>Introduction&#xD;
&#xD;
Government of India proclaimed an across the country lockdown for 21 days on 24th May 2020, as a preventive measure against the Covid-19 pandemic in India. The national wide lockdown in India has been reached out past 4th May 2020 for an additional fourteen days. Once more, it was extended out up to 31st May 2020. The flare-up of Covid-19 in India caused an open frenzy and emotional wellness worry, with an expanding number of cases being analysed. Psychological wellbeing is more than insignificant nonattendance of mental issues. It alludes to a perspective which is described by enthusiastic prosperity, relative opportunity from tension and crippling manifestations, and an ability to set up useful connections and adapt to the conventional requests and worries of life.&#xD;
&#xD;
All the instructive organisations have been shut due to Covid-19 episode. In the interim, school and college students are worried about inns, residence clearing and wiping out of foreseen occasions, exchange studies and graduation functions. Final year students are anxious about the job market they are going to enter soon. The assessments were deferred because of the lockdown impact and the genuine date of the test is nobody knows and questionable. In this context, numerous students were experiencing mental pressure and there is a solid need to think about their psychological wellness status. The constant spread of the pandemic, exacting disconnection measures and postponements in beginning schools, colleges, and universities across the nation are expected to impact the mental health, emotional wellbeing of the students. &#xD;
&#xD;
There have been provided details regarding the psychological effect of the pandemic on the overall public, patients, clinical staff, youngsters, and more established grown-ups. Studies have revealed that a greater part of the students are experiencing nervousness issue and anxiety.1-3 However, even those students who are living at home have grumbled about experiencing suffering from interpersonal issues. Indian Psychiatry Society study revealed that there is up to a 20 per cent expansion in cases related to emotional wellbeing and mental health issues. Initially, it was about the course completion and the University and college educators began a web based instructing, however, the issues have moved to assessment. Students, particularly from the more vulnerable segment who may not have a computer, laptop and smartphone are worried about the method of assessment and examinations. Numerous uncertain family issues come out which were not tended to yet being bound to one space for the day has constrained these issues to come out and these students are in the middle of it. &#xD;
&#xD;
Different studies have affirmed the effect of communicable disease episodes on open psychological wellbeing, such as serious intense respiratory disorder in 2003 and the 2009 novel influenza epidemic. These kinds of pestilences increase mental issues, such as stress, disappointment, discouragement, stress, frustration, depression, anxiety, and tension. A few investigations have demonstrated that post-traumatic stress disorder is firmly identified with melancholy, depression, psychological problems, and other mental issues. Some studies conducted concerning the mental health risks of Covid-19 in vulnerable populations include older adults4, the homeless destitute5, migrant workers 6 the intellectually ill7,8, pregnant ladies 9 and Chinese students studying abroad.10 A considerable number of people are working in IT, ITES, education, and other industries where they can work from home. Hence, their arena physical contacts which helped for better social distancing.11 An investigation conducted in China12 on the impact of Covid-19 on youth psychological well-being, mental health and in India13 discussed the significance of therapists during the Covid-19 pandemic is featured on teaching critical thinking, problem-solving strategies to adapt to the current emergency. Haimin14 investigated to look at university students&#x2019; family life in the Covid-19 and found that an alternate learning experience in this situation from the time with this circumstance from when they were on campus previously. There are various ways a student can use this time profitably and gain something out of it. However, technology and innovation have made our life simpler and easier as well as entertaining. &#xD;
&#xD;
However, sometimes it is an absence of interest that individuals feel exhausted significantly in the wake of being involved by the electronic devices. Fatigue is an opportunity for the individual to improve their life in a few or another manner. The University Grant Commission has been utilising customary warning to all Universities to take conceivable precautions and measures for wellbeing and security of students. To maintain a strategic distance from any sort of stress Universities will take a few measures for the psychological wellbeing psychosocial viewpoints and prosperity of the students. From the above, it was discovered that a couple of studies have detailed the effect of the Covid-19 pandemic on emotional wellness, mental health and way of life of public and adolescent youths. No such study has been conducted on psychological wellbeing and way of life of University students of India. Therefore, the study intended to explore the mental health and lifestyle of University students during the lockdown period and whether there was a quick effect of the Covid-19 pandemic. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The present study was a cross-sectional investigation. A snowball sampling strategy was utilised for the collection of information from university students. Before conduct the research study, ethical approval has been taken from Mizoram University Research Ethical Committee having no MZU/DoE/249 and also consent was taken from the Mizoram University students. An online semi-organised survey questionnaire was utilised for an assortment of data by utilising Google forms. The connection of the semi-organized poll was sent through messages, What Sapp and other social media to the students who have connected with the contacts of the investigator. The members were urged to reveal the study to whatever number individuals as would be prudent. Accordingly, the link was sent to the students apart from the primary purpose of contact. Part-A of the survey which incorporates sex, the stream of instruction, area of residence and course. Part-B of the survey questionnaire was to gauge the mental health of the students. Respondents are solicited to answer the Part-C from the poll for examining the effect of the Covid-19 pandemic on mental health-related lifestyle changes having yes and no responses. Furthermore, students are approached to answer their learning experiences with online courses, assessment of the government measures against the Covid-19 spread, view of the impact of the pestilence on their thoughts, behaviours, and practices.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
The information was gathered from 894 university students with 513 females and 381 males. Out of total participants 224 Arts, 107 commerce, 284 science and 279 students are from professional courses. Concerning the area of residence, 376 students are from urban and 518 students are from rural background (Table 1). &#xD;
&#xD;
&#xD;
&#xD;
From the above table, it tends to be seen that 69 per cent of students are in general course participated in the study and 31 per cent students are from a professional course like Engineering, MBA, M.Ed. MSW, M. Lib., and MJMC course. Concerning stream of instruction 25.06 per cent are from Arts 11.97 per cent students are from commerce and 31.76 per cent are from science background remaining students were from other streams. Fifty-eight per cent of students are from rural and 42 per cent of students are from an urban background. &#xD;
&#xD;
Following the onset of the pandemic, more than half of the participants 67.2 per cent reported no expanded worry, stress from scholastics. Additionally, 78.2 per cent mentioned that they did not experience increased financial stress arising from the pandemic. A total of 74.5 per cent of participants reported that they did not encounter increased stress from home. There was 65.2 per cent of participants who reported that they were paying more attention to their emotional wellness, mental health following the pandemic. Additionally, 66.3 per cent of participants reported that they were investing more time to rest. The majority of participants 65.2 per cent expressed that they were spending more time to relax. More than half of the participants 69.7 per cent reported that they were spending more time exercising.&#xD;
&#xD;
Since the pandemic is not finished at this point and there is a further spread of the pandemic throughout the country, it is conceivable that the Covid-19 pandemic will cause an extreme frenzy, excessive panic, uneasiness, and anxiety in inhabitants living inside and outside states of India on account of the expanding number of Covid-19 cases around the world. Along these lines, some may contend that the reactions from the relevant authorities should have been quicker and progressively proactive. Simultaneously, government and private clinics to battle the Covid-19 pandemic were assigned by the concerned specialists. However, it was imperative to ensure that these quarantine facilities were not planned simply for lodging huge quantities of individuals, indeed, which can spread the contamination further. Occasion periods were additionally delayed and school openings were stretched out to decrease the quantities of new Covid-19 cases.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The overall score in participants showed a gentle distressing effect. One potential reason behind this finding is that the infection flare-up was not viewed as serious during the time that there was conducted. Moreover, it is conceivable that members despite everything probably would not have been all around educated about the seriousness of the infection, as referenced beforehand.&#xA0; When this investigation was conducted, the whole India was locked down as had happened in Mizoram University is located in the Aizawl (Northeast of India) and the road distance between plane India state Assam and Aizawl is approximately 400 km. &#xD;
&#xD;
By the month May 2020, the quantity of affirmed Covid-19 cases in Mizoram is just one, which is extremely little than that of the rest of India. Besides, most of the members reported that they got extended social and family support. The present study also documented that the vast majority of the members had positive mental health, psychological well-being connected way of lifestyle changes. Spending more time to rest was also associated with a lower score in the respondents of the present study. &#xD;
&#xD;
Albeit the greater part of the members, 52.1 per cent reported that they felt stunned and uncertain because of the Covid-19 pandemic, they did not feel helpless because of the pandemic. Additionally, the majority of participants revealed that they were paying more attention to their mental health, psychological wellness, spending more time relaxing, resting and practising after the onset of the pandemic. These positive effects on mental health, psychological wellness may have helped the participants adapt with other negative impacts on mental health, including increased pressure and stress. Then again, an expansion in money related and family worry in a debacle could be related with some shirking practices, which would have compounded their psychological wellness, mental health and lead to a progressively latent way of life and more passive lifestyle. &#xD;
&#xD;
The current study results were consistent with the findings reported by Lau et al. (2006) who explored mental health, psychological wellbeing, quality of life and personal satisfaction in Hong Kong residents during the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003. The authors also reported increased social and family support as well as positive psychological wellness, mental health-related lifestyle changes. One potential reason behind these findings was that during the pandemic, the pace of the entire society eased back down. This could have then created more chances and time among the community members to help, support and care for each other. &#xD;
&#xD;
Besides, during the some Ugadi, Ramzan and other various festivals in each state, relatives, family members and companions were tremendously esteemed and there was expanded correspondence with relatives and companions. Family members were bound to think about one another and fraternize because they were approached to abstain from going to open places and remain at home, particularly during the celebrations and festivals. Besides, these festivals and celebrations are the most significant state festivals and celebration because it marks the beginning of a new year according to the traditional local calendar. It also signifies an opportunity for a new beginning and a hope of good things to come. Companions were likewise bound to send respects to one another using WhatsApp and potentially other social media. &#xD;
&#xD;
This study was one of the first studies to investigate the impact of the Covid-19 pandemic, as this study was taken more than weeks after the lockdown in Aizawl other areas and cities in Mizoram were imposed by the Indian government. This is especially important, as this study serves as some of the main information about the mental health, emotional wellness impacts of the Covid-19 pandemic. Furthermore, the current study pilot-tested the legitimacy of the questionnaires used to ensure that they were appropriate in the present investigating context and setting. However, the present study conducted from the limitations associated with the modest number of the sample size and for little timeframe, poor adherence to the investigation and the sampling method, which constrained the speculation of present findings to the entire university student population in mainland India. &#xD;
&#xD;
It is also possible that the members were limited to only those who have the passionate and mental scope to respond these questions, which may have skewed entirely of the appropriate responses towards those normal of a &#x201C;healthier&#x201D; population in this circumstance. During this moment of increased security, particularly digital security aimed at playing down the crisis, any sort of critical responses. Additionally, the conceivable recall inclination from members may have confounded the present findings. The pay level of participants&#x2019; family was not assessed in the study. Despite the fact in this study researcher collected the occupational information of the guardians, the researcher did not collect specific details including whether their parents&#x2019; occupation and income were related to healthcare. Additionally, the researcher did not collect information on whether participants had family members, relatives and friend who contracted the virus or who developed symptoms.&#xD;
&#xD;
The researcher did not utilize any promotional material for the survey because, during this sensitive time, the degree to which members may sensibly perceive the survey as a sort of institutional surveillance may have affected the legitimacy of the responses. Participants were approached to refer to the data concerning Covid-19 updates and the prevention measures released by the administration. Enormous scope with both qualitative and quantitative techniques ought to be conducted in all districts of different nations to explore the mental health and quality of life among citizens and residents, especially in the areas most severely impacted by the pandemic. &#xD;
&#xD;
Following the current study, the researcher will likewise research whether these members develop post-traumatic stress after the Covid-19 pandemic is over. Ideally, by at that point, researchers and scientists will have some ideas on what transmits the SARS-CoV-2 infection and how this infection comes through. Researcher emphatically urges that health workers ought to incorporate emotional mental health advancement as part of their follow-up after the pandemic.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Future investigation should also incorporate more issues related to mental health questions. Young members express a stronger sense of helplessness, which might be correlated with an expanded utilization of social media. These young members watch and tune in to increasingly more negative news which will at that point strengthen their sentiments of tension and discouragement during an emergency. Therefore, questions related to social media use, or internet use, or news consumption, would be useful to comprehend the effect of such epidemics on mental health. Also, questions regarding family members, relatives or friends who have contracted the infection, health history of the people, and their relationship with healthcare sectors in the case for work, and existing mental health issues ought to be included.&#xD;
&#xD;
The ministry of health and family welfare, the government of India, has provided health advisories, videos, posters and even conducted webinars on handling mental health issues of peoples. Two sorts of devices cell phone 78.35 per cent and PC 21.65 per cent were utilized by the students for accessing the online course. Concerning the online course, live telecast, instead of recorded broadcast, of the courses was the best choice of most of the students 73.60 per cent. Nearly 55 per cent of students took part in the zoom class with a length of 35 to 40 minutes.&#xA0; About 65.7 per cent of students gain proficiency with their course employing the learning management system. Also, 72 per cent of students learn through WhatsApp and social media.&#xD;
&#xD;
Regarding the activities of the students performed in their home during lockdown period, they spare time, watching TV 75.4 per cent, reading books 38.7 per cent, writing assignments 34.8 per cent, and playing computer games 26.8 per cent. Further, 34.5 per cent of the students viewed the news from TV newspaper and social media about the covid-19 pandemic for each day. Overall, nearly 37.3 per cent students felt fairly exhausting dating comfortable, and 46.70 per cent of them perceived family life during the unique time as not terrible, but not great either and 17 per cent not exhausting. Although personal hygiene was profoundly accentuated, there were a little proportion of the students 12 per cent who believed that they did not pay more attention to personal hygiene than previously and 88 per cent of the students deemed that wearing facemasks would be necessary while heading outside and beneficial for themselves even when the epidemic is under control and vanishes. &#xD;
&#xD;
Conclusion &#xD;
&#xD;
Since the lockdown is not finished at this point and there is a further spread of the pandemic, the Covid-19 pandemic may cause extreme panic and anxiety among understudies living inside and outside the home. Albeit the maximum number of participants revealed that they have expanded worry of learning, worry for conclusive final university examination, career stress and upset during the lockdown time. Moreover, a very few percentages of participants reported that they were paying more attention to their emotional well-being, mental health, investing more energy unwinding, resting and practising after the beginning of the pandemic. These positive effects on psychological wellness, mental health may have helped the members adapt to other negative effects on emotional wellness, including expanded pressure. The present study results are depicting expanded social and family support just as positive psychological wellbeing connected way of life changes. One potential purpose behind these discoveries was that during the pandemic, the pace of the entire society eased back down. In this study, it was discovered that there were professional students with an inclination toward mental issues and psychological problems, which was higher than the proportion of mental issues in different studies.&#xD;
&#xD;
Aknowledgement- The researcher acknowledged the students of Mizoram university who have helped a lot in the collection of data for the study. Further, the researcher acknowledged the authors whose articles have given in references and the university authorities who have permitted to conduct the study during the pandemic period.&#xD;
&#xD;
Conflict of Interest &#x2013; The research has no conflict of interest for publication in your reputed journal&#xD;
&#xD;
Source of Funding &#x2013; This project was not funded by any funding agency.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3390</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3390</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Reliability of Predicting the Final Treatment Outcome in Surgery First Orthognathic Approach (SFOA)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>103</FirstPage><LastPage>111</LastPage><AuthorList><Author>Lakshmi Rathan AC</Author><AuthorLanguage>English</AuthorLanguage><Author> Vivek Narayanan</Author><AuthorLanguage>English</AuthorLanguage><Author> Saravanan Chandran</Author><AuthorLanguage>English</AuthorLanguage><Author> Karthik Ramakrishnan</Author><AuthorLanguage>English</AuthorLanguage><Author> Cynthia Scott</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Face form is largely dictated by one&#x2019;s ethnic origin and genetic inheritance. Individuals presenting with significant facial disproportion may be disadvantaged both aesthetically and functionally. Surgery First Orthognathic Approach (SFOA) is a novel approach which was floated initially a decade ago. . The major driving factor for SFOA is the immediate esthetic results for the patient as well as reduction of the duration of treatment. Objective: To reliably predict the final structural, functional and esthetic outcome of patients with facial disproportion undergoing &#x201C;Surgery First Orthognathic Approach (SFOA)&#x201D; before the commencement of procedure and compare it with the final achieved result. Methods: Study conducted at our centre was a prospective study over 24 months. Participants with facial disproportion who met the criteria for SFOA were included in our study. Complete data acquisition was carried out for all the participants, following which both conventional and digital assisted cephalometric analysis was done. Based on these analyses, the treatment plan was formulated and the surgical procedure was finalized. At 6 month, post-op lateral cephalogram was obtained and both conventional and digital assisted cephalometric analysis was done and compared with a predicted outcome. Results: Twelve participants reported with facial discrepancy during our study period, of which seven participants met the criteria for SFOA. Among seven participants, all had manual and Digital assisted cephalometric tracing. Four Participants had Computer Assisted Surgical Simulation (CASS). Our result showed no statistically significant differences between the predicted and final outcome in both conventional and digital assisted cephalometric analysis. Conclusion: In our study, we found that the maxillary repositioning was reliably predicted by both Conventional and digital assisted Cephalometric prediction analysis whereas conventional prediction was still much better than the digital prediction for mandibular repositioning.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>SFOA, Orthognathic Surgery, Digital assisted cephalometric analysis, CASS, Prediction tracing, Virtual Planning</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The golden proportion of face has always been associated with classical beauty as described in our ancient painting and sculptures. Face form is largely dictated by one&#x2019;s ethnic origin and genetic inheritance. Individuals presenting with significant facial disproportion may be disadvantaged both aesthetically and functionally.1,2 In such cases orthodontic treatment alone might be insufficient to correct deformities. A combination of orthodontic treatment with Orthognathic surgery is needed to achieve optimal results.3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the mid 20th century with the advancement in orthodontic therapy in the form of fixed appliances, orthognathic surgery developed into a multidisciplinary exercise.4 This conventional approach involves a significant period of presurgical orthodontics followed by surgery. Most patients also need a varying period of post-surgical orthodontics to settle the dentoalveolar component into a more stable occlusion.5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Surgery First Orthognathic Approach (SFOA) is a novel approach which was floated initially a decade ago by a Nagasaka et al.6,7 There are many published case reports of surgery only approach to address facial disproportion with varying results. SFOA as a concept is primarily a combined approach where the phase of presurgical orthodontic decompensation is minimal. This included levelling and aligning of arches. The major driving factor for SFOA is the immediate esthetic results for the patient, which significantly increases the acceptability.8 It also may result in a reduction in the duration of treatment time.&#xA0; In its current format, SFOA is reserved for a few selected clinical conditions which include moderate to well-aligned arches with minimal transverse discrepancies.9&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study aims to evaluate the reliability of predicting the final treatment outcomes in Surgery First Orthognathic Approach (SFOA) using conventional cephalometric analysis and digital assisted cephalometric analysis&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This study was approved by the Institutional Ethics Committee (1258/IEC/2017) and was conducted over twenty-four months. Patients presenting with facial disproportion either to the Department of Oral and Maxillofacial Surgery or to the Department of Orthodontics and Dentofacial Orthopaedics during the study period were included. Postoperative follow up was done for a period of minimum six months. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The inclusion criteria were patients with skeletal malocclusion (Angle&#x2019;s class I, II, III), Age group between 18-35 years, American Society of Anesthesiologists (ASA) category I, II. Patients with severe crowding, the exaggerated curve of Spee, systemic illness, syndromic conditions and patients not willing to participate in the study were excluded.&#xD;
&#xD;
Procedure&#xD;
&#xD;
Pre-operative &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All patients underwent complete data acquisition, which included clinical examinations, clinical photographs (Figure 1), standardized digital lateral cephalogram (Figure 2a) and study models. High Resolution Computed tomography (HRCT) in a prescribed format was also obtained. Patient in natural head position and gently biting in centric relation, with the lips in a relaxed position, all the images were obtained in 1mm slice thickness DICOM (Digital Imaging and Communications in Medicine) format. Once the data acquisition, clinical evaluation and cephalometric analysis were done, problem list was made for all the participants based on which treatment objectives were obtained.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Conventional cephalometric tracing and cephalometrics for Orthognathic Surgery (COGS) analysis for both hard and soft tissue was done using acetate paper. Cephalometric prediction tracing was carried out for all the participants with the simulation of proposed surgical movements.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Digital lateral cephalogram was incorporated into Dolphin Imaging version 11.0 Premium software and calibrated. COGS analysis was done for all the participants and skeletal linear measurements were obtained. Using the software, surgical movements were simulated thereby achieving the proposed surgical plan and skeletal linear measurements were recorded. However soft tissue prediction analysis was not possible due to its unavailability in the current software.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; HRCT in DICOM format was incorporated into Materialise&#x2122; (Materialise Interactive Medical Image Control System) MIMICS medical version 21.0 software. Masking was done and virtual Skull models were created. Using the software templates, surgical osteotomies were performed and the planned surgical movements were simulated (Figure 3). &#xD;
&#xD;
The fixed appliance was placed three to five days before the surgery for all the patients. The surgical procedures as planned were carried out under general anaesthesia.&#xD;
&#xD;
Post-operative&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Postoperatively, orthodontic teeth movements were initiated three to four weeks following surgery for all participants to utilize Rapid Accelerated Phenomenon (RAP). &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The postoperative lateral cephalogram (Figure 2b) and cephalometric tracing are done at six months were considered as the outcome tracing. This tracing was superimposed over the predicted tracing (Figure 5, Figure 6). The linear differences in the landmarks were measured and analyzed.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Similarly six months postoperative digital lateral cephalogram was incorporated into the dolphin software. Cephalometric tracing was made following calibration and Skeletal linear measurements were recorded. Tracing superimpositions were done using software and the linear difference in the landmarks were measured as well as analyzed (Figure 7, Figure 8).&#xD;
&#xD;
Statistical analysis &#xD;
&#xD;
Statistical analysis was carried out using version 20 SPSS software. Statistical analysis was made using a Paired t-test to compare the predicted value and final value of both conventional hard and soft tissue parameter and digital hard tissue parameter. the p-value of &#x2264;0.05 was considered statistically significant.&#xD;
&#xD;
Results&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; During the study period, twelve patients reported to our department with the facial disproportion of which seven patients met our inclusion criteria. Among the seven patients, four of them were males and three were females. Distribution of age among the study group ranged from 21 to 31 years, with the mean being 25 years.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Out of the seven patients, two of the patients had a major discrepancy in a single jaw. One patient had a maxillary discrepancy whereas the other had a mandibular discrepancy. The remaining five patients had the combination of both maxillary and mandibular discrepancies. The types of osteotomy procedure performed for various discrepancies are tabulated in table-1.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The initial predicted and final tracing values of both conventional hard and soft tissue analysis are summarized in table-2 and table-3 respectively. Similarly, the values of digital hard tissue analysis are summarized in table-4.&#xA0; &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The mean comparison between predicted and final values within the group was analysed using the Paired t-test for conventional hard tissue tracing are summarized in table-5. No statistically significant difference was evident between the predicted and final values in all the parameters within the conventional cephalometric hard tissue tracing. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The mean comparison between predicted and final values within the group was analyzed using Paired t-test for conventional soft tissue tracing are summarized in table-6. No significant difference was statistically evident between the predicted and final values in all the parameters within the conventional cephalometric soft tissue tracing.&#xA0; &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The mean comparison between predicted and final values within the group was analyzed using Paired t-test for digital hard tissue tracing are summarized in table-7. No statistically significant difference was found between the predicted and final values in all the parameters within the digital assisted cephalometric tracing.&#xD;
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Discussion&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Facial disproportions are a deviation from the normal facial harmony. The acceptable level of variation from normal facial proportion is still debatable.1,2&#xA0;&#xA0; These discrepancies can happen in various planes. Individuals with facial disproportions often encounter with aesthetic, functional and psychological disturbances. The goal of orthognathic surgery is to restore facial form and function.10&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Until the introduction of fixed orthodontic appliances therapy in mid 20th century, most of the osteotomies performed were surgery only approach which has major limitation such as occlusal instability, relapse as a result of the type of muscle attachment to osteotomized segments. In 1976, Worms et al advocated the orthodontics-first concept for individuals with facial disproportion and stated that the best possible surgical repositioning of the maxillomandibular complex (MMC) is only possible following pre-surgical orthodontics.4&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Conventional orthognathic surgery includes presurgical phase followed by orthognathic surgery and postsurgical phase was considered as standard protocol. The main purpose of presurgical phase is decompensation of the dentition by correcting severe crowding and rotated teeth, levelling of the curve of Spee, levelling and alignment of teeth thereby achieving interarch relationship.3 It has been argued that repositioning of jaws is only possible after decompensation of dental discrepancies. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To overcome the shortcoming of Presurgical phase, Brachvogel et al in 1991 put forth the idea of &#x201C;Surgery First and Orthodontic second Approach&#x201D;. He also stated that tooth movements were facilitated by surrounding soft tissues which helps in reducing overall treatment time.11&#xA0; Although in literature surgery first procedure has been emphasized, Nagasaka et al in 2009 popularised the protocol for Surgery First Orthognathic Approach.7 The major driving factor for SFOA is the immediate esthetic result as well as the reduction in the duration of overall treatment time.8 As per Liou et al certain criteria&#x2019;s were mandatory for selection of individuals with facial disproportion for SFOA which includes moderate to well-aligned arches with minimal transverse discrepancies, minimal discrepancies in the inclination of the anterior teeth and flat to the mild curve of Spee.12&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; One of the basic requirements of successful orthognathic surgery involves the accurate prediction of the final position to assess the feasibility of the treatment. The conventional methods of treatment planning include cephalometric analysis and prediction as well as a simulated model surgery on an anatomical articulator with appropriate splint fabrication. Although these methods had certain limitations, these are widely used protocol for achieving optimal results. The cephalometric tracing also aids in assessing the positioning of the maxilla in the anatomical articulator. The major limitations of manual tracing are human errors and time consumption.13&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A paradigm shift in planning the orthognathic surgical movements happened with the digital revolution. The availability of 2Dcephalometric planning software-enabled surgeon precise planning and with further application of the technology the 2Dimensional planning has now reached the next generation as three-dimensional virtual simulations.14 It improved the accuracy of predicting hard tissue as well as soft tissue profile and enabled to perform precise surgical movements. They also provide better outcome by transferring the predicted plan to the operating room with the fabrication of digitally assisted customized splints.15,16&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Our study aimed to reliably predict the outcome in SFOA participants. In this period twelve participants reported, of which seven were planned for SFOA and five for conventional. In our study, the prediction tracing was done using a manual method for hard tissue and soft tissue and dolphin software for hard tissue parameters. Additionally, we also performed Virtual simulation for a few participants using CASS protocol.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The cephalometric landmarks were traced preoperatively and six months postoperatively. The preoperative prediction tracing was compared with six months of postoperative final tracing. On comparing the manual hard tissue tracing, the predicted value and final value were similar and there was no statistically significant difference between both the values. Likewise in the soft tissue manual and predicted tracing had no statistically significant difference with that of final values. It was in contrast to the study conducted by Pospisil et al. in 1987 as they reported that 60% of prediction tracing are inaccurate with that of postoperative tracing.17 However the study published by Bryan et al. in 1993 showed similar result to that of our study. They found that there is no significant difference between the planned postsurgical position of the jaws and the position achieved at the surgery.6&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In Digital assisted hard tissue tracing, the predicted and final outcome was statistically similar, this result was in contrast to a systematic review reported by Kaipatur et al. in 2009 which stated that computer programs cannot consistently predict the skeletal changes occurring after orthognathic surgery.18 The manual prediction tracing and digital prediction tracing were compared. The maxillary parameters were reliably predicted in both Conventional Cephalometric analysis and Dolphin software. However, the mandibular parameters were reliably predicted with manual tracing. It was similar to the study conducted by Gossett et al. in 2005 for the conventional approach group. He reported that both the conventional visual treatment objectives and Dolphin assisted visual treatment objectives have a high level of reliability for the maxilla and conventional visual treatment objectives were slightly better at predicting the actual surgical changes in the mandibular arch.19 Yet another study conducted by Arslan et al. in the year 2018 yielded similar results to that of our study.20&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In our study, the final orthodontic movements were not predicted. Most of the cases included in our study were participants belonging to strict SFOA criteria. These patients did not need a lot of orthodontic movements. We had prediction planning at immediate postoperative and six months postoperative period. However, our six months postoperative value was similar to that of predicted value and was taken into consideration.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The success of SFOA relies on case selection, accurate prediction and fixation which can yield good results even without orthodontic preparation. Given the present scenario, the conventional procedure for tracing is better, however, the next step would require at predicting the final orthodontic movements which can give more promising results.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Accurate prediction of the possible postoperative changes is of paramount impact in the success of orthognathic surgery. The different technique has been followed to achieve a reliable prediction including model surgery, cephalometric prediction and the contemporary digital planned visual surgery. This prediction becomes more challenging in the SFOA scenario due to the increasing variability which in overall to be achieved by orthodontic means. Our study focused on comparing the reliability of both manual and digital prediction in cases satisfying the SFOA criteria. Further studies which would also predict the orthodontic movements and incorporate in surgical planning can help to expand the envelope of the spectrum of the patients chosen to undergo SFOA. Further prediction should be able to accurately project both hard and soft tissue changes. However, the ultimate breakthrough in orthognathic planning will arrive when the dynamic soft tissue changes can reliably be predicted over the static hard tissue change.&#xD;
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Acknowledgement of technical support: Dr. Shantanu Patil, Head and Consultant, Department of Translational Medicine and Research, SRM Medical College, Hospital and Research Centre&#xD;
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Source(s) of support: NIL&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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Conflicts of Interest: NIL&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3391</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3391</Fulltext></URLs><References>&#xD;
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	Arslan C, Altu? AT, Toygar Memiko?lu TU, Arslan EM, Ba?p?nar E. Comparison of the Accuracy of Manual and Digital Cephalometric Prediction Methods in Orthognathic Surgical Planning: A Pilot Study. Turk J Orthod 2018; 31(4): 133-138.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Formulation of Natural Elite Dye Remover from Textile Effluent&#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;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>112</FirstPage><LastPage>116</LastPage><AuthorList><Author>Sri Sowmitha Ramesh</Author><AuthorLanguage>English</AuthorLanguage><Author> Komala Devi S</Author><AuthorLanguage>English</AuthorLanguage><Author>Tamilselvi S</Author><AuthorLanguage>English</AuthorLanguage><Author> Moni Philip Jacob K</Author><AuthorLanguage>English</AuthorLanguage><Author> Ragamathi S</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajaseetharama S</Author><AuthorLanguage>English</AuthorLanguage><Author> Jeyavel Karthick P</Author><AuthorLanguage>English</AuthorLanguage><Author> Pavithra MKS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The dyes used in the textile industry poses a major problem to wastewater sources and the environment. Common ways of wastewater treatment containing dyes include adsorption, sedimentation, chemical analysis, chemicoagulation, biological methods, and advanced oxidation procedures. Objective: To produce the papaya seed, banana pith and pineapple peel powder and treat textile synthetic wastewater with these natural coagulants. Methods: Papaya seed, Banana pith and Pineapple peel were dried at a particular temperature and ground into powder. Coagulation and flocculation tests were carried out using the jar test apparatus in which 500mL of raw water sample was treated with different concentration of natural coagulants. BOD and COD were determined, FTIR analysis was made to know the functional group of natural coagulants which is responsible for efficient dye removal. Results: The turbid remaining vs. coagulant dosage graph has been plotted. The treated textile wastewater sample is tested for the presence of BOD; initially, the value was 337.25mg/L with dark blue colour and after 5 days of incubation the colour reduces and brownish precipitate forms with a value of 185.43mg/L. Treated textile wastewater is tested for the presence of the chemical oxygen demand, after 2 hours of digestion, titration is carried out, which showed the change in bluish-green colour to red colour. The result indicates initially COD value as 480mg/L which is reduced to 323mg/L. Conclusion: The FTIR results showed the presence of potential functional group which is responsible for dye removal. The initial value of BOD and COD was reduced from its original value. Hence, natural coagulants play a potential role in the treatment of Dyes in textile effluent.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Papaya seed, Banana pith, Pineapple peel, Natural coagulant, Textile colouring water</Keywords><Fulltext>INTRODUCTION&#xD;
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Textile industries produce a huge amount of coloured wastewater which contains pollutants such as heavy metals, chemicals, and various dyes. Waterbody pollution is considered as a serious life threat environmentally across the globe. Discharge of untreated wastewater to water bodies causes various types of problems to the marine and terrestrial ecosystem.1,2 Throughout year Textile industries release massive amount to wastewater, these effluents are highly resistant to pH, light, microbial attack and this makes them stable for a longer period in environment.2,3 In India, around 80% or 1,30,000 tons of dyes consumes in the textile industry due to elevated demand for cotton and polyester. These harmful dyes effectively create a bad impact on photosynthetic function in plants, due to penetration of low light and consumption of oxygen creates a huge impact on aquatic life and also decreases the capacity of oxygen and food production in algae.1,4,5 &#xA0;&#xD;
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The reuse of textile wastewater, efficient treatment is necessary to achieve water scarcity. Globally several studies have been undergone for the treatment of textile dye waters through Advanced oxidation with biological oxidation, Granular activated carbons, Coagulation-electro-oxidation, Adsorbent, Wet oxidation, Fenton&amp;#39;s reagent.6 The mentioned techniques work in the mechanism of production of hydroxyl free radical (HO) that destroys the chemical bond of dyes and thus lowering the concentration value of BOD and COD. Another most effective technique used for the treatment is Membrane-filtration. However, these conventional methods have some of the disadvantages such as high cost, more number of by-products, generation of more sludge, high cost of operating, limited to pilot scale. So far, Synthetic conventional techniques have certain disadvantages researchers done another way of treatment using inorganic coagulants. Aluminium sulfate, ferric chloride, poly aluminium chloride effectively acts as the remover of dyes in wastewater, But still, there are certain potential causes of serious health issues. Due to drawbacks of synthetic conventional techniques and inorganic coagulants paves a way for the another safer, eco-friendly techniques for the treatment of wastewater is that Natural coagulants.7,8 Natural coagulants can be extracted from the plants, animals and microorganisms.9 Natural coagulants satisfy the drawbacks of synthetic treatments, in contrast, it produces a very limited amount of sludge production and also higher nutritional sludge value.8,10&#xD;
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In the present study, we explore the effectiveness of natural coagulants of plant3 and non-plant based and showed the results of the effectiveness of three combinations of fruit waste powders (Plant-based) such as papaya seed,6,11 Banana pith and Pineapple peels that are mixed with the certain ratio which acts as natural coagulants. These combinations of different natural coagulants owing to the multifunctional characteristics are facilitated by polyelectrolyte interactions, which form the precipitation of synthetic dyes and heavy metals present. Carica papaya (Papaya) is a tropical fruit found in Asia and South America. Papaya seeds have been used to treat turbid water can be used to treat turbid water with faecal bacteria. Anana scomosus (Pineapple) also a tropical fruit found in Costa Rica are found in South America.12,13 Due to the production of adsorbent Pineapple used for removal of dye and also prevents disposal cost.7 Musa (Banana) a tropical fruit widely found in Tamil Nadu and Kerala. Banana pith is a natural polyelectrolyte which is acting as a good natural absorbent in the treatment of textile colouring water.5 From the present research of this combination samples, used for the treatment of textile synthetic wastewater and then results were confirmed and characterized using intensity difference, the effect of pH and coagulant dosage, % of BOD and COD.7,8&#xD;
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MATERIALS AND METHODS&#xD;
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Collection of water sample and preparation&#xD;
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Textile coloring water was collected from the RATHI TEX DYEING manufacture situated in the Tirupur district, Tamil Nadu.&#xD;
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Papaya, Banana pith and Pineapple were purchased from the local market Annur locality. Desired portions from the fruits were separated as such Papaya seeds, Banana pith and Pineapple peels were washed thoroughly using distilled water and dried at a temperature of Papaya seeds (110 ?C for 10 hours), Banana Pith4 (60 ?C for 6 hours) and Pineapple peels (105 ?C for 2 to 3 hours), ground and then sieved to obtain powder in the mesh size of 10&#x2013;20 mm. Then the powders were stored in the airtight containers for further use.&#xD;
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Coagulation Test&#xD;
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Jar Test &#xD;
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Coagulation and flocculation tests were studied using a jar test apparatus. Three Jars were filled with 500mL of the raw water sample. The pH was adjusted using NaOH or sulfuric acid to different pH such as 5.0, 5.5, 6.0, 6.5, 7.0, and 7.5. Different concentrations of powdered coagulant samples were added to each jar containing raw water samples of 5, 10, 15 and 20mg/ml. Each jar rapidly mixed at 100-150 rpm for 5 minutes. Later, the stirring speed was reduced to 25-30 rpm and mixing was continued for 15-20 minutes. The mixers were turned off and allowed flocs to settle for 30-45 minutes. The final residual turbidity in each sample was measured.&#xD;
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Evaluation of Biological Oxygen Demand&#xD;
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100mL raw water sample was filled in a BOD bottle without making air bubbles. 2mL of Manganese sulphate and Alkali-iodide azide reagent were inserted by pipette just below the surface of the water. Formation of a brownish precipitate indicates the presence of oxygen. Finally, 2mL of concentrated sulphuric acid was added and closed. The bottle was incubated for 5 days. Later, the titration was carried out using sodium thiosulphate which changes the colour to pale yellow and 2mL of starch was titrated and changes the colour to blue and finally, readings were noted. &#xD;
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Evaluation of Chemical Oxygen Demand&#xD;
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The raw water samples were diluted to 1:250 ratios, from the diluted sample 2.5mL was taken and prepare blank to which 1.5mL of potassium dichromate and 3.5mL of sulphuric reagent was added to the COD tube. Now, each turbid water samples of 2.5mL were taken in different tubes and 1.5mL of potassium dichromate and 3.5mL of sulphuric reagent was added to each tube and subjected to COD digester for 150 ?C for 20 minutes. After attaining strong heating point the tubes were left at 150 ?C for 2 hours. In the end, the titration was carried out using 0.1N FAS, 2 drops of ferroin indicator, which changes the green to red in the colour end product to find the difference in the intensity of the sample and graph were plotted.&#xD;
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Statistical Analysis &#xD;
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All the experiments were performed in triplicates. The statistical significance was measured using one way ANOVA. The &#x2018;P-value&#x2019; was found to be </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3392</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3392</Fulltext></URLs><References>&#xD;
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	Suryawan WK, Helmy Q, Notodarmojo S. Textile wastewater treatment: color and COD removal of reactive black-5 by ozonation. Ear Env Sci 2018;106:12102.&#xD;
	&#xD;
	&#xD;
	&#xA0;Kizhakedathil MPJ, Sinha P, Mahuwala AA, Subramanian S. In-vitro Hemolytic and Clot Buster Activity of the Extracts of Ananas Comosus (Pineapple).&#xA0;Int&#xA0; J Pharm Sci Rev Res 2016;41(44):239-243.&#xD;
	&#xD;
	&#xD;
	&#xA0;Kizhakedathil MPJ, Ali MA, Vishnu H, Shylaja G, Mythili S, Sathiavelu A. Evaluation of antibacterial and antioxidant activity of Garcinia gummigutta.&#xA0;Int&#xA0; J&#xA0; Drug Devp Res 2015;7:57-59.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Formulation and Evaluation of Polyherbal Gel for the Management of Acne&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>117</FirstPage><LastPage>122</LastPage><AuthorList><Author>Ajinkya Mate</Author><AuthorLanguage>English</AuthorLanguage><Author> Padmashri Ade</Author><AuthorLanguage>English</AuthorLanguage><Author> Ajay Pise</Author><AuthorLanguage>English</AuthorLanguage><Author> Sachin More</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpa Pise</Author><AuthorLanguage>English</AuthorLanguage><Author> Rohini Kharwade</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Acne vulgaris is a chronic inflammatory disorder of the skin which affects approximately 80% adolescent during puberty stage. The increasing frequency of intake of antibiotics to overcome this problem explores several side effects. Therefore it needs to focus on the herbal formulation as a topical first-line treatment. Objective: In the present study, three medicinal plants Citrus sinensis, Curcuma longa and Aloe barbadensis having significant antibacterial potential were selected to formulate a polyherbal gel for the management of acne vulgaris problem. Method: Extraction of Citrus sinensis, Curcuma longa and Aloe barbadensis was done and characterized. The topical gels were prepared which comprised extract of orange peel, aloevera, and turmeric with a different concentration. The prepared gel was kept at room temperature for 24 hours and evaluated. Result: Based on this study, polyherbal anti-acne gel showed significant antibacterial activity on Staphylococcus aureus and Staphylococcus epidermis with no irritation. The physicochemical evaluation of developed formulation showed clear, uniform and free from fibre and particle. It was also observed good spreadability and consistency with pH nearer to skin. Conclusion: Thus the study result concluded that the polyherbal gel with extract of Citrus sinensis, Aloe barbadensis and Curcuma longa with concentration 0.2%, 1% and 0.8% respectively was an appropriate formulation for the first-line topical treatment of acne vulgaris.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Polyherbal Gel, Anti-acne formulation, Acne vulgaris, Citrus sinensis, Curcuma longa</Keywords><Fulltext>Introduction&#xD;
&#xD;
Skin disease normally arises due to accumulating toxins in blood due to impurities in blood, improper food habits and lifestyle. Acne vulgaris is a disorder of the skin which affects most of the adolescents during puberty stage due to hormonal changes which changes path-physiologic factors.1 This condition is related to obstruction in follicular distention with activation of inflammatory response with open or close comedones, inflammatory papules and nodules. Gram-positive bacterium such as Staphylococcus, Propionibacterium and Escherichia species are linked to the skin condition of acne. Acne vulgaris normally affects the skin areas with dens sebaceous follicles such as the face, upper chest, back. Symptoms of acne vulgaris include pain, tenderness, or erythema.2 &#xD;
&#xD;
Various synthetic antibiotic drugs such as clindamycin, doxycycline, minocycline are used to overcome this problem. Most of the time topical therapy is the first-line treatment with benzyl peroxide and retinoids. However, increasing frequency of antibiotics and its side effects there should be necessary to focus on the exploration of herbal drugs.&#xA0; Its reported safety with minimal adverse effect, in recent years there is a gradual development of interest in the use of the medicinal plant. Several Indian medicinal plants certified with various pharmacological activities due to diversified classes of phytoconstituents. Literature also proved that medicinal plant with varying potency when combined, it produces the synergistic therapeutic effect with improving patient&#x2019;s compliance.3 &#xD;
&#xD;
Plant such as Citrus sinensis, Curcuma longa and Aloe barbadensis possess many potential therapeutic activities due to individually presence of rich phytoconstituents. The ripen pericarp of Citrus sinensis (Rutaceae) is reported to have several bioactive compounds including geranial, Beta linalool, D &#x2013; limonene, Beta myrcene, Diethyl phthalate which are mostly used in brighten the skin, removing tan layer and provide fairness. This essential oil also used to treat erythema, papules, and vesicles upon the skin. Rhizomes of Curcuma longa (Zingiberaceae) have more potent superoxide anion, hydroxyl radical, singlet oxygen, peroxynitrite and nitric oxide which shows anti-inflammatory, antioxidant property and therefore used in various skin infection. Leaves of Aloe barbadensis (Liliaceae) is reported to have Bradykinase helps to reduce excessive&#xA0;inflammation when applied to the skin topically and Aloin and emodin act as analgesics, antibacterials.4,5 &#xD;
&#xD;
Moreover, these medicinal plants are easily available, cost-effective and commonly used by human beings. Taking these facts into considerations, the present study was designed to systematically explore and analyse the phytoconstituents of these plant extracts and formulate a new polyherbal gel formulation under their antiacne potential effects.&#xD;
&#xD;
Material and Methods&#xD;
&#xD;
Materials&#xD;
&#xD;
Collection of the specimen such as Ripen pericarp of fruits Citrus sinensis (Rutaceae), leaves of Aloe barbadensis (Liliaceae) and Rhizomes of Curcuma longa (Zingiberaceae). The specimens for the proposed study were collected and authenticated. Other chemicals were obtained from Himedia Laboratories Pvt. Ltd, and Loba Chemie, Mumbai.&#xD;
&#xD;
Procedures&#xD;
&#xD;
Extraction of the pericarp of fruits Citrus sinensis (Orange peel)&#xD;
&#xD;
Citrus sinensis peels were collected from an orange juice manufacturer. The peels were then washed and fully dried in an oven at 60oC for 72 hrs. Using Mortar and pestle the dried peels were powdered with particle size ranging of 0.5 mm to 0.1 mm and socked in methanol with mass to volume ratio 1:25(g/mL) for 72 hrs. It was then filtered through Whatman No. 1 filter paper and collected into glass Petri plates (Figure 1). &#xA0;This complete process of extraction and purification was repeated two-three times followed by evaporation of the collected extracts and dry at 37?. 6, 7 &#xD;
&#xD;
&#xD;
&#xD;
Extraction of leaves of Aloe barbadensis (aloe vera)&#xD;
&#xD;
Aloe Vera leaves collected from the local nursery. The leaves washed with water and rinds were removed (Figure 2). The inner gel scrapped and cut into pieces, solar-dried at 30-45oC for 3 weeks and dry gel particles were collected.8&#xD;
&#xD;
&#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;
&#xD;
Extraction of Curcuma longa (Turmeric extract)&#xD;
&#xD;
Take 20gm of Curcuma longa powder was mixed with a sufficient amount of n-Hexane and kept aside for 2 hrs. Then the solution was filtered and then precipitated powder was mixed within acetone for 10-15 minutes. The solution was filtered again and the filtrate was dried in air (Figure 3), the extracted curcumin was isolated by scrapping using a spatula.9,10&#xD;
&#xD;
&#xD;
&#xD;
Evaluation and Phytochemical screening of extract&#xD;
&#xD;
All extract was analyzed by FTIR and for its phytoconstituents such as saponins, anthraquinone glycosides, phytosterols, tannins, flavonoids, carbohydrates, triterpenoids, polyphenol and alkaloids. 11,12 &#xD;
&#xD;
Antibacterial Activity &#xD;
&#xD;
Preparation of inoculum &#xD;
&#xD;
Uniform suspension of microorganism is obtained by suspending 24 h fresh culture of bacteria (S. aureus and S. epidermis) in several 15mL of the sterile water.13&#xD;
&#xD;
Determination of the zone of inhibition &#xD;
&#xD;
Agar well diffusion method was used to determine the antibacterial activity of the prepared extract. Transferred 20 mL of liquefied agar medium previously inoculated with 0.1 mL bacteria into the sterile petri dish having an internal diameter of 8.5 cm and allowed to form the uniform thickness of the medium in the petri dish. After complete solidification of the liquefied inoculated medium, the wells were made aseptically with cork borer having 6 mm diameter. 100mg/mL of each extract was carefully added into the well and the plates were kept for 30 min for pre-diffusion of the extracts. After pre-diffusion, the Petri plates were incubated at 37&#xBA;C for 24 hrs in the incubator and measured the zone of inhibition for its antibacterial activity.13, 14&#xD;
&#xD;
Method of Preparation of Gel Containing Extract&#xD;
&#xD;
The topical gels were prepared which comprised extract of orange peel, aloe vera, and turmeric with a different concentration (Table 1). The gels were prepared by using Carbapol 940, propylene glycol-400, ethanol, methylparaben, propylparaben, EDTA, triethanolamine and required amount of water in a sufficient quantity to prepare 50 g of gel. Water required for these formulations was divided into two parts. In one part, an accurate amount of extracts were separately dissolved in 15 mL of water and to this calculated quantity of propylene glycol-400 and ethanol were added.8 In another part, Carbapol-940 was dissolved in 35 mL and to this solution methylparaben, propylparaben and EDTA(Ethylenediaminetetraacetic acid) were added.15 Both of these solutions were mixed in a beaker and triethanolamine was added dropwise to the formulation for adjustment of required skin pH (6.8&#x2014;7) and to obtain the gel with required consistency. It was then stirred by using propeller for 2 hours at 500 rpm. After stirring, the prepared gel appeared to be homogeneous and devoid of any bubbles. The prepared gel was kept at room temperature for 24 hours. 16&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Physicochemical evaluation of formulations&#xD;
&#xD;
Physical evaluation &#xD;
&#xD;
Physical parameters such as colour, homogeneity, phase separation and consistency were checked visually.&#xD;
&#xD;
pH &#xD;
&#xD;
The aqueous solution (1%) of the formulation was measured by using a calibrated digital pH meter at a constant temperature. &#xD;
&#xD;
Rheological study &#xD;
&#xD;
By using Cone and Plate viscometer, the viscosity of the formulated batches was determined. In a procedure, a definite quantity of gel was added to a beaker covered with a thermostatic jacket. The gel was rotated at 100 rotations per minute with spindle 7. 17&#xD;
&#xD;
Spreadability &#xD;
&#xD;
Two sets of a glass slide with standard dimension were taken. Polyherbal formulation gel was placed in between the two slides and sandwiched about the length of 60mm. Removed the adhered excess gel on the surface of the glass slides and fixed to a stand without any disturbance. In the upper slide, 20 g weight was tied and noted the time taken for movement of the upper slide to the distance of 60mm under the influence of weight.18 Meantime was calculated by repeating the experiment three times and the spreadability was calculated using the following equation 1.&#xD;
&#xD;
Spreadability = (Weight &#xD7; Length) / Time&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (Equation 1)&#xD;
&#xD;
Antibacterial activity studies &#xD;
&#xD;
Transferred 20 mL of liquefied agar medium previously inoculated with 0.1 mL bacteria into the sterile petri dish having an internal diameter of 8.5 cm and allowed to form the uniform thickness of the medium in the petri dish. After complete solidification of the liquefied inoculated medium, the wells were made aseptically with cork borer having 6 mm diameter. 500mg concentrations of polyherbal gel were weighed and diluted with 2 mL of sterile water in sterile test tubes. The drug solution was carefully transferred into the cup and incubated at 37 &#xB0;C for 24 h and the zones of inhibition were measured. 13&#xD;
&#xD;
Ex- vivo skin irritation studies &#xD;
&#xD;
The albino Wistar rats were divided into two groups with 3 rats in each group. On the previous day of the experiment, the hairs on the backside area of rats were removed. The animals of group I was served as the control, without any treatment. Another group of animals (Group II) was applied with prepared polyherbal gel. The gel was applied once a day for 7days and the site was covered with a cotton bandage and observed for any sensitivity. The score of erythema is read and recorded as Score 0 for no erythema; Score 1 for Mild erythema (barely perceptible- light pink); Score 2 for Moderate erythema (dark pink); Score 3 for Severe erythema (Extreme redness). 19, 20&#xD;
&#xD;
Accelerated Stability Studies&#xD;
&#xD;
Stability testing of the formulation is a part of drug discovery and ends with the commercial product, to assess the drug and formulation stability, stability studies were done. The stability study was carried out for the most satisfactory formulation. The optimized gel formulation was sealed in a glass vial and kept at 40 &#xB1;2&#xB0;C at 75 &#xB1; 5 % RH for 1months and analyzed. At the one month ending the samples were analyzed for the physicochemical analysis, pH, viscosity, phytochemical constituents. 19&#xD;
&#xD;
Result &#xD;
&#xD;
Pre-formulation study&#xD;
&#xD;
The colour of Citrus sinensis, Aloe barbadensis and Curcuma longa were observed dark orange, white and brown powder respectively (Figure 1, 2, 3). The extracts are tested for its phytochemical analysis like saponins, anthraquinone glycosides, Phyto steroids, tannins, flavonoids, carbohydrates, triterpenoids, polyphenol and alkaloids. The phytochemical analysis and pH of the various extracts results are shown in Table 2 and 3. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Antibacterial Activity&#xD;
&#xD;
From the antibacterial activity study, it confirmed that all the selected herbal plants showed antibacterial activity against acne-causing bacteria staphylococcus aureus and staphylococcus epidermis. The antibacterial activity study results are shown in Table 4.&#xD;
&#xD;
&#xD;
&#xD;
Physicochemical Evaluation of Gel Formulation&#xD;
&#xD;
The formulated gel formulations were evaluated visually for colour, homogeneity, consistency and phase separation (Table 5). The visual inspection of the prepared formulation indicated no lumps and to have uniform colour dispersion, free from any fibre and particle, easily washable. The pH of all formulation is nearer to the skin pH with better spreadability and viscosity (Table 6). From the physicochemical evaluation, F2 shows more compatible to skin with pH 6.9, Viscosity 6505 cps at room temperature and 11.87 g cm/ sec spreading coefficient.&#xD;
&#xD;
&#xD;
&#xD;
Antibacterial activity of the formulation &#xD;
&#xD;
The antibacterial activity studies were performed by well diffusion method by measuring the zone of inhibition (in mm). The study results of the polyherbal gel showed antibacterial activity in a dose-dependent manner against the bacteria causing acne. The antibacterial activity study of the formulation is shown in Figure 4. From the antibacterial activity of all formulation, the formulated polyherbal gel F2 shows better antibacterial activity with the zone of inhibition 36 mm for Staphylococcus aureus and 44 mm for Staphylococcus epidermis. In addition to this, The polyherbal gels showed a synergistic effect as compared to individual extract which can be useful for the treatment of local inflammation. Thus this topical formulation was suitable for the treatment of local anti-acne application and selecting for further tests. &#xD;
&#xD;
&#xD;
&#xD;
Ex- vivo skin irritation studies &#xD;
&#xD;
From Antibacterial Skin Irritation studies were carried out on albino Wistar rats revealed that the gel formulation shows no erythema, oedema or ulceration. It shows to be non-irritant. &#xD;
&#xD;
Accelerated Stability study&#xD;
&#xD;
On storage of anti-acne polyherbal gel sample at 40 &#xB1;2&#xB0;C at 75 &#xB1; 5 % RH, the appearance of the formulation was found to be clear with no significant variation in pH, spreading coefficient and viscosity. The results of accelerated stability studies are present in table 7.&#xD;
&#xD;
.&#xD;
&#xD;
Discussion&#xD;
&#xD;
Acne vulgaris is a chronic inflammatory disorder of the skin which affects approximately 80% adolescent during puberty stage. Gram-positive bacterium such as Staphylococcus, Propionibacterium and Escherichia species are linked to this skin condition. The increasing frequency of intake of antibiotics to overcome this problem explores several side effects. Therefore it needs to focus on the herbal formulation as a topical first-line treatment.1-4&#xD;
&#xD;
Plant such as Citrus sinensis, Curcuma longa and Aloe barbadensis possess many potential therapeutic phytoconstituents which helps to reduce skin inflammation, prevent the skin from oily and dry with potential antibacterial activity. Taking these facts into considerations, the present study was designed to systematically explore and analyse the phytoconstituents of these plant extracts and formulate a new polyherbal gel formulation under their antiacne potential effects.&#xD;
&#xD;
The extracts were tested for its phytochemical analysis, the reports showing that alkaloids and flavonoids were present in the extracts, which are responsible for antibacterial activity. 19,20&#xA0; From the antibacterial activity study results, the inhibition zone for the acetone extract of Curcuma longa exerted an exclusive antibacterial effect against gram-positive staphylococcus aureus and staphylococcus epidermis bacteria with a zone of diameter 17.5&#xB1;0.37mm and 15.6&#xB1;0.41mm. This value showed a bactericidal effect.13-16 However, the zone inhibition study of extracts Aloe barbadensis and Curcuma longa exrted bacteriostatic effect. From the physicochemical evaluation, F2 shows more compatible to skin with pH 6.9, Viscosity 6505 cps at room temperature and 11.87 g cm/ sec spreading coefficient. Entrapment of water molecules and the presence of hyaluronic acid (extract of Aloe vera) in gel allow hydration without leaving a greasy residue on the surface of the skin. This is the reason that gel moisturizers go best with acne-prone, oily skin. 6,7 The abundant antioxidants in orange peel extract prevent the skin from oily and dry. It also works as a toner, removing dead cells and tightening pore.13,14 From the antibacterial activity of all formulation, the formulated polyherbal gel F2 shows better antibacterial activity with the zone of inhibition 36 mm for Staphylococcus aureus and 44 mm for Staphylococcus epidermis. In addition to this, The polyherbal gels showed a synergistic effect as compared to individual extract which can be useful for the treatment of local inflammation.18,19 Thus this topical formulation was suitable for the treatment of local anti-acne application with no irritation and selecting for further tests.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Recently herbal medicines are more considered as safe with fewer side effects than synthetic drug for the treatment of acne vulgaris. Therefore In the global market. Natural remedies including herbal formulation are in great demand. It is a very good attempt to formulate and evaluate the polyherbal anti-acne gel along with the stability studies. Based on this studies, polyherbal anti-acne gel prepared from the extract of Citrus sinensis (0.2%), Aloe barbadensis (1%) and Curcuma longa (0.8%) showed significant antibacterial activity on Staphylococcus aureus and staphylococcus epidermis with no irritation. The polyherbal gel showed a synergistic effect as compared to individual extract with good stability. Thus the study result concludes that the formulated polyherbal gel with extract of Citrus sinensis, Aloe barbadensis and Curcuma longa with concentration 0.2%,1% and 0.8% respectively can be used for the treatment of acne vulgaris. &#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=3393</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3393</Fulltext></URLs><References>References&#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Prabu SL, Umamaheswari A, Kumar CA, Banumuthupriya M, Dhanasekaran D. Formulation and Evaluation of Polyherbal Gel Containing Natural Antimicrobials for the Management of Acne Vulgaris. Int Res J Pharm 2017;8(5):65&#x2013;69. &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Prasad SB. Acne vulgaris: A review on pathophysiology and treatment. Asian J Pharm Clin Res 2016;9(4):54&#x2013;59. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sinha P, Srivastava S, Mishra N, Yadav NP. New Perspectives on Antiacne Plant Drugs: Contribution to Modern Therapeutics. Biomed Res Int 2014;2014: 301304. &#xA0;&#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mishra BP. A quest of Anti-acne Potential of Herbal Medicines for extermination of MDR Staphylococcus aureus. Int J Pharm Sci Invent 2014;3(6):12&#x2013;17. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; El-Ishaq A. Extraction of limonene from orange peel. Nutr Heavy Met 2015;1&#x2013;15. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gotmare S. Orange Peel: A Potential Source of Phytochemical Compounds. Int J ChemTech Res 2018;7(3): 231. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Arunkumar S, Muthuselvam M. Analysis of phytochemical constituents and antimicrobial activities of Aloe vera L. against clinical pathogens. World J Agric Sci 2009;5(5):572&#x2013;576. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rani. RHP shetty; M. Phytchemical analysis of methanolic exctract of Curcuma longa Linn Rhizome. Int J Univers Pharm bio Sci 2013;2(2):285&#x2013;297. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Gangane PS, Ghughuskar SH, Mahapatra DK, Mahajan NM. Evaluating the role of Celosia argentea powder and fenugreek seed mucilage as natural super-disintegrating agents in gliclazide fast disintegrating tablets. Int J Curr Res Rev 2020;12(17):101&#x2013;108. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Dhandapani R, Sabna B. Phytochemical constituents of some Indian medicinal plants. Anc Sci Life 2008;27(4):1&#x2013;8. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Kharwade RS, More SM, Mahajan UN. Formulation and evaluation of gastroretentive floating tablet using Hibiscus rosa-Sinensis mucilage. Asian J Pharm Clin Res 2017;10(3):444&#x2013;448. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Bhinge SD, Bhutkar MA, Randive DS, Wadkar GH, Kamble SY, Kalel PD, et al. Formulation and evaluation of polyherbal gel containing extracts of Azadirachta indica, adhatoda vasica, piper betle, Ocimum tenuiflorum and Pongamia pinnata. Marmara Pharm J 2019;23(1):44&#x2013;54. &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Singh S. Extraction and characterization of Orange peel. World J Pharm Res 2015;20. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Bhutkar K. Formulation and evolution of herbal. 2019;11: 291-295. &#xD;
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17. &#xA0;&#xA0;&#xA0;&#xA0; Misal G, Dixit G, Gulkari V. Formulation and evaluation of herbal gel. Indian J Nat Prod Resour 2012;3(4):501&#x2013;505. &#xD;
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18. &#xA0;&#xA0;&#xA0;&#xA0; Rahman A, Hussain A, Hussain S, Singh LR. Lecithin-microemulsion based organogels as topical drug delivery system (tdds). 2011;03(03):22&#x2013;33. &#xD;
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19. &#xA0;&#xA0;&#xA0;&#xA0; &#xA0;Kharwade RS, Mahajan NM. Formulation and Evaluation of Nanostructured Lipid Carriers Based Anti-Inflammatory Gel for Topical Drug Delivery System. Asian J Pharm Clin Res. 2019;12(4):286&#x2013;291. &#xD;
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20. &#xA0;&#xA0;&#xA0;&#xA0; Gatne MM, Tambe K, Adarsh, Ravikanth K. Acute Dermal Irritation study of polyherbal gel Mastilep in rabbits. Int J Pharm Sci Res 2015;6(8):3473&#x2013;3476.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Epileptic Seizure: Classification Using Autoregression Features&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>123</FirstPage><LastPage>131</LastPage><AuthorList><Author>Rajendran T</Author><AuthorLanguage>English</AuthorLanguage><Author> Sridhar K P</Author><AuthorLanguage>English</AuthorLanguage><Author> Vidhupriya P</Author><AuthorLanguage>English</AuthorLanguage><Author> Gayathri N</Author><AuthorLanguage>English</AuthorLanguage><Author> Anitha T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: This research focuses on neural networks based biological signal processing to solve the complex classification problems. Many types of research of classification algorithms have been published, but none has effectively focused on implementing them in brain Epileptic Seizure Electroencephalography pattern analyses and lobe classification. Objective: To develop different autoregression feature extraction algorithms for identifying accurate features in the epileptic seizure EEG signals for the neural network-based classification. Methods: In this research, the Probabilistic Neural Network (PNN) is considered for classifying the brain tissue samples by mapping the input pattern to several classifications. The dataset is retrieved from the Karunya University Epileptic Seizure Database for verifying the experiment with 10-20 electrodes. Different mental tasks are considered here to verify the proposed Probabilistic Neural Network-based Epileptic Lobe Seizure classifier. Results: The experiments are carried out with several Auto Regression features. Further, the obtained result proves that the proposed PNN model has a maximum accuracy of 96.30%. Conclusion: This research work has aimed to design a PNN classifier for detecting Seizure by incorporating AR parametric features. The proposed system bears the potential of providing an exact identification of faults and noise with various age criteria. It will help process the data in a user-friendly manner.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Classification, Discrete Wavelet Transform, Electroencephalography, Epileptic seizure, Probabilistic Neural Network, Feature extraction</Keywords><Fulltext>Introduction&#xD;
&#xD;
In the human body, the brain is the major source to manage all the organs, internal glands, body temperature, and breathing. The brain helps self-triggering based on the surroundings and makes a person active. It processes a constant stream of sensory data, which are the stored record of every moment of human activity. Many researchers state that brain waves are collected as electrical signals.1 It is believed that the electrical signals generated by the brain represent not only the brain function but also the status of the whole body throughout life. This assumption motivates to apply advanced digital signal processing methods to the electroencephalogram (EEG) signals measured from the brain of a human subject. As shown in figure 1, the frontal lobe is classified as superior, middle, inferior and medial frontal gyri.&#xA0; The parietal lobe is used for sense and navigation purpose. The occipital lobe is considered as a visual processing centre and temporal lobe is for auditory processing. The common problem identified in each lobe is complex seizure detection.2&#xD;
&#xD;
&#xD;
&#xD;
With recent advancement, diagnosing is an important factor that may decide the whole framework. In this research, classification is considered an important process that helps us to understand group seizures in various aspects. The major requirement of Epileptic Seizureclassification is to analyze patients by miscellaneous audiences (i.e., pharmacists, researchers, clinicians, etc.). The classification must be taken care of for long-term prognosis.&#xD;
&#xD;
The classification helps us to characterize epilepsy disorders, anticipate seizures, and recognize potential seizure triggers. Figure 2 provides the initial stages of the classification process and its spectral analysis. &#xD;
&#xD;
&#xD;
&#xD;
New classification strategy must have a deliberate and organized process to follow a patient&#x2019;s data that determine epilepsy. An exact characterization of epilepsy may not only enhance the performance but also give a clear idea to improve collective research. The main objective of this research is to develop the optimum feature extraction algorithm to classify seizure disorder activities and develop optimum Probabilistic Neural Network based on Parametric Features and classify the seizure disorder activities in the brain. Finally, the results of developed classifiers are recognized with seizure disorder activities.3,4,5 &#xD;
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This research concentrated on Parametric Features such as AR Burg (ARB), AR YuleWalker (ARYW), AR Covariance (ARC), AR Modified Covariance (ARMC), and Levinson Durbin Recursion (LDR), and Linear Prediction Coefficient (LPC) is analyzed with the EEG dataset considered from Karunya University and another open-access database. Further, this research is organized as follows: Section 2 provides a detailed review of the usefulness of EEG in assessing neurological disorders and analyzed different statistical techniques based on brain-maps and some ongoing research activities. Different causes of epilepsy and classification are analyzed. Section 3 discusses the outcome of the survey and mentioned some exact problems in classification. Then, the proposed detection module with a Probabilistic Neural Network (PNN) classifier is discussed in section 4. Section 5 provides test results and its validated discussion. Finally, the research is summarized in section 6. &#xD;
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Literature Survey&#xD;
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In some cases, the Second-Order Difference Plot (SODP) is the model used for detecting the congestive heart failure employing classification. Similarly, Pachori and Patidar1,6 focussed on seizure-free classification technique applied to the EEG signals by combining the SODP and Intrinsic Mode Functions (IMFs) as a hybrid model for achieving the decomposition module. Initially, it acquires dataset from the Andrzejak.7,8 The analysis is completely carried out by MATLAB based on varying different ellipse area and its structure to find the exact classification. &#xD;
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Joshi3 utilized the sample values for training the EEG signal with a Support Vector Machine (SVM). The process is completely admitted with two types of samples named as A and B. Finally, the SVM is considered for maximizing the boundary for those two samples to classify the ictal and seizure-free structure. The normal EEG signal contains spikes and some sharp waves. To identify such exact patterns and avoid the unwanted patterns, Srinivasan4 presented a concept with the ANN. Subasi5 presented a dynamic wavelet network for detecting the non-stationary signals in EEG recorded wave. Here, feed-forward error-back propagation artificial neural network detection module is outperformed by the proposed wavelet detection module. Tzallas6 concentrated on time-frequency (t-f) analysis to achieve good localization effect in EEG classification. Some extension of the Fourier transform was carried out to measure the Power Spectrum Density (PSD). Mormann2,7 critically discussed seizure prediction and suggested related concepts to utilize the overall technology. Ponten8 presented an intracerebrally recorded mesial temporal lobe seizure to characterize synchronization patterns in intracerebral EEG recordings.9&#xD;
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In recent days, the detection of Epileptic diseases has been automated. For example, an automated detection module framed by Dogali and Bozkurt10 detected the normal and epileptic structures by analyzing the two datasets from the University of Bonn, Germany. Then the data reduction process applied by non-parametric features is handled by interfacing the graphical user interface module in MATLAB and tested with various samples. The process is completely trained and classified by ANN. Patnaik and Manyam11 analyzed the ANN and genetic algorithm (GA) for classifying the EEG signal obtained from Albert-Ludwigs-University, Germany. They selected level 5 wavelet decomposition for initiating individual coefficient and windowing technique for decomposition. The process was completely trained and tested by the neural network and further, it proceeded to post-classification. If the samples were valid then the process terminated, else it further moved to genetic algorithm stage for computation to maximize the sensitivity.&#xA0; &#xD;
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To identify the spectral differences in EEG signals, Sakkalis12 have examined mild epilepsy in children.12&#xA0; It helps to test controlled epileptic conditions in both cases (i.e., nonparametric and parametric analysis). It is designed for maintaining the reliability in classification.&#xA0; Similar to this concept, Raja and Priya13,14 presented recent research in the diagnosis of the autism spectrum disorder with 92.69 % classification accuracy as maximum with the utilization of FFNN. Later, they extended the same research with Elman neural network and traditional Cascade forward back propagation neural network to improve the classification accuracy of the detection.15,16 Finally, they pointed out the best combination as ENN with AR Burg extraction with the maximum accuracy rate of 95.63%. Some recent researchers have focused on error-free EEG signal empirical mode decomposition and approximate entropy (ApEn) is proposed by Ramakrishnan and Kanagaraj17, Novel Signal Modeling Approach by Gupta18 and a Levenberg-Marquardt algorithm by Narang for epileptic seizures.19,20&#xD;
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Problem Statement&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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The existence of EEG signal processing, normalizing, classifying and detection process provides the motivation to apply more recent concepts to provide excellent EEG signal processing. Most of the brain signals are represented in electrical characteristics. Hence, to find the exact variation in EEG signal a representative must understand every activity, but it results in some wrong interpretations. Another major limitation is a misunderstanding of brain data and it may result in serious errors.18,19,20 The EEG signal is captured and recorded with the help of the electrode, but the electrode captures all the brain activities and its surrounding active electrical units. Hence, there is a need for a filtering process before the extraction process. In this research, an EEG analysis is carried out with the potential field on the scalp to classify the exact Epileptic seizure. From the previous research, the classification accuracy is reviewed and some improvement is suggested in the classifier stage. Hence, Probabilistic Neural Network-based classifier model is assumed here for training and classifying the EEG data.21-24 &#xD;
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The Proposed detection module with a Probabilistic Neural Network (PNN) classifier&#xD;
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As shown in figure 3, the data acquisition process is carried out initially. The Karunya University data set is carried out throughout the research. It is donated with 175 epilepsy disorder patients&#x2019; record from the following link: (http://www.karunya.edu/research/EEGdatabase/public/view_all.php)21 and 71 non-epileptic seizure signal from Louis33 is used. The EEG data used in this work are acquired using 10-20 electrodes, stipulated by the standard international system. These data have been recorded from 18 channels (16 scalp electrodes and 2 periocular electrodes, concerning right and left mastoid) at a sampling rate of 256 Hz with an analogue passband of 0.01 to 100 Hz. The below figure 3 shows the flow chart for classifying the epileptic seizure signals using a probabilistic neural network. 25,26&#xD;
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Next process followed by data acquisition is data reduction. The EEG signal is processed with the help of the Discrete Wavelet Transform (DWT) to reduce the noise present in the EEG recorded signal. It is selected because it can separate the EEG samples into wavelets with different series and it can localize frequency and time. Hence, for biomedical applications and real-time applications, DWT is preferred because of its detection speed of operation and Multi-Resolution Analysis (MRA).27,28 &#xD;
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The feature extraction process helps to find the average accuracy of the system. The following coefficients such as Autoregressive (AR) Burg, AR Yule-Walker method, AR Covariance, AR Modified Covariance, Levinson Durbin Recursion, and Linear Prediction Coefficient are selected for verification of the extraction process. It helps to minimize the EEG structures and modules based on the training process.29-32&#xD;
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	AR (Autoregression) &#xD;
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The autoregression model is used to reduce the least square model and prediction errors. The main advantage of selecting this module is that it remains stable while processing the signal. The input to this module is in the form of a column vector. Its parameters may be in terms of both several co-efficient and reflection coefficients. Wright15have reviewed some parameter estimate error and multiple regression analyses for EEG signal analysis. The AR module provides an alternative way of analyzing the EEG spectral properties estimation.33-36 &#xD;
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Based on the discrete linear stochastic process, it is expressed as, yt = &#xB5; + et +&#xA0; y1 et-1 + y2 et-2 + &#xB7;&#xB7;&#xB7;&#xD;
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The errors are expressed as, et = yt - &#xB5; -&#xA0; y1 et-1 - y2 et-2 - &#xB7;&#xB7;&#xB7; .&#xD;
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Assume the stationarity model that holds for et must hold true for et-1 , then et-1 = yt-1 - &#xB5; -&#xA0; y1 et-2 - y2 et-3 - &#xB7;&#xB7;&#xB7; .&#xD;
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Finally, substitute the model for et-1 into the model for yt&#xD;
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Where, y1, y2, &#xB7;&#xB7;&#xB7;, yn are the observations with a joint density Pr(y1, y2, &#xB7;&#xB7;&#xB7;, yn). et are the error concerning time.&#xD;
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	AR Covariance&#xD;
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The parameter gj is known as theauto covariance XE "autocovariance&#x201D; at lag j.&#xA0;&#xA0; Adding all results together, then it will be &#xD;
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Like all covariance matrices, V(y) is symmetric.&#xA0; If E(yt) does not depend on t, which it should not with a stationary series, then we would ordinarily expect to find the series in the neighbourhood of &#xB5;. History tends to repeat itself, probabilistically.37,38 &#xD;
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If gj &gt; 0 we would expect that a higher than usual observation would be followed by another higher than usual observation.&#xA0; We can standardize the covariance by defining the autocorrelation,&#xD;
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As usual, r0 = 1.&#xA0; The structure of the autocorrelations will greatly help us in understating the behaviour of the series, y.&#xA0; &#xD;
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	AR Yule-Walker&#xD;
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Alkan and Yilmaz16 estimated the AR Yule walker function. It computes the AR parameters by forming a biased estimate of the signal&#x2019;s autocorrelation function and solving the least square minimization of the forward prediction error. Here, the process directly depends upon the amplitude of a signal at a given period. The amplitude is obtained by summing different amplitudes of the previous samples and estimation error. The order of the filter directly depends on the number of AR coefficients. The modelling degree (p) always uses the Akaike Information Criteria (AIC).39,40,41 &#xD;
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In general, an AR model of order p can be expressed as &#xD;
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The autocorrelations and the fi are related to each other via what are known as the Yule-Walker Equations XE "Yule-Walker equations&#x201D;: &#xD;
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which can be used to estimate values.&#xA0; &#xD;
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The Yule-Walker AR methods are estimated by minimizing an estimate of the prediction error power.&#xD;
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d)&#xA0;&#xA0; &#xA0;AR Modified Covariance&#xD;
The autoregressive modified covariance is used to estimates the power spectral density (PSD) of an EEG input signal. The main motive of this research is to minimize the forward and backward prediction errors in the least-squares sense. Finally, the estimation order parameter must be less than, or equal to, two-thirds of the input vector length to finalize the result. This process is entirely described by a linear combination of previous outputs and driving noise. It estimates the P coefficients, where P is the model order, by minimizing the forward and backward prediction errors in the least-squares sense.42,43&#xD;
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Where for &#xA0; &#xA0;the data length is N and &#xA0;is the AR coefficient of the term?&#xD;
e)&#xA0;&#xA0; &#xA0;Levinson Durbin Recursion&#xA0;&#xD;
It is a simple algorithm that is easy to solve; here, the system fork =1 and k +1 coefficients sized problems. &#xA0;The first step carried out in Levinson Durbin Recursion is to minimize the error. Then the input vector and error vector are computed. Compute the k values from o to m.&#xD;
f)&#xA0;&#xA0; &#xA0;Linear Prediction Coefficient&#xD;
In the autocorrelation method of linear prediction, the linear prediction coefficients are computed from the Bartlett-window-biased autocorrelation function.&#xA0;&#xD;
g)&#xA0;&#xA0; &#xA0;Probabilistic Neural Network algorithmic steps&#xA0;&#xD;
Step 1: Select the input layer and represent the training samples in the vector format.&#xD;
Step 2: Initially, the training sample vector is transferred to neurons of the input layers.&#xD;
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Where d is the pattern vector of y and its neuron vector is &#xA0;.&#xA0;&#xD;
Step 3: Frame the connection weights between the input and pattern layers.&#xA0;&#xD;
Step 4: Establish the relationship between the initial cell concerning the corresponding accumulate layer.&#xD;
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Where Ni denotes the total subcells in the EEG samples.&#xA0;&#xD;
Step 5: Repeat all the steps until the remaining EEG vector samples.&#xA0;&#xD;
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Step 6: Compute the distances from the input vector samples to train the EEG input samples.&#xD;
Step 7: Process the training input with the first layer and contribute the class of inputs based on the input probabilities.&#xA0;&#xD;
Step 8: Finally, an output transfer function is framed by second layer output with the maximum probabilities and make the process as 1 and 0 to state the difference.&#xD;
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As shown in figure 4. It also stated that PNN was two lakh times faster than the back-propagation process. The important aspects of selecting this PNN were its simple training strategy and the ability to provide instantaneous results. 44,45&#xD;
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Figure 4: Structure of PNN&#xD;
After completing feature selection and extraction, the PPN was utilized for both training and classification. Specht9 presented the PNN by replacing the sigmoid functions. It helped to the analysis of nonlinear boundaries and elucidates some complex optimization process. The term neuron helped to map several classifications. Most of the real-time applications and modules preferred this algorithm to represent individual subcategories. Hence, it would be helpful to solve more complex optimization problems. Traditionally, many applications and researches proved that PNN is active and more accurate than the multilayer perceptron networks. PNN is relatively insensitive to outliers and results on the predicted target.32,33&#xD;
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RESULTS AND DISCUSSION&#xD;
As shown in figure 5, the individual patient data are stored in the Karunya University website with a unique ID. Based on the tests, we have to select the region/lobe of focus in the brain. The corresponding data are collected and fed into the proposed algorithm to verify them. The detail of the dataset is considered here to display the exactness of research. It is acquired with 10-20 electrodes, as determined by the international standard system. The metrics are collected from the 16 scalp channels and two periocular electrodes. Some important metrics of the EEG dataset are shown in Table 1.21&#xD;
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Table 1: EEG dataset parameters21&#xD;
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The patient information is mentioned in different definitions like a patient ID in 5 digit character alphanumeric term, age is mentioned in text integer, Sex is indicated through (M/F) and disorder/Seizure types are mentioned in the text format as shown in figure 5.&#xA0;&#xD;
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As shown in figure 6, the waves are stored with each seizure. For evaluation, the right region with sharp waves is considered. This research focused, particularly on Epileptic Seizure Classification.&#xA0;&#xD;
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Table 2 shows the dataset representation of 11 patients which includes patient ID, age, sex, condition on the provisional diagnosis, disorder type, seizure types, and the region or lobe region of the brain&#xD;
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Figure 7 shows the Comparative analysis of two patient&#x2019;s (A0019 and A0049) data classification using Probabilistic Neural Network for six different Autoregression features. &#xA0;&#xD;
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The performance of the PNN is shown in Figure 8, for the six parametric feature sets. It is observed that AR Burg outdid the other feature sets with the highest mean accuracy of 96.3% for the patient (IDA0023) aged 9. It has the lowest mean accuracy of 93.74% for subject 20.&#xD;
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The next best performance is observed for the AR Yule feature sets at 94.21% and the lowest mean accuracy for the same feature sets is 94.1% for the same patient. The Probabilistic Neural Network provides simple implementation and easy design with maximum classification accuracy.41-44&#xD;
Another process is to analyze the classification based on the separation of age. It is attempted to check overall variations in the PNN algorithms with respect to the subjects. Here, the samples are collected from different age groups represented by their patient&amp;#39;s ID. The age group is selected from the database: (Patients ID) 9 (A0023), 16 (A0019), 13 (A0023) and 82 (A0014).&#xD;
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It is observed from the results that the younger age classification prediction is improved when compared with the other age groups. The parametric analysis of each sample is shown in figure 8. Its experimental outcome is listed in table 2.&#xA0;&#xD;
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From the above results, the maximum performance will be achieved throughout in all types of age group, which is observed for the AR Burg feature sets for PNN classification. Further, the sensitivity, specificity, and accuracy are calculated and compared with the traditional methodologies that are listed in table 3.&#xA0;&#xD;
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For two different training samples, the Back Propagation Neural Network has the same sensitivity as 74% and specificity as 60% for a constant threshold value. Its graphical representation is shown in figure 10.&#xD;
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From the results, it is concluded that the proposed methodology named as PNN has the maximum accuracy of 96.30% when compared with the traditional methodologies.41-45&#xD;
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CONCLUSION&#xD;
This research work has aimed to design a PNN classifier for detecting Seizure by incorporating AR parametric features. The proposed system bears the potential of providing an exact identification of faults and noise with various age criteria. It will help process the data in a user-friendly manner. &#xA0;One of the benefits is high accuracy when comparing it with a complex data set. Here, various complex datasets are collected from Karunya University. Based on the age group, the evaluation has been made, which is proved in the experimental section. For an exact verification, different parametric features are considered such as Autoregressive (AR) Burg, AR Yule-Walker method, AR Covariance, AR Modified Covariance, Levinson Durbin Recursion, and Linear Prediction Coefficient. It is observed that AR Burg outdid the other feature sets with the highest mean accuracy of 96.30% for the patient (IDA0023) aged 9. It has the lowest mean accuracy of 93.74% for subject 20. The proposed classification performs well when compared with the backpropagation, Multilayer perceptron neural network, and combined neural network concepts. In future, the classification accuracy is to be estimated with a huge difference among these comparisons and it must help to improve the diagnosis.&#xA0;&#xD;
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Ethics Approval and Consent to Participate: Not applicable.&#xD;
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Human and Animal Rights: No animals/humans were used for studies that are the basis of this research.&#xD;
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Consent for Publication: Not applicable.&#xD;
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Availability of Data and Materials: Available data and materials have been included in the article contents.&#xD;
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Funding: None.&#xD;
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Conflict of Interest&#xD;
The authors declare that there is no conflict of interest, financial or otherwise. Still, the authors would like to mention the earlier version of the article titled &#x201C;Epileptic Seizure-Classification Using Autoregression Features&#x201D;, which is communicated to the International Journal of Current Research and Review (Radiance Research Academy Publisher) is published under the title &#x201C;Epileptic Seizure-Classification Using Probabilistic Neural Network Based on Parametric Features&#x201D; (older version) in a predatory journal site (https://ijprjournals.com), which has been withdrawn to prove the authors&amp;#39; academic credibility. After the publication of this article titled &#x201C;Epileptic Seizure-Classification Using Autoregression Features&#x201D; (Present Version), and the same becomes the sole property of the concerned authors and the Radiance Research Academy Publisher and the &#x201C;Epileptic Seizure-Classification Using Probabilistic Neural Network Based on Parametric Features&#x201D; (older version) published in the https://ijprjournals.com becomes invalid.&#xD;
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Acknowledgements&#xD;
The authors would like to thank Prof. Thomas George, Ph.D, and his team, Department of Biomedical Engineering, Karunya Institute of Technology &amp; Sciences (Deemed to be University), Coimbatore, for their efforts in creating an open-access Epileptic Seizure database for the global research community and also Authors would like to thanks Dr. Louis Korczowski, Ph.D., and his team, GIPSA-lab, University of Grenoble-Alpes, France, for their P300 BCI (bi2014a) EEG open-access dataset which is used for normal brain activity classification in this research, without these two open-access databases my research work would not be possible.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3394</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3394</Fulltext></URLs><References>1. Pachori RB, Patidar S. Epileptic seizure classification in EEG signals using a second-order difference plot of intrinsic mode functions. Comp Meth Progr Biomed 2014;113(2):494-502.&#xD;
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39. Praveen KS. Detection of Fraudulent Transactions in Credit Card using Machine Learning Algorithms. In Proceedings of the Fourth International Conference on I-SMAC (IoT in Social, Mobile, Analytics and Cloud) (I-SMAC); 2020 Oct 7-9:pp. 659-663.&#xD;
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40. Praveen KS. Sampling Based Join-Aggregate Query Processing Technique for Big Data. Indian J Comp Sci Eng 2020;11(5):532-546.&#xD;
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41. Sasirekha SP, Priya A, Anitha T, P Sherubha P. Data Processing and Management in IoT and Wireless Sensor Network. J Phys Conf Ser 2020;1712(1):012002.&#xD;
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42. Anitha T, Latha GCP, Surendra PM. A Proficient Adaptive K-means based Brain Tumor Segmentation and Detection Using Deep Learning Scheme with PSO. J Comp Sci Intell Technol 2020;1(3):09&#x2013;14.&#xD;
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43. Latha GCP. Sridhar S. Prithi S. Anitha T. Cardio-Vascular Disease Classification Using Stacked Segmentation Model and Convolutional Neural Networks. J Cardiovasc Dis Res 2020;11(4):26-31.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Standardized Formula to Analyse the Neurovascular Safety in Clavicular Plating; An Anatomical Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>132</FirstPage><LastPage>138</LastPage><AuthorList><Author>Shruthi BN</Author><AuthorLanguage>English</AuthorLanguage><Author> Vivikta Venkatesh</Author><AuthorLanguage>English</AuthorLanguage><Author> Chandrakala C</Author><AuthorLanguage>English</AuthorLanguage><Author> Akash Venkatesh</Author><AuthorLanguage>English</AuthorLanguage><Author> Sarala HS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Clavicle shaft fractures are common traumatic injuries that occur in the middle third of the clavicle, treatment is controversial but may be nonoperative or operative based on the degree of displacement and patient factors. Objective: Our present study aims to determine a relationship between the length of the clavicle and the depth at which the neurovascular structures lie. Methods: Our study was conducted on 30 cadavers (30 right upper limbs &amp; 30 left upper limb). Measuring tape, vernier callipers and cay wires were used to determine the length and the depth of the clavicle. Results: After the thorough statistical observation and analysis of the data set, we were able to apply the regression equation. By careful calculation, we derived the regression coefficient for this particular data set and were able to arrive at an accurate result. Conclusion: Hence, by this equation, we could determine the depth of the neurovascular structures just by knowing the length of the clavicle. The present study could help orthopaedics intraoperatively in the precise selection of the screws which could minimize the risk of injury to subclavian vessels in the surgery and favour desirable outcomes.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Clavicular fracture, Clavicular plating, Subclavian vessels, Clavicular length, Neurovascular bundle, Standardized formula</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The clavicle or the collar bone is one of the most peculiar bones in our body. It is the only long bone which lies horizontally and has two primary centres of ossification with a membranous development. This bone is responsible for the transmission of weight from the upper limb to the trunk. The clavicle is closely related to the neurovascular structures supplying the upper limb. Hence, breakage or fracture of the bone can have adverse effects on the day to day lifestyle of the affected individual. The clavicle has important anatomical relationships with subclavian vessels and brachial plexus, especially in its middle third, where the curvature is the reference point used for accessing these structures. In case of trauma or surgery in the middle third of the clavicle, fixation is done employing open surgery using synthetic material; these structures may become injured because of their anatomical proximity.1,2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Plating of clavicle fractures has been thought a safe and reliable procedure but it is not without risks. There are 2 described locations for plate placement in clavicle fractures, superior and anterior. Those who advocate of superior plating claim less soft-tissue injury, stronger biomechanical profile, and easier surgical technique.3-5 Complications of superior plating include injuries to major neurovascular structures as subclavian vessels and brachial plexus.6 Iatrogenic neurovascular complications are fortunately rare. However, there are several case reports and small series of limb-threatening and even fatal neurovascular complications after clavicle surgery.7 These injuries have been reported while drilling or screwing.8-10&#xD;
&#xD;
Given their rarity, we could find no high-level studies that looked specifically at neurovascular injuries but represents a potentially devastating outcome from an operation that is treating a problem that is neither life nor limb-threatening. If the screw applies pressure to the underlying structures or pierces it, it could lead to adverse effects since these underlying structures are responsible for the entire neurovascular supply of the upper limb. Several reports have advocated different techniques to avoid damaging these important infraclavicular structures but an excessive undesired soft-tissue dissection is required or a safe drilling angle should be calculated which is not easy during the trauma surgery. &#xD;
&#xD;
This study aims to find the simple and effective method to avoid neurovascular complications in clavicle fractures plating by determining the relationship between the depth at which the neurovascular structures lie from the length of the clavicle. This helps the orthopaedic surgeons by choosing the right sized screw for clavicular plate fixture surgeries. This establishes neurovascular safety at the surgery of the middle third of the clavicle, employing dissection in cadavers.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Inclusion and Exclusion Criteria&#xD;
&#xD;
This study is cadaveric, 30 cadavers of an elderly age group between 55-70yrs, with a mean weight of 70kg, mean height 1.7m. Both sides of the cadaveric specimen were used and they were void of any congenital malformations, trauma or previous surgery in the shoulder region. &#xD;
&#xD;
Instruments&#xD;
&#xD;
Cay wires, bone drill, measuring tape, vernier callipers and instruments in the anatomical dissection kit were used which include scalpel, forceps and scissors. &#xD;
&#xD;
Procedure&#xD;
&#xD;
30 adult south Indian cadavers were dissected in the clavicular region bilaterally. The standard guidelines to expose the clavicular area were followed according to Cunningham&#x2019;s manual of dissection, volume 1, 16thedition11. Deep dissection was performed on either side of the cadavers to expose the clavicle and the neurovascular structures beneath it. The following structures were identified: subclavian vein, upper trunk of brachial plexus and supraclavicular nerves. The subclavian vein is marked to measure the distance from the most proximal point of the middle third of clavicle (Figure 1).&#xD;
&#xD;
The baseline anatomical measurements like the length of the clavicle are measured by plating from the acromioclavicular joint that is the outermost part of acromial end on the lateral side to the sternoclavicular joint that is the innermost part of sternal end on the medial side by using measuring tape without considering the bony curvatures (Figure 2). While taking the length of clavicle the midpoint was calculated and marked with marking pencil. The superior clavicular plate was screwed from the superior surface and screw was introduced at the midpoint of the clavicle consequently, the depth is measured from the nearest clavicular cortex from the screw tip to the subclavian vein by keeping the arm in anatomical position. The data obtained were photographed and tabulated separately for right and left upper limbs. Then the data was statistically analysed using Microsoft excel. &#xD;
&#xD;
&#xD;
&#xD;
The regression equation is as follows:&#xD;
&#xD;
Y-y=byxX-x&#xD;
&#xD;
Y is the depth of the subclavian vessels from the clavicle&#xD;
&#xD;
X is the length of the clavicle for which you would calculate the depth&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
Based on the regression equation our research has arrived at a formula which can determine the depth at which the subclavian vessels are situated concerning the clavicle measuring from its superior surface by knowing the length of the clavicle. The regression equation helps us in determining a dependent variable based on an independent variable. In this case, the independent variable would be the length of the clavicle and the dependent variable would be the depth of the neurovascular structures from the clavicle. &#xD;
&#xD;
The regression equation of Y on X&#xD;
&#xD;
To estimate the depth of subclavian vessels are situated based on length of clavicle both on Right side and Left side)&#xD;
&#xD;
Y = y + b yx (X- x)&#xD;
&#xD;
Here,&#xD;
&#xD;
Y is the depth of the subclavian vessels from the clavicle&#xD;
&#xD;
y is the mean of the depth of the clavicle&#xD;
&#xD;
byx is the regression coefficient &#xD;
&#xD;
X is the length of the clavicle for which you would calculate the depth&#xD;
&#xD;
x is the mean of the length of the clavicles&#xD;
&#xD;
The regression coefficient can be calculated as follows:&#xD;
&#xD;
byx=n&#x2211;xy-&#x2211;x &#x2211;y&#xA0; / n &#x2211;x2 &#x2013; (&#x2211;x)2&#xD;
&#xD;
Here,&#xD;
&#xD;
&#x2211;xy is the sum of the product of the length of the clavicle and underlying depth.&#xD;
&#xD;
&#x2211;x is the sum of the lengths of the clavicles &#xD;
&#xD;
&#x2211;y is the sum of the underlying depths of the structures&#xD;
&#xD;
&#x2211;x2 is the sum of the squares of the lengths of the clavicle&#xD;
&#xD;
(&#x2211;x)2 is the square of the sum of the lengths of the clavicle&#xD;
&#xD;
N is the number of specimens&#xD;
&#xD;
RESULTS&#xD;
&#xD;
The anatomical distance from the midpoint of the clavicle to the subclavian vein was measured in all the specimens with the arm held in anatomical position. The mean values of all the specimens are tabulated in table 1 and 2. A data set was formed with the following information, length of the clavicle, mid-point of where the hole was drilled and the depth of the neurovascular structures.&#xD;
&#xD;
The mean length of clavicular length on right 14.81cm and left side 14.84 cm, and from the middle of the clavicle to the subclavian vein, the mean depth is 1.33cm &amp; 1.43 cm on right and left side respectively. &#xD;
&#xD;
The standard deviation of the clavicular length on the right and left side is 1.53cm on both right and left side. The SD of the depth at which the vessels lie is 0.24cm and 0.20cm on right and left sides respectively.&#xD;
&#xD;
RIGHT SIDE&#xD;
&#xD;
Calculating for the right side Regression Coefficient,&#xD;
&#xD;
&#x2211;x=444.2&#xD;
&#xD;
&#x2211;y=39.86&#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;
&#xD;
&#x2211;xy= 589.74 &#xD;
&#xD;
&#x2211;x2=6644.58 &#xD;
&#xD;
(&#x2211;x)2=197313.6&#xD;
&#xD;
X= 14.81&#xD;
&#xD;
Y= 1.33&#xD;
&#xD;
Substituting the above values in the equation for the regression coefficient formula we get,&#xD;
&#xD;
Regression coefficient (byx) = n&#x2211;xy-&#x2211;x &#x2211;y&#xA0; / n &#x2211;x2 &#x2013; (&#x2211;x)2&#xD;
&#xD;
= 30*596.35-(444.2) (39.86)/ 30*6644.58-197313.6&#xD;
&#xD;
byx = -0.0067&#xD;
&#xD;
Therefore, regression co efficient (byx) for the right side = -0.0067&#xD;
&#xD;
Y on X Regression equation is fitted, to find the depth of subclavian vessels is situated based on length of clavicle on Right side. &#xD;
&#xD;
For example to estimate depth when length of clavicle on right side is x = 12.4&#xD;
&#xD;
Y = y + b yx (X- x)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; = 1.33 + (-0.0067) (X &#x2013; 14.81)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; =1.33-0.0067X +0.0992&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; = 1.4292 &#x2013; 0.0067X&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; = 1.4292 &#x2013; 0.0067 (12.4)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; = 1.4292-0.0830&#xD;
&#xD;
&#xA0; Y (12.4) =1.3462&#xD;
&#xD;
LEFT SIDE&#xD;
&#xD;
&#x2211;xy=634.2&#xD;
&#xD;
&#x2211;x=445.3&#xD;
&#xD;
&#x2211;y=42.9&#xD;
&#xD;
&#x2211;x2=6677.51&#xD;
&#xD;
(&#x2211;x2) =198292.1&#xD;
&#xD;
X= 14.84&#xD;
&#xD;
Y= 1.43&#xD;
&#xD;
Substituting the above values in the equation for the regression coefficient formula we get,&#xD;
&#xD;
Regression coefficient (byx) = n&#x2211;xy-&#x2211;x &#x2211;y&#xA0;/ n &#x2211;x2 &#x2013; (&#x2211;x)2&#xD;
&#xD;
=30*634.2-445.3*42.9/30*6677.51-198292.1&#xD;
&#xD;
byx = - 0.0381&#xD;
&#xD;
Therefore, regression co efficient (byx) for the left side is = - 0.038&#xD;
&#xD;
Y on X Regression equation is fitted, to find the depths of subclavian vessels are situated based on length of clavicle on Left Side. &#xD;
&#xD;
For example to estimate depth when length of clavicle on left side is x = 12.3&#xD;
&#xD;
Y = y + b yx (X- x)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; = 1.43 + (-0.0381) (X &#x2013; 14.84)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; =1.43-0.0381X + 0.5654&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; = 1.9954 &#x2013; 0.0381X&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; = 1.9954 &#x2013; 0.0381 (12.3)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; =1.9954-0.4686&#xD;
&#xD;
&#xA0;&#xA0; Y(12.3) =1.5268&#xD;
&#xD;
To Analyse the Z test by using Mean length and depth of Right and left side Clavicle is given in Table 1.&#xD;
&#xD;
&#xD;
&#xD;
Z test: (To know is there any significant difference in length of Clavicle considering in right and left side)&#xD;
&#xD;
To analyse the significant difference between Right and Left side Length of Clavicle &#xD;
&#xD;
The Null Hypothesis:&#xD;
&#xD;
H0:&#xA0; There is no significant difference between Right and Left side Length of Clavicle&#xD;
&#xD;
H1:&#xA0; There is a significant difference between Right and Left side Length of Clavicle&#xD;
&#xD;
Under H0 the test statistic is &#xD;
&#xD;
Z =&#xA0; X1 &#x2013;X2&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;is&#xA0; ~&#xA0; N(0,1)&#xD;
&#xD;
s12 +s22&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; n1&#xA0;&#xA0;&#xA0;&#xA0; n2&#xD;
&#xD;
Z= -0.093, (The P-value is 0.9259, 0.9259 &gt;0.05 therefore it is not significant)&#xD;
&#xD;
Here the test is the two-tail test at 5% level of significance, the critical values are -1.96 and 1.96&#xD;
&#xD;
Since the value lie within this region, therefore, H0 is accepted,&#xD;
&#xD;
That is there is no significant difference between Right and Left side Length of Clavicle&#xD;
&#xD;
Z test: (To know is there any significant difference in depth of Clavicle considering in right and left side)&#xD;
&#xD;
To analyse the significant difference between Right and Left side depth of Clavicle &#xD;
&#xD;
The Null Hypothesis:&#xD;
&#xD;
H0:&#xA0; There is no significant difference between the Right and Left side depth of Clavicle&#xD;
&#xD;
H1:&#xA0; There is a significant difference between the Right and Left side depth of Clavicle&#xD;
&#xD;
Under H0 &#xA0;the test statistic is &#xD;
&#xD;
Z =&#xA0; X1 &#x2013;X2&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;is&#xA0; ~&#xA0; N(0,1)&#xD;
&#xD;
s12 +s22&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; n1&#xA0;&#xA0;&#xA0;&#xA0; n2&#xD;
&#xD;
Z= -1.758 (The P &#x2013;value is 0.0787, 0.0787 &gt;0.05 therefore it is not significant)&#xD;
&#xD;
Here the test is the two-tail test at 5% level of significance, the critical values are -1.96 and 1.96&#xD;
&#xD;
Since the value lie within this region, therefore, H0 is accepted.&#xD;
&#xD;
Correlation Analysis is used to find the correlation between length and depth of Right and left side Clavicle (Figure 1)&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Figure 1: Correlation between length and depth of clavicle in right limbs. r = -0.0419, P-value 0.829, It is not significant. Calculations and digits are expressed in centimeter.&#xD;
&#xD;
Correlation Analysis is used to find the correlation between length and depth of Right and left side Clavicle (Figure 2) &#xD;
&#xD;
&#xD;
&#xD;
Figure 2:&#xA0; Correlation between&#xA0; length and depth of the clavicle in left limbs. r = - 0.2905, P-value 0.12, It is not significant. Calculations and digits are expressed in centimeter.&#xD;
&#xD;
After the data set were grouped &amp; thorough statistical analysis we came to know that:&#xD;
&#xD;
&#xD;
	&#xD;
	There is no significant difference between Right and Left side Length of Clavicle&#xD;
	&#xD;
	&#xD;
	There is no significant difference between the Right and Left side depth of Clavicle.&#xD;
	&#xD;
	&#xD;
	Z test: (To know there is any significant difference in depth of Clavicle considering in right and left side)&#xD;
	&#xD;
	&#xD;
	Z= -1.758 (The P &#x2013;value is 0.0787, 0.0787 &gt;0.05 therefore it is not significant)&#xD;
	&#xD;
	&#xD;
	Here the test is the two-tail test at 5% level of significance, the critical values are -1.96 and 1.96&#xD;
	&#xD;
	&#xD;
	Since the value lie within this region, therefore, H0 is accepted&#xD;
	&#xD;
	&#xD;
	Correlation between Right length and depth of clavicle : r = -0.0419, P value 0.829, It is not significant.&#xD;
	&#xD;
	&#xD;
	Correlation between Left length and depth of clavicle : r = - 0.2905, P value 0.12, It is not significant.&#xD;
	&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Clavicular fractures at midshaft (at the junction of medial 2/3rdand lateral 1/3rd) are very common. The most common and current treatment of choice is the internal fixation with superior plating. Though there are many options available for surgical fixation, like clavicular plating and intramedullary(IM) fixation they pose highest risk. IM fixation has the potential advantages of a smaller incision and less dissection and soft tissue exposure. For the last two decades, the use of rockwood and hagie pins represented the most popular form of IM implants. The use of alternate IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants.&#xD;
&#xD;
Though there are several studies which have reported regarding the morphometry of clavicle, there is less number of studies which report a method which aids in the accurate selection of screws to avoid these iatrogenic injuries. The present study establishes the interrelationship between the length of the clavicle to that of the depth at which the subclavian vein lies to reduce the complications caused due to IM devices.&#xD;
&#xD;
The 3-dimensional study by Sinha12have reported that the subclavian vein is closely related to the clavicle in the medial half, drills and screws should be aimed superior to inferior in the medial third and anterior to posterior in the middle third of the clavicle. Caution must be employed if the measured screw length is &gt;16 mm. This is derived from the narrowest reported clavicle thickness (11 mm) and the closest reported distance of the vessels to the middle third of the clavicle (5 mm). If the screw is longer than this or is markedly longer than the adjacent screws, the surgeon must pay close attention to the trajectory of the screw and the degree of prominence to ensure they are within the safe range. The maximum allowable is 4 mm, based on the closest reported distance of the vessels to the middle third of the clavicle (5 mm).&#xD;
&#xD;
A cadaveric study by Robinson3 has found out that the closest structure to the clavicular cortex is a subclavian vein which lies about 4.8mm. Unlike other surgical approaches, palpation or visualization of the deep neurovascular structures at risk is difficult to be performed by a single approach and performing additional incisions is not part of the routine approach.&#xD;
&#xD;
The minimum screw prominence resulting in a vascular injury was 8 mm. It is alarming that this length is less than the report</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3395</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3395</Fulltext></URLs><References>1. Standring S. Gray&amp;#39;s anatomy: the anatomical basis of clinical practice. 40th ed. New York: Churchill Livingstone; 2008:406-407.&#xD;
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2. Basamania CJ, Rockwood CA Jr. Fractures of the clavicle. In: Rockwood CA Jr, Matsen FA 3rd, Wirth MA, Lippitt SB, editors. The shoulder. 4th ed. Philadelphia: Saunders; 2009:617-770. &#xD;
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3. Hussey MM, Chen Y, Fajardo RA. Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. J Orthop Trauma 2013;27:627&#x2013;632.&#xD;
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4. Celestre P, Roberston C, Mahar A. .Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability?&#xA0; J Orthop Trauma 2008;22:241&#x2013;247.&#xD;
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5. Iannotti MR, Crosby LA, Stafford P. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 2002;11:457&#x2013;462.&#xD;
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6. Qin D, Zhang Q, Zhang YZ. Safe drilling angles and depths for plate-screw fixation of the clavicle: avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury. J Trauma 2010;69:162&#x2013;168.&#xD;
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7. Clitherow HDS, Bain GI. Major neurovascular complications of clavicle fracture surgery. Shoulder Elbow 2015;7:3&#x2013;12.&#xD;
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8. Ding M, Hu J, Ly H. Iatrogenic subclavian arteriovenous fistula: a rare complication of plate osteosynthesis of clavicle fracture. Orthopedics 2012;35:287&#x2013;289.&#xD;
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9. Johnson B, Thursby P. Subclavian artery injury caused by a screw in a clavicular compression plate. Cardiovasc Surg 1996;4:414&#x2013;415.&#xD;
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10. Ring D, Holovacs T. Brachial plexus palsy after intramedullary fixation of a clavicular fracture. A report of three cases. J Bone Joint Surg Am 2005;87:1834&#x2013;1837.&#xD;
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11. Cunninghams manual of dissection. Vol 1, 11th edition; Pg 54-58.&#xD;
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12. Sinha A, Edwin J, Sreeharsha B. A radiological study to define safe zones for drilling during plating of clavicle fractures. J Bone Joint Surg Br 2011;93B:1247&#x2013;1252.&#xD;
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14. Galley IJ, Watts AC, Bain GI. The anatomic relationship of the axillary artery and vein to the clavicle: A cadaveric study.&#xA0;J Shoulder Elbow Surg&#xA0;2009;18:21&#x2013;25.&#xA0;&#xD;
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15. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures.&#xA0;Arch Orthop Trauma Surg&#xA0;2012;132:617&#x2013;625.&#xD;
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16. Collinge C, Devinney S, Herscovici D.Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma 2006;20:680&#x2013;686.&#xD;
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17. Venkatachalam S, Packer GJ, Sivaji CK. Anterior versus superior plating of fresh mid-shaft clavicular fractures. Injury Extra 2008;39:170&#x2013;171.&#xD;
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18. Chauhan A, Gawande V, Saoji KK, Mittal A. The outcome of Distal End Clavicle Fractures Treated with Locking Plates, Int J Curr Res Rev 2020;12(14):30-34&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>KI-67 Index as a Prognostic Factor in Correlation with Other Clinico-Pathological Factors in Breast Cancer - An Institutional Experience&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>139</FirstPage><LastPage>146</LastPage><AuthorList><Author>Mahin Nallasivam</Author><AuthorLanguage>English</AuthorLanguage><Author> Mohanapriya Thyagarajan</Author><AuthorLanguage>English</AuthorLanguage><Author> Balaji Singh Krishna</Author><AuthorLanguage>English</AuthorLanguage><Author> Manuneethimaran Thiyagarajan</Author><AuthorLanguage>English</AuthorLanguage><Author> Nitesh Navrathan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Breast cancer is a complex aggressive disease with different subtypes due to multiple biomolecular interactions (genetic heterogeneity) and demonstrates the extensive variation in patients clinical feature based on the ethnic group that makes the diagnosis and treatment challenging. Numerous breast cancer markers had been established like Progesterone Receptor (PR), Estrogen Receptors (ER), Human Epidermal growth factor Receptor (HER2neu) as well as clinical-pathological factors such as the stage of the disease, extent of axillary lymph node involvement, tumour size, histological grade, a mitotic rate, patient age, menopausal status etc. Ki?67, cyclin D1, cyclin E, and ER&#x3B2; had been advocated to exhibit both the predictive and prognostic value in breast cancer patients. Objectives: The objective of the current study is to evaluate the relevance and correlation of Ki-67 index in relation with other clinicopathological factors that determine the prognosis in Carcinoma breast and thereby, defining the staining thresholds and cut-off of Ki-67 immunohistochemistry. Methods: A consecutive number of 200 patients who had undergone modified radical mastectomy were included in this study. The postoperative specimen was for the assessment of histopathology diagnosis and the tumour size, nodal status, histological grading, tumour pathological type, mitotic rate, and lymphovascular invasion apart from Estrogen Receptor status, Progesterone Receptor status, Human Epidermal growth factor Receptor 2neu status and Ki-67 protein expression. Patient&#x2019;s clinical data were collected prospectively. SPSS software version 19 was used for statistical analysis. One way Anova and chi-square analysis was applied to assess the relation of Ki-67 index score with other prognostic factors. Results: Ki-67 protein expression showed no correlation with age (irrespective of age classification), menopausal status, histological subtypes, lymphovascular invasion, mitotic rate, ER and HER2neu, but still the levels of Ki-67 protein increases with ER negativity (p&gt;0.05). The overall histological grading showed statistical significance between grade I Vs III and grade II Vs III which reflects the linear relationship whereas chi-square analysis did not show. Progesterone Receptor showed an inverse relationship with Ki-67 expression (p=0.0005) and whereas, tumour size and nodal involvement revealed a linear relationship(p=0.02). Conclusion: Hence, the study had lucidly established the fact that Ki-67 index is superior to the mitotic rate and can be routinely employed for predicting the prognosis in breast cancer patients. The current paper recommends the use of the staining thresholds and cut-offs of Ki-67 immunohistochemistry used in the current study for future studies since all the patients expressed Ki-67 protein.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Carcinoma breast, Correlation, Ki-67 index, Prognostic factors, Tumour size</Keywords><Fulltext>Introduction&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Breast cancer is a complex aggressive disease with different subtypes due to multiple biomolecular interactions (genetic heterogeneity) and demonstrates the extensive variation in patients clinical feature based on an ethnic group that makes the diagnosis and treatment challenging.1 Carcinoma breast constitutes about 22% of women malignancy and it is the second commonest malignancy in females.2,3 Among the different types of cancers, worldwide data suggested that breast cancer in females occupies 25% which is nearly a quarter with a projected 1.67 million new cases every year. According to GLOBOCAN(The Global Cancer Observatory) 2018 report, the incidence of breast cancer is 11.6%, of which the mortality is documented to be 6.6% in females globally. At the same time, age-standardized risk and cumulative risk (age up to 75 yrs in %) are found to be 46.3 and 5.03 respectively.4In India, breast cancer ranks first with an incidence of age-adjusted rate and mortality to be 25.8 and 12.7 per 100,000 women.5 A recent Indian study had revealed that age-adjusted incidence of breast cancer in Chennai (37.9 per 100,000 women) was higher next to Delhi (41 per 100,000 women) when compared over the other states and also showed that the incidence is escalating annually.6&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Considering the elevating yearly incidence, mortality, different subtypes and the challenges faced in diagnosis and treatment strategy of breast cancer patients, identification of factors that possess both the predictive and prognostic values in breast cancer management becomes essential. Numerous breast cancer markers had been established like Progesterone Receptor (PR), Estrogen Receptors (ER), Human Epidermal growth factor Receptor (HER2neu) as well as clinical-pathological factors such as the stage of the disease, extent of axillary lymph node involvement, tumour size, histological grade, a mitotic rate, patient age, menopausal status etc. Ki?67, cyclin D1, cyclin E, and ER&#x3B2; had been advocated to exhibit both the predictive and prognostic value in breast cancer patients. Gerdes et al (1983) had described Ki-67 (395kDa) as a master switch controller of cellular proliferation and found to have the most appropriate and superior correlation with histological parameter and proliferating (mitotic) activity by the previous literatures.7,8There exist a controversy regarding the staining thresholds and cut-offs of Ki-67 immunohistochemistry (not uniformly standardized) since different criteria have been employed by different studied authors.9-12 Also, few numbers of literature are available among the Indian population regarding Ki-67 status. Hence, the objective of the current study is to evaluate the relevance of Ki-67 index in relation with other clinicopathological factors that determine the prognosis in Carcinoma breast as well as to correlate Ki-67 protein expression with patient&#x2019;s age, Menopausal Status, Tumour grade, Pathological type, Mitotic rate, Tumour size (T), Nodal status (N), Lymphovascular invasion, ER/PR status, HER2neu receptor status and thereby, defining the staining thresholds and cut-off of Ki-67 immunohistochemistry.&#xD;
&#xD;
Materials and Methods &#xD;
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Patient selection&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The present study was conducted after the approval of the Institutional Ethics Committee (IEC) of the hospital. A consecutive number of 200 patients who had undergone modified radical mastectomy for early-stage primary breast carcinoma in our hospital from January&#xA0; 2016 to 2019 were included in this study after obtaining their informed consent. Patients with metastatic breast cancer or presented with a previous history of neo-adjuvant chemotherapy, or breast surgery outside our hospital including male breast carcinoma were excluded from the study. The postoperative specimen was sent for routine hematoxylin and eosin stains for the assessment of histopathology diagnosis and the tumour size, nodal status, histological grading, pathological type of the tumour, mitotic rate, and lymphovascular invasion apart from ER status, PR status, HER2neu status and Ki-67 protein expression.&#xA0; Immunohistochemistry protocol for the analyses of ER, PR, HER2neu and Ki-67 status was performed according to the protocol.13 Ki-67 protein expression levels were classified based more than 20%, between 10 to 20%, between 1% to 10% and 0% staining as high, borderline,&#xA0; low and negative respectively. Patient&#x2019;s clinical data were collected prospectively. The ethical clearance number: CSP &#x2013; MED/15/OCT/25/89&#xD;
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&#xA0;Statistical analysis&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; SPSS software was used for the statistical analysis of the clinical data. One way Anova was applied to assess the relation of Ki-67 index score with other prognostic factors including patient&#x2019;s age, menopausal status, grade of the tumour, pathological type, mitotic rate, tumour size (T), nodal status (N), lymphovascular invasion, ER/PR status and HER2neu receptor status. Correlations of Ki-67 index score level with clinicopathological parameters were determined using chi-square analysis. All the data were expressed as mean &#xB1; Standard Deviation (SD) or frequencies by per cent. The relationship between the prognostic factors and the Ki-67 index score was considered statistically significant only if the p-value is less than 0.05.&#xD;
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Results &#xD;
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Patient characteristics&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The median age of the study population at the time of presentation was 53 years, ranging from 27 to 84 years. There was no difference in frequency distribution observed concerning menopausal status among the studied populations (50% in each group). Majority of the patients had tumour size ranging from 2cm to 5cm (T2) followed by less than 2cm (T1) and larger than 5 cm (T3). According to the histological analysis, the predominate percentage was observed in well-differentiated carcinoma (grade II). Invasive Ductal Carcinoma (IDC) was the commonest pathological diagnosis and the least miscellaneous groups comprise of Invasive Papillary Carcinoma (IPC), Papillary Carcinoma Variant (PCV), Squamous Cell Carcinoma (SCC), Invasive Medullary Carcinoma (IMC) with one patient each. All the patients had non-metastatic status. Almost all the patients had a nearly similar frequency of proliferation (mitotic rate) but still, moderate (grade II) was prominent followed by rapid (grade III) and low (grade I). A maximum number of patients had the absence of lymph node involvement and lymphovascular invasion. ER, PR, HER2neu positivity was documented in the 52%, 42% and 30% of the population accordingly. The Ki-67 index score levels according to the Ki-67 protein staining cells, patients had high levels in 68% followed by low levels in 18% and then, borderline levels in 14% among the studied population. The mean percentage of Ki-67 protein expression was found to be 36.8 &#xB1; 22.9 (range from 2 to 80%) of the complete cases. Patient&#x2019;s detailed information&#x2019;s is presented in Table 1. The median age of the study population at the time of presentation was 53 years, most of the patients had tumour size ranging from 2cm to 5cm (T2), Grade II was the most common tumour grade. Invasive Ductal Carcinoma (IDC) was the commonest pathological diagnosis. A maximum number of patients had the absence of lymph node involvement and lymphovascular invasion. ER, PR, HER2neu positivity was documented in the 52%, 42% and 30% of the population accordingly. The mean percentage of Ki-67 protein expression was found to be 36.8 &#xB1; 22.9.&#xD;
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&#xD;
&#xD;
&#xD;
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Ki-67 protein expression correlation with clinical characteristics&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To identify the significance of Ki-67 protein expression percentage with demographic and clinic-pathological parameters, the prognostic factors were divided into subcategories as shown in Table 2. On association analysis through student t-pair test, it was observed that the subcategories within age, menopausal status, histological tumour type, mitotic rate, lymphovascular invasion, ER, HER2neu concerning Ki-67 index score level of the total studies cases do not exhibit any correlation. In converse, tumour size, histological grade, nodal involvement and PR showed a positive correlation. The comparison within the PR status showed a statistically high significant correlation concerning the percentage of Ki-67 protein expression than the other parameter. The statistically significant association was found only between T1 and T2 (tumour size), grade I and grade III, and grade II and grade III (histological grade) and N0 with N2 and N3 (Nodal involvement) when compared against the respective percentage of Ki-67 score index.&#xD;
&#xD;
Ki-67 protein expression correlation with clinical characteristics&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To identify the significance of Ki-67 protein expression percentage with demographic and clinic-pathological parameters, the prognostic factors were divided into subcategories as shown in Table 2. On association analysis through student t-pair test, it was observed that the subcategories within age, menopausal status, histological tumour type, mitotic rate, lymphovascular invasion, ER, HER2neu concerning Ki-67 index score level of the total studies cases do not exhibit any correlation. In converse, tumour size, histological grade, nodal involvement and PR showed a positive correlation. The comparison within the PR status showed a statistically high significant correlation concerning the percentage of Ki-67 protein expression than the other parameter. The statistically significant association was found only between T1 and T2 (tumour size), grade I and grade III, and grade II and grade III (histological grade) and N0 with N2 and N3 (Nodal involvement) when compared against the respective percentage of Ki-67 score index.&#xD;
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&#xD;
&#xD;
UL-Upper Level; LL-Lower Level; Miscellaneous-Invasive Papillary Carcinoma, Papillary Carcinoma Variant, Squamous Cell Carcinoma, Invasive Medullary Carcinoma and Invasive Lobular Carcinoma; Vs-Versus; NS-Non significant;*- represents the statistical significance.&#xD;
&#xD;
Correlation of Ki-67 scoring with clinical characteristics&#xD;
&#xD;
Ki-67 protein expression scoring levels were assessed for correlation with the prognostic factors.&#xA0; In similar to the findings of Table 2, the correlation analysis (chi-square) of Table 3 also further provided the profound findings of tumour size, nodal involvement and PR status positively related with different Ki-67 score levels with statistical significance except for histological grade. Concerning the histological tumour type, Invasive Ductal Carcinoma and ductal carcinoma in-situ combined (60%) showed the higher level of expression than the rest of the pathology but statistical significance was not identified within the groups. Table 3 showed a linear relationship when compared the tumour size with ki-67 proteins levels. As the tumour grade increases, Ki-67 protein expressions also raised and in converse, when the tumour grade decreases, the respective expressions levels also minimized (p=0.02). When the nodal system involvement advances, Ki-67 protein expressions levels also increased and had decreased expression, when the nodal involvement is less (0.02) in similar tumour grade findings. There was no statistical significance difference observed either between the presence and absence or the positivity and negativity of the lymphovascular invasion or ER and HER2neu respectively concerning the either high or low or borderline levels of Ki-67 protein expression. The majority of the patients who had shown negative results for ER, PR and HER2neu demonstrated increased levels of Ki-67 proteins. The higher level of statistical significance was noted between the positivity and negativity of PR with the Ki-67 score index levels among the studied cases.&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Cellular proliferation is the hallmark in any cancer and hence, regular examination of cell proliferation is suggested in the pathological assessment especially in invasive carcinoma breast, which in turn accounts for the traditional scoring of mitotic activity (simple and commonly employed tool). Hence, cell proliferation is an essential part of histological grading and well known as the prognostic marker. The major disadvantage of mitotic index assessment is that it is time-consuming and the results are non-reproducible but still are employed in clinical practice.13,14 Therefore, investigation on more sensitive tumour biomarker has led to the identification of several markers related to the patient and the tumour has been established in predicting the risk of mortality, recurrence and metastasis in breast malignancy. These factors are the number of positive axillary lymph nodes, size of the tumour, histological grade of the tumour, lymphovascular invasion, hormone receptor (ER/PR) positivity and Her2neu gene amplification.15 Recently, one such tumour proliferation biomarker known as Ki-67 protein (proliferating cell nuclear antigen) is being established as a prognostic and predictive indicator in patients with breast cancer and possesses strong association with cellular proliferation.16, 17&#xD;
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Ki-67 protein (non-histone) is expressed during all the phases of the cell cycle (late G1, S, G2 and M phase) except at early G1 and G0 (quiescent cells) phases, and are detected during M phase at the chromosomal surface which makes it unique and more specific biomarker.18,19 The expressions of Ki-67 protein is up-regulated in rapidly dividing cells and hence, the cells stains more positive. The role of Ki-67 has been well analyzed in various research studies for its prognostic value and reliability in breast carcinoma, cervical cancer, sarcomas, neurological malignancies, bronchogenic carcinoma and prostatic cancer.20-24 Many investigating modalities have used Ki-67 as a successful diagnostic marker.25-28 Positive immunostaining for the Ki-67 expression has been accepted as an investigative tool and positive staining ranging from 10 to 14% has been defined as high risk.29-31 The 2009 Saint Gallen consensus declared that the patients with higher levels of Ki-67 nuclear protein expression required additional chemotherapy and hormonal therapy for all ER PR positive breast malignancies.32&#xD;
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In our study, the protein expression levels of Ki-67 was defined as negative, high, low and borderline only when the positive tumour cells percentage (Ki-67-LI) is 0%,&gt;20%, 10% and &gt;20% staining as high in dissimilar and similar to our study respectively. To coincide with our classification, Marwah N et al13 defined high as &gt;20% except </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3396</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3396</Fulltext></URLs><References>&#xA0;&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Significance of Spirituality and Health Care: A Holistic Approach&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>147</FirstPage><LastPage>151</LastPage><AuthorList><Author>Aruna Dhamija</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Spirituality plays a vital role in the workplace which directly impact on the health status of employees. Taking care of health in every profession is a threat due to competition, expectations and new challenges in an organization an employee&#x2019;s faces. Managing the work along with spirituality could bear the consequences come on the health of employees. Employee&#x2019;s health status depends on how much the individual is spiritually connected and working with that state of mind at the workplace. The attempt made in this paper is to focus on the ways of improving the spiritual health of employees at the workplace and to recover from tough times. The purpose of this have a look at is while spiritually health care is taken it ends in try for a kingdom of harmony with others whilst running to balance inner wishes and with the relaxation of the world. The Present study will facilitate to understand the essentials required to grow spiritually and enhance non-secular health through Silence, Discussion on Spirituality, Probing and Inquisitive, Willing to Forgive and Be Cheerful. The effect of the current study is that the spirituality assists in understanding diseases and decision to hunt mental support as well as spirituality play an integral role in the holistic care of employees working in the organization.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Spirituality, Healthcare, Workplace, Relaxation, Health Status, Mental Support</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Spirituality alludes thereto centre estimation of you this is your deepest self that offers with a significant vibe of which you&#x2019;re, where you originated from, where you&amp;#39;re going and the way you will probably arrive at your goal. Spiritual health or wellness appropriately being played out a pivotal capacity in presence; anyway, its significance is stronger than one may furthermore concur with. Spirituality wellbeing may likewise recommend various issues to uncommon people.1 For a few, Spirituality may likewise be equivalent with traditional religion, simultaneously concerning others it relates when all is said in done to the standard of private connections or love for nature. An essential reason for strict wellbeing may likewise be the experience that presence is critical and you have watched your private home in it. &#xD;
&#xD;
Studies have proven that spiritually strong individuals their health condition is better than who don&#x2019;t have trust towards God. Spiritual wellness can be achieved physically and mentally that depend on one&amp;#39;s morals, attitude, and purpose. The spiritual as a dimension is the commitment to one&#x2019;s value system. It draws upon the sources that inspire and uplift you and tie timelessly towards truths of humanity. The three different aspects of seeing life are facilitating, setting up, and serving. When one facilitate, life is considered weak. When fix, life taken as broken. While one serve&#x2019;s life becomes whole. Fixing and encouraging can be crafted by the sense of self, and supplier the artistic creations of the spirit.2&#xD;
&#xD;
In an intriguing investigation at the job of Spirituality in wellness care, creator3 noticed that the technological advances of the past century tended to change the focus of medicine from a caring, service-oriented model to a technological, cure-oriented model. Spirituality - the more extensive of the two terms - might be characterized as an affectability or connection to non-common or different qualities that encourage somebody advantage observation, self-know-how, and an uplifted skill of presence. The search for meaning and purpose in human existence is to live healthy and few things that require Zero talent such as work ethics, passion, positive attitude and effort. Life has plenty of opportunity for the ones who want to remain healthy. In each tough situation connect towards God and with a constant positive attachment will bring deep internal change and progress in life. &#xD;
&#xD;
Spirituality is vital to whole or all-encompassing, care in that it assists with managing individuals&amp;#39; know-how of battling and adjust. Profound viewpoints and practices can offer a setting wherein nerves about physical and mental working could likewise be confronted, felt, and comprehended. A dynamically building group of exploration shows that Spirituality and strict practices help wellness. Wellbeing is portrayed today inside the elements of considerations, edge, and soul.4 Remembered for those measurements is in essence, mental, enthusiastic, sexual, social and non-mainstream wellness. We can&amp;#39;t have generally speaking wellbeing if we overlook any one of these measurements. A considerable lot of the practices related to prosperity are key added substances of a solid non-common life. Models incorporate volunteerism, social duty, good faith, adding to society, connectedness with others, the sentiment of having a place/being a piece of a gathering and love of self/cause to fear for self. &#xD;
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Seeking Spirituality in one&amp;#39;s understanding is to discover spirituality for oneself and how it can play an important role in your life. Proper awareness and knowledge will provide hints to enhance your spiritual well-being.5 It will offer the answer for some inquiry one if confronting disarrays in their ways of life. It will assist with finding suitable reaction of numerous hard inquiries alongside what offers your life which means and cause, what offers you want, how might one get through difficult stretches, wherein have you at any point discovered solace, what are your most noteworthy examinations, on the off chance that you have a place with a strict network, how you can interface. Practising and figuring out will help to discover to most tricky questions of life. &#xA0;A short time later can portray a period or occasion when you felt loose and that each one turned out to be direct with the world, time when your reality was loaded up with a vibe of significance or when you encountered a vibe of dread.&#xD;
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ESSENTIALS TO IMPROVE HEALTH THROUGH SPIRITUALITY&#xD;
&#xD;
Spirituality assess spiritual health which describes the state of mind one is involved. Employees working in the same environment with the same people and no change in their pedagogy will lead to creating monotony. But if the individual is involved with spiritual mindset then will discover hope, positive outlook, forgiveness, self-reputation, dedication, that means and motive in lifestyles, clean values, the experience of worth, peace, worship, prayer, and meditation. It has been observed that individuals not having association towards spirituality and consider atrophy as &#x2018;wasting away of the body or part of an organ&#x2019; or as &#x2018;degeneration, decline, or decrease as from disuse.6 The three D&#x2019;s of Spiritual Atrophy &#x2018;degeneration, decline, or decrease&#x2019; could have begun feeling of vacancy, anxiety, loss of meaning, self-judgment, self-condemnation, apathy, conflicting values, worried/annoyed/acting in haste and without rituals.&#xD;
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FIVE TECHNIQUES TO GROW SPIRITUALLY AND ENHANCE NON SECULAR HEALTH &#xD;
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1) Silence: Spiritual realities oftentimes are to be had the state of a still little voice that is difficult to focus on over the bedlam and disarray of a wild way of life. Set aside an ideal opportunity for isolation and reflection. &#xD;
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2) Discussion on Spirituality: Spiritual examinations frequently are to be had astounding organization and bundles. They wonder us. Cultivate a nonjudgmental mentality so you&amp;#39;re friendly the profound measurement in any ways of life occasion - from hoeing the grass, to see a spot of destiny, from looking a swimming meet to considering the morning paper. &#xD;
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3) Probing and inquisitive: A mentality of dynamic looking builds your other options and your potential for spirituality focusing. Try not to close entryways sooner than you look at what&amp;#39;s at the rear of them. For instance, the hint of hands may likewise be a solid focusing experience. A quiet retreat may reestablish your eagerness. Contemplation or yoga may likewise okay allow you to delight in serenity and harmony. &#xD;
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4) Willing to Forgive: Agony empowers us to practice inside the broadest inquiries of our being. It&amp;#39;s far a deepener. Existence of a human being is to experience shallow ways of life. Permit yourself to sympathize with your agony totally, at that point ask, "What is it endeavouring to uncover me?"&#xD;
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5) Be cheerful: Play can be wonderful, freeing appreciates. It breeds unconstrained energy and gathering. When you make melody, move and chuckle, sing - however you play - tune in for hints of the soul. &#xD;
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The representatives while comprehending the significance of non-common wellness, indications of Spiritual Health might be obvious because the astuteness and sustaining dating with self as well as other people will enhance and will build solid non-open cost framework with the expectation to develop and satisfy the intention of ways of life. &#xD;
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PREPARATION FOR SPIRITUAL HEALTH &#xD;
&#xD;
Spiritual health could be considered as a way to remain energetic, mindful, vigilant and always enthusiastic to meet our life goals. When one is healthy by mind will lead to creating happiness around his world. Following are few remedies through which one if follows can become strong and develop a healthy state of mind: &#xD;
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&#x2022; Take time for self-recharging &#xD;
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&#x2022; Practice hallowed ceremonies &#xD;
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&#x2022; Practice acknowledgement and non-judgment &#xD;
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&#x2022; Keep the religion, supplicate; don&amp;#39;t desert convictions in emergency &#xD;
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&#x2022; Embrace spine chiller. Permit yourself to concur with things that cannot be clarified &#xD;
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&#x2022; Embrace the shadow, your dull perspective. Perceive and recognize it &#xD;
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&#x2022; Forgiveness &#xD;
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&#x2022; Put sympathy without hesitation &#xD;
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&#x2022; Live up with pleasure&#xD;
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EXPLORATION ON THE ROLE OF SPIRITUALITY IN HEALTH CARE &#xD;
&#xD;
The effect of Spirituality on wellbeing is an area of dynamic exploration immediately. Other than being concentrated by the method of doctors, it is concentrated by methods for therapists and various experts. The examination tends to fall under three prevalent territories: mortality, adapting and mending &#xD;
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All through records and across societies, Spirituality has been unequivocally identified with human services. Everything changed on occasions. Innovative advances and contemporary-day logical investigations revelations have little inquiry included exceptional improvement in drugs enabling to drag out and spare lives.7 Then again, those advanced procedures have moreover changed the essential objective of medications from a stressing, influenced individual orientated, the administration arranged model to a fix situated, illness orientated and innovative model. &#xD;
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Understanding the noteworthy capacity of Spirituality in human services and seeing its points of interest for patients, inside the current years, a few doctors are attempting to solidness their activity with Spirituality.8 Numerous medical clinics offer peaceful consideration and strict contributions to their victims and family units. More clinical specialists are rehearsing humane consideration getting the opportunity to serve the total man or lady, including their physical, enthusiastic, social and non-common pleasantly being. Exploration has demonstrated that Spirituality can advantage people&amp;#39;s wellbeing and affect their mortality, adapting and reclamation. &#xD;
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MORTALITY &#xD;
&#xD;
Exploration has demonstrated that individuals who have a step by step Spiritual practice tend to degree longer. Spirituality can upgrade pressure control, prompting better adapting abilities, quickened private force and more prominent social help. Some observational examinations recommend that oldsters who have typical profound practices commonly watch out for degree longer. Another examines focuses on a potential instrument. Expanded degrees are related with an all-encompassing pervasiveness of infirmity. &#xD;
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An examination takes a gander at concerning more established grown-ups demonstrated that individuals who non-mainstream in nature. The specialists speculated that non-mainstream responsibility may likewise improve strain control by methods for bestowing better ways of dealing with stress, more extravagant social help, and in this way the intensity of individual qualities and perspective. &#xD;
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COPING/ADAPTING &#xD;
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Spiritual exercise can help patients managing disease, throb and favoured ways of life stresses. It can assist them with owning an excellent viewpoint, to consider in the treatment plan, to think about reclamation and to make a far superior nature of presence. The examination has furthermore demonstrated that they consider more prone to have more prominent satisfaction, that implies, and reason throughout everyday life. They are bound to be searching for out those methods for their contamination. Spiritual solace and association can assist them in managing their disease and association. Even though the situation of throb medication is very indispensable, examines has demonstrated that unwinding, supplication, reflection, contact, and rubdown would all be able to help with hurt administration. In conclusion, Spirituality can direct relatives and buddies to address their adored one&amp;#39;s contamination or passing. &#xD;
&#xD;
Some exploration shows that the ones which are profound for the most part watch out for own a more phenomenal standpoint and a mile better fine of life. For instance, victims with deadly diseases discovered relief from their strict and profound standards had been more prominent happy with their lives, had been more joyful, and had considerably less hurt. Spirituality is a fundamental piece of the "existential territory" estimated in magnificent of-presence evaluations. Positive surveys on the ones estimate an important non-open life, accomplishment of presence objectives, and an encounter that life thereto point was advantageous associated with a fair remarkable of life for victims with unrivalled affliction. &#xD;
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Some exploration has likewise taken a gander at the situation of Spirituality concerning throb. One inspects indicated that non-common pleasantly being changed into identified with the power to delight in ways of life even inside the middle of signs, comprehensive of torment. Along these lines that Spirituality may likewise be an essential clinical objective. &#xD;
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Spiritual convictions can assist patients with managing illness and face biting the dust. At the point when mentioned what helped them adapt, they referenced non-mainstream convictions. Top issues have been discovering friendship and profound solace picked over things like development mandates, financial/money-related issues, and social concerns. Those that had been studied referred to a few profound consolations that could reassure them. The major typical strict consolations expressed have been convictions that they are most likely inside the caring nearness of God or a more powerful, that downfall wasn&amp;#39;t the zenith however a section, which they may live to tell the story through their youths and relatives. &#xD;
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Mourning is viewed as probably the best pressure. Guardians whose children had kicked the bucket of malignant growth found that they acquired encouragement from their non-mainstream convictions after their youngster&amp;#39;s death toll. Those guardians had a higher physiologic and passionate modification. Furthermore, mother and father announced a fortifying in their strict commitment through the span of a year sooner than their infant&amp;#39;s passing. &#xD;
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RECOVERY/CONVALESCENCE &#xD;
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Simply looking for fake treatment research, we will see that how ground-breaking conviction itself is routine. Patients are given fake treatment revel in gifts since they accepted that they were given genuine medication. They&amp;#39;re prepared to spigot into their &amp;#39;recalled prosperity&amp;#39; and feel higher. Spirituality can be a far more profound confidence in an option that could be more prominent than us and confidence in life itself. Profound practices can bring down nervousness, improve vanity, and upgrade substantial working. Patients visit their medical clinic treatment doctor with strain-related issues; Spirituality is as often as possible basic to bring down pressure and improves wellness.9 At last, humane and profound consideration can upgrade the influenced individual specialist seeking improving trust and rebuilding generously.&#xD;
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Spiritual commitment tends to boost restoration from distinct diseases. Individual&#x2019;s people who participated in religious sports with their beliefs had been work higher and progressed physical and intellectual functioning. They develop higher tiers of self-esteem and had much less tension and fewer health issues. Generally, human beings that don&#x2019;t fear the maximum quantity tend to possess higher fitness outcomes.10 Maybe spirituality permits human beings to strain much less, to forsaking and sleep at this moment. Associated with spirituality is that the electricity of believe and wonderful wondering. Spirituality is functionality to faucet into one&#x2019;s resource to heal shows that three additives make contributions to the effect of the patient-health practitioner courting: tremendous ideals and expectations on a part of the patients, positive ideals and expectations at a part of the physician or health care professional, and a sincere dating among the two parties.11&#xD;
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Explicit profound practices are appeared to decorate wellbeing impacts. Inside the began research at the impact of strict practices on wellbeing. Some people that rehearsed supernatural reflection moved toward him inside the Nineteen Sixties and mentioned him to exercise if contemplation had valuable wellness results. He found that ten to twenty minutes of contemplation multiple times everyday impacts in diminished digestion, diminished heartbeat, the diminished charge of respiratory, and more slow mind waves. &#xD;
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Meditation is a couple of things that every individual can rehearse regardless of their confidence, religion or Spirituality.12 It can hose down the flight-or-battle system on your body, decline cholesterol, bring you rest, make greater dependability, and increment your real and mental country. Meditation as a method goes to acknowledge oneself totally, each from inside and outside.13 It likewise facilities to perceive who you are internal and the way you respond to what&amp;#39;s outside. Most importantly, reflection is playing oneself inside the strict feeling of the planet observed that contemplation while through with full mindfulness and devotion it outcomes in wellness favours like reduce pressure, improves nervousness, decreases gloom, promotes passionate wellness, increases an inspirational point of view, increases reluctance, reduces age-related amnesia, generates consideration, helps to forestall addictions, improves rest, helps controlling hurt, decreases imperative sign, improves generally speaking physical and mental nation.8 &#xD;
&#xD;
Meditation helps to improve the wellbeing of the individual. Only requires firmness and loyalty. If it&amp;#39;s followed with seriousness, there are steps to meditate which is as follows:&#xD;
&#xD;
&#x2022; Set your aim. &#xD;
&#xD;
&#x2022; Eliminate all reasons to prevent you from completing your contemplation repeating. &#xD;
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&#x2022; Find a territory to sit effortlessly. It is regularly a seat, a pad or the floor.&#xD;
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&#x2022; Don&amp;#39;t get excessively comfortable. Remain quiet, anyway ready. Try not to rest off &#xD;
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&#x2022; Keep your spine tall. Breathe in with the guide of moving your shoulders in your ears and breathe out through bringing down them. &#xD;
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&#x2022; Close your eyes. &#xD;
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&#x2022; Maintain a simple breath through and out your nose. &#xD;
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&#x2022; Be influenced individual. Give time as a learning method. &#xD;
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&#x2022; Observe your considerations without judgment. &#xD;
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&#x2022; Don&amp;#39;t communicate in or watch your psyche. Simply plunk down and be. Permit them to go as they get up. &#xD;
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&#x2022; Shifts happen. Interruption is a piece of the methodology. Acknowledge it and hold. &#xD;
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&#x2022; Move on the off chance that you need to. On the off chance that you have to scratch a tingle or shake your hands, move inside the roughage at that point come back to your breath.&#xD;
&#xD;
PERSPECTIVES AND CONCLUSION&#xD;
&#xD;
Healthcare is often considered with utmost compassionate care of the individuals who require special attention. Healthcare is quite identifying diseases and treating them with medication and surgery. People long for support. Helping involves caring, spending time, asking questions, talking about what&#x2019;s crucial and holding hand. &#xA0;&#x201C;Man isn&amp;#39;t destroyed by suffering; he&amp;#39;s destroyed by suffering without meaning,&#x201D; said Viktor Frankl, psychiatrist, and Holocaust. Spirituality helps find this aiming to get through an illness, deal with pain and find healing and may support patients and their families through compassionate care. The spiritual state of mind individual care and listen can provide true support. The role of spirituality has been more widely known when supporting permanently ill and dying patients, but equivalent support should be there for those with less serious issues, treatable diseases, and chronic illness. Understanding spirituality can help to treat individual better. Spirituality may play a task in understanding diseases and decision to hunt mental support. Religious convictions also can play a task in deciding.1 Spiritual practices are often a huge role in individual and their families coping. Therefore, spirituality plays an integral role in the holistic care of employees working in the organization. &#xD;
&#xD;
To provide compassionate care following practices will facilitate to enhance the mental and physical well-being of employees like practice compassionate presence, provide a secure zone, hear their pain, fears, hopes and dreams, find their spiritual history, suggest spiritual practices (meditation, yoga) as appropriate, listening to know the holistic point of view including their body, mind and soul.3 Spiritual counsellors and spiritual leaders can initiate prayers or other religious activities to attach and motivate mentally and physically fit. Practising compassionate care and supporting spiritual aspects of healing encouraged sharing spiritual beliefs. Through this who feels weak within by applying compassionate care can get thinking about them &#x201C;Healthy Hero&#x201D; and initiate themselves to require care of their health and have interaction in spiritual practices to enhance your health and well-being. Spirituality helps to understand individual to go by the current. The majority go by the wind. Being everybody else comes without much effort. You were never meant to be everybody else.&#xA0;It also highlights that if a thousand people do something wrong, it doesn&amp;#39;t make it right. Be your person. Remain as original as ever.&#xA0;Spirituality also clarifies that original who sticks to their game produce masterpieces. The midst of mediocrity, strive for superiority. Whilst everyone is lowly minded, think highly. The ordinariness that you see around is not for you to replicate but for you to challenge.&#xD;
&#xD;
While working in an organization one should have a purpose. Success comes to those with success consciousness. If one&#x2019;s think failing, don&amp;#39;t be surprised by the outcome. Ignite your passion and move ahead. Role of spirituality emphasis that never thinks of defeat, but that vision of across and never mind what anyone will say to distract. Keep moving until and unless reach to your goal. If the individual start working with a positive attitude will never allow a background to put back on the ground, make life count start breaking barriers, be inquisitive and persistent. No one could stop anyone.&#xD;
&#xD;
ACKNOWLEDGEMENT: I express my sincere gratitude to Dr. Somesh Dhamija, Professor and Head of Department (UG) Institute of Business Management, GLA University, who took sincere care and provide support, motivation and encouragement like lighting a candle in my research and life. I sincerely thanks to Mr. Krishanveer Singh, Assistant Professor, Institute of Business Management for his consistent support to complete the research work. I thank the University Authorities for providing all the facilities and permission to complete my work without any delay.&#xD;
&#xD;
CONFLICT OF INTEREST: Nil&#xD;
&#xD;
SOURCE OF FUNDING: Self&#xD;
&#xD;
ETHICAL CLEARANCE: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3397</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3397</Fulltext></URLs><References>1. Dubhashi SP, Dalvi SD, Goel RB, Kadam NN, Kadam SN, Jadhav, PM. Gandhian Values in Health Science Education: Need for Global Revamp in Higher Education. Int J Curr Res Rev 2020;12(14):40.&#xD;
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2. Remen RN. Educating for Mission, Meaning, and Compassion. In book: The Heart of Learning: Spirituality in Education. 1999. 33-50.&#xD;
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3. Puchalski CM. The Role of Spirituality in Health Care. Proc (Bayl Univ Med Cent) 2001;14(4): 352&#x2013;357.&#xD;
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4. Cole K, Daly A, Mak A. Good for the soul: The Relationship between Work, Wellbeing and Psychological Capital. J Socio-Econ 2009;38(3):464-474.&#xD;
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5. Heintzman P. A Conceptual Model of Leisure and Spiritual Well-Being. J Park Recrea Adminis 2002;20:4.&#xD;
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6. Owen AD, Hayward RD, Koenig HG, Steffens DC. Payne ME. Religious Factors and Hippocampal Atrophy in Late Life. PLoS One 2011;6(3):e17006.&#xD;
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7. Ombati M. Rainmaking Rituals: Song and Dance for Climate Change in the Making of Livelihoods in Africa. Int J Modern Anthropol 2017;1(10):74-96.&#xD;
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8. Woods O. Sonic Spaces, Spiritual Bodies: The Affective Experience of the Roots Reggae Sound System. Transact Institute Br Geograp 2019;44(1):181-194.&#xD;
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9. Pesut B, Fowler M, Taylor EJ, Reimer Kirkham S, Sawatzky R. Conceptualising Spirituality and Religion for Healthcare. J Clin Nur 2008;17(21):2803-2810.&#xD;
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10. Cobb M, Puchalski CM, Rumbold B. The Future of Spirituality and Healthcare. 2012.&#xD;
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11. Benson H. Timeless Healing: The Power and Biology of Belief. New York:Simon and Schuster, 1996.&#xD;
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12. Shenwai RS, Tare KN. Integrated Approach towards Holistic Health: Current Trends and Future Scope. Int J Curr Res Rev 2017;9(7):11-14.&#xD;
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13. Dhamija A, Somesh D, Amit K. Wisdom of Yoga and Meditation: A Tight Rope to Walk Purushartha. J School Mgmt Ethics Spiritu 2017;10(1):117-125. &#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Case Study on Management of Complex Renal Calculi (Mutrashmari) by Ayurvedic Formulation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>152</FirstPage><LastPage>156</LastPage><AuthorList><Author>Wairagade SD</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagrare AV</Author><AuthorLanguage>English</AuthorLanguage><Author> Wairagade T</Author><AuthorLanguage>English</AuthorLanguage><Author> Umate K</Author><AuthorLanguage>English</AuthorLanguage><Author> Lamture Y</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Kidney stone disease should be viewed as a systemic disorder, associated with hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. Mutrashmari (Renal calculi/ Kidney stones) is one among the Ashtamahagada (eight fatal conditions) and is Kaphapradhan Tridoshaja Vyadhi. It is correlated with urolithiasis. The prevalence of symptomatic urolithiasis is approximately 10 per cent in men and 5 per cent in women. Many treatment modalities have been introduced in medical sciences, but it is very costly and even the recurrence of production of stone cannot be prevented. Objectives: To find out easily available, a cost-effective medicine to treat Mutrashmari. The available treatments options for prevention of stone recurrence can be divided into lifestyle interventions and pharmaceutical therapies. Case Presentation: In the first follow-up; the patient informed the stone was expelled out through urine, and he experienced moderate pain and disturbance in the urine flow on 30th day. The patient got moderate relief from pain in the abdomen and did not experience dysuria. Conclusion: Our present findings suggest that Chandraprabha Vati, Ayurvedic Formulation Tablet, Varunadi Kshaya is a safe and effective approach for the management of patients with renal stones.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Renal calculi, Mutrashmari, Shaman Chikitsa, Ayurvedic formulation, Urolithiasis</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dietary and lifestyle changes represent an important strategy for the prevention of kidney stone recurrences and cardiovascular damage.1 Stones that grow in the urinary tract (recognized as nephrolithiasis or urolithiasis) form when the urine becomes excessively supersaturated concerning a mineral, leading to crystal formation, growth, aggregation and retention within the kidneys.2 Worldwide, approximately 80% of kidney stones are composed of calcium oxalate (CaOx) mixed with calcium phosphate (CaP). Stones composed of uric acid 9%, struvite 10% and cystine of 1% are common.3&#xD;
&#xD;
Renal calculi (Kidney stones) are mineral densification in the renal calyces and pelvis that are found free or attached to the renal papillae.4 In our country kidney stone comprise one of the commonest diseases. Pain due to kidney stones is recognized as worse than that of labour pain. The information regarding Ashmari5 is available in almost all Samhita of Ayurveda. In India, approximately 5-7 million patients suffer from stone disease6,7 and at least one from 1000 patients of Indian population needs hospitalization due to kidney stone disease. Thus, the disease is as common as it is old, particularly in countries with hot and dry climate.8 These are &#x201C;stone belt regions&#x201D;. The incidence of calculi varies as per geographical distribution, sex and age group. The reappearance rate is 60 to 80%. Males are more commonly affected than the female with their ratio is 4:3.9 The incidence is higher in the age group between30-45 years and incidence diminishes after the age of 50 years.&#xD;
&#xD;
Many medicinal formulations mentioned in Ayurvedic literature for the management of Mutrashmari, are cost-effective, devoid of complications and provide wide scope for the successful treatment of Urolithiasis. Formation of calcium oxalate stones has been found significantly reduced by a small reduction in urinary oxalate. Hence, oxalate-rich foods like cucumber, beetroot, spinach, soya bean, chocolate, popcorn, and sweet potato should be avoided. Many studies have established calcium restriction increase the risk of stone disease; therefore, dietary calcium restriction is not suggested. Fluid consumption and dietary improvements are effective steps in avoiding kidney stone recurrence. Several studies have shown that increasing urine volume to at least 2 L/day OR 2 lit/day will decrease stone disease recurrence by up to 40-50 per cent.10 The consumption of fluids should primarily involve water. As tea and coffee contain oxalate, it is essential to add milk (which binds free oxalate) to them. Increasing the amount of urine, however, has a downside of lowering urinary citrate. The patient is given Chandraprabha vati which promotes strength and immunity, Ayurvedic formulation tablets which are used in urinary retention, dysuria, renal calculi, hematuria, and burning in urination due to acidic urine and Varunadi Kashaya which is capable of lithotriptic action, reducing pain intensity, dysuria and is also capable of reducing haematuria.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
It is a single analysis of a case and the patient&amp;#39;s informed consent is taken in his language.&#xD;
&#xD;
History of Present Illness&#xD;
&#xD;
Before 4 months, a 36-year-old man was in a good state, then he started to complain of abdominal pain and it was discovered that the pain was sporadic and colicky and it was present on the right side of the abdomen, which radiated from the loin to the groin area; difficulty urinating normally at the start of pricking type urination; often burning micturition. These chief complaints are briefly mentioned in Tables 1 and 2.&#xD;
&#xD;
Demographic Details:&#xD;
&#xD;
The patient aged 36 years (male) visited to our hospital on 05/10/2020.&#xD;
&#xD;
OPD Registration no. 2010060014&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Treatment Advised&#xD;
&#xD;
By analyzing the above pathogenesis of disease in this patient following Shaman Chikitsatreatment plan was prescribed (Table 3).&#xD;
&#xD;
&#xD;
&#xD;
Assessment of Patient&#xD;
&#xD;
Overall assessment of the therapy was made based on the improvement in pain, Mutra Pravrutti and ultrasonography (USG) finding.&#xD;
&#xD;
Assessment parameter&#xD;
&#xD;
Objective parameters&#xD;
&#xD;
USG of KUB was done before (0 days) and after the intervention (30th Day) for the assessment of change in the size of urinary calculi.&#xD;
&#xD;
Subjective parameter&#xD;
&#xD;
The assessment was done before (0day) and after the intervention (30thday) based on grading of symptoms as follows.&#xD;
&#xD;
Assessment of the overall effect of therapy&#xD;
&#xD;
The overall effect of the therapy was assessed by adopting the following criteria.&#xD;
&#xD;
&#xD;
	&#xD;
	Complete Remission: 100% relief in Chief complaints and absence of renal calculi in USG of KUB.&#xD;
	&#xD;
	&#xD;
	Marked improvement: &gt;75% and </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3398</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3398</Fulltext></URLs><References>&#xD;
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	Alessandro S, Ferraro PM, Cianchi C, Barsotti M, Gambaro G, Cupisti A. Which Diet for Calcium Stone Patients: A Real-World Approach to Preventive Care, Nutrients 2019; 11(5):1182.&#xD;
	&#xD;
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	Finlayson B. Physicochemical aspects of urolithiasis.&#xA0;Kidney Int&#xA0;1978;13:344&#x2013;360.&#xD;
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	Evan A. Physiopathology and aetiology of stone formation in the kidney and the urinary tract.&#xA0;Pediatr Nephrol&#xA0;2010;25:831&#x2013;841.&#xD;
	&#xD;
	&#xD;
	Khan SR. Nephrocalcinosis in animal models with and without stones.&#xA0;Urol Res&#xA0;2010;38:429&#x2013;438.&#xA0;&#xD;
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	&#xD;
	Shastri K. Charaka Samhita of Agnivesha with Vidyotini Hindi commentary, Chikisasthan 26/59-60. (reprint edition), Chaukhambha Sanskrit Sansthan, Varanasi, 2006.&#xD;
	&#xD;
	&#xD;
	Shastri K. Sushrut Samhita with AyurvedtatvaSandipika Hindi commentary, Nidaansthan 3/7. (12th ed), Choukhambha Sanskrit Sansthan, Varanasi 2001.&#xD;
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	&#xD;
	Williams N Bulstrode. Bailly &amp; Love&#x2019;s short practice ofSurgery. Chapter 71. (25th ed), Hodder Arnold Publishers, London 2010.&#xD;
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	Townsend C. SabistonTextbookofSurgery. In editor. Sabiston Textbook of Surgery. Elsevier publications, New Delhi, 2010.&#xD;
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	Shastri K. Sushrut Samhita with Ayurvedtatva Sandipika Hindi commentary, Nidaansthan&#xBE;. (Reprint edition), Choukhambha Sanskrit Sansthan, Varanasi 2001.&#xD;
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	Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: A 5-year randomized prospective study.&#xA0;J Urol&#xA0;1996;155:839&#x2013;843.&#xD;
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	Mishra S. Madhya khanda, chikitsasthana. Verse 70. In: Bhavprakash Samhita. Varanasi, India: ChaukhambaSurbharatiPrakashan; 2012: 383.&#xD;
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	Sheetprabha tablets: benefits, dosage, side?effects, ingredients. Sheetaprabha Tablet - Benefits, Dosage, Side Effects, Ingredients (ayurmedinfo.com)&#xD;
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	Christopher J. Global Burden of 87 Risk Factors in 204 Countries and Territories, 1990&#x2013;2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1223&#x2013;1249.&#xD;
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	Vos T. Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990&#x2013;2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204&#x2013;1222. &#xD;
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	Balwani M. Attitude of the Chronic Kidney Disease Patients Toward Xenotransplantation of Organs. Transplantation 2018;102(7):S740. &#xD;
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	Balwani M. Minimal Change Disease and Kimura&#x2019;s Disease Responding to Tacrolimus Therapy. Saudi J Kidney Dis Transpl 2019;30(1):254&#x2013;257.&#xD;
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	Jain J. Kikuchi&#x2019;s Disease (Histiocytic Necrotizing Lymphadenitis): A Rare Presentation with Acute Kidney Injury, Peripheral Neuropathy, and Aseptic Meningitis with Cutaneous Involvement. Ind J Path Microb 2018; 61(1):113&#x2013;115. &#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Acceptability of Different Behaviour Management Techniques in Paediatric Dentistry: A Study of Chinese, Indian and Malay Parents&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>157</FirstPage><LastPage>161</LastPage><AuthorList><Author>Md Toufiqur Rahman</Author><AuthorLanguage>English</AuthorLanguage><Author> Aimi Kamarudin</Author><AuthorLanguage>English</AuthorLanguage><Author> Sumaiya Zabin Eusufzai</Author><AuthorLanguage>English</AuthorLanguage><Author> Noraida Mamat</Author><AuthorLanguage>English</AuthorLanguage><Author> Ahmad Shuhud Irfani bin Zakaria</Author><AuthorLanguage>English</AuthorLanguage><Author> Mohmed Isaqali Karobari</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Uncooperative behaviours of Paediatric patients disrupt the quality of the treatment rendered, thereby increasing the treatment time, triggering restlessness amongst the young patients and in some instances increase risk of accidental injury. Objective: To assess the parental acceptance of different behaviour management techniques (BMTs) used during the dental treatment of children in three major ethnic groups (Chinese, Malay, and Indian) in Malaysia. Methods: A total of 72 parents were included in the study, further divided 3 groups depending on ethnicity. Two university hospitals within Malaysia were chosen for data collection in the years 2019 and 2020. A videotape was used according to American Academy of Paediatric Dentistry (AAPD) derived BMTs to showcase consenting parents ten of the AAPD approved BMTs in the following order: Tell Show Do, Voice Control, Modelling, Action Restraints, Distraction, Parents Present or Absent (PP/A), Hand Over Mouth (HOM), Nitrox Oxide (NO), Oral sedation (OS) and General Anaesthesia (GA). The parents were asked by a coordinator to mark on the scale. Results: Statistical analysis of individual BMTs revealed a significant difference in the three ethnicities (P=.05) with all other techniques remaining unremarkable when compared in the three groups. Conclusions: Tell-show-do, distraction and modelling parental presence/absence and reinforcements have been shown to produce similarly acceptable results amongst. Physical restraint, oral sedation and general anaesthesia were the least approved in the current study.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Behavior management techniques, Dental treatment, Paediatric dentistry, Ethnic groups, Chinese, Malay, Indian</Keywords><Fulltext>Introduction&#xD;
&#xD;
Paediatric dentists reported that 13% of all children demonstrate reluctance as patients while 11% act negatively.1 Such uncooperative behaviours disrupt the quality of the treatment rendered, thereby increasing the treatment time, triggering restlessness amongst the young patients and in some instances increase risk of accidental injury. Such reluctant and uncooperative patients are often managed by various pharmacological (sedation and anaesthesia) and non-pharmacological Behaviour Management Techniques (BMT). Most commonly used techniques according to the American Academy of Paediatric Dentistry (AAPD) include positive pre-visit imagery, direct observation, tell-show-do (TSD), ask-tell-ask, voice control, modelling, positive reinforcement and descriptive praise, distraction, parental presence/absence, and advanced behaviour guidance techniques, such as protective stabilization, sedation, the controversial &#x2018;hand-over-mouth&#x2019; technique and general anaesthesia.2&#xD;
&#xD;
Most of the widely available methods require the parents and legal guardians to approve of the means, which is affected by a multitude of socioeconomic, racial, philosophical, cultural, and geographic factors. 3, 4 While there have been studies evaluating parental acceptance to such techniques in the Western world no such evaluations have been made as of now within the Asian sphere. Therefore, the current study aimed to evaluate the parental acceptance to various BMTs when the study was subjected to three of the major ethnic groups of Asia; Chinese, Indian and Malay. The null hypothesis was formulated that there will be no significant differences in parental acceptance of different BMTs when assessing the three ethnic groups. &#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
Two university hospitals within Malaysia were chosen for data collection in the years 2019 and 2020. Only parents of the three ethnicities educated in written and spoken English have considered whose children were under the age of 18. Children with special disabilities were excluded. Seventy-two parents were conveniently considered with 22 in each of the 3 groups. Ethical approval for the study was obtained from Jawatankuasa Etika Penyelidikan Manusia (JEPeM) of USM (USM/JEPeM/19070410).&#xD;
&#xD;
A videotape was made according to AAPD derived BMTs to showcase consenting parents ten of the AAPD approved BMTs in the following order: Tell-Show-Do (TSD), Voice Control (VC), Modelling, Action Restraints, Distraction, Parents Present or Absent (PP/A), Hand Over Mouth (HOM), Nitrox Oxide (NO), Oral sedation (OS) and General Anaesthesia (GA). The video was 10 minutes in duration, after which the parents were asked to express their level of agreement to each method using a 100-point visual analogue scale (VAS). The left end of the scale read &#x201C;completely acceptable&#x201D; and the right end of the scale read &#x201C;completely unacceptable&#x201D;. The parents were asked by a coordinator to mark on the scale. &#xD;
&#xD;
A statistical software (SPSS, IBM Corporation) was used to evaluate the normality and was followed by 1-way ANOVA to compare the mean of three independent groups and Post Hoc Analysis (Bonferroni). &#xD;
&#xD;
Results&#xD;
&#xD;
The demographics of the parents have been described in Table 1. The rankings provided by the parents of each ethnicity have been demonstrated in Table 2. Statistical analysis of individual BMTs revealed a significant difference in the three ethnicities (P=.05) with all other techniques remaining unremarkable when compared in the three groups. Detailed outcomes of each BMT has been described in Table 3.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The current study aimed to evaluate the different BMT acceptability levels within Chinese, Indian and Malay ethnicities. Nine out of 10 BMTs demonstrated no significant differences in the amount of approval among the three ethnicities with only BMT modelling showing significant differences (P=.05). Therefore, the null hypothesis was partly rejected. &#xA0;This study found that all three ethnicities equally approved Tell-Show-Do, Audio Visual (distraction), Parental Absence/Presence and Modelling. However, there was a significant difference (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3399</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3399</Fulltext></URLs><References>1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; O&amp;#39;Callaghan PM. The efficacy of noncontingent escape for decreasing disruptive behaviour during dental treatment. J Appl Behav Anal 2006;39(2):161&#x2013;171.&#xD;
&#xD;
2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Nunn J, Foster M, Master S, Greening S. British Society of Paediatric Dentistry: a policy document on consent and the use of the physical intervention in the dental care of children. Int J Paediatric Dent 2008;18:39-46.&#xD;
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3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Roberts J, Curzon M, Koch G, Martens L. behaviour management techniques in paediatric dentistry. Eur Arch Paediatr Dent 2010;11(4):166-174.&#xD;
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4.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Levitt J, McGoldrick P, Evans D. The management of severe dental phobia in an adolescent boy: a case report. Int J Paediatr Dent 2000;10(4):348-353.&#xD;
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5.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Melamed BG, Hawes RR, Heiby E, Glick J. Use of filmed modelling to reduce the uncooperative behaviour of children during dental treatment. J Dental Res 1975;54(4):797-801.&#xD;
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6.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ghose LJ, Giddon DB, Shiere FR, Fogels HR. Evaluation of sibling support. ASDC J Denti Children 1969;36(1):35.&#xD;
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7.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gordon D, Terdal L, Sterling E. The use of modeling and desensitization in the treatment of a phobic child patient. ASDC J Dent Child 1974;41(2):102.&#xD;
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8.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Wright GZ, Kupietzky A. non-Pharmacologic approaches in Behavior Management. Behav Mgmt Dent Children 2014:63-69.&#xD;
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9.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Newton JT, Sturmey P. Students&amp;#39; perceptions of the acceptability of behaviour management techniques. Eur J Dental Edu 2003;7(3):97-102.&#xD;
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10.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Campbell C, Soldani F, Busuttil-Naudi A, Chadwick B. Update of Non-pharmacological behaviour management guideline. 2011;34:1-37.&#xD;
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11.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chang CT, Badger GR, Acharya B, Gaw AF, Barratt MS, Chiquet BT. Influence of ethnicity on parental preference for pediatric dental behavioral management techniques. Pediatr Dent 2018;40(4):265-272.&#xD;
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12.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Coll CG, Pachter LM. Ethnic and minority parenting. Handbook of Parenting Volume 4 Social Conditions and Applied Parenting. 2002:1.&#xD;
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13.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Machen JB, Johnson R. Desensitization, model learning, and the dental behavior of children. J Dent Res 1974;53(1):83-87.&#xD;
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14.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Greenbaum PE, Turner C, Cook EW, Melamed BG. Dentists&amp;#39; voice control: Effects on children&amp;#39;s disruptive and affective behavior. Health Psychol 1990;9(5):546.&#xD;
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15.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Wong D, Perez-Spiess S, Julliard K. Attitudes of Chinese parents toward the oral health of their children with caries: a qualitative study. Pediatr Dent 2005;27(6):505-512.&#xD;
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16.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Robinson CC, Mandleco B, Olsen SF, Hart CH. Authoritative, authoritarian, and permissive parenting practices: Development of a new measure. Psychol Rep 1995;77(3):819-830.&#xD;
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17.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Aminabadi NA, Deljavan AS, Jamali Z, Azar FP, Oskouei SG. The influence of parenting style and child temperament on child-parent-dentist interactions. Pediatr Dent 2015;37(4):342-347.&#xD;
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18.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Howenstein J, Kumar A, Casamassimo PS, McTigue D, Coury D, Yin H. Correlating parenting styles with child behavior and caries. Pediatr Dent 2015;37(1):59-64.&#xD;
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19.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Casamassimo PS, Wilson S, Gross L. Effects of changing US parenting styles on dental practice: perceptions of diplomates of the American Board of Pediatric Dentistry. Pediatr Dent 2002;24(1):18-22.&#xD;
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20.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Juneja A, Sultan A, Siddiqui M. A Retrospective Evaluation of Traumatic Dental Injuries in Children Visiting Dental Setup in Delhi NCR. Int J Cur Res Rev 2020;12(22):76-81&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Research Protocol for Validation of &#x2018;Purishdhara Kala Sa Eva Ashtidhara Kala&#x2019; Using Unripe Bael Fruit (Aegle Marmelos Linn.) in Osteoporosis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>162</FirstPage><LastPage>165</LastPage><AuthorList><Author>Giri D</Author><AuthorLanguage>English</AuthorLanguage><Author> Desai P</Author><AuthorLanguage>English</AuthorLanguage><Author> Wanjari A</Author><AuthorLanguage>English</AuthorLanguage><Author> Deshmukh M</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagpure S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>The Kala is the structure that intervenes between the Dhatus(the vital tissues) and their Ashayas(the structure that holds the particular tissue). Kala is seven in number. As per the commentary by Acharya Dalhana, the PurishdharaKala is the AsthidharaKalawhich is described in visha-vegantara in kalpasthana. This relationship has also clinical importance in Ayurvedic treatment. This relation has not yet been studied. As Kala is the structure intervening Dhatu and it&#x2019;s Ashaya, the AsthiDhatu(bones) is directly related to AsthidharaKala, whereas the Purishdhara Kala is situated in the large intestine. A Research Protocol for Validation of &#x2018;Purishdhara Kala Sa Eva Ashtidhara Kala&#x2019; Using Unripe Bael Fruit (Aegle Marmelos Linn.) In Osteoporosis. In the present study, unripe Bael fruit (Aegle Marmelos Linn.) has been taken into account as an intervention because the Bael fruit is considered as the best remedy for gastrointestinal disorders, particularly the diseases of the large intestine. During this preclinical study, osteoporosis (OP) will be induced in Sprague Dawley rats with steroid. Unripe Bael fruit powder mixed with distilled water will be administered to the rats orally and transrectal. At the end of the study, the changes will be assessed on the following parameters. The histological changes in the colon and periosteum will be studied with the help of expert histopathologists. After resection of the portion of the colon, the mucosal surface will be graded with the help of a magnifying lens. A piece of the colon will be fixed in phosphate-buffered formaldehyde, embedded in paraffin, sectioned (4 &#x3BC;m thick), and stained with hematoxylin and eosin. Each sample will be observed and evaluated under a light microscope by two independent observers. We anticipate that there will be an improvement in markers for osteoporosis after administration of unripe Bael fruit. Hence here is an effort to determine the protocol for the assessment of the relationship between Purishadhara and Asthidhara Kala.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Purishdhara kala, Asthidhara kala, Bael fruit, Eagle Marmelos L., Osteoporosis</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Kala is well-defined as &#x201C;Dhavtashayantar Maryada&#x201D; in classical Ayurvedic text.&#xA0; Kalais stratum or sheath existing between Dhatu and Ashaya. Acharya Sushrut has described Kala Sharir in Sharirsthana of Sushrut Samhita. Among the seven Kalas, Purishdhara Kalais the fifth Kala. Pakwashaya is the location of Purishdhara Kala. Purishdhara Kalacovers Pakwashaya internally from Unduka (Cecum) to Guda (anal canal). The Kalais located in the large intestine. It is the internal layer of the colon. Separation of Ghana mala (faeces in solid form) from the Drava mala (faeces in liquid form) is completed by the PurishdharaKala.&#xD;
&#xD;
According to Acharya Dalhana, Purishdhara Kalais the same as Asthidhara Kala. The statement by Acharya Dalhana regarding Purishdhara Kala, gives us a new vision to study Purishdhara Kalaagain and explore the possibilities of physiology, pathology of the Kalain a new perspective. The Purishdhara Kala provides us with a new pathway to the area of orthopaedics. It can give us a new approach for the treatments of diseases like osteoporosis. Osteoporosis is broadly defined as &#x201C;a progressive systemic skeletal disease characterized by a low bone density mass and microarchitectural deterioration of bone tissue and a consequent increase in bone fragility and susceptibility to fracture.1&#xD;
&#xD;
Previous studies in humans and animals point out that ageing is related to the increase in reactive free radicals are the principal factors for deterioration of bone strength and mass.2 The risk factors identified along with reduced bone density include heredity or maternal family history of hip fracture, hormonal disturbances, weight or height reduction, sedentary lifestyle, low body mass index, smoking and deficiencies in calcium. Osteoporosis may also be caused by other diseases such as rheumatic joint disorders or gastrointestinal disease as well as prolonged corticosteroid therapy.3&#xD;
&#xD;
The present study has been undertaken to analyse the possibility of Purishdhara Kala as principal factor responsible for the metabolism in bone tissue and thus to define the role of Purishdhara Kalaas a route of drug administration to reach the bones more effectively.&#xD;
&#xD;
Aegle Marmelos is one of the prominent medicinal plants in Ayurveda. It is also known as Bael in local language and is used in various traditional medicines in India, Nepal, Sri Lanka, Bangladesh, andMyanmar.4 The common English names used to refer A. Marmelos are viz. wood apple, Bengal quince, golden apple, Indian quince, holy fruit, and stone apple.5 A sweet drink made from the pulp of ripe fruit is intended to be protective against bacillary dysentery. Bael&amp;#39;s unripe fruits are stated to help treat diarrhoea, dysentery with constipation spells, and stomach ache.6 Extract of Wood apple unripe fruit displays efficacy against inflammatory bowel disease (IBD) in Wistar albino rats.7 A dose-dependent decrease in intestinal inflammation occurs following the treatment with unripe fruit extract. Likewise, significant protection in mast cell degranulation is observed in acetic acid and indomethacin-induced IBD models. Similarly, ethanolic extracts of A. Marmelos ripe fruit demonstrate the diuretic effect in rats.8&#xD;
&#xD;
Many researchers have studied Purishdhara Kala as Asthidhara Kal as a literary study. Few clinical studies can be found, but it is assessed on subjective parameters. The validation of Purishdhara Kala as Asthidhara Kalahas not been undertaken on objective parameters. Supportive objective parameters e.g. biochemical parameters, and BMD are not found to be studied. If the study could validate Acharya Dalhana&#x2019;s statement about Purishdhara Kala as Asthidhara Kalait could be a breakthrough in the treatment of osteoporosis. Bael is a native of India and is easily available in India. It is consumed as an ingredient of local beverages by the Indians. Bael can prove to be a safe and cheaper source of medicine for bone disorders.&#xD;
&#xD;
To validate the Purishdhara Kala as the Asthidhara Kala, using unripe Bael fruit (Aegle marmelos L.) as an anti-osteoporotic treatment in rats with induced osteoporosis&#xD;
&#xD;
&#xD;
	&#xD;
	To study Ayurvediya concepts of Purishdhara Kala and AsthidharaKala.&#xD;
	&#xD;
	&#xD;
	To study the effect of administration of unripe Bael fruit (Aegle marmelos L.) on Asthidhara Kalain osteoporotic rats with oral and transrectal route&#xD;
	&#xD;
	&#xD;
	To study the effect of unripe Bael fruit (Aegle marmelos L.) on biochemical parameters selected the for study&#xD;
	&#xD;
	&#xD;
	To study the effect of unripe Bael fruit (Aegle marmelos L.) on bone mineral density.&#xD;
	&#xD;
	&#xD;
	To study the effect of unripe Bael fruit (Aegle marmelos L.) on histology of the colon and periosteum in the control group and the experimental group.&#xD;
	&#xD;
	&#xD;
	Comparison of effect on biochemical parameters, bone mineral density and histological changes in colon and periosteum in the control group and experimental group.&#xD;
	&#xD;
&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Settings:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study will be conducted in the Department of Rachana Sharir at Mahatma Gandhi Ayurved College Hospital and Research Centre, (Datta Meghe Institute of Medical Sciences) in collaboration with Wardha Jawaharlal Nehru Medical College, Sawangi (Meghe), and DMAMCH&amp;RCNagpur. As per the necessity, the study will be conducted as per certified centre recognized by DMIMS of national repute.&#xD;
&#xD;
Research design:&#xD;
&#xD;
Study design - Randomised disease control animal study in Sprague Dawley rats. The data collected will be qualitative as well as quantitative.&#xD;
&#xD;
Qualitative data will be acquired from the histological study of the samples of the colon. Quantitative data will be collected in the form of biochemical parameters and values of the bone mineral density.&#xD;
&#xD;
Duration of the study: 3years&#xD;
&#xD;
Participants and sources: Total of 24 Sprague-Dawley rats will be recruited. 4 groups will be prepared with 6 Sprague-Dawley rats per group. Animals will be housed under a standard condition of temperature (22&#xB0;C &#xB1; 2&#xB0;C), the relative humidity of 55 &#xB1; 5% and 12 h light/dark cycles. The animals will be given standard pellet diet and water.&#xD;
&#xD;
Preparation of the Material:&#xD;
&#xD;
Unripe fruit will be collected from the botanical garden of MGAC, Wardha in the season of availability of the Bael fruit. Fruit pulp will be collected. The pulp will be shade dried and powdered fine. The E. marmelos L. fruit pulp powder will be stored in air tight container. The powder will be used as per dosage with distil water for rectal administration to the rats.&#xD;
&#xD;
Selection of material&#xD;
&#xD;
The plant material will be authenticated and identified from FRLHT Banglore or BSI Pune.&#xD;
&#xD;
Safety profile&#xD;
&#xD;
An acute oral toxicity study has been performed as per OECD-423 guidelines. Adult albino Sprague-Dawley rats were administered 5, 50, 300, and 2000 mg/kg body weight of aqueous extract of unripe fruit of A. marmelos orally. The control group received distilled water. The animals were observed for 14 days. There was no mortality or behavioural changes observed during the study period.9&#xD;
&#xD;
Sampling Procedure &amp; Sample Size&#xD;
&#xD;
24 Sprague-Dawley rats will be randomly divided into 4 groups. As per OECD guideline (Table 1)&#xD;
&#xD;
&#xD;
&#xD;
Induction of Osteoporosis and Intervention&#xD;
&#xD;
Osteoporosis (OP) will be induced in rats with steroid. All the rats in the disease control and experimental group will be given a steroid for 4 weeks and will be divided into the following groups (Table 2).&#xD;
&#xD;
&#xD;
&#xD;
Dose:&#xD;
&#xD;
The animal dose will be extrapolated from the human dose using the rat conversion factor. &#xD;
&#xD;
Oral route: 3 gm - 6 gm of fruit pulp powder as per API.10&#xD;
&#xD;
Rectal route: 75% (3/4) of the oral route&#xD;
&#xD;
Total clinical dose (Human dose) x conversion factor (0.018) per 200 gm of rat Dose calculation for 4.5 gm of human dose (Mean dose)&#xD;
&#xD;
For oral route: 4.5 x 0.018 = 0.081 gm of powder /day orally&#xD;
&#xD;
For rectal route: 0.081 x 3/4 = 0.060 gm of powder/ day rectally&#xD;
&#xD;
Duration of intervention: The drug will be given for 12weeks11&#xD;
&#xD;
Assessment parameters&#xD;
&#xD;
Radiological parameters:&#xD;
&#xD;
Bone mineral density (BMD): The BMD of the femur will be evaluated&#xD;
&#xD;
Biochemical parameters:&#xD;
&#xD;
Osteocalcin (OCN), serum calcium, inorganic phosphate, TRAP 5b&#xD;
&#xD;
Histological study:&#xD;
&#xD;
The histological changes in the colon and periosteum will be studied with the help of expert histopathologists.&#xD;
&#xD;
Macroscopic study:&#xD;
&#xD;
After resection of the portion of colon, the mucosal surface will be graded with the help of a magnifying lens&#xD;
&#xD;
Microscopic study:&#xD;
&#xD;
A piece of colon will be fixed in phosphate-buffered formaldehyde, embedded in&#xA0; paraffin, sectioned (4 &#x3BC;m thick), and stained with hematoxylin and eosin. Each sample will be observed and evaluated under light microscope by two independentobservers.&#xD;
&#xD;
Variables:&#xD;
&#xD;
Quantitative and qualitative variables will be used for the study. Quantitative variables will the values of biochemical parameters and bone mineral density whereas qualitative variables will be the histological study of the colon.&#xD;
&#xD;
Analysis Plan: Student?s Paired t-test, one way ANOVA test.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Results will be assessed with the help of statistical test observations, biochemical parameters, bone mineral density, and histopathology reports.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
At the end of the study, the conclusion will be made based on the results of Statistical Analysis biochemical parameters, bone mineral density, and histopathology reports. Osteoporosis is a metabolic disease. It affects a large population worldwide. Bone mass is reduced in osteoporosis and it leads to fractures of the bones making the people dependent on others. Current treatments like hormone replacement therapy, administration of calcium, cholecalciferol have its limitations and complications. Ayurvediya experts consider Purishdhara Kalais the Asthidhara Kala. It means that the Ayurvedic medicines which are effective in the diseases of the colon can be effective in the diseases of bones.&#xA0; To analyze the statement we have chosen the medicine, Bael (Aegle marmelos L.) that has well-known action on colon disorders. The Bael fruit is easily and abundantly available in India. It is cheaper also. With the proposed study we are looking forward to providing a reliable, safe and cheaper treatment for bone disorders. The study can provide a new aspect to the management of osteoporosis.&#xD;
&#xD;
Limitations: Osteoporosis will be induced in animals artificially. There may be some kind of variation in the pathology of actual osteoporosis in human and osteoporosis due to induction. Nuances while handling animals in laboratory technique may cause alteration in the result. However, the disease arising due to pathological processor with the induction, manifestation of the disease remains the same. That&#x2019;s why in the field of medical science, animal study has its importance. Further clinical studies with more precise biochemical parameters are needed to confirm the efficacy of the drug.&#xD;
&#xD;
&#xA0;Conflict of Interest: None&#xD;
&#xD;
&#xA0;Source of Funding: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3400</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3400</Fulltext></URLs><References>&#xD;
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	Martin RB, Burr DB, Sharkey NA. Skeletal Tissue MechanicsNew York: Springer Verlag, 1998. &#xD;
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	Manolagas S. From estrogen-centric to ageing and oxidative stress: a revised perspective of the pathogenesis of osteoporosis. Endocr Rev 2010;31:266-300.&#xD;
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	Baliga MS, Thilakchand KR, Rai MP, Rao S, Venkatesh P. Aegle M. Correa (Bael) and Its Phytochemicals in the Treatment and Prevention of Cancer. Integr Cancer Ther 2013; 12(3) 187&#x2013;196. &#xD;
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	Jatav S. Properties and Important Molecules of Medicinal Interest in Wood Apple (Aegle Marmelos). In Book: Synthesis of Medicinal Agents from Plants. 2018;127(50): 25. &#xD;
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	Dhuley J. Investigation on the Gastroprotective and Antidiarrhoeal Properties of Aegle Marmelos Unripe Fruit Extract. Hindustan Antibiotics Bulletin 2003;1(4):41-46.&#xD;
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	Behera J. Effect of aqueous extract of Aegle Marmelos unripe fruit on inflammatory bowel disease. Indian Journal of Pharmacology 44, no. 5 (2012): 614-18. &#xD;
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	Musale P. Assessment of the relationship between purisadhara and asthidhara Kala by using clinical study. Int J Res Ayu&#xA0; Pharm 2017;12(3):172-175. &#xD;
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	Baliga M. Aegle Marmelos (L.) Correa (Bael)and Its Phytochemicals in the Treatment and Prevention of Cancer. Integrative Cancer Therapies. 2013;12(3):187-96. &#xD;
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	The ayurvedic pharmacopoeia of India, Part- I Volume - I, the government of India ministry of health and family welfare department of Ayush. &#xD;
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	Guerra J. Modulation of Bone Turnover by Cissus Quadrangularis after Ovariectomy in Rats. J Bone and Mineral Metab 2019;37(5):780-795.&#xD;
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	Mekhale SM, Budruk PA. A conceptual study on osteoporosis and gastrointestinal tract symptoms with reference to purishdhara kala sa eva asthidhara kala. Ayurline: Int J Res Indian Med 2019;3(3):1-5.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Association of Anthropometric Characteristics with Fielding Skill among Male Softball Players&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>166</FirstPage><LastPage>170</LastPage><AuthorList><Author>Mandeep Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Jaspal Singh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Objective: The purpose of this study was to ascertain the relationship between anthropometric and body composition characteristics with fielding skills among softball players. Methods: A total one hundred and fifty male softball players, aged 18-30 years, from the various states and universities of India were selected to participate in the study. All the subjects were assessed for anthropometric characteristics viz. height, body weight, length measurements, circumferences, diameters and skinfolds thicknesses of body parts. Percentage body fat was estimated from the sum of skinfolds was calculated using the standard equations. The Fielding skill test of the players was assessed with the help of the AAHPERD softball skill test battery edited by Dr. Roberta Rikli. Results: The results of the correlation analysis revealed a significant association of weight (p=0.045) with the fielding skill. The fielding skill was also observed to be significantly associated with upper arm circumference (p=0.049) and bicondylar humerus diameter (p=0.020) among softball players. Among the body composition parameters, only lean body mass (p=0.005) was observed to be significantly associated with the fielding skill among softball players. Conclusion: Anthropometric and body composition characteristics should therefore be taken into account during softball talent selection and development, as they tend to be a requirement for future high-level performance in the game.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Anthropometric Characteristics, Softball, Performance, Fielding, Percent Body Fat</Keywords><Fulltext>INTRODUCTION&#xA0; &#xD;
&#xD;
The game of softball has many skills such as throwing, fielding, pitching, catching, base-running and hitting.1,2 To develop these skills, many factors play a significant role like practice, level of physical activity, techniques, psychological traits, nutrition and other environmental factors. However, a particular body structure and certain genetically conditioned abilities and features are required to achieve top-level performance. Physical and body composition characteristics of elite athletes are different among sports. While selecting athletes for a particular sport, the focus should be on those traits and abilities which have the most significant influence on sports performance, such as anthropometric characteristics and body composition components.3 Anthropometric characteristics of an individual player are the most significant factors that contribute to the success of a whole team in the competition. Anthropometry is the science that deals with the measurement of size, weight, proportions and compositions of the human body, as body size and proportions, body composition and physique are vital ingredients of physical performance and fitness.4 Anthropometric characteristics of an athlete are important prerequisites for competitive success in any sport.5 Indeed, it can be assumed that an athlete&#x2019;s anthropometric characteristics can in some way influence his/her level of performance, at the same time helping to find a suitable physique for a particular sport.6-8 The other factors such as physical training and exercise can improve the performance up to a certain limit that is set up by his genotype.9 Many studies have been reported that performance in sports is associated with specific anthropometric measurements, body composition and physique of the sportspersons.7,10,11 There have been many more reports on investigations on the association of anthropometric characteristics with physical performance and sports performance. Chen12 evaluated the impact of anthropometric characteristics and physical performance on the success in the competition and suggested that anthropometric characteristics and physical performance are strongly associated with each other.&#xD;
&#xD;
Apart from the role of body size, the constitutional makeup of body composition components is also important. Body composition refers to the distribution of muscle and fat in the body. Assessment of anthropometric parameters and body composition, therefore, has an important role in sports and health. Excess body fat besides leading to obesity and disease causation may also hinder performance.13 Body composition is an important aspect of fitness14 and can be predicted from anthropometric measures4. Body composition of athletes is a vital tool to monitor the effects of a training program and to determine optimal competitive body weight and body composition.15 It is generally accepted that lower relative body fat is desirable for competitive success in the sports. This is because excessive adipose tissue acts as a dead weight in activities where the body mass must be repeatedly lifted against gravity during locomotion.16,17 Higher levels of fat mass slow down the performance and increase the energy requirements of the activity. On the other hand, lean body mass contributes to power generation during high-intensity activity. Several studies also reported that the lean body mass has a better correlation to success in sport (maximum aerobic performance, running time, strength etc) than the percentage body fat.18-20 It has been earlier reported that the magnitude and proportion of the active mass are closely linked to various functional variables like e.g. oxygen consumption while at rest and work, cardiac output, circulating blood volume etc.21 Studies of body composition in certain sports such as football, weight lifting and shot put indicated that athletes who were lean but heavy because of a well-developed musculature were superior in performance in competitive sports activities.22 The aim of the present study, therefore, is to study the relationship of anthropometric characteristics and body composition with the fielding skill among the male softball players.&#xD;
&#xD;
MATERIALS AND METHODS&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
The present study was conducted on 150 male softball players. The male softball players of different universities and states of India were selected to participate in the study. The mean age of the subjects was 21.35&#xB1;2.57 years. &#xD;
&#xD;
Anthropometry&#xD;
&#xD;
Weight of the softball players was assessed with a portable weighing machine to the nearest 0.5 kg. Height and arm and leg length measurements of the softball players were measured with the help of anthropometric rod to the nearest 0.5 cm (HG-72, Nexgen ergonomics, Canada). Flexible steel tape was used to measure the circumferences of body parts of players. The diameters of the body parts of the softball players were assessed with the help of digital sliding calliper. Harpenden skinfold calliper was used to assess the skinfolds thicknesses of body parts of the subjects. &#xD;
&#xD;
Body Composition&#xD;
&#xD;
Different components of body composition viz. percentage body fat, total body fat and lean body mass were calculated from the sum of skinfolds by using the equations of Siri23 and Durnin and Womersley.24 The regression equations for the calculation of body density from the sum of skinfold thickness at four sites are as follows:&#xD;
&#xD;
&#xD;
&#xD;
Fielding Ground Balls Test &#xD;
&#xD;
Fielding skill test of the players was assessed as given in the AAHPERD softball skill test battery.25 This test item assesses the fielding ground ball ability of the subject. Validity coefficient of correlation has been found to range from 0.60 to 0.85. The reliability coefficient of correlation ranged from 0.69 to 0.91 from the intra-class test-retest scores. For this test, the area was marked as shown in figure 1. The subject stood behind the restraining line (Point A). A thrower (Point B) stood behind the throwing line and throws six test balls to each subject. Each throw must strike the ground before the 30-feet line and must stay within the sideline boundaries of the marked area. The throws were sidearm, with sufficient velocity to carry an untouched ball beyond the end line (Point C). Of the six test trials, two balls (in varying order) were thrown directly to the subject, two to the right and two to the left side of the subject. Each ball cleanly fielded in front of the 60-feet line was count 4 points. A ball counted 2 points when it was stopped, but bubbled. Balls fielded behind the 60-foot line received one-half the points normally earned. Balls that get past the subject scored no points. The final score was the sum of six trials.&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
Statistical analyses for the present study were done with the help of SPSS version 16.0 for windows (SPSS Inc, Chicago, IL, USA). To determine the association between anthropometric and body composition characteristics and fielding skill test among the softball players, Karl Pearson&#x2019;s product-moment coefficient of correlation was applied. Significance levels were set at p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3401</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3401</Fulltext></URLs><References>&#xD;
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	American Academy of Pediatrics. Policy statement baseball and softball. Paediatrics. 2012; 129(3):842&#x2013;856.&#xD;
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	Craig&#xA0;SB, Craig&#xA0;S, Johnson K. The softball handbook. Leisure Press. 1985; 16-22.&#xD;
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	Carter JEL, Heath BH. Somatotyping-development and applications, Cambridge University Press, New York; United States. 1990.&#xD;
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	Duncan MJ, Woodfield L, al-Nakeeb Y. Anthropometric and physiological characteristics of junior elite volleyball players. Br J Sports Med 2006;40:649-651. &#xD;
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	Chen S. Some differences in non-technique factor between Asian and Euro-American female volleyball player. J China Sport Sci Tech 1999;35.&#xD;
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	Prior BM, Modlesky CM, Evans EM, Sloniger MA, Saunders MJ, Lewis RD, Cureton KH. Muscularity and the density of the fat-free mass in athletes. J Appl Physiol 2001; 90:1523-1531.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Ayurvedic Management of Vipadika Kushtha (Palmoplantar Psoriasis) - A Single Case Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>171</FirstPage><LastPage>175</LastPage><AuthorList><Author>Gabhane SM</Author><AuthorLanguage>English</AuthorLanguage><Author> Waghmare S</Author><AuthorLanguage>English</AuthorLanguage><Author> Andhare R</Author><AuthorLanguage>English</AuthorLanguage><Author> Uke P</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Vipadika is one form of the Kushtha with Pani Pada Sputhana (cracking of the skin in the palms and soles) and Teevra Vedana (severe pain) as the cardinal symptoms. It can be correlated with Palmoplantar psoriasis (PPP) having symptoms fissuring of skin in the palms and soles, severe pain, burning, itching and roughness. It is Vata-kaphaj Kushtha. In the pathogenesis of Kushtha, Tridoshas, Twacha, Rakta, Mamsa and Lasika are involved. In this case, treatment was planned to alleviate Vata and Kapha Dosha. Twak, Rakta, Mamsa and Lasika Dushya were treated effectively. Kushthaghna medicines were used along with this. In the end, significant results were found in the patient.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Vipadika Kushtha, Palmoplantar psoriasis, Raktapachak Yoga, Arogyavardhini Vati, Khadirarishta, ErandaHaritaki, Jivantyadi Yamakam</Keywords><Fulltext>&#xD;
Introduction&#xD;
&#xD;
Skin is the largest protective organ of the body covering an area of just under 2m2. Along with this, it also performs sensory and thermoregulatory functions. Healthy and attractive skin plays a major role in one&#x2019;s self-worth, and it is a key component of the image to be presented to the outside world. Skin diseases are more common. In Ayurveda, all skin diseases come under Kushtha.&#xD;
&#xD;
Kushtha is also included in eight Mahagad (dreadful diseases).1 It is further classified into Mahakushtha and Kshudra Kushtha. Vitiation of Tridosha and their invasions into four Dhatus like Twak, Rakta, Mamsa and Lasika lead to Kushtha. These seven are called as the seven morbid factors (Sapta Dravya Sangraha) of Kushtha.2 Kushtha do not manifest itself due to the aggravation of single Dosha. Vipadika is one form of the Kushtha with Pani Pada Sputhana (cracking of the skin in the palms and soles) and Teevra Vedana (severe pain) as the chief symptoms.3 Acharya Charaka and Acharya Vagbhata described it under Kshudra Kushtha.4,5 It manifests due to the aggravation of Tridosha especially the dominance of Vata and Kapha.6&#xD;
&#xD;
Psoriasis is a non-infectious, chronic inflammatory disease of the skin that occurs with exposure to certain triggers. Researchers suggest that the worldwide prevalence of psoriasis ranges between 0.09% and 11.4% making psoriasis a serious global problem.7 In India the prevalence is between 0.44-2.8 per cent.8 Psoriasis is clinically classified into 2 groups: pustular and non-pustular lesions. Palmoplantar psoriasis (PPP) is non-pustular psoriasis. This type of psoriasis affects the palms of the hands and soles of the feet, and thenar regions are more frequently affected than hypothenar regions. Squamae are the predominant lesions.9&#xD;
&#xD;
About 2.8% to 40.9% psoriasis patients are thought to have PPP.10 Palmoplantar psoriasis can occur at any age. Similar to other forms of psoriasis, it is an autoimmune condition. It probably occurs due to a combination of genetic and environmental factors. In this disease, patients may&#xA0;experience exacerbations due to seasonal changes, household work, and detergents. Palmoplantar psoriasis is more common amongst farmers, manual labourers, and housewives.10-12 From the modern side, treatment of psoriasis contains steroids and these steroids have many serious adverse effects and also have limitations for long term therapy. Considering this there&#x2019;s a need for treatment which can have more efficacies with a low toxic profile in this condition. Here a case is discussed which has given Shaman Chikitsa according to Ayurveda.13-15&#xD;
&#xD;
&#xD;
&#xD;
Case Report&#xD;
&#xD;
A 44 years old female patient came to the outpatient department on date 14/2/2019 with complaints of fissuring of skin of both palms scaling on bilateral palms, severe pain, burning sensation, itching; especially at night also in cold and dry weather dryness, bleeding sometimes represented in figure 1. &#xD;
&#xD;
&#xD;
&#xD;
These complaints were present for the last 10 years. Due to these complaints, she found difficulty in doing daily routine work. She was treated with allopathic medicines such as corticosteroids but did not get complete relief. So she came for further treatment in Ayurveda. She was not having a history of diabetes mellitus, hypertension or any major illness, however agreed to have taken Hetu: Taking peanuts in excess since 2-3 years. Personal history is depicted in table 1.&#xD;
&#xD;
&#xD;
&#xD;
Clinical findings&#xD;
&#xD;
The general condition of the patient was fair and table 2 showed general sign and table 3 presented the ashtavidha parikshan. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Local examination&#xD;
&#xD;
Appearance: Rough, dry and scaling in palmer surface of both hands. &#xA0;Multiple cracking were present (Table 3,4).&#xD;
&#xD;
Colour: Blackish Temperature: Normal&#xD;
&#xD;
Anupama: Koshna Jala (Lukewarm water) Duration of treatment: 30 days ( Table 5).&#xD;
&#xD;
&#xD;
&#xD;
Follow up: After 7 days.&#xD;
&#xD;
Diet plan&#xD;
&#xD;
Take healthy food.&#xD;
&#xD;
Avoid heavy, spicy, fermented food, stale food, junk food, bakery products, cold water and fruits with milk.&#xD;
&#xD;
Avoid sleeping in the day time.&#xD;
&#xD;
Avoid the use of soap and other cosmetics. Maintain hygiene.&#xD;
&#xD;
Do regular exercise and meditation ( Table 6).&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Results&#xD;
&#xD;
Assessment of the patient was done for 30 days with Ayurvedic treatment (Table 7).&#xD;
&#xD;
Predominantly. The similarity between Palmoplantar psoriasis and Vipadika Kushtha is given in table 8 and figure 3. &#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
As per symptoms explained in Ayurveda, Palmoplantar psoriasis can be correlated with Vipadika Kushtha. It is included in Kshudra Kushtha with the involvement of Vata-Kaphaja Dosha.17,18 &#xD;
&#xD;
As Vipadika is Vata &#x2013;Kaphaj Kushtha. So, treatment should be aimed at alleviating Vata and Kapha Dosha. Twak and Rakta, Mamsa and Lasika Dhatu are Dushya which should be treated effectively. So Kushthaghna medicines are used along with this.&#xD;
&#xD;
Mode of action of medicines&#xD;
&#xD;
Raktapachak yoga contains Patol, Sariva, Musta, Patha, and Kutaki. All the contents of this Vati act as Kushthagna, Raktaprasadak. By Tikta Rasa and Laghu, Ruksha Guna it does Rakta- Mamsagatakleda Shoshana. It is Kapha Pitta Shamak.15,16&#xD;
&#xD;
Arogyavardhini Vati contains the drugs having&#xA0; Kushthanasaka properties (can alleviate all types of skin disorder).&#xA0; It is indicated in all type Kushtha specially Vataj and VataKaphaja such as Kapal, Mandal, Ekakushtha, Kitibh, Vipadika, Charmadala, &#xA0;Alasaka. It helps in purifying blood and also forms proper Dhatus. It pacifies Tridosha. Due to its Katu, Tikta Rasa Ushna, Laghu and Ruksha Guna enhances the digestive capacity and acts as Deepana, Pachana, Kledashoshana, Malabhedak. It also contains Tamra (Copper) which acts on Lasik.&#xD;
&#xD;
Khadirarishta is beneficial in all types of Kushtha. It acts on the Dushya of Kushtha specially&#xD;
&#xD;
Lasika and resists vitiation of further Dhatus.&#xD;
&#xD;
Eranda Haritaki has Anulomaka property. Improper functioning of Large intestine is the primary cause for all types of Kushtha. It causes Malavarodha (constipation) which vitiates Vata and further vitiation of Pitta and Kapha occurs. Erand enhances the property of Haritaki i.e. Anulomana. By Anulomaka property it helps in removing constipation.&#xD;
&#xD;
&#xD;
Jivantyadi Yamakam is indicated in Vipadika Kushtha. It is applied externally to heal cracked palms, feet and lips. It relieves pain and burning sensation.19,20,21&#xD;
&#xD;
Conclusion&#xD;
&#xD;
In this case, study marked improvement was seen in the patient of Vipadika Kushtha. The Ayurvedic treatment of mentioned oral medications and the local application was found effective in relieving the symptoms and pacification of vitiated Dosha from the body. Further studies should be done in more numbers of cases to validate multiple actions of Ayurvedic treatment without any recurrence.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Source of funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3402</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3402</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Antimicrobial Activity of Alkaloids from Withania Somnifera and Clitoria Ternatea&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>176</FirstPage><LastPage>179</LastPage><AuthorList><Author>Thamilarasu R</Author><AuthorLanguage>English</AuthorLanguage><Author> Arun Kumar M</Author><AuthorLanguage>English</AuthorLanguage><Author> Vignesh M</Author><AuthorLanguage>English</AuthorLanguage><Author> Pavithra MKS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Withania somnifera and Clitoria ternatea are commonly used herbs for the preparation of Ayurvedic products to treat most health problems. Objective: The present study was carried out to determine the Minimum Inhibitory Concentration (MIC) against microbes in stagnated rainwater. Methanolic extract of Withania somnifera root and Clitoria ternatea root were prepared and subjected to identification of the presence of alkaloids. Methods: Thin Layer Chromatography (TLC) method and the concentration was measured by UV spectrometry. Solvent extraction was carried out by maceration, orbital shaker and microwave oven methods. The extract was concentrated by the distillation process. The extract of W.somnifera collected from room temperature and the methanolic extract of C.ternatea was subjected to TLC method with the methanol as mobile phase. The compounds separated in the TLC plate was scraped off and subjected to UV spectrophotometry to identify the concentration of alkaloids present in the extract of both W.somnifera and C.ternatea. The extracts were tested for the anti-bacterial and anti-fungal activity. Results: The results found that the extraction of alkaloid compounds from W.somnifera can be enhanced by the microwaveassisted extraction and there was no change in the amount of extraction of alkaloids in C.ternatea. Finally, both the extract was subjected to anti-bacterial and anti-fungal activity. Different extracts from a single plant extracted by different extraction process show the different antimicrobial effect on microbes on stagnant rainwater. The type of extraction affects the anti-microbial effect of the extracts.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Withania somnifera root, Clitoria ternatea, Distillation, TLC, Anti-microbial</Keywords><Fulltext>&#xD;
Introduction&#xD;
&#xD;
Withania somnifera&#xA0;extracts possess multiple biological activities like cardio-protective, neuro-protective, anticancer, and anti-inflammatory.1-4 Withanolides and phenolic compound aids in the medicinal properties of this plant. Withanolides A exhibits anticancer and anti-inflammatory activities.5&#xD;
&#xD;
Clitoria ternatea&#xA0;used for the treatment of snakebite and scorpion string, skin disease, asthma and pulmonary tuberculosis.6,7 The active chemical constituents are tannins, resins, taraxerol, flavonoids, saponins and starch.8 The plant extract shows strong anti-microbialeffect.9&#xA0; This experiment was carried to determine comparative analysis between these plants and for the isolation of alkaloids from the W.somnifera extract. The experiment was carried out to find the antimicrobial effects of both the plant extract extracted by various extraction method against the microbes in stagnant rainwater.1,10&#xD;
&#xD;
Methodology&#xD;
&#xD;
Sample collection&#xD;
&#xD;
Both plant samples were collected from the nearby area of Sathyamangalam in Erode district. The roots were separated from it and dry it in sunlight until all the moisture removed from the root. Later the dried root part was subjected to grinding to make it powder-like substance and store it.11&#xD;
&#xD;
Extraction from root&#xD;
&#xD;
Three types of extraction for both samples were carried out with the methanol as solvent. The powder along with the solvents was placed in Microwave oven, Room temperature, Orbital shaker. In the microwave oven, 100 g of root powder were dissolved in 150 ml methanol and subjected to 180&#xB0;C for 60 sec. The extract was filtered with Whatman filter paper and this above method was repeated for the collection of 250 ml extract. In-Room temperature, the same amount of powder and solvent were taken as the microwave condition. The mixture was allowed to stands for 4&#x2013;5 hrs and the extract was filtered. In Orbital shaker, the mixture was kept in 80-95 rpm and the extract was filtered from it. All the extracts were concentrated using a rotary evaporator.12 &#xD;
&#xD;
&#xD;
Spectral analysis&#xD;
&#xD;
The spectral analysis was performed using UV-Vis spectrophotometer. The absorbance measured under the UV light at 210 &#x2013; 700 nm range using a UV visible spectrometer.11&#xD;
&#xD;
Thin Layer Chromatography Studies&#xD;
&#xD;
Thin layer Chromatography method is used to separate the non-volatile component. Pre-coated and pre-activated TLC Silica gel 60 F254 plates used in the study was procured from Merck Specialties Private Limited. The samples were loaded on the TLC plate 0.50 cm above its bottom using capillary glass tubes. After the application of the sample, the plates were kept insolvent saturated TLC glass chamber for the elution of the molecules. The solvent system used for fingerprinting analysis is Chloroform: Methanol (15:1). Dragendroff&amp;#39;s reagent is sprayed over the plate. Observe the Orange-brown spot in the plate, spray the sodium nitrate reagent if the intensity of the colour is faded. Finally, the dark brown colour was obtained.10&#xD;
&#xD;
Media Preparation&#xD;
&#xD;
In 250 ml conical flask, take 150 ml distilled water and add 4.2 g of nutrient agar and 2 g agar was added for solidification of media, heat to dissolve it and autoclaved at 121&#xB0;C, the pressure of 15psi for 15min.13&#xD;
&#xD;
Antimicrobial studies&#xD;
&#xD;
Various concentrations of the extracts were prepared in sterile water and the resultant extracts were used to determine the antimicrobial activity through well diffusion method. 15 ml of stagnated water was collected in a beaker. After media preparation, 10-5 and 10-6 times diluted stagnant water was swabbed over the media in 4 Petri plates to test the inhibition activity. 5 wells were punched using a sterile syringe. In each well, different concentration of extracts of both the extracts in the respective Petri plates was added 20 &#xB5;l, 40 &#xB5;l, 60 &#xB5;l, 80 &#xB5;l and 100 &#xB5;l respectively. The plates were incubated at 37?C for 7 days. The radius for the zone of inhibition was measured in millimetres and recorded against the corresponding concentration. Experiments were carried out with three replicates per treatment. The respective inhibition zone was measured in each of the plates. The experiments were carried out in triplicates and the mean values are considered along with the standard deviation.6,7,12 &#xD;
&#xD;
Gram Staining&#xD;
&#xD;
Gram staining was done to identify the type of microorganism present in the stagnant water. Crystal violet was added to the heat fixed organism in the slides. After washing in the flow of sterile water, few drops of iodine were added. After 1 min, the iodine was removed by washing with water. Then the slides were washed with the decolourizer subsequent washing with water. Finally, safranin was added and washed with water. Then the slides were observed under the microscope to identify the presence of either gram-negative or gram-positive organisms.12 The colonies were isolated and subjected to sequencing for species identification. &#xD;
&#xD;
Results and Discussion&#xD;
&#xD;
Dragendroff&#x2019;s reagent test&#xD;
&#xD;
Dragendroff&#x2019;s reagent test was performed with the 3 root extracts to confirm the presence of alkaloids by observing the colour change to orange. The presence of alkaloids (Figure 1) was confirmed by this test.&#xD;
&#xD;
UV Spectrometer &#xD;
&#xD;
Estimation of biomolecules by UV spectrophotometer was carried out to estimate the presence of alkaloids at the &#x3BB;max using Double beam, UV-VIS (Make: Perkin Elmer &amp; Model: Lambda 35) Spectrophotometer. The result (Figure 2) showed that the peak value to be 1.928 which confirm the presence of Withaferin A in microwave-assisted extraction. The results (Figure 3) showed that the peak value to be 2.321 which confirm the presence of alkaloid in C. ternatea extract prepared using microwave-assisted extraction.&#xD;
&#xD;
Thin-layer chromatography&#xD;
&#xD;
Thin-layer chromatography aids in better identification of therapeutically active compounds. The TLC profiling of the leaf extracts shows the presence of diverse metabolites such as alkaloids, flavonoids, phenols, and tannins. The chromatogram depicts the differences in the concentration of biomolecules possessed by the plant by distinguishing the intensity of the secondary metabolites. The Rf values of the molecules provide a shred of evidence about the polarity that shall aid in selecting the particular solvent system for extended studies on the characterization of metabolites using spectroscopic and chromatographic techniques. Low polarity molecules show high Rf value in a less polar solvent system, whereas high polarity molecules have a low Rf value. The results of TLC confirm the presence of alkaloids at the RF 0.66 (Figure 4) in W. somnifera and Rf 0.53 (Fig 4) in C. ternatea. &#xD;
&#xD;
Antimicrobial Assay&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The stagnated water was spread over the media and (Figure 5). The zone of inhibition was measured in each well and the results are tabulated. &#xD;
&#xD;
Gram Staining &#xD;
&#xD;
The colonies on the plate were purified, stained and observed under the laboratory microscope. The presence of both gram-positive and gram-negative microorganisms in the water sample was confirmed. The antimicrobial activity of the plant extracts with the pure cultures (Figure 6) was determined. The zone of inhibition was measured (Table 1). It was thus validated that the plant extracts possess antimicrobial activity towards both gram-positive and gram-negative bacteria. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
The different parameters of extraction including ethanolic extraction at room temperature, microwave-assisted extraction, orbital shaker assisted extraction, screened using two-level factorial design. Each factor was evaluated to find out the most significant and contributing factor in achieving high extraction yield and total alkaloid content of ashwagandha extract. Results indicated that ethanolic extract assisted by microwave was the most significant and contributing factor affecting the results of ashwagandha extracts, while extraction room temperature and extract assisted by orbital shaking exhibited the least significance and contribution. The factor levels for screening purpose was selected based on OFAT experimental design. The results also found that the extraction of bioactive compounds from ashwagandha can be enhanced by enhancing the microwave-assisted extraction parameter. Different types of microorganisms both gram-positive and gram-negative microbes are present in the stagnant rainwater. The above result shows that these both extracts act growth-inhibiting agents indicating that these compounds can be a microbial inhibiting factor. The pure form of this compound is extracted by the TLC methods. The possible interaction between the drug and excipient will be studied by FTIR spectroscopy to show the interaction between the drug and polymer. The extract can be used in the form of either powder or tonic for many medicinal purposes mentioned above. Preparation, attractiveness and the drug release characteristics, hard candy lozenges are ideal and attractive alternatives for drug delivery from Lidocaine lozenges for its Local anaesthetic action.&#xD;
&#xD;
Source of Funding&#xD;
&#xD;
The work is self-supported&#xD;
&#xD;
Conflict of Interest: None&#xD;
&#xD;
Conflicts of interest&#xD;
&#xD;
There are no conflicts of interest.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
The authors are thankful to The Chairman, Trustee, and The Principal of Bannari Amman Institute of Technology, Sathyamangalam, for constant support and continuous&#xA0; encouragement.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
Figure 1. Dragendroff&#x2019;s reagent test for each of three forms of extraction. The colour change to reddish orange supports the presence of alkaloids in the extract. &#xD;
&#xD;
&#xD;
&#xD;
Figure 2. UV spectrum for withaferin A for microwave assisted extraction. The &#x3BB;max at 330 nm confirms the presence of Withaferin A with absorbance 1.928 &#xC5;.&#xD;
&#xD;
&#xD;
&#xD;
Figure 3. UV spectrum for Clitoria ternatea extract. The &#x3BB;max at 290 nm confirms the presence of indole alkaloid in C.ternatea extract with an absorbance of 2.321 &#xC5;.&#xD;
&#xD;
 &#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Figure 4: TLC for microwave assisted extraction Withania somnifera and Clitoria ternatea. &#xD;
&#xD;
&#xD;
&#xD;
Figure 5: Antimicrobial activity of Withania somnifera and Clitoria ternatea at two different dilutions supporting. The absence of microbial growth on and near the wells supports the potential of plant extracts in inhibiting the growth of microorganisms present in stagnated water. A: Withania somnifera at 10-5 dilution; B: Withania somnifera at 10-6 dilution; C: Clitoria ternatea at 10-5 dilution; D: Clitoria ternatea at 10-6 dilution&#xD;
&#xD;
&#xD;
&#xD;
Figure 6: Results of Staining using Grams reagent revealing the presence of both gram positive and negative strains. A: Gram Negative organism from 10-5 dilution; B: Gram Positive organism from 10-5 dilution; C: Gram Positive and Negative organism from 10-5 dilution; D: Gram Negative organism from 10-6 dilution&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3403</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3403</Fulltext></URLs><References>1. Barik DP, Naik SK, Mudgal A, Chand PK. Rapid plant regeneration through in vitro axillary shoot proliferation of butterfly pea (Clitoria ternatea L.) a twinning legume, In vitro. Cell Dev Bio-Plan 2007;42:144-148.&#xD;
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2. Dhar N, Razdan S, Rana S, Bhat WW, Vishwakarma R and Lattoo SK. A decade of molecular understanding of withanolide biosynthesis and in vitro studies in Withania somnifera (L.) Dunal: Prospects and Perspectives for Pathway Engineering. Front Plant Sci 2015;1026:1031. &#xD;
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3. Mohanty I, Gupta SK, Talwar KK. Cardioprotection from ischemia and reperfusion injury by Withania somnifera: A hemodynamic, biochemical and histopathological assessment. Mol Cell Biochem 2004; 260:39&#x2013;47.&#xD;
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4. Chandra P, Kannujia R, Saxena A. Quantitative determination of multi markers in five varieties of Withania somnifera using ultra-high-performance liquid chromatography with hybrid triple quadrupole linear ion trap mass spectrometer combined with multivariate analysis: Application to pharmaceutical dosage forms. J Pharm Biomed Anal 2016; 129:419-426.&#xD;
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5. Oguis GK, Gilding EK, Jackson MA, Craik DJ. Butterfly Pea (Clitoria ternatea), a cyclotide-bearing plant with applications in agriculture and medicine.&#xA0;Front Plant Sci 2019; 610:645.&#xA0; &#xD;
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6. Alok S, Gupta N, Kumar A and Malik A. An update on Ayurvedic herb Vishnukanta (Clitoria ternatea Linn.): A review. Int J Life Sci Rev 2015;1(1):1-9. &#xD;
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7. Kumar V, Dey A, Hadimani MB, Marcovic T, Emerald M. Chemistry and pharmacology of Withania somnifera: An update. Tang Hum Med 2015;5(1):23-26. &#xD;
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8. Kannan KP, Poorani T, Venupriya V, Sathya R, Sivapriya V, Senthamarai M, Pavithra MKS, Madhankumar D. Comparative studies on the phytoconstituents, antibacterial and pesticidal activities of blue and white varieties of Clitoria ternatea Linn. Acta Biomed Sci 2016;3(4):218-213. &#xD;
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9. Sethiya NK, Trivedi A, Patel MB, Mishra SH. Comparative pharmacognostic investigation on four ethnobotanicals traditionally used as Shankhpushpi in India. J Adv Pharm Tech Res 2010;1(4):388-395. &#xD;
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10. Petruczynik A, Waksmundzka-Hajnos M, Michniowski T. Thin-layer chromatography of alkaloids on cyanopropyl bonded stationary phases, Part I. J Chromatogr Sci 2007; 45(7):447-454.&#xD;
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11. Dhruv KS,&#xA0;Bhavana S,&#xA0;Archana S.&#xA0;Spectrophotometric determination of rauwolfia alkaloids: estimation of reserpine in pharmaceuticals.&#xA0;Anal Sci&#xA0;2004;20(3):571-573&#xD;
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12. Coico R. Gram staining. Current protocols in microbiology, 2006 (1): A-3C.&#xD;
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13. Rios JL Recio MC. Medicinal plants and antimicrobial activity. J Ethnopharmcol 2005;100(1-2):80-84.&#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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Scattered References of Ayurvedic Concepts &amp; Dravyas in Vedas&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>180</FirstPage><LastPage>183</LastPage><AuthorList><Author>Zade D</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhoyar K</Author><AuthorLanguage>English</AuthorLanguage><Author> Tembhrnekar A</Author><AuthorLanguage>English</AuthorLanguage><Author> Guru S</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhawane A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Ayurveda and Veda have an in-depth relationship. The Ayurveda system is not simply medical. It is the holiest science of creation. It allows the person to lead a happy life with a pure body and spirit. The Vedas date back five thousand years or so. They&#x2019;re preaching life philosophy. Ayurveda is known as Atharvaveda&#x2019;sUpaveda. The Vedas are ancient doctrines of great terrestrial knowledge. Vedas are mantras sets. It portrays ancient people&#x2019;s living habits, thinking, traditions, etc.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Ayurveda, Veda, Upaveda, Atharvaveda</Keywords><Fulltext>Introduction&#xD;
&#xD;
Ayurveda means "Science of life and longevity." Ayurveda is one of India&amp;#39;s traditional systems. This is the absolute experience of a long existence. It is the oldest divine science that explains illnesses and wellbeing. It also determines medications, diets, and disciplines that foster health and cure diseases. &#xD;
&#xD;
In addition to addressing the ideals of health maintenance, a broad variety of clinical approaches have also been developed to treat illness. The physical emotional, social and spiritual wellbeing of human beings is linked to these values of positive health and therapeutic steps. &#xD;
&#xD;
The Medieval Era (8th-15th century) and the Current Period (16th century)1. The documentation on medicinal plants finds a location in over a period, Rishis and Munis, or sages contributed to the hymns, mantras, and medical knowledge found in the Vedas. Many of these sages, who dedicated their lives to learning the world, were learned, saints. They are the Vedic era (4000 BCE-1500 BCE), the Samhita period (1500 BCE-7th century), the Medieval period (8th-15th century) and the Current period (1500 BCE-1500 BCE)2. In three of the four Vedas3, the medicinal plant documentation finds a spot. Rigveda has 67 medicinal plants recorded, while Yajurveda and Atharvaveda have 82 and 288 medicinal plants recorded, respectively. In reality, Ayurveda is known as Atharvaveda Upaveda.3 There is also a place for medicinal plants in the Upanishads, where about 31 plants are recorded.4&#xD;
&#xD;
Samhitas are, chronologically, the next source of medicinal plant knowledge. Charaka Samhita (1000 BCE-200 CE) and ShusrutaSamhita (1500 BCE-1000 BCE) are the first to describe the various forms and medicinal uses of plants.5 Charaka Samhita offers detailed accounts of 620 plants with 12,800 references, and SusrutaSamhita has 775 plants with 9676 references.6,7 Extensive information is given in the texts on various aspects of medicinal plants, such as therapeutic uses, classifications, pharmacology, pharmacy, collection time and methods, incompatibility, medical recipes, parts used.8. Ashtanga Samgraha (500 CE) and Ashtanga Hrudaya are the other Samhitas of the time (600 CE). There are 755 medicinal plants distributed by 20,500 references in AshtangaSamgraha.9 HaritaSamhita, BhelaSamhita, Kashyapa Samhita, Sharangadhara Samhita and Bhavaprakasha Samhita10 are Samhitas written after 700 CE. No systematic incentivisation of plants has so far been attempted in these documents. From the 8th century onwards, like Vyakhyas and Nighantus, the next collection of major works in Ayurveda with data on medicinal plants can be seen. Critical comments written on the Samhitas are Vyakhyas. An essential part of the Vyakhyas is the development of the identification and use of medicinal plants described in the Samhitas. Glossaries written based on medicinal plants described in Samhitas are Nighantus. In the time from the 8th to the 19th century, there are 16 significant Nighantus written and the last of them is SaligramaNighantu with 4200 plant references. As in, as in Samhitas, no full compilation is available for the Vyakhyas and Nighantus medicinal plants.&#xD;
&#xD;
Ayurveda definition&#xD;
&#xD;
In addition to indicating steps for healthy living for the full span of life, it is the awareness of life science that deals extensively and at length with circumstances beneficial or otherwise beneficial to humanity and factors conducive to happiness or responsible for misery or sorrow.11 Health is regarded as a prerequisite for achieving the ultimate ends of life, consisting of justice, riches, creative ideals and spiritual freedom, according to the ancient books of wisdom. In the definition of positive health, preventive and curative aspects of diseases are considered to be essential components. Ayurveda is one of the oldest health care systems to deal most systematically with both the preventive and curative aspects of life. The existence of two schools of physicians and surgeons and eight specialities suggests an overview of its many classical treatises." Ashtanga Ayurveda" can usually suggest these eight disciplines and these are as follows;&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kaya Chikitsa - Internal Medicine&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; KaumarBhritya &#x2013; Paediatrics&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Grahachikitsa- Psychiatry&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Shalakyatantra - Otorhinolaryngology and Ophthalmology&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Shalyatantra &#x2013; Surgery&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; AgadTantra - Toxicology&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rasayana &#x2013; Geriatrics&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Vajikarana - Eugenics and aphrodisiacs&#xD;
&#xD;
Ayurveda in Vedas&#xD;
&#xD;
Ayurveda&amp;#39;s real history begins at the time of the holy scriptures, the Vedas. Ancient mythology contends that Lord Brahma, the founder of the universe himself, revealed the principle and meaning of Ayurveda.12,13&#xD;
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Four Vedas are there. There are:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rig Veda&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Yajur Veda&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sama Veda&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Atharvana Veda&#xD;
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Each Veda has its own Upa-Veda order.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rig Veda - Dhanur Veda (Deals with Archery)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Yajur Veda &#x2013; Gandharva Veda (Music Science)&#xD;
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Sama Veda &#x2013; Stapatya Veda (Architecture)&#xD;
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Atharvana Veda &#x2013; Ayurveda (Science of Life)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In Rig Veda, the ceremonies of paying respects to the five great elements are clarified since these were the Gods who were to take charge of the world. The procedures were outlined in the Yajur Veda. If the five great elements such as drought were reversed, the people of that era knew how to trigger change by praying to the God of the Rain, the God of Fire. They knew the importance of fire and paid tribute to it. &#xD;
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All of the Stanzas and Slokas were written down in Sama Veda. The prayers they used to chant were these. From this Veda comes all Indian classical music. They found that singing (Achamana) had an influence on well-being and it is what we understand as vibrational medicine today. The medical uses of plants are further described in Atharvana Veda. Many of these plants, such as Brahmi, which is good for the mind, were offered to the Gods. They used these plants and were conscious of what each plant was good for. The disease mechanism was recognized by them. They were also acquainted with the animal kingdom&amp;#39;s internal anatomy. They understood how physiology is linked to our anatomy from all this knowledge. The concepts of healing on which Ayurveda is based are found in Atharva Veda. Not only were the doctors of ancient India well versed in human anatomy, but also the anatomy of goats, horses, and elephants. In all Vedas, references about micro-organisms (krimi) are available.14,15,16&#xD;
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Dravyaguna in Veda&#xD;
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The classification of many herbs has been noted in the Vedas based on their morphology and medicinal properties. It also listed the classification of metals and minerals. In Vedas, some drugs and their uses are also noted. Vedic literature provides different explanations of medicine and medicine. &#xA0;In different Sukta contain various plants for different diseases such as in ShwetaKustha (Lucoderma) Rama (Ghrutakumari, Lakshana), Krushna (KrushnaTulasi, Pippali), Ashiavni (Ashikani) etc was suggested.12 There was plant named soma which was derived from Munjavaan mountains can treat the diseases like Atisaar (Diarrhea), Bahumutra(excessive micturition), Munja named plant was the best medicine to treat wound.13 ArjunaBark, Java (Flaxseed), Tila (sesame seed) was useful in hereditary diseases14. Prushnaparni was used to treat all types of difficult vatajavyadhi (Vaataj diseases).15 Pippal grown in close vicinity with Khadirplant have properties which act on infertility.16 There is the red variety of Rohini plant which acts as rejoining the broken bones like plaster and even heal the wounds also.17 Apamarga which is acts as Purgative, infertility, Excessive thirst &amp; appetite, hereditary disorders.18 Ajashrungi kills on microbes &amp; water-born bacteria19. Even Guggula, Pilu, Naladi (Jatamansi), Aukshgandhi (Type of Jatamansi), Pramodini (Dhatvruksha) makes inactive water-born bacteria.20 There is mentioned about Ashvathaplant grown on Shami plant can be used for punsavanvidhi.21 There is the reference of Haridra (curcumin) to increase hair length.22 Varuna has Anti-tubercular activity.23 The plant Pippali(piper) was used in Unmaad (Mania, Hysterical).24&#xD;
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Rasa shastra in Vedas&#xD;
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Some preparations also found in the Vedas. Soma Rasa is the first Kalpana juice ever extracted by Swarasa. The ninth section of Riga Veda is entirely dedicated to Soma in its praise, but nothing is written about the preparation of Soma Rasa Annotation 6-68-10 details of various liquors are contained in Riga Veda. The planning process is not given. There are different examples of cereal grains, milk preparations, and more.&#xD;
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Some of the preparations include, for example, Dhana (roasted food grains), saktu (roasted food grain flour), Parivaap (roasted food grain), Dadhi (curd), Amiksha (boiled and clotted milk). There are also some preparations in the Vedas, such as Ksheerapaaka (medicated milk), Takra (curd milk), navaneeta (butter), Payasya (cheese), tokama (germinated paddy grains), Madhu (honey). There are references from pre-Vedic times to the use of metals in Indian literature. The numerous uses of metals and minerals are available in the Vedas at home and for commercial purposes. One portion of the Atharvana Veda is devoted to working with lead, making vessels, bracelets, etc and applying them in the form of collyrium externally.&#xD;
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In Ayurveda, more stress is put on Ayurveda drugs by AcharyasCharaka, Sushruta and Vagbhatta. For alchemy, the era between the 8th and the 10th centuries AD is called the golden age. Some books published in the 10th century speak about the use of mercury as a drug by people. &#xD;
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Due to benefits in dosage, methods of administration, planning and swiftness of action, Alchemy (Rasa Shastra) in Ayurveda slowly gained prominence in the 11th century. From this time on, books dedicated to alchemy began to be written. Former alchemists made the refining of base metals into precious metals such as gold and silver more important.23,24&#xD;
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In Rig Veda (1/56/1, 1/122/2), the use of metals such as Tamra, Swarna and Kamsya is seen. Ayas is referred to as Tamra here. Tamra refers to Lohitayas and Loha refers to Krishnayas. There is a reference to six Dhatus in Yajur Veda 18/13 and Atharvana Veda 11/3/7-8. References to Swarna, Ayas, Syama, Loha, Trapu and Sesa are found in Yajur Veda. References are noted in Atharvana Veda 1/13/2-4 concerning Rajata, Lohitayas, Syamayas and Seesa.25&#xD;
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In Rig Veda Ayurveda&#xD;
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Rig Veda&amp;#39;s period is approximately about 1700-1100 B.C. In Rig Veda, you will find a connection to three doshas of the body. Five elements of the earth (Panchabhootas) have also been described, and the balance of the three doshas is called health. The names of the three doshas are mentioned as Vata, Kapha, and Pitta. As the symbolic representative of the three doshas of the body, air, fire and water have been clarified. In Rig Veda, descriptions of the body and diseases such as tuberculosis and heart disease are available. Rig Veda also deals with animal care (Mriga Ayurveda) (Mriga Ayurveda). For the prevention of diseases, Rig Veda describes the use of natural therapies such as sunrays, fire, air, water.&#xD;
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In Yajur Veda Ayurveda&#xD;
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It is estimated between 1,400 and 1000 B.C. to have been composed. Yajur Veda, SuklaYajur Veda and Krishna Yajur Veda have two primary variants. References have been extensively debated on the anatomical structure of human beings and animals. Morphological characteristics of significant herbs that are used in rituals were discussed. SuklaYajur Veda&amp;#39;s 12th chapter clarifies the medicinal properties of plants, their uses, selection and preservation.26,27&#xD;
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In Sama Veda Ayurveda&#xD;
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It is assumed that its earliest pieces date from 1700 B.C. References to the use of natural remedies are used. The number of bones in the human body is reported as 360. Sama Veda. Sama Veda also clarifies the absorption, assimilation, metabolism and nourishment mechanism of the body.&#xD;
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In Atharvaveda Ayurveda&#xD;
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The period is between the 12th and 10th centuries B.C. Atharva Veda describes Ayurveda&amp;#39;s mythological history in detail. All have been defined by anatomical structures, digestion and metabolism, circulatory system, anatomy, herbology, general medicine, metals and minerals, their proper applications, surgical techniques. The signs and symptoms were discussed of irregular labour and puerperal disorders. The identification and classification of plants in Atharvaveda are available. The plants are classified based on shape, scale, colour, morphology and habitat.28-30&#xD;
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Discussion&#xD;
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The universe was formed by Brahma, according to Hindu mythology. By collecting information from the four directions, he established Vedas. There is information about the World in the Vedas. Therefore, there is also information about life. So, Brahma is known as Ayurveda&amp;#39;s Adya (first) Guru. The subjects of Ayurveda are discussed not only in the Vedas but also in the Aranyakas, Brahmanas and Upanishads. Garbhopanisad mentions doshas, dhatu, and foetus growth. Only in the 2nd century B.C. did a systematic presentation or treatise on Ayurveda take place. A.D. and the 10th century. Charaka Samhita and SusruthaSamhita are the most common and authentic Samhitas which are still in use. Charaka Samhita focuses primarily on general medicine (Kaya Chikitsa) and SusruthaSsamhita focuses primarily on surgery (ShalyaTantra).&#xD;
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As the backbone of Ayurveda Samhita, AgniveshaSamhita (Charaka Samhita) was well accepted and was propagated. There was a Sushruta Samhita written by Sushruta. The complete systematic approach to ShalyaKriya (General Surgery) and ShalakyaTantra is discussed (Eyes, Ear, Throat and Nose). SushrutaSamhita&amp;#39;s time is deemed to be about 500 B.C. Only before the Buddhist Period. Few of the related studies in recent time were reviewed.27-30 &#xD;
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Conclusion&#xD;
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Ayurveda is the science that describes the ways and steps to be taken to preserve and prolong life. Health is regarded as a prerequisite for achieving the ultimate ends of life, consisting of justice, riches, creative ideals and spiritual freedom, according to the ancient books of wisdom. In the definition of positive health, preventive and curative aspects of diseases are considered to be essential components.&#xD;
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Such positive health values and preventive interventions contribute to human beings&amp;#39; physical, emotional, social and spiritual well-being. Ayurveda has therefore become one of the oldest medical systems, dealing most systematically with both the preventive and healing aspects of life.&#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=3404</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3404</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Self-Instructional Module on Knowledge Regarding Prevention and Management of Gastritis Among Adolescents&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>184</FirstPage><LastPage>188</LastPage><AuthorList><Author>Sakarwade P</Author><AuthorLanguage>English</AuthorLanguage><Author> Waghmare P</Author><AuthorLanguage>English</AuthorLanguage><Author> Wankhede A</Author><AuthorLanguage>English</AuthorLanguage><Author> Wankhede P</Author><AuthorLanguage>English</AuthorLanguage><Author> Vidhvaskar D</Author><AuthorLanguage>English</AuthorLanguage><Author> Satpute U</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Gastric problems can also impair psychological development and negatively influence the environment and leisure time. The self-instructional module on prevention of gastritis among adolescence helps to improve and update the knowledge regarding healthy lifestyle practices. Objective: To evaluate the effectiveness of the self-learning module on knowledge regarding prevention and management of gastritis among adolescents. Methods: Non-convenience sampling technique was used to collect data from teenagers by providing structure multiple-choice questionnaires. The self-learning module was arranged for the involvement of gastritis in samples. Seven days were provided to the samples for utilising self-learning module which was organised for 45-50 minutes through self-learning, discussion and planned Audio-Visual (AV) aids. Post-test information was gathered after seven days from the day of the learning intervention. Seven days was assigned after getting expert opinions as well as to give time for the implication of knowledge through the practice of prevention and management of gastritis. Chi-square test was also used to find out the association between knowledge of adolescents regarding the prevention and management of gastritis and selected demographic variables. Results: The mean pre-test knowledge score was 8.32 and mean post-test knowledge score was 21.90. There was a statistically significant improvement in the level of knowledge regarding prevention and management of gastritis among adolescents (t0.001, 99=1.98). There was a significant association of knowledge score concerning the education of adolescent and education of father. There was no significant association of knowledge score concerning age, gender, education of mother and area of residence. Conclusion: The post-test knowledge score improved than the pre-test knowledge score. So the self-instructional module has proved to improve adolescents knowledge regarding prevention of gastritis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Teenagers, Efficacy, Self-learning module, Gastritis, Prevention and management</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3405</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3405</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Cephalometric Relation of Mandibular Body to the Surface Area of the 2 Paranasal Sinusesfor Mandibular Growth Prediction in Different Skeletal Malocclusions &#x2013; A Lateral Cephalometric Retrospective Study Using 2D Dolphin Software&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>189</FirstPage><LastPage>194</LastPage><AuthorList><Author>Karthick D Shetty</Author><AuthorLanguage>English</AuthorLanguage><Author> Veera Sawant</Author><AuthorLanguage>English</AuthorLanguage><Author> Pranita Jadhav</Author><AuthorLanguage>English</AuthorLanguage><Author> Keval Shroff</Author><AuthorLanguage>English</AuthorLanguage><Author> Aarti Sethia</Author><AuthorLanguage>English</AuthorLanguage><Author> Akil Shetty</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: The largest sinus is the maxillary sinus. The growth and development commence during fetal development (3rd Month) by the infundibulum present on ethmoid bone. Post birth, it expands in the lateral direction during the growth spurt period (Birth - 3 years and 7 - 12 years). Aim/Objectives: The aim was to determine the relation of mandibular body length with the area dimensions of the maxillary and frontal sinus using digital lateral cephalogram. Materials and Methods: 60 Digital lateral cephalograms were equally divided to form 3 groups of Class I, Class II, Class III patients comprising 20 each with equal inclusion of male and female patients. The Dolphin 2017 software was used to calculate the area dimensions and individual variables of both the paranasal sinuses, mandible size and both cranial bases with their growth pattern. Results: Class III malocclusion showed greater dimensions and surface area compared to those in other groups. Mandibular body length showcased a positive correlation to the sinus dimensions. Results obtained showed that the mean value of frontal sinus area for Class I was 335.59 mm2, Class II was 257.64 mm2 and Class III was 393.82 mm2. The mean value of maxillary sinus area for Class I was 973.70 mm2, Class II was 690.48 mm2 and Class III was 1078.75 mm2. Males showed greater values than the female group. Conclusion: Class III malocclusion showed higher values for dimensions and surface area compared to the other sample groups. Values calculated had a positive relation with both the cranial bases and mandibular body size.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Para Nasal Sinus, Mandibular Body Length, Dolphin Software, Malocclusion, Dimensions and Surface Area, Growth</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4658</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4658</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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Evaluation of the Effect of the Restoration of Lost Vertical Dimension with Permissible Splint on Posture using Photogrammetry and S-EMG - An In-Vivo Study&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>195</FirstPage><LastPage>204</LastPage><AuthorList><Author>Swapnita Vaity</Author><AuthorLanguage>English</AuthorLanguage><Author> Omkar Shetty</Author><AuthorLanguage>English</AuthorLanguage><Author> Anu Arora</Author><AuthorLanguage>English</AuthorLanguage><Author> Vibha Kailaje</Author><AuthorLanguage>English</AuthorLanguage><Author> Pritesh</Author><AuthorLanguage>English</AuthorLanguage><Author> Yash Gujar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: Occlusion is a multidimensional phenomenon of which vertical dimension is an important factor. Maintenance of occlusal harmony along vertical dimension helps in better prognosis of the treatment performed. Along with the stomatognathic system, it has also been found to be beneficial for overall health of the postural muscles. Therefore, co-relation between vertical dimension and postural muscles analysis is significant. Aim/Objectives: To evaluate the effect of the restoration of lost vertical dimension with a permissible splint on posture using photogrammetry and S-EMG. Methods and Material: Fifteen patients were selected according to the inclusion and exclusion criteria for the study. Vertical dimension of rest and occlusion were measured using Niswonger&#x2019;s technique. Posture was evaluated using photogrammetry and S-EMG. For photogrammetry, CVA angle and Gaze angle were measured using photographs on Kinovea software. The posture was evaluated by measuring the activity of postural muscles, namely Sternocleidomastoid [SCM], upper trapezius and spinous erectae using S-EMG. Permissible splints were constructed at restored vertical relation and given to the patient after occlusal equilibration. 30 days post-restoration, the posture was re-evaluated using same methods. Results: Difference between right and left side reduced from pre to post but was not statistically significant. Relation was found only between right upper trapezius and right spinous erectae and left upper trapezius and left SCM. Conclusion: Posture is affected by a number of factors, one of which happens to be occlusion. This study proved that occlusion does have an effect on body posture and an improvement in occlusion will only aid in improving body posture&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Vertical Dimension, Postural Muscles, Photogrammetry, Body Posture, S-EMG, Occlusion</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4659</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4659</Fulltext></URLs><References></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>4</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>February</Month><Day>16</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Esthetic Rehabilitation Using a Modified Groper&#x2019;s Appliance for a 3-year-old Child: A Unique Case Report&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>205</FirstPage><LastPage>208</LastPage><AuthorList><Author>Amil Joshi</Author><AuthorLanguage>English</AuthorLanguage><Author> Rachna Anand</Author><AuthorLanguage>English</AuthorLanguage><Author> Sanjana Kodical</Author><AuthorLanguage>English</AuthorLanguage><Author> Ishani Ratnaparkhi</Author><AuthorLanguage>English</AuthorLanguage><Author> Nikitha Balasubramanian</Author><AuthorLanguage>English</AuthorLanguage><Author> Miloni Sanghavi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: Esthetic rehabilitation of a young child with early childhood caries or dental trauma is one of the most important treatment modalities in pediatric dentistry. Parental motivation is a vital factor for the placement of an anterior esthetic appliance. Case Report: The present article discusses about a case report that highlights the fabrication of a modified Groper&#x2019;s appliance in a 3-year-old child with severe early childhood caries (S-ECC). Its design included the placement of stainless-steel bands on primary second molars attached to a wire containing an acrylic flange bearing trimmed acrylic teeth anteriorly and a distal stop on the canine in order to prevent distal migration. Conclusion: The appliance was functional and fulfilled the esthetic demands.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Esthetics, Early childhood caries, Functional, Groper&#x2019;s appliance, Acrylic teeth, Pediatric patients</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4661</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4661</Fulltext></URLs><References>&#xD;
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