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<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Bio-based Polymers: Historical Events to Modern Medical Application Context&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>02</LastPage><AuthorList><Author>Mereena Luke</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3494</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3494</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Occupational Safety Aspects in Tertiary Care Hospital: A Letter to the Editor&#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=3495</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3495</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of the Functional State of the Endothelium in Patients with Viral Hepatitis before Tooth Extraction&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>04</FirstPage><LastPage>08</LastPage><AuthorList><Author>Rakhmatullaeva OU</Author><AuthorLanguage>English</AuthorLanguage><Author> Shomurodov KE</Author><AuthorLanguage>English</AuthorLanguage><Author> Khadjimetov AA</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Tooth extraction is the most common operation, after which hemorrhagic complications often occur, especially in patients with chronic viral liver disease. This condition is caused by damage to the endothelial lining of blood vessels. Objective: Based on this, this study aimed to study the features of endothelial dysfunction before tooth extraction in patients with viral hepatitis. Methods: 58 patients with hepatitis B and C with different duration of the disease were examined. In patients with viral hepatitis before tooth extraction, an increase in platelet aggregation activity on the effect of an ADP inducer (Tma) was noted by 45%. Results: The observed lengthening of the activated recalcification time (AVR) 37-37% in patients with viral hepatitis reflects a deficiency of plasma factors (XII, XI, XIII) of the blood coagulation system and indicates a state of hypercoagulation. Against this background, high values of alpha-2 macroglobulin in the blood ( 4 times) and Willebrand factor (15%) and a significant decrease (35%) in the content of protein C in the blood of the examined patients were noted. Conclusion: The results of the study indicate that these patients have a narrow band of maintaining hemostatic balance, and the existing balance can easily be transformed into hypo - or hypercoagulation, which requires preventive measures to prevent complications after tooth extraction.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Viral hepatitis B and C, Endothelium, Fibrinolysis, Thrombotic complications</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3496</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3496</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>09</FirstPage><LastPage>13</LastPage><AuthorList><Author>Alkhansa Mahmoud</Author><AuthorLanguage>English</AuthorLanguage><Author> Maria Teresa Mancuso</Author><AuthorLanguage>English</AuthorLanguage><Author> Barbara Tanno</Author><AuthorLanguage>English</AuthorLanguage><Author>  Md Zuki Abu Bakar</Author><AuthorLanguage>English</AuthorLanguage><Author> Hazilawati Hamzah</Author><AuthorLanguage>English</AuthorLanguage><Author> Mohd Hezmee Mohd Noor</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Breast cancer, Cell lines, Somatostatin receptors and mRNA expression</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Breast cancer is the most common type of cancer and the second leading cause of cancer-related deaths in women worldwide.1,2 It is the most common cancer in both developed and developing countries,2but still diagnosed in late-stage due to lack of awareness and knowledge for most of risk factors, signs and symptoms of breast cancer.3 Breast cancer is considered a heterogeneous disease because of the changes in the mammary epithelial cells leading to aggressive cell proliferation.4 The three main biomarkers of interest in breast cancer include estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Currently, four molecular subtypes with different levels of expression of these receptors are luminal A, luminal B, HER2 enriched, and basal-like have been identified. Triple-negative breast cancer (TNBC), which is a part of the basal-like subgroup, is characterized by the lack of PR, ER, and HER2 expression.5 Different breast cancer subtypes extremely high mortality, poor drugs response and recurrence.6 At the most advanced stage of breast cancer, in particular, the hormone-independent cancers develop resistance to therapy and leading to increasing cases of mortality. Breast cancer cure and control includes surgery, radiation therapy and chemotherapy as well as hormone therapy.7The peptide hormones are expressed in tumour tissues affected cellular process regulation and proliferation which causing therapy resistance.8 Somatostatin (SST) is an endogenous peptide known to inhibit the cellular processes such inhibits the motility and acid secretion of GI, it&#x2019;s effectively stopped bleeding in cases with acute upper GI bleeding,9 neurotransmissions, hormonal secretion and cell proliferation as well as induced apoptosis through SSTRs subtypes (1-5) encoded by five distinct SSTR genes on chromosomes 14, 16, 17, 20 and 22, respectively.10 Somatostatin receptors (SSTRs) are G-protein-coupled plasma membrane receptors, initially secreted as a long precursor molecule; it undergoes specific enzymatic degradation generation with two forms of SST peptides, SS-14 and SS-28, as their natural ligands.11 SSTRs1-5 expressed in normal and tumour tissues depending on cell type. In normal tissues, SSTRs are found mainly in the brain, pancreas, stomach and kidney, while in tumour tissues their expression depending on the type of tumour and biological characteristics.12 SSTRs have direct and indirect effects on tumour biology. The direct effect includes the inhibition of tumour proliferation and induction of pro-apoptotic pathways including both intrinsic and extrinsic apoptosis pathway.13,14 Meanwhile, the indirect effects include the inhibition of hormones and growth factors.15,16 SSTRs mediate signal transduction pathways via inhibition of adenylyl cyclase (AC) and guanylyl cyclase (GC), protein phosphorylation and activation of mitogen-activated protein kinase (MAPK).17,18 However, the activation of signalling pathways affected cell cycle arrest through activation of cyclin-dependent kinase inhibitor (p27Kip1) and apoptosis.&#xA0; Cancer cells with positive SSTRs are less malignant with higher survival whereas the lack of SSTRs expression has been associated with the poorly differentiated and invasive tumour. However, several effects demonstrated subtype selectivity, and subtype-specific signalling has been reported.19 SSTR1, 2, 4 and 5 frequently interfere with the mitogen-activate protein kinase pathway to modulate cell proliferation, whereas SSTR3 was indicated to have an increased potential to induce apoptosis.4 Furthermore, SSTR2 is considered a prognosis factor because it is associated with low proliferative and invasive breast cancer. Also, SSTRs being frequently expressed in the same cell, and the existence of ligand-induced dimerization proposed for G?protein-coupled receptors.12 Therefore, somatostatin analogues (SSAs) have been used in the treatment of SSTR-positive tumours.14 However, the therapeutic results of SSAs treatment varied due to different SSTR expression patterns and reasons that are not understood.20 SSTRs levels have been investigated in different kinds of human cancer such as hepatocellular carcinoma, pancreatic cancer and breast cancer.21 SSTRs are highly expressed in neuroendocrine tumours but their levels of expression in breast cancer are not well documented.22 However, in breast cancer, SSTRs are expressed in different levels and are correlated with various histological markers in a receptor-specific manner.23 Previous studies reported that of SSTRs expressed variety in tumour tissues and cancer cell lines.24 In the present study, MCF-7 (estrogen-receptor-positive breast cancer cell line) and MDA-MB231 (estrogen receptor-negative breast cancer cell line) have been used in vitro as common breast cancer models to determine the expression of these receptors. The MCF7 cell line characterised by differentiated mammary epithelium including the ability to process estradiol via cytoplasmic estrogen receptors. While,&#xA0; MDA-MB231 is a highly aggressive, invasive but poorly differentiated triple-negative breast cancer (TNBC) cell line that lacks receptors for estrogen (ER) and progesterone (PR) expression, as well as human epidermal growth factor receptor 2 (HER2) amplification,25 and is known to be resistant to several anti-cancer agents. 26 The aim of this study was, therefore, to evaluate the mRNA expression for SSTRs (1-5) in human breast cancer cell lines MCF7 and MDA-MB231 using quantitative real-time polymerase chain reaction (qRT- PCR).&#xD;
&#xD;
Materials and methods&#xD;
&#xD;
Cell culture &#xD;
&#xD;
MCF7 and MDA-MB231 human breast cancer cell lines were kindly donated by the National Cancer Institute Regina Elena Rome, Italy. Both cells were purchased from the American Type Culture Collection (Manassas, VA, USA). MCF7 and MDA-MB231 cells were grown in a humidified 37&#xB0;C incubator in 5% CO2 and cultured in Dulbeccos modified essential medium /F12 complete media supplemented with 10% fetal bovine serum, 1% penicillin/streptomycin and 1% L-glutamine. &#xD;
&#xD;
RNA extraction&#xD;
&#xD;
Total RNA from MCF7 and MDA-MB231 cell lines was extracted by using EXIQON kit. The concentrations of total RNA were quantified by Nanodrop 2000 (Thermo Scientific, Hvidovre, Denmark), and all samples were stored at -20&#xB0;C until analysis. &#xD;
&#xD;
Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR)&#xD;
&#xD;
RNA was converted into complementary DNA (cDNA) by reverse transcriptase process according to the manufacturer&amp;#39;s instruction. After addition oligo (dT), samples were incubated at 42&#xB0;C for 1 hour in a thermal.&#xD;
&#xD;
Quantitative Real-time Polymerase Chain Reaction (qRT -PCR)&#xD;
&#xD;
qRT-PCR was performed using q RT- PCR Systems (Bio-Rad) to detect the expression of SSTRs1-5 levels in MCF7 and MDA-MB231 breast cancer cell lines. qRT-PCR was performed using 2 &#x3BC;g of retro-transcribed RNA and normalized with GADPH. The quantity of mRNA relative to the reference gene was calculated by 2-&#x394;C? methods, the analysis type is Singleplex, and RQ min/max confidence level is 95.0. Samples were analysed using SYBR Green Supermix (Bio-Rad) according to the manufacturer&#x2019;s instructions. The sample analysis was performed in triplicate and the experiments have been repeated in different batches of cell lines. Primer sequences were obtained from thermo-fisher used for SSTRs (1-5) are shown in &#xD;
&#xD;
&#xD;
&#xD;
Statistical analysis&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
The SPSS software version 22 (IBM&#xAE;) was used for the analysis. The mean and standard deviation of SSTRs expression levels in MCF7 and MDA-MB231 cell lines were compared using a T-test. P-values of &lt; 0.05 were considered statistically significant.&#xD;
&#xD;
Results &#xD;
&#xD;
SSTR1-5 mRNA expression was determined in both MCF-7 and MDA-MB-231 breast cancer human cell lines (Figure 1) and the overall expression levels differ between the two cell lines. The SSTR1, 2, 3 and 4 mRNA levels were significantly higher in MDA-MB231 cell line in relation to MCF-7 cell line (P=0.02, 0.002, 0.001, 0.01) respectively. While no different significant of SSTR5 in MCF7 compared to MDA-MB231 (P=0.2). The expression of SSTR4 mRNA was highest in the MDA-MB231 cell line followed by SSTR2, SSTR1, SSTR5 and SSTR3 mRNA. In the MCF7 cell line, SSTR4 has the highest expression levels, followed by SSTR1, SSTR5, SSTR2 and SSTR3. SSTR3 mRNA was least expressed in both cell lines, while SSTR4 has highly expressed in both cell lines too. An arbitrary score was adopted to summarize the expression levels of SSTRs as in (Table 2). &#xD;
&#xD;
&#xD;
&#xD;
Discussion &#xD;
&#xD;
In this study, our data showed that all the SSTRs1-5 were expressed in both MCF-7 and MDA-MB-231 breast cancer cell lines. Similar findings have been reported that all the SSTR subtypes were expressed in both MCF7 and MDA-MB231 and SSTR3 mRNA being the least expressed in both cell lines. SSTR4 was found to be express highly in MDA-MB231 cell lines while it is often reported that SSTR2 is predominant on breast cancer cells,27 however, our somatostatin receptors&amp;#39; expression levels differ from the literature, but several other studies were in agreement with our results.7 The expression of SSRT2, SSTR3 and SSTR4 were significantly higher in the MDA-MB231 cell line.28 The association between SSTRs and ER/PR positive receptors, it might be suggested that SSTR were overly expressed in MDA-MB231 cell lines that were correlated with poorly differentiated cancer cells. STTR1, 2, 3 and 4 have a key role in blocking tumour growth by inhibiting cell cycle progression and inducing apoptosis. Furthermore, SSA antagonist may have more clinical benefits for ER and PR negative tumours. The highly expressed SSTR4 and low expressed SSTR3 agreed with earlier reports.29,30 The high expression of SSTR3 and SSTR2 or SSTR4 in MCF7 cell lines were associated with apoptosis. Meanwhile, SST enhanced cytotoxicity via SSTR2 and SSTR3.31 The low-level expression of SSTR3 has made it a target for breast cancer therapy. The activation of SSTR3 in MCF7 and MDA-MB231 breast cancer cell lines by SST for cancer treatment is now been explored.31,32 However, the mechanism of SSTR3 in apoptosis and cell cycle arrest is still unclear.30 Besides, estrogen and progesterone receptors in MCF7 are important in breast cancer prognosis and development33, and the positive estrogen effect on SSTR2 expression on regulation in breast cancer cells development has been documented.34 Furthermore, many SST analogues have been synthesized for activation SSTRs while SST agonist is currently under development to control cancer cell proliferation.35,36 Several studies demonstrated that SSTRs expression in breast cancer is down-regulated either in more aggressive and less differentiated tumours37 or in anti-estrogen agents.38 In this study, the high levels of SSTRs expression were documented in aggressive tumours and thus, MDA-MB231 may be considered as a target for therapeutic strategy. Meanwhile, the activation of the expression levels of SSTR1, SSTR2, SSTR3 and or SSTR4 might enhance apoptotic activity in MCF7 cells. Several previous studies have investigated that SSTR expression may be able to be explored for further insights into the therapeutic of breast cancer. Besides, the antiproliferative role of SST and its analogues have also been demonstrated. Several in vitro studies have investigated the anti-proliferative effect of somatostatin analogues in breast cancer cells. Previous studies have also shown that SSTR2 overexpression produces an anti-proliferative role in the estrogen-dependent MCF-7 cells by inducing apoptosis and decreasing EGFR expression.12 These results highlighted the SSTRs -targeted therapy in which the evaluation that SSTR1-5 is expressed in both breast cancer cell lines MCF7 and MDA-MB231. These findings recommended more understanding of the role of SSTRs functions in breast tumour biology to improve therapy in estrogen receptors positive and estrogen receptors negative breast cancers.&#xD;
&#xD;
Conclusion &#xD;
&#xD;
SSTRs (1-5) were expressed in both MDA-MB231 and MCF7 cell lines, but the level of expression differed between both cell lines. The activation of SSTRs receptors in ER+, PR+ tumour may be considered. SSTRs overexpression in aggressive tumours (ER-, PR-) may be considered as a target for therapeutic strategy. Future research is warranted to study the functions of SSTRs.&#xD;
&#xD;
Abbreviations&#xD;
&#xD;
SSTRS: Somatostatin receptors; qRT-PCR: Quantitative polymerase chain reaction; mRNA: Messenger RNA; ER: Estrogen receptors; PR: Progesterone receptors.&#xD;
&#xD;
Acknowledgements&#xD;
&#xD;
Authors acknowledge the Programme for Training and Research in Italian Laboratories (TRIL) fellowship. The authors would like to thanks Dr G. Bossi for kindly gifted MCF7 and MDA-MB231 human breast cancer cell lines. The 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&#xD;
&#xD;
Nothing to report &#xD;
&#xD;
Source of funding &#xD;
&#xD;
International Centre for Theoretical Physics (ICTP) - Training and Research in Italian Laboratories (TRIL). &#xD;
&#xD;
Conflicts of interest&#xD;
&#xD;
The authors have no conflict of interest. &#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study to Assess the Predictors of Aggression Among School Going Children&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>14</FirstPage><LastPage>18</LastPage><AuthorList><Author>Arati Raut</Author><AuthorLanguage>English</AuthorLanguage><Author> Pragati Mahakulkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Rutusha Landge</Author><AuthorLanguage>English</AuthorLanguage><Author> Gayatri Ledange</Author><AuthorLanguage>English</AuthorLanguage><Author>  Mayuri Lende</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhagyashri Mahabudhe</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Predictors, Aggression, Among, School children</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3498</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3498</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Clinical Profile of Diagnosed Cases of Acute Pancreatitis Coming to a Tertiary Care Hospital&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>19</FirstPage><LastPage>22</LastPage><AuthorList><Author>Rahul Ranjan</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharaddendu Bali</Author><AuthorLanguage>English</AuthorLanguage><Author> Tushar Parmeshwar</Author><AuthorLanguage>English</AuthorLanguage><Author> Akhilesh Yadav</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acute pancreatitis, Pain in abdomen, Alcohol</Keywords><Fulltext>Introduction&#xD;
&#xD;
The pancreas is a major gland situated behind the stomach and next to the small intestine. It releases powerful digestive enzymes into the small intestine to aid food digestion. There are two main things the pancreas does. It stimulates the hormones insulin and glucagon in the bloodstream, too. These hormones allow the body to monitor the way food is used for energy.1 Pancreatitis is a disease where the pancreas is inflamed. Pancreatic damage occurs when digestive enzymes are stimulated before they are released into the small intestine and begin targeting the pancreas. Exocrine and endocrine (sometimes) parenchymal injury are correlated with pancreatitis, resulting in clinical manifestations varying in intensity from a mild, self-limited disease to a life-threatening acute inflammatory phase, which may range in duration from a temporary assault to a permanent pancreatic function loss. Pancreas inflammatory disease can be known as acute or chronic pancreatitis.2,3 A sudden inflammation that persists for a brief period is acute pancreatitis. It can range from moderate pain to a serious, life-threatening illness. Chronic pancreatitis is an inflammation of the pancreas that is long-lasting. It most commonly occurs after an acute pancreatitis episode.4,5 The aetiology of pancreatitis varies according to geographical location, but alcohol, gallstones, metabolic factors and medications are most frequently involved. By both clinical and routine radiological approaches, the pancreas is a hard organ to test. The inflammatory pathology involving the pancreas may be included in the differential diagnosis of other abdominal pain disorders. In most patients, the combination of sufficient clinical results and laboratory testing allows for a correct diagnosis of acute pancreatitis. On the other hand, chronic pancreatitis forms a far more complicated clinically or biochemically assessable entity.6&#xD;
&#xD;
Material AND methods&#xD;
&#xD;
This is a Prospective, observational, Clinical study on Diagnosed cases of Acute Pancreatitis coming to our hospital. A total of 50 consecutive cases fulfilling the eligibility criteria were taken for study after informed consent. Valid informed consent was taken from patients or patients relatives to be included in the Study. The clinical, laboratory and radiological data were collected from each patient diagnosed with acute pancreatitis within 24 hours of presentation. &#xD;
&#xD;
Inclusion Criteria: All adults (&gt; 18 years) of both genders. Cases of acute pancreatitis with raised serum lipase/ amylase levels and confirmed on USG/ CT scan.&#xD;
&#xD;
Exclusion Criteria: Pancreatitis with gut perforation &amp; Pancreatitis in pregnancy.&#xD;
&#xD;
Results&#xD;
&#xD;
&#xD;
&#xD;
Mean age of the study cases was 41.56 years with over half of the cases (52%) were between 21-40 years of age. &#xD;
&#xD;
&#xD;
&#xD;
Male predominance was seen among study cases with 64% males to 36% females.&#xD;
&#xD;
&#xD;
&#xD;
Most common symptoms among presenting cases was pain in abdomen (100%) and vomiting (76%). Other symptoms include fever (42%) and jaundice (28%).&#xD;
&#xD;
&#xD;
&#xD;
The most common aetiology for pancreatitis among study cases was alcohol (52%) followed by biliary calculi (24%) and idiopathic (24%).&#xD;
&#xD;
&#xD;
&#xD;
Good outcome was seen in 46% of cases while mortality rate was 2%. Associated complications include pancreatic fluid collection (24%), pancreatic pseudocyst (14%), organizing necrosis (12%) and ascites/ pleural effusion (2%).&#xD;
&#xD;
&#xD;
&#xD;
Mean hospital stay among study cases ranges from 1-30 days with a mean stay of 10.2 days.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The mean age of the study cases was 41.56 years with over half of the cases (52%) were between 21-40 years of age. The findings show that pancreatitis occurs in relatively younger adults. Male predominance was seen among study cases with 64% males to 36% females with male to female ratio as 1.78:1. In a similar study by Shakeel et al,7 mean age of study subjects was 37.4 years with the highest patients in the age group of 20 &#x2013; 39 years (51%) followed by 40 &#x2013; 59 years (36%). Males constituted 80% and females 20%. In another study on acute pancreatitis by Prasad et al,8 out of 40 patients, 22 were males and 18 were females. The majority of patients were in the age group of 21-40 (57.5%). The study by Negi N et al9 included 89 (72.35%) male and 34 (27.65%) female patients with a male to female ratio were 2.6:1. The age of patients ranged between 18 to 81 years. The mean age was 42.89 &#xB1;12.53 years. The result observed in the present study and that by other authors showed that pancreatitis mainly affects younger adults with the male being affected more than females. The gender bias can be attributed to the aetiology of the pancreas i.e. alcohol which is consumed predominantly by males in the Indian community. In the present study, the most common symptoms among presenting cases were a pain in the abdomen (100%) and vomiting (76%). Other symptoms include fever (42%) and jaundice (28%). Although pain in the abdomen is the most common symptom of pancreatitis, no specific features easily distinguish pain caused by pancreatitis, from that caused by other abdominal conditions. In a study by Shakeel MD et al, abdominal pain was the presenting symptom in all the patients with acute and acute chronic pancreatitis. Our results also correlate with a study conducted by Lee MG et al10 in which 30 (86%) patients out of 35 cases had abdominal pain. Also in this study 16 out of 31 chronic pancreatitis patients did not have pain. In another study by Prasad et al, all the patients with acute pancreatitis presented with pain abdomen, 80% of them presented with nausea/ vomiting, 42.5% of them presented with fever and 30 % of them with jaundice. The most common aetiology for pancreatitis among study cases was alcohol (52%) followed by biliary calculi (24%) and idiopathic (24%).&#xD;
&#xD;
In a study by Prasad et al, the most common aetiology observed among male cases of acute pancreatitis was alcoholism (50%) while in female cases was biliary pathology (72%). In Negi et al, the major etiological groups for cases of acute pancreatitis were: alcohol 73 cases (59.3%) and gallstones, (35.6%). Panda et al10 in their study observed alcohol as the most common aetiology (54.84%) followed by idiopathic cases (48.39%). Good outcome was seen in 46% of cases while the mortality rate was 2%. Associated complications include pancreatic fluid collection (24%), pancreatic pseudocyst (14%), organizing necrosis (12%) and ascites/ pleural effusion (2%). Persistent organ failure &gt; 48 hours i.e. severe acute pancreatitis (SAP) was seen in 8 cases (16%). Macherla R et al11 in their study observed complications in acute pancreatitis as the pancreatic fluid collection (20%), organizing necrosis (14%) and ascites/ pleural effusion (6%). Severe acute pancreatitis was seen in 8 cases (20%). Yadav J et al12 in their study observed the following complications: pancreatic pseudocyst (27.7%), organizing necrosis (39.5%) and severe acute pancreatitis (35.2%). Incidence of severe acute pancreatitis as 19.8% and 23% respectively in previous studies.13,14 The mortality rate in the study by Negi et al was 5.7% while in the study by Bota S et al the mortality rate was 4.6%. Mortality rates observed in the previous studies was also in the range of 6-15%.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Identification of patients at risk for mortality early in the course of acute pancreatitis is an important step in improving outcome. The mean age of the study cases was 41.56 years with over half of the cases (52%) were between 21-40 years of age. Male predominance was seen among study cases with 64% males to 36% females. The most common symptoms among presenting cases were a pain in the abdomen (100%) and vomiting (76%). The most common aetiology for pancreatitis among study cases was alcohol (52%) followed by biliary calculi (24%) and idiopathic (24%). Good outcome was seen in 46% of cases while the mortality rate was 2%. Mean hospital stay among study cases ranges from 1-30 days with a mean stay of 10.2 days.&#xD;
&#xD;
Acknowledgement &#xD;
&#xD;
The author acknowledges the immense help received from the scholars whose articles are cited and included in references to this manuscript. The author is also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. &#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=3499</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3499</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Differences of Domain-specific Physical Activity Levels among the Adults of Majha Region of Indian Punjab: A Cross-sectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>23</FirstPage><LastPage>26</LastPage><AuthorList><Author>Harmandeep Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Sukhdev Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Amandeep Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Tarsem Singh</Author><AuthorLanguage>English</AuthorLanguage><Author>  Vikesh Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Regular participation in physical activity is essential to attain health benefits. Previous studies have stressed to consider domains of physical activity while assessing the physical activity levels across the different sections of the populations. Objective: To assess the differences in physical activity levels between males and females of the Majha region of Indian Punjab. Methods: A cross-sectional survey was conducted including the four districts of the Majha region of Indian Punjab. A total of 1130 participants including 628 females and 502 males were interviewed using the WHO-recommended Global Physical activity questionnaire (GPAQ). Physical activity was assessed in three domains viz. work, transport and recreational. Mann-Whitney U test was applied to compare the non-parametric data of physical activity levels. Results: No significant differences were found in the work domain and transport domain in any of the age group. However, the age group of 53-64 years and the overall sample showed significant differences between both genders (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>GPAQ, Recreation, Work, Transport, WHO, Domain</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Research has shown that regular physical activity (PA) engagement harvests multiple physical and mental health gains.1 Earlier studies have outlined various factors that affect participation in physical activity such as age, gender, socioeconomic status, residence, job nature, health status, self-efficacy, and many more.2,3 Of these, gender is one such factor that has been consistently remained a determinant of participation in physical activity.4 A large body of literature reports that males engage more in physical activity than females.5 Psycho-social factors such as self-efficacy, social support, and motivation are the dominant determinants of females&amp;#39; less participation in physical activity.5&#xD;
&#xD;
Studies in developed nations have assessed the differences in physical activity levels and patterns concerning age and gender among youngsters. A survey conducted by The Health and Behaviour of School Children (HBSC) in twenty European nations indicated that engagement in physical activity decreases with age, and females had less physical activity levels than males.6 As per the previous research, males have lifelong higher physical activity levels than females.7 Following the literature review, we hypothesized significant gender differences in physical activity levels in all age groups. We conducted this study to assess the gender differences of domain-specific physical activity levels among the different age groups. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Study design and participants&#xD;
&#xD;
The study design was cross-sectional. The participants were 1130 adult participants constituting 628 females and 502 males from the four districts (Amritsar, Gurdaspur, Tarn Taran, and Pathankot) of the Majha region of Indian Punjab. The age ranged from 18-64 years, which was further classified into different intervals, viz. 18-29, 30-40, 41-52 and 53-64 years. &#xD;
&#xD;
Data collection&#xD;
&#xD;
The WHO recommended Global Physical Activity Questionnaire (GPAQ) was used to collect data. The GPAQ consists of 15 items that ask the respondents to report moderate and vigorous-intensity physical activities performed in three domains, viz. work domain, transport domain, and recreational domain.10,18 The questionnaire derives the metabolic equivalents of task (MET-minutes/week) during a typical week. MET (Metabolic equivalent of task) is the fraction of an individual&#x2019;s working metabolic rate relative to their metabolic rate while at rest.16 The GPAQ also includes one item of sedentary behaviour, but it was not considered in the analyses.10The data cleaning, coding and processing was done as per the manual of GPAQ.19The students of Master of Physical Education acted as interviewers under the supervision of the principal investigator. A pilot test on 20 subjects tested the data reliability by correlating the data derived by the interviewers against the data derived by the principal investigator.&#xD;
&#xD;
Ethical approval and consent &#xD;
&#xD;
The study was approved by the Board of Control (BOC) of Faculty of Physical Education (T), Guru Nanak Dev University, Amritsar (Letter no. 1150-52/Gen/Ph.D dated 23/09/15). The informed consent was taken from all the participants before the data collection. &#xD;
&#xD;
Statistical Analyses&#xD;
&#xD;
IBM SPSS version 21 was utilized to analyze the data. The normality of data was tested with the Kolmogorov&#x2013;Smirnov and Shapiro-Wilk tests. Since the data were not normally distributed, comparisons of the physical activity levels between genders were made by running the Mann-Whitney U test for non-parametric data. The comparisons were made for each age interval and overall sample in three different domains of physical activity. The alpha level was set at .05 level in all analyses.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Of the total participants, 502 (44.42%) were males. Results of gender differences of MET minutes/week in the work domain are presented in table 1. Mann-Whitney test revealed that no significant differences existed between both genders in the work domain PA in any of the age group. &#xD;
&#xD;
Table 2 outlines the results of gender differences of MET minutes/week in the transport domain. The p-value of each age group (p&gt;.05) exhibited that differences in PA were not significant between males and females. &#xD;
&#xD;
Table 3 outlines the results of gender differences of MET minutes/week in the recreation domain. No significant differences were found in the age group of 18-29, 30-40 and 41-52 years. However, in the age group of 53-64, the mean ranks of males and females were 107.68 and 93.33 respectively. The p-value of .023* (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3500</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3500</Fulltext></URLs><References>&#xD;
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	World Health Organization. Physical Activity. Fact Sheets. 2018 Feb. https://www.who.int/health-topics/physical-activity#tab=tab_1. &#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Knowledge, Attitude and Practice Study Among Rural Antenatal Women Regarding Anaemia, Iron Rich Diet and Iron Supplement&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>27</FirstPage><LastPage>32</LastPage><AuthorList><Author>Archana Dhok</Author><AuthorLanguage>English</AuthorLanguage><Author> Ajay Meshram</Author><AuthorLanguage>English</AuthorLanguage><Author> Lata Kanyal Butola</Author><AuthorLanguage>English</AuthorLanguage><Author> Ruchir Khare</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Pregnancy, Anaemia, Nutrition, Haemoglobin level</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
During Pregnancy maternal nutrition and lifestyle significantly influence the health of mother and child. Maternal nutrition during conception and pregnancy influences the growth and development of the fetus and results in a healthy baby. It is usually assumed that a balanced diet is necessary for all human beings for the proper function of the body system. This indicates that nutrition is a fundamental pillar for human beings, for the health and proper development of the human being.1 It is believed that during pregnancy, it is necessary to have a properly balanced diet to make sure sufficient energy intake without the utilization of the mother&#x2019;s tissues for adequate growth of the fetus to maintain pregnancy.2&#xD;
&#xD;
Iron demand is higher in Pregnancy due to physiological changes for the development and growth of the placenta and fetus. Despite increased iron requirements, pregnancy is a period of increased risk of anaemia, which is higher than that of a non-pregnant state.3-5 According to WHO, the definition of anaemia is &#x201C;a condition in which the number of red blood cells (RBCs) or their oxygen-carrying capacity is inadequate to meet the physiologic demands in the body, in which the haemoglobin level may vary by age, sex, altitude, smoking, and pregnancy status&#x201D;. Anaemia in pregnancy is identified by the WHO as haemoglobin (Hb) level less than 11g/dl and is divided into three levels in terms of severity; Mild anaemia (Hb level, 9 -10.9g/dl), Moderate anaemia (Hb level, 7-8.9g/dl), and Severe anaemia (Hb level 7-4.5 g/dl).6&#xD;
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Anaemia&#xA0;is one of the most common nutritional deficiency disorders affecting&#xA0;pregnant&#xA0;women; the&#xA0;prevalence&#xA0;in developed countries is 14%, in developing countries 51%, and in&#xA0;India, it varies from 65% to 75%. (Feb 15, 2018) World Health Organization (WHO)/World Health Statistics data shows that 40.1% of pregnant women worldwide were anaemic in 2016.7&#xD;
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Anaemia is an indicator of nutritional status, which can significantly contribute to various newborn disorders like birth defects, preterm labour, and low birth weight, which can lead to a global public health problem. Nutritional iron deficiency anaemia (IDA) is the commonest (90%) cause of anaemia in pregnancy. Good nutrition is the best way to prevent iron deficiency anaemia in pregnancy as medication has its side effects. Awareness refers to the knowledge or perception of a situation or fact.8,9&#xD;
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Iron is essential for Fetal and placental development and to expand maternal red cell mass. The requirement of&#xA0; Iron in pregnancy is 27 mg/day compared to 18 mg/day in a non-pregnant state.10 If before conception, the iron levels of a woman is adequate, the physiological changes in pregnancy like cessation of menstruation, increased intestinal absorption and mobilization of reserves, would be sufficient to cover the increased demand in pregnancy. However, epidemiological data indicate that about 41.8% of pregnant women worldwide are anaemic before pregnancy and at least half of this anaemia burden is thought to be due to iron deficiency.11 In 2012 a Cochrane systematic reviewed that women taking daily iron supplements were less likely to have low birth weight babies compared to controls (RR 0.81). Thus daily iron supplementation reduced the risk of maternal anaemia at term by 70% and iron deficiency at term by 57%.12 The recent WHO guidelines recommend daily oral iron supplementation with 30-60 mg of elemental iron as part of antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency .13&#xD;
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During pregnancy, the need for iron for mother and fetus gradually increases and will reach its highest level at the end of pregnancy. The reason for this high demand is mother&#x2019;s blood volume increases up to about 35%, fetus growth, placenta and other mother tissues increase the need for iron up to three to five times in the second and third trimesters. In situations of the low level of storage, this high demand could not be provided even by a diet enriched in iron and can only be partially compensated by an increase in iron absorption.14&#xD;
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Iron deficiency anaemia is a leading cause of maternal morbidity and mortality, prenatal infant loss; physical and cognitive losses in developing countries.15 Women with&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Iron deficiency anaemia are prone to an increased chance of preeclampsia and postpartum haemorrhage, and even a minimal blood loss during birth cannot be tolerated. Iron deficiency anaemia is also associated with a higher incidence of low-birth weight ,preterm birth, pre-maturity, stillbirth, and neonatal death.16 Lack of awareness is the major factor to reach millennium development goal, as the awareness of anaemia among pregnant women is only 72%. It is estimated that iron deficiency and other micronutrients are the main causes of anaemia among women of reproductive age.17 Many pregnant women suffer from a combination of malnutrition, poor weight gain and other micronutrient deficiencies, as well as infections like HIV and malaria which may lead to anaemia 18&#xD;
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Even though anaemia has been identified as a global public health problem for several years, no rapid progress has been observed, and that the prevalence of the disease is still high globally.19 Although there are various methods for treatment and prevention of maternal anaemia, there are still many pregnant women affected by and the contributing factors for the persistence of high incidences are not known.20 It is, therefore, very important to work out a method for the reduction and control of anaemia in women. This study focuses on the prevalence of awareness of anaemia among antenatal women and the association of knowledge, attitude and practice of nutrition during pregnancy and taking iron-rich food. Assessing nutrition-related knowledge, attitudes and practices offer an opportunity to better understand a given situation by providing insights into the social, psychological and behavioural determinants of nutritional status. Thus one of the most effective steps to reduce the prevalence of anaemia during pregnancy is health promotion through various interventions or programmes.&#xD;
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Studies that access and analyse people&#x2019;s nutrition-related knowledge, attitudes and practices (KAP) are a useful method for gaining such an insight into peoples&#x2019; determinants of their dietary habits.&#xA0; It also helps for evaluating people&#x2019;s nutrition-related knowledge, attitudes and practices. In the context of nutrition-related projects or programmes, a situation analysis describes the type and magnitude of nutrition issues and identifies possible causes of the nutritional problems observed. The findings of a situation analysis will help in planning a nutrition intervention aimed at alleviating the nutrition problems identified.&#xD;
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This study can contribute to a situation analysis by helping determine the existing knowledge, attitudes and practices relating to nutrition, which identifies nutrition education priorities. &#xD;
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MATERIALS AND METHODS&#xD;
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The present study comprised 100 Second Trimester Pregnant Women after taking proper consent from them. Pregnant women in the second trimester attending Gynecology and Obstetrics OPD of AVBRH, Sawangi Wardha are included in the study. The pilot study has been done on ten patient and found that majority of them came to ANC investigation in the early second trimester. In First-trimester iron supplementation is not given so their practice about the iron supplement in the form of tablets cannot be assessed. This study was intended to compare the haemoglobin level at the end of the third trimester after giving health promotion through various interventions or programmes depending on the result of the study. It could not be possible in the current scenario of the covid-19 pandemic as a patient was lost to follow up. Data was gathered by using a structured and pretested questionnaire which asked questions on nutrition in pregnancy, anaemia and associated factors. It has three parts as per&#xA0; FAO Guidelines - Macias and Glasauer 10&#xD;
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	&#xD;
	Knowledge &#xD;
	&#xD;
	&#xD;
	Attitudes&#xD;
	&#xD;
	&#xD;
	Practices&#xD;
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Sample Size: N=100&#xD;
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Inclusion criteria: Second-trimester pregnant women, Gravida status both Primigravida and multigravida.&#xD;
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Statistical Analysis &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The data obtained was analyzed statically by computing median (Range). &#xD;
&#xD;
Karl Pearson analysis was used to access the significance of correlation and calculate the p-value. The results were considered statistically significant p&#x2264;0.05. The obtained data in the study were tabulated using Microsoft Excel. Statistical analysis was done using Statistical Package for Social Sciences, version 20.0 software (IBM-SPSS).&#xD;
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RESULTS&#xD;
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This study included a total of 100 students. Out of the 48 were primigravidae and 52 were multigravidae. All pregnant women belong to the second trimester (Table 1).&#xD;
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Out of 100 pregnant women included in the study, 27% were non-anaemic, 62% were mildly anaemic, 11% were mild anaemic depending on the Hb level in gm per dl ( Table 2).&#xD;
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A total of 100 pregnant women participates in the study, out of the majority of them heard about anaemia, Knows about symptoms and causes of anaemia. However many of them did not know about the consequences that occur during pregnancy due to anaemia. A maximum number of women Knows about ways to prevent anaemia and are aware of iron-rich foods. They are in lack knowledge regarding Iron absorption (Table 3).&#xD;
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&#xD;
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Approximately 50 % of women are aware of anaemia and many of them know that it is a serious health problem. They know the importance of including iron-rich foods in their diet but are not that much aware of the preparation of iron-rich foods. Many of them feel that iron-rich foods are tasty but are not confident regarding their preparation (Table 4).&#xD;
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Many of them Practice Consumption of Vitamin C rich fruits, other fruits and consumption of tea/coffee regularly ( Table 5).&#xD;
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The knowledge level of subjects was significantly correlated with their Haemoglobin levels. This indicates that whether the subjects knew about anaemia, its symptoms, causes, consequences or dietary prevention methods, it improves their Haemoglobin levels. There was a significant positive correlation between the Attitude scores of subjects and Haemoglobin levels. This indicates that self-awareness regarding anaemia, attitude on the importance of including iron-rich foods in the diet, attitude regarding the preparation of iron-rich foods and self-confidence in preparing iron-rich foods resulted in better Hemoglobin levels. No significant positive correlation was found between Practice Scores of Subjects and Haemoglobin levels. Practices like consumption of vitamin C rich fruits, frequency of eating fruits and consumption of tea/coffee regularly etc should be incorporated for better Haemoglobin levels of subjects (Table 6).&#xD;
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&#xD;
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Some finding revelled through open-ended questions&#xD;
&#xD;
&#xD;
	&#xD;
	Most pregnant women discontinue the iron tablet due to its side effects and forgetfulness of taking tablets.&#xD;
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	They are not aware of many sources of iron-rich food and their importance in the diet.&#xD;
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	They are not aware of their complications&#xD;
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	&#xD;
	Wrong practice of taking iron tablets&#xD;
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DISCUSSION&#xD;
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This study provides the understandings regarding Knowledge, Attitude and Practice study among rural antenatal women regarding anaemia, iron-rich diet and iron supplement. The majority of the women had heard the term &#x201C;Anaemia&#x201D; and most of the women knew IFA supplements as &#x201C;tablet of strength&#x201D; and were unaware of the terminologies. 70% of the study participants knew about anaemia prevention through dietary measures. They mentioned some common foods in India which are sources of iron. Most of the subjects recognized the lack of iron in food as the cause of anaemia. Knowledge level and attitude scores of subjects were significantly correlated with their Haemoglobin levels. Iron deficiency anaemia is a global health problem as it ranks in the top-20 causes of disability-adjusted life years lost, It is a main cause of morbidity for women of reproductive age, but little is known about knowledge, attitudes and practices related to screening for and management of this problem. This study provides insight into the knowledge, attitude and practices regarding the prevention of IDA among pregnant women attending AVBRH Sawangi, Wardha Maharashtra. According to Allah et al. 21, the risk of IDA anaemia increased with gravidity, decreased birth spacing, gestational age, drinking tea and coffee after meals, and decreased intake of proteins and low level of knowledge and income. Increasing the efforts toward the educational interventions of women of reproductive age regarding preconception counselling and adequate intake of iron-rich food sources, iron and folic acid supplementation and early detection and treatment the anaemia before childbirth.22 Shilpa Jose et al concluded that the Knowledge level of subjects was not significantly correlated with their Haemoglobin levels but a positive correlation between the Attitude and Practice Scores of subjects and Haemoglobin levels.23 &#xA0;Yousuf et al found out that Pregnant women do not have sufficient knowledge related to anaemia during pregnancy. Their perception of complication of anaemia in pregnancy is also poor and attitude towards preventing and treating anaemia is also not satisfactory.24 In this study the pregnant women has knowledge and awareness about anaemia in pregnancy but their practice regarding intake of iron tablets and iron-rich food does not correlate with haemoglobin level. Thus healthy practices should be implemented by them to prevent anaemia. Raksha M, Shameem VPA their study concluded that educating antenatal women about the importance of an iron-rich diet and implementing this into practice will help in the prevention of anaemia. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The current study concluded that the studied pregnant women had good knowledge and positive attitudes but poor practice toward prevention and the prevalence of iron deficiency anaemia. To address the issue of anaemia, the health service sector needs to incorporate health promotion strategies that will positively impact the attitude and practice level of the population.&#xD;
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RECOMMENDATIONS&#xD;
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Education should include antenatal care that focuses on the intake of iron-rich foods, iron supplementation and anti-helminths. Counselling and health education are important for pregnant women with anaemia, to improve their knowledge, awareness and practice to prevent anaemia. Encourage pregnant women to practice intake iron-rich food and iron tablets during pregnancy in the proper way. &#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflicts of Interest -NIL&#xD;
&#xD;
Source of Funding - NIL&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3501</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3501</Fulltext></URLs><References>1.&#xA0; &#xA0; &#xA0;Daba G, Beyene F, Fekadu H, Garoma W. Assessment of knowledge of pregnant mothers on maternal nutrition and associated factors in GutoGidaWoreda, East Wollega Zone, Ethiopia. J Nutr Food Sci 2013;4(1):1-7.&#xD;
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2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Subarnalata S, Basmati P. A study of the nutritional status of pregnant women of some villages in Balasore district, Orissa. J Hum Ecol 2006;20(3):227-232.&#xD;
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3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Dim CC, Onah HE. Prevalence of anaemia among pregnant women at booking in Enugu, South Eastern Nigeria. Med Gen Med 2007;9(3):11- 81.&#xD;
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4.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Noronha JA, Khasawneh EAI, Seshan V, Ramasubraman S, Raman S. Anaemia in pregnancy and challenges. J South Asian Feder. Obst Gynae 2012;4(1):64-70.&#xD;
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5.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Tay KCS, Agboli E. Walana W. Malaria, and anaemia in pregnant and nonpregnant women of child-bearing age at the University Hospital, Kumasi, Ghana. Open J Med Microbiol 2013;3(3):193-200.&#xD;
&#xD;
6.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; World Health Organization Serum Ferritin Concentrations for the Assessment of Iron Status and Iron Deficiency in Populations. Available online: http:// www.who.int/vmnis/ indicators/ serum_ferritin.pdf.&#xD;
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7.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015. http://apps.who.int/iris/bitstream/10665/177094/1/9789241564960_eng.pdf.&#xD;
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8.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; World Health Organization; Global nutrition targets 2025: Anaemia policy brief. &#xD;
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9.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Anthony SF. Harrison principle of internal medicine, 19th edition, McGraw-Hill Education 2015;625-650.&#xD;
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10.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Italian Society of Human Nutrition. DRI of energy and nutrients for the Italian population.A summary document of the XXXV National Congress of The Italian Society of Human Nutrition. Last updated: 2012&#xD;
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11.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; WHO/CDC. Worldwide prevalence of anaemia 1993&#x2013;2005.WHO Global Database on Anaemia. Geneva: World Health Organization, 2008 &#xD;
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12.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Pe&#xF1;a-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012;12:CD004736. &#xD;
&#xD;
13.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.&#xD;
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14.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Balasubramanian T, Aravazhi M, Sampath SD. Awareness of Anaemia among Pregnant Women and the Impact of Demographic Factors on their Hemoglobin Status. Int J Sci Stud 2016;3(12):303-305.&#xD;
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15.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Okeke UP. Anaemia in pregnancy is a persisting public health problem in Porto Novo Cape Verde. J Med Sci 2011;5(4):193-199. &#xD;
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16.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Salzberg HS. Nutrition in pregnancy. In J.J Sciarra (Ed.), Gynecology and obstetrics. Philadelphia: Lippincott Williams &amp; Wilkins. 2002&#xD;
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17.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, et al. The prevalence of nutritional anaemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health 2010;10(32):329.&#xD;
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18.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Huffman SL. Zehner E. Martin L. Mwadime R. Essential Health Sector Actions to Improve Maternal Nutrition in Africa. Essential Health Sector Actions to Improve Maternal Nutrition in Africa. The LINKAGES Project, Academy for Educational Development 29 January 2014. &#xD;
&#xD;
19.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ou&#xE9;draogo S, Koura GK, Accrombessi MM, Bodeau-Livinec F, Massougbodji A, Cot M. Maternal anaemia at first antenatal visit: prevalence and risk factors in a malaria-endemic area in Benin. Am J Trop Med Hyg 2012 Sep;87(3):418-424. &#xD;
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20.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Margwe JA, LupinduAM. Knowledge and Attitude of Pregnant Women in Rural Tanzania on Prevention of Anaemia. Afr J Reprod Health 2018;22(3):71-79.&#xD;
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21.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; AlflahYM, Wahdan IH, Hasab AA. Taye DI, Prevalence and Determinants of Anaemia in Pregnancy, Sana&#x2019;a, Yemen. Int J Public Health Sci 2017;6(3):213-220. &#xD;
&#xD;
22.&#xA0; &#xA0;&#xA0;&#xA0;Alghamdi A. Prevalence of Anaemia among Pregnant Women in Riyadh, Saudi Arabia. International J Health Sci Res 2016;6(9):54-60.&#xD;
&#xD;
23.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Shilpa J, Sreni CA, Betty RI. Impact of Knowledge, Attitude and Practice on Anaemia status among women in coastal Kochi, Kerala. Int J Multidisci Curr Res 2016;9(3):346.&#xD;
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24.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Shagufta Y. KAP study of mothers with anaemia in pregnancy. Int J Sci Res 2019;8(8):2277&#x2013;2282.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Clinical Profile of Upper Gastrointestinal Endoscopy Patients in a Tertiary Healthcare Facility: Cross-Sectional Research&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>33</FirstPage><LastPage>35</LastPage><AuthorList><Author>Rajesh Kothari</Author><AuthorLanguage>English</AuthorLanguage><Author> Sanjay Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Vineeta Kothari</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Upper gastrointestinal endoscopy, Upper gastro-intestinal haemorrhage, USG-Abdomen</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Upper gastrointestinal haemorrhage is a common and potentially life-threatening gastrointestinal emergency, described as a haemorrhage derived from a source proximal to the Treitz ligament, with a broad range of clinical severity, ranging from insignificant bleeds to catastrophic exsanguinating haemorrhage, and is associated with significant morbidity and mortality.1,2 The frequency of upper gastrointestinal bleeding varies from a population of 50 to 150/100,000 each year and time trend analyses indicate that aged people represent a growing proportion of those with acute upper gastrointestinal bleeding. As many as 70% of acute upper gastrointestinal bleeding episodes occur in patients older than 60 years, and the incidence is likely to increase with age due to the increased intake in elderly patients of non-steroidal anti-inflammatory drugs (NSAIDs), which trigger ulcerogenic.3,4 Approximately two-thirds of all patients who have gastrointestinal bleeding in the emergency department have upper gastrointestinal bleeding as the trigger. As both have different treatment procedures and prognosis, patients can be divided as having either variceal or non-variceal causes of upper gastrointestinal haemorrhage.5 The first involves lesions due to portal hypertension, including gastroesophageal varices and portal hypertensive gastropathy; the second includes lesions found in the general population (peptic ulcer, erosive gastritis, esophagitis of reflux, Mallory-Weiss syndrome, tumours, etc.).6&#xD;
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MATERIALS AND METHODS&#xD;
&#xD;
This was a cross-sectional analysis carried out over two years at the tertiary health care centre referred for Upper gastro-intestinal Endoscopy. 256 patients were referred for the procedure during this time. They were subjected to upper gastro-intestinal endoscopy with all aseptic precautions and normal procedures after written and explained consent. Both patients underwent USG &amp; the findings were entered and evaluated by SPSS in excel sheets (Statistical Package for Social Sciences).&#xD;
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RESULTS&#xD;
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The patients had a mean age of 11.42 &#xB1; 6.22 years. The range was from 1-60 Yrs. (The Min-Max)&#xD;
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The majority of the patients were 52 % female and 48 % male.&#xD;
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Hematemesis under investigation was the most common provisional diagnosis (56), accompanied by abdominal mass (40), foreign body (34), vomiting under investigation (28), fever under investigation (26), ascitis under investigation (22), cirrhosis with hypertension portal (14), upper gastrointestinal obstruction (12), dysphagia under investigation (12) and malena under investigation (12) (8).&#xD;
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Coarse echotexture of the liver (64), diffuse liver parenchyma (46), dilated portal vein with splenomegaly (26), dilated portal vein with per fibrosis, massive splenomegaly (24), hepatitis with splenomegaly (22), hepatomegaly with cirrhosis of the liver with splenomegaly (14), hepatomegaly with thickening of the gall bladder with massive ascites (12), hepatomegaly with coarse echotechymia (14), hepatomegaly with thickening of the gall bladder with massive ascites (12), hepatomegaly with coarse echotechymia (12) were the most common USG findings.&#xD;
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&#xD;
DISCUSSION&#xD;
&#xD;
A common reason for doctor consultations and hospital admissions is gastrointestinal haemorrhage.7-9 Endoscopy has been identified as the first-line diagnostic tool in upper Gastro-intestinal haemorrhage, and many therapeutic modalities have been created. Nuclear scintigraphy, mesenteric angiography and colonoscopy are methods of diagnosing lower Gastro-intestinal haemorrhage, however, a single standard procedure has not been developed since each has inherent advantages and disadvantages.10-11 In the diagnosis of inflammatory bowel disease, ischaemic colitis, bacterial colitis and malignant bowel tumours, and other bowel diseases, the sono-morphological presence of bowel wall thickening in patients with acute or chronic gut disorders has recently been assessed for its importance.12 A non-invasive and repeatable imaging analysis that can be done effectively without bowel planning is trans-abdominal ultrasonography.13-15 In our analysis we have shown the average age of the patients was 11.42 &#xB1; 6.22 Yrs. The range was from 1-60 Yrs. (The Min-Max). The majority of the patients were 52 % female and 48 %, male. Hematemesis under investigation was the most common provisional diagnosis (22 %), followed by mass per abdomen (16 %), foreign body (13 %), vomiting under investigation (11 %), fever under investigation (10 %), ascites under investigation (9 %), hypertension portal cirrhosis (6 %), upper gastrointestinal obstruction (5 %), dysphagia and dysphagia (3 %). Coarse liver eco texture (25 %), diffuse liver parenchyma (18 %), dilated portal vein with splenomegaly (10 %), dilated portal vein with per fibrosis, massive splenomegaly (10 %), hepatitis with splenomegaly (9 %), hepatomegaly with splenomegaly liver cirrhosis (6 %), hepatomegaly with splenomegaly (6 %), hepatomegaly with M gall bladder thickening(2 %), were the most common USG findings.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
From our study, it can be concluded that Hematemesis under study followed by Mass per abdomen was the most common provisional diagnosis. Coarse Ecotexture of Hepatic accompanied by Diffuse Parenchymal Hepatic modifications were the most common USG findings. For diagnosis and treatment of patients, this sonographic examination along with clinical results is useful. Aggressive public education and close monitoring of patients who are found to have alcohol-related liver disorders are recommended. If life expectancy rises, caution should be taken for older adults and patients with comorbid conditions, leading to high mortality from GI bleeding.&#xD;
&#xD;
&#xA0;Acknowledgement:&#xA0;The author acknowledges the immense help received from the scholars whose articles are cited and included in references to this manuscript. The author is also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. &#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=3502</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3502</Fulltext></URLs><References>1. Rockall T, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National audit of acute upper gastrointestinal haemorrhage. Lancet 1996;347:1138&#x2013;1140.&#xD;
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2. Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J. 2002;78(915):4&#x2013;14.&#xD;
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3. Thomopoulos K, Vagenas KA, Vagianos CE, Margaritis VG, Blikas AP, Katsakoulis EC, et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal haemorrhage during the last 15 years. Eur J Gastroenterol Hepatol 2004;16:177&#x2013;82.&#xD;
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4. Van Leerdam ME, Vreeburg EM, Rauws EAJ, Geraedts AAM, Tijssen JGP, Reitsma JB, et al. &#xA0;Acute upper GI haemorrhage: Did anything change? Time trend analysis of incidence and outcome of acute upper GI haemorrhage between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494&#x2013;1499.&#xD;
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5. Rockall T, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal&#xA0; Haemorrhage. BMJ 1995;311:222&#x2013;226.&#xD;
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6. Srygley F, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA 2012;307:1072&#x2013;1079.&#xD;
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7. Ginn J, Ducharme J. Recurrent haemorrhage in acute upper gastrointestinal haemorrhage: Transfusion confusion. CJEM 2001;3:193&#x2013;198.&#xD;
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8. Wardehoff D, Gros H. Endoscopic haemostasis by injection therapy in high-risk patients. Endoscopy 1982; 14: 196&#x2013;9.&#xD;
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9. Sugawa C, Fujita Y, Ikeda T, Walt AJ. Endoscopic haemostasis of haemorrhage of the upper gastrointestinal tract by local injection of 98% dehydrated ethanol. Surg Gynecol Obstet 1986;162:159&#x2013;163.&#xD;
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10. Panes J, Viver J, Forn&#xE9; M, Garcia-Olivares E, Marco C, Garau J. Controlled trial of endoscopic sclerosis in haemorrhage peptic ulcers. Lancet 1987;ii:1292&#x2013;1294.&#xD;
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11. Shorvan P, Leung JW, Cotton PB. Preliminary clinical experience with the heat probe at endoscopy in acute upper gastrointestinal haemorrhage. Gastrointest Endosc 1985;31:364&#x2013;366.&#xD;
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12. Zackerman G, Prakash C. Acute lower intestinal haemorrhage. I. Clinical presentation and diagnosis. Gastrointest Endosc 1998;48:606&#x2013;617&#xD;
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13. Gostout CJ. The role of endoscopy in managing acute lower gastrointestinal haemorrhage. N Engl J Med 2000;342:125&#x2013;127&#xD;
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14. Lim J, Ko YT, Lee DH, Lim JW, Kim TH. Sonography of inflammatory bowel disease: findings and value in the differential diagnosis. AJR Am J Roentgenol 1994;163:343&#x2013;347&#xD;
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15. Kunihiro K, Hata J, Haruma K, Manabe N, Tanaka S, Chayama K. Sonographic detection of longitudinal ulcers in Crohn disease. Scand J Gastroenterol 2004;39:322&#x2013;326.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Haematological Findings and Pattern Analysis in Patients with COVID-19 Infection&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>36</FirstPage><LastPage>41</LastPage><AuthorList><Author>Piyush Sahu</Author><AuthorLanguage>English</AuthorLanguage><Author> Anshika Rai</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpi Sahu</Author><AuthorLanguage>English</AuthorLanguage><Author> Kishor Raut</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Coronavirus, COVID-19, Neutrophil: Lymphocyte ratio, Platelet: Lymphocyte ratio, Complete blood cell count</Keywords><Fulltext>Introduction&#xD;
&#xD;
Today the world is facing a pandemic, caused by a novel virus, Severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV).1 The Clinical characterization of COVID-19 has been broadly defined by WHO 2 with most of the confirmed COVID-19 cases have mild to the moderate clinical presentation which can rapidly deteriorate threatening life. The diagnosis of COVID-19 is confirmed by RT-PCR, which has limited availability, variable turnaround time, and low sensitivity. Basic haematological indicators can be readily obtained from a routine complete blood cell count (CBC), is inexpensive and may provide prognostic information thereby lowering the mortality rate.1-3 &#xD;
&#xD;
The National Health Commission of China,3 WHO interim Guidance 2 &#xA0;as well as many Chinese and western studies currently recommend many haematological parameters including Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio may also have prognostic value in determining severity. However, there is a need for research to evaluate the pattern of the haematological parameters of COVID-19 patients in the Indian population.4, 5 In the present study we aimed to study the haematological parameters in COVID-19 patients, which includes haemoglobin, RBC indices, Platelet count, Total leucocyte count, differential count, Neutrophil: Lymphocyte ratio (NLR), Platelet: Lymphocyte ratio (PLR) and Peripheral smear findings. In addition, we will establish the correlation between various haematological parameters. &#xD;
&#xD;
Material and Methods&#xD;
&#xD;
A retrospective study carried out on 150 COVID-19 positive patients admitted in June and July 2020 in a tertiary care hospital, Navi Mumbai, India. Institutional Ethics committee approval was obtained. The positive cases of COVID-19 by RT-PCR were included in the study. Patients with chronic lung diseases, haematological disorders and malignancy on treatment were excluded from the study. In this study, for both Non-ICU and ICU patients, the first blood sample collected for obtaining the haematological parameters was considered and compared for statistical analysis.6-8&#xD;
&#xD;
CBC was done on 7-part haematological analyzer (Sysmex XN &#x2013; 1000). It includes following parameters with their respective cut-off values: Hemoglobin: 13.5 &#x2013; 17.5 g/dl (male) and 12.0 &#x2013; 15.6 g/dl (female); Platelet count: 1.5 &#x2013; 4.5 lakh/cumm; Total WBC count: 4,000 &#x2013; 11,000/cumm, Absolute neutrophil count (ANC):1,500- 8,000/cumm; Absolute lymphocyte count (ALC):1,000 &#x2013; 4,800/cumm; Neutrophil count: 55-70%; Lymphocyte count: 20-40%; Eosinophil count: 0-6%; Monocyte count: 0-7%. &#xD;
&#xD;
Neutrophil lymphocyte ratio (NLR) was calculated by taking the ratio of absolute neutrophil count to absolute lymphocyte count with cut-off &lt; 3.13. Platelet Lymphocyte ratio (PLR) was calculated by taking the ratio of platelet count to absolute lymphocyte count with cut-off 3.13 were prone to develop severe illness. In a study by Forget et al., it was identified that normal NLR values in a healthy adult should be between 0.78 and 3.53. In an Indian study based in Noida, similar findings were observed.43 All these studies suggested that the NLR was the most useful prognostic factor affecting the prognosis for severe illness patients.35&#xD;
&#xD;
Platelets&#xD;
&#xD;
In the present study, there was no significant difference observed in the platelet count. However, many other studies suggest thrombocytopenia be a predominant feature in severe COVID-19 patients.8 Although, few studies23 did not indicate any differences in platelet count between patients with severe disease and those exhibiting mild disease. Despite the differences in individual observations made by the authors, recent studies suggest coagulopathy as a known complication of COVID-19. Severe cases may be at risk of developing thrombocytopenia, so it is advisable to monitor the platelet count in all ICU cases.34&#xD;
&#xD;
Platelet Lymphocyte Ratio (PLR)&#xD;
&#xD;
The ratio of Platelet count to absolute lymphocyte count was not found to be having a significant difference while comparing both groups. In one study, PLR emerged as an independent prognostic factor for prolonged hospitalization in the multivariate analysis.24 It was suggested that a high PLR may indicate a more pronounced cytokine storm due to enhanced platelet activation. In a study conducted by Tiwari33 no significant differences in PLR were seen, as observed in the present study. However, as the platelets are dynamic parameter, the relevance of PLR can only be interpreted if follow up samples at different time points are taken.&#xD;
&#xD;
Peripheral smear findings&#xD;
&#xD;
Significant Peripheral smear findings in the form of reactive changes in neutrophils, lymphocytes and monocytes were observed in few ICU cases as described above. Similar morphological features were noted in the study done in Ludhiana, India.35 This can be attributed to the viral cytopathic effect of SARS-CoV.&#xD;
&#xD;
Limitation of the study&#xD;
&#xD;
We took the above parameters as a one-time value i.e. during admission to the Wards and after shifting to ICU. To access the severity, it&amp;#39;s better suggested to take multiple samples at regular intervals to demonstrate a trend. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
The confirmatory diagnosis of COVID-19 requires RT-PCR analysis, which is time-consuming and less accessible test. Therefore, for initial diagnosis, as well as decision-making for deciding severity and ICU requirement, certain haematological parameters are valuable. We observed lymphopenia, eosinopenia, neutrophilia, leucocytosis and decline of haemoglobin in COVID-19 confirmed cases. All these parameters showed significant aggravation in critically-ill ICU patients as compared to the non-ICU group. Increased NLR identified as an important risk factor of severe illness in patients with SARS-CoV-2 infection and could be used as a basic haematological tool in deciding the prognosis. A onetime PLR is not indicative of disease progression. The morphology of leucocytes showing viral effects can be readily identified on peripheral smear and can be easily and serially monitored, which could also aid in diagnosis and prognostication. The effects of SARS-CoV-2 on hematopoiesis are still poorly understood, which deserves further exploration.&#xD;
&#xD;
Disclosure of Conflict of interest:&#xD;
&#xD;
The authors have no potential conflicts of interest to disclose.&#xD;
&#xD;
Source of funding:&#xD;
&#xD;
Since it was a retrospective study requiring medical report data, no funding was needed.&#xD;
&#xD;
Acknowledgements:&#xD;
&#xD;
We are deeply grateful to all the healthcare workers in our hospital who are fighting bravely against this pandemic. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3503</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3503</Fulltext></URLs><References>1. Cheng VC, Lau SK, Woo PC, Yuen KY. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Micr Rev 2007;20(4):660-694.&#xD;
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15. Dinga X, Yua Y. Dynamic profile and clinical implications of haematological parameters in hospitalized patients with coronavirus disease 2019. Clin Chem Lab Med 2020;58(8):1365&#x2013;1371.&#xD;
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35. Li Q, Ding X, Xia G. A simple laboratory parameter facilitates early identification of COVID-19 patients. medRxiv 2020. doi:10.1101/2020.02.13.20022830&#xD;
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38. Liu Y, Yang Y, Zhang C. Clinical and biochemical indexes from 2019-to infected patients linked to viral loads and lung injury. Sci China Life Sci 2020;63(3):364&#x2013;374.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of Cartridge Based Nucleic Acid Amplification Testing in Diagnosis of Extrapulmonary Tuberculosis- Experience from a Teaching Institution in Eastern India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>42</FirstPage><LastPage>47</LastPage><AuthorList><Author>Mukherjee S</Author><AuthorLanguage>English</AuthorLanguage><Author> Biswas D</Author><AuthorLanguage>English</AuthorLanguage><Author> Begum S</Author><AuthorLanguage>English</AuthorLanguage><Author> Ghosh P</Author><AuthorLanguage>English</AuthorLanguage><Author> Pal A</Author><AuthorLanguage>English</AuthorLanguage><Author> Sarkar S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Extrapulmonary tuberculosis, Nucleic acid amplification test, Pus, Rifampicin resistance, Multi-drug resistant tuberculosis</Keywords><Fulltext>Introduction&#xD;
&#xD;
Extrapulmonary tuberculosis (EPTB) accounts for about one-fourth of tuberculosis (TB) cases worldwide and in India, it accounts for about 15%-20% of the total tuberculosis cases.1-3 Diagnosis of EPTB is often challenging because the yield of smear and/or mycobacterial culture is often low and time-consuming. Demonstration of a caseating granuloma on biopsy specimens is not always confirmatory but the facility of histopathology with mycobacterial culture from the biopsy tissue sample is not always available.4-6 Moreover, mycobacterial culture is time-consuming and is costly, too.7,8 CBNAAT is a completely automated test that utilizes principles of nested polymerase chain reaction (PCR)and can identify genes specific for Mycobacterium tuberculosis. It detects rifampicin resistance as well and the result is obtained very quickly, World Health organisation has endorsed the use of CBNAAT as a rapid molecular diagnostic test.9,10&#xA0; There has been a paucity of data from eastern India regarding the role of CBNAAT&#xA0; in the diagnosis of&#xA0; EPTB cases post-implementation of CBNAAT as a rapid diagnostic test in RNTCP.In this background, the study was conducted to evaluate the diagnostic role of CBNAATin&#xA0; different forms of EPTB.&#xD;
&#xD;
Material and Methods&#xD;
&#xD;
A prospective, observational and analytical study of all adult cases (above 12 years of age) of EPTB, attending outpatients department or admitted in the&#xA0; Respiratory Medicine and other departments of a tertiary care Hospital in Kolkata was undertaken throughout one and half year (July 2017-December 2018).&#xD;
&#xD;
Case definition11&#xD;
&#xD;
Microbiologically confirmed Extra-Pulmonary tuberculosis (EPTB): refers to a presumptive EPTB with nonrespiratory clinical sample positive for acid-fast bacilli (AFB) by Ziehl-Neelsen (Z-N) stain or positive for Mycobacterium tuberculosis on culture, or positive for tuberculosis through a quality-assured rapid molecular diagnostic test.&#xD;
&#xD;
Clinically/histologically diagnosed EPTB case&#xD;
&#xD;
A patient diagnosed as EPTB on clinical, radiological and/or cytopathology /histopathology evidence of caseating epithelioid granuloma with giant cells consistent with tuberculosis in absence of a microbiological confirmation. Written informed consent was obtained. Institutional ethics committee approval was taken (IEC No.- (CMSDH/IEC/78/04-2017).&#xD;
&#xD;
Inclusion/Exclusion criteria&#xD;
&#xD;
All cases of microbiologically confirmed or clinically or histologically diagnosed EPTB cases attending outpatients department or admitted in different indoor departments of the teaching hospital during the study period. Patients with age less than 12 years, unable to provide consent for the study were excluded..&#xD;
&#xD;
Study protocol&#xD;
&#xD;
All patients satisfying the case definition and inclusion criteria were considered for subsequent investigation and analysis. Patients were evaluated with history and clinical examination and organ-specific sample was sent for CBNAAT as per Revised National Tuberculosis Control Program (RNTCP) protocol for Mycobacterium tuberculosis(Cepheid, GX-IV Processing Unit: 11.00" w x 12.00" h x 11.70" d, GXIV-4-D).9,11,12 The second falcon tube was sent for Line Probe Assay (LPA) for the first line and second line baseline drug sensitivity testing (FL-LPA and SL-LPA) to an intermediate reference laboratory (IRL) if Rifampicin resistance detected. Clinical specimens were also sent for smear microscopy for AFB by Z-N stain. Clinical samples were tested for mycobacterial culture (BACTEC), cytopathology, histopathology, cytology, biochemical estimations, estimation of adenosine deaminase (ADA) in relevant cases. Sputum for AFB smear and chest X-ray posteroanterior (PA) view was done in all patients. Computed Tomography (CECT) scan of thorax with contrast, ultrasonography (USG) of abdomen, magnetic resonance imaging (MRI) of brain and spine were done additionally in respective cases of EPTB. Blood were sent for testing for HIV infection at the integrated counselling and testing centre (ICTC) of our hospital. Relevant haematological investigations like fasting blood sugar, complete hemogram, urea, creatinine and baseline liver function test were also done in all patients. &#xD;
&#xD;
A composite reference system (CRS) [ comprising of positive AFB smear and/or positive mycobacterial culture and/or positive cytopathology/histopathology demonstrating caseating epithelioid granuloma with giant cells, and/or positive radiological findings, and/or positive cellular and biochemical parameters (lymphocytosis and raised&#xA0; ADA ), and/or clinical diagnosis of EPTB with the response to treatment with antitubercular drugs] was considered as the gold standard for diagnosis of EPTB in this study and performance of CBNAAT was compared with the CRS.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
SPSS version 20.0 (SPSS inc. Chicago, IL) was used for statistical analysis. Categorical data were expressed in terms of percentages and mean&#xB1;standard deviation (mean&#xB1;SD) was used for analyzing continuous variables. Fisher&#x2019;s exact test and Chi-Square test were used for calculation of P-value and the P value of less than 0.05 was considered to be of significance for this study.&#xD;
&#xD;
Results&#xD;
&#xD;
Distribution of Extra-pulmonary TB cases&#xD;
&#xD;
A total of 502 cases of EPTB were recruited during the study period. Out of this 502 cases, 284 were tubercular pleural effusion, ten were tubercular empyema, 26 cases were tubercular ascites, 114 cases were tubercular lymphadenopathy, 51 cases were tubercular cold abscess,&#xA0; eleven cases were caries spine with paravertebral abscess, four cases were tubercular meningitis and two cases were endometrial tuberculosis. Twenty-five cases (4.98%) had a previous history of anti-tubercular drug intake for more than one month. Seventy-three (14.5%) patients were referred from private practitioners.&#xD;
&#xD;
Demographic profile&#xD;
&#xD;
The mean age of EPTB patients in the study population was 36.49 &#xB1;14.05 years with male predominance (61.1%, 306 of 502). There was no significant difference in age distribution between male and female EPTB patients but tubercular meningitis (p-0.023) and tubercular empyema (p-0.04) affected the younger population more compared to other subgroups of EPTB. Disseminated tuberculosis was found in five cases and was significantly more associated with TB meningitis (p-0.003). Diabetes mellitus was detected in 36 patients (7.17%) and human immunodeficiency virus (HIV) co-infection was found in ten cases (1.99%).&#xD;
&#xD;
The pleural fluid AFB smear had a yield of 4.8% (12 out of 294) (tubercular effusion 5 out of 284; Tubercular empyema 7 out of 10). Sputum for AFB smear was positive in four out of ten (40%) empyema cases. Pleural fluid ADA level was more than 70 unit in 129 out of 284 patients (47.4%). Caseating granuloma was detected in 18 out of 35 pleural biopsy specimens (51%). Lymph node FNAC showed AFB smear positivity in 28 out of 114 cases (24.6%), and five out of eleven (45.5%) cases of cold abscess aspirate.&#xD;
&#xD;
Result of CBNAAT&#xD;
&#xD;
Overall, CBNAAT was positive in 138 patients out of 502 patients (27.5%). CBNAAT result showed very high yield in caries spine (10 out of 11; 90.9%), tubercular empyema (9 out of 10; 90%), TB meningitis (3 out of 4; 75%) and tubercular cold abscess (36 out of 51; 74.5%); the moderate yield was seen in tubercular lymphadenopathy (60 out of 114; 52.6%) and endometrial tuberculosis (50%); but in case of tubercular pleural effusion (6.3%) and ascites (3.8%) yield of CBNAAT was very low. On comparing the rate of CBNAAT positivity among different organ-specific samples, the yield was very highly positive in samples containing pus (p-</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3504</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3504</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Management of Herpes Zoster (Visarpa) by Combination Therapy &#x2013; A Case Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>48</FirstPage><LastPage>50</LastPage><AuthorList><Author>Wairagade SD</Author><AuthorLanguage>English</AuthorLanguage><Author> Wairagade T</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagrare AV</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahakalkar C</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Herpes Zoster, Pittaj Visarpa, Shaman Chikitsa, Ayurvedic formulation Lepa</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Herpes zoster is commonly known as shingles caused by the varicella-zoster virus (VZV). Due to ageing or immunosuppression decrease in immunity for VZV causes reactivation of VZV in dorsal root ganglia. There is unilateral vesicular eruption within the dermatome associated with severe pain.1 Modern medicine doctors routinely manage it with antiviral therapy like acyclovir, corticosteroids and the local application of lidocaine jelly. In herpes zoster, early clinical diagnosis and management within 72 h after the appearance of the rash is important to avoid complications.2 The main aim of treatment is pain management; induce healing, reduction in viral spread and avoidance of complications. This technique is cost-effective and easy to apply. It is being used for a wide range of diseases in Ayurveda including pain and burning management and skin diseases.3&#xD;
Exosomes are extracellular vesicles released from cells upon fusion of an intermediate endocytic compartment, the multi-vesicular body (MVB), with the plasma membrane. They are means of intercellular communication and transmission of macromolecules between cells. Exosomes have been attributed roles in the spread of proteins, lipids, mRNA, miRNA and DNA and as contributing factors in the development of several diseases including herpes. Exosomes are involved in immune responses; they activate T cells in the activation of immune responses. Exosomes transfer protein, lipids mRNA and microRNA into acceptor cells. They also provide the means of bad communication in various neurodegenerative diseases. They can be found in various body ?uids like blood, CSF, Stool, Urine and even exhaled air.4 In Ayurveda, Visarp is Vata pitta predominant, and a wide range of acute skin diseases may be included under herpes is one of them.&#xA0;&#xD;
&#xD;
Patient information&#xD;
It is a single case study and the informed consent of the patient is taken in his language. A 28-year-old male visited in OPD (OPD no. &#x2013; 2011060009) of &#xA0;Kayachikitsa at Datta Meghe Ayurved Medical College Hospital and Research Centre with blisters in the left axilla and left the subscapular region with severe burning pain.&#xA0;&#xD;
&#xD;
FINDINGS&#xD;
General examination:&#xD;
The patient was febrile, pulse 80/min, blood pressure 110/80 mm Hg. His appearance was pale. Blisters were present in the left axilla and left sub- scapular region.&#xD;
&#xD;
Systemic examination:&#xD;
In the systemic examination, respiratory, cardiovascular system examination was within normal limits. The patient was conscious but he was restless, severe pain and burning at the site of the axillary nerve was also present, his pupillary re?exes were within normal limits. Deep tendon re?exes &amp; super?cial re?exes were also normal.&#xD;
Ashtavidha Parikshan his Nadi (pulse) was Vatpittaj, Jivha (tongue) was Sama (coated), Aakriti was Madhyam (medium built), bowel habit was regular and normal. Druk (vision) was normal.&#xD;
&#xD;
Clinical ?ndings&#xD;
The patient had a complaint of blisters in the left axilla and left the sub- scapular region with severe burning pain ZBPI Score was very high that eventually reduced after treatment.&#xD;
&#xD;
Diagnostic assessments&#xD;
The patient was diagnosed based on clinical ?ndings. Photographs are given in Figure 1. The assessment was done based on the Zoster Speci?c Brief Pain Inventory (ZBPI) questionnaire.5 It is a Pain Scale based on a Brief Pain inventory. It is herpes zoster; hence a more reliable for diagnostic and therapeutic assessment of herpes in clinical trials. This also measures intensity, Duration, the area covered, mental condition relations of patients with other people, ability to perform daily activities.6&#xD;
&#xD;
THERAPEUTIC INTERVENTION&#xD;
The treatment plan was done considering Vatpitta Dosha, Rakt Dhatu, Tvacha Sthan. Removal of Dushta Rakta along with Shaman through internal medicines was considered. The involvement of Ambu (Kled) is also considered an important factor during planning the treatment6. Ayurveda Treatment was planned considering Vyadhi Sankar of Visarpa. S. Table 1 summarizes various properties of internal medicines mentioned in Ayurveda.7 Easy availability of these medicines at our hospital and Ayurveda description of the medicines both were given importance to choose particular medicines.&#xA0;&#xD;
A] Chandrakala Vati&#xD;
B] Panchatiktaghruta guggulu&#xD;
C] Ayurved formulation Lepa no.1 &#x2013;&#xA0;&#xD;
Gairika Churna 5gm + Yastimadhu Churna 3gm + Chandan 1gm for Lepa (external application) twice daily with Dugdha was given for local application. This Lepa is mainly indicated in burning and wound healing.&#xD;
D] Acyclovir (400 mg)&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
Follow up and outcomes&#xD;
The patient got relief in the severity of burning pain and other symptoms; rash and blisters were also subsided due to combination therapy within 3 days. This was assessed by the ZBPI questionnaire. Changes after 3 days follow-ups are shown in images [Figure 1 and 2]. Currently patient does not have any pain, burning related to herpes till the date of submission of this version of the manuscript.&#xA0;&#xD;
&#xD;
&#x2003;&#xD;
&#xD;
DISCUSSION&#xD;
Herpes zoster commonly known as shingles has a rapid spread along with severe burning at the site of lesion Varicella virus (VZV). Skin disorders vary greatly in symptoms and severity. So they can be temporary or permanent. They can be situational or genetic, minor or mortal. Thus, Visarpa is one which if mismanaged can lead to a life-threatening situation. Tvaka Roga is Chirakari and so recurrent relapse occurs easily. It has been stated that, Punahpunah shodhan in Bahudoshajanya Tvak Roga.5-7&#xA0;&#xD;
&#xD;
Chandrakala Vati: This contains Vanga, Ayasa, Abhraka bhasma, Kajjali, Shalmali etc with Bhavana of GhritKumari, durva in it. It acts upon Pittaj vyadhi Hence Beneficial in all kind of Daha.8&#xD;
Panchatiktaghruta guggulu:9 This is a very potent drug indicated exclusively by Chakradutta in Kushtha Adhikar, due to the combination of Tikta Rasa and Ghruta kalpana, this makes it very potent as Raktadosha Pachaka and Raktaprasadaka. It acts on Vatashonitaja vyadhi. If Vata is aggravated in excess compared to Pitta then Tiktaghruta is useful.9&#xD;
Gairika Bhasma - Gairika a silicate of alumina and oxide of Iron. As per Acharya Charaka, Garika is one among Khusthahar Pradeha. It is having properties i.e. Madhur Kashaya Rasa Snigdh Guna and Sheet Virya Due to its property it Act as Pitta Shamka.10&#xD;
Yastimadhu churna - It is the most commonly used Ayurvedic herbs. It is having property i.e. Madhura in Rasa, Guru, Snigdha in Guna, Madhura in Vipaka, and Sheet Virya in nature, Due to its property, it pacifies the aggravated Pitta and Vata. It is also having the property of a blood purifier and increases the quality and quantity of blood so useful in a bleeding disorder.&#xD;
Chandan powder - The strong antiseptic property, trigger the immune system and supports the body to heal. Chandan powder shows minimal side effects such as dermatitis, itching and digestive problems. It is not recommended to be used raw on the skin, for applying on the skin always blend it with some type of liquid base.&#xD;
Acyclovir - Acyclovir is considered the &#x201C;gold standard&#x201D; of treatment.10 &#xA0;Acyclovir, an acyclic purine nucleoside analogue, is a highly potent inhibitor of herpes simplex virus (HSV), types 1 and 2, and varicella-zoster virus, and has extremely low toxicity for the normal host cells.&#xD;
This case is a successful presentation of the management of an acute condition like Visarpa through Combination Therapy. It has shown relief in the symptoms of Visarpa like Daha and Pidika. Use of Kashaya - Tikta Rasa Pradhan Shaman Aushadhi has relived Kandu and Toda&#xD;
CONCLUSION&#xD;
The disease Herpes Zoster in modern medicine and Visarpa has a lot of similarities, particularly Pittaja and Vatapittaja Visarpas can be correlated with Herpes Zoster. Ayurvedic Treatment with Antiviral Acyclovir as a combination therapy has shown better and faster relief in Visarpa (Herpes Zoster).&#xD;
&#xD;
SOURCE OF FUNDING: Nil&#xD;
&#xD;
CONFLICT OF INTEREST: There are no conflicts of interest.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3505</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3505</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study on Single versus Multiple Symptoms of Computer Vision Syndrome (CVS) among Engineering Students in Kancheepuram District, Tamil Nadu&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>51</FirstPage><LastPage>55</LastPage><AuthorList><Author>Sanjay Selvaraj</Author><AuthorLanguage>English</AuthorLanguage><Author> Dinesh Kumar Ganesan</Author><AuthorLanguage>English</AuthorLanguage><Author> Timsi Jain</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Computer Vision Syndrome (CVS), Digital screen, Engineering students, Dry eye, Screen time, Gadget use</Keywords><Fulltext>Introduction&#xD;
&#xD;
The introduction of the computer has brought a phenomenal change in our daily lives. Almost all institutions, workplaces, and homes are using computers regularly which has its advantages as well as drawbacks.1 The term Computer Vision Syndrome (CVS) is applied to a set of different symptoms for those who use computers or smartphones for a long-time during day and night. The Prevalence of CVS ranges from 64% to 90% among computer users. Nearly 60 million people suffer from CVS globally. A million new cases of CVS occur each year. Millions of people including children, college students are using computers for prolonged hours.2 Symptoms of CVS are dry and irritated, eye strain/fatigue, blurred vision, red eyes, burning eyes, excessive tearing, double vision, headache, light/glare sensitivity, slowness in changing focus and changes in colour perception.3 Nowadays, a large number of university students are using computers for studies and research work. Also, computers are used by them for seeing movies, playing computer games, and online chatting. The discomfort associated with computer usage has not yet been proven to result in permanent damage but may cause a reduction in work accuracy.4 Computer Vision Syndrome affects mental and physical well-being and impairs productivity. Computer Vision Syndrome can be virtually eliminated by taking a few simple, inexpensive precautions.5CVS is an increasing health issue unnoticed by many which affects the lives of many especially students and through our study, we try to find out more about this issue. The objective of this study is to determine the prevalence of CVS and its associated risk factors (single vs multiple) among undergraduate computer science engineering students.&#xD;
&#xD;
Materials AND Methods&#xD;
&#xD;
A cross-sectional study was conducted among students in an Engineering college in South India. The Study duration was for 3 months(February-April 2020) and we included the Computer science branch of Engineering students in our study. The sample size was estimated using the Prevalence of 80.1% according to a study conducted in Chennai 1 and by that estimate, we required around 250 samples. We were able to collect 253 samples. Ethical approval (SMC/IEC/2020/03/410) was sought from the IRB of Saveetha Medical College and Hospital.&#xD;
&#xD;
Study Tool&#xD;
&#xD;
The study tool was a Pre-tested, semi-structured questionnaire that included variables like socio-demographic profile, questions on screen time, symptoms of CVS, type of gadget used. The study participants were instructed to mark any eye and other related symptoms experienced during the usage of gadgets.&#xD;
&#xD;
Diagnostic Criteria of Computer Vision Syndrome&#xD;
&#xD;
Students experiencing at least one of the CVS related symptom like redness of eyes, burning sensation, eye strain, headache, blurred vision, dry eye, backache, and neck or shoulder pain 5&#xD;
&#xD;
Data Collection&#xD;
&#xD;
The questionnaire prepared was sent as Google forms to representatives of each class of all semesters of the Computer Science Engineering department through WhatsApp. They were encouraged to fill out the form in their spare time and submit it within a stipulated period. &#xD;
&#xD;
Data Analysis&#xD;
&#xD;
The responses received were compiled in the Microsoft Excel sheet and analyzed using SPSS software. Data were expressed as proportions and chi-square was used to measure the association between the variables. A p-value of less than 0.05 was considered to be statistically significant.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Socio-demographic variables of the Study Participants&#xD;
&#xD;
A total of 253 students were included in the study based on the In the population studied, Majority i.e. 129/253 (51%) were females, 98/253 (38.7%) were from 3rd Year, 132/253 (52.1%) were staying with their parents and 83/253 (32.8%) travel to college by College Bus (Table 1).&#xD;
&#xD;
Patterns and usage of gadgets by study participants&#xD;
&#xD;
The majority of study subjects i.e. 173/253 (68.5%) were using Mobile phones as frequent computer digital screen followed by 42/253 (16.6%) were Laptop, 142/253 (57.7%) were using continuously the digital screen without interruption for more than 30 minutes, 77/253 (30.9%) were using a digital screen for around 3-4 Hours daily, 161/253 (63.8%) were using the digital screen during Nighttime and 180/253 (71.1%) the purpose of use of computer digital screen for both educational and recreational purposes, separately 49/253 (19.4%) were using it only for recreationally and&#xA0; 24/253 (9.5%) were used only for educational purposes ( Table 2).&#xD;
&#xD;
Single versus Multiple CVS symptoms and its affecting factors&#xD;
&#xD;
The prevalence of Computer vision syndrome in our study 97% is out of which 89/253 have a single symptom of CVS, while 157/253 are having multiple symptoms of CVS. There is an equal distribution of males and females with multiple symptoms of CVS. The majority (107) of those with multiple CVS symptoms use gadgets for more than 3 hours. The difference when compared to whose use gadgets less than 3 hours per day is statistically significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3506</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3506</Fulltext></URLs><References>&#xD;
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	Logaraj M, Madhupriya V, Hegde SK. Computer vision syndrome and associated factors among medical and engineering students in Chennai. Ann Med Health Sci Res 2014;4(2):179-185.&#xD;
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	Al Rashidi SH, Alhumaidan H. Computer vision syndrome prevalence, knowledge and associated factors among Saudi Arabia University Students: Is it a serious problem? Int J Health Sci (Qassim) 2017;11(5):17-19.&#xD;
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	Ranasinghe P, Wathurapatha WS, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, et al. Computer vision syndrome among computer office workers in a developing country: an evaluation of prevalence and risk factors. BMC Res Notes 2016;9(1):150.&#xD;
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	Assefa NL, Weldemichael DZ, Alemu HW, Anbesse DH. Prevalence and associated factors of computer vision syndrome among bank workers in Gondar City, northwest Ethiopia, 2015. Clin Opthalmol 2017;9:67-76.&#xD;
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	Ranganatha SC, Jailkhani S. Prevalence and associated risk factors of computer vision syndrome among the computer science students of an engineering college of Bengaluru-a cross-sectional study. Galore Int J Health Sci Res 2019;4(3):10-15.&#xD;
	&#xD;
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	Abudawood GA, Ashi HM, Almarzouki NK. Computer Vision Syndrome among Undergraduate Medical Students at King Abdulaziz University, Jeddah, Saudi Arabia. J Ophthalmol 2020;2020: Article ID 2789376&#xD;
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	&#xD;
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	&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Modified Approach in Fistula in ano by Interception of Fistula Tract and Ksharsutra (IFTAK) Method: A Case Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>56</FirstPage><LastPage>59</LastPage><AuthorList><Author>Prafulla Fadanvis</Author><AuthorLanguage>English</AuthorLanguage><Author> Amruta Tembhurnikar</Author><AuthorLanguage>English</AuthorLanguage><Author> Shubhada Guru</Author><AuthorLanguage>English</AuthorLanguage><Author> Poonam Madan</Author><AuthorLanguage>English</AuthorLanguage><Author>  Anagha Hirapure</Author><AuthorLanguage>English</AuthorLanguage><Author> Swarupa Chakole</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Problems of Ksharsutra, Fistula, Interception of fistulous tract with the application of Kshara Sutra</Keywords><Fulltext>Introduction&#xD;
&#xD;
Fistula-in-and is an inflammatory disease that forms a tract in the anal region with a primary internal opening in the anal canal and a secondary external opening on the perianal skin. It is an abnormal connection between two epithelized surfaces lined with granulation tissue. The main pathology lies in cryptoglandular infection in the intersphincteric region. Even after several advancements in fistula treatment, failures are quite high.1 It has been considered a notorious disease to treat due to its recurrence and incontinence. The chances of recurrence in different types of anal fistulae range between 7% and 50%.2&#xA0; Ksharsutra is the most widely used treatment for fistula in and in India. Success rate and non-recurrence are surely appreciable but weekly sittings and pain during changing of Ksharsutra make it difficult for the patient to pursue the treatment.3 Also, the discomfort of Ksharsutra being in situ is significant to disturb the daily routine of the patient. Cutting and simultaneous healing of the fistula is time-consuming which depends on the length and type of fistula tract. So discomfort, irritation, itching, burning at the anal region persist during the treatment. Hence a new approach was mandatory.4,5 &#xD;
&#xD;
IFTAK is the Interception of the fistulous tract with an application of Ksharsutra. IFTAK technique is the procedure introduced by Dr. Manoranjan Sahu from Banaras Hindu University, Varanasi. This technique is also called a BHU technique for fistula-in-ano.4 This technique is mostly used for treating the complex fistula with a high recurrence rate.5 A fistula case treated with IFTAK method is discussed here.3,4&#xD;
&#xD;
Case Study&#xD;
&#xD;
A 45 male patient came to Shalya Tantra OPD of DMAMCHRC with complaints of pain at the perianal region on the left side of the buttock. The patient had a history of perianal abscess, blood mixed pus discharge from the right side of the buttock for 18 months which was treated conservatively by a physician. The patient presented with pain and swelling in the left perianal region for 15 days.&#xD;
&#xD;
On examination, the patient was normotensive, non-diabetic without any other systemic disease. On local inspection in the lithotomy position, there was swelling, redness at 5 o&#x2019;clock position on perianal region 6 cm away from the anal opening. There was also an opening on the perianal region at 10 o&amp;#39;clock 4 cm from the anal verge (Figure 1). On Palpation at 5 o&#x2019;clock local temperature was raised with significant tenderness and induration. Induration was going radially towards the anal canal. Mild mucopurulent discharge from 10 o&#x2019;clock skin opening was observed. On Per rectum examination a dimple was felt in the anal canal below the anorectal ring. &#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;&#xD;
&#xD;
The patient had given a history of recurrent abscess and purulent discharge from the 10 o&#x2019;clock opening. After history taking and physical examination diagnosis of fistula-in-and was confirmed. MRI Fistula (dated 25/01/2020) reported, Grade III transphincteric fistula on both side of the perianal region with the internal opening at 6 o&#x2019;clock 2.2cm in the anal canal (Figures 2, 3) &#xD;
&#xD;
&#xA0;&#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;&#xD;
&#xD;
After all preoperative investigations, the patient was posted for surgery under spinal anaesthesia. &#xD;
&#xD;
In lithotomy position painting, draping and isolation of part were done. A small incision was taken on induration at 5 o&#x2019;clock. The mild haemo-purulent collection was drained. The solution of Hydrogen peroxide and povidone-iodine was injected in the new opening at 5 o&#x2019;clock and also old 10 o&#x2019;clock openings. The solution was coming from the same internal opening at the 6 o&amp;#39;clock position. So intra-operative patency test findings were consistent with MRI fistula. The fistula tract with the anterior external opening at 10 o&#x2019;clock was probed and found internal opening posteriorly at 6 o&#x2019;clock. So the course of the tract was curvilinear. Probing from the posterior opening at 5 o&#x2019;clock was going radially at the same internal opening in the anal canal. &#xD;
&#xD;
With probe inside posterior fistula tract, a small incision was made at 6 o&#x2019;clock just outside sphincter muscles approximately 2 cm from the anal verge. The incision was deepened with microtip artery forceps to expose the probed fistula tract. As both the tracts were transphincteric, the exposed fistula tract was intercepted by an incision on it just outside the sphincter complex. The probe was inserted from the new opening at 6 o&#x2019;clock, guided out from the internal opening. The thread was inserted along with the probe. Anterior fistula tract was curetted, probed and guided out from the new external opening at 6 o&#x2019;clock along with thread. The thread was also inserted in the posterior fistula tract from 5 o&#x2019;clock to the external opening at 6 o&#x2019;clock after curettage. All External openings were widened for proper drainage of secretions from the fistula.&#xA0; All the tracts were irrigated with H2O2 and povidone-iodine solution. The dressing is done with gauze packing. (Figures 4, 5) Postoperatively the patient was treated with IV antibiotics, anti-inflammatory, IV fluids and other appropriate medicine. The patient was discharged the next day.&#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; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0; &#xA0;&#xD;
&#xD;
Ksharsutra was inserted in the primary tract at the 6 o&#x2019;clock position on the third day after subsiding surgical oedema. The other two tracts with the external opening at 10 and 5 o&#x2019;clock were irrigated with Triphala Kwath and Jatyadi Tail. Plain threads in these two secondary tracts were kept for drainage for 1 week and then removed. Secondary tracts healed in the next 16 days (total 22 days after surgery). Ksharsutra in primary fistula was changed weekly for 4 more weeks to cut through (total of 5 weeks of treatment Figure 6).&#xD;
&#xD;
During treatment, the patient was advised Saptavinshati Guggul 250 mg 2 tabs thrice a day. Gandhak Rasayan 250 mg 2 tabs thrice a day. &#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; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xD;
&#xD;
Discussion&#xD;
&#xD;
Even after the success rate in the fistula, Ksharsutra causes irritation and pain till it is in situ. Unit cutting time for conventional Snuhi Ksharsutra is averagely 7days /cm.6 Duration of complete cut-through of fistula tract depends on length and type of fistula i.e. more time in transphicteric fistula. In this case, the fistula was transphincteric with two tracts anterior and posterior. The conventional method would have taken more than 8 weeks to cut and heal.7,8 In the IFTAK method fistula tract is intercepted just outside the sphincter muscles and Ksharsutra is inserted in it.4,5 In this patient also IFTAK was performed, rest of the track was corrected, widened and a seton was kept for drainage in both tracts which was removed after 1 week. Both tracts healed secondarily with minimal scarring. By this method length of the fistula tract was decreased with the new external opening at the point of interception, which ultimately reduced the duration of treatment to just 5 weeks.6-8 Main aim of Ksharsutra treatment is to deal with the cryptoglandular infection in an inter-sphincteric plane. By the IFTAK method also the main pathology is treated. Due to the decrease in duration of Ksharsutra treatment, associated discomfort like itching, burning at the anal region, pain during changing of Ksharsutra also decreased. So the patient gets back to disease-free condition sooner. &#xD;
&#xD;
Conclusion &#xD;
&#xD;
Interception of the fistula tract and Ksharsutra is useful than the conventional Ksharsutra method as it reduces the duration of Ksharsutra treatment. Associated complaints like itching, burning at the anal region during Ksharsutra are decreased. The use of this method will be helpful to attract more patient for Ksharsutra treatment.&#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=3507</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3507</Fulltext></URLs><References>&#xD;
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	Bakhtawar N. Factors Increasing the Risk of Recurrence in Fistula-in-ano.&#xA0;Cureus&#xA0; 2019;11(3):e4200. &#xD;
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	Dutta G, Bain J, Ray AK, Dey S, Das N, Das B. Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano. J Nat Sci Biol Med. 2015;6(2):406&#x2013;410.&#xD;
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	Sahu M. A manual on Fistula in ano and Kshara Sutra therapy published by NRC Dept. of Shalyatantra, IMS, BHU, First edition 2015.&#xD;
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	Choudhary P. Interceptive less invasive Ksharsutra therapy in transphincteric fistula in ano. World J Pharma Res 2015;4:1641-1649.&#xD;
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	Gupta R. Comparative Study Of The Effect Of Modified Kshar Sutra With That Of Standard Ksharsutra In The Treatment Of Fistula In Ano. IAMJ 2014;2(5):125-129.&#xD;
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	Lamtur Y. entero-cutaneous fistula in an operated case of total abdominal hysterectomy: A rare case report. J Crit Rev2020;7(8):1085-1088.&#xD;
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	Chandak S. Traumatic low fistula-in-ano. J Datta Meghe Inst Med Sci Univ 2019;14(3):256-257.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Brief Note on Menstrual Stigma: Social Assumptions and Responsibilities&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>60</FirstPage><LastPage>63</LastPage><AuthorList><Author>Chaturvedi B</Author><AuthorLanguage>English</AuthorLanguage><Author> Goswami S</Author><AuthorLanguage>English</AuthorLanguage><Author> Pal N</Author><AuthorLanguage>English</AuthorLanguage><Author> Singh RP</Author><AuthorLanguage>English</AuthorLanguage><Author> Yadav T</Author><AuthorLanguage>English</AuthorLanguage><Author> Gangwar S</Author><AuthorLanguage>English</AuthorLanguage><Author>  Mishra KN</Author><AuthorLanguage>English</AuthorLanguage><Author> Kumudhavalli MV</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Menstruation- a sign of women&#x2019;s well being. However, it is associated with a bunch of restrictions, taboos, and social myths. Menses begins at the onset of puberty biologically termed as menarche. It is usually associated with notorious discomfort, uneasiness and shyness. This review paper highlights the myths and assumptions of the society which is pulling down the status and self-confidence of women and proves that there is no gender equality rather it makes them silent. Our society has modified this physiological process in such a way that now it is a &#x2018;taboo&#x2019; for boys males and females and hence established a communication gap, this gap creates difficulties to tackle with menstruation and leads to Reproductive Tract Infections (RTI) die to unhygienic practice and lack of correct information. One another important reason for unhygienic practice is limited economic resources. A study shows that only 15% of girls in India had access to sanitary pads during the lockdown. Also, the prime minister of India is planning to launch a scheme across India to ensure east access at rs 1/ pad suvidha brand. However by increasing educational opportunities, empowerment we can overcome the cultural misinformation and taboos which has been transferred from generation to generation and make them physical psychologically strong and fit. This will create a healthy society which will be benefited by all.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Menstruation, Taboos, Menarche, Myths, Empowerment</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Menstruation has been a mystery throughout history.&#xB9; But this mystery is completely a biological process that ensures the transformation of a young girl into women.&#xB2; Nonetheless, the story behind the menstruation by which females are blessed is very sorrowful because of society. Menstruation is derived from the Latin word &#x201C;mensus&#x201D; which means &#x201C;month&#x201D; or &#x201C;period&#x201D;. The process is regulated by female sex hormones in which the endometrium, lining of the uterus thickens every month and shed off. This shedding process usually lasts for 3-7days.&#xB3; The amount of bloodsheds off every month ranges from 29-80cc, an average of 35cc.4&#xD;
&#xD;
Generally, it varies from female to female. This is a special phase of a woman&#x2019;s life that symbolizes good health; her ability to give birth to a new-born therefore menstruation must be celebrated. Menstruation in many countries including India is full of myths and taboos that date back. During menses,&#xA0;women&#x2019;s are considered impure, untouchable.5 Some older Vedic books contemplate &#x201C;earth&#x201D; and &#x201C;river&#x201D; as women and similar to the female Homo sapiens, earth and river also menstruate. And like women&#x2019;s earth and river are also considered impure during their menses. Hence sowing in the earth is avoided during the menstruation period of the earth. During monsoon, the&#xA0;bloody red colour of river water is considered as menstrual blood. Menstruation is associated with physical, social and mental discomfort due to which dysmenorrhea (period pain) is commonly observed in all menstruating women below the age of 25 but it has no pathological evidence.&#xB9; Women usually take OTC analgesic like PCM or ibuprofen to relief dysmenorrhoea.6 There are some latest phyto therapeutic based treatment including chaste berry &#x2013; for mild sedation, feverfew- analgesic, anti-inflammatory, ginkgo Biloba- used in PMS treatment.&#xD;
&#xD;
MYTHS AND SOCIETY ASSUMPTION OF MENSTRUATION&#xD;
&#xD;
Society has an indispensable impact on our minds sometimes pragmatic and sometimes it serves as pessimistic. As society assumptions are the myths hence varies differently in different countries. But a common myth about menstruating women is that they are sinful.&#xB9; Women&#x2019;s during their periods are not allowed to cook food, not allowed to touch pickles and other sour food products because the people believe that the foul odour that comes from their body will spoil the things. Apart from this, they are not permitted in any temple or other religious place but there is no scientific proof behind this.2,7 People also believe that menses are associated with evil spirits and some malicious person can use menstrual blood for black magic this is why women bury their uses cloth.&#xB3; The sad truth is behind this is that in Asia these are still practices without any logic. In most of the place, menstruation is a female thing and girls and women&#x2019;s are not allowed to discuss with the male members of the family, not even any serious problems which are shameful. This attitude towards menstruation forces a woman to feel embarrassment and shame about this virtue which cause psychological harassment.5,8&#xD;
&#xD;
There are bulks of restrictions which bound female while menstruation as they are not allowed to read books, not play music because it makes mischief their menses.1 Female are not allowed to do physical exercise because people believe it may cause dysmenorrhoea and side effects but doing exercise will make them healthy and happy as of the release of serotonin- also known as the happy hormone.? Some myths and social assumptions regarding menstruation are tabulated in Table 1. Believes are so weird that a cow becomes fertile if touched by a menstruating girl. Most of the girls in rural areas drop out the school when they began menstruation and some girls miss school during their menstrual period.&#xB9; Common toilets in the schools of villages both for the boys and girls negatively impacted school participation.&#xB9; Along with the inadequate knowledge and failure of private space for sanitation women&#x2019;s handle difficulties during the menstrual cycle every month.9&#xD;
&#xD;
In India, 77% of the women use old cloth and reuse it and 88% of women use ashes, newspaper, dried leaves, sand etc.&#xA0; Overall apart from myths, hygiene management is nil as these things can cause serious RTI. In the Brazil tribe, menstruating women are kept in a separate room and all the other members of the tribe pull her hair. In Europe, people think that if a menstruating woman is near to a sick person; her condition will get worse.7&#xD;
&#xD;
&#xD;
&#xD;
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&#xD;
&#xD;
RESPONSIBILITY OF THE SOCIETY&#xD;
&#xD;
We all know that the mothers are our teacher in all aspects similarly mother is the primary source of information for every new menstruating girl also.2 But the majority of these girls do not know menses before their first period. A UNICEF study revealed that 1 in every 3 girls in South Asia has no idea of menstruation before their first period.4 Hence sudden menarche makes them cry. They are told by their mother&#x2019;s not to share with anyone. Also, teachers are not able to discuss the topic frankly but this wall of shyness between teachers and girls need to be broken.6 Therefore together mother&#x2019;s and teachers should teach them about menses at a certain age and make them comfortable with menstruation before their real experience so that it will not be something very new n scary, they should tell them about PMS includes mood swings, tender breast, irritability, food craving, fatigue etc.20 The embarrassment about the naturally occurring periods us so deep-rooted which is harming the girls so badly, therefore, it requires immediate action.2,4 Along with this, they should be taught to maintain good menstrual hygiene and the various products available in the market to use during menstruation like pads, tampons, menstrual cups etc. and the instructions for proper disposal.3&#xD;
&#xD;
Menstruation is a female thing but it is not written anywhere that it cannot be discussed with boys and men. A research study shows that the majority of the boys said &#x201C;WE DON&#x2019;T KNOW&#x201D; about menstruation; some thought that it is a disease. Boys in school make fun of girls which gives them mental discomfort and embarrassment. So society needs to change such things and practice to think in a general way by understanding the natural rules of nature. Instead, boys and men should talk to them nicely, ask for any help, make them laugh; make them feel happy by doing things they love like cooking, shopping, going out etc.21 Boys and the men of the family should support the females and there should be a healthy environment to discuss menses just like any other natural phenomenon this will make them feel comfortable.8,9 The cultural restrictions which abide them to discuss shall be stopped immediately.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
This review paper concludes the myth followed in various countries and the role of the mother&#x2019;s, teachers and men&#x2019;s to vanish such practices. Instead of creating a taboo everyone should get enough knowledge and make women&#x2019;s feel comfortable and confident. In one cross-sectional Knowledge and Practice study in Baghdad among 1084 women age between 15-21 years had been found that 36% of them have a good knowledge regarding the menstrual cycle, 84.2% of girls avoid physical activities during their periods and 22.6% did not take a shower while menstruating.22 Another cross-sectional KAP (Knowledge, Attitude and Practice) study among 187 adolescent girls from four government schools of Delhi, India revealed that major groups of girls nearly 95.7% of girls are unaware of the source of uterine bleeding. Only 40% of girls had known about the menstrual cycle properly. Among 60% of girls were facing menstrual cramps and 34% did not bath during menses.23 Because of the negative approach about menstruation pulls a girl to fall behind boys not only in education but in sports and other extra curriculum activities. So it is the responsibility of the families, schools and society especially doctors and pharmacists to create awareness, provide complete correct information regarding sex education to both boys and girls and remove their myths, an embarrassment in discussing menstruation with anybody. Therefore everyone should respect this power of procreation as nature&#x2019;s blessing.&#xD;
&#xD;
The qualitative survey in Maharashtra revealed that 40% of the young girls did not receive any information before their onset of menstruation.30 Another study tells that only 36% of women in India use sanitary pads rest all still use other alternatives and put their lives at huge risks.23 Some foundations like &#x201C;Goonj&#x201D; and &#x201C;Sukhibhava&#x201D; are also working in rural and slum area to end the menstrual stigma, taboo, myths and creating awareness for menstrual hygiene practices.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The aim of writing about menstruation and society assumptions is to make people think from a different edge and also to create awareness about various ruthless myths and taboos. By providing correct information right from the home and school will remove the communication gap and shyness among all generations, which is a major issue regarding menstruation. A small change in our mentality and vision regarding menses can create a healthy environment. Also supporting girls in all situations make them super bold to tackle any problems. An overall change in the social perception is very important to overcome these assumptions faced by the majority of girls all over the world especially ruler urban areas. This change will also prevent deadly infections occur due to a lack of knowledge about menstruations hygiene. So there is a need to change the view towards menstruation and menstruating women.&#xD;
&#xD;
CONFLICT OF INTEREST: Nil&#xD;
&#xD;
SOURCE OF FUNDING: Nil&#xD;
&#xD;
AUTHOR CONTRIBUTIONS: The concept of the paper was given by Mr. Shambaditya Goswami. Designing and drafting of the paper were done by Ms.Bhumi Chaturvedi and Ms.Shanky Gangwar. Reviewing and corrections are done by Ms.Nikita Pal. Analysis and interpretation of the data was done by Mr. Tejpal Yadav and final revision and approval for publication were done by Dr. RP Singh and Mr. KN Mishra&#xD;
&#xD;
ACKNOWLEDGMENT: The authors have gratefully acknowledged the management and Director of NIMS Institute of Pharmacy for the valuable and immense support to write this review article.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3508</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3508</Fulltext></URLs><References>&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>64</FirstPage><LastPage>66</LastPage><AuthorList><Author>Ibatova ShM</Author><AuthorLanguage>English</AuthorLanguage><Author> Mamatkulova FKh</Author><AuthorLanguage>English</AuthorLanguage><Author> Rakhmonov YA</Author><AuthorLanguage>English</AuthorLanguage><Author> Shukurova DB</Author><AuthorLanguage>English</AuthorLanguage><Author> Kodirova MM</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Rickets, Dismetabolism, Fatty acids, Apricot oil, Aevit, Traditional treatment, Modified method of treatment</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3509</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3509</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Analysis of Cataract in Diabetic and Non-Diabetic Patients&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>67</FirstPage><LastPage>71</LastPage><AuthorList><Author>Manasvi P</Author><AuthorLanguage>English</AuthorLanguage><Author> V. Panimalar A. Veeramani</Author><AuthorLanguage>English</AuthorLanguage><Author> Divya N</Author><AuthorLanguage>English</AuthorLanguage><Author> Bindu Bhaskaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Cataract, Cortical cataract, Diabetes Mellitus, Nuclear cataract, Posterior subcapsular catarac</Keywords><Fulltext>INTRODUCTION&#xD;
A cataract is defined as the loss of transparency and opacification of the clear lens.1 It is the most common cause of blindness accounting for 51% of the world&#x2019;s total blindness and 33% of the world&#x2019;s visual impairment.2 It is one of the most common causes of avoidable blindness and if left untreated, many patients will face the tragic outcome of partial or total blindness. It becomes increasingly common with advancing age.&#xD;
Diabetes mellitus is a metabolic disorder which is characterized by hyperglycaemia.3 &#xA0;There are currently 351.7 million people of working age (20&#x2013;64 years) with diabetes in 2019. This number is expected to increase to 417.3 million by 2030 and to 486.1 million by 2045.4 Diabetes mellitus is a multisystem disorder that causes several complications in various organs of our body. In the eyes, it most commonly causes cataract and diabetic retinopathy. Cataract tends to develop at an earlier age in diabetics, and progression of cataract is much more rapid in diabetics.5-8 This increases the burden both visually and financially on the community as a more young population are being affected. In a study by Leske, evaluating the relationship between diabetes and lens opacities among the black population it was found that a history of diabetes mellitus (18% prevalence) was related to all lens changes at a younger age.9&#xD;
The purpose of this study is to assess the differences in the parameters such as age, sex, type of cataract, systemic comorbidities that contribute to the formation of cataract among diabetics and non-diabetics.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
This is a cross-sectional study conducted between January to March of 2020 among patients admitted to the ophthalmology department of Saveetha Medical College and Hospital, Chennai for cataract surgery. A total of 35 patients were taken in this study, out of which 17 were diabetic and 18 were non-diabetic. 4 diabetic eyes and 6 non-diabetic eyes were pseudophakic and was excluded from the study. A complete examination of the remaining 60 eyes was done which included visual acuity, slit-lamp examination, and fundus examination. The type of cataract was noted by slit-lamp examination.&#xA0;&#xD;
The inclusion criteria for the patient with diabetes was fasting blood glucose level &#x2265;126 mg/dL, postprandial blood glucose &#x2265;200 mg/dL and HbA1c &#x2265;6.5%. The duration of diabetes was taken as the period from the diagnosis of DM to the day of examination for cataract surgery as informed by the patient. Their medication status was also recorded. Other comorbidities such as hypertension and dyslipidemia were also taken into account.&#xD;
The study was conducted as per the guidelines and approval of the Institutional Ethics Committee, the ethical clearance number of which is: SMC/IEC/2020/03/373. Informed consent was obtained from the patient. Excel sheets were prepared and statistical analysis was done using SPSS software. The significant difference between types of cataract, gender and age was analysed by chi-square test and p-value were calculated.&#xA0;&#xD;
&#xD;
RESULTS&#xD;
Among the total number of patients (n=35) 14 were male and 21 were female.&#xD;
The sex distribution is shown in table 1.&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The chi-square statistic is 5.3814. The p-value is .020352. The result is significant at p &lt; 0.05. Here, among the diabetics, there is a predilection of females to develop cataract than the males (female: 82.35%, male: 17.64%). And among the non-diabetics males developed cataract slightly more than the females (female: 44.44%, male: 55.55%). The result is significant at p &lt; .05. &#xA0;&#xA0;&#xD;
The age distribution is shown in table 2.&#xA0;&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
The chi-square statistic is 6.5557. The p-value is .010455. The result is significant at p &lt; 0.05. Here, there is a marked difference between the distribution of cataract among the two age groups. Diabetics developed cataract earlier than non-diabetics. 76.47% of patients with diabetes developed cataract within the 40-60 year age group, whereas 66.66% of non-diabetics developed a cataract in the 61-80 year age group. The result is significant at p &lt; .05.&#xD;
The treatment for diabetic patients is shown in table 3.&#xD;
Table 3: Treatment for Diabetes&#xD;
&#xD;
&#xD;
41.1% of patients were on oral hypoglycaemic drugs, 47% were on insulin therapy and 11.7% were not taking any diabetes treatment. The distribution of type of cataract among diabetics and non-diabetics is shown in table 4.&#xD;
&#xA0;&#xD;
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&#xD;
&#xD;
&#xD;
HMC: hypermature cataract; MC: mature cataract; NC: nuclear cataract; PSCC: posterior subcapsular cataract; CC: cortical cataract. The chi-square statistic is 15.9139. The p-value is .003137. The result is significant at p &lt; 0.01. Here, among the diabetics, the most prevalent type was posterior subcapsular cataract (PSCC: 50%) which was followed by mature cataract (MC: 20%). Among the non-diabetics, the most prevalent type was nuclear cataract (NC: 56.66%) followed by cortical cataract (CC: 20%). The result is significant at p &lt; .01.&#xA0;&#xD;
Associated comorbidities are given in table 5.&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The chi-square statistic is 18.0445. The p-value is .000121. The result is significant at p &lt; 0.01.&#xD;
Prevalence of hypertension and dyslipidaemia is markedly higher among the diabetics compared to the non-diabetics. Among the diabetics, 58.82% were hypertensives, 23.32% had dyslipidemia. While, among the non-diabetics, 88.88% had no associated comorbidities. &#xA0;&#xD;
The association between treatment for diabetes and the type of cataract is shown in figure 1. 1.&#xA0;&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
OHA: oral hypoglycemic agent; HMC: hyper mature cataract; MC: mature cataract; NC: nuclear cataract; PSCC: posterior subcapsular cataract; CC: cortical cataract.&#xA0;&#xD;
&#xD;
Posterior subcapsular cataract (9) was found to be more prevalent in patients taking oral hypoglycaemic agents. Posterior subcapsular cataract (4) and Mature cataract (4) occurred equally among patients on insulin therapy. And Posterior subcapsular cataract (2), Mature cataract (1), Hypermature cataract (1) occurred almost equally in patients who did not take any diabetes treatment.&#xD;
The Association between duration of diabetes and type of cataract is shown in figure 2. &#xA0;&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
HMC: hyper mature cataract; MC: mature cataract; NC: nuclear cataract; PSCC: posterior subcapsular cataract; CC: cortical cataract.&#xA0;&#xD;
&#xD;
4 eyes (13.3%) developed cataract within 1-3 years of onset of diabetes, 18 eyes (60%) developed cataract within 4-6 years and 8 eyes (26.6%) developed cataract within 7-9 years of onset of diabetes.&#xA0;&#xD;
The association between HbA1C levels and type of cataract is shown in the figure: 3. &#xA0;&#xA0;&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
HMC: hyper mature cataract; MC: mature cataract; NC: nuclear cataract; PSCC: posterior subcapsular cataract; CC: cortical cataract.&#xD;
Here, at HbA1C levels of 6.1 to 9, 6 developed PSCC, 3 developed NC and 1 developed MC. At HbA1C levels of 9.1 to 12, 6 developed PSCC, 3 developed MC, 3 developed CC and 2 developed NC. At HbA1C levels of 12.1 to 15, 3 developed PSCC, 2 developed MC and 1 developed HMC.&#xD;
&#xD;
DISCUSSION&#xD;
Results of the present study found that the formation of cataract occurs at a younger age among diabetic patients as compared to non-diabetics. 76.47% of patients with diabetes developed cataract within the 40-60 year age group, whereas 66.66% of non-diabetics developed a cataract in the 61-80 year age group. The result is significant at p &lt; .05. This is supported by a study by Klein, where cataracts were seen among the younger population.5 Similarly, in a study by Aslam, (71.1%) cataracts developed frequently in the 35-50 years age group among the diabetics.10&#xD;
The prevalence of cataract in our study was higher in diabetic females (82.35%) compared to non-diabetic females (44.4%), this corresponds to a study done by Delcourt where there was an increased risk of cataract among the females.11 Also in a study done by Raman the prevalence of cataract was higher in females (51.4%).12 In our study, 13.3% developed cataract within 1-3 years of onset of diabetes, 60% developed cataract within 4-6 years and 26.6% developed cataract within 7-9 years this can be compared to the study by Raman where known diabetics (50.3%) and long-standing diabetes (64.5%) developed cataract 12 &#xA0;Similarly, in a study by Kim showed that long duration of diabetes mellitus is the most significant risk factor for the development of cataract in diabetics as accumulated hyperglycemia is related to lens opacity.13 &#xA0;&#xD;
In our study, among the diabetics, the most prevalent type of cataract was posterior subcapsular cataract (PSCC: 50%) which was followed by mature cataract (MC: 20%). Among the non-diabetics, the most prevalent type was nuclear cataract (NC: 56.66%) followed by cortical cataract (CC: 20%). The result is significant at p &lt; .01. In a study done by Chen, the prevalence of nuclear cataract, cortical cataract, and posterior subcapsular cataract among type II diabetics were 22.5, 20.2, and 19.9% respectively.14 Similarly, in a study done by Olafsdottir, the prevalence of nuclear cataract, cortical cataract, and posterior subcapsular cataract among type II diabetics were 48%, 65.5% and 42.5%, respectively.15 A study done by Lathika associating grade of cataract with the duration of type II diabetes mellitus showed that immature senile cataract was the most common type of cataract detected in patients who had diabetes for 15 years or more.16 In an epidemiological study done by Hiller, diabetics have a higher risk of developing PSCC than NC or CC.17 Similarly, a study done by Miglior found that PSCC was the most prevalent type of cataract in diabetics.18 Diabetic patients have an increased risk of developing posterior subcapsular, cortical, and mixed cataracts.19 But, in contrast to the Beaver Dam Eye Study, it was found that older onset diabetes was associated with age-related lens changes and cortical opacity.20&#xD;
In our study, there was a markedly increased number of patients with associated hypertension and dyslipidaemia among the diabetics which could suggest the increased prevalence of cataract among patients with metabolic syndrome. In a study done by Nirmalan in a rural population in Southern India, it was found that hypertension and diabetes were associated with the development of cataract.21 In a study done by Chen among type II diabetics in Kinmen, Taiwan it was found that increased triglyceride levels may increase the risk of development of PSCC and NC.15 Similarly, in the Framingham studies, hypertriglyceridemia is associated with the development of posterior subcapsular cataract in men.22 In a study done by Shabana, there was an increased prevalence of lipid abnormalities among female diabetics.23&#xD;
The present study was able to find a statistically significant correlation between age, sex and the type of cataract which develops in the two groups. Appropriate glycemic control was established among the uncontrolled diabetic patients and all were operated on with intraocular lens implantation. The main limitations of this study are the sample size as the study was completed within the given time constraints. Other parameters like BMI, Socioeconomic status was not included in the study.&#xD;
&#xD;
CONCLUSION&#xA0;&#xA0; &#xA0;&#xD;
Incidence of cataract occurs at a younger age among diabetics and there is a predilection towards females. Posterior subcapsular cataract was the most common type of cataract among diabetics followed by mature cataract. Longer duration of diabetes and poor glycaemic control were the risk factors for the development of cataract in diabetics. Proper control of blood sugar at the early stage of disease will hamper the development of cataracts among diabetic, thereby reducing the burden on society.&#xD;
&#xD;
&#xD;
ACKNOWLEDGEMENT:&#xA0;&#xD;
Authors of this manuscript are grateful to the management of Saveetha Medical College and Hospital who provided us with all necessary facility for this study and also grateful to all the patients who are involved in this study. We 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. &#xA0;The authors are also grateful to the editors of this journal for providing the necessary guidelines for the publication of this study.&#xD;
CONFLICT OF INTEREST: NIL&#xD;
SOURCE OF FUNDING: NIL&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3510</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3510</Fulltext></URLs><References>1. Tandon R. Parsons&amp;#39; Diseases of the Eye. Elsevier India; 2019 Aug 10.&#xD;
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2. https://www.who.int/blindness/causes/priority/en/index1.html&#xA0; &#xD;
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3. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison&amp;#39;s Principles of Internal Medicine, 20e&#xD;
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4. International Diabetes Federation. IDF diabetes atlas. Ninth edition, 2019.&#xD;
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5. Klein BE, Klein R, Moss SE. Prevalence of cataracts in a population-based study of persons with diabetes mellitus. Ophthalmology 1985;92(9):1191-1196.&#xD;
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6. Javadi MA, Zarei-Ghanavati S. Cataracts in diabetic patients: a review article. J Ophthal Vision Res 2008;3(1):52.&#xD;
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7. Nielsen NV, Vinding T. The prevalence of cataract in insulin?dependent and non?insulin?dependent?diabetes Mellitus. Acta ophthalmologica 1984;62(4):595-602.&#xD;
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8. Negahban K, Chern K. Cataracts associated with systemic disorders and syndromes. Curr Opin Ophthalmol 2002;13(6):419-422.&#xD;
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9. Leske MC, Wu SY, Hennis A, Connell AM, Hyman L, Schachat A. Barbados Eye Study Group. Diabetes, hypertension, and central obesity as cataract risk factors in a black population: the Barbados Eye Study. Ophthalmology 1999;106(1):35-41.&#xD;
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10. Aslam K, Sufyan M, Ansari A, Khalid I, Nafees K. Frequency of Cataract in Diabetic Verses Non-Diabetic Patients. Pak J Ophthalmol 2019;35(1).&#xD;
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11. Delcourt C, Cristol JP, Tessier F, Leger CL, Michel F, Papoz L. POLA Study Group. Risk factors for cortical, nuclear, and posterior subcapsular cataracts: the POLA study. Am J Epidemiol 2000;151(5):497-504.&#xD;
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12. Raman R, Pal SS, Adams JS, Rani PK, Vaitheeswaran K, Sharma T. Prevalence and risk factors for cataract in diabetes: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study, report no. 17. Investig Ophthalmol Visual Sci 2010;51(12):6253-6261.&#xD;
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13.&#xA0; Kim SI, Kim SJ. Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus. Korean J Ophthalmol 2006;20(4):201-204.&#xD;
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14. Chen SJ, Liu JH, Shih HC, Chou P, Tsai CY, Tung TH. Prevalence and associated factors of lens opacities among Chinese type 2 diabetics in Kinmen, Taiwan. Acta Diabetol 2008;45(1):7-13.&#xD;
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15. Olafsdottir E, Andersson DK, Stef&#xE1;nsson E. The prevalence of cataract in a population with and without type 2 diabetes mellitus. Acta ophthalmol 2012;90(4):334-340.&#xD;
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16. Lathika VK, Ajith TA. Association of the grade of cataract with the duration of diabetes, age and gender in patients with type II diabetes mellitus. Int J Adv Med 2016;3(2):304-308.&#xD;
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17. Hiller R, Sperduto RD, Ederer F. Epidemiologic associations with nuclear, cortical, and posterior subcapsular cataracts. Am J Epidemiol 1986;124(6):916-925.&#xD;
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18. Miglior S, Marighi PE, Musicco M, Balestreri C, Nicolosi A, Orzalesi N. Risk factors for cortical, nuclear, posterior subcapsular and mixed cataract: a case-control study. Ophthal Epidemiol 1994;1(2):93-105.&#xD;
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19. Leske MC, Chylack LT, Wu SY. The lens opacities case-control study: risk factors for cataract. Arch Ophthalmol 1991;109(2):244-251.&#xD;
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20. Klein BE, Klein R, Wang Q, Moss SE. Older-onset diabetes and lens opacities. The Beaver Dam Eye Study. Ophthal Epidemiol 1995;2(1):49-55.&#xD;
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21. Nirmalan PK, Robin AL, Katz J, Tielsch JM, Thulasiraj RD, Krishnadas R, Ramakrishnan R. Risk factors for age-related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study. Br J Ophthalmol 2004;88(8):989-994.&#xD;
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22. Hiller R, Sperduto RD, Reed GF, D&#x2019;Agostino RB, Wilson PW. Serum lipids and age-related lens opacities: a longitudinal investigation: the Framingham Studies. Ophthalmology 2003;110(3):578-583.&#xD;
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23. Shabana S, Sasisekhar T. Effect of gender, age and duration on dyslipidemia in type 2 diabetes mellitus. Int J Cur Res Rev 2013;5(6):104-107.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An Evaluation of Best Corrected Visual Outcome (BCVA) after Nd-YAG Laser Posterior Capsulotomy in Patients of Posterior Capsular Opacification (PCO): A Prospective, Single Centre, Observational Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>72</FirstPage><LastPage>76</LastPage><AuthorList><Author>Nishant V Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajendra Choudhary</Author><AuthorLanguage>English</AuthorLanguage><Author> Meet Mashru</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Posterior Capsular Opacity (PCO), Posterior Capsulotomy, Nd-YAG Laser</Keywords><Fulltext>Introduction&#xD;
&#xD;
Secondary cataract, also known as posterior capsular opacification (PCO), is the most common complication after cataract surgery, resulting from migration and proliferation of residual epithelial cells onto the central posterior capsule, leading to decreased visual function, and ultimately decreased visual acuity. &#xD;
&#xD;
&#xA0;Posterior capsular opacification of initially clear posterior capsule occurs frequently in patients after extracapsular cataract extraction of senile cataracts. Although the time of opacification is highly variable, PCO occurs in somewhere between 25% &amp; 43% of patients by 5 years after cataract surgery.1 In adult patients, the usual time from surgery to visually significant opacification varies from few months to years and the rate of opacification declines with increasing age, while in younger age groups almost 100% opacification occurs within two years after surgery.2&#xD;
&#xD;
Amongst multiple methods to treat thickened posterior capsule including capsulotomy with a knife, the Nd YAG laser is preferred because it is non-invasive and it is an OPD basis procedure considering the comfort of the patients.3 The Neodymium Yttrium Aluminium Garnet (Nd: YAG) laser with the wavelength of 1064nm as a pulsed instrument that acts by the formation of plasma at its focus point inducing an expansion of the tissue. 4 Patient enjoys instant and rapid improvement in the best-corrected visual acuity after the procedure as the procedure helps in clearing the visual axis completely. This improvement in vision is maintained as it is unless any other comorbidities of the eye or the complications of the procedure occur in due period.&#xD;
&#xD;
In our study, we have used Nd: YAG laser for posterior capsulotomy as the technique is rapid, relatively safe and provides controlled opening of the posterior capsule. The instrument is easy to handle and the technique is simple, effective and has abolished many complications of the surgical methods. The vision was assessed by Snellen&#x2019;s chart for distance visual acuity and for near visual acuity Jaegger&#x2019;s charts are utilized.&#xD;
&#xD;
MaterialS and Methods&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This prospective, observational study was carried out with the primary objective to evaluate the Best Corrected Visual Outcome (BVCA) after Nd-YAG Laser Posterior Capsulotomy in Patients of Posterior Capsular Opacification in the ophthalmology department of GMERS Hospital, Gandhinagar, Gujarat for the total duration of two years between October-2017 to September-2019.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; After obtaining the approval from the Institutional Ethics Committee (IEC) Dated 18/01/2017 with No. GMERS/MCG/IEC/02/2017, patients of either gender and above 18 years of age having a history of more than 6 months of previous cataract surgery and Intraocular Pressure (IOP) of </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3511</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3511</Fulltext></URLs><References>&#xD;
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	Sundelin K, Sj&#xF6;strand J. Posterior capsule opacification 5 years after extracapsular cataract extraction. J Cataract Refract Surg 1999;25(2):246-250.&#xD;
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	Raj SM, Vasavada AR, Johar SR, Vasavada VA. Post-operative capsular opacification: a review.&#xA0;Int J Biomed Sci 2007;3(4):237-250.&#xD;
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	Aron-Rosa D, Aron JJ, Griesemann M, Thyzel R. Use of the neodymium-YAG laser to open the posterior capsule after lens implant surgery: a preliminary report. Am Intra-Ocul Implant Soc J 1980;6(4):352-354.&#xD;
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	Wayne F.March: Ophthalmic Lasers: A Second Generation, The University of Michigan 1990, Slack Publisher, ISBN 1556420579.&#xD;
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	Magno BV, Datiles MB, Lasa MS, Fajardo MR, Caruso RC, Kaiser-Kupfer MI. Evaluation of visual function following neodymium: YAG laser posterior capsulotomy. Ophthalmology 1997;104(8):1287-1293.&#xD;
	&#xD;
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Skolnick KA, Perlman JI, Long DM, Kernan JM. Neodymium: YAG laser posterior capsulotomies performed by residents at a Veterans Administration Hospital. J Cataract Refract Surg 2000;26(4):597-601.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Protective Role of Molecular Hydrogen in Cancer Radiotherapy: An Update&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>77</FirstPage><LastPage>84</LastPage><AuthorList><Author>Ziad Abuawad</Author><AuthorLanguage>English</AuthorLanguage><Author> Mousa Numan Ahmad</Author><AuthorLanguage>English</AuthorLanguage><Author> Slezak J</Author><AuthorLanguage>English</AuthorLanguage><Author> Lahham A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Antioxidants, Carcinoma, Hydrogen-rich water, Radiation therapy, Oxidative stress</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Cancer is an abnormal growth of cells that tend to proliferate in an unrestrained manner and, in some cases, to metastasize to other areas of the body.1 It is the second leading cause of death globally, accounting for an estimated 9.6 million deaths.2 The most common types of cancer in men are the lung, prostate, colorectal, stomach, and liver, whereas, in women, they are cancers of the breast, colorectal, lung, cervical, and thyroid.2 Over the past half-century, progress has been achieved in basic and clinical research, resulting in a decrease in the incidence and death rates of some types of cancer, due, largely, to primary prevention and early detection of the disease, rather than the effectiveness of any drug.3&#xD;
&#xD;
Cancer often necessitates multimodal therapy which includes surgery, radiotherapy (RT), and chemotherapy, or a combination.4 RT deposits high-energy radiation and thus destroys cancerous tissues and provides a significant survival benefit.5 The opinion that cancerous cells are more sensitive than normal cells to radiation constitutes the basis of RT. The ability of cancerous cells to repair damaged DNA is limited as they tend to divide rapidly, while normal cells surrounding tumour lesions can withstand RT and recover.6 Despite efforts to deliver a maximum radiation dose to the target cancerous area and simultaneously protect the nearby normal tissues from radiation injury, there remains significant toxicity of RT to the latter tissues;7 a matter that leads to several side effects such as fatigue, irritation of skin and bladder, nausea, diarrhoea, constipation, painful bowel movements, sexual problems, scarring, fibrosis, and reduced quality of life.8,9 RT also increases long-term risks of cancer, central nervous system disorders, cardiovascular disease, and cataracts.8,9 Local treatment of a primary tumour with RT has produced unpredictable systemic effects on tumour growth, such as enhanced growth of distant metastases or inhibition of distant tumour growth that is known as the abscopal effect.8,9 Moreover, enhanced tumour cell recruitment of circulating tumour cells is another adverse local effect of RT.10 Several findings have implied that RT can paradoxically enhance tumour recurrence and metastasis via multiple pathways6.&#xD;
&#xD;
It is believed that most RT-induced symptoms are associated with increased oxidative stress (OS) and inflammation.8-10 Ionizing radiation produces toxic reactive oxygen species (ROS) and free radicals.9 ROS represents the imbalance between the production of oxidants especially free radicals and ROS and the capacity of disposing of them through antioxidants11. Several radioprotectors and mitigators have received substantial interests to eliminate or reduce these side effects and thus improve therapeutic efficiency; however, their role in cancer treatment is unclear.12-14&#xD;
&#xD;
Molecular hydrogen (H2) is a novel and safe medical gas.15 It can be dissolved in water and administered through drinking, inhalation, baths, and intravenous drip infusion of H2-rich saline.15 Moreover, H2 is a new antioxidant that scavenges free radicals and reduces oxidative load.16,17 In contrast to other antioxidants, gaseous H2 can effectively enter the cell, organelle membranes, and defuse ROS because of its neutrality and small size.18 Therefore, H2 is recommended as an appropriate candidate for or contributor to the therapeutic strategies for many metabolic diseases, such as certain types of cancer, especially liver carcinoma.19 This article discusses the current literature addressing the role of H2 in the reduction of RT-induced adverse effects in cancer and evaluates the findings of recent human clinical trials.&#xD;
&#xD;
LITERATURE SEARCH&#xD;
&#xD;
An up-to-date literature review was conducted on the role of H2 in the reduction of RT-induced adverse effects in various types of cancer. The search was limited to recent English publications. Relevant articles were principally identified through an up-to-date online search of the PubMed, Medline, Scopus, Science Direct, Google Scholar, PsycINFO, registered clinical trials, WHO site, and other available databases. The search was performed using the following keywords or their combinations: hydrogen-rich water, gaseous molecular hydrogen, cancer, radiotherapy, radiotherapy-induced adverse effects, antioxidants, oxidative stress, reactive oxygen species, and free radicals. Included articles were mainly original observational, experimental, and clinical, case study, intervention, and cross-sectional researches in humans or animals. For further search accuracy, the reference lists of works were checked for additional publications from the major databases.&#xD;
&#xD;
OXIDATIVE STRESS IN CANCER&#xD;
&#xD;
OS is an imbalance between the production of free radicals and reactive metabolites, the so-called oxidants or ROS, and the protective mechanisms which involve their elimination referred to as antioxidants.11 This imbalance causes damage to cells and biomolecules with a potential effect on the entire organism.20 ROS are the products of oxygen-derived small molecules that play a role in normal cellular metabolism including oxygen radicals, such as superoxide anion (O2&#x2022;&#xAD;_), hydroxyl (&#x2022;OH), peroxyl (RO2&#x2022;), and alkoxyl (RO&#x2022;), as well as non-radicals.11,20 The latter can be transformed into radicals or serve the purpose of an oxidizing agent and include hydrogen peroxide (H2O2), hypochlorous acid (HOCl), ozone (O3), and singlet oxygen (1O2). ROS enhances DNA synthesis, cellular proliferation and survival, cellular migration and invasion, tumour metastasis, and angiogenesis. In aerobic cells, endogenous metabolic reactions produce O2&#x2022;&#x2212;, H2O2, and &#x2022;OH.21 The continuous exposition of mitochondria to high levels of ROS leads to mitochondrial DNA damage and increase O and &#x2022;OH levels in cellular apoptosis.21 The generation of ROS in cells exists in equilibrium with a large variety of antioxidant defence mechanisms that include enzymatic scavengers such as superoxide dismutase (SOD), catalase, glutathione peroxidase and peroxiredoxins, and non-enzymatic scavengers like vitamins C and E, glutathione, lipoic acid, carotenoids, and iron chelators.22 &#xD;
&#xD;
Tumour cells produce ROS in larger quantities than normal cells elevating OS in these cells.22,23 ROS damages DNA in many chronic inflammatory diseases and a wide variety of cancer types. ROS can initiate tumorigenicity and subsequent tumour promotion and progression by damaging DNA23. ROS also produces and introduces respectively gene mutations and structural alterations into the DNA during the initiation stage of cancer.21,24 Furthermore, ROS plays key roles in the stimulation of cell signalling pathways in intra- and extracellular environmental conditions, regulation of gene mutations, and balance of cell proliferation and apoptosis.25 Peroxisome proliferator-activated receptor-&#x3B3;, nuclear factor-&#x3BA;B, &#x3B2;-catenin/Wnt, activator protein 1, nuclear factor erythroid 2-related factor 2, tumour protein&#xA0;p53, and hypoxia-inducible factor1-alpha &#xA0;are among the many transcription factors that can be activated by OS.20&#xA0; ROS controls and mediates the effects of C-radiation and various chemotherapeutic agents used to treat cancer. It is known that chronic inflammation caused by long-term ROS&#xA0; activates the effector molecules. ROS also alters the malignant transformation and the expression of genes involved in immune, inflammatory responses, carcinogenesis, and metastasis.20,25 The hypermetabolic state is one of the characteristics of malignant carcinomas that results in a persistent OS state in a cellular microenvironment. As a result, the utilization of antioxidants that antagonize ROS seems to be a feasible strategy in cancer therapy.21,26&#xD;
&#xD;
OXIDATIVE DAMAGE OF RADIATION&#xD;
&#xD;
Radiation energy in the exposure pathway causes direct detrimental biological effects by targeting several biomolecules, mainly DNA, proteins, and lipids.26,27 Hydroxyl radicals target DNA forming 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of carcinogenesis, from deoxyguanosine.28&#xA0; &#xA0;The initial formation of ROS, a result of H2O radiolysis, intervenes in the radiation-induced DNA lesions, which leads to indirect detrimental biological impacts.28&#xA0; The generation of HO&#x2022;, ionized water (H2O+), hydrogen radicals, and hydrated electrons are the quick result of exposure of water to ionizing radiation. The reaction of the initially produced radicals generates hydrogen peroxide (H2O2) and superoxide anion (O2&#x2212;&#x2022;). The radiation-induced increase of ROS could damage cellular constituents and induce OS; this is because ROS is produced endogenously, and its level is regulated by several antioxidant defence mechanisms.29 &#xD;
&#xD;
Free radicals target the lipid layer of cell membranes.28 ROS reacts with membrane polyunsaturated fatty acids.30 The process involves the abstraction of the bis-allylic position of these fatty acids either by HO&#x2022; or by a thiyl radical (RS&#x2022;) forming peroxyl radicals. The latter can abstract a hydrogen atom from another fatty acid, inducing the so-called peroxidation reactions.29 Malondialdehyde (MDA), acrolein, and 4-hydroxy-2-nonenal are some of the break-down products of hydroperoxides that are considered chemical indicators of lipid peroxidation reactions or even indices of defective permeability and fluidity of cell membranes.29-31&#xD;
&#xD;
RADIOTHERAPY IN CANCER&#xD;
&#xD;
Cancerous cells have a degree of self-sufficiency that causes them to not respond to the signals which activate the normal cell cycle leading to uncontrolled growth and proliferation of transformed cells.1,2 If the proliferation of cancerous cells continues, it can be fatal.32 It is estimated that metastasis is responsible for about 90% of cancer deaths.33 The type of cancer, its locality, and stage of progression determine the selection of treatment of cancer and its progress. Some of the traditional and most widely used treatment methods are surgery, RT, and chemotherapy, or a combination.4 Hormone-based therapy, anti-angiogenic modalities, stem cell therapies, and immunotherapy are some of the modern modalities.32 More than half of the cancer patients receive RT during their illness; RT is of prime importance, especially in patients with untreatable tumours or incompletely resected tumours and for those with recurrent disease.34 RT can be used to downstage primary tumours, to reduce the risk of recurrence in the adjuvant setting, and in the palliative setting, to improve the quality of life at each stage of the disease.10 Treatment with surgery, often followed by RT is used in most breast cancer patients in stages I, II, or III. About half of women (49%) with stage I or II breast cancer undergo breast-conserving surgery followed by RT.35 Women (56%) diagnosed with metastatic disease (stage IV) most often receive radiation and/or chemotherapy alone.35&#xD;
&#xD;
Before surgery, RT is often applied to disrupt the ability of cancer cells to grow and divide, slow their growth, and shrink tumour areas.5 The use of RT is based on the theory that cancerous cells are more sensitive to radiation than normal cells as the former cells have a limited ability to repair damaged DNA and tend to divide more quickly, while the latter cells surrounding tumour lesions can withstand RT and recover.36 The mechanism underlying this theory lies in the fact that the damaged DNA is unable to replicate, and thus cell division is halted, resulting in the death of cells.36 Targeting normal cells that lie in the peripheries of the main tumorous mass is the main adverse effect of RT. Nevertheless, improved imaging techniques for accurate targeting of the cancer mass, in addition to the ability of normal cells to regain normal function faster than cancer cells, could minimize the damage caused by RT.32 Fatigue, nausea, diarrhoea, and dry mouth, loss of appetite, hair loss, sore skin, and depression are some of the acute radiation-associated side effects. The probability of radiation-generated complications is linked to the size or area of the radiation treated body parts, the given dose of radiation and its fractionation and rate of application, and individual radio-sensitivity.9&#xD;
&#xD;
RT remains the most effective non-surgical technique to achieve control of malignant tumors.32-38 The past two decades have witnessed a rapid rise in technological advancement aimed at improving endurance, accuracy, and efficacy through RT used more than a century ago. On the other hand, there is evidence to suggest that the various changes caused by radiation in the tumour environment can also pose a metastatic risk that may offset the long-term effectiveness of treatment. Several theoretical mechanisms have been largely suggested by which radiation exposure can increase the risk of metastases. These include the direct release of tumour cells into the circulatory system, systemic effects of the tumour, irradiation of normal tissues, and changes caused by radiation in the phenotype of tumour cells.37 It is a new scientific topic for radiologists to examine highly effective low-toxic radiation protectants. The focus has always been on deploying ideal radiation protectants in the radiation field.28,38&#xD;
&#xD;
ANTIOXIDANT ACTIVITY OF MOLECULAR HYDROGEN&#xD;
&#xD;
The oxidants in ROS are reduced by H2. When selectively dissolved in the cultured medium, H2 reduces the strongest oxidants, such as OH and ONOO-, in cell signals.25 However, H2 does not disturb the cellular levels of O2, NO&#xB7;, or H2O2. ROS is also involved in metabolic oxidation-reduction reactions in cell-free systems. Because OH is strong enough to interact with H2, it can be a sign of the oxidative strength of ROS. Hydroxyl radicals (&#xB7;OH) produced by radiolysis or photolysis of H2O significantly reduced by H2 treatment leading to decrease levels of &#xB7;OH in cultured cells, thus protecting the mitochondria from OH.21&#xD;
&#xD;
H2 has promising physical-chemical properties as a therapeutic antioxidant. It is smaller than molecular oxygen and is electrically neutral.18,21 This allows it to easily penetrate cell membranes and spread into cellular organelles, mainly the nucleus and mitochondria. Moreover, H2 has a very mild reactivity so that it does not interact with important physiologically relevant ROS that is involved in cell signaling.18,21,28 It also does not affect physiology, temperature, blood pressure, pH, or pO2, nor has it been reported to be toxic at much higher levels than clinically effective doses. H2 excess simply expires across the lungs when much is delivered. H2 treatment enhances endogenous antioxidant enzymes and thus contributes to improved OS. Catalase, SOD, and glutathione peroxidase are the important cellular antioxidant enzymes.39 Table 1 summarizes the physical-chemical properties of H2 that determine its antioxidant therapeutic benefits.&#xD;
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&#xD;
RAIOPROTECTIVE EFFECT OF MOLECULAR HYDROGEN&#xD;
&#xD;
Molecular hydrogen has appeared as a promising cancer treatment either as a preventive agent or in combination therapy with anticancer drugs.40-43 The consumption of hydrogen-rich water (HRW) may reduce the side effects of anticancer drugs by reducing OS and improving metamorphosis due to decreased apoptosis.40 H2 also protects the immune system through radiation protection action. Moreover, H2 may reduce radiation-induced blood injury, as well as save depletion of white blood cells and platelets.41 HRW causes telomere shortening in cancer cells, suppressing tumour angiogenesis by clearing intracellular ROS as well as suppressing gene expression and secreting vascular endothelial growth factors.42&#xD;
&#xD;
Several side effects of RT are believed to be associated with increased OS and inflammation due to ROS generation during RT.9 Daily consumption of HRW is a potential new treatment strategy to improve the quality of life after exposure to RT. It has been reported that the life quality of patients with liver carcinoma who were given a placebo decreased significantly during the first month of RT.43 One of the most common complaints in patients undergoing RT is symptoms of the digestive system.43 Compared to patients consuming placebo, patients consuming HRW had significantly less appetite loss and fewer taste disorders, with no significant difference in the average degrees of vomiting or diarrhoea. The biological reaction to RT-induced OS without compromising antitumor effects was reduced by HRW consumption.43&#xD;
&#xD;
It has been reported that &#xB7;OH was significantly decreased in cultured cells using H2 treatment by radiolysis or photolysis of H2O and thus protecting the mitochondria21. H2 also penetrates the biological membranes and diffuses into organelles, thereby reducing the cellular levels of ATP synthesized in the mitochondria and the nucleus. H2 effectively reduces cyclooxygenase-2, a marker of OS, in immune-positive neurons due to its antioxidant and anti-inflammatory neuroprotective effects44. Induction of inflammatory cytokines and inhibition of cell signalling factors activates the anti-inflammatory and anti-allergic properties of H2. Moreover, H2 has been shown to reduce the expression of several pro-inflammatory factors, including tumour necrosis factor (TNF)-&#x3B1;, interleukin (IL)-6, IL-1&#x3B2;, IL-10, IL-12, and chemokine ligand 2, intercellular adhesion molecule 1, nuclear factor-&#x3BA;B, high mobility group box 1 protein, and prostaglandin E. H2-rich saline reduces serum diamine oxidase, TNF-&#x3B1;, IL-1&#x3B2;, IL-6, tissues MDA, protein carbonyl and myeloperoxidase activity, as well as discouraging pro-apoptotic players, including c-Jun N-terminal kinase and caspase-3.44,45 IL-4 serum level decreased significantly after H2 inhalation. H2 gas inhalation upregulated SOD activity and significantly reduced the increased level of MDA and myeloperoxidase in allergic asthmatic mice.21,46 The protective effect of H2 against the development and invasion of the tumour enables it to act as an antitumor factor. Hence, the electrically neutral HRW was shown as an antioxidant to counteract ROS, inhibition of cancer cell proliferation, and invasion, together with the removal of intracellular oxidants.21&#xD;
&#xD;
Increased antioxidant capacity as indicated by decreased levels of oxidative products, increased activities of antioxidation-related enzymes and decreased early and late levels of pro-inflammatory cytokines in serum and tissues are the three main positive effects of the treatment with H2 on organ damage. H2 has also been used to treat many OS-associated diseases, such as cardiovascular disorder.39 Regardless of the form that is used, H2 gas or H2 water, treatment with H2 improves the quality of life of patients receiving chemotherapy or RT. Energy metabolism, measured by O2 consumption and CO2 expiration, was stimulated by drinking HRW. These results indicate the potential advantage of H2 in improving obesity, diabetes and metabolic syndrome.39 Consuming HRW can prevent arteriosclerosis more effectively than other antioxidants and may delay the development and progression of Parkinson&amp;#39;s disease. The brain OS was also reduced by continuous consumption of HRW. Oral HRW is an effective antioxidant and anti-inflammatory agent that reduces chronic allograft nephropathy.47 Accumulated data also show the possibility of H2 as an anti-ageing solution and in wellness applications, especially sports and injuries.48&#xD;
&#xD;
H2 therapy can work with cancer treatments such as surgical removal, chemotherapy, and RT, which often lead to systemic inflammation, to restore tissue function.40 H2 rapidly spreads to reduce cytotoxic and inflammatory radicals in tissues. The antioxidant properties of H2 gas or H2 water have been shown to improve the quality of life of cancer patients during chemotherapy. Nephrotoxicity, mortality, and body weight loss caused by cisplatin were reduced by inhaling 1% of H2 gas or drinking H2 water. The level of renal apoptosis was also reduced by drinking H2. Most of the symptoms caused by radiation are believed to be associated with increased ROS and inflammation during RT significantly affecting the patient&amp;#39;s quality of life.9 HRW consumption reduces biological interactions with the radiation-induced OS without damaging antitumor activities. Inflammation in OS-related cancer can be protected by inhaling H2 gas and giving H2 orally. This improves the antitumor effect of cancer management.21 H2 may act alone or in conjunction with another treatment to suppress tumour growth by inducing apoptosis, reducing proliferation, regulation of structural maintenance of chromosome 3, and inhibiting cell cycle-related factors.9,49-54 Table 2 presents a summary description of some studies on the therapeutic potentials of molecular hydrogen in cancer.&#xD;
&#xD;
&#xD;
&#xD;
Pt-nc= Platinum nano colloid; mFOLFOX6= A chemotherapy consisting of leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin; PI3K= Phosphatidyl inositol-3 kinase; LY294002= A&#xA0;morpholine-containing drug; SMC3= Structural&#xA0;maintenance&#xA0;of&#xA0;chromosome&#xA0;3; PD 1+= A protein found on T cells.&#xD;
&#xD;
The gastrointestinal tract ranks the second-most sensitive organ to irradiation injury during cancer RT after the bone marrow.55 Injection of H2-rich saline before radiation in a mouse model protected the gastrointestinal endothelia from RT-induced injury, decreased plasma MDA and intestinal 8-OHdG levels, and protected plasma levels of endogenous antioxidant enzymes such as SOD and glutathione peroxidase.28,56 Lungs are also radiosensitive to pneumonitis in acute and subacute settings and pulmonary fibrosis in chronic settings.57,58,62 Pretreatment of H2 reduced OS products, mainly 4-hydroxy-2-nominal and 8-OHdG. The levels of apoptosis-associated proteins, including Bax and active caspase 3 in irradiated A549 cells, after 24-hour incubation with H2-rich solution, were significantly reduced by H2. Five months after irradiation, lung fibrosis, Ashcroft scores, and type III collagen deposition were reduced by H2 treatment.28,50 &#xD;
&#xD;
Due to their postmitotic state, cardiac myocytes are relatively resistant to radiation damage.59 Endothelial cells are known to be sensitive to radiation, and their damage is associated with the pathophysiology of most forms of cardiac injuries, which may result from loss of alkaline phosphatase activity of capillary endothelial cells.60,61 In addition to myocardial degeneration, perivascular and interstitial fibrosis are seen. H2 pretreatment proved to have cardioprotective properties by decreasing MDA and 8-OHdG levels.28&#xA0;&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Collectively, the role of antioxidants in preventing and treating cancer has been well studied, but the majority of research has not paid much attention to molecular hydrogen. In this context,&#xA0; H2 has antioxidant, anti-inflammatory, and antiallergic effects by its selective removal of free radicals. H2 treatment can alleviate the harmful effects of chemotherapy and RT to improve the quality of life for cancer patients. H2 treatment may also delay the development of cancer; combined use of H2 with other anticancer drugs may enhance anticancer effects in treatment. H2 is then included as a treatment, with highly reactive ROS, and effective diffusive action in cells. Characteristics of the strength of body temperature in mammalian cells, a virtually event-free tolerance profile, and the ability to administer therapy in a variety of ways to fit a patient or indication treatment, with minimal cost-effective surgical intervention. The expanded nature of the effects of H2 means that it has therapeutic potential across a wide range of medical applications. The definition of H2, as a type of antioxidant, cannot explain all its radioprotective effects. The exact mechanism and signal pathway involved in the protective role of H2 in ionizing radiation injury needs further studies in the future. Only a few studies describe how H2 exerted its effect not only as an antioxidant. For the first time, H2 may become a gaseous signaling molecule like nitric oxide, carbon monoxide, and hydrogen sulfide. However, several randomized clinical trials are needed to confirm whether H2 treatment is applicable in the clinical setting and whether it affects the efficacy of RT. Although the field is still relatively new, H2 appears promising in preventive care and treatment of ROS-related diseases.&#xD;
&#xD;
Acknowledgements: This study was supported by the University of Jordan, Amman, Jordan, Slovak Academy of Sciences, Bratislava, Slovakia, and Al-Quds University, Al-Quds, Palestine. 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: The authors declare no conflict of interest.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Succinct Analysis for Deep Learning in Deep Vision and its Applications&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>85</FirstPage><LastPage>92</LastPage><AuthorList><Author>Preethi N</Author><AuthorLanguage>English</AuthorLanguage><Author> W. Jai Singh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Deep learning methodologies can achieve forefront results on testing deep vision issues, for instance, picture portrayal, an object area, face affirmation, Natural Language Processing, Visual Data Processing and online life examination. ConvNet, Stochastic Hopfield network with hidden units, generative graphical model and sort of artificial neural network castoff to absorb competent information coding in an unproven way are deep learning plans used in deep vision issues. Objection: This paper gives a succinct survey of without a doubt the most critical Deep learning structures. Deep vision assignments, for instance, object revelation, face affirmation, Natural Language Processing, Visual Data Processing, web-based life examination and their utilization of this task are discussed with a short record of the historic structure, central focuses and impair-mental. Future headings in arranging Deep learning structures for Deep vision issues and the troubles included are analysed. Method: This paper consists of surveys. In Section two, Deep Learning Approaches and Changes are audited. In section three, we tend to portray the uses of Applications of deep learning in deep vision. In Section four, Deep learning challenges and directions are mentioned. At long last, Section five completes the paper with an outline of the results. Results and Conclusion: Though deep learning can recall a huge proportion of data and info, it&#x2019;s feeble cognitive and perception of the data makes it a disclosure answer for certain applications. Deep learning despite everything encounters issues in showing various erratic facts modalities at the equal period. Multimodal profound learning is an extra notable heading in progressing deep learning research.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>ConvNet, Stochastic Hopfield network, Generative graphical model, Social media analysis, Data processing, Deep  Learning</Keywords><Fulltext>INTRODUCTION&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Deep vision is an integrative intelligent arena that oversees in what way deep tin be ended to build raised equal appreciation since deep pictures or chronicles. Since the viewpoint of building, it attempts to deep endeavours that the hominid graphic structure tin do.1 Deep learning grants machine models of various taking care of layers to be told and address knowledge with various degrees of reflection addressing however the neural structure sees and grasps multimodal data, as needs are unquestionably getting included structures of colossal extension data. What perceived deep vision from the basic field of cutting edge picture getting ready around then remained a yearning toward isolate three-D structure after pictures by the area of accomplishing complete act thoughtful. Training during the 1970s moulded the initial basics aimed at countless the deep vision figuring that happen nowadays, as well as withdrawal of limits as of pictures, naming of appearances, non-polyhedral and polyhedral illustrating, the depiction of articles as inter associates of humbler constructions, visual stream, and development approximation.2 The desire to form a structure that reproduces the human brain drove the elemental progression of neural frameworks. In 1943, McCulloch and Pitts5endeavoured toward realizing however the neural structure might create uncommonly complicated models by victimization organized developed cells, known as neurons. The McCulloch and Pitts prototypical of a vegetative cell, known as an MCP prototypical, has created a vital duty toward the advance of pretending neural frameworks.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Deep learning has drove fantastic strolls in&#xA0;briefing&#xA0;of&#xA0;computer&#xA0;vision&#xA0;complications,&#xA0;let&amp;#39;s say, entity identification, movement following, activity acknowledgment, human&#xA0;skill&#xA0;estimation, and&#xA0;linguistics&#xA0;division.3-7&#xA0;During this&#xA0;arrangement, we&amp;#39;ll&#xA0;minimal rustically evaluation&#xA0;the core&#xA0;progressions in deep learning models besides figuring for&#xA0;computer&#xA0;vision bids during the extraordinary circumstance, Three&#xA0;of&#xA0;the foremost&#xA0;vast&#xA0;sorts of&#xA0;deep learning prototypical with relevancy&#xA0;their significance in visual kind, that is, ConvNet, the "Boltzmann special"&#xA0;composed with&#xA0;Deep Belief Networks (DBNs) and Deep&#xA0;Boltzmann&#xA0;Machines (DBMs) and Stacked (Denoising) Autoencoders.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This paper consists of surveys. In Section two, Deep Learning Approaches and Changes are audited. In section three, we tend to portray the uses of Applications of deep learning in deep vision. In Section four,&#xA0; Deep learning challenges and directions are mentioned. At long last, Section five completes the paper with an outline of the results.&#xD;
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DEEP LEARNING APPROACHES AND CHANGES&#xD;
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ConvNet&#xD;
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ConvNet victimization&#xA0;the&#xA0;boner&#xA0;incline and accomplishing usually&#xA0;astounding&#xA0;ends up in&#xA0;a briefing&#xA0;of model affirmation tasks.8 ConvNet is spurred by the visual schemes assembled, and&#xA0;expressly&#xA0;through its prototype planned&#xA0;in.9 The principle&#xA0;machine prototype&#xA0;dependent&#xA0;unprocurable&#xA0;systems among neurons and logically&#xA0;created&#xA0;changes out of the copy are created in Neocognitron,&#xA0;which&#xA0;delineates that&#xA0;once&#xA0;neurons through comparative limits are suitable on areas of the past pane by&#xA0;completely dissimilar&#xA0;zones,&#xA0;a method&#xA0;of&#xA0;change of location&#xA0;in vacillation is secured.&#xD;
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A CNN incorporates&#xA0;3&#xA0;commonplace&#xA0;forms of&#xA0;neural layers, to be&#xA0;express, (a) ConvNet Phase, (b) combining layers, and (c)&#xA0;whole&#xA0;Merging&#xA0;layers.&#xA0;Variety of phase&#xA0;settles for&#xA0;substitute activity. Figure 1 shows a CNN building for&#xA0;a piece&#xA0;characteristic&#xA0;proof in&#xA0;copy&#xA0;mission.&#xA0;Each phase of a ConvNet changes info&#xA0;capacity to a yield capacity of&#xA0;somatic cell&#xA0;commencement, over the&#xA0;long-term&#xA0;agitative&#xA0;the last&#xA0;whole&#xA0;connected&#xA0;layers, achieving a mapping of&#xA0;the info&#xA0;to a 1D&#xA0;embody&#xA0;vector. CNN&amp;#39;s&#xA0;are&#xA0;exceptionally productive in deep vision applications,&#xA0;to Illustrate, face affirmation, object revelation, driving idea in apply autonomy vehicles.&#xD;
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a) ConvNet Phase. ConvNet Phase, a ConvNetusesnumerous bit to rotate the entire copy similarly to the midway component maps, delivering diverse component plots. As the advantages of the complication action, a couple of task have planned it as an additional for totally associated phase through the ultimate objective of achieving speedier learning events. &#xD;
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b) Combining Phase: Combining Phaseremainin charge of diminishing the three-dimensional estimations of the data capacity aimed at the following difficult phase. The combining phase doesn&amp;#39;t impact the significance estimation of the capacity. This action achieved through this lateral indicated sub examining or down testing, by way of the diminishing of scope prompts a concurrent lack of evidence. In any case, mishap may be helpfully aimed at the framework because the decline in dimensions prompts fewer figures overhead used for the future phases of the framework, also besides that kills overflow. Typical combing and max combining are the maxima generally applied procedures. Distinct academic examination of max combining and ordinary combining shows is assumed, and exhibited the most extreme combing could provoke speedier intermixing, select dominating constant structures, and upgrade hypothesis. Different various assortments of the combining phase of the composition, inspired through changed motivation sand helping indisputable necessities.11&#xD;
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c) Completely Linked Layers. Following&#xA0;one or two complexity and combining phase,&#xA0;large phase intuition&#xA0;within the&#xA0;neural framework is achieved by strategies for wholly&#xA0;associated&#xA0;phase. Neurons&#xA0;in an exceedingly&#xA0;wholly&#xA0;associated&#xA0;phase take complete relationship with completely&#xA0;sanctionative&#xA0;within past phase, as per their tag recommends.&#xA0; In the beginning,&#xA0;this point&#xA0;forward is&#xA0;non-commissioned&#xA0;with a structured growth followed by&#xA0;an inclination&#xA0;offset.&#xA0;wholly&#xA0;associated&#xA0;phase&#xA0;ineluctably&#xA0;change the&#xA0;2nd&#xA0;article plots into a 1D&#xA0;embrace&#xA0;path. The result and path moreover&#xA0;may well remain an addressed&#xA0;advancing to selected&#xA0;ranging orders used for a game&#xA0;set up or might remain&#xA0;thought-about&#xA0;as per a&#xA0;path for&#xA0;additional&#xA0;method.12&#xD;
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ConvNet structure uses three strong attention: (a) area responsive range, (b) fixed burdens, and (c) Structural subsample. Taking into account close by responsive range, every component in a convolutional layer gets ideas of neighbouring components having a spot with the last layer. Thusly neurons are fit for removing simple visual features, for instance, boundaries or joints. The above-mentioned selections&#xA0;are formerly joined through&#xA0;the following&#xA0;complex phases&#xA0;acknowledge complex solicitation structures. Plus, straight forward part locators, that&#xA0;are&#xA0;helpful&#xA0;on&#xA0;a touch&#xA0;of&#xA0;a picture, are&#xA0;presumptively&#xA0;attending to be vital&#xA0;over&#xA0;the complete&#xA0;figure is&#xA0;ample&#xA0;through&#xA0;the chance&#xA0;of joint burdens.&#xA0;The joint burdens goal is a good&#xA0;deal of items&#xA0;toward its&#xA0;vague&#xA0;burdens. Decidedly, the elements of a convolutional layer sifted through the sphere. Entireelementsset up&#xA0;supply&#xA0;a comparable game plan of burdens. Hence,&#xA0;every&#xA0;plane is&#xA0;in danger&#xA0;of building&#xA0;a selected&#xA0;part. The yields of the sphere are&#xA0;known as&#xA0;structural plots.&#xA0;Every&#xA0;convolutional layer involves&#xA0;one or two planes, thus varied phase maps&#xA0;are&#xA0;created in&#xA0;every&#xA0;region.&#xA0;throughout&#xA0;the advancement on the part plot,&#xA0;these complete figures are checked through elements that are taken care of at&#xA0;staring at&#xA0;regions&#xA0;within the phrase&#xA0;maps. This improvement is&#xA0;like&#xA0;a convolution action, trailed by&#xA0;an extra&#xA0;substance tendency period and sigmoid edge:&#xD;
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Here, ???? states the &#xA0;importance&#xA0;of the convolutional layer, the&#xA0;weight cross-section is denoted by W, and the&#xA0;inclination term is denoted by b. Completely&#xA0;associated&#xA0;neural frameworks,&#xA0;burden&#xA0;lattice is filled, that is, interfaces all commitment&#xA0;to the respective&#xA0;element through&#xA0;totally unlike&#xA0;burdens. For ConvNet,&#xA0;W is the burden&#xA0;system which is&#xA0;too little&#xA0;visible&#xA0;of&#xA0;the chance&#xA0;of tied burdens. &#xD;
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Here w is matrices taking comparative estimations with the units&amp;#39; open fields. victimisation&#xA0;associate&#xA0;inadequate weight matrix diminishes&#xA0;the quantity&#xA0;of the framework&amp;#39;s tunable parameters and&#xA0;thus&#xA0;grows its theory limit.&#xA0;increasing&#xA0;W with layer inputs takes&#xA0;once&#xA0;convolving the commitment with w,&#xA0;which might&#xA0;be seen as a trainable channel. If the commitment to ????&#x2212;1 convolutional layer is of estimation ????&#xD7;????&#xA0;and therefore the&#xA0;responsive field of units at&#xA0;a particular&#xA0;plane of convolutional layer ???? is of estimation ????&#xD7;????, by then the created&#xA0;element&#xA0;guide&#xA0;is going to be&#xA0;a structure of estimations (????&#x2212;????+1)&#xD7;(????&#x2212;????+1). Precisely, the&#xA0;phase&#xA0;of feature plot at (????,????)&#xA0;tract&#xA0;is going to be&#xD;
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With&#xD;
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Here the scalar is b. Using (2) and (3) consecutively for entirely (????,????) spots&#xA0;of knowledge, the&#xA0;half&#xA0;plot for the relating plane&#xA0;is made.&#xD;
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The difficulties which will develop by preparing of CNNs needs to fix with the tremendous variety of strictures which has got acknowledged, that can incite the effort by overfitting. to the present finish, frameworks, maybe, random pooling, dropout, and information development are planned. additionally, CNNs are as typically as attainable assumed to pre-processing, which is, a technique that instates the framework by pre-processing parameters as hostile without aim set ones. Pretraining will enliven the educational technique and update the hypothesis limit of the framework. All things thought-about, CNNs were looked as if it would primarily trump commonplace AI methods is a very wide extent of Deep vision and model affirmation errands,13 samples are given in Section3. Its splendid show got alongside the relative simplicity in preparing are the essential reasons that specify the unfathomable arrive of their predominance in the course of the most recent number of years.&#xD;
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Generative graphical model and Stochastic Hopfield network with hidden units&#xD;
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Deep Belief Networks and Deep Boltzmann Machines are Deep learning models that belong to the "Boltzmann family," as they utilize the Restricted Boltzmann Machine (RBM) as a knowledge module. The generative stochastic artificial neural network is also called the Restricted Boltzmann Machine (RBM). DBNs have an objectiveless relationship by two layers that structure an RBM and guiding relationship with the lesser layers. The generative graphical model has directionless association among full layers of the framework. An apt representation of DBNs and DBMS can be initiate in (Figure 2). In going with subclasses, we will depict the major characteristics of DBNs and DBMs, in the wake of presenting their fundamental structure hinder, the RBM.&#xD;
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Generative graphical model&#xD;
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Deep Belief Networks (DBNs) are probabilistic generative models that provide a probability transport ended perceptible information and also names. That is shaped by loading RBMs and setting them up in a covetous way, which are planned in.14 A DBN from the start uses a helpful layer-by-layer energetic knowledge procedure to gift many frameworks, and, within the facet project, adjusts all plenty in conjunction with the right yields. DBNs are graphical models that add up the way to evacuate a big dynamic depiction of the readiness information. They model the be a part of t spread between watched vector x and also the ???? lined layers h???? as follows:&#xD;
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where x =h0,????(h???? |h????+1)is Associate in Nursing unforeseen alternative aimed at the perceptible components at level ???? adjusted arranged the lined components of the RBM at equal????+1, and ????(h????&#x2212;1|h????) remains that the taken for granted - lined joint unfold within the top-ranking RBM.&#xD;
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The top two layers of a DBN structure a directionless outline n and the remainder of the layers structure a conviction facilitate by composed, top-down affiliations. In a DBM, all affiliations are directionless. &#xD;
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The standard of m voracious layer-wise freelance coming up with is functional to DBNs by RBMs because the structure frustrates for every layer.15 A summary portrayal of the system is as follows: &#xD;
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(1) Train the chief layer as an RBM which models the rough info x=h0 as its perceptible layer. &#xD;
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(2) Practice that 1st layer to secure an outline of the info which may be used as data for the following layer. 2 typical game plans exist. This depiction is picked just like the mean authorization (h1=1|h0) or trial of (h1|h0). &#xD;
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(3)Train the second layer as an RBM, which modified information (tests or mean commencement) as coming up with examples(for the conspicuous layer of that RBM). &#xD;
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(4) Restate steps ((2)and(3)) for the right variety of layers, whenever multiplying upward either test or mean characteristics. &#xD;
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(5) Fine-tune all the limits of this vital structure with relevancy a middle person for the DBN log-likelihood, or concerning a regulated coming up with live (consequent to adding further learning device to vary over the perceptive depiction into oversaw gauges, e.g., an instantaneous classifier). &#xD;
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There are 2 essential inclinations within the above-depicted unsatiable learning methodology of the DBNs.16 First, it handles the trial of acceptable assurance of parameters, that once during a whereas will incite poor within reach optima, as desires are guaranteeing that the framework is befittingly conferred. Second, there&amp;#39;s no essential for checked information since the system is freelance. Regardless, DBNs are in a like manner full of totally different deficiencies, parenthetically, the procedure value connected with putting in a DBN and also the manner that the strategies towards any improvement of the framework dependent on most outrageous chance preparing gauge are cloudy.15 to boot, a very important obstruction of DBNs is that they don&amp;#39;t speak to the 2D structure of an information image, which can primarily impact the show and connection in deep vision and sight and sound examination problems. Regardless, a later assortment of the DBN, the CDBN is a generative graphical model.17 uses the three-dimensional info of neighbouring pixels by presenting convolutional RBMs, afterwards creating a change invariant generative model that with success scales with relevancy high dimensional photos.&#xD;
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APPLICATIONS OF DEEP LEARNING IN DEEP VISION&#xD;
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These days, employments of Deep learning join anyway are not obliged to NLP (e.g., sentence gathering, translation, etc.), visual data dealing with (e.g., Deep vision, blended media data assessment, etc.), talk and sound getting ready (e.g., overhaul, affirmation, etc.), relational association examination, and restorative administrations. This portion offers nuances to the unrelated techniques used for the respective application. &#xD;
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Natural Language Processing &#xD;
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NLP is a movement of estimations and frameworks that essentially based on demonstrating deep to fathom the human language. NLP endeavours fuse report portrayal, understanding, revise recognizing confirmation, content closeness, summary, and question answering. NLP progression is attempting a direct result of the multifaceted nature and unsure building of the human language. Furthermore, ordinary language is significantly setting express, where severe ramifications change subject to the kind of words, joke, and region distinction. Significant learning systems have starting late had the choice to show a couple of compelling undertakings in attaining high precision in NLP errands. &#xD;
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Most NLP models follow a practically identical pre-planning step: (1) the information content is isolated into words by tokenization and a while later (2) these words are rehashed as vectors or n-grams. Addressing words in a low estimation is fundamental to make a precise perspective on similarities and differentiation among numerous words. The test shows up when there is essential to pick the length of words limited in each n-gram. This strategy is setting express and needs previous region data. A part of the outstandingly noteworthy systems in appreciating the most prominent NLP assignments are presented underneath. &#xD;
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Sentiment Analysis&#xD;
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This bit of NLP supervises looking at a book and organizing the propensity or evaluation of the author. Maximum datasets for end assessment are separate as either confident or undesirable, and reasonable enunciations are expelled by bias demand philosophies. The single commended model is the Standford Sentiment Treebank (SST),18 a dataset of film surveys set apart into five classes (going from negative to unfathomably positive). Near to the preface to SST, Socher et al.18 propose a Recursive Neural Tensor Network (RNTN) that usages word vectors and parses a tree to address an enunciation, getting the coordinated efforts among the parts with a tensor-based strategy work. This recursive methodology is perfect concerning sentence-level depiction since the emphasis reliably shows a tree-like structure. &#xD;
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Kim19 improves the correctness for SST by next a substitute technique. Notwithstanding the way that CNN models were first made considering picture insistence and strategy, their execution in NLP has displayed to be a triumph, accomplishing brilliant outcomes. Kim grants a direct CNN model utilizing one convolution layer on masterminded word2vec vectors in a BoW structure. The representations were spared sensibly crucial with relatively few hyperparameters for change. By a mix of low tuning and pre-trained task-express parameters, they understand how to accomplish high precision on two or three standards. Online life is a prominent wellspring of information while dissecting notions.&#xD;
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Machine Translation&#xD;
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Deep learning has accepted a noteworthy activity in the updates of customary customized translation systems. Cho et al.20 presented a new RNN-based encoding and unwinding configuration to set up the words in a Neural Machine Translation (NMT). The RNN Encoder-Decoder framework practices two RNNs: one plot a data progression into fixed-length vectors, however, the other RNN translates the vector into the goal pictures. The problem with the RNN Encoder-Decoder is the introduction fall as the data course of action of pictures extends. Bahdanau et al.16 address this question by introducing a dynamic-length vector and by together knowledge the alter and disentangle techniques. Their approach is to play out a matched mission to scan for syntactic structures that are commonly judicious for understanding. In any case, the starting late planned translation schemes are known to be computationally classy and incompetent in dealing with sentences covering unprecedented words.&#xD;
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Paraphrase Identification&#xD;
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Rework distinguishing proof is the path toward separating two sentences and foreseeing how equivalent they rely upon their essential covered semantics. A key part that is useful for a couple of NLP occupations, for instance, copyright encroachment acknowledgement, answers to questions, setting area, abstract, and region recognizing evidence. Socher et al.18 suggest the usage of spreading out Recursive Autoencoders (RAEs) to amount the resemblance of two sentences. Using syntactic trees to progress the part space, they measure both word-and articulation level comparable qualities. Notwithstanding the way that it is on a very basic level equivalent to RvNN, RAE is useful in the independent request. Not in the slightest degree like RvNN, RAE registers a generation screw up in its place of a controlled score during the meeting of two vectors into a compositional vector. This article furthermore introduced a dynamic pooling layer that can consider and bunch two sentences of unlike sizes as either a translation or not. &#xD;
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Visual Data Processing &#xD;
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Deep learning techniques have developed the central bits of numerous front line intelligent media systems and Deep vision.21 Even more unequivocally, CNNs have exhibited basic results in different genuine endeavours, including picture taking care of, object acknowledgement, and video getting ready. This zone discusses more bits of knowledge concerning the most recent significant learning structures and estimations planned over the late years for visual data taking care of.&#xD;
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Image Classification&#xD;
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In 1998, LeCun et al. prevailing the essential type of LeNet-5 [43]. LeNet-5 is a standard CNN that joins two convolutional layers close by a subselection layer ultimately getting done through a complete relationship in the previous layer. Despite the way that, since the mid-2000s, LeNet-5 and other CNN strategies were hugely used in dissimilar issues, counting the division, area, and portrayal of pictures, they were nearly rejected by data mining and AI study get-togethers. Over a multi decade later, the CNN figuring has started its thriving in Deep vision systems. Exactly, AlexNet22 is seen as the first CNN prototype that significantly enhanced the image portrayal consequences on an amazingly colossal dataset (e.g., ImageNet). It was the victor of the ILSVRC 2012 and improved the best results from the prior years by for all intents and purposes 10% concerning the best five test bumble. To recover the effectiveness and the rapidity of setting up, a GPU execution of the CNN is used in this framework. Data increment and dropout methods are furthermore used to altogether lessen the overfitting issue. &#xD;
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Object Detection and Semantic Segmentation &#xD;
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Deep learning methodology accepts a noteworthy activity in the movement of article distinguishing proof starting late. Before that, the best article acknowledgement execution began from complex structures with a couple of low-level structures (e.g., SIFT, HOG, etc.) and huge level settings. In any case, with the methodology of new significant learning frameworks, object ID has in like manner showed up at another period of progress. These advances are driven by compelling methodologies, for instance, zone recommendation and section-based CNN (R-CNN).23 R-CNN defeats any obstruction among the article area and picture game plan by presenting section grounded thing repression strategies using deep frameworks. Besides, the move to learn and relating on a colossal dataset (e.g., ImageNet) is applied since the little thing acknowledgement datasets (e.g., PASCAL [46]) fuse lacking named data to set up a gigantic CNN sort out. In any case, in R-CNN, the readiness computational time and memory are over the top costly, particularly on novel ultra-significant frameworks (e.g., VGGNet). &#xD;
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Video Processing &#xD;
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Video examination has pulled in broad thought in the deep vision organize and is measured as a troublesome task since it consolidates mutually spatial and brief data. In an early slog, colossal degree YouTube accounts containing 487 game classes are used to set up a CNN model.24 The model fuses a multiresolution designing that employs the close-by development data in accounts and joins setting stream (for low-objectives picture illustrating) and fovea stream (for significant standards picture dealing with) modules to arrange chronicles. An occasion acknowledgement from game chronicles using significant learning is presented.25 In that work, both spatial and brief data are determined using CNNs and feature mix through standardized Autoencoders. Starting late, another framework called Recurrent Convolution Networks (RCNs) was introduced for video dealing. It smears CNNs on video traces for pictorial comprehension and a short time later deals with the housings to RNNs for exploring transient information in accounts.&#xD;
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Social Media Analysis&#xD;
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Social Web Analysis&#xD;
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The notoriety of various relational associations like Facebook and Twitter has engaged customers to part a ton of data with their photographs, considerations, and sentiments. Because of the way that significant knowledge has revealed hopeful execution on visual data and NLP, unmistakable significant learning methods have been grasped for relational association examination, including semantic evaluation, interface estimate, and crisis response.26,27 The semantic appraisal is a huge field in casual association assessment, which means to help machines with understanding the semantic significance of posts in relational associations. Though a collection of techniques have been planned to separate works in NLP, these strategies might disregard to address a couple of standard difficulties in relational association assessment, for instance, spelling botches, abbreviated structures, unprecedented characters, and easy-going vernaculars.28 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Twitter can be considered as the most routinely used wellspring of appraisal request for relational association examination. Generally speaking, feeling examination hopes to choose the mien of analysts. Consequently, SemEval has given a standard dataset reliant on Twitter and run the assessment game plan task since 2013. Another practically identical model is Amazon, which ongoing as an online book shop and is as of now the world&amp;#39;s greatest online retailer. With an abundance of acquirement trades, a colossal proportion of evaluations are made by the clients, making the Amazon dataset a remarkable hotspot for tremendous extension estimation plan.29&#xD;
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Information Retrieval&#xD;
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Deep adapting incredibly influences information recuperation. Deep Structured Semantic Modelling (DSSM) is planned for text recuperation and web search,30 where the dormant semantic examination is driven by a DNN and the inquiries nearby the explore data are used to choose the eventual outcomes of the recuperation. The encoded requests and explore data are mapped into 30k-estimation by term hashing and a 128-estimation feature space is delivered by the multilayer nonlinear plans. The proposed DNN is set up to interface the offered inquiries to their semantic criticalness with the help of the explore data. Regardless, this proposed classical treats each term autonomously and disregards the relationship among the terms.&#xD;
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DEEP LEARNING CHALLENGES AND DIRECTIONS&#xD;
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With the extraordinary progression in profound learning and its assessment scenes existence at the centre of attention, profound learning has expanded excellent power in talk, language, and visual revelation structures. In any case, a couple of spaces are still faultless by DNNs owing to either their troublesome countryside or the nonattendance of data openness for the overall populace. This makes important possibilities and productive ground for compensating upcoming study streets. The most significant future AI issues won&amp;#39;t have sufficient getting ready tests with names.31 Beside the zettabytes of starting at now open data, petabytes of data are incorporated every day. This exponential improvement is gathering data that can never be named by human aid. The current estimation is pleasing to coordinated learning, by and large under the immediately open imprints and the little sizes of current datasets. Regardless, with the brisk augmentations in the scope and unpredictability of information, independent learning will be the predominant course of action later on. Current profound learning models will in like manner need to conform to the rising issues, for instance, data sparsity, missing data, and disordered data to get the approached in forever discernments as opposed to getting ready. &#xD;
&#xD;
&#xD;
&#xD;
Another achievement challenge looked at by profound learning techniques is the decline of dimensionality without losing fundamental information required for request. In clinical applications like danger RNA sequencing examination, generally, the amount of tests in each imprint is far not the number of features. In current profound learning models, this causes outrageous overfitting issues and limits the fitting course of action of lacking cases. Current profound learning structures require broad proportions of computational advantages for a push toward the front line presentations. One system attempts to vanquish this test by using store preparing. Added different is to custom the slow systems that misuse medium and colossal datasets on separated getting ready. In rhythmic movement years, various researchers have moved fixation to develop equivalent and versatile profound learning frameworks. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Deep learning, another and fervently discussed the issue in AI, can be described as a course of layers acting nonlinear getting ready to get comfortable with various degrees of data depictions. This article contemplates the top tier counts and methods in deep learning. A couple of disclosures of this article and likely future work are dense underneath: &#xD;
&#xD;
&#x2022;Thoughdeep learning can recall a huge proportion of data and info, it feels cognitive and perception of the data makes it a disclosure answer for certain applications. The interpretability of deep learning should be inspected later on. &#xD;
&#xD;
&#x2022;Deep learning despite everything encounters issues in showing various erratic facts modalities at an equal period. Multimodal profound learning is an extra notable heading in progressing deep learning research. &#xD;
&#xD;
&#x2022;Disparate human personalities, deep adapting needs wide datasets (unmistakably named data) for coming down the machine and anticipating the inconspicuous information. This issue turns out to be all the more overwhelming when the existing datasets are pretty much nothing (e.g., social protection data) or when the data ought to be arranged ceaselessly. One-shot learning and zero-shot learning have been packed in the continuous hardly any years to help this issue. &#xD;
&#xD;
&#x2022;In disdain of all the profound learning types of progress starting late, various applications are up &amp;#39;til now flawless by profound learning or are first and foremost times of using the profound learning systems (e.g., disaster information the load up, cash, or clinical data assessment)&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3513</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3513</Fulltext></URLs><References>&#xD;
1. Ballard DH, Brown CM. Deep Vision. Prentice Hall 1982.&#xA0;ISBN&#xA0;978-0-13-165316-0.&#xD;
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3. Ouyang W, Zeng X, Wang X. DeepID-Net: Object Detection with Deformable Part Based Convolutional Neural Networks. IEEE Transactions on Pattern Analysis and Machine Intelligence 2017; 39(7):1320&#x2013;1334.&#xD;
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4. Doulamis N, Voulodimos A. &#x201C;FAST-MDL: Fast Adaptive SupervisedTrainingofmulti-layereddeeplearningmodelsfor consistent object tracking and classification,&#x201D; in Proceedings of the 2016 IEEE International Conference on Imaging Systems and Techniques 2016 pp.318&#x2013;323.&#xD;
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7. Noh H, Hong S, Han B. Learning deconvolution network for semantic segmentation. Proceedings of the 15th IEEE International Conference on Deep Vision, ICCV 2015, pp. 1520&#x2013;1528, Santiago,Chile,December2015. &#xD;
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11. Scherer D, Muller A, Behnke S. Evaluation of pooling operations in convolutional architectures for object recognition,&#x201D; Lecture Notes in Deep Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics): Preface 2010;6354(3):92&#x2013;101. &#xD;
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12.Krizhevsky A, Sutskever I, Hinton GE. Image net classification with Deep convolutional neural networks. Proceedings of the 26th Annual Conference on Neural Information Processing Systems (NIPS &#x2019;12), pp. 1097&#x2013;1105, Lake Tahoe, Nev, USA, December2012. &#xD;
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14. Hinton GE, Salakhutdinov RR. Reducing the dimensionality of data with neural networks. Am Assoc Adv Sci 2006;313(5786):504&#x2013;507.&#xD;
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13. Bengio Y. Learning deep architectures for AI. Foundat Trends Mach Lear 2009;2(1):1&#x2013;27.&#xD;
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15. Bengio Y, Courville A, Vincent P. Representation learning: a review and new perspectives. IEEE Transactions on Pattern Analysis and Machine Intelligence 2013;35(8):1798&#x2013;1828.&#xD;
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16. Bahdanau D, Cho K, Bengio Y. Neural machine translation by jointly learning to align and translate. CoRRabs 2014;1409.0473. Retrieved from http://arxiv.org/abs/1409.0473.&#xD;
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20. Cho K, van Merrienboer B, G&#xFC;l&#xE7;ehre C, Bahdanau D, Bougares F, Schwenk H, Bengio Y.. Learning phrase representations using RNN encoder-decoder for statistical machine translation. In The Conference on Empirical Methods in Natural Language Processing &#xA0;2014:1724&#x2013;1734.&#xD;
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27. Vosoughi S, Vijayaraghavan P, Roy D. Tweet2Vec: learning Tweet embeddings using character-level CNN-LSTM encoder-decoder. In The 39th International ACM SIGIR Conference on Research and Development in Information Retrieval. ACM, 2016.1041&#x2013;1044.&#xD;
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31. Zhu Y, Urtasun R, Salakhutdinov R, Fidler S. SegDeepM: Exploiting segmentation and context in deep neural networks for object detection,&#x201D; in Proceedings of the IEEE Conference on Deep Vision and Pattern Recognition, CVPR 2015:4703&#x2013; 4711.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Novel Quality Improvement Approach to Improving Physical Healthcare Monitoring in an Acute Mental Health Unit&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>93</FirstPage><LastPage>95</LastPage><AuthorList><Author>Rasan Burhan</Author><AuthorLanguage>English</AuthorLanguage><Author> Thron Miah</Author><AuthorLanguage>English</AuthorLanguage><Author> Raza Butt</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Clinical Guidelines, Healthcare, Progress, Patient-centered care, Multimorbidity</Keywords><Fulltext>Introduction&#xD;
&#xD;
Parity of Esteem is the principle whereby physical health is given equivocal importance to mental health - due to the inextricable link between them. The relationship between physical and mental health is such that poor mental health leads to poor physical health, and vice versa. This principle was embedded into the Health and Social Care Act 2012.1 This came in response to the finding that patients in mental health services often have high morbidity and mortality rates concerning their physical health outcomes, and steps must be taken to address this.2 It was deemed of such high priority and concern that it was highlighted as one of the 13 National Indicators under the clinical quality and transformational indicators goals for 2017-2019: The need to improve physical healthcare to reduce premature mortality in people with serious mental illnesses.3&#xD;
&#xD;
The Lester Health Tool was developed in 2014 to combat this, and consists of recording a series of cardiometabolic parameters for patients, and applying relevant associated interventions.4However, despite the extensive evidence base incorporated into the tool, it was often difficult for staff to use (due to time and system constraints).&#xD;
&#xD;
To address this, the authors developed a Modified Lester Health Tool to achieve the same desired effect; in a simple and user-friendly mat. The Modified Lester Health Tool involved simplifying the categorisation of the cardiometabolic parameters into an easy to follow checklist. The interventions were also simplified for each domain (diabetes, obesity, hypertension and lipid modification) according to guidelines set out by the National Institute for Health and Care Excellence.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Initial data were collected from a population sample of 18 patients at an acute mental health inpatient unit. Data were collected according to the parameters of the Modified Lester Health Tool (Figure 1), which was utilised in every ward round (Figure 2). Data were extracted from the Silverlink database.5&#xD;
&#xD;
&#xD;
&#xD;
The Modified Lester Health Tool was subsequently introduced to the inpatient unit after a roundtable discussion with medical and nursing staff &#x2013; leading to all key stakeholders buying into the implementation of the tool.&#xD;
&#xD;
All members of staff on the ward were trained in how to optimally utilise the tool - executing the relevant interventions as guided. This involved staff teaching on the adapted tool embedded into the trusts Information technology (IT) system. Teaching sessions were given as one-on-one and group tutorials to staff on the ward &#x2013; at various time-points. These include during times before and after the ward round - as well as during free periods for staff. Large posters were also put up across the ward to remind patients and staff of the tool - and the importance of its implementation. It was emphasised to staff that it&#x2019;s not just important to screen but to also intervene. &#xD;
&#xD;
Data was recollected 6 months following the implementation of the initial data set with a population sample of 15 patients.&#xD;
&#xD;
Results&#xD;
&#xD;
The study found that before the implementation of the health tool, there was minimal recording of patients cardiometabolic parameters within the inpatient unit. It was found that even where parameters were recorded, there were no active interventions on those parameters - when they would have triggered an intervention as per the National Institute of Health and Care Excellence (NICE) Guidance.&#xD;
&#xD;
However, following the implementation of the Modified Lester Health Tool, there was a significant increase in the percentage of patients who had their cardiometabolic parameters recorded. Additionally, when these cardiometabolic parameters triggered the need for an intervention as per NICE Guidance, the Modified Lester Health Tool would prompt the clinicians to consider one of the NICE recommended interventions, which would be acted upon.&#xD;
&#xD;
Quantitative data from the study showed the following improvements in recording parameters:&#xD;
&#xD;
Smoking 78% to 100%. Diet 78% to 87%. Lifestyle 39% to 60%. Weight change 27% to 80%. BP remained at 100%. HbA1c 28% to 93%. Fasting Plasma Glucose 0% to 93%. Random Plasma Glucose 56% to 100%. Lipid profile 11% to 80%. &#xD;
&#xD;
Follow through parameters showed improvement across the board:&#xD;
&#xD;
Smoking 78% to 100%. Diet 30% to 87%. Lifestyle 0% to 60%. BMI 19% to 80%. Weight change 27% to 80%. Blood pressure 19% to 100%. HbA1c 28% to 93%. Fasting Plasma Glucose 0% to 93%. Random Plasma Glucose 56% to 100%. Lipid Profile 11% to 100%. &#xD;
&#xD;
&#xD;
&#xD;
As shown here in Figure 2, nine out of ten parameters saw an improvement in the recording on the re-assessment and all ten parameters showed an improvement in the follow-through in the re-assessment. &#xD;
&#xD;
Patients&#x2019; clinical characteristics in the ward were varied. Several patients were in relatively good physical health whilst others had systemic co-morbidities. There was also qualitative data observed from the study with patients beginning to ask questions about the calorie content of foods, and enquiring about how to be referred to for smoking cessation. Additionally, they were making very positive affirmations about wanting to improve their diet, improving their lifestyle and losing weight. This led to a positive atmosphere across the ward with an increased focus on developing and maintaining good health. &#xD;
&#xD;
Discussion&#xD;
&#xD;
The success of this quality improvement came about as a result of regular training for all staff, raising awareness of the project through the use of posters and accountability of staff via the tool - if parameters triggered were not being followed through. This involved a collective endeavour from all staff involved and patients &#x2013; fostering initiative and proactivity. There were nevertheless some limitations noted in the project. For example, we had a minority of patients declining smoking cessation. To improve further we could look to developing integrated education programmes (videos and interactive sessions) on the ward to increase awareness regarding the dangers of smoking. Furthermore, the acute unit within which the design of the study was conducted was a female inpatient unit - hence it would be worthwhile expanding this to mixed-wards and male-only wards as well. We envision this would have equally positive outcomes. &#xD;
&#xD;
To continue going forward, we should look to ensure training is provided at regular intervals and staff are updated with the latest statistics at regular meetings. This would help to ensure that the high-standards demonstrated are maintained going forward. This quality improvement project was a success and demonstrated the importance of developing interventions as a result of initial findings - as well as the importance of effective data collection. The project demonstrated a novel way to improve the morbidity and mortality of patients under our care - by effectively focusing on physical health parameters and treating these with equivocal importance to co-existing mental health diagnoses. &#xD;
&#xD;
Funding&#xD;
&#xD;
Funded by HC-UK for Presentation to NHS Quality Improvement Staff from trusts across the United Kingdom at the Annual Summit. &#xD;
&#xD;
The Graphics team at the trust were commissioned by Lincolnshire Partnership NHS Foundation Trust to design and print posters as per the prototype.&#xD;
&#xD;
Author Contributions:&#xD;
&#xD;
Rasan Burhan: Project Lead&#xD;
&#xD;
Thron Miah: Project Team&#xD;
&#xD;
Raza Butt: Project Team&#xD;
&#xD;
Ethics approval and consent to participate:&#xD;
&#xD;
Approval obtained from QI/Audit Team at Institution&#xD;
&#xD;
Competing interests:&#xD;
&#xD;
No competing interests from any author&#xD;
&#xD;
Acknowledgements:&#xD;
With thanks to Dr KuganandaParanthaman (Medicine) and Dr BeenaRajkumar (Consultant Psychiatrist) for helping facilitate effective implementation of the project. With also extend our gratitude to all nursing and allied healthcare staff at the trust for co-operation with the project. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3514</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3514</Fulltext></URLs><References>1) Department of Health. GOV.UK. United Kingdom: Health and Social Care Act 2012 Fact Sheets; [updated April 2012; cited August 24 2020]. Available from:&#xA0; www.gov.uk/government/publications/health-and-social-care-act-2012-fact-sheets. &#xD;
&#xD;
2) NHS England. NHS.UK. United Kingdom: Parity of Esteem (Valuing Mental Health Equally With Physical Health); [updated November 2013; cited August 24 2020]. Available from: www.england.nhs.UK/mentalhealth/parity.&#xD;
&#xD;
3) NHS England. NHS.UK. United Kingdom: Commissioning for Quality and Innovation; [updated November 2016; cited August 24 2020]. Available from: www.england.nhs.uk/nhs-standard-contract/cquin/cquin-17-19.&#xD;
&#xD;
4) Royal College of Psychiatrists. RCPsych.ac.uk. United Kingdom: Lester Adaptation of the Cardiometabolic Health Resource; [updated June 2014; cited August 2020]. Available from: www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/ncap-e-version-nice-endorsed-lester-uk-adaptation.pdf&#xD;
&#xD;
5) Patient Administration System [Computer Software]. Version 1.0. United Kingdom: Silverlink Software Limited; 2013.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Awareness of Glaucoma Patients on Risk of Glaucoma in Close Relatives and to Determine its Prevalence&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>96</FirstPage><LastPage>100</LastPage><AuthorList><Author>Meena M</Author><AuthorLanguage>English</AuthorLanguage><Author> V. Panimalar A. Veeramani</Author><AuthorLanguage>English</AuthorLanguage><Author> Divya N</Author><AuthorLanguage>English</AuthorLanguage><Author> Bindu Bhaskaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Glaucoma is a multifactorial, chronic and progressive optic neuropathy that results in visual field defects and it is commonly associated with increased intraocular pressure. It is one of the most important causes of irreversible blindness left untreated. Objective: This study aims to assess awareness of glaucoma patients on the risk of development of glaucoma in close relatives and to determine the prevalence of glaucoma in close relatives. Methods: This is a self-designed questionnaire-based study with three sections consisting of demographic details and questions about knowledge and awareness of the patients. One hundred participants attending the ophthalmology outpatient department of a tertiary care hospital filled the questionnaire. Results: According to the responses obtained, 44 (44%) patients were unaware of the term glaucoma until they were diagnosed with the disease. Only 24(24%) patients had actual knowledge about glaucoma. It is also seen that positive family history is seen as a risk factor in only 30(30%) patients. Only 19(19%) of the patients urged their relatives to get screening to post their diagnosis out of which 7(36.8%) patients had one or more relatives diagnosed with glaucoma. Conclusion: Awareness can be increased by mass media announcements, health programs and Ophthalmologists at the time of diagnosis and follow up by educating diagnosed patients and also encouraging them to instruct their relatives to undergo screening. This creates positive health-seeking behaviour leading to early diagnosis and better prognosis of glaucoma.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Knowledge, Awareness, Glaucoma, Family History, Relatives</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Glaucoma is one of the leading causes of irreversible blindness worldwide. Based on the available data, there are approximately 11.2 million people aged 40 years and older with glaucoma in&#xA0;India.1 Studies have shown that 50 - 90% of glaucoma cases remain undiagnosed2 and a large number of cases are diagnosed at a later stage of the disease.3 Lack of awareness about glaucoma is an important reason for its late presentation,4 which increases the risk of blindness due to glaucoma.5 It has been estimated that almost 90% of glaucoma-related blindness can be prevented with early and proper treatment.6 For effective treatment to be possible, awareness about the disease is extremely crucial.&#xD;
&#xD;
The spread knowledge regarding some well-recognized risk factors of glaucoma may enhance more awareness. These include positive family history. &#xA0;A positive family history of glaucoma encourages a search for the presence of the disease and its assessment among the family members and thus increases health-seeking behaviour. A study by Leske et al. reported a positive family history of 13% to 25% and has been proven to be an important risk factor for the disease.7 Several studies have also indicated that most individuals do not have an accurate understanding and knowledge of this disease despite being aware of this disease8. Thus the assessment of awareness is the first step in the planning of disease management.&#xD;
&#xD;
This study deals with the assessment of awareness and knowledge of glaucoma in diagnosed patients, awareness about positive family history and prevalence of the same. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This is a population-based study, using a questionnaire exploring the details of awareness and knowledge of glaucoma among known glaucoma patients with special interest in the inheritance and positive family history. It was conducted in the ophthalmology outpatient department of Saveetha Medical College, a tertiary care centre between January 2020 and March 2020. The study was approved by the Institutional Medical Ethics Committee. Written informed consent was obtained from all the participants after explaining the nature of the study. IEC no: SMC/IEC/2020/03/377&#xD;
&#xD;
Data collection&#xD;
&#xD;
All the patients above 40 years, diagnosed with glaucoma were chosen randomly and a self-designed questionnaire (in English and Tamil) was distributed to the participants. Illiterate patients had questions read out to them by nurses and interns to prevent interviewer bias. Patients with any other eye disorder except glaucoma were excluded. &#xD;
&#xD;
The questionnaire had three sections &#x2013; The first section about information about the patient&amp;#39;s demographic characteristics (age, gender, education level and socioeconomic data). Section two was designed to know the patient&amp;#39;s awareness of the disease through six multiple-choice questions. Section three was based on knowledge about glaucoma, through eleven multiple-choice questions. Awareness was defined as &#x2018;having heard of glaucoma&#x2019;. Knowledge was defined as when the subject had some understanding of glaucoma in terms of cause and/or symptoms.&#xD;
&#xD;
Data analysis&#xD;
&#xD;
All responses were tabulated using Microsoft Excel software. Graphical representations were made in places necessary. Statistical analysis was done using SPSS software and p-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3515</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3515</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Usha BR, Usha MS, Brinda Prasad M, Outcome of conventional trabeculectomy with or without cataract surgery. Int J Curr Res Rev 2015;7(17):20-26. &#xD;
&#xD;
2.. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh SV, et al. Prevalence of Primary Open-angle Glaucoma in an Urban South Indian Population and Comparison with a Rural Population. The Chennai Glaucoma Study. Ophthalmology 2008;115(4):648-654.e1. &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Oliver JE, Hattenhauer MG, Herman D, Hodge DO, Kennedy R, Fang-Yen M, et al. Blindness and glaucoma: a comparison of patients progressing to blindness from glaucoma with patients maintaining vision. Am J Ophthalmol 2002;133(6):764&#x2013;772. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Fraser S, Bunce C, Wormald R. Risk factors for late presentation in chronic glaucoma. Investig Ophthalmol Vis Sci 1999;40(10):2251&#x2013;2257. &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Javitt JC. Preventing blindness in Americans: the need for eye health education. Surv Ophthalmol 1995;40(1):41&#x2013;44. &#xD;
&#xD;
6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996;80(5):389&#x2013;393. &#xD;
&#xD;
7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Leske MC, Connell AMS, Wu SY, Hyman LG, Schachat AP. Risk Factors for Open-angle Glaucoma: The Barbados Eye Study. Arch Ophthalmol 1995;113(7):918&#x2013;924. &#xD;
&#xD;
8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rewri P, Kakkar M. Awareness, knowledge, and practice: A survey of glaucoma in north Indian rural residents. Indian J Ophthalmol 2014;62(4):482&#x2013;486. &#xD;
&#xD;
9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kizor-Akaraiwe NN, Monye HI, Okeke S. Awareness and knowledge about glaucoma and proportion of people with glaucoma in an urban outreach programme in Southeast Nigeria. BMJ Open Ophthalmol 2017;1(1):e000018. &#xD;
&#xD;
10. &#xA0;&#xA0;&#xA0;&#xA0; Sathyamangalam RV, Paul PG, George R, Baskaran M, Hemamalini A, Madan R V., et al. Determinants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol 2009;57(5):355&#x2013;360. &#xD;
&#xD;
11. &#xA0;&#xA0;&#xA0;&#xA0; Pfeiffer N, Krieglstein GK, Wellek S. Knowledge about glaucoma in the unselected population: A German survey. J Glaucoma 2002;11(5):458&#x2013;463. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Tenkir A, Solomon B, Deribew A. Glaucoma awareness among people attending ophthalmic outreach services in Southwestern Ethiopia. BMC Ophthalmol 2010;10:17. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Ichhpujani P, Bhartiya S, Kataria M, Topiwala P. Knowledge, attitudes and self-care practices associated with glaucoma among hospital personnel in a tertiary care center in &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;North India. J Curr Glaucoma Pract 2012;6(3):108&#x2013;12. &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Celebi ARC. Knowledge and Awareness of Glaucoma in Subjects with Glaucoma and their Normal First-Degree Relatives. Med hypothesis, Discov Innov Ophthalmol J 2018;7(1):40&#x2013;7. &#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0; Mitchell P, Rochtchina E, Lee AJ, Wang JJ. Bias in self-reported family history and relationship to glaucoma: The Blue Mountains Eye Study. Ophthalmic Epidemiol 2002 Dec;9(5):333&#x2013;345. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Gramer G, Weber BHF, Gramer E. Results of a patient-directed survey on frequency of family history of glaucoma in 2170 patients. Investig Ophthalmol Vis Sci 2014;55(1):259&#x2013;264. &#xD;
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17. &#xA0;&#xA0;&#xA0;&#xA0; Nguyen RL, Raja SC, Traboulsi EI. Screening relatives of patients with familial chronic open angle glaucoma. Ophthalmology 2000;107(7):1294&#x2013;1297. &#xD;
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18. &#xA0;&#xA0;&#xA0;&#xA0; Wolfs RCW, Klaver CCW, Ramrattan RS, Van Duijn CM, Hofman A, De Jong PTVM. Genetic risk of primary open-angle glaucoma: Population-based familial aggregation study. Arch Ophthalmol 1998;116(12):1640&#x2013;1645. &#xD;
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19. &#xA0;&#xA0;&#xA0;&#xA0; Vegini F, Figueiroa Filho N, Lenci RF, Neto DG, Susanna R. Prevalence of open angle glaucoma in accompanying first degree relatives of patients with glaucoma. Clinics ((Sao Paulo) 2008;63(3):329&#x2013;32.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Microcurrent Electrical Stimulation on Two Acupoints to Control Anxiety in Patients Receiving Prosthodontics Treatment&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>101</FirstPage><LastPage>106</LastPage><AuthorList><Author>Tanvi R. Balwani</Author><AuthorLanguage>English</AuthorLanguage><Author> Surekha Godbole Dubey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>ntroduction: Dental fear is the most common issue which is present in patients. Therefore managing anxiety has become a task to achieve successful treatment. Therefore, dental anxiety is linked with an undesirable effect on oral health. Objective: To evaluate the effect of microcurrent electrical stimulation on two Acupoints i.e yintang and shamen points to control the level of anxiety amongst the patients. Methods: A total number of 30 patients who scored more than 10 in the MDAS questionnaire were enrolled in the study. Before commencing prosthodontic treatment procedures pulse oximeter and MDAS was used to assess anxiety levels. After which acupuncture and acupressure therapy was performed on acupoints using the acupuncture meridian pen. Treatment procedures were carried out after the therapy. The pre-treatment and post-treatment values were compared. Results: Acupuncture and acupressure performed at Bintang acupoint 8.62 &#xB1; 2.32 (mean&#xB1;SD) proved to be more effective compared to when men point 9.62&#xB1; 2.26 (mean&#xB1;SD). But when compared with the control group both the acupoints were effective in controlling anxiety levels. The decrease in anxiety levels was statistically significant(p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acupuncture, Anxiety, Novel Technique, Acupressure</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dental fear is the most common issue which is present in patients. Therefore managing anxiety has become a task to achieve successful treatment. Therefore, dental anxiety is linked with an undesirable effect on oral health.1,2 Here are the number of treatment options that have come across for the treatment of dental anxiety. There is two treatment option which includes pharmacological and non-pharmacological methods. The use of Pharmacological methods although is effective but it also has its side effects. Due to which there is a high demand for non-pharmacological techniques.1 One of the recent technique for the management of anxiety disorders is the use of acupuncture and acupressure.&#xD;
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In the dental field, a study on adult populations reported a reduction in anxiety after acupuncture; another study proved this procedure to be as in effect as intranasal midazolam in decreasing anxiety in dental patients.2,3The constant need to incorporate alternative techniques into clinical dental practice led to the introduction of acupuncture, which is apart of ancient Chinese medicine. The technique is created upon the conception of Qi (whose pronunciation is &#x201C;chee&#x201D; meaning &#x201C;life force, energy flow&#x201D;), which states that most of the physical and emotional issues begin at a level of function that is subtler than the chemistry of the brain and organ function. The specific locations where this Qi gathers are termed acupoints, into which needles are put in to achieve numerous effects.4 This procedure has proven its effectiveness in the management of insomnia, asthma, general anxiety, and anxiety disorders.5-10&#xD;
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Acupuncture done by traditional method using needles can be traumatic for the patients. So by using microcurrent electrical stimulation, acupressure and acupuncture&#xA0; works by stimulating (tonify or sedate) specific reflex points which are present along the lines of energy that run through the body, called Meridians.12&#xD;
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This original research study aims to &#x201C;Evaluate the effect of microcurrent electrical stimulation on two Acupoints that is yintang and shenmen points to control the level of anxiety amongst the patients&#x201D;. In this original research study, a novel technique was used to control anxiety levels in patients receiving Prosthodontic treatment.&#xD;
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MATERIALS AND METHODS&#xD;
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Ethical clearance was obtained from the Ethics Committee of the university and performed at the Department of Prosthodontics And Crown &amp; Bridge Sawangi Meghe Wardha.(DMIMS(DU)/IEC/2018-19/7633) A total of 30 patients were selected for the age group (18-45 years). They were planned for Prosthodontic treatment were performed. Patients were enrolled only after they gave written informed consent.&#xD;
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The inclusion and exclusion criteria were as follows:&#xD;
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	&#xD;
	Exclusion criteria included dental emergencies, &#x2018;those who have experienced acupuncture, &#x2018;language difficulties&#x2019;, &#x2018;history of drug abuse&#x2019;, &#x2018;chronic pain therapy&#x2019;, &#x2018;neurological or psychiatric disorders&#x2019;, &#x2018;malignomas&#x2019;, &#x2018;lesions at the external ear&#x2019;, &#x2018;immunosuppression&#x2019;, &#x2018;pregnancy&#x2019;, &#x2018;asthma and &#x2018;coagulation disorders&#x2019;.&#xD;
	&#xD;
	&#xD;
	Inclusion criteria were patients who fall under 10 to 25 score of modified dental anxiety scale, Patients who will give informed consent for the therapy, patients coming for prosthodontic treatment procedures, patients above the age of 18 years.&#xD;
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The patient was randomly divided into three groups 1, 2 and 3. Ten patients were present in each group. In all three groups, prosthodontics treatment procedures were done. Before and after which the Patient was selected based on the anxiety measuring scale and using a pulse oximeter, pulse rate, as well as oxygen saturation level, were evaluated before the patient underwent the therapy which was evaluated again after the therapy was done.&#xD;
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Modified Dental Anxiety Scale (MDAS) was used to assess the anxiety levels. It has a score of 0-25(not anxious to extremely anxious). In which Patient&#x2019;s under fairly anxious to extremely anxious that is from score (10 to 25) anxiety scale were selected for the study. &#xD;
&#xD;
Group 1 received electrical pulses at yintang anxiolytic point as shown in figure 1 (located midway between the medial ends of the two eyebrows) using a laser acupuncture pen. This pen automatically searches the site, no piercing of the skin is done, it is safe and effective with no side effects. It has 9 intensity levels so a mild range level that is up to 3 intensity level was used in the patients. After this using Pulse oximeter, pulse rate and oxygen saturation levels were checked pre-treatment and post-treatment. Levels of pulse rate and oxygen saturation helped to evaluate whether there is a reduction in anxiety level amongst the patients.&#xD;
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Group 2 received microcurrent electrical pulses to stimulate anxiolytic points the auricular Shen Men point as shown in figure 2(located at lateral third of the triangular fossa, in the bifurcating point between superior and inferior crura of antihelix)&#xD;
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Group 3 was the placebo group, received microcurrent electrical pulses on point not documented to reduce anxiety (located on the forehead above the eyebrows 3 cuns aways from yintang point). The placebo point was selected different from yintang point and Shenmen point to check the efficacy of microcurrent stimulation using a laser acupuncture pen on a point that is different from an acupuncture point which does not have any anti-anxiety effect. For all the patients in treatment groups, a self-report measure of anxiety (MDAS) was recorded 40 minutes before starting the treatment.1 Those receiving microcurrent electrical stimulation at the selected acupoints were held passively every 3 minutes for approximately 10 minutes.1&#xD;
&#xD;
After completion of the intended treatment, Modified Dental Anxiety Scale (MDAS) scores were recorded again. All the variations in the pulse rate, beginning with 40 minutes before starting the treatment to 15 minutes post-treatment, were recorded.1 With the help of the anxiety measuring scale before and after values were compared. Based on which it was concluded that microcurrent electrical stimulation is effective in reducing Anxiety.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; RESULTS&#xD;
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Statistical analysis was done by using descriptive and inferential statistics using one way ANOVA and Multiple comparisons: Tukey test and software used in the analysis was SPSS 22.0 version and p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3516</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3516</Fulltext></URLs><References>&#xA0;&#xD;
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	Avisa P, Kamatham R, Vanjari K, Nuvvula S. Effectiveness of acupressure on dental anxiety in children. Pediatr Dent 2018;40(3):177-183.&#xD;
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	Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, et al. Impact of oral submucous fibrosis on oral health?related quality of life: A condition?specific OHRQ oL?OSF instrument analysis. Oral Dis 2018;24(8):1442-1448.&#xD;
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	Karst M, Winterhalter M, M&#xFC;nte S, Francki B, Hondronikos A, Eckardt A, et al. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg. 2007;104(2):295-300.&#xD;
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	Rosted P, Bundgaard M, Gordon S, Pedersen AM. Acupuncture in the management of anxiety related to dental treatment: a case series. Accupun Med 2010;28(1):3-5.&#xD;
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	Ramey D, Buell PD. A true history of acupuncture. Focus on Alternative and Complementary Therapies. Acupun Med 2004;9(4):269-73.&#xD;
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	Spence DW, Kayumov L, Chen A, Lowe A, Jain U, Katzman MA, et al. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report.&#xA0; J Neuropsy Clin Neurosci 2004;16(1):19-28.&#xD;
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	Liu CF, Chien LW. Efficacy of acupuncture in children with asthma: a systematic review. Ital J Ped 2015;41(1):48.&#xD;
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	Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders&#x2013;a systematic literature review. Acup Med 2007;25(1-2):1-10.&#xD;
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	Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg 2001;92(2):548-553.&#xD;
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	Bussell J. Acupuncture and anxiety 2013: the year in (literature) review. Altern Med 2014;2(1):3.&#xD;
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	Errington?Evans N. Acupuncture for anxiety. CNS Neurosci Therap 2012;18(4):277-284.&#xD;
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	Raghavan R, Sathish S. Acupuncture in prosthodontics. Guident 2016;9(3).&#xD;
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	Carvalho F, Weires K, Ebling M, de Souza Rabbo Padilha M, Ferr&#xE3;o YA, Vercelino R. Effects of acupuncture on the symptoms of anxiety and depression caused by the premenstrual dysphoric disorder. Acupun Med 2013;31(4):358-363.&#xD;
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	Singla D, Anand A, Dharma P, Sharma A. Evaluation Of Pulse Rate And Arterial Oxygen Saturation (Sa02) Levels In Children During Routine Dental Procedures. J Den Speci 2013;1(2):27-34&#xD;
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	Khanam N, Wagh V, Gaidhane AM, Quazi SZ. Assessment of work-related musculoskeletal morbidity, perceived causes and preventive activities practised reducing morbidity among brick field workers. Ind J Comm Health 2019;31(2):462-468.&#xD;
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	Khandelwal V, Gupta N, Nayak UA, Kulshreshtha N, Baliga S. Knowledge of hepatitis B virus infection and its control practices among dental students in an Indian city. Int J Adol Med Health 2017 Aug 18;30(5): 1089-1091.&#xD;
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	Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala BM, Thirunavukarasu M, et al. Gender Differences in Obsessive-Compulsive Disorder: Findings from a Multicentric Study from Northern India. Asian J Psychol 2018:37:3&#x2013;9. &#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</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>107</FirstPage><LastPage>111</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></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 the 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;
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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;
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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;
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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;
&#xA0;&#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=0.05) 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.&#xD;
&#xD;
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=3517</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3517</Fulltext></URLs><References>1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; O&amp;#39;Callaghan PM, Allen KD, Powell S, Salama F. The efficacy of noncontingent escape for decreasing disruptive behaviour during dental treatment. J Appl Behav Anal 2006 Summer; 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 Paediatr 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 &#xA0;Dent 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 modelling and desensitization in the treatment of a phobic child patient. ASDC J Dent Children 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;23:63-9.&#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. p. 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 behavioural 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 behaviour of children. J Dental 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 behaviour. 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 behaviour 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 Curr 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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Review on Scattered References of Prakrut and Vikrutnidra (Sleep) from Brihattrayee&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>112</FirstPage><LastPage>116</LastPage><AuthorList><Author>Kaustubh Bhoyar</Author><AuthorLanguage>English</AuthorLanguage><Author> Santosh Pusadkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Arshiya Khan</Author><AuthorLanguage>English</AuthorLanguage><Author> Sonali Bhoyar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Swarupa Chakole</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Nidra&#xA0;is one of the most important phenomena which is directly related to and influences the achievement of happiness and misery in a man&#x2019;s life. Similarly, as diet and exercise regimen is important for the health of a human being, Nidr? plays a vital role in maintaining proper health and so is the key to live a successful and healthy life. The importance of Nidr? has also been elaborated by Acharya Charaka as follows: As proper ?h?r is required for maintenance of health similarly Nidr? is required for happiness and health. Obesity and leanness also depend on Nidr?. Thus, it is stated that when there is decrease in the Satva Guna in human beings, then it ultimately increases the effect of T?masika Guna. Due toincrease in the T?masa temperament, there is more influence of Nidr? on an individual.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Nidr?, V?da, Bhutadh?tri</Keywords><Fulltext>Introduction&#xD;
&#xD;
The word Nidr? means sleep. One can get references for Nidr? from the period of V?da. The term Nidr? appears in Rigv?da, Yajurv?da etc. Nidr? is mentioned with different synonyms in different periods of Veda, in Rigv?da it is mentioned as &#x201C;Svapna&#x201D;.1 In Rigveda, it is mentioned that The Gods never have Nidr?.2 This is because they have absence of Tama Guna. This highlights the fact that Nidr? is related to the tama guna of the body. People with the predominance of Satva Guna have fewer Nidr? as compared to those having the predominance of Tama guna. When a person awakens from deep sleep, it is a sense of pleasure and a sense of satisfaction. Lord Shri Krishna has also explained the importance of proper sleep for a Dhyana Yogi in Bhagwad Git?.3 According to him, both excessive sleep and ceaselessly awakening is not good.&#xD;
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Mythology of Nidr?&#xD;
&#xD;
References about Nidr? in the V?dika era have been seen. It is known that the period of the earth is divided into four Yuga viz. satayuga, tr?t?yuga, dv?parayuga and kaliyuga, so the Nidr? of God viz&#xB8; at the end of each Yuga is termed as Yoga Nidr? (As mentioned inraghuvamsma 10.14). In other references, it is also mentioned that Nidr? is the great sleep of God bramh? during the period between the Pralaya(destruction) and Utpatti (production) ofSr?sti. God Bramh? creates life on earth whereas God Vishnu maintains it and finally God?iva destroys it. Nidr? is also said to be the name of Goddess Durg?.4Ayurveda clearly emphasizes on the importance of Nidr? for maintaining a healthy lifestyle. Considering K?la of Yajurved?, people of that time period had a very low quantity of Nidr? due to the presence of Satva guna and the absence of Tama guna. But considering this quote from a different angle, it could have been stated for Div?svapna or too much quantity of night sleep also. Mah?bh?rata, the great epic of Indian history also mentions the merits of Nidr?and demerits of r?trij?garana. It states that the persons who are keen for health should not indulge themselves in being awake at night, sleeping in daytime, laziness, getting addicted to bad things and other such factors. Thus, it is stated that when there is the decrease in the Satva Guna in human beings, then it ultimately increases the effect of T?masika Guna. Due to increase in the T?masa temperament, there is more influence of Nidr? on an individual. The ancient seers of India have not only recognized the natural constructive power of sleep&#xA0; but have also attributed to it, a supernatural power that is beneficial for health, happiness and longevity. The daily rhythm of life is thus an instinct related to the rhythm of night and day existing in nature. Ayurveda regards Nidr? as one of the most essential factors responsible for a healthy and fulfilled life. It is one of the Trayopastambhas or three great supporting pillars on which the health of a person is firmly balanced. Every country has had great scientists who have tried to study sleep, its nature and its causes. Sleep is the non-deliberate absence of thought waves or knowledge. Dreamless sleep is an inert state of perception in which the sense of existence is not felt. In sleep, the senses of perception rest in the mind, the mind in the consciousness and the consciousness in the being. In deep sleep, the senses of perception cease to function because their master, the mind is at rest. When the Chitta becomes exhausted, it goes inward, away from the sense impulses of worldly objects; hence the sleep is a resting phase of the mind. At that time, there is the absence of knowledge about the orientation of time and place. In this condition, it is believed that the Chitta resides in the MedhyaN?di. Acharya Dalhana has explained the importance and benefits of good Nidra when there is sama yoga of MedhyaN?di and Manah through which pleasure is obtained by the Deha and Indriya. The references of Nidr? areas such mentioned in the V?dic era and are also available in scattered form in the Ayurvedic classics. In the Ayurvedic classics, the usefulness of sleep and its role in the maintenance of health is elaborately discussed. It is to be considered that all the living creatures must enjoy the sleep in quality and quantity to keep themselves fit. Acharya Charak propounded a theory that explains why human beings sleep. According to Acharya Charak, Nidr? is nothing but a combined stage of tired mind and body. It means when the mind takes out its attention from its work and the sense organs get tired due to heavy workload then this combined stage leads to sleep. From the very birth, the amount of sleep (in hours) of a newborn is maximum. Generally, sleep occurs during the night and at about the same time for a particular duration every day and as such in Ayurved?, Nidr? is said to be Ratrisvabh?vaPrabhava (Prakriti Nidra). According to Sushruta Samhita, Nidr? is provoked due to nature and considered as SvabhavikaRoga. Therefore, the Acharyas have advised that a man should not suppress this important natural urge. It is quite evident from the above discussion that sleep is one of the basic need of every living being. Any living organism of whatever nature always feels the need for resting after an activity. The various organs and the parts of the body can be given rest independently but complete rest for the entire organism is possible only when it goes to sleep. Similarly, in nature, it is observed that not only animals but plants also enjoy recreation in the night by contracting the petals of the flowers, leaves etc., at the time of sunset and in the next morning relaxing and reopening.&#xD;
&#xD;
Occurrence of &#xA0;Nidr?&#xD;
&#xD;
It is a question from time immemorial as to what sleep is and how it occurs and what is the&#xD;
&#xD;
role of sleep in health. Scientists have tried to think over the phenomena of sleep.&#xD;
&#xD;
Etymology and Synonyms of Nidra&#xD;
&#xD;
The derivation of the word &#x2018;Nidra&#x2019; is as follows:&#xD;
&#xD;
The term &#x2018;Nidr?&#x2019; is derived from the root &#x2018;da&#x2019; with prefix &#x2018;ina&#x2019; means undesired to lead, it&#xD;
&#xD;
is a state which is hated, therefore, it is termed as &#x2018;Nidr?&#x2019;.&#xD;
&#xD;
In Samhit?kala the terms used for Nidr? are&#xD;
&#xD;
1. Vaishnavi&#xD;
&#xD;
2. Bhut?dh?tri&#xD;
&#xD;
3. P?pmula&#xD;
&#xD;
4. Tamobhava&#xD;
&#xD;
5. T?masi&#xD;
&#xD;
Here, Nidr? is stated as the energy of God and naturally, it has its effects over all created&#xD;
&#xD;
beings. So it is termed Vaishnavi, as it is the energy of God Vishnu. All the animals are&#xD;
&#xD;
created by God, hence Nidr? has its effect on them.&#xD;
&#xD;
Similarly, Bhutadh?tri term mentioned for Nidr? by Acharya Charak is explained as follows-&#xD;
&#xD;
Dhatri- Responsible for nourishment, nurturing.&#xD;
&#xD;
Thus Bhutadh?tri is the one which is protective, nurtures and responsible for the growth of all&#xD;
&#xD;
living beings. &#xD;
&#xD;
The word dh?tri indicates, to take care and the word bhuta is mentioned for all the created&#xD;
&#xD;
living beings. Hence collectively the word bhut?dhatri indicates or holds up the life&#xD;
&#xD;
without causing any symptoms or diseases.&#xD;
&#xD;
P?pmula or p?pm?nam because it destroys the effect of all good works and has its effect on&#xD;
&#xD;
all the created beings. Nidr?&amp;amp; some other term: [Tamom?yi and Tamomul?]-&#xD;
&#xD;
In the occurrence of Nidr?, Tama is the basic cause and Nidr? is its effect, so Nidr? is also&#xD;
&#xD;
known as tamomula.4-6&#xD;
&#xD;
Nidr? is also called &#x2018;Tamo-mayi&#x201D;. Tamasa guna rises at its peak during Nidr? (sleep) hence&#xD;
&#xD;
it is also named &#x201C;Tamomayi&#x201D;. T?masa guna appears at night.&#xD;
&#xD;
Nidr? as the Trayopastambhas (3 Pillars of Life)&#xD;
&#xD;
Nidr? is also one of the only Adharniyavegas which is given as the importance to be included in Trayopastambhas. Diet, Sleep and non-celibacy if indulge with good adequate sense then they hold the body as that of pillars that holds a house.&#xD;
&#xD;
In Ayurveda, it is accepted that body, sense organs, Satva and ?tma are the components of life. And it is rightly mentioned that Nidr? gives rest to the sensory organs, the mind and the&#xD;
&#xD;
body also which indicates that the components of life and the life itself cannot sustain&#xD;
&#xD;
without proper Nidra. Hence, Nidr? is placed as one of the trayopastambhass in Ayurved?.&#xD;
&#xD;
Acharya Charak has also beautifully explained that adequate Nidr? helps a man to become&#xD;
&#xD;
stout and achieve strength like a pig.&#xD;
&#xD;
But on the other hand, if sleep is not taken regularly then it may directly affect the health.&#xD;
&#xD;
The strategy behind this is that the sleep not taken for 2 to 3 days or more irregularly affects&#xD;
&#xD;
mostly on the mind and the strength of the working organs.4,5&#xD;
&#xD;
Benefits of Nidr? for Sharir Bhavas&#xD;
&#xD;
Acharya Sushrut states that Nidr? taken at the proper time gives us stoutness, glowing of skin, strength, activeness, proper digestion and most importantly Dhatusamya which is the one of&#xD;
&#xD;
the goal of Ayurveda from the treatment point of view.&#xD;
&#xD;
The above benefits of Nidr? related to Sharirbhavas are one of the important functions of&#xD;
&#xD;
tridoshas in the body and thus directly states the relation of Nidr? with the normal functions of&#xD;
&#xD;
the body.&#xD;
&#xD;
Site of Nidr?&#xD;
&#xD;
Acharya Sushrut had beautifully explained and mentioned that the heart is the seat of Chetna in the body and when this is invaded by Tamo guna, the body gets Nidr? due to work, mind and sense organs get tired and it further leads to Nidr?. Therefore these (mana and indriya) withdraw from their functions.&#xD;
&#xD;
The onset of Nidr?&#xD;
&#xD;
According to Acharya Sushrut, Tamoguna is the cause for Nidr? and satva guna is the cause for bodhana. Nidr? (sleep) is the offspring of Tamo guna and awaking process is the quality of sattva guna. Here, the mythological references about Gods and the predominance of Satva in them&#xD;
&#xD;
resulting in absence of Tama guna can be correlated. Also, the onset of Nidr? indicates the involvement of the predominance of Satva and tamo guna in human beings and Tamo guna is thus responsible for Nidr?.&#xD;
&#xD;
Factors responsible for Nidr?&#xD;
&#xD;
When the sense organs get functionless and tamoguna is greatly increased then Bhut?tm? is said to be sleeping though it is not sleeping. These are the important reasons for the Nidr? (sleep). If we glance through them then we can understand the importance of the Nidr?&#xD;
&#xD;
(sleep) for our daily work and also its importance for our body, sense organs and mind. According to Ayurveda as there are three vital substances present in the body. These are Vata, Pitta and Kapha. These three regulates the body in normal condition and they may also&#xD;
&#xD;
cause diseases in their improper equilibrium. Kapha plays an important role in the sleep of&#xD;
&#xD;
human being. Whenever there is the aggravation of Kapha or whenever naturally it has its sway&#xD;
&#xD;
then the sleep appearing at that time is called normal sleep. It means that the Kapha dosha&#xD;
&#xD;
and the tamasa guna of mind play an important role in the formation of sleep.1-3 &#xD;
&#xD;
Following may be the reason for the urge of Nidr? (sleep) &#x2013;&#xD;
&#xD;
1. When Kapha dosha gets increases then it blocks the different systems of the body and&#xD;
&#xD;
this condition generally arises at night time, after a meal. After taking the meal, Kapha&#xD;
&#xD;
dosha increases and due to this it blocks the channels of the body. According to &#xD;
&#xD;
Ayurveda Kapha normally shows its influence in the starting of the digestion, hence&#xD;
&#xD;
one can experience the effect of Nidr? (sleep) after taking the meal. In this process, our&#xD;
&#xD;
sense organs unable to do their proper work and ultimately this results in the Nidr?&#xD;
&#xD;
(sleep).&#xD;
&#xD;
2. We get knowledge of our surroundings due to our sense organs. But if these sense&#xD;
&#xD;
organs get tired or if they become unable to do their work properly then the body shows&#xD;
&#xD;
the symptoms of Nidr? (sleep) as well.&#xD;
&#xD;
Review of Vikrut Nidr?&#xD;
&#xD;
VikrutNidr? can be grouped as the types of Nidr?, i.e. abnormal types of Nidr?. These are&#xD;
&#xD;
explained in the scattered form in B?ihattray?.&#xD;
&#xD;
Types of Nidr? (Accoding to Acharya Charak)&#xD;
&#xD;
Acharya Charaka 1 mentioned 6 types of Nidr? as&#xD;
&#xD;
1. Tamobhav?&#xD;
&#xD;
2. ?leshmasamudbhav?&#xD;
&#xD;
3. Manah?arirashr?masambhava&#xD;
&#xD;
4. ?gantuki&#xD;
&#xD;
5. Vy?dhyinuvartini&#xD;
&#xD;
These are VikrutNidra elaborated as follows: -&#xD;
&#xD;
1. ?leshmasamudbhav? - Nidr? which appears due to the excess of kapha dosha then it&#xD;
&#xD;
is called ?leshmas?mudbhav?Nidr?.&#xD;
&#xD;
2. Manah?arirashr?masambhava - Nidr? which appears due to the tiredness of mind and&#xD;
&#xD;
body because of heavy work, then it is called as manahsharirashr?masambhavaNidr?.&#xD;
&#xD;
3. Mental and physical exertion brings about the inactivity of the mind resulting in the&#xD;
&#xD;
detachment of the mind and the sense organs from their objects which is responsible&#xD;
&#xD;
forNidr?. But if there is excessive exertion, this may cause vitiation of Vata leading&#xD;
&#xD;
toAnidr?. Thus even though exertion is the causative factor for Nidr? excessive&#xD;
&#xD;
exertion is responsible for the aggravation of Vata, which causes Anidr?.2,3&#xD;
&#xD;
4. ?gantuki &#x2013; Aagantuki type of Nidr? (sleep) is caused due to external factors and as&#xD;
&#xD;
such it is in itself incurable. According to Acharya Chakrapani this type of Nidra is&#xD;
&#xD;
called as ristabhuta i.e. the Nidr? (sleep), which indicates the death signs.&#xD;
&#xD;
5. Vyadhyianuvartini (Complication of other diseases) - Nidr? which appears due to&#xD;
&#xD;
diseases called vyadhyanuvartiniNidr?. Normally Nidr? appears due to the influence&#xD;
&#xD;
of Kapha dosha hence whenever there is the increase in Kapha dosha more than its normal&#xD;
&#xD;
equilibrium then the sleep appears at that time. This type of sleep is indicative of vyadhi i.e. disease.&#xD;
&#xD;
Types of Nidr? (According to Acharya Sushruta):&#xD;
&#xD;
Types of Nidr? according to Acharya Sushruta 2 &#x2013;&#xD;
&#xD;
Nidr? is the elusive energy of God and it has its effect naturally over all created beings. The kind of Nidr? which sets in when the sensation carrying channels of the body are choked by kaphadosha (shleshma), which bounds the quantity of Tamo guna, is known as &#x2018;t?msiNidr?&#x2019;. This type of Nidr? produces unconsciousness at the time of death.&#xD;
&#xD;
The person with the deprived condition of the Kapha dosha &amp;amp; aggravated condition of v?ta dosha or suffering from any type of troubles, get very little Nidr? or absolutely no Nidr?.&#xD;
&#xD;
This type of Nidr? is called &#x2018;VaikarikiNidr?&#x2019;.&#xD;
&#xD;
The Nidr? which appears due to the influence of Tama guna called as t?masiNidr?. It produces unconsciousness at the time of death. This type is similar to the tamobh?vaNidr? said by Acharya Charak.&#xD;
&#xD;
Types of Nidr? (According to Acharya VrudhaV?gbhata)&#xD;
&#xD;
Acharya VrudhaV?gbhata 3 mentioned 7 types of Nidr? as &#x2013;&#xD;
&#xD;
? K?lasvabh?vaja&#xD;
&#xD;
? A?mayakhedaprabh?vaja&#xD;
&#xD;
? Chittakhedaprabh?vaja&#xD;
&#xD;
? Dehakhedaprabh?vaja&#xD;
&#xD;
? Kaphaprabh?va&#xD;
&#xD;
? ?gantuki&#xD;
&#xD;
? Tamobh?va&#xD;
&#xD;
Amongst these except K?laswabh?vajaNidr?, the VikrutNidr? types are explained here as&#xD;
&#xD;
follows:&#xD;
&#xD;
1. Aamayakhedaprabh?va &#x2013;&#xD;
&#xD;
The Nidr? which appears due to the diseases present in the sharira called aamayakheda&#xD;
&#xD;
Nidr?. The word ?ma is used for the factor generates in the sharira due to the undigested food. According to Ayurveda, the ?ma is responsible for creating various diseases. This type of Nidr? resembles that of Vyadhyanuvartini type of Acharya Charaka and vaikarikiNidr? of Acharya Sushruta.3,4&#xD;
&#xD;
2. Chittakhedaprabh?vaNidr? &#x2013;&#xD;
&#xD;
The Nidr? which appears due to the disturbances in the mind called chittakheda&#xD;
&#xD;
prabh?vaNidr?. This type resembles with manahsharirashramasambh?vaNidr? of&#xD;
&#xD;
Acharya Charaka and vaikarikiNidr? of Acharya Sushruta.&#xD;
&#xD;
3. Deha khedaprabh?vaNidr? &#x2013;&#xD;
&#xD;
The Nidr? which appears due to tiredness of the body called as dehakhedaprabh?va&#xD;
&#xD;
Nidr?. This type resembles the manahsharirasramasambhavaNidr? of Acharya&#xD;
&#xD;
Charaka and vaikarkiNidr? of Acharya Sushruta.&#xD;
&#xD;
4. Kaphaprabh?vaNidr? &#x2013;&#xD;
&#xD;
Nidr? which appears due to aggravated Kapha dosha called kaphaprabh?va Nidr?.&#xD;
&#xD;
Kapha dosha closely resembles the tama guna of the mind and combined they cause&#xD;
&#xD;
The Nidr? in the night. But when there is the increase in the Kapha dosha of the body, then the&#xD;
&#xD;
Nidr? also appears in the daytime or may persist for a longer time than normal. In such&#xD;
&#xD;
a condition, the Nidr? is called kaphaprabh?vanidra. This type resembles the&#xD;
&#xD;
shleshmasamudbh?vanidra of the Acharya Charaka and vaikariki of Acharya Sushruta.&#xD;
&#xD;
5. ?gantukiNidr? &#x2013;&#xD;
&#xD;
?gantukiNidr? appears due to external factors like accidents, injuries etc. Hence this&#xD;
&#xD;
type of Nidr? is also considered abnormal. This type resembles that of ?gantuki&#xA0; type of Nidr? of Acharya Charaka and vaikariki type of Acharya Sushruta.5&#xD;
&#xD;
6. Tamobh?vaNidr? &#x2013;&#xD;
&#xD;
This type of Nidr? appears due to the aggravated stage of tamo guna of mind. It results&#xD;
&#xD;
in sinful behaviour. Therefore Acharya Sushruta and Acharya Charaka mentioned it&#xD;
&#xD;
asp?pamula (the root of the bad works). This type of Nidr? mainly appears at the time of&#xD;
&#xD;
death. Acharya Charaka mentioned this as tamobhavaNidr? as Acharya Vagbhata&#xD;
&#xD;
and Acharya Sushruta named this type as tamsinidra. Acharya also mentioned that this&#xD;
&#xD;
type of Nidr? is dangerous for the life of man and may lead to death also.6&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Nidr? is one of the most important phenomena which is directly related to and influences</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3518</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3518</Fulltext></URLs><References>1. ?????????????????????????????????.?.??&#xD;
&#xD;
2. Rigveda 8.2.18.&#xD;
&#xD;
3. Bhagvada Gita 5/8-9&#xD;
&#xD;
4. V?caspatyamaBhagam 6.4848&#xD;
&#xD;
5. Yajurv?da 30.17&#xD;
&#xD;
6. Dalhan Tika Sushutra Sutrasthana 1/25./A.Sa.Su.9/48/Su.Sh.4/356. Chakrapanitika. Ashtangahridaya B.sitaram&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Cross-sectional Study to Assess Serum Insulin Like Growth Factor-1 Levels (IGF-1) in Female and Male Subjects in Relation to Various Stages of Cervical Vertebrae Maturation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>117</FirstPage><LastPage>123</LastPage><AuthorList><Author>Kahlon SS</Author><AuthorLanguage>English</AuthorLanguage><Author> Aggarwal V</Author><AuthorLanguage>English</AuthorLanguage><Author> Ahluwalia KS</Author><AuthorLanguage>English</AuthorLanguage><Author> Narang RS</Author><AuthorLanguage>English</AuthorLanguage><Author> Singh B</Author><AuthorLanguage>English</AuthorLanguage><Author> Kahlon M</Author><AuthorLanguage>English</AuthorLanguage><Author>  Chopra S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Insulin-like growth factor-1 levels (IGF-1), Cervical vertebrae, Maturation, Lateral Ceph</Keywords><Fulltext>&#xD;
Introduction &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; While making orthodontics treatment planning the most important objective is to correct skeletal discrepancies by utilising the growth potential of the patient so that the most favourable results could be achieved.1&#xA0; Response to orthopaedic treatment modalities is maximum during the peak of the adolescent growth spurt. The correct identification of the pre-pubertal and post-pubertal growth phases on an individual is very important in orthodontic diagnosis and treatment planning.2Orthopaedic treatment of patients with Class III malocclusion and rapid maxillary expansion achieve maximum efficacy when performed at a pre-pubertal growth phase. On the other hand, in Class II subjects the amount of supplementary mandibular growth induced by functional appliances appears to be significantly greater when the treatment is performed during the pubertal growth phase. Thus determining the growth potential in both genders is an essential step for orthodontic practitioners.2,3&#xD;
&#xD;
&#xA0;Different methods have been reported in an attempt to determine the best indicator of maturity. These include height, weight, chronological age, sexual maturation, Frontal sinus, biological age or physiological age, Hand-wrist maturity,4,5 Cervical vertebrae, dental eruption, dental calcification stages and biomarkers.6&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chronological age and dental emergence be poorly related to skeletal maturation. Other methods includeradiographic assessment of skeletal structures like hand wrist radiographs in which appearance and union of different skeletal centresof ossification of bones give growth assessment. In 1972, Lamparski7 introduced a method for assessing cervical vertebral maturation on cephalometric radiographs. Hassel and Farmanmodified the cervical vertebrae and found them as reliable and valid for assessing skeletal age. But despite being reliable these methods are invasive as they give an X-ray exposure to the patient. Moreover, cervical vertebral maturity (CVM) staging though widely used has decreased reproducibility and subjective errors with Intra and inter-observer disagreements.7,8 Furthermore, the onset of the peak in mandibular growth cannot be accurately defined by the CVMI staging.However new possibilities might be provided by biochemical markers, i.e. biomarkers that avoid invasive X-ray exposure and represent agents that are directly involved in bone growth and remodelling.9,10&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A biomarker is defined as &#x201C;any substance, structure, or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease.10 Biomarkers represent agents that are directly involved in bone growth and remodelling and would help the clinicians in assessing the growth status of the orthodontic patient.11&#xA0; Amongst all biomarkers, IGF-1 is a very important one that varies according to age and sex. The IGFs play important role in the function of almost every organ in the body. IGFs are essential for embryonic development. After birth, however, IGF-I appears to have the predominant role in regulating growth Serum, IGF-1 level is a reliable maturation factor as it quantitively assesses the growth. Therefore the intensity of the growth can be estimated which will help in assessing the exact timings of the treatment. Many variables, such as age, sex, nutritional status, and growth hormone secretion, affect serum IGF-I concentrations. The concentrations are low at birth, increase substantially during childhood and puberty, and begin to decline after puberty.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; According to all the literature available to date on biomarkers, Insulin-like growth factor 1 (IGF-1), Insulin-like growth factor Binding Protein-3 (IGF-BP3) and Alkaline phosphatase (ALP) are common substances that have proved to be most reliable in all the studies. The pubertal peak occurs approximately two years earlier in girls than in boys. So separate studies are needed for male and female subjects. This cross-sectional study is to access the serum IGF-1 levels as markers for the evaluation of skeletal growth assessment in different stages of cervical skeletal maturation. &#xD;
&#xD;
Materials and methods&#xD;
&#xD;
The study sample consisted of 240 subjects, 120 females and 120 males, in the age range of 8-16 years, who reported for orthodontic treatment. A random sampling of male and female subjects was done who met the inclusion criteria, to avoid bias. Inclusion criteria include healthy individuals, same Socio-economic status and same ethnic group. Exclusion criteria included the presence of signs of acute inflammation or infection at the time of blood sampling, patients on medication, patients with systemic disease, serious illnesses, growth abnormality, no bone disease or deformities, no bleeding disorders, no history of any serious trauma or injury to the face or hand and wrist region. &#xD;
&#xD;
Lateral cephalograms were obtained from male and female subjects. Radiographs were assessed for different CVMI stages. Parents of subjects were explained about the study. Those who were willing to give blood samples were included in the study. After evaluating the x rays for CVMI stages, subjects were placed into different groups. Subjects were placed into 6 groups viz Group 1 corresponding to CVMI 1 stage, Group 2 corresponding to CVMI 2 stage, Group 3 corresponding to CVMI 3 stage, Group 4 corresponding to CVMI 4 stage, Group 5 corresponding to CVMI 5 stage and Group 6 corresponding to CVMI 6 stage, both for male and female subjects separately.&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All subjects were explained about the design of the study and informed consent was taken from all parents before enrolling them for study. The research protocol was approved by the Institutional Review Board. The parental informed consent form was taken before enrolling each subject in the study.&#xD;
&#xD;
Blood samples were collected from the median cubital vein. The time of blood sample collection for all subjects was between 10 AM to 12&#xA0; noon. Serum was separated from the clotted blood samples and labelled with a patient code (without any mention of the patient&#x2019;s details, such as name, age and sex). It was then properly sealed and stored in a box with an ice pack and sent to the laboratory for chemiluminescence immunoassay for determination of IGF-1 levels using IGF-1 600 ELISA (DRG Instruments GmbH,Germany). &#xD;
&#xD;
Procedure for Lateral Cephalograms&#xD;
&#xD;
Lateral cephalograms were taken in a natural head position. The cervical staging technique, as described by Hassel and Farman,was used to stage the cervical vertebrae. &#xD;
&#xD;
Hassel and Farman rule for the assessment of cervical vertebrae skeletal maturation as a predictor&#xD;
&#xD;
&#xA0;&#xA0; Modification of Lamparski&#x2019;s criteria, which assess maturational changes of the second, third and fourth cervical vertebrae. Three parts of the cervical vertebrae were traced on matte acetate with a 0.5 mm diameter mechanical lead pencil. These entities were the dens (odontoid process), the body of the third cervical vertebra (C3), and the body of the fourth cervical vertebra (C4). These areas were selected because C3 and C4 could be visualised even when a thyroid protective collar is worn during radiation exposure.&#xD;
&#xD;
I. Initiation stage of cervical vertebrae (CVMI &#x2013; 1)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; C2, C3 and C4 inferior vertebral body borders were flat with tapered superior vertebral borders of C3 and C4&#xA0; from posterior to anterior (a wedge shape) and 80% to 100% of adolescent growth was expected (Figure 1).&#xD;
&#xD;
II. Acceleration stage of cervical vertebrae (CVMI &#x2013; 2)&#xD;
&#xD;
Concavities begin to develop on the inferior borders of C2 and C3 with the flat inferior border of fourth cervical vertebrae, vertebral bodies of C3 and C4 are nearly rectangular with 65-85% of remaining pubertal growth (Figure 1).&#xD;
&#xD;
III.Transition stage of cervical vertebrae (CVMI &#x2013; 3)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Distinct concavities have seen in the lower borders of C2 and C3 cervical vertebrae.developingconcavity seen in the lower border of the body of C4 cervical vertebrae and 25-65% of pubertal growth expected (Figure 1).&#xD;
&#xD;
IV . Deceleration stage of cervical vertebrae (CVMI &#x2013; 4)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; Distinct concavities in lower borders of C2, C3 and C4 cervical vertebrae are observed with C3 and&#xA0; C4 cervical vertebrae nearly square in shape with 10-25% of pubertal growth expected (Fig 1).&#xD;
&#xD;
V. Maturation stage of cervical vertebrae (CVMI &#x2013; 5)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Accentuated concavities of inferior vertebral body borders of C2, C3 and C4 cervical vertebrae are observed with C3 and C4 cervical vertebrae square in shape and 5-10% of pubertal growth expected (fig 1)&#xD;
&#xD;
VI. Completion stage of cervical vertebrae (CVMI &#x2013; 6)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Deep concavities are present for inferior vertebral body borders of C2, C3 &amp; C4 cervical vertebrae with greater C3 &amp; C4 cervical vertebrae height than widths alongwith the completion of pubertal growth(Figure 1).&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0; All radiographs were evaluated by the same operator and later verified by an independent evaluator to determine any interoperator and intraoperator errors. CVMI staging of all samples was performed separately by two investigators at different times. Both investigators were blinded regarding the patient&#x2019;s details. For all samples, the primary investigator-assessed CVMI stages twice at an interval of 21 days. Another investigator assessed the radiographs.&#xD;
&#xD;
&#xD;
Results&#xD;
&#xD;
The assessment of average age and standard deviation of the age in the male and female in all the stages of CVMI has been shown in Table 1. The average age in CVMI 6 in the male category is 16.89 years and in the female 15.12&#xA0; years. &#xD;
&#xD;
&#xD;
&#xD;
The serum IGF-1 values for the males and females in all the stages of CVMI has been depicted in Table 2.&#xA0; The highest average level of Serum IGF-1 in the males has been shown in CVMI 3rd stage in both males and females, however, the lowest level of serum IGF-1 has been shown in CVMI stage 1 in both males and females (Table 2).&#xD;
&#xD;
&#xD;
&#xD;
Bonferroni test has beenapplied for the multiple comparisons of serum IGF-1 values for all the stages of CVMI in all the male subjects (Table 3). The significant diff&#xE9;rence has been observedwhencomparisonshave been donewith CVMI stage 1 with CVMI stage 3 and 4, Stage 3 with stage 1,5 and 6, Stage 4 with stage 1, Stage 5 with Stage 3 and Stage 6 with stage 3 witha P value of lessthan 0.005.&#xD;
&#xD;
&#xD;
&#xD;
Bonferroni test has been applied for the multiple comparisons of serum IGF-1 values for all the stages of CVMI in all the femalesubjects(Table 4). The significant diff&#xE9;rence has been observedwhencomparisonshave been done CVMI stage 1 with CVMI stage 3, Stage 2 with Stage 3, Stage 3 with stage 1,2,5 and 6, Stage 4 with stage 1, Stage 5 with Stage 3 and Stage 6 with stage 3 and 4 witha P value of lessthan 0.005.&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
Procedures requiring growth modulation are carried out during the active growth phase for achieving more predictable results. In adolescence, there are many physiological differences in the development of individuals of the same chronological age. There area wide variation between dental age, chronological age and skeletal age. Thus only chronological age or dental age cannot be used to predict growth status. As human growth is mediated through growth hormones, so not only chronological events but also physiological and biological events are seen to assess the growth status of the individual. Growth prediction can be estimated using physiological parameters like peak growth velocity in height, dental development, pubertal markers, and radiographs of skeletal maturation.1 Skeletal age is for a very specific and short period. It is usually assessed using radiographs of one or more specific body parts. There are different methods proposed by various authors in determining the skeletal maturation of the individual. It includes radiographic assessment using lateral cephalograms, OPG, hand wrist radiographs or IOPA`s. &#xD;
&#xD;
The present cross-sectional study was conducted on 240 male and female subjects in the age group of 8-16 years.&#xA0; Patients were assessed in all 6 stages of CVMI. These stages correspond to pre-pubertal, pubertal and post-pubertal stages. Patients in these age group report for orthodontic treatment, functional correction and orthopaedic treatment. Lateral cephalograms of subjects were assessed for CVMI stages in the beginning. 20 subjects both males and females were placed in each CVMI stage. The grouping was done randomly. Evaluation of results revealed that the average age of male subjects in CVMI stage 1 was 10.15&#xA0; years, in CVMI-2 was 11.76 yrs, in CVMI-3 was 13.04 yrs, in CVMI-4 was 14.29, in CVMI-5 was 15.45 and in CVMI-6 was 16.89 (Table 1). Further evaluation of results revealed that the average age of female subjects in CVMI stage 1 was 8.83&#xA0; years, in CVMI-2 was 9.66 yrs, in CVMI-3 was 11.25 yrs, in CVMI-4 was 12.38, in CVMI-5 was 13.89 and in CVMI-6 was 15.12 (Table 2). A higher mean age of male and female patients by about a year.3,5 There is a variation in the age group of male and female subjects.4,6 As expected, sex was a significant factor associated with the age of attainment of each CVMI stages. Male subjects showed on average delayed attainment of the CVMI stages by about 14 months later as a comparison to females. Thus Chronological age alone cannot be used to predict the growth status of individuals. Hand bones and teeth have well-defined appearances during stages of development, but in contrast, cervical vertebrae have a variance of shapes, and it is difficult to define their peculiar appearances. There is not much difference between adult and child as far as the geometry of cervical vertebrae is concerned. This might limit the usefulness of cervical vertebrae in age estimation.9 Additionally, the drawback of repeatability in radiographic methods has questioned the reliability12 of these methods to be used for growth assessment. Gabreils et al.13 and Nestman14 and in their studies have observed insufficient repeatability in identification the stages of CVMI.&#xA0; &#xD;
&#xD;
There has been a long quest to find an alternate method that is non-invasive, simple and gives a quantitive value to find pubertal growth peak. Thusa newly emerging method for determining skeletal growth is the evaluation of biomarkers. Biomarkers are those agents which are directly involved in bone growth and remodelling. A biomarker is a measurable indicator of some biological state or condition. Biomarkers are measured and evaluated to examine normal biological or pathological processes or pharmacologic responses to a therapeutic intervention.&#xA0; Several parameters are considered for including a biomarker as a diagnostic tool, which includes sensitivity, specificity, robustness, accuracy, reproducibility, practicality and ethicality.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Thus various biomarkers have been suggested for predicting the peak growth spurts. During the active phase of growth and development, certain biomarkers present in high concentration in body fluids. Thus biomarkers should be used for monitoring skeletal change during puberty as they have the potential to provide a comprehensive skeletal picture of the individual without the limitations of radiation exposure.15&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Insulin-like growth factors (IGF), also known as somatomedin C or non-suppressible insulin-like activity, that play an important role in regulating cellular proliferation, growth, differentiation, survival, migration and development.16 IGF-1 is also known to increase both bone formation and resorption. Two types of IGFs, IGF-I and IGF-II circulate through the bloodstream. IGF-1 is secreted by many tissues and the secretory site seems to determine its actions.IGFs are in ternary complexes with varying half-lives from a few min to more than 12 hours.17,18By the process of proteases IGF is released and later it binds with type I IGF-receptor (IGF-1R).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In our study, we found that IGF-1 values increased from stage 1 to stages 3 and then declined as can been seen in Tables 4 &amp; 5 in both male and female subjects. Though serum IGF-1 values are higher in male subjects as compared to female subjects in all stages of CVMI, there is no statistically significant difference between the mean values of males and females. IGF-1 serum values are low during early childhood, increases progressively through childhood, with the typical pubertal peak around 11.5 and 13 years of age in girls and boys respectively. The increased GH secretion that is provoked by the increased production of gonadal steroids most likely initiates the pubertal increase. After puberty, IGF-I serum values decrease across CVMI stages but not sharply as stated in other studies. IGF-1 shows a positive relation for 8-12 and 9-13 years in female and male subjects and shows a negative relation form 12-18 and 14-18 years in male and female subjects. Despite using a similar methodology (chemiluminescent assays), the mean reference values of serum IGF-1 of ouradolescent&amp;#39;ssubjects are different from that of Sweden, Belgium and Germany.19&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; IGF-1 values were maximum in CVMI stage 3 as reported in other studies. Data from all stages were evaluated and compared to each stage individually in male and female subjects. In male subjects, it started from 248.25 ng/ml from CVMI 1 stage, peaked at 372.45 ng/ml in the CVMI3 stage and later decline to 269.58 ng/ml in CVMI 6 stage. There was a relatively high standard deviation seen in our study. This could be due to fact that there is great variation in the individual during puberty, the duration of the growth spurt, and the peak annual growth increment or it could be due to inherent problem seen in cross-section study design.20 Evidence suggests that changes in environmental and socioeconomic factors can greatly influence the timing and patterns of growth in a population. In male subjects, it showed that there is a statistically significant difference for serum IGF-1 values of CVMI stage 1 to CVMI stage 3 and CVMI stage 4.&#xA0; There is a statistically significant difference for serum IGF-1 values of CVMI stage 3 concerning CVMI stage 1, CVMI stage 5 and CVMI stage 6. There is also a statistically significant difference for serum IGF-1 values of CVMI stage 4 to CVMI stage 1, serum IGF-1 values of CVMI stage 5 to CVMI stage 3 and serum IGF-1 values of CVMI stage 6 to CVMI stage 3. As evident from higher values of IGF-1 in CVMI stage 3 as compared to values in other CVMI stages, it is of opinion that serum IGF-1 values can be used as a tool to predict the peak velocity growth. There need to consensus and data to have reference values for a male subject who are normal and healthy. As the results are following other studies but mean values are different. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Data from female subjects showed a similar trend as was seen in male subjects. In female subjects, it started from 229.40 ng/ml from the CVMI 1 stage, peaked at 353.40 ng/ml in the CVMI3 stage and later decline to 251.21 ng/ml in CVMI 6 stage. There is a statistically significant difference for serum IGF-1 values of CVMI stage 1 concerning CVMI stage 3 and CVMI stage 4; serum IGF-1 values of CVMI stage 2 to CVMI stage 3;&#xA0; serum IGF-1 values of CVMI stage 3 to CVMI stage 1, CVMI stage 2, CVMI stage 5 and CVMI stage 6; serum IGF-1 values of CVMI stage 4 to CVMI stage 1 and CVMI stage 6.&#xA0; Thus comparison shows that values of CVMI stage 3 for both male and female subjects were much higher compared to other CVMI stages. Serum IGF-1 levels tend to peak whenever there is accelerated growth whether it is due to pubertal growth spurt21, adrenarche22,acromegalyor tumorous growth occurring in the body23. We found peak mean IGF-1 levels in male subjects at CVMI3 at a mean age of 13.04 years in comparison to the peak value in males found at CS4 at a mean age of 14.5 years in the study by Ishaq et al.24 and in stage CS4 with a mean age of 14.04 years in a previous study.25 &#xD;
&#xD;
Disagreement to other studies may be attributed to the difference in ethnic backgrounds, the methodology for serum value evaluation. Also, the role of environmental and genetic factors affecting sex steroid control and IGF-1 cannot be excluded.25On the critical assessment of IGF-1 trends, we found that in males subjects IGF-1 serum levels increased from CVMI1 to CVMI2, with a sudden rise seen from CVMI2 to peak at CVMI3, followed by a gradual decline from CVMI3 to CVMI4 and then a sudden fall in value from CVMI4 to CVMI6; while in female subjects, there was a sudden increase in IGF-1 serum levels from CVMI1 to CVMI2, which peaked at CVMI3 followed by a slow decline to CVMI4 continuing to suddenly decline from CVMI4 to CVMI 6. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; On evaluating the reference values of IGF-1 in both males and females in our study, the mean IGF-1 levels in CVMI stages 2,3,4,5 and 6 lie above 250 ng/ml. Masoud et al.26in a longitudinal study investigated mandibular growth and IGF-1 levels. The authors find that if serum levels of IGF-1 are above 250 ng/ml on periodic testing, average mandibular growth of 5.5 mm can be anticipated. If levels of IGF-1 have an ascending trend and an average of below 250 ng/ml, the average growth rate of 2 mm or f is expected. 25.26.27. It is in contrast to a study by Gupta et al where it was seen only CVMI 3 to CVMI 6 stages. But it can be assumed that regularly follow up of subjects will show ascending or descending trend, which can be used to predict remaining growth in individuals using IGF-1 values. Several growth studies have shown that serum IGF-1 levels reflect serum GH levels but without the diurnal variations involved with the latter. Thus, IGF-1 levels have been used to diagnose GH activity27,28. Serum IGF-1 levels have also been related to chronologic age and sexual maturity stages, and have been shown to peak late in puberty28.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
This study reveals that Serum IGF-1 levels are at a peak in CVMI Stage 3 in both males and females.Biomarker- IGF-1 serve as an alternate method for growth assessment which is non-invasive to x-ray exposure, simple and gives a quantitative value to find pubertal growth peak.In comparison to handwrite radiographs and repeatability of lateral cephalograms, biomarkers serve as an adjunctive and reliable tool in growth assessment.The greater binding affinity of IGF-1 to other proteins makes it necessary for conducting further studies.&#xD;
&#xD;
Conflict of interest: None&#xD;
&#xD;
Source of Funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3519</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3519</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Diagnostic Implication of Phosphatase and Tensin Homolog Expression in Endometrial Lesions&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>124</FirstPage><LastPage>128</LastPage><AuthorList><Author>Abu Shahma Khan AS</Author><AuthorLanguage>English</AuthorLanguage><Author> Alam K</Author><AuthorLanguage>English</AuthorLanguage><Author> Akhtar K</Author><AuthorLanguage>English</AuthorLanguage><Author> Khan T</Author><AuthorLanguage>English</AuthorLanguage><Author> Alam F</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> PTEN, Endometrial hyperplasia, Carcinoma, Immunohistochemistry</Keywords><Fulltext>INTRODUCTION&#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xD;
&#xD;
&#xA0;Endometrial diseases are the most common gynaecological disorders affecting women worldwide.1 They constitute around 70.0% of all gynecologic consultancies in the peri-menopausal and postmenopausal age group.2 They usually present with abnormal uterine bleeding (AUB), which is the most common and challenging problem presenting to the gynaecologist regardless of the age of the women.3 The International Federation of Gynaecology and Obstetrics ( FIGO) working group on menstrual disorders developed a FIGO classification system for the causes of AUB in non-gravid women of reproductive age group.4 Its main categories are: polyp, adenomyosis, leiomyoma, hyperplasia and malignancy, coagulopathy, ovulation, endometrial, iatrogenic and not yet classified.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Endometrial hyperplasia and malignancy are important neoplastic lesions causing AUB. Endometrial hyperplasia is characterized by an increased proliferation of endometrial glands relative to stroma resulting in increased gland to stromal ratio than normal endometrium. The hyperplastic glands vary in shape and size and may shows cytologic atypia, which may progress or co-exist with endometrial carcinoma. Hyperesterogenic state is most commonly associated with endometrial hyperplasia. Prolonged estrogenic stimulation of the endometrium may be due to anovulation, obesity, polycystic ovarian disease, functional granulosa cell tumors of the ovary and estrogen replacement therapy.5 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The WHO 2014 classification divides endometrial hyperplasia into 2 categories: hyperplasia without atypia and atypical hyperplasia/endometrioid intraepithelial neoplasia. This reduction in to 2 categories reflects a new understanding of molecular genetic changes. Hyperplasia without atypia showed no relevant genetic changes. They are benign entities and will regress with time after the endocrine milieu (physiological gestagen levels) has normalized. Atypical endometrial hyperplasias exhibit many mutations typical for invasive endometrioid endometrial carcinoma. In approximately 60.0% of such cases, patients have coexisting invasive cancer or are at increased risk of developing invasive cancer.6,7 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Phosphate and Tensin Homologue (PTEN) is a tumor suppressor gene. Expression of PTEN is lower in endometrial cancer than in normal endometrium. It is involved in the regulation of focal adhesion, cellular migration, and tumor cell proliferation and somatic mutations of this gene have been identified in a large number of other human malignancies.8 Although most pre-cancers and cancers had a mutation in only one PTEN allele, endometrioid endometrial adenocarcinomas showed complete loss of PTEN protein expression in 61% of cases, and 97.0% cases showed at least some diminution in expression. Cancers and most pre-cancers exhibited contiguous groups of PTEN negative glands, while endometria altered by unopposed estrogens showed isolated PTEN-negative glands. Loss of PTEN function by mutational or other mechanisms is an early event in endometrial tumorigenesis, and it may occur in response to known endocrine risk factors and offers an informative immune-histochemical biomarker for premalignant disease. Individual PTEN-negative glands in estrogen-exposed endometria are the earliest recognizable stage of endometrial carcinogenesis. Proliferation into dense clusters that form discrete premalignant lesion follows.9 PTEN mutations have been seen in about 55% of patients with endometrial hyperplasia. 10 Loss of PTEN function has, therefore, been proposed as an early event in the pathogenesis of endometrioid carcinogenesis.&#xD;
&#xD;
Materials and methods&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;This study was performed on 278 women attending the Outpatient and Inpatient Departments of Obstetrics and Gynecology and Pathology with complaints of abnormal uterine bleeding (AUB), after approval from the hospital ethics committee. A thorough clinical history of patients was collected and complete physical examination findings and other relevant investigations were recorded. All the endometrial biopsies/curettage and hysterectomy specimen sent for histopathological evaluation with a history of abnormal uterine bleeding were included in the study, while all other malignancies of the female genital tract and patients not giving informed consent were excluded. Specimens were processed in 10% neutral buffered formalin (10 ml of 40% formaldehyde diluted in 90 ml of water). Tissues were fixed for 24 hours with two changes of formalin and embedded in paraffin which was further cut into 4-5 &#xB5;m thick sections. The sections were routinely stained with haematoxylin and eosin (H&amp;E) stain. Immunohistochemical staining using the PTEN monoclonal antibodies was performed on diagnosed cases of endometrial lesions. The various histomorphological and immunohistochemical patterns were identified and classified according to the percentage of cell stained and intensity of staining on immunostained slides. PTEN staining pattern was evaluated as: absent staining- 0, mild-1+, moderate-2+, Intense- 3+. 11&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Statistical analysis was performed using Fisher&#x2019;s exact test. Data was statistically analyzed using SPSS software version (20.0). Chi-square tests were used in the analysis of dichotomous or categorical variables. When expected cell frequencies were </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3520</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3520</Fulltext></URLs><References>&#xD;
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	Khan R, Sherwani RK, Rena S. Clinicopathologic pattern in women with DUB. Iran J Pathol 2016;11:12-16.&#xD;
	&#xD;
	&#xD;
	Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health 2012;3:84-88.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Knowledge, Attitude and Practice of Bronchial Asthma Among Medical Students - A Questionnaire Based Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>129</FirstPage><LastPage>134</LastPage><AuthorList><Author>Kavya A</Author><AuthorLanguage>English</AuthorLanguage><Author> Joy P</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Attitude, Bronchial asthma, Knowledge, Medical students, Practice</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The World Health Organisation (WHO) recognizes bronchial asthma as a major health problem. Bronchial asthma is a heterogeneous pulmonary disorder characterized by recurrent episodes of breathlessness, cough, wheezing and bronchial hyper-responsiveness which usually vary in frequency and severity from person to person. In affected individuals, symptoms may occur several times in a day or week, and become worse for some people during physical activity or at night.1,2 It is estimated that more than 339 million people suffer due to bronchial asthma globally.3 Usually, children and young adults are commonly affected age group but it can occur at any age.4 Bronchial asthma is often left under-diagnosed and under-treated and it creates considerable burden to both patients and their families.5&#xD;
&#xD;
Proper management of bronchial asthma requires both adequate knowledge of the disease and its treatment. The treatment regimen will fail with a lack of knowledge because the patient is unaware of appropriate steps of management and how to avoid triggers as medications are not the only way to control asthma it is also necessary to avoid the triggers. Health professionals play a pivotal role in empowering patients with the necessary skills and knowledge to manage bronchial asthma.6,7 The aim of asthma management is to control symptoms effectively and prevent future exacerbations.8,9 There is a global problem with the management of bronchial asthma either under ignorance in treatment or lack of knowledge about the disease in patients. An average asthmatic patient is generally benighted about his illness and has misbelieved, which needs to be corrected.10&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
As future health professionals, medical students must acquire adequate knowledge of bronchial asthma before completing their medical school so that he/she can bring out better understanding about the disease on the patient which can change patient&#x2019;s knowledge and attitude towards the treatment of disease and improve the medication adherence and eventually the therapeutic outcome. The present study is aimed to assess the knowledge, attitude and practice of bronchial asthma among medical students.&#xD;
&#xD;
MATERIAL AND METHODS &#xD;
&#xD;
Study design&#xD;
&#xD;
This is a prospective, observational, questionnaire-based study&#xD;
&#xD;
Study Area and Population&#xD;
&#xD;
The study was conducted at Saveetha Medical College, Thandalam, Chennai. There are a totally of 750 medical students in our institute each year comprising of 150 students. All the 750 medical students were included in this study.&#xD;
&#xD;
Sample size&#xD;
&#xD;
The sample consisted of 750 medical students&#xD;
&#xD;
Study period&#xD;
&#xD;
The study was carried out for a period of 3 months between January 2020 to March 2020&#xD;
&#xD;
Study tool and data collection method&#xD;
&#xD;
A semi-structured questionnaire was used as the study tool for data collection. Data collection was done through online Google-forms. The questionnaire consisted of details regarding name, age, sex, year of study and a total of 25 questions in which the first 15 questions reflected the knowledge about the disease, the next 5 questions regarding the attitude towards the disease and the last 5 were related to practice on bronchial asthma among the study participants. The students were expected to respond to the questionnaire within 15 minutes without using any reference material &#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Data entry was done and analyzed using Microsoft Excel 2007. The descriptive statistics were calculated and presented in frequency tables and graphs. The categorical variables were compared using the Chi-square test and P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3521</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3521</Fulltext></URLs><References>[1] World Health Organization.Asthma.2020.Available at: https://www.who.int/news-room/fact-sheets/detail/asthma. &#xA0;Accessed: 20 June 2020 &#xD;
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[2] Behera D, Sehgal IS. Bronchial asthma-Issues for the developing world. &#xA0;Ind J Med Res 2015;141(4):380.&#xD;
&#xD;
[3] GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211-1259.&#xD;
&#xD;
[4] Prakruthi GM, Bharathi DR, Yogananda R. A case-control study on determinants of childhood asthma in school children of Chitradurga city. Int J Curr Pharm Res 2018;10:11&#x2013;15&#xD;
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[5] Aparna G, Sreenivasan VK. A clinical study of knowledge, attitude and practices regarding asthma among the parents of asthmatic children. Int J Med Health 2019-5(8):119-123&#xD;
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[6] Gajanan G, Padbidri VS, Chaudhury A. Assessment of knowledge and attitude of parents towards the allergy and bronchial asthma in their children. Int J Med Pub Health2016;6(3):231.&#xD;
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[7] Franks T J, Burton DL, Simpson M D. Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia. Therapy Clin Risk Manag 2005;1(1):33-38&#xD;
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[8] Global Initiative for Asthma. GINA. 2018. Available at: https://ginasthma.org/gina-reports/. Accessed: September 2020.&#xD;
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[9] McCracken JL. Diagnosis and management of asthma in adults: A review. J Aca Med Assoc 2017;318(3):279-290.&#xD;
&#xD;
[10] Gibson PG, Wilson AJ. The use of continuous quality improvement methods to implement practice guidelines in asthma. J Qual Clin Pract 1996;16(2):87-102.&#xD;
&#xD;
[11] Maria Ayub, Shahtaj Ahmed, Zubaria Mursaleen, Shamsa Ashfaq, Zunaira abid, Noor Sab. Assessment of knowledge, awareness and practice of asthma disease among medical students. Res J&#xA0; Bri Phy Sci 2016:2(4):143-145&#xD;
&#xD;
[12] Bhagavatheeswaran KS, Kasav JB, Singh AK, Mohan SK, Joshi A. Asthma-related knowledge, attitudes, practices (KAP) of parents of children with bronchial asthma: A hospital-based study. Ann Trop Med Pub Health 2016;9(1):23.&#xD;
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[13] Gare MB, Godana GH, Zewdu B. Knowledge, Attitude, and Practice Assessment of Adult Asthmatic Patients towards Pharmacotherapy of Asthma at Jimma University Specialized Hospital. EC Pulmonol Resp Med 2020;9(2):01-10.&#xD;
&#xD;
[14] Aherkar RY, Bhamare CG, Ghongane BB, Deshpande PK. Assessment of Medical Student&#x2019;s Knowledge on Metered Dose Inhaler Technique and Asthma in a Tertiary Care Teaching Hospital. Asi Pac J Alle&#xA0; Imm 1997;15(4):135-137.&#xD;
&#xD;
[15] Quah BS. Knowledge of childhood asthma among medical students. Asi Pac J Alle&#xA0; Imm 1997;15(4):1065-1067.&#xD;
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[16] Niazi SM. Knowledge of Medical students towards Childhood Asthma. J Pharm Sci Res 2018;10(8):2034-2036.&#xD;
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[17] Al-Harbi S, Al-Harbi AS, Al-Khorayyef A, Al-Qwaiee M, Al-Shamarani A, Al-Aslani W, Kamfar H, Felemban O, Barzanji M, Al-Harbi N, Dhabab R. Awareness regarding childhood asthma in Saudi Arabia. Ann Thor Med 2016;11(1):60.&#xD;
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[18] Al-Ali LA, Al Jasmi SA, Al Yammahi LM, Syeed A, Darwish EA. Parental knowledge, attitudes, and practices regarding the use of prescribed inhalers in asthmatic children attending Ambulatory Healthcare Services Clinics. Ibn J Med Biomed Sci 2019;11(2):68.&#xD;
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[19] Muniz JB, Padovani CR, Godoy I. Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices. J &#xA0;Pneumo 2003;29(2):75-81.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Thalassemia in Children: A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>135</FirstPage><LastPage>137</LastPage><AuthorList><Author>Laltanpuii</Author><AuthorLanguage>English</AuthorLanguage><Author> Maurya A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Thalassemia, Cooley&#x2019;s anaemia, Mediterranean anaemia, Hereditary, Hepatosplenomegaly</Keywords><Fulltext>Introduction&#xD;
&#xD;
Thalassemia produces hypochromic microcytic anaemia due to defective haemoglobin of RBCs, hemolysis and ineffective erythropoiesis. It can be considered as hemolytic and hypo - proliferative anaemia related to abnormal haemoglobin. It was first noticed in patients, originating from the littoral countries of the Mediterranean Sea. At present, the disease has been found in several countries all over the world. The prevalence of the disease in India is high among Gujaratis, Sindhis and Punjabis. Millions of people are found to be carriers of the thalassemia gene and every year thousands of thalassemic children are born in our country.1&#xD;
&#xD;
Progressive pallor, anaemia, fatigue or weakness, jaundice, hepatosplenomegaly, recurrent respiratory infection, failure to thrive, facial bone deformities are common symptoms of thalassemia.2 Blood examination, Bone marrow study, Osmotic fragility test, radiological screening are common investigations done in thalassemia.1 Mild thalassemia might not be needed to be treated but severe thalassemia required regular blood transfusions along with symptomatic treatment.2&#xD;
&#xD;
Thalassemia is classified into three main types, the classification depends on the number of gene mutation and the part of haemoglobin molecules which are affected either alpha or beta.3 The different types are Thalassemia major &#x2013; Here thalassemia genes (beta) are inherited from both the parents and it is associated with the homozygous state. Synthesis of the beta chain is markedly reduced. Thalassemia intermedia: It is chronic hemolytic anaemia caused by alpha or beta chain synthesis. It is also a homozygous form. Thalassemia minor: It is a mild form of illness and produced by heterozygosity of either alpha or beta chain.1&#xD;
&#xD;
Management of thalassemia is mostly done by Repeated blood transfusion, iron chelation therapy, splenectomy, folic acid supplementation, bone marrow transplantation, gene therapy and gene mutation, supportive management.1&#xD;
&#xD;
Patient Identification: &#xD;
&#xD;
A male child of 8 years from Shirajgamwas admitted to pediatric ward no. 14, AVBRH on 23rd January 2020 with a known case of Thalassemia major. He was 25 kg and his height was 126 cm on admission.&#xD;
&#xD;
Present medical history: &#xD;
&#xD;
A male child of 8 years old was brought to AVBRH on 23rd January 2020 by his parents with a complaint of abdominal pain (left hypochondriac region) and fever and he was admitted to Pediatric ward no 14. He is a known case of Thalassemia Major and his Hemoglobin level at the time of admission was 6.4gm%. The child was weak and not cooperative on admission.&#xD;
&#xD;
Past medical history: &#xD;
&#xD;
My patient was diagnosed to have thalassemia at the age of 8 months when he was admitted to the hospital due to fever. From that time onwards, he was admitted to the hospital from time to time for blood transfusion.&#xD;
&#xD;
Family history: &#xD;
&#xD;
There are four members of the family. My patient was diagnosed to have a Thalassemia major and his parents were the carrier of thalassemia. The type of marriage of the parents is non &#x2013; consanguineous marriage. All other members of the family were not having complaints about their health except for my patient who was being admitted to the hospital.&#xD;
&#xD;
Past interventions and outcome: &#xD;
&#xD;
My patient got diagnosed with thalassemia when he was 8 months old, from that time onwards he was admitted to hospital from time to time for treatment of the disease mostly blood transfusion. It was found effective as the patient does not develop complications till then.&#xD;
&#xD;
Clinical findings: &#xD;
&#xD;
Abdominal pain, fever (Temperature - 101?F), Anemia (Hb &#x2013; 6.4gm%)&#xD;
&#xD;
Aetiology: &#xD;
&#xD;
Thalassemia occurs when there is a mutation or any abnormality in any one of the genes which take part in producing haemoglobin. When there is a genetic abnormality, it can be pass &#x2013; on from parents to children. When only one of the parents is a carrier, there is the chance of developing a mild form of thalassemia that is thalassemia minor where symptoms might not be seen but the person will be a carrier. When both the parents are the carrier, there is a great chance of developing a severe form of thalassemias like thalassemia major or thalassemia intermedia.4&#xD;
&#xD;
Pathophysiology&#xD;
&#xD;
&#xD;
&#xD;
Physical examination &#xD;
&#xD;
There was not many abnormalities found in head to toe examination, the child is lean and thin. He is weak and not so cooperative. Though it was found that the child is having splenomegaly from ultrasonography, it is not palpable.&#xD;
&#xD;
Diagnostic assessment&#xD;
&#xD;
Pathology: &#xD;
&#xD;
HB% &#x2013; 6.4gm%, Total RBC count &#x2013; 2.3 millions/cu.mm, RDW &#x2013; 18.2%, HCT &#x2013; 20.2%, Total WBC count &#x2013; 3200/cu.mm, Monocytes &#x2013; 02%, Granulocytes &#x2013; 20%, Lymphocytes &#x2013; 77%. &#xD;
&#xD;
Biochemistry: &#xD;
&#xD;
AST(SGOT) &#x2013; 112 U/L. &#xD;
&#xD;
Peripheral Smear: RBC &#x2013; mild hypochromic with mild cystosis which show few microcytic. Platelets &#x2013; Reduced on smear, APC &#x2013; 62,000 cells. &#xD;
&#xD;
Ultrasonography: Splenomegaly.&#xD;
&#xD;
Management&#xD;
&#xD;
Medical management: &#xD;
&#xD;
Blood transfusion, Inj. Cefotaxime 750mg IV x BD, Syr. Azee 4ml x OD, Tab. Folic Acid 5mg x OD, Tab. Udiliv 150mg x BD, Cap. Hydra 500mg x OD, Tab. Prednisolone 10mg x BD&#xD;
&#xD;
Nursing Management: &#xD;
&#xD;
My patient&#x2019;s Hb% was 6.4gm% on admission and doctors prescribed blood transfusion, I have started blood transfusion according to prescription and during a blood transfusion, I have assessed the condition of the patient, monitor vital signs and there was no complication due to blood transfusion. The child also complained of abdominal pain and fever, for abdominal pain I gave a comfortable position according to the child&#x2019;s preference and for fever I gave cold sponging. I have provided medications according to prescriptions of the physicians and evaluate for therapeutic response. Give health teaching to both the child and parents related to disease condition and treatments.&#xD;
&#xD;
Discussion&#xD;
&#xD;
A male child of 8 years old from Shirajgam was admitted to pediatric ward no 14, AVBRH on 23rd January 2020 with a complaint of abdominal pain, fever and Hb% less than the normal limit. He is a known case of thalassemia major which was diagnosed when he was 8 months old. As soon as he was admitted to the hospital investigations were done and appropriate treatment was started. After getting treatment, he shows great improvement and the treatment was still going on till my last date of care. Among inheritable diseases, thalassemia is one of the most common diseases in the world. It needs long &#x2013; term treatment so it is better to take preventive measures.5 Mostly, screening for carrier and counselling are done voluntarily.&#xD;
&#xD;
A study was done on, &#x201C;A clinical &#x2013; epidemiological study of thalassemia cases in India&#x201D;. It was done to assess the clinical presentation and management practices in thalassemia. For the study, patients case sheets were collected between 2005 &#x2013; 2014 which is 10 years. These case sheets were being examined and recorded in a specially made proforma for the study. The result from the study was &#x2013; a total of 183 cases are recorded and among those, 179 (97.8%) were beta-thalassemia major, 3 (1.6%) were beta-thalassemia intermedia and 1 (0.6%) was beta-thalassemia minor. Most of the case was diagnosed at age of 1 year, and one-fourth of the case was diagnosed in the first 6 months. Fever present in 34 patients (18.6%), pallor found in 179 patients (97.8%), hepatomegaly seen in 172 patients (94%) and bone deformity found in 13 patients (7.1%). One-third of the under-five patients were found to be underweight and more than half of the patients were found to be stunted. The mean post-transfusion value of haemoglobin after 1 year of transfusion among cases was 10&#xB1;1.6g%, 51 patients (27.9%) were given desferrioxamine as iron chelation therapy and the mean age of starting this therapy was 11.1&#xB1;8.2 years. In 4 cases of beta-thalassemia, major splenectomy was done at a mean age of 10.7&#xB1;4.8 years. On the treatment of thalassemia with desferrioxamine lenticular opacity was found in greater proportion. The study concluded that among thalassemic patient different kinds of complications were found so it is important to involve different specialization in the care of thalassemia patient to control the problems.6&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Thalassemia is one of the most common cases found among children, it is very important to diagnose in the early stage and start treatment so that the child will not develop complications. It is also very important to take preventive measures like antenatal screening and genetic counselling. My patient shows great improvement after getting the treatment and the treatment was still going on till my last date of care.&#xD;
&#xD;
Ethical approval: Not applicable &#xD;
&#xD;
Patient Inform consent: Informed consent has been taken from the patient&#x2019;s parents.&#xD;
&#xD;
Conflict of Interest: The author declares that there are no conflicts of interest.&#xD;
&#xD;
Funding: Not applicable&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3522</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3522</Fulltext></URLs><References>&#xD;
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	Shilpa A. Everything you need to know about thalassemia. August, 2019. Healthline. Available from https://www.healthline.com/health/thalassemia&#xD;
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	Nitin J, Pai S, Sengupta S. A clinico &#x2013; epidemiological study of thalassemia cases in India. J Nat Sci Biol Med 2018;9(2):236-241.&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Correlation between Diabetic Retinopathy and Cognitive Impairment in Patients with Type 2 Diabetes&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>138</FirstPage><LastPage>142</LastPage><AuthorList><Author>SG Mathupriya</Author><AuthorLanguage>English</AuthorLanguage><Author> V Panimalar A Veeramani</Author><AuthorLanguage>English</AuthorLanguage><Author> Divya N</Author><AuthorLanguage>English</AuthorLanguage><Author> Bindu Bhaskaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cognitive function, Early Treatment Diabetic Retinopathy Study classification, Mini-cog, Mini-Mental State Examination,  Montreal cognitive assessment, HbA1c</Keywords><Fulltext>Introduction&#xD;
&#xD;
The incidence of type 2 diabetes is increasing worldwide and became a leading cause of morbidity and mortality.1 Diabetic retinopathy is an important ocular neurovascular complication that was the leading cause of blindness 2 decades back.2,3 Diabetes is associated with an increased risk of cognitive decline and an independent risk factor for the development of Alzheimer disease. Even mild cognitive impairment may lead to the development of dementia and Alzheimer disease.4 This mild cognitive impairment might hamper everyday activities depending on the work and situation, which requires various cognitive domains such as general intelligence, processing speed, psychomotor efficiency, attention, perception, learning, memory, and executive functions. Retinal and cerebral small vessels have similar embryological origin, anatomy and physiological characteristics.5 Hence retinal microvascular abnormalities have been associated with cognitive impairment, possibly serving as a marker of cerebral small vessel disease. Therefore the purpose of this study is to find the association between diabetic retinopathy and cognition impairment in patients with type 2 diabetes. This could be useful for identifying patients with risk of dementia and Alzheimer disease and for the development of preventive measures in diabetic patients.&#xD;
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Materials and method&#xD;
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This is a hospital-based descriptive cross-sectional study. The proposal for the study was submitted to the institutional ethics committee and approval was obtained. The ethical clearance approval number is SMC/IEC/2020/03/376.&#xA0; The study was conducted on 100 patients with type 2 diabetes in the age group 35-75 years attending the outpatient department over two months in a tertiary care centre. After obtaining informed consent, Vision, slit-lamp examination, detailed fundus evaluation was done. Retinal photographs were taken whenever needed. Known cases of Type 2 Diabetes mellitus attending outpatient department were included in the study. Other co-morbid conditions like hypertension, cardiovascular disease, chronic kidney disease, pre-existing dementia and hearing impairment were excluded. Diabetic Retinopathy (DR) graded as No DR, Mild NPDR, Moderate NPDR and Severe NPDR and PDR using ETDRS classification. Since the minimum number of patients are involved in the study, it categorized into three groups as No DR, Mild and Moderate NPDR, Severe NPDR and PDR. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Mini-cog. Data collection was done by face-to-face interviews in the outpatient department. The maximum score for MoCA and MMSE is 30. In MoCA, a score lesser than 26 is considered to have cognition impairment. In MMSE, a score of 23 or lower is indicative of cognitive impairment. In mini-cog, the total score is 5 and the score lesser than 3 is considered as cognition impairment 6. The most recent value of HbA1c, on the day of administering the cognition tests, were taken from the medical records and correlated with cognitive impairment. Descriptive statistics were presented as numbers and percentages. Pearson&#x2019;s Chi-square test was used to evaluate how the distribution of categorical variables differed from another. A two-sided p-value less than 0.05 was considered statistically significant.&#xD;
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Results&#xD;
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A total of 100 patients with type 2 diabetes were involved in the study. The distribution of the number of cases in different grades of diabetic retinopathy is given in Table 1.&#xD;
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Out of this, 61 were male and 39 were female. The age group of the study population is between 35 and 75 years.&#xA0; Correlation of the socio-demographic features of the study population with the grades of diabetic retinopathy is given in Table 2.&#xD;
&#xD;
Cognitive function was assessed using three cognitive tests, Montreal Cognitive Assessment, Mini-Mental State Examination and Mini-cog. The results of the cognitive tests were correlated with the grades of diabetic retinopathy in Table 3. &#xD;
&#xD;
Since MoCA is more sensitive than MMSE and Mini-cog, cognitive function was calculated using MoCA and correlated with the grades of retinopathy in Tables 4 and 5&#xD;
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Scores of cognitive tests with the grades of Diabetic retinopathy was then correlated in Table 6. &#xD;
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Recent values of HbA1c of the study population on the day of administering cognitive tests are then correlated with the cognitive impairment in Table 7.&#xD;
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Discussion&#xD;
&#xD;
The prevalence of type 2 diabetes and cognitive impairment has increased over the past 2 decades.4 Longer duration of diabetes and poorer glycemic control are highly associated with diabetic retinopathy and cognition impairment.7,8 Identifying the disease process that correlates the diabetic microvascular changes and cognitive impairment could be useful for the development of preventive measures in people with diabetes. The present study examined the prevalence of cognitive impairment in patients with diabetic retinopathy in a tertiary care centre in South India. &#xD;
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In this study, 100 patients with type 2 diabetes were included over two months in the outpatient department of a tertiary care centre and the results were analyzed. The patients are categorized based on their grades of diabetic retinopathy using ETDRS classification. On correlating the socio-demographic details, it was found that patients with older age are more affected with diabetic retinopathy. Several other studies also reveal that elderly people are more affected.5 In this study, diabetic retinopathy is higher among male but statistically, there is no significant association between diabetic retinopathy and gender. Yet several studies reveal male predominance.4,5 In the present study, patients with primary education are more affected by diabetic retinopathy. This shows that lack of awareness on regular eye checkup in diabetic patients with primary education paved way for the development of diabetic retinopathy. This was proved by another study that reveals that people with higher education have better awareness regarding the regular eye checkup and progression of the disease.9 The socioeconomic status of the patients involved in the study has no statistical significance. But some studies reveal that higher severity of retinopathy was found in deprived classes of society.10&#xD;
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In this study, three cognitive tests, MoCA, MMSE, Mini-cog were used to correlate the cognitive function with grades of diabetic retinopathy. All three cognitive tests reveal that a greater percentage of people with mild and moderate NPDR have cognitive impairment. In MoCA, 77% of patients, in MMSE 74% of patients and Mini-cog 72% of patients with mild and moderate NPDR have cognitive impairment and they are statistically significant with p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3523</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3523</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Review on Efficient Food Waste Management System Using Internet of Things&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>143</FirstPage><LastPage>150</LastPage><AuthorList><Author>T. Bharath Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Prashar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Food Waste, IoT, Intelligent Refrigerator, Food Supply Chain, Sensors</Keywords><Fulltext>Introduction&#xD;
&#xD;
Meeting the food needs of an increasing population sustainably one of humanity&amp;#39;s major problems in the coming decades is to be focused on scarce resources while protecting the environment. Present demographic patterns and consumption habits will continue to raise food demand for at least a further 40 years. Approximately one-third of the edible portions of world food generated, it is projected that human intake is missed or unused. In reaction to this vulnerability, the FAO has The Food Loss Index has been developed to measure how much food is lost. Until it hits the retail level, output or in the supply chain 14 per cent of food is diverted across the supply chain, according to FAO 2019, Before having hit the supermarket stage.&#xD;
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This paper is organized into different sections. The introduction is under section I, Internet of Things under section II, Aim of the Review is under Section III, Key findings of the Review Article is under Section IV, Research gap Identification/Future Directions are under Section V, Discussion is under Section VI and Conclusion in Section VII.&#xD;
&#xD;
Internet of Things tells about connecting physical objects like mobile phones, vehicles, home appliances etc. to the internet to exchange data from anywhere to anywhere. By having this type of technology human intervention will be reduced a lot and works will be done easily. At present by 2020 approximately 50 million devices are connected to the internet and this number will be increased from day to day [Figure 1]. The applications of IoT include health, homes, cities, energy systems, retail, logistics, industry, agriculture sector, etc.&#xA0; The following figure 2 shows various IoT communication technologies and figure 3 shows the current IoT enabled technologies. The goal of this literature review is to provide participants with a way to reduce food waste. It would ideally evoke more studies on IT applications for the elimination of food waste.&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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Key Findings&#xD;
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The following table 1 shows key findings in the Literature and future challenges also mentioned.&#xD;
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Research gap Identification/Future Directions&#xD;
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1. Increasing the incentives for the workers of supermarkets, packaging, etc. to control the food waste.&#xD;
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2. Research on different policies to control food waste.&#xD;
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3. Finding the loss estimates of other commodities like dried fruits, dairy products etc.&#xD;
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4. Find other algorithms for processing, Shipment and&#xA0; Quality Management.&#xD;
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5. Improving the quality of the food items inside the smart refrigerator.&#xD;
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6. Investigation of food waste into bio-fuel with simple and clean methods.&#xD;
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7. Improvisation of better efficiency of HSGB&#x2019;S.&#xD;
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8.Better connectivity and using protocols for communication to improve begins to collect food waste.&#xD;
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9. Improve the security and privacy concerns to minimize the chances of hacking the smart refrigerator.&#xD;
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10. Concentrate on high-quality resolution cameras for quality photos inside the smart refrigerator.&#xD;
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11. Use of Big data to enhance food security.&#xD;
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12. Improving the shelf life to minimize food waste in the supply chain.&#xD;
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13.Improving food tackling the methods for measuring food waste.&#xD;
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14. Updating the Photodiodes to RFID technology for identifying the presence of objects inside&#xA0;&#xA0; the fridge&#xD;
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15. Use more sensors to install on the raspberrypi3 to reduce the need for a plug system and apply this methodology for cabinets and living rooms.&#xD;
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Discussion&#xD;
&#xD;
In this review article, we can observe many ways to control food waste in different situations. The majority of the papers are focusing on food waste control in the food supply chain because this chain consists of many modules like processing, preparing, packaging, classifying, transportation and distribution. So whenever control starts in this chain automatically there will be a change in food waste before consumption. The intelligent refrigerator also takes a major portion in reducing the food waste at household and restaurants because of inbuilt sensors and machine learning technique used in the implementation. The design of smart garbage systems also played a better role in collecting food waste and sending information to the higher authorities for further action. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
The Internet of Things (IoT) involvement is increasing in reducing and updating the food waste across the country from time to time. Because of the availability of many sensors and communication technologies in IoT. This article provides an extensive survey of food waste management techniques/methods. The major concern is about reducing food waste to accommodate more number of people across the country. The researcher(s) can concentrate on the above gaps to improve food availability and reduce wastage. &#xD;
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Acknowledgement&#xD;
&#xD;
We thank our colleagues from B V Raju Institute of Technology, Narsapur who provided insight and expertise that greatly assisted the research, although they may not agree with all of the interpretations/conclusions of this paper. We are also grateful to authors/ editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
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Conflict of Interest:&#xD;
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There is no conflict of Interest.&#xD;
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Financial Support: Not applicable&#xD;
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Human or animal study Ethical clearance letter: Not Applicable&#xD;
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Informed consent: Not Applicable&#xD;
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Author Contribution:&#xD;
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T. Bharath Kumar: Literature review, Writing Manuscript, and Comparison of results.&#xD;
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Dr Deepak Prashar: Reviewed the complete article. &#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Design of UWB Slot Antenna for WBAN Application&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>151</FirstPage><LastPage>155</LastPage><AuthorList><Author>Sesha Vidhya S</Author><AuthorLanguage>English</AuthorLanguage><Author> Rukmani Devi S</Author><AuthorLanguage>English</AuthorLanguage><Author> Shanthi KG</Author><AuthorLanguage>English</AuthorLanguage><Author> Nowshith Parveen N</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> UWB (Ultra Wide Band) Antenna, Linear plotting slits, WBAN (Wireless Body Area Networks), SAR (Specific Absorption  Rate), Edge feeding, On-body communication</Keywords><Fulltext>Introduction&#xD;
&#xD;
The drastic evolution of medical science and health care systems&#xA0;has paved the path for the application of UWB. It is merged with material science engineering to provide its service in the Body Centric Wireless Communication (BCWC). These systems have brought down the cost and increased dependability because of their potentially feasible features and applications. Thereby improving the quality of living of the people, by their application in the bio-medical industries. The UWB satisfies the maximum requirement of an antenna in the bio-medical and bio-equipment industries. These antennas provide lower power spectral densities of about 41.3dBm/MHz which would manage to provide low to medium data rate for computing applications. Apart from low spectral densities, they are preferred because of their appreciative compact size, lightweight and minimal radioactive standards for avoiding radiation risk.1-3&#xD;
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The UWB antenna provides a broad range of frequency with a low SAR value. As the transmission power is low, UWB antennas are most suitable for Wireless Body Area Network. And the communication period is also impulsive this antenna does not affect the human body. In amidst various types of antenna, the microstrip patch antenna is widely used in wireless applications due to its low profile, low cost, lightweight and simple architecture.4,5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;The normal working range of the UWB antenna is from 3.1GHz to 10.6 GHz. Also, the characteristic like low profile, reliability and high performance makes it more suitable and appropriate for WBAN application.6,7 &#xD;
&#xD;
Roger Duroid- 5870 is used for the fabrication of substrate which has a permittivity of 2.33. It is laminated uniformly from one plane to the other and provides a constant value over a wide range of frequency. As discussed in the paper mentioned, the UWB antenna is applicable for bio-medical application as it provides high fidelity, low bit rate and bandwidth.8,9 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A special material called meta-material is used for the fabrication of the antenna. Due to their macroscopic periodic nature, they are capable of providing low loss, better efficiency and effective bandwidth, thus making it easy to handle.10,11 The microstrip patch antenna can provide better performance in off body radiation and making it user friendly, which can also be demonstrated in the open environment along with the real-time application.12,13For a wireless body area network, the SAR value for on body radiation should be less than 1.6 W/Kg as per the standardization.14 The different slotted or slit shapes have been designed, and also concluded that among all shapes, S shape is the better most choice for the overall size reduction of the Microstrip antenna.15&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The problem to be addressed for a reliable on-body application is overcome by providing wide bandwidth small size and low backward radiations. The same is achieved by slotting the structure and implementing partial ground proportionally. The proposed antenna is designed for UWB range in wireless body area network (WBAN) for on-body communication. This antenna uses a linearly plotted slit shape microstrip patch for size reduction and wider Bandwidth. To reduce power consumption and avoid the back radiation the partial ground technique is employed. &#xD;
&#xD;
The organization of the paper is as follows; the second section presents the material used, design and structure of the antenna, the third section gives simulated results in terms of antenna parameters and the same has been compared with tested results. Finally, the conclusion is presented in the fourth section.&#xA0;&#xA0; &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The basic design of this antenna is implemented using Linear Plotting Slit structure for improving the bandwidth and for size reduction.18 The ground is partially sized with the dimensions of 28x7 mm2 beneath the substrate. Roger Duroid 5870 is used as the substrate material to provide higher efficiency and a larger band range. And the substrate is spread over the surface of 28x33x1.6 mm3 giving it a compact nature. A bidirectional pattern is produced which reduces the power loss thus producing minimal return loss. The edge feeding technique is used to attain impedance matching. Figure 1a displays the front view of the simulated antenna using HFSS.&#xD;
&#xD;
Figure 1b shows the front view of the fabricated Antenna. Overall dimensions achieved by this design are 0.691&#x3BB;, 0.823&#x3BB;, and 0.039&#x3BB; at the operating frequency of 5GHz. Thus, providing an antenna with smaller dimensions and makes the antenna convenient for the body area network.&#xD;
&#xD;
&#xD;
&#xD;
Table 1 and Table 2 represent the dimensions of the Antenna and Antenna Parameters respectively. The antenna performance characteristics are discussed in the later section.&#xD;
&#xD;
&#xD;
&#xD;
Result and Discussion&#xD;
&#xD;
The designed Roger Duroid 5870 based UWB antenna is operating at a frequency of 5GHz.The same has been simulated using HFSS software. The simulated S11 plot is shown in figure 2. The return loss is the measure of how well the device or the line are matched and the power reflected from the antenna, at 4.5 GHz the return loss is found to be -16.92 dB. The fabricated antenna is tested and obtained return loss at the operating frequency is found to be -17.13 dB at 4.52GHz, -10.76 dB at 7.56GHz and -24.25 at 3.6GHz. The extensive simulation and calibration process produced wider bandwidth trading off between directivity as shown in figure 2. This plot covers the desired band range of UWB frequency operating from 4.13 to 5.18 GHz providing 1.68 GHz as bandwidth. &#xD;
&#xD;
Thus, better matching between the feed probe and the patch is achieved. It is also seen that due to effective wave designing and feeding technique the bandwidth achieved is 1.68GHz.&#xD;
&#xD;
&#xD;
&#xD;
Result and Discussion&#xD;
&#xD;
The designed Roger Duroid 5870 based UWB antenna is operating at a frequency of 5GHz.The same has been simulated using HFSS software. The simulated S11 plot is shown in figure 2. The return loss is the measure of how well the device or the line are matched and the power reflected from the antenna, at 4.5 GHz the return loss is found to be -16.92 dB. The fabricated antenna is tested and obtained return loss at the operating frequency is found to be -17.13 dB at 4.52GHz, -10.76 dB at 7.56GHz and -24.25 at 3.6GHz. The extensive simulation and calibration process produced wider bandwidth trading off between directivity as shown in figure 2. This plot covers the desired band range of UWB frequency operating from 4.13 to 5.18 GHz providing 1.68 GHz as bandwidth. &#xD;
&#xD;
Thus, better matching between the feed probe and the patch is achieved. It is also seen that due to effective wave designing and feeding technique the bandwidth achieved is 1.68GHz.&#xD;
&#xD;
&#xD;
&#xD;
The energy absorbed by the human body when exposed to a radio frequency (RF) electromagnetic field is known as the Specific Absorption Rate (SAR). The average SAR value for a human body is 1.6 W/kg. The simulated SAR pattern for the designed antenna is shown in figure 3. There is a uniform distribution of deep blue over the patch of the antenna which represents zero SAR value which makes it most suitable for the on-body application. Figure 4a shows the far-field radiation pattern at 0&#xB0;. Figure 4b shows the far-field radiation pattern at 90&#xB0;. Figure 4c shows the far-field radiation pattern at 180&#xB0;.&#xD;
&#xD;
&#xD;
&#xD;
The term Gain combines antenna directivity and electrical efficiency. The gain performance of the Roger Duroid UWB antenna is shown in figure 5. The graph result shows that the UWB antenna proposed provides a peak gain of 3.23 dB which makes this antenna more suitable for biomedical application.&#xD;
&#xD;
&#xD;
&#xD;
The plot of the gain as a function of direction is bidirectional and hence capable of transmitting and receiving electromagnetic radiation. Directivity is the concentration of emitted radiation in a single particular direction. The Directivity for the proposed UWB antenna is shown in figure 6. The directivity obtained for this antenna is 3.21dB.&#xD;
&#xD;
&#xD;
&#xD;
VSWR defines the power reflected from the antenna. The VSWR is found to be 1.33 at a resonant frequency of 4.6 GHz as shown in figure 7. &#xD;
&#xD;
&#xD;
&#xD;
As a result, better impedance matching has been obtained and more power is delivered to the antenna. The E-field, 3-D radiation pattern of this antenna is shown in the figure 8.&#xD;
&#xD;
&#xD;
&#xD;
The H-field 3-D radiation pattern of the proposed antenna is shown in the figure 9.&#xD;
&#xD;
&#xD;
&#xD;
The J-field 3-D radiation pattern of the proposed antenna is shown in figure 10.&#xD;
&#xD;
&#xD;
&#xD;
And the overall simulated performance characteristic of this proposed antenna is given in table 3.&#xD;
&#xD;
&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The optimal pulse shaped patches and partially slotted ground led to attaining a satisfactory wideband frequency of 1.68 GHz and minimum SAR required for the antenna to be concerned in the Bio-medical applications. Also, the proposed antenna radiates with an efficiency of 98% and a return loss of -16.4dB. These crucial factors empower this antenna idyllic for on-body WBAN applications.&#xD;
&#xD;
&#xA0;Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
&#xA0;Conflict of Interest: NIL&#xD;
&#xD;
Source of Funding: NIL&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3525</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3525</Fulltext></URLs><References>&#xD;
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	Sesha VS, Rukmani D, Shanthi KG. Design Trends in Ultra Wide Band Wearable Antennas for Wireless On-Body Networks. ARPN J Engi Appl Sci 2017; 12(9):2782-2790. &#xD;
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	Poffelie LAY, Soh PJ, Yan S, Vandenbosch GAE. A High Fidelity All Textile UWB Antenna with low back radiation for off body WBAN Application. IEEE Transac Anten Propag 2016;64(2):757-760.&#xD;
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	Ahmed F, Hasan N, Md. Chowdury HM. A Compact Low-profile Ultra Wideband Antenna for Biomedical Application. Cox&#x2019;s Bazar, Bangladesh 2017.&#xD;
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	Wang J C, Lin E G, Leach M, Wang Z, Manand K L Huang Y. Conformal Wearable Antennas for WBAN Application. IMECS, Hongkong 2016; 2.&#xD;
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	Samal P B, Soh P J, Vandenbosch G A E. UWB All-Textile Antenna with full Ground Plane for off-Body WBAN Communication. IEEE 2016.&#xD;
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	Hraga H I, See C H, Abd-Alhameed R A, Mcewan N J. Miniaturized UWB Antenna for a wireless Body Area Network. Loughborough, UK. 2012.&#xD;
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	Alomainy A, Hao Y, Parini CG, Hall PS. Comparison between two Different Antennas for UWB on-body Propagation Measurements. IEEE Antennas Wireless Propagation Letters 2005;4:31&#x2013;34. &#xD;
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	Alomainy A, Sani A, Rahman A, Santas J G, Yang H. Transient Characteristics of wearable antennas and radio propagation channels for UWB body-centric wireless communications. IEEE Transac Anten Propag 2009;57(4):875&#x2013;884.&#xD;
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	Biswas A, Islam A J, Al-Faruk A, Alab S S. Design and Performance Analysis of a Microstrip Line-fed On-Body Matched Flexible UWB Antenna for Bio Medical Application. Cox&#x2019;s Bazar, Bangladesh 2017. &#xD;
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	Dong Y, Itoh J. Metamaterial-Based Antennas. IEEE Journals and Magazines 2017.&#xD;
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	Behera B R, Suraj P. Performance Analysis of Microstrip Patch Antenna with Metamaterial and Genetic Algorithm. ICIIS.2016.&#xD;
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	Dumanli S, Sayer L, Mellios E, Fafoutis X, Hilton G S, Craddock I J. Off-Body Antenna Wireless Performance Evaluation in a Residential Environment.2017;65(11).&#xD;
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	Gajanan V. Wasalwar, Wasnik D S. Reliability of Physical Examination and Electrocardiogram in Determination of Acute Myocardial Infarction: A Hospital Based Study. Int J Curr Res Rev 2020;12(19). &#xD;
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	Soh P J, Vandenbosch G A E, Wee F H, Bosch A V D, Vazquez M M, Schreurs D. Specific Absorption Rate (SAR) Evaluation of Textile Antennas.Germany:1-21.&#xD;
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	Nasimuddin P, Zhi NC, Xianming Q. Circularly Polarized Slotted/Slit-Microstrip Patch Antennas. Microstrip Anten 2015;24:341-360.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Detection of Polycystic Ovarian Syndrome using Convolutional Neural Networks&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>156</FirstPage><LastPage>160</LastPage><AuthorList><Author>Vikas B</Author><AuthorLanguage>English</AuthorLanguage><Author> Radhika Y</Author><AuthorLanguage>English</AuthorLanguage><Author> Vineesha K</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Convolutional Neural Networks (CNN), Data Augmentation, Deep Learning, Over-fitting, Polycystic Ovarian Syndrome  (PCOS), Transfer Learning</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Fertility is the most important reason which affects the uprightness of a household while infertility is a complication that occurs in the reproduction system of women or men. Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrinal disorder that affects most women of their reproductive age. The first recognition of an association between the presence of polycystic ovaries and signs of hirsutism and amenorrhea was by Stein and Leventhal.1 It causes a wide range of symptoms such as an increase in weight, growth of ovarian cysts, ovulation disorders, acne, facial hair, depression, anxiety2 and heavy menstrual periods, and it may take years for women to get diagnosed. Almost 5-10% of women in their childbearing age are affected by this abnormality.3 Moreover, current studies have shown that women have high risk of miscarriage in their first trimester. Women with PCOS may develop sleep apnea.4 The treatments for PCOS comprises of changing lifestyle, usage of birth control pills to avoid irregular periods and the usage of drugs like Metformin and anti-androgens.5 Also 6% to 10% of women worldwide, generally those between the ages of 18 to 44 are affected with PCOS.&#xD;
&#xD;
As stated in the Rotterdam conference,1 a woman has PCOS if she is said to possess two of the three symptoms: (1) ovulation failure, (2) higher androgen levels, or (3) the presence of polycystic ovaries. As in structure, when one or both the ovaries contain 12 or more follicles of diameter 2-9 mm, or when the ovarian size exceeds 10 cm3 it can be said that polycystic ovaries are present2 and a woman is said to be infected with this disorder. So, to precisely predict this syndrome the doctor manually examines the Ultrasound image of PCOS as shown in figure 1 by counting the number and size of follicles in the ovaries. Moreover, this investigation takes plenty amount of time and needs very high accuracy to detect whether the patient has polycystic ovarian syndrome or not. &#xD;
&#xD;
Despite the gravity of conditions and available choices of medication, there are very little options to treat this disorder. So, it is very important to provide awareness among patients about this ovarian dysfunction at an early stage to prevent any consequences because it is the main cause of infertility and no cure has been discovered yet. &#xD;
&#xD;
Convolutional Neural Networks has been considered as the best approach for the classification of images.6&#xA0; In previous studies, some systems classify the ultrasound image by using many methods. But still, all the approaches manually extract features from an ultrasound image. The present study aims to compare the performance of popular deep learning techniques. The flowchart of the proposed system is shown in figure 2. Firstly, CNN is used to train the model and then by applying the regularization method, the importance of drop out mechanisms is shown. Then, data augmentation is another technique that is applied to the CNN model. The dataset used in this paper is the Ultrasound images of PCOS, which is very confidential and has privacy issues and around 100 images of PCOS affected and another 100 images of Non-PCOS images have been gathered and are separated as train, validation and test sets and then data augmentation has been applied only to the train set to increase the effectiveness of the data. Finally, by using the VGG-16 model, the Transfer Learning technique is applied which produced results with improved accuracy without over-fitting when compared to the basic CNN model.&#xD;
&#xD;
&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The retrieved PCOS dataset is given as input and the class label is set appropriately. Next, the most popular deep learning method Convolutional Neural Network is applied to the collected dataset. Then accuracy measures of the implemented technique were examined and later checked whether the model is overfitting or not. The dataset collected is very small, so, Data Augmentation technique is applied to the dataset to multiply data&#x2019;s effectiveness and improve the accuracy of the data. Later the model is checked for overfitting. Then finally Transfer Learning, which is another deep learning method is implemented where a model that is built and trained for a particular task is re-used on a similar task to improve the optimization performance of the model. Transfer Learning is applied when there exists a new dataset smaller than the original dataset which is used to train the pre-trained model. Finally, after implementing both the mentioned deep learning methods, accuracies of the models are checked and compared and then the model is tested on the test dataset which predicts whether the image is PCOS or Non-PCOS. In this project, 50 per cent of the data is taken for training, 25 per cent of the data for validation and 25 per cent of the data for testing the model. The entire process is shown in figure 2.&#xD;
&#xD;
CONVOLUTIONAL NEURAL NETWORKS&#xD;
&#xD;
Convolutional Neural Networks (CNN) has achieved great success in recent years. CNN is composed of an input layer, multiple hidden layers and an output layer. The hidden layers of CNN include convolutional layers, pooling layers, fully connected layers and normalization layers (RELU). In the proposed architecture, a three-layered CNN model is designed, combined with a max pooling layer, to extract the features from the acquired dataset and to downsample the output of feature maps from the convolutional layer.&#xD;
&#xD;
&#xD;
&#xD;
The output from the third convolution layer is 128 of the 17 x 17 feature maps. So, a flatten layer is used to flatten this obtained output. This is then passed to the dense layers to obtain the final prediction of whether the image is&#xA0;PCOS (1)&#xA0;or&#xA0;non-PCOS (0). All of this comes under the model training process, and the model is trained using the fit() function. The train set consisting of 100 images i.e., 50 images of PCOS and non-PCOS each is trained over a total of 25 epochs and validated simultaneously on the validation set which consists of 50 images i.e., 25 images of PCOS and non-PCOS each.&#xD;
&#xD;
From the basic CNN performance, it is understood that the model started to overfit after 2-3 epochs. The reason for the overfitting of the model is the dataset acquired contains fewer training data, so the model keeps on seeing the same images overtime during each epoch. So, the basic CNN model is enhanced by including one more convolution layer, and a dense hidden layer. Apart from these, a dropout of&#xA0;0.2&#xA0;is included after every hidden dense layer to implement regularization. Dropout is a very powerful mechanism that is used for regularization in deep neural networks. It is applied to input layers and hidden layers separately. Generally, dropout hides the outputs by a fraction of units from a layer by making their output zero (in this case, it is 20% of the units in the dense layers). From the CNN Regularization performance, it is observed that over-fitting has been gradually reduced and, the accuracy was around 88%.&#xD;
&#xD;
DATA AUGMENTATION&#xD;
&#xD;
When a machine learning model is trained, parameters&#xA0;of the model are adjusted so that they map a specific input (an image) to a specific output (a label). The main aim is to build an effective model where the loss of the model is low, this takes place only when the parameters are adjusted in the right way.7 When there are a&#xA0;lot of parameters, the machine learning model also needs a greater number of examples, so that the model can perform well. &#xD;
&#xD;
Also, the number of&#xA0;parameters&#xA0;required corresponds&#xA0;to the&#xA0;complexity&#xA0;of the task the machine learning model must carry out. Sometimes things might still go wrong even if we have the right&#xA0;sized&#xA0;training set. An important point to remember is algorithms will not think like humans: while humans are capable of classifying images based on a natural understanding. If a user creates a model that identifies cats/dogs and nearly all the training images of dogs consists of snowy surroundings, then the algorithm might learn the wrong rules. So, having images from different viewpoints and with different conditions is very important. So, to get more data, it is necessary to augment&#xA0;the dataset: to make it more effective without collecting more training data. It means, users just need to make minor changes to the existing dataset such as flips, translations and rotations which is termed as Data Augmentation. The neural network would think that these are different images.&#xD;
&#xD;
Dataset augmentation can multiply the data&#x2019;s effectiveness. Data augmentation is the process of increasing the amount and diversity of data. New data need not be collected; rather the already existing data can be transformed.&#xA0;By carrying out augmentation, the neural network can be avoided from learning irrelevant patterns, essentially boosting overall performance. There are various ways to transform and augment the image data. The most used operations are7-&#xD;
&#xD;
&#xD;
	&#xD;
	Rotation- image is rotated in random directions.&#xD;
	&#xD;
	&#xD;
	Shifting- an image is shifted to left or right, and the translation range is specified manually to alter the location of the image. &#xD;
	&#xD;
	&#xD;
	Cropping- part of the original image is cropped and resized to a specific resolution.&#xD;
	&#xD;
	&#xD;
	Flipping- the image is flipped in the horizontal direction.&#xD;
	&#xD;
	&#xD;
	Changing the brightness level- images are randomly darkened and brightened.&#xD;
	&#xD;
&#xD;
&#xD;
The images in figure 3 obtained from data augmentation operations mentioned above&#xD;
&#xD;
&#xD;
&#xD;
Now the regularized CNN model is enhanced by including more data by using the above-listed data augmentation methods. From its performance, over-fitting has been gradually reducing and, the accuracy was around 91% which is better than the previous models.&#xD;
&#xD;
TRANSFER LEARNING&#xD;
&#xD;
Transfer Learning is a deep learning method where a model that is built and trained for a particular task is then re-used on a similar task to improve the optimization performance of the model.8 Transfer Learning is applied when there exists a new dataset smaller than the original dataset which is used to train the pre-trained model.9 Pre-trained models can be used in two ways whenever a new model is developed, or a model is being re-used:&#xD;
&#xD;
&#xD;
	&#xD;
	By making use of a pre-trained model to extract features.&#xD;
	&#xD;
	&#xD;
	By fine-tuning the pre-trained model.&#xD;
	&#xD;
&#xD;
&#xD;
In this work, the proposed system uses a model VGG-16 (Visual Geometry Group from Oxford) which was previously trained on a base dataset (ImageNet) and is currently being reused for a similar task to learn features (or transfer them), to be trained on a new dataset which consists of ultrasound images of PCOS and non-PCOS&#xD;
&#xD;
VGG-16 Pre-trained Model&#xD;
&#xD;
The VGG-16 model comprises 16 layers (convolution and fully connected) that are set up on the ImageNet database, developed for image recognition and classification tasks. This model was developed by Karen Simonyan and Andrew Zisserman.10&#xD;
&#xD;
From the figure 4, it can be observed that the model consists of&#xA0;13&#xA0;convolution layers applying&#xA0;3 x 3&#xA0;convolution filters combined with max-pooling layers for downsampling. There are two fully connected hidden layers of&#xA0;4096&#xA0;units in both the layers and a dense layer of&#xA0;1000&#xA0;units. Here each unit indicates one of the image categories in the ImageNet database.&#xD;
&#xD;
&#xD;
&#xD;
In the proposed system the last three layers are not needed since we will be using our own fully connected dense layers to predict whether the image will be a PCOS affected or a non-PCOS image. &#xD;
&#xD;
VGG-16 as a Feature Extractor&#xD;
&#xD;
In this method, as shown in figure 5 the five convolution blocks in the VGG-16 model are frozen so that their weights will not be updated after every epoch. The last activation feature map in the VGG-16 model i.e., the output from&#xA0;block5 pool gives us the bottleneck features, which are flattened and passed as an input to the fully connected layers.&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
In this work bottleneck feature vectors of size 8192 is passed as input to the classification model. The same model which has been developed previously is used here regarding the dense layers and a dropout of 0.1 is added after every dense layer and the model has trained over 25 epochs. From the graph in Figure 5, it can be observed that the model&#x2019;s validation accuracy is close to 94%, which is almost a 2-3% improvement from the basic CNN model with image augmentation, which is excellent. The model is not overfitting. This is the best model so far.&#xD;
&#xD;
VGG-16 with Fine-tuning and Image Augmentation&#xD;
&#xD;
In this method, the last two blocks of the VGG-16 model i.e., Block 4 and Block 5 are set to unfreeze so that their weights get updated in every epoch (per batch of data) as the model is trained. &#xD;
&#xD;
&#xD;
&#xD;
From figure 6, blocks 4 and 5 are set to unfreeze and, they are now trainable. It means in every epoch; the weights of these layers will get updated with backpropagation as each batch of data is passed. Here there is no need to extract the bottleneck features because training is done on data generators; hence, the&#xA0;VGG model&#xA0;is passed as object as an input to the model and dropout of 0.2 is added after each dense layer and then the model is trained over 25 epochs.&#xD;
&#xD;
From the graph in figure 6 the model&#x2019;s validation accuracy is around&#xA0;98%, which gave 4%&#xA0;enhancement from the previous model. Altogether, this model has gained a&#xA0;10%&#xA0;improvement in validation accuracy from the first basic CNN model implemented in this work. This indicates that transfer learning can be very useful. The model&#x2019;s performance is excellent here.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
This work deals with the application of three deep learning methods on the obtained data set. Models built were evaluated by testing them on the test set. The performance of the model from the three selected techniques namely Convolutional Neural Networks, Data Augmentation and Transfer Learning after testing are shown below.&#xD;
&#xD;
Based on the various model performance metrics mentioned in the below-mentioned table, it can be observed that the models have provided improved results in each case. Each successive model performed better than the previous model since each of the models consists of advanced techniques. The best model is transfer learning with fine-tuning as well as image augmentation, which provided a model accuracy and F1-score of&#xA0;98% and this model showed an improvement of 10% from the basic CNN model as shown in below Table 1.&#xD;
&#xD;
&#xD;
&#xD;
a) CNN with Regularization, b) CNN with Data Augmentation, c) Transfer Learning Feature Extraction, d) Transfer Learning Fine-tuning with Data Augmentation&#xD;
&#xD;
&#xD;
&#xD;
From the above figure, when data is limited the best results can be obtained by data augmentation and transfer learning. Also, the issue of overfitting can be resolved with this approach. In this dataset where the data is very less, transfer learning on such augmented data helped in getting a better accuracy, 98%.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In this work, Deep Learning methods were selected to assess the performance of a deep neural network in terms of performance metrics such as accuracy, precision, recall and F1-score to classify whether a particular patient is suffering from PCOS or not. Deep Learning techniques were considered in this study as it assists doctors to analyze any kind of disorders precisely and helps them to medicate the patients better, thus resulting in better medical decisions. The dataset used in this study is the ultrasound images of PCOS and NON_PCOS collected from Kaggle and various other resources. It has also been noticed that all the opted techniques show near about accuracies, allowing the user to select any of the methods. By summing up the information to these deep learning techniques, doctors can predict whether a particular patient is susceptible to the syndrome and helps in curing PCOS by seeking medical help and switching to a healthier lifestyle.&#xD;
&#xD;
Conflict of Interest: Nil. &#xD;
&#xD;
Funding: Nil.&#xD;
&#xD;
Acknowledgements: We would like to pay our heartfelt gratitude to Dr. Vijaya Lakshmi Chandrasekhar, Department of Obst. &amp; Gyn., GIMSR, GITAM (Deemed to be University), Visakhapatnam for her generosity in accumulating the data and apprising us about the relationships among various symptoms.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3526</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3526</Fulltext></URLs><References>&#xD;
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	The Rotterdam ESHRE/ASRM?sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long?term health risks related to polycystic ovary syndrome (PCOS). Human Reprod 2004;19(1):41&#x2013;47.&#xD;
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	Trivax B, Azziz R. Diagnosis of polycystic ovary syndrome.&#xA0;Clin Obstet Gynecol 2007;50(1):168-177.&#xD;
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	Does PCOS Put Women at Risk for Other Health Problems. &#xD;
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http://totalpregnancycare.com/pre-conception/polycystic-ovariansyndrome/doespcos-put-women-at-risk-for-other-health-problems/&#xD;
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	Polycystic ovary syndrome. http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome&#xD;
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	Wisesty UN, Nasri J, Adiwijaya. Modified Backpropagation Algorithm for Polycystic Ovary Syndrome Detection Based on Ultrasound Images. International Conference on Soft Computing and Data Mining 2016;141-151.&#xD;
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	Connor S, Taghi M. Khoshgoftaar, A survey on Image Data Augmentation for Deep Learning, J Big Data 2019;6(60):1-48.&#xD;
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	Yuqing G, Khalid M. Deep Transfer Learning for Image-Based Structural Damage Recognition. Computer-Aided Civil Infrastruc Engi 2018; 33(9): 748-768.&#xD;
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	Larsen-Freeman D. Transfer of Learning Transformed. Language Learning 2013;63:107-129.&#xD;
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	Simonyan K, Zisserman A. Very Deep Convolutional Networks for Large-Scale Image Recognition. 2014 arXiv:1409.1556v6.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Classification of Algorithms Supported Factual Knowledge Recovery from Cardiac Data Set&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>161</FirstPage><LastPage>166</LastPage><AuthorList><Author>M. Sivakami</Author><AuthorLanguage>English</AuthorLanguage><Author> P. Prabhu</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Improvised modern lifestyle with more fascination towards fast food causes severe anxieties over human health standards. This renders the society to visit the physicians often, which in turn generates terabytes of diagnostic data. The stored data on critical mining using algorithm provides a wealth of information to clinicians and back them to execute a better treatment. Heart disease rank&#x2019;s first among the charted ailments due to its life-threatening concerns. Objectives: In the present work mining of cardiac data sets obtained from the University of California Irvine (UCI) repository was done using algorithms such as Linear Regression, Naive Bayes and Decision Stump algorithms in Waikato Environment for Knowledge Analysis (WEKA) environment. Result and Conclusion: The obtained results concluded that the Naive Bayes classifier offered the highest accuracy with specificity among the studied algorithms&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Decision stump, Heart disease, Linear regression, Mining, Naive Bayes</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Cardiovascular disease (CVD) is a disease of the heart which results in the reduction of blood flow to the heart and the body due to fatty deposits in arteries. CVD causes a major life threat among the various diseases noticed worldwide. Coronary heart disease, stroke and peripheral arterial disease1,2 are the three major types of heart disease. Globally a handful of people are suffering from CVD and volumes of data are generated clinically for treatment. Machine learning of created data provides valuable information for physicians. However, the mining of healthcare data had many challenges due to its veracity. The application of a proper mining algorithm in a versatile tool will solve this problem to a maximum extent and provides viable information to clinicians. In this paper, we explore how the data mining techniques help predict heart diseases by classification algorithms such as linear regression algorithms, Naive Bayes and Decision Stump. Based on the attributes the classifier&#x2019;s accuracy level is reported.&#xA0; &#xD;
&#xD;
A handful of authors have worked a lot whose some of the recent contributions are listed here. Mukherjee et al. analyzed 270 clinical records relating to heart disease by machine learning approach.3 The crucial risk factor were taken into account from patient case history and diagnosis was done using Support Vector Machines (SVM), Multi-Layer Perceptron ensembles (MLPE) classifiers and Generalized additive model (GAM) regression technique. The decision support system arrived using the above techniques were meaningful.3 Navies Bayes, Linear regression and K-means algorithm are the techniques employed by Swaminathan et al. for analyzing the data of diabetic children. The designed model exhibits a maximum accuracy of 96%.4 Fact of finding methods on heart disease dataset was carried out by using algorithms such as k-means, WAC, prediction tree c5 whose results are arguable.5,6 Thomas et al. underwent a survey for predicting the risk level of heart-related persons based on their clinical assessments by employing Naive Bayes, KNM, DT, Neural Network algorithms. The Result showed that the accuracy level increases with the increase of clinical attributes.7 &#xA0;Patil et al. proposed an efficient approach for the mining of heart disease dataset using the k-means clustering algorithm and MAFIA algorithm are obtained significance relation in predicting heart attack from the dataset.8 Meaningful information in finding out heart patients before proceeding to serious conditions was done by Chadva et al. and successfully implemented with effectiveness.9 Tuli et al. developed a framework called Healthfog by ensemble deep learning in an edge computing device for the prediction of heart disease in a user-friendly manner.10 Prabhu et.al. analyzed among various classification techniques such as Na&#xEF;ve Bayes, Logistic regression, deep belief network SVM, Random Forest, Neural Network and Decision Tree and proposed that the deep belief network model produced the highest accuracy in predicting the patients affected by diabetic complaints.11 Prabhu et.al. employed Self Organizing Map (SOM) Back-Propagation Network (BPN), kmeans-Back Propagation Network,&#xA0; Fuzzy C Means-Back Propagation Network on&#xA0; MovieLens datasets and concluded that&#xA0; Self Organizing Map&#xA0; Back-Propagation Network algorithms mines effectively the studied data. Among the studied algorithm Self Organizing Map&#xA0; Back-Propagation Network method produces the precision level of 85%.12&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
System Architecture&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The system architecture is depicted in Figure 1. In this paper classification technique such as Linear Regression, Naive Bayes and Decision Stump are analyzed and the algorithm with the highest accuracy is to be reported.&#xD;
&#xD;
Data Set Description &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There are 14 attributes used in the present system, which includes 8 symbolic features and 6 numeric features. They are age (Continuous), sex (Discrete), chest pain type (Discrete), rest blood pressure (Discrete), serum cholesterol (Continuous), fasting blood sugar (Discrete), resting electrocardiogram (Continuous), maximum heart rate (Continuous), exercise-induced angina (Discrete), old peak (Continuous), slope (Discrete), major vessel (Continuous), thal(Discrete) and irreversible defect class(Discrete).&#xA0; The data employed are Cleveland data set obtained from the UCI machine learning repository. The above said attributes are taken into consideration for predicting heart diseases. 303 instances are considered as trained data after preprocessing. Moreover, the trained data set are tested by 10 fold cross-validation and the predicted accuracy are reported here.&#xD;
&#xD;
Preprocessing&#xD;
&#xD;
&#xA0;Data sets are preprocessed by cleaning, transformation and reduction methods. Normalization&#xD;
&#xD;
Cleaning of data was done manually on 303 instances.&#xD;
&#xD;
Attribute Selection&#xD;
&#xD;
By the method of attribute selection data, the transformation was done to make the classification process methodological. A new attribute named class was added to the already existing attribute in the Cleveland dataset to mine the records by Naive Bayes and Decision Stump classifier&#xD;
&#xD;
Data Reduction&#xD;
&#xD;
Reduced representation of the data set was done by data reduction strategies. Out of the fourteen attributes used for the present study prediction of heart disease by linear regression analysis employed diagnosis of heart disease as a prediction parameter.&#xD;
&#xD;
Linear Regression&#xD;
&#xD;
Regression analysis is a method of numerical prediction in which the model builds a relationship between the predictor (independent) and response (dependent) variable. One such method is linear regression whose predictor variable(y) is connected to response variables(x) as follows.&#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; Y=W0+W1X&#xD;
&#xD;
PSEUDOCODE&#xD;
&#xD;
Step 1: &#xD;
&#xD;
Assign values for variable Ai and Bi. &#xD;
&#xD;
Step 2: &#xD;
&#xD;
The average is calculated for the variable Ai as a= (A1 +A2 +&#x2026;&#x2026;..+ Ai)/ Ai &#xD;
&#xD;
Step 3: &#xD;
&#xD;
Find the average for the variable Bi such that b= (B1 +B2 +&#x2026;&#x2026;..+ Bi )/ Bi &#xD;
&#xD;
Step4: &#xD;
&#xD;
Regression coefficient &#x3B2; is calculated by substituting Ai, Bi values and the average of Ai &amp;Bi in equation 2 &#xD;
&#xD;
Step 5: &#xD;
&#xD;
Find the regression coefficients value &#x3B1; by substituting the values of &#x3B2; as per in step 4 and also find out the average values for Ai and Bi. &#xD;
&#xD;
Step 6: &#xD;
&#xD;
The value of regression coefficients &#x3B1; and &#x3B2; is calculated using the equation B= &#x3B1; + &#x3B2;A.&#xD;
&#xD;
&#xA0;Decision Stump&#xD;
&#xD;
&#xA0;It is a decision tree that splits the root at one level leading to leaf nodes. The tree splitting is based on a specific attribute/ value pair.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
PSEUDOCODE&#xD;
&#xD;
1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Analyze the best attribute and consider it as a root of the tree.&#xD;
&#xD;
2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Divide the training set into subsets.&#xD;
&#xD;
3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Do step 1 and 2 on every subset until getting the leaf node in all branches.&#xD;
&#xD;
Naive Bayes Classifier&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A Bayesian classifier is a learning agent which builds a probabilistically model based on observed variables. Using the model, classification of latent variable which is probabilistically related to the observed variable is done. Thus the classification results in inference. The easiest case is the Na&#xEF;ve Bayesian classifier which works in a supervised manner. The classifier objective is to predict accurately an incoming test instance using the class label of the training instance. The bayesian equation is given as&#xD;
&#xD;
P(H|X)=P(X|H)P(H)&#xD;
&#xD;
--------------&#xD;
&#xD;
P(X)&#xD;
&#xD;
Where H is the prediction of an event whose results is based on certain confirmed instances (X).&#xD;
&#xD;
PSEUDOCODE&#xD;
&#xD;
Input:&#xD;
&#xD;
Consider T as Training data&#xD;
&#xD;
Predictor variable in testing dataset is considered as A = (a1, a2, a3&#x2026;. an)&#xA0; &#xD;
&#xD;
Output:&#xD;
&#xD;
Set of testing data;&#xD;
&#xD;
Steps:&#xD;
&#xD;
1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Get the training dataset TD;&#xD;
&#xD;
2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mean and standard deviation for the predictor variables is calculated;&#xD;
&#xD;
3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The process is executed again &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; a)&#xA0;&#xA0; Find out the probability of ai using the gauss density equation in every class;&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; b)&#xA0;&#xA0; Until the probability of all predictor variables (a1, a2, a3&#x2026;an) has been calculated.&#xD;
&#xD;
4.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The likelihood for every class is calculated;&#xD;
&#xD;
5.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Identify the highest likelihood;&#xD;
&#xD;
EXPERIMENTAL SETUP&#xD;
&#xD;
WEKA Tool&#xD;
&#xD;
&#xA0; In this paper, the WEKA tool is used to analyze the prescribed attributes. WEKA is assembled with a lot of machine learning algorithms. The same algorithms can be applied openly to the Testing and Training data. WEKA tool encompasses Classification, Clustering, Association, Regression and visualization. The prediction can be calculated in the form of accuracy, precision, sensitivity and specificity as mentioned as following.&#xA0; &#xD;
&#xD;
a.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Accuracy = (TP+TN)/ (TP+TN+FP+FN)&#xD;
&#xD;
b.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Precision = TP / (TP + FP)&#xD;
&#xD;
c.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sensitivity = TP / (TP + FN)&#xD;
&#xD;
d.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Specificity = TN / (FP + TN)&#xD;
&#xD;
Where&#xD;
&#xD;
&#xD;
	&#xD;
	TP (True Positive): Represents the number of records categorized as true while they were really true. &#xD;
	&#xD;
	&#xD;
	FN (False Negative): Represents the number of records categorized as false while they were true.&#xD;
	&#xD;
	&#xD;
	FP (False Positive): Represents the number of records categorized as true while they were false.&#xD;
	&#xD;
	&#xD;
	TN (True Negative): Represents the number of records categorized as false while they were false.&#xD;
	&#xD;
&#xD;
&#xD;
The determined outputs are presented as a confusion matrix and the flow of system architecture is depicted in Figure 1.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
Performance of Linear Regression Algorithms &#xD;
&#xD;
The results obtained using regression analysis in the employed tool is given in Table 1. The classifier outlined the diagnostic equation with nine attributes as against the fourteen mined attributes whose regression expression is of the form &#xD;
&#xD;
Diagnosis of heart disease = 0.1804 * Sex + 0.2006 * Chest Pain Type +0.0984 * resting electrocardiographic results -0.0041 * maximum heart rate achieved +&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 0.259 * exercise induced angina +&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 0.2006 * ST depression induced by exercise relative to rest +&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 0.1583 * the slope of the peak exercise ST segment +0.4084 * number of major vessels impairment + 0.1394 * defect -0.78.&#xD;
&#xD;
The tenfold cross-validation expression has an RMSE (Root Mean Square Error) value of 0.8643. The value however seems to be arguable. On applying a said tuple of the trained dataset (Table 2) we obtained the result as 0.0564 as depicted below (Table 4 and 5).&#xD;
&#xD;
Diagnosis of heart disease = 0.1804&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 1&#xA0;&#xA0; +&#xA0;&#xA0; 0.2006&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 1&#xA0;&#xA0; +&#xA0;&#xA0; 0.0984&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 2&#xA0;&#xA0; -&#xA0;&#xA0; 0.0041&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 150&#xA0;&#xA0; +&#xA0;&#xA0; 0.259&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 0&#xA0;&#xA0; +&#xA0;&#xA0; 0.2006&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 2.3&#xA0;&#xA0; +&#xA0;&#xA0; 0.1583&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 3&#xA0;&#xA0; +&#xA0;&#xA0; 0.4084&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 0&#xA0;&#xA0; +&#xA0;&#xA0; 0.1394&#xA0;&#xA0; &#xD7;&#xA0;&#xA0; 6&#xA0;&#xA0; -&#xA0;&#xA0; 0.78 = 0.0564.&#xD;
&#xD;
The obtained results do not correlate exactly with the given data set whose assigned value in the tuple is 0.&#xA0; The mined data has a correlation coefficient of 0.7111 which signifies to proceed for another classifier (Table 2).&#xD;
&#xD;
Mined Results of Decision Stump Algorithm&#xD;
&#xD;
Decision Stump is a machine learning algorithms in which the root node is directly connected with the terminal nodes. It provides a one-level decision tree based on a single input feature. In the present study mining using the Decision stump on the given dataset was done for diagnosis of heart disease and computed results are shown in Table 3. Based on the attributes, the classifier correctly classifies 219 instances out of 303 tuples which equates to 72% of validity. The area under ROC (Receiver operating characteristics) curve was found to be 0.907 which makes the prediction acceptable. The RMSE value calculated was 0.2544 which means that the square root of the variance of the residuals was lower and the suggested model provides a better response. Based on the confusion matrix the selectivity and sensitivity were calculated (Table 3). &#xD;
&#xD;
The output of the Naive Bayes Algorithm&#xD;
&#xD;
Bayes is a highly flexible and robust classifier whose predicting ability is more attentive than explanatory ability 11 and computed results from the employed tool are depicted in Table 4.&#xA0; The model exhibits 0.998 under the ROC curve, which signifies that the probability of a randomly chosen positive instance will be 0.998 more highly than a randomly chosen negative instance. The classifier provides a sensitivity of 98.35%, such that 298 patients are correctly predicted as heart patients in the given data set of 303 instances (Table 4).&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The present study was aimed to predict the heart patients by Linear Regression, Decision stump and Naive Bayes in Cleveland data set obtained from UCI machine learning repository. The study concluded that the Naive Bayes classifier optimizes the data set with an accuracy level of 98.35% as compared to the Decision Stump of 72.28% and Linear Regression of 71.11% (Table 4). The data sets can be further employed in hybrid models by combining classifier whose output may be better than the currently predicted. The statistical parameters obtained using the techniques Decision Stump and Naive Bayes are presented in Table 5. The measured accuracy level by employing the confusion matrix of Decision Stump and Naive Bayes algorithms are shown in Table 6.&#xA0; Figure 2 depicts the various accuracy levels of the studied algorithms.&#xD;
&#xD;
FUTURE SCOPE &#xD;
&#xD;
For future work, the real patient&#x2019;s data will be taken and a large volume of data is also taken into the account. The hybrid model of data mining techniques will be effectively utilized to detect the accurate prediction of heart diseases.&#xD;
&#xD;
ACKNOWLEDGEMENTS&#xD;
&#xD;
This research work was carried out with the financial support of the RUSA-Phase 2.0 grant sanctioned vide Letter No. F24-51 / 2014-U, Policy (TNMulti-Gen) Dept. of Edn. Govt of India, Dt.09.10.2018 &#xA0;at Alagappa University, Karaikudi, Tamilnadu, India.&#xD;
&#xD;
CONFLICT OF INTEREST &#xD;
&#xD;
There are no relevant financial or non-financial competing interests to report.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3527</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3527</Fulltext></URLs><References>&#xD;
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	Tan P, Steinbach, M, Kumar, V. Introduction to Data Mining. Kindle Edition, Pearson India Education Services Pvt. Ltd, 2006.&#xD;
	&#xD;
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	Hussain S, Dahan NA, Alwi F. Ribata N. &#xA0;Educational Data Mining and Analysis of Students&amp;#39; Academic Performance Using WEKA. Indo J Elec Engg Comp Sci 2018;9:447-459.&#xD;
	&#xD;
	&#xD;
	Mukherjee S,&#xA0; Kapoor S, Banerjee P.&#xA0; Diagnosis and Identification of Risk Factors for Heart Disease Patients Using Generalized Additive Model and Data Mining Techniques. J Cardiovasc Dis Res 2017;8:137-144.&#xD;
	&#xD;
	&#xD;
	Saminathan K. Prediction of Type 1 Diabetes Mellitus using Data mining Techniques. Inter. J Engg Adv Tech 2019; 9(1):884-887.&#xD;
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	Rajalakshmi K, Nirmala K. Heart Disease Prediction with Map Reduce by using Weighted Association Classifier and K-Means. Ind J Sci Tech 2016;9(1):231-237.&#xD;
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	Jagtap SB, Kodge BG. Census Data Mining and Data Analysis using WEKA. Int Con Emerg Trends Sci Tech Manag 2013;4:35&#x2013;40. &#xD;
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	Thomas, J, Theresa Princy, R. Human Heart Disease Prediction System using Data Mining Techniques, International Conference on Circuit, Power and Computing Technologies, Nagercoil, India. 2016.&#xD;
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	Patil SB,&#xA0; Kumaraswamy YS. Extraction of Significant Patterns from Heart Disease Warehouses for Heart Attack. Inter. J Comp Sci Netw Secur 2009;9(2):228-235.&#xD;
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	Chadva PP, Pithadia YM, Bhavsar HH, Kotecha R. Early detection of cardiac disease using machine learning, 2nd International Conference on Advances in Science &amp; Technology, Mumbai, India. 2019.&#xD;
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	Tuli S, Basumatary N, Gill SS,&#xA0; Kahani M, Arya RC, Wander GS, Buyya, R. HealthFog: An Ensemble Deep Learning-based Smart Healthcare System for automatic Diagnosis of Heart Diseases in Integrated IoT and Fog Computing Environments. Future Gener Comp Sys 2020; 104:187-200.&#xD;
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	Prabhu P, Selvabharathi S.&#xA0; Deep Belief Neural Network Model for Prediction of Diabetes Mellitus. 3rd International Conference on Imaging, Signal Processing and Communication. &#xA0;2019:138&#x2013;142.&#xD;
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	Prabhu P, Anbazhagan N. A Neural Network Based Collaborative Filtering Model. Int J Sci Tech Mgmt 2015; 4 (1); 164-175.&#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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Upper Airway and its Association with Neck Circumference and Hyoid Position in OSA Subjects -&#xA0;A Cephalometric Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>167</FirstPage><LastPage>171</LastPage><AuthorList><Author>Parvathy Ghosh</Author><AuthorLanguage>English</AuthorLanguage><Author> N. K. Sapna Varma</Author><AuthorLanguage>English</AuthorLanguage><Author> V. V. Ajith</Author><AuthorLanguage>English</AuthorLanguage><Author> Anand Suresh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Airway space, Apnea hypopnea index, Body mass index, Cephalometry, Neck circumference, Obstructive sleep apnea</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Obstructive sleep apnea (OSA) occurs as a result of intermittent reduction or complete pause in breathing due to constriction of upper airway during sleep leading to excessive daytime sleepiness (ESS).1 It is often associated with obesity, hypertension, type II diabetes mellitus, cardiovascular diseases resulting in reduced quality of life and increased risk for road traffic and workstation accidents.2,3 Both anatomical and functional abnormalities of the upper airway contributes to compromised airway space and thus increases upper airway collapsibility during sleep. Although changes in ventilatory and neuromuscular control mechanisms can result in the reduced airway patency, anatomical factors play an essential role in the development of OSA.4 &#xD;
&#xD;
Polysomnography (PSG) is regarded as the gold standard in diagnosing OSA,5 but it does not explain the structural flaws in an individual. Upper airway imaging techniques like Computed tomography, Magnetic resonance imaging, lateral cephalograms have provided significant insights regarding the pathogenesis of OSA. Lateral cephalometric radiographs which is more economical method can be used as a primary screening tool for studying the upper airway obstruction, tongue and hyoid positioning caused by skeletal and soft tissue abnormalities.6&#xD;
&#xD;
Obesity is regarded as one of the major risk factor for the occurrence and progression of OSA and a number of parameters such as altered body mass index (BMI), neck as well as waist circumference, and waist to hip ratio (WHR) are all considered as risk factors for OSA7.Neck circumference (NC) is a strong predictor of OSA,8 and the differences in the severity of OSA explained by central obesity also depends on the variation in the NC. Obesity and craniofacial abnormalities have shown to account for more than two-thirds of the variations in the Apnea-Hypopnea (AHI) score.9&#xA0; In the majority of the diagnosed patients, the association with anatomic factors together with other symptoms are the main contributing factors for the development of OSA. Although Neck circumference and hyoid bone position are known to be related to the severity of OSA, the correlation between this pharyngeal collapsibility and anatomical variables is less studied. Thus this study aimed to establish any correlation between neck circumference and hyoid position on upper airway collapsibility among OSA patients.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Records of 40 PSG diagnosed OSA patients (males=30 &amp; females=10) aged above 20 years satisfying the inclusion criteria were selected from the Department of Orthodontics, Amrita School of Dentistry, Kochi, Kerala. The study protocol was evaluated and accepted by the institutional review board (IRB-AIMS-2020-113) at Amrita Institute of Medical Sciences, Kochi, Kerala. All the included subjects had undergone Overnight PSG using a home sleep test using Philips Respironics AliceNight machine. An experienced laboratory technician recorded the sleep data according to the standard criteria. Apnea and hypopnea were described according to the Chicago criteria as proposed by the American Academy of Sleep Medicine.6 Inclusion criteria were patients with AHI &gt;15 indicating moderate to severe OSA (Apnea-Hypopnea Index, AHI) and exclusion criteria were those with severe periodontal disease, edentulous arch, pathologic airway obstruction, TMJ disorders.&#xD;
&#xD;
Neck circumference (cm) were measured for all subjects at the level of cricothyroid membrane (Figure 1).7 In obesity, NC will be &gt;34cm for females and &gt;37cm for males. Lateral cephalograms were recorded at the natural head position with voluntary relaxed lip position and with teeth in maximum intercuspation. All radiographs were recorded with the same machine, Cranes D X-ray digital unit, version 3 (Soredex Co., Tuusula, Finland) and hand traced on matte acetate by one investigator to eliminate any inter-examiner variability The airway was analysed as described by Battagel et al.10 Upper airway and hyoid position variables shown in Figure 2. &#xD;
&#xD;
Superior pharyngeal airway space (SPAS) - measured from the point midway between posterior nasal spine to tip of the soft palate (PNS-P) parallel to the line that intersects the gonion and B point and it represents the distance between the dorsal surface of the soft palate and the posterior pharyngeal wall. &#xD;
&#xD;
Middle pharyngeal airway space (MPAS)- measured through the posterior tip of the soft palate (P), parallel to the line that intersects B point and gonion and it represents the distance between the dorsal surface of the base of the tongue and the posterior pharyngeal wall. &#xD;
&#xD;
Inferior pharyngeal airway space (IPAS) - measured on the line that intersects gonion and B point and represents the distance between the dorsal surface of the base of the tongue and the posterior pharyngeal wall. &#xD;
&#xD;
Length of the soft palate (P-PNS) - measured by the length of the line that connects the tip of the soft palate with the posterior nasal spine.&#xD;
&#xD;
&#xD;
	&#xD;
	H-C3- Distance of hyoid to C3 vertebrae&#xD;
	&#xD;
	&#xD;
	H- MP- Distance of hyoid perpendicular to mandibular plane&#xD;
	&#xD;
&#xD;
&#xD;
Statistical analysis &#xD;
&#xD;
This was performed using IBM SPSS 20 (SPSS Inc, Chicago, USA). To determine the relationship between neck circumference and hyoid position variables Pearson correlation&#xA0;coefficient test was used.&#xA0; p-value &lt; 0.05 was considered statistically significant. Ethical Clearance Number: IRB-AIMS-2020-113.&#xD;
&#xD;
&#xD;
&#xD;
RESULTS&#xD;
&#xD;
40 PSG diagnosed OSA patients were included in the study.&#xD;
&#xD;
Correlation between neck circumference with upper airway and hyoid variables. Neck circumference shows a negative moderate degree of correlation correlated with superior airway space (r= -0.62), middle airway space (r= -0.69), inferior airway space (r= -0.63) and was statistically highly significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3528</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3528</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Mucocele on Lower Lip: A Case Report&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>172</FirstPage><LastPage>174</LastPage><AuthorList><Author>Mayura Mahajan</Author><AuthorLanguage>English</AuthorLanguage><Author> Abhishek Jadhav</Author><AuthorLanguage>English</AuthorLanguage><Author> Pooja Kamath</Author><AuthorLanguage>English</AuthorLanguage><Author> Priyadharshini T K</Author><AuthorLanguage>English</AuthorLanguage><Author> Aditi Vaidhya</Author><AuthorLanguage>English</AuthorLanguage><Author> Rutuja Gajanan Vidhale</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: The mechanical trauma to the Salivary Glands&#x2019;(SG) excretory duct causes the most prevalent benign lesion of minor glands named the oral mucocele. The most vital cause for the lesions was the trauma or lip-biting habit that occurs most commonly in the Lower Lip (LL). Mucous extravasation development and mucous retention type were the 2 varieties. The most prevalent one is the extravasation type. Case Report: Here, a case study of a 32-year-old male patient with a painless bulge on the LL&#x2019;s right aspect for the past two weeks, together with a lip-biting history for a 1-month duration was reported. Conclusion: In any population, Mucocele can be generated. Therefore, if possible, they should be accurately treated and prohibited.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mucocele, Lower lip, Mucous salivary glands, Mucous extravasation cyst, Vital cause, Painless bulge</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4665</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4665</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Anxiety and Stress Induced Xerostomia and It&#x2019;s Management: A Case Report&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>175</FirstPage><LastPage>177</LastPage><AuthorList><Author>Poonam Rai</Author><AuthorLanguage>English</AuthorLanguage><Author> Yashashree Chande</Author><AuthorLanguage>English</AuthorLanguage><Author> Mancy Modi</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhargavi Sheth</Author><AuthorLanguage>English</AuthorLanguage><Author> Devanshi Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Shamit Thaper</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: A 26-year-old man complained of dry mouth, difficulty in speech, chewing and intake of food. An in-detail medical history and physical examination revealed that due to his financial constraints at home, the patient is under constant stress, which may have caused this condition. Moreover, a tendency of snoring while sleeping which is probably stress related, may be contributing to his uncomfortable state. Aims: The aim of this report is to probe into the knowledge on management and treatment of patients affected by xerostomia. Case Report: A 26 years old man reported to the out-patient Department of Periodontology and reported with a chief complaint of a dry mouth, with difficulty in speech, swallowing and intake of food. The above symptoms were noticed starting 2 years back, when his family started facing financial constraints, due to which the patient felt constantly pressured and stressed. Discussion: Lot of patients experience difficulty while eating food that is of dry or hard consistency, they are left with no other option but to switch to a soft-consistency diet. Conclusion: Xerostomia when neglected can adversely impact the Oral-Health-Related Quality of Life (OHRQoL) of a patient.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Xerostomia, Salivary flow, Among elderly, Quality of Life, Complexity, Periodontology</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4666</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4666</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>6</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>March</Month><Day>20</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Comparative Analysis of the Properties of Temporary Cement &#x2013; An In Vitro Study&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>178</FirstPage><LastPage>182</LastPage><AuthorList><Author>Priyanka Panikkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Lalitagauri Mandke</Author><AuthorLanguage>English</AuthorLanguage><Author> Radhika Navare Kulkarni</Author><AuthorLanguage>English</AuthorLanguage><Author> Mansi Vandekar</Author><AuthorLanguage>English</AuthorLanguage><Author> Preethi Durairaj</Author><AuthorLanguage>English</AuthorLanguage><Author> Hitesh Pawar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: Microbial eradication from the pulpal spaces plays a pivotal role in the success of endodontic treatment. The intricate internal tooth anatomy challenges the clinician at every instance - be it the cleaning, shaping, or complete restoration of the root canal system. Aim: To assess and compare sealing ability, water sorption and solubility of temporary restorative materials. Material and Method: Thirty extracted premolars were endodontically treated and restored with temporary restorations, 10 teeth in each group. The groups were - Cavit G, Zinconol, Coltosol F. Teeth were thermocycled and sectioned. Microleakage was tested with Methylene blue dye under stereomicroscope. For solubility and sorption analysis, disc-shaped specimens (10 each) were prepared and restored with temporary cements and divided into three groups, depending on the cement used. Specimens were stored in desiccator; dry mass (m1) was obtained. After storing in distilled water, mass after saturation (m2) and thereafter constant dry mass was obtained (m3). Water sorption and solubility was determined by prescribed formulas. Kruskal Wallis and Dunn&#x2019;s Post-hoc test were used for microleakage. For water sorption and solubility Kolmogorov-Smirnov normality test, ANOVA and Tukey&#x2019;s post hoc test were used. Result: Coltosol exhibited least microleakage followed by Cavit and Zinconol. Cavit exhibited maximum sorption and solubility, followed by Coltosol and Zinconol. Conclusion: Coltosol exhibited the least amount of microleakage compared to Cavit and Zinconol. It also demonstrated intermediate level of sorption and solubility. Hence it can be recommended for use as a temporary restorative material during endodontic treatment.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Laboratory research, Sealing ability, Solubility, Water sorption, Temporary cement, Restoration</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4667</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4667</Fulltext></URLs><References>&#xD;
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