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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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Smart Medical Self-diagnostic Tools&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>03</LastPage><AuthorList><Author>Aparna Beena Unni</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3644</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3644</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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle></ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>04</FirstPage><LastPage>04</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=3645</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3645</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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>05</FirstPage><LastPage>09</LastPage><AuthorList><Author>Mardhiah Kamaruddin</Author><AuthorLanguage>English</AuthorLanguage><Author> Siti-Azrin Ab Hamid</Author><AuthorLanguage>English</AuthorLanguage><Author> Fauziah Jummaat</Author><AuthorLanguage>English</AuthorLanguage><Author>  Azreen Syazril Adnan</Author><AuthorLanguage>English</AuthorLanguage><Author>Bachok Norsa'adah</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Hypertension complication during the pregnancy will lead to morbidity and fatality in pregnancy. Objective: The study was done to identify the differences of calculated creatinine clearance level between two groups of pregnant patients which were gestational and chronic hypertension patients from pregnancy to the postpartum period. Methods: A prospective cohort study was done from September 2015 to April 2016 on the Obstetrics &amp; Gynaecology Clinic of Hospital USM patients. A total of 10 pregnant mothers from gestational hypertension patients and 10 pregnant mothers from chronic hypertension patients who signed the consent form were included in the study. The patient&#x2019;s medical records were re-viewed. Patients with proteinuria &gt; 300mmHg, preeclampsia or eclampsia, on Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and those who have present or history of diabetes, renal disease, liver disease, systemic lupus erythematosus, hepatitis, hyperaldosteronism, renal artery stenosis or thyrotoxicosis were excluded from the study. Blood for renal function test was collected at three phases. The collection was at the last trimester of pregnancy followed by six weeks and 12 weeks after labour. Repeated measure ANOVA was used to analyze the pattern of the calculated creatinine clearance between the groups from pregnancy to postpartum. Results: The pattern of calculated creatinine clearance is the difference between groups. In the gestational hypertension group, the calculated creatinine clearance was an increase from 6 weeks postpartum to 12 weeks. The pattern of calculated creatinine clearance still declined in the chronic hypertension group after 6 weeks postpartum. Conclusion: The women with previous hypertensive disorders during pregnancy should have a regular checkup especially on checking renal function test as it is one of the major causes of unintended of having renal disease.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Creatinine clearance, Chronic hypertension, Gestational hypertension, Pregnancy, Postpartum</Keywords><Fulltext>Introduction&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Globally, hypertension existing in all pregnancies by up to 10%. This complication during the pregnancy will lead to morbidity and fatality in pregnancy.1 The disease has been growing among inpatients who delivered at the hospital.1 The occurrence of hypertensive disorders during pregnancy in the United States is 5 to 10% that shown the second-highest leading cause of mortality in maternal death.2 Based on the study in Kuala Lumpur, 7.14% maternal death was reported because of preeclampsia and 4.41% patients had gestational hypertension during pregnancy.3&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Human renal function will change due to the hormonal changes in pregnancy. The increase of creatinine clearance during pregnancy because of the increase of ultrafiltration volume and reduced average colloid osmotic gravity.4 The size of the pregnant women will rise to 1 cm and the most notable modifications that can be found are in the urinary area.5 The renal hemodynamic will changed and it can be noticed during the completion of the first trimester when both creatinine clearance and renal plasma flow increase by 50%.5 The renal plasma flow decline starting from week 12 till week 38 while GFR will stabilize around 4 to 6 weeks after delivery.6 The discrepancy in GFR value happens when serum creatinine level decreases during pregnancy. In pregnancy, the average of serum creatinine falls to a pregnancy range of 0.4-0.8 mg/dl.7 It was found that the creatinine clearance was 40% higher compared with non-pregnant women.4 Then, the value of creatinine clearance returns to normal around a month after delivery.4 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Prakash et al. (2006) reported 25% of chronic hypertension pregnant women had a normal renal function.8 Of all the reported patients with chronic hypertension, 9.72% had a higher serum creatinine concentration which is more than 3 mg/dl with a not serious renal failure. The majority had mild renal failure while four patients had a serious renal failure that depends on the haemodialysis. The risk causes that contribute to the exposure of getting renal problem among chronic hypertension patient was gout, the users of the diuretic agent, obesity and older age.9 The hazard ratio of getting chronic kidney disease (CKD) and end-stage renal failure (ESRD) in hypertensive disorders women was 9.3 compared to healthy women.10&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Another study reported the effect of increased systolic blood pressure (SBP) towards the probabilities of a fast decrease of renal function.11,12 Hanratty et al. (2011) reported there was an association between high blood pressure and CKD.13 Increased level of SBP that more than 120 mmHg will increase the risk of developing CKD.13 The collaboration of a multidisciplinary team between obstetricians and nephrologists is crucial to monitor the blood pressure in women with renal injury so that it can keep the kidney from other worsening condition.14 The objective of the study was to determine the changes of calculated creatinine clearance from the third trimester to 12 weeks after delivery in gestational and chronic hypertension women.&#xD;
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Materials and Methods&#xD;
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Study Participants and Categories&#xD;
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A prospective cohort study was conducted on women who were diagnosed with gestational and chronic hypertension and had to follow up treatment at Obstetrics and Gynaecology (O&amp;G) Clinics of Hospital Universiti Sains Malaysia (USM) during the antenatal and postpartum period from December 2015 to February 2016. The patients were excluded if had proteinuria &gt; 300mmHg,&#xA0; preeclampsia or eclampsia, on Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and had a history of diabetes, renal disease, liver disease, systemic lupus erythematosus, hepatitis, hyperaldosteronism, renal artery stenosis or thyrotoxicosis. The study protocol was approved by a hospital university where the research was conducted. A written consent form was given to each patient before joining the research as an agreement towards the study protocol. &#xD;
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Hypertension was defined as SBP over 140 mm Hg and/or DBP over 90 mm Hg during pregnancy.8 chronic hypertension was defined as hypertension that diagnosed before the pregnancy or before the 20 weeks of pregnancy 18 and gestational hypertension was defined as hypertension that never diagnosed before the pregnancy and was diagnosed after 20 weeks of pregnancy. &#xD;
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Clinical data and sample collection and measurement&#xD;
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A study proforma was used to collect information from the medical record on maternal parameters and foetal parameters. Maternal parameters include age, weight, height, gestational age at delivery, body mass index (BMI), gravida and parity, type of hypertension, creatinine clearance and blood pressures. Foetal parameters include gender, birth weight, Apgar score, complication and method of delivery.&#xA0; Blood samples for the renal function test were collected at the third trimester,&#xA0; six weeks after delivery and 12 weeks after delivery.&#xA0; The Modification of Diet in Renal Disease (MDRD) formula was used to calculate the creatinine clearance level. The serum creatinine results from the renal function tests were obtained to generate the creatinine clearance. The blood taken was done by the nurse at O&amp;G Clinic. The blood was submitted to the chemical pathology laboratory. The result of the blood tests was obtained from the electronic record. &#xD;
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Statistical analysis &#xD;
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Univariable analyses were performed to compare the baseline characteristics and foetal parameter between gestational and chronic hypertension patients. Mann Whitney was applied to determine the difference of means between groups for variables: age, gestational ages at delivery, birth weight, and BMI. The level of significance was set as 0.05. Repeated Measure ANOVA was used to see the differences of creatinine clearance from the last trimester of pregnancy to 2 months postpartum for both groups. Statistical Package for Social Sciences version 24.0 (IBM Corporation, 2013) was used to perform data entry and data analyses.&#xD;
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Results&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; The maternal characteristics between chronic hypertension and gestational hypertension were not statistically significant except for the history of previous miscarriage (Table 1). &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; There was a declination of creatinine clearance in chronic hypertension participants from the last trimester of pregnancy to 2 months postpartum compared to gestational hypertension participants (Figure 1). The total mean difference from the third trimester to 12 weeks postpartum in chronic hypertension participants was 28.85 ml/min while for gestational hypertension participants were 23.66 ml/min. The calculated creatinine clearance still declined in chronic hypertension participants at 12 weeks postpartum by 1.83 ml/min, but it showed the increment of calculated creatinine clearance in gestational hypertension participants by 2.33 ml/min (Table 2).&#xD;
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Discussion&#xD;
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Maternal and foetal characteristics based on the type of hypertension&#xD;
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There was no significant difference in maternal parameters between groups except for a previous history of miscarriage. The findings were similar to a study conducted in Chicago where there was no difference in maternal characteristics between gestational hypertension and chronic hypertension.15 A cohort study of 33 856 singleton pregnancy reported that those with chronic hypertension had a higher risk of miscarriage by 2.89 odds compared to those without chronic hypertension.16 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; The previous study proposed that there was a relationship between small birth weight and the number of previous miscarriage(s).17 In the current study, the mean birth weight for chronic hypertension was 2.59 kg and 2.88 kg for gestational hypertension. The lower birth weight in chronic hypertension participants might reflect the significant history of miscarriage. Another study reported that women aged 35-39 years old increase the chance of getting miscarriage by 2.4 compared to women aged less than 35 years old.18 The current study showed that participants in chronic hypertension were older compared to gestational hypertension. So, age might be one of the factors that affect the previous miscarriage in chronic hypertension for the current study.&#xD;
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The trend of creatinine clearance level in the last trimester of pregnancy to postpartum&#xD;
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The level of calculated creatinine clearance declined from the third trimester to six weeks after delivery in gestational hypertension patients. The mean difference between these two measurements was 25.99 ml/min. But, there was only a slight increase of calculated creatinine clearance level from six weeks postpartum to 12 weeks postpartum with 2.33 ml/min. The mean level of calculated creatinine clearance in gestational hypertension participants declined from the third trimester to 12 weeks after delivery with 98.86 ml/min to 75.73 ml/min respectively. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; There was a declination of calculated creatinine clearance from the third trimester to six weeks postpartum for both groups. It was recognised that the size of kidneys increases up to 30% during pregnancy because of vascular and interstitial spaces changes.6 Renal function changes starting before conception in reaction to hormonal deviations during the menstrual cycle.4 The increase of GFR can be noted at four and nine weeks gestation by 20% and 45% respectively.4 The physiologic adaptation that mostly can be seen in normal pregnancy is glomerular hyperfiltration. It will reduce the serum creatinine, so that increase the GFR level in pregnancy.6 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Yelumalai et al. reported that the serum creatinine in normal pregnancy and six weeks postpartum was 50.5 &#xB5;mol/L and 59.4 &#xB5;mol/L&#xA0; respectively.19 GFR remains increase throughout pregnancy and then normalise at six to eight week of postpartum.6 Three studies reported the decline of creatinine clearance from pregnancy to postpartum and its restoration to normal level in the postpartum period.20 The study proposed that the level of creatinine clearance among gestational and chronic hypertension was rising throughout pregnancy.14,21&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; As for chronic hypertension women, the blood pressure declined until 12 weeks postpartum that one of the reasons associated with the decline of the calculated creatinine clearance. Many studies showed a direct relationship between renal function progression and blood pressure.22,23 It can be concluded that the severity of increase in levels of diastolic blood pressure was connected to the reduction in final creatinine clearance. Participants with chronic hypertension also received antihypertensive treatment during postpartum that may cause the reduction of calculated creatinine clearance after three months of delivery. It was also proven that the antihypertensive agent would increase the risk of increasing the serum creatinine by 1.26 odds compared to those who did not receive antihypertensive agent.24 &#xD;
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The major limitations of this study was the small sample size due to the time constraint and obstacles. There was a limited number of the patient without underlying diseases who delivered from 1st December 2015 to 31st December 2016. In the beginning, the total number of patients available for the study setting for gestational hypertension and chronic hypertension was approximately 50 patients but due to the development of preeclampsia and superimposed preeclampsia after delivery, they were excluded from the study. There were also many hypertensive disorders at pregnancy who had diabetes and other diseases. From the study population, 20% developed preeclampsia or superimposed preeclampsia at delivery or postpartum and 40% had other diseases. There were no creatinine clearance results for patients after delivery so it was impossible to use another study design rather than a Prospective Cohort Study. &#xD;
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Conclusions&#xD;
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Chronic hypertension had more reduction of calculated creatinine clearance after postpartum compared to gestational hypertension participants. Blood pressure may affect the declination of creatinine clearance level in chronic hypertension participants. The women with previous hypertensive disorders during pregnancy should have a regular checkup especially on checking renal function test as it is one of the major causes of unintended of having a renal disease&#xD;
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Acknowledgement&#xD;
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The publication of the research was supported by Fundamental Research Grant Scheme (FRGS) under Malaysia&#x2019;s Ministry of Higher Education (Grant number: R/FRGS/A0100/01605A/002/2018/00548).&#xD;
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Conflicts of interest: The study had no conflicts of interest.&#xD;
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FJ, AHSA, and ASA were responsible to look at, design the study and arrange for the research materials. MK conducted research, collected data, analysed and interpreted the data. All authors agreed on the final draft, provided logistics support, and involved in each part in finishing the manuscript. &#xD;
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Ethical approval &#xD;
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Approval was obtained from the Human Research Ethics Committee Universiti Sains Malaysia (reference number: USM/JEPem/15080277).&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3646</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3646</Fulltext></URLs><References>1. Duley L. The global impact of pre-eclampsia and eclampsia. Semi Perin 2009;33(3):130-137.&#xD;
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2. Sibai B, G Dekker, M Kupferminc. Pre-eclampsia. Lancet 2005; 365(9461): 785-799.&#xD;
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3. Malhotra S, Yentis SM. Reports on Confidential Enquiries into Maternal Deaths: management strategies based on trends in maternal cardiac deaths over 30 years. Int J Obstet Anesth 2006 Jul;15(3):223-6.&#xD;
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4. Hussein W, Lafayette RA. Renal function in normal and disordered pregnancy. Curr Opin Nephrol Hypert 2014; 23(1):46.&#xD;
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5. Podymow TP. August. Hypertension in pregnancy. Adv Chron Kid Dis 2007;14(2):178-190.&#xD;
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6. Odutayo A, M Hladunewich. Obstetric nephrology: renal hemodynamic and metabolic physiology in normal pregnancy. Clin J Am Soc Nephrol 2012;7(12):2073-2080.&#xD;
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7. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chron Kid Dis 2007; 14(2): 132-145.&#xD;
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8. Prakash J, Pandey LK, Singh AK, Kar B. Hypertension in Pregnancy : Hypertension Based Study. J Assoc Physic India 2006; 54: 273-278.&#xD;
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9. Johnson RJ, Segal MS, Srinivas T, Ejaz A, Mu W, Roncal C, et al. Essential hypertension, progressive renal disease, and uric acid: a pathogenetic link? J Am Soc Nephrol 2005; 16(7): 1909-1919.&#xD;
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10. Wang IK, Muo CH, Chang YC, Liang CC, Chang CT, Lin SY, et al. Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study. Canadian Med Assoc J 2013; 185(3): 207-213.&#xD;
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11. Strevens H. Blood pressure, renal functional and structural changes, in normal and preeclamptic pregnancy. Helena Strevens, Department of Obstetrics and Gynecology, University Hospital, 2002;S-221 85 Lund, Sweden,.&#xD;
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12. Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, et al. Cystatin C and the risk of death and cardiovascular events among elderly persons. New Engl J Med 2005;352(20):2049-2060.&#xD;
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13. Hanratty R, Chonchol M, Havranek, EP, Powers JD, Dickinson LM, Ho PM, et al. Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Clin J Am Soc Nephrol 2011;6(11):2605-2611.&#xD;
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14. Taylor RN, Roberts JM, Gary Cunningham F, Lindheimer MD. Chesley&amp;#39;s Hypertensive Disorders in Pregnancy. Academic Press, Elsevier, 4th Edition, 2014.&#xD;
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15. Cruz MO, W Gao, JU Hibbard. Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension. Am J Obstet Gynecol 2011;205(3):260.e1-260.e9.&#xD;
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16. Akolekar R, Bower S, Flack N, Bilardo CM, Nicolaides KH. Prediction of miscarriage and stillbirth at 11&#x2013;13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 2011;31(1):38-45.&#xD;
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17. Jivraj S, Anstie B, Cheong YC, Fairlie FM, Laird SM, Li TC. Obstetric and neonatal outcome in women with a history of recurrent miscarriage: a cohort study. Human Reprod 2001;16(1):102-106.&#xD;
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18. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol 2005;105(5,Part 1): 983-990.&#xD;
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19. Yelumalai S, Muniandy S, Omar SZ, Qvist R. Pregnancy-induced hypertension and preeclampsia: levels of angiogenic factors in Malaysian women. J Clin Biochem Nutr 2010;47(3):191-197.&#xD;
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20. Roberts JM, FG Cunningham, MD Lindheimer. Chesley&amp;#39;s hypertensive disorders in pregnancy. Academic Press 2009;&#xD;
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21. Baert A, et al. Trends in contrast media. 2012: Springer Science &amp; Business Media. 483.&#xD;
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22. Whelton PK, Perneger TV, He J, Klag MJ. The role of blood pressure as a risk factor for renal disease: a review of the epidemiologic evidence. J Human Hyperten 1996;10(10):683-689.&#xD;
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23. Wright Jr JT, Bakris G, Greene T. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002;288(19): 2421-2431.&#xD;
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24. Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 1989;13(5 Suppl): I80-193&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Detection of Non-Proliferative Diabetic Retinopathy from Digital Fundus Images&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>10</FirstPage><LastPage>15</LastPage><AuthorList><Author>Parashuram Bannigidad</Author><AuthorLanguage>English</AuthorLanguage><Author> Asmita Deshpande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Microaneurysms, Digital fundus images, Optic disc, GLCM features, Decision tree classifier, Diabetic Retinopathy, HOG  features</Keywords><Fulltext>Introduction&#xD;
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Human beings in different age groups are commonly affected by a lifestyle disorder known as Diabetes. It deteriorates the working of numerous organs, particularly the functioning of the human eye and retina. Diabetic patients suffer from several retinal complications such as Diabetic Retinopathy, Glaucoma, Macular Edema and others. Nowadays, Ophthalmologists use a non-mydriatic fundus camera to check the presence of these diseases. The interior portion of the eye can be examined with the help of a fundus camera. It gives a view of the fovea, optic disc, macula, and retina. High levels of blood sugar can damage the retina leading to loss of vision. Microaneurysms are the first signs of Non-Proliferative Diabetic Retinopathy (NPDR). They appear as tiny red dots caused by swellings of the capillaries. They are localized capillary dilatations, which are often present in clusters. A fundus image with Microaneurysms is shown in Figure 1.&#xD;
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Many researchers have worked on fundus images to explore image processing techniques for the detection of Microaneurysms. Quereshi et al.1 have reviewed significant CAD systems developed using digital image processing techniques. They also describe the limitations and future trends of CAD systems to aid the researchers in working with Diabetic Retinopathy. Malay Kishore Dutta et al.2&#xA0; have worked on a region-based approach for the detection and grading of Diabetic Retinopathy. Istvan Lazar and Andras Hajdu3 explored the possibility of detection of Microaneurysms by analyzing directional cross-section profiles centred on the local maximum pixels of the preprocessed image. Sreng et al.4 have used image enhancement techniques and 2D wavelet transformation for the detection of Microaneurysms. Ren et al.5 have applied Top-hat transformation on the green channel to separate the Microaneurysms from the vasculature along with Gaussian filtering. Hipwell et al.6 have extracted candidate Microaneurysms by applying algorithms that highlight small circular features. Rosas-Romero et al.7 implemented normalization of fundus images with its statistical properties and morphological operations for candidate extraction. Khojasteh et al.8 used convolution neural for automated detection of Microaneurysms. &#xA0;Manjaramkar and Kokare9 distinguished between MA and Non-MAs regions by exploring the statistics of geometrical properties in connected regions. Li. et al.1 presented a cross-disease attention network (CANet) for grading Diabetic Retinopathy and macular oedema. They explored image-level supervision to find the relationship between the diseases. They developed an attention module that can select useful features for specific diseases and the further captured relationship between the two diseases using a disease-dependent attention module. Bannigidad and Deshpande17 implemented a multistage approach for exudates detection in fundus images that consolidates morphological operations and thresholding. The objective of this paper is to detect Microaneurysms using morphological operations and thresholding and explore GLCM and HOG features along with various machine learning algorithms.&#xD;
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Materials and Methods&#xD;
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This experiment is implemented using fundus images from STARE11, e-Ophtha12, and DIARETDB113 databases. These databases are free and are made available for research purposes. STARE database consists of 20 digital fundus images and 20 ground truth images, which can be used for evaluating different vessel segmentation algorithms. These images have been captured by a TopCon TRV-50 camera having 700 &#xD7; 605 pixel resolution. e-Ophtha is another database containing fundus images specially established so that research work in Diabetic Retinopathy can be undertaken. It consists of 148 images with Microaneurysms and 233 images having no lesions. Image sizes are in the range of 1440&#xD7;960 pixels to 2544&#xD7;1696 pixels. The DIARETDB1 data set contains a total of 89 fundus images captured with a 50-degree field-of-view. Among them, 84 contain signs of Diabetic Retinopathy and 5 do not contain any Microaneurysms.&#xD;
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Proposed method&#xD;
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Microaneurysms present in a retinal image is detected by a multi-stage approach in the proposed method. The multistage process proceeds by initially performing preprocessing, followed by segmentation, optic disc elimination, and Microaneurysms detection. This is aided by the feature extraction process and classification. The different stages in the proposed method are presented in Figure 2&#xD;
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Preprocessing&#xD;
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Preprocessing is an essential step in fundus images because lesions and exudates have almost the same intensity values as the remaining normal components of the retina. It is essential to highlight smaller details like red dots that indicate Microaneurysms, Yellow regions, indicating exudates and haemorrhages to detect the presence of Diabetic Retinopathy. Most fundus images suffer from illumination differences due to the type of camera used, the field of view used to capture the fundus image, and lighting. Initially, the original fundus images from all databases are resized to a standard size of 576 X 720, followed by the extraction of the green channel. This facilitates the detection of Microaneurysms to a large extent. This image is then converted into grayscale16. The contrast of the grayscale image is enhanced using Contrast Limited Adaptive Histogram Equalization (CLAHE). It transforms the intensity values to higher intensities to increase the contrast.&#xA0; The grayscale image is depicted in Figure 3A and the fundus image after contrast adjustment is shown in Figure 3B. &#xD;
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Canny edge detection14 is further applied to the fundus image to highlight the edges. The circular border of the fundus image is masked and eliminated, as shown in Figure 3C. Next, a binarized image is obtained by setting a threshold value. &#xD;
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Blood Vessel Removal&#xD;
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A network of blood vessels is prominently present in the retina. Identification and elimination of the complete vasculature are essential to accurately identify candidates15 Microaneurysms from the digital fundus images. Morphological operations14are implemented to detect the blood vessel network and eliminate them from the fundus image.&#xD;
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where I(x,y) is the image obtained after preprocessing, and S(x&#x2019;,y&#x2019;) is the structuring element. The image thus obtained is shown in Figure 4.&#xD;
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Segmentation&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Ophthalmologists identify Microaneurysms as tiny dots that are red and have a diameter ranging between 25 to 100 &#xB5;m. Segmenting the candidates correctly is a challenging task due to their tiny size. Segmentation techniques such as circular Hough transform don&#x2019;t work well due to the small size. An important characteristic of the retinal image is that there are disparities in intensity and texture. Thus, a local thresholding based segmentation technique proposed and used in this experiment. Column wise neighbourhood operation is performed on In and the fixed threshold (T) is applied to filter the Microaneurysms.&#xD;
&#xD;
&#xD;
&#xD;
where, T = 0.7. An important task at this stage is to identify and eliminate the optic disc which a&#xA0;natural&#xA0;anatomical&#xA0;circular&#xA0;structure&#xA0;that&#xA0;is&#xA0;present&#xA0;on the retina. Optic Disc identification is a challenging task in the processing of fundus images because the&#xA0;exact&#xA0;location&#xA0;of&#xA0;the&#xA0;optic&#xA0;disk&#xA0;is&#xA0;not&#xA0;known. It may be present at the left, right or centre of the retina. In the segmented image, the largest connected component is computed to locate the optic disc. The equation of a circle is used to compute a circular mask for eliminating the optic disc.&#xD;
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&#xD;
&#xD;
where x, y, mc, mr are mesh grid vectors and medians of a row and column coordinates respectively. The optic disc is eliminated by subtracting the mask(M) from the segmented image as follows:&#xD;
&#xD;
&#xD;
&#xD;
Next, the outer border is eliminated to obtain image Inc and morphological closing operation is applied to detect the Microaneurysms accurately.&#xD;
&#xD;
&#xD;
&#xD;
Further, contrast enhancement is applied using CLAHE so that the affected regions are highlighted. This is followed by an AND operation on ?(Ima) and &#x3C8;(Ima). ?(Ima) complements the image and &#x3C8;(Ima) inverts the fundus image to highlight the microaneurysms. Figure 5 shows the fundus image obtained after the segmentation of Microaneurysms.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The algorithm for the proposed method is described below:&#xD;
&#xD;
&#xD;
&#xD;
This algorithm explores Gray Level Co-occurrence Matrix (GLCM) and Histogram of Oriented Gradients (HOG) features for classification. GLCM is a method to statistically determine the spatial relationship of pixels. It also calculates how often certain specific values occur in the image. HOG is commonly used to detect objects and plays a vital role in computer vision. HOG features are obtained by dividing the image into regions, and for each region, gradients and orientations are computed. The feature descriptor for HOG highlights the structure or shape of an object18. In this experiment, various classifiers such as the Support Vector Machine (SVM) classifier, k-Nearest Neighbour (k-NN) classifier, and Decision tree classifiers have been tested. It was found that the Decision tree classifier yields the best results of classification for the proposed method. Decision tree classification is based on tree representation wherein every leaf node represents a class label, and the internal nodes represent attributes. &#xD;
&#xD;
Experimental Results and Discussions&#xD;
&#xD;
The proposed algorithm was executed on public fundus databases viz, STARE, e-Ophtha, and DIARETDB1 and implemented using MATLAB R2015b. These are freely available databases designed to facilitate research in the detection of retinal disorders. In all, 20 images from the STARE database, 381 images from thee-Ophtha database, and 89 images from DIARETDB1 have been tested in the experiment.&#xA0; Sample digital fundus images from STARE, DIARETDB1 and e-Ophtha are shown in Figure 6a, 6c and 6e and their corresponding segmented images using the proposed method are depicted in Figure 6b, 6d and 6f respectively. &#xD;
&#xD;
&#xD;
&#xD;
The classification of fundus images from STARE, e-Ophtha, and DIARETDB1 databases using GLCM features with various classifiers is shown in Table 1.&#xD;
&#xD;
&#xD;
&#xD;
The classification of fundus images from STARE, e-Ophtha, and DIARETDB1 databases using HOG features with various classifiers is shown in Table 2.&#xD;
&#xD;
&#xD;
&#xD;
The performance of the proposed method is evaluated on the basis various evaluation measures [16] as follows:&#xD;
&#xD;
&#xD;
&#xD;
Accuracy: Classification accuracy relates to the number of correctly identifies images, either healthy or diseased from a given set of images.&#xD;
&#xD;
&#xD;
&#xD;
Recall: The ability of a classifier to find all positive images correctly is known as Recall. The recall is defined as:&#xD;
&#xD;
&#xD;
&#xD;
Precision: In&#xA0;Information retrieval systems precision&#xA0;is the fraction of relevant instances of images classified among the retrieved instances.&#xD;
&#xD;
The comparison of results based on the test parameters using GLCM features on STARE, e-Ophtha, and DIARETDB1 databases are given in Table 3.&#xD;
&#xD;
&#xD;
&#xD;
For the STARE database, the SVM classifier yielded values 0.7 for accuracy, 0.9 for recall, and 0.64 for precision. Similarly, accuracy 0.76, recall 0.58, and precision 0.76 were computed for e-Ophtha database and accuracy 0.94, recall 0.94, and precision 1.0 for DIARETDB1 database. When the proposed method was tested with a k-NN classifier, for the STARE database, the yielded values were 0.9 for accuracy, 0.8 for recall, and 1.0 for precision. Similarly, accuracy 0.76, recall 0.58, and precision 0.76 were computed for the e-Ophtha database and accuracy 0.94, recall 0.94, and precision 1.0 for the DIARETDB1 database. The decision tree classifier for the STARE database yielded values for accuracy 0.85, recall 0.8, and precision 0.88. Similarly, accuracy 0.88, recall 0.93, and precision 0.88 were computed for e-Ophtha database and accuracy 0.97, recall 0.96, and precision 1.0 for DIARETDB1 database. Also, the comparison of results based on the test parameters on the STARE database, e-Ophtha database, and DIARETDB1 database using HOG features are given in Table 4.&#xD;
&#xD;
&#xD;
&#xD;
For the STARE database, the SVM classifier yielded values 0.95 for accuracy, 0.90 for recall, and 1.0 for precision. Similarly, accuracy 0.76, recall 0.87, and precision 0.75 were computed for the thee-Ophtha database and accuracy 0.94, recall 1.0, and precision 0.94 for the DIARETDB1 database. When the proposed method was tested with a k-NN classifier, for the STARE database, the yielded values were 0.75 for accuracy, 0.9 for recall, and 0.69 for precision. Similarly, accuracy 0.66, recall 0.59, and precision 0.80 were computed for e-Ophtha database and accuracy 0.94, recall 1.0, and precision 0.94 for DIARETDB1 database. The decision tree classifier yielded values for accuracy 0.95, recall 0.9, and precision 1.0 for the STARE database. Similarly, accuracy 0.91, recall 0.94 and precision 0.92 were computed for the thee-Ophtha database and accuracy 1.0, recall 0.94 and precision 1.0 for the DIARETDB1 database.&#xD;
&#xD;
The comparative results of the proposed method using HOG features with other methods suggested by various researchers are given in Table 5.&#xD;
&#xD;
&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This paper reports a method based on morphological operations and thresholding for the detection of Microaneurysms in fundus images. The proposed algorithm consolidates morphological operations for the elimination of the vasculature present in the retina, removal of the optic disc and accurate detection of Microaneurysms. The proposed technique extracts HOG features and proposes the use of a decision tree classifier as it yields better results of classification on all the databases tested in this experiment. The Decision tree classifier yielded values for accuracy 0.95, recall 0.9, and precision 1.0 for the STARE database. Similarly, accuracy 0.91, recall 0.94, and precision 0.92 were computed for the e-Ophtha database and accuracy 1.0, recall 0.94, and precision 1.0 for the DIARETDB1 database. The encouraging values reported in this paper based on measures of performance evaluation testify to the efficiency of the proposed method.&#xD;
&#xD;
Acknowledgements: The authors wish to acknowledge developers of STARE, e-Ophtha, and DIARETDB1 databases for facilitating the research fraternity with fundus datasets publicly and freely. The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Source of funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3647</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3647</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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of Cartridge Based Nucleic Acid Amplification Testing (CBNAAT) in Diagnosis of Extrapulmonary Tuberculosis- Experience from a Teaching Institution in Eastern India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>16</FirstPage><LastPage>21</LastPage><AuthorList><Author>S Mukherjee</Author><AuthorLanguage>English</AuthorLanguage><Author> D Biswas</Author><AuthorLanguage>English</AuthorLanguage><Author> S Begum</Author><AuthorLanguage>English</AuthorLanguage><Author> P Ghosh</Author><AuthorLanguage>English</AuthorLanguage><Author> A Pal</Author><AuthorLanguage>English</AuthorLanguage><Author> S Sarkar</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 in 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) (IECNo:CMSDH/IEC/78/04-2017)&#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 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&#xD;
&#xD;
Exclusion criteria&#xD;
&#xD;
Patients with age less than 12 years and patients not giving consent for the study were excluded from the study. &#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 were 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 first-line and second-line baseline drug sensitivity testing (FL-LPA and SL-LPA) to the 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 the abdomen, magnetic resonance imaging (MRI) of brain and spine were done additionally in respective cases of EPTB. Blood was 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 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 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 (mean&#xB1;SD) 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;
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=3648</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3648</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Non-resolving Consolidation by Computerized Tomography (CT) Guided Biopsy: An Etiological and Diagnostic Perspective&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>22</FirstPage><LastPage>25</LastPage><AuthorList><Author>Imran Nazir Salroo</Author><AuthorLanguage>English</AuthorLanguage><Author> Javvid Muzamil</Author><AuthorLanguage>English</AuthorLanguage><Author> Musharaf Bashir</Author><AuthorLanguage>English</AuthorLanguage><Author> Amir Shafi</Author><AuthorLanguage>English</AuthorLanguage><Author> Haseeb Mohammad Khandwaw</Author><AuthorLanguage>English</AuthorLanguage><Author> Abdul Ahad Wani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Percutaneous, Transthoracic, Needle biopsy, Consolidation, CT, Non-resolving</Keywords><Fulltext>Introduction&#xD;
&#xD;
Pulmonary consolidation is a common clinical entity characterized by signs and symptoms of pneumonia and presence of lung infiltrate on plain chest radiograph in which radiological appearance of pneumonia may include lobar consolidation due to typical bacteria, interstitial infiltrates due to atypical organisms, or cavitation.1 Clinical signs and symptoms in presence of infiltrates on plain radiograph is the gold standard for diagnosis of pneumonia whereas microbiological features are supportive.2 ForaRadiologist, it is not possible to reliably differentiate between bacterial and non-bacterial pneumonia based on radiological appearance alone.3 Nevertheless, a chest radiograph (posterior-anterior view and lateral view) is generally adequate for clinical care of most patients with pneumonia.4 However, there is marked and substantial variation (inter-observer) in the interpretation of chest radiograph in patients of possible pneumonia between different radiologists.5 High-resolution computerized tomography (HRCT) is superior to chest radiograph in detecting lesions and defining anatomical changes.6 Consolidation is considered to be persistent when it fails to resolve by 50% in 2 weeks or completely in 4 weeks.7 Persistent consolidation may be due to inadequately treated infection, atypical infections, malignancy, organizing pneumonia, sarcoidosis, tuberculosis or vasculitis.8 Slow or the incomplete resolution of pneumonia despite treatment is a common clinical problem, estimated to be responsible for approximately 15% of inpatients of pulmonary consolidation and 8% of bronchoscopies.7 Approximately 20% of non-resolving pneumonia are due to noninfectious causes.9 This broad difference creates a clinical situation that frequently demands further testing including bronchoscopy and tissue biopsy.&#xD;
&#xD;
While no consensus guidelines exist, bronchoscopy, broncho-alveolar lavage (BAL) and transbronchial tissue biopsy are usually preferred methods for evaluation of non-resolving consolidations.10 Chest CT, particularly HRCT is the primary radiographic tool for assessing treatment failure in non-resolving pneumonia. Bronchoscopy, BAL and transbronchial lung biopsy can be used successfully to diagnose the aetiology in approximately90% of patients with non-resolving consolidations.10 Transbronchial or open lung biopsy is nowadays very well included in the diagnostic algorithm of non-resolving pneumonia. In cases where bronchoscopic evaluation is non-diagnostic, additional tissue sampling is included especially in peripheral lesions.11 Traditionally surgical biopsy was preferred in such cases; however, CT guided biopsy is a promising alternative as it is less invasive and is associated with fever complications.10PTNB is a well-established and safe for diagnosis of pulmonary nodules, masses and non-resolving consolidation.10 Role for obtaining tissue for molecular testing of lung cancer continues to grow.12 To the best of our knowledge few studies are reporting diagnostic accuracy and safety of PTNB in pulmonary consolidation. Therefore, we aimed the study and determine the clinical role, safety and diagnostic accuracy of CT guided PTNB for etiological and diagnostic perspective.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
This double centre retrospective study was conducted from February 2018 to January 2020in SKIMS Medical College, Bemina, Srinagar, J&amp;K, India and Khyber Medical Centre, Srinagar, J&amp;K, India. This study was designed and conducted according to the Standards of Reporting of Diagnostic Accuracy Studies [STARD 2015].13 Complications were categorized following the Society of International Radiology Clinical Practice Guidelines.14Written consent was taken from each patient before taking the biopsy. All biopsies were performed by an experienced Radiologist under CT guidance using a 16 slice-Multi Detector CT scanner (MDCT). Whenever possible the densest part of consolidation was targeted rather than an area of ground glass. Fine needle aspirate obtained was submitted to a histopathologist for interpretation. Microbiology of the aspirate was also done to rule out pneumonia, tuberculosis, fungal infections, vasculitis and malignancy.&#xD;
&#xD;
The sensitivity and specificity of PTNB for infections were calculated. A positive result was considered to be true positive when there was a specific infection or organism detected by PTNB and the patient developed a response after treatment. Those who had a positive PTNB result but were not on therapy had no clinical signs of infection and showed a progressive decline of lesions on follow up CT was taken as false positives. Malignancy, suspected malignancy, nonspecific benign or non-diagnostic lesions were considered to be negative results. True negatives were defined as those who had a clinical diagnosis of non-infectious disease. PTNB result was considered to be falsely negative when there was evidence of infections.&#xD;
&#xD;
To ascertain risk factors for diagnostic failure of PTNB, patients were categorized into two groups. success-group and failure-group. The success group included truly diagnosed cases whereas the failure group included non-diagnostic, nonspecific benign and falsely diagnosed cases.&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
All statistical testing was performed using Stata software (version14, StataCorp LLC, Texas, USA). A P-value of 0.05% or less was considered significant. &#xD;
&#xD;
Results&#xD;
&#xD;
Over 2 years 475 patients were diagnosed as having consolidation. Out of 475 consolidations, only 21 failed to resolve (4.45%). These 21 patients were subjected to PTNB for confirmation of diagnosis [Figure 1]. The majority of patients were males who had a history of smoking 17/21. The mean age of these patients was 64.04 &#xB1; 5.12 years. The male-female ratio was approximately 4:1. The consolidation involved the right lung in 9/21(42.85%), left lung in 12/21(57.15%). only 1/21 patients had a cavitation lesion [Table 1].&#xD;
&#xD;
Out of 21 patients, PTNB accurately established diagnosis in 20/21 (95.23%) patients. Malignancy was detected in 15/21 patients (71.42%). Tuberculosis was found in 2/21 patients (9.52%). Lymphoma was found in 3/21 patients (14.28%). Biopsy was inconclusive in 1/21 (4.76%) patient of non-resolving consolidation. 3/21 (14.28%) patients had metastasis lung with primaries in kidney, uterus and ovary respectively [Figure 2].&#xD;
&#xD;
No death or major complication was resulting from PTNB. There were no complications in15/21 (71.42%) patients. Minor complications occurred in 5/21 (23.8%). Pneumothorax [Figure 3] was seen in 2/21 (9.52%) patients and mild self-limited hemoptysis in 3/21 (14.2%) patients. The chest tube was needed in 2/21 (9.52%) patients with pneumothorax and they were discharged after two days [Figure 4]. All other patients were discharged after 4 hours. The pain was minimal in all patients as none of them required any form of analgesic.&#xD;
&#xD;
Discussion&#xD;
&#xD;
In this study, the diagnostic yield of PTNB in non-resolving consolidation was high 97 %. Diagnostic failure was found in only 1 out of 21 patients whose biopsy came inconclusive. This study did not observe greater diagnostic failure or complications. It was found that CT guided PTNB provided a definite diagnosis in most of the cases, both malignant and infectious. Kirantawat et al.10 found that CT-guided PTNB gave conclusive diagnoses in all cases of consolidation, both in cases of malignancy and infection, with inconclusive bronchoscopic results even if antibiotics had been started before taking a biopsy. In another study by Ozun C et al.15 in which they analyzed 442 patients who underwent CT guided lung biopsy, they found that the diagnostic accuracy, sensitivity and specificity were 97.6%, 97.3%, and 100% respectively. They concluded that CT guided biopsy is a safe and reliable technique with high diagnostic accuracy. Similar findings were observed in our study. Our findings were much higher than reported earlier by Hur et al.16 who found that CT guided aspiration has sensitivity, specificity and accuracy of 84.100 and 91% respectively in patients of non-resolving consolidation after indeterminate transbronchial biopsy. &#xD;
&#xD;
In this study, immune-histochemistry was also done in 16 /23 samples. With rapid advances in targeted cancer therapies, the role of PTNB for molecular testing of non-small cell carcinoma continuous to increase.10 Several studies have found that PTNB provides sufficient tissue for molecular testing of non-small cell lung carcinoma.10 Our study confirmed that molecular testing can be safely performed when lung carcinoma presents as consolidation. We found that PTNB is a safe technique to take the sample from consolidations. Previous studies of PTNB of the pulmonary lesion have reported 17 to 37% incidence of pneumothorax and 1 to 14% incidence of chest tube replacement.17 The incidence of chest tube insertion in this study was 2/21 (9.5%).15 Mild hemoptysis was seen in 3/21 (14.28%) which is close to the reported incidence0.2-8.4%.18&#xD;
&#xD;
This study has a few limitations. The retrospective nature of the study may have introduced a selection bias. Another limitation is the small number of cases included. Our results are based on experience at two academic medical centres and may not be widely applicable to centres that are not experienced enough in PTNB.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
It may be concluded that pulmonary lesion can be safely evaluated by CT-guided percutaneous needle biopsy. PTNB may be used for tissue sampling from pulmonary consolidations and accurate diagnosis of malignancy. Our results support the important diagnostic role of PTNB in the evaluation of persistent pulmonary consolidation.&#xD;
&#xD;
Acknowledgement: We acknowledge the great help received from the researchers whose articles are cited and included in references to this manuscript.&#xD;
&#xD;
Author contribution&#xD;
&#xD;
Imran Nazir Salroo: Data collection, Manuscript preparation.&#xD;
&#xD;
Javid Muzzamil: Data collection.&#xD;
&#xD;
Musharaf Bashir: Manuscript preparation&#xD;
&#xD;
Amir Shafi: Data analysis&#xD;
&#xD;
Haseeb Mohammad Khandwaw: Data analysis&#xD;
&#xD;
Abdul AhadWani: Manuscript revision, Data analysis.&#xD;
&#xD;
Funding: None&#xD;
&#xD;
Conflict of interest: None&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3649</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3649</Fulltext></URLs><References>&#xD;
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	Walker CM, Abbott GF, Greene RE. Imaging pulmonary infections: Classic signs and patterns. Am J Roentgenol 2014; 202 (3): 479-92.&#xD;
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	Stadler JAM, Andronikou S, Zar HJ. Lung ultrasound for the diagnosis of community acquired pneumoniain children. Pediatr Radiol 2017;47(11);412-19.&#xD;
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	Beigelman-Aubry C, Godet C, Caumes E. Lung infections: the radiologist&#x2019;s perspective. Diagn Interv Imaging 2012; 93(6):431-40.&#xD;
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	Wootton D, Feldman C. The diagnosis of pneumonia requires a chest radiograph (x-ray)- yes, no or sometimes? Pneumonia 2014;5:1-7. &#xD;
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	Neuman MI, Lee EY, Bixby S. Reliability of CXR for pneumonia. J Hosp Med 2012; 4: 294-98.&#xD;
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	Kang M, Deoghuria D, Varma S. Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia. Lung India 2013;30(2):124-30. &#xD;
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	Chaudhary AD, Mukherjee S, Nandi S, BhuniyaS, Tapadar SR, Saha M. A study on non-resolving pneumonia with special reference to the role of fibreoptic bronchoscopy. Lung India 2013; 30(1): 27-32. &#xD;
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	Bajaj SK, Tombach B. Respiratory infections in immunocompromised patients: Lung findings using chest computed tomography. Radiol Infect Dis 2017; 4: 29-37. &#xD;
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	Palkar AV, Rapose A. Non-resolving pneumonia. BMJ Case Rep 2012; bcr2012006861. &#xD;
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	Kiranantawat N, McDermott S, Fintelmann FJ.&#xA0;The clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation.&#xA0;Respir Res&#xA0;2019; 20 (23):145-48&#xD;
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	Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F. Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis 2017;9(7): 2186-203. &#xD;
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	Lim C, Sekhon HS, CutzJC, Hwang DM. Improving molecular testing and personalized medicine in non-small-cell lung cancer in Ontario. Curr Oncol 2017;24(2):103-10. &#xD;
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	Cohen JF, Korevaar DA, Altman DG. &#xA0;STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 2016;6:e012799.&#xA0; &#xD;
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	Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of Interventional Radiology Clinical Practise Guidelines. J Vasc Interv Radiol 2009;20(7):189-91. &#xD;
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	Uzun C, Akkaya Z, Atman ED. Diagnostic accuracy and safety of CT-guided fine-needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single centre experience with 442 biopsies. Diagn Interv Radiol 2017;23(2):137-43. &#xD;
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	Hur J, Lee HJ, Byun MK. Computed tomographic fluoroscopy-guided needle aspiration biopsy as a second biopsy technique after indeterminate transbronchial biopsy results for pulmonary lesions: comparison with second transbronchial biopsy. J Comput Assisst Tomogr 2010;34(2):290-95. &#xD;
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	Bossuyt PM, Reitsma JB, Bruns DE. STARD 2015; an updated list of essential items for reporting diagnostic accuracy studies. Radiology 2015;351: h5527. &#xD;
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	Tai R, Dunne RM, Trotman-Dickenson B, Jacobson F. Frequency and severity of pulmonary haemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: singleinstitution experience of 1175 cases. Radiology 2016;279(1):287-96.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An Ayurvedic Approach of Pinda Sweda and its Different Modalities&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>26</FirstPage><LastPage>29</LastPage><AuthorList><Author>Swati Tikale</Author><AuthorLanguage>English</AuthorLanguage><Author> Krutika Umate</Author><AuthorLanguage>English</AuthorLanguage><Author> Madhulika Tiwari</Author><AuthorLanguage>English</AuthorLanguage><Author> Nikhil Dhande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Swedana, Pinda Sweda, Panchakarma Chikitsa, Samhitas</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
All the Panchakarma procedures divided into three karma i.e. Poorva karma (Pre-operative), Pradhana Karma (operative) and Paschat karma (post-operative). The Swedana karma is included in Poorva karma for Panchakarma procedures. Swedana is the karma that causes the body to perspire.1 It can be achieved by many methods. The Sweda karma classified into two types as Sagni Sweda (direct contact with fire) and Niragni Sweda (without the direct contact of fire).2 Sankara Sweda is one among the 13 Saagni Sweda. In our classics text, the Sankaradi Sweda is mentioned as one of the most ancient treatments in Ayurveda.3 Pinda Sweda works on the principles of Sankara Sweda. Pinda Sweda falls into the category of &#xA0;Tapa Sweda of four types of Sweda. Sankara Sweda is the method in which the materials are wrapped in a cloth and used for Swedana purpose and it is known as Pinda Sweda.4 The Sankara Sweda is again classified based on dravya used as Rooksha Sankara Sweda and Snigdha Sankara sweda. In the case of Ruksha (dry) Sankara Sweda, hot solid substances which are used as the stool of different animals like Cow, Horse, Camel, Sand, Brick, Stone and this type Swedana mainly practised in Kapha vitiated patients.5 In type of Snigdha (Unctuous) Sankara Sweda, the thick gruel is prepared from the materials like-Tila (Sesame), Masha (Black gram), Kulatha (Horse gram), Amla Dravya (Citric fruits,) Ghrita (ghee), Taila (oil), Payasa (rice and milk pudding) and this Swedana is more practised in the conditions of KevalaVata.6 There are varities of Pinda Sweda as Shashtika Shali Pinda Sweda and Nirgundi Patra Pinda. &#xD;
&#xD;
Depend on the properties of the Dravya utilized for the Swedana karma is of three types Snigdha -Ruksha, Snigdha, Ruksha which are adopted mainly for Vata-Kapha, Vata and Kapha Pradhan Vyadhi respectively.7 So we can systematize Pinda Sweda concerning the Guna of Dravyas used (Table 1).&#xD;
&#xD;
&#xD;
&#xD;
VALUKA SWEDA &#xD;
&#xD;
Valuka sweda is one among the Ruksha sweda. Valuka Sweda is the treatment in which sand is used for fomentation (sweat-inducing) of painful parts. It can be done as Sarvanga (whole-body) or Ekanga (locally) Swedana procedure. It provides relief from pain, inflammation, swelling and stiffness. It is mainly used in Sandhigata Vata (osteoarthritis), Amavata (rheumatoid arthritis), Urustambha (stiffness of the thighs) Obesity, Granthi, Kapha Medavritavata (Table 2).8 &#xD;
&#xD;
MATERIALS REQUIRED &#xD;
&#xD;
&#xD;
&#xD;
The Valuka is heated and pottalis are made. It can be applied directly on the body or by dipping into Kanji9. This is very useful in alleviating Vata and Kapha diseases and pain all over the body etc. &#xD;
&#xD;
Probable Alteration in Valuka Sweda &#xD;
&#xD;
Pranipurisha (Stool of animals), Lavana (rock salt), Ishtikachoorna (brick powder), Vatahara Patras, Nirgundi (Vitex negundo), Arka (Calotropis Procera), Agnimantha (Clerodendrum phlomidis), Dhatura (Datura metel), Vatahara choorna, Rasna (Pluchea lanceolata), Devdaru (Cedrous deodara) etc. can be used before applying Taila (NimbaTaila, Brhat Saindhavadi Taila, Sahacharadi Taila).&#xD;
&#xD;
PATRA PINDA SWEDA &#xD;
&#xD;
Patra Pinda Sweda is the type of Pinda Sweda where leaves of medicinal plants that have the property of Vata Kaphahara are roasted in a pan with little oil and a bolus is prepared by tying in the cloth10. It is one of the types of Ushma Sweda ( Table 3).&#xD;
&#xD;
Ingredients Required&#xD;
&#xD;
&#xD;
&#xD;
Possible Modifications &#xD;
&#xD;
Instead of different combinations of Patras, only single patra pottali can be practised. Eg.- Nirgundi patra pinda sweda, Arka patra pinda sweda and also Anda Sweda,&#xA0; Bhusa Pinda Sweda, Karish Pinda Sweda, etc11 can be used in practice. Various choorna combinations can be used. &#xD;
&#xD;
JAMBEERA PINDA SWEDA &#xD;
&#xD;
The word &#x201C;Jambira Pinda&#x201D; is made up of two words Jambira means Lemon and Pinda means bolus. Jambira Pinda Sweda assigns to the Pinda Sweda performed by the specially prepared bundles of Jambira and other drugs12. This is mainly used in Vata-Kapha morbidity conditions. It is usually practised in Rheumatoid Arthritis, Osteoarthritis, Lumbar Spondylosis, frozen shoulder, plantar fasciitis, and traumatic conditions. It is used in pain, swelling and stiffness associated with joints, spine, nerves etc (Table 4). &#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
Probable modifications &#xD;
&#xD;
Matulunga (Citrus medica) can be used instead of lemon. For frying purpose instead of taila, Vasa (fat) and Majja (bone marrow) of different animals can be used.13&#xD;
&#xD;
SHASHTIKA SHALI PINDA SWEDA &#xD;
&#xD;
Shashtika Shali Pinda Sweda is the type of Snigdha Sankara Sweda14 which falls into the type of Sagni Sweda15. In this procedure of Swedana, Shashtika Shali16 (a variety of rice with the medicinal value which is cropped in just 60 days) processed in Kwatha (decoction) of Balamoola (the root of Sida cordifolia) and milk. It is known in Kerala as Navarakizhi. It does the function of Swedana, Snehana and Brimhana (anabolic quality) simultaneously; it is mostly used in Vata vitiated disorders.&#xA0; It also possesses inherent cool property, so can also be advised in moderately vitiated Pitta ( Table 5).&#xD;
&#xD;
Materials Required &#xD;
&#xD;
&#xD;
&#xD;
Probable Modifications &#xD;
&#xD;
Ashwagandha churna, Rasyan churna, Balya churna, Masha churna, Tila churna, Godhuma (wheat flour) can be added to get more benefits of Shashtika Shali Pinda Sweda. &#xD;
&#xD;
CHOORNA PINDA SWEDA &#xD;
&#xD;
Choorna pinda sweda is one of the types of Ushma sweda. The Churna Pinda Sweda is the treatment in which with the mixture of various choorna combinations like Methika (Fenugreek), Sarshapa (Mustard), Shatapushpa (Anethum graveolens), Jatamansi (Nardostachys jatamansi), Atasi (flax seeds) are used. This procedure can be done in two way; Snigdha and Rooksha.15,16&#xD;
&#xD;
In Snigdha pinda sweda, first Abhyanga with oil is done all over the body and the Pottalis are also heated in oil. In Rooksha Pinda Sweda the Pottalis are directly applied all over the body without Abhyanga. The Procedure can also be modified by dipping Pottali into the steam of different Drava (liquid) dravyas like Dhanyamla in some specific conditions (Table 6). &#xD;
&#xD;
Ingredients Required &#xD;
&#xD;
&#xD;
&#xD;
NEW ADVANCEMENTS &#xD;
&#xD;
Choorna Pinda Sweda with dipping in Dhanyamla shown ingredients in Table 7. &#xD;
&#xD;
&#xD;
&#xD;
Dhanyamla Dipping&#xD;
&#xD;
The Choorna of above drugs are mixed with 500 ml of Dhanyamla properly and cooked. The Pottali is dipped in heated Dhanyamla and Swedana was done Ekanga or Sarvanga, up to the achievement of proper symptoms of Swedana. During the procedure, the Dhanyamla should be reheated to maintain the same temperature throughout the procedure. Pottali should be used only one time. &#xD;
&#xD;
Probable Modifications &#xD;
&#xD;
Different choornas can be used like- Kolakullathadi choorna, Kottamchukadi choorna, Triphaladi choorna or a combination of different single drug choorna. &#xA0;Instead of Dhanyaml, Chincha rasa, Gomutra, Single drug Kashaya, Takra can be used. &#xD;
&#xD;
CHINCHA LAVANA PINDA SWEDA &#xD;
&#xD;
Ingredients required &#xA0;for Chincha lavana pinda Sweda in Table 8&#xD;
&#xD;
&#xD;
&#xD;
Other probable Dravyas for Pinda Sweda &#xD;
&#xD;
Busa, Laja (Puffed grain), Navdhanya (Nine grains), Sarshapa (Mustard seeds), Maize. &#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
Swedana is one of the crucial treatment modality which is useful in the treatment of diseases in the form of Poorvakarma, Pradhana karma as well as Paschata karma. The Materials and drugs mentioned for Swedana each of them have their specific properties and actions, so it should be used depending upon the condition. Already there are many Dravya mentioned by our Acharya, we should select them depending upon Desha, Roga, and availability of Dravya. Pinda Sweda is a widely and mostly practised Swedana procedure where the principle of treatment is based on the combined effect of heat and the medicinal properties of drugs. Hence, based on Roga (disease) and Rogi (patient) one can opt for different combinations of Pinda Sweda according to the availability and properties of the drugs.&#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=3650</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3650</Fulltext></URLs><References>1. Jadavaji T. Charaka Samhita of Agnivesha revised by Charaka and completed by Dridhabala, Sutrasthana Chapter 14/13. Varanasi, Chaukhamba Orientalia, 2017;88. &#xD;
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11.&#xA0; Surendran E. Panchakarma: a guide to treatment procedure in Ayurveda. 1st Edition,&#xD;
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Kottakalam,Varier Ayurveda College, 2006;109.&#xD;
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12. Vasant CP. Principles and Practice of Panchkarma, Chaukhambha Publications, New Delhi 5 th edition. 2015,212-213.&#xD;
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&#xD;
16. Upadhyaya VY (Ed.). Astanga Hridya, Sutrasthana, Chapter 6/7. Varanasi, India: Chaukhambha Prakashan.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Stress and Social Isolation- A Study of Behavioural and Attitudinal Changes among College Students During Covid-19&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>30</FirstPage><LastPage>35</LastPage><AuthorList><Author>Usha Sadasivan</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhuvaneswari Balachander</Author><AuthorLanguage>English</AuthorLanguage><Author> S. Vijayalakshmi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Stress, College students, Social isolation, Missing friends, Covid-19, Behaviour, Relationships, Stress level,  Physiological.</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Humans are a part of society. Society is defined as a&#xA0;group&#xA0;of individuals involved in persistent&#xA0;social interaction. Societies are characterized by patterns of relationships between individuals who share a distinctive&#xA0;culture&#xA0;and&#xA0;institutions. Social behaviour has been defined by physiologists and sociologists as the behaviour directed towards society. In a sociological hierarchy social behaviour is followed by social actions which are directed at other people and are designed to induce a response. Further along this ascending scale are social interaction and social relation.2&#xA0;&#xD;
&#xD;
What differentiates man from animals is this ability to socialize and this societal bonding has become an indispensable part of his life, so much so that it is as important as breathing. So when this is removed, even though temporarily,&#xA0; there is an immediate feeling of loss. Those undergoing this loss begin to experience a sense of an indefinable state of panic or stress. This stress condition indicates that the situational demands exceed the personal and social resources they can mobilize. Of the members of society, a sizable chunk is the youngsters who have got so used to socializing and hanging out with their peer groups that when they are suddenly faced with a situation where even going out of the house is not something they can do now without a lot of restrictions is unpalatable for them.&#xA0;&#xA0; These adolescents are already undergoing physiological stress and experiencing a sense of role confusions. With the usual stress activators such as academic tests and exams they now have to face the new stress of forced social isolation. &#xD;
&#xD;
Such situational constraints will inevitably cause psychological, physical, and behavioural problems. Taking these environmental and behavioural factors into account an effort has been made to understand the stress and emotional adjustments of today&#x2019;s youth. The authors have undertaken this study of the anxiety and stress levels of young college students of the city, to study the effect of being socially distant from peer groups. This study it is hoped will throw light on the various factors that lead to emotional non adjustment among the student community at large. The inference of this study may lead to a better understanding of this problem of social adjustment. &#xD;
&#xD;
Hypothesis&#xA0; &#xD;
&#xD;
Hypothesis 1: Prolonged periods of peer deprivation will induce the feeling of loneliness among college students.&#xA0; &#xD;
&#xD;
Hypothesis 2: Social isolation will make students suffer unknown fears. &#xD;
&#xD;
Hypothesis 3: Social isolation will induce fear of dying among students.&#xD;
&#xD;
Hypothesis 4: Social isolation will affect the sleep patterns of students.&#xD;
&#xD;
Hypothesis 5: Not being able to go out and socialize causes stress among students&#xD;
&#xD;
Hypothesis 6:&#xA0; Meditation reduces levels of stress among students. &#xD;
&#xD;
Review of literature &#xD;
&#xD;
What is this fear that is taking over young minds? What is it that is causing this narrowing down of attention span, resulting in the mental block, loss of creative thinking skills, loss of positive thinking, and less involvement in the world around them?&#xA0; Other stress factors that are seen are avoidance of talk with friends, and reveal reduced levels of adaptability. Normal levels of coping with adverse situations take a beating, and they are unable to think clearly that they can control the situation and not let the situation control them. Their mind has become so numbed that they think they are at the mercy of circumstances and a host of negative emotions begins to shake their otherwise stable equilibrium. The thought that they are thinking differently itself is enough to put all sorts of unnatural fears in them. Their natural self makes them act in a pseudo-natural manner but actually, they are disturbed internally. This internal stress causes eating disorders and disturbed sleep patterns.&#xD;
&#xD;
Study on coping strategies listed restraint coping as one of the coping strategies used when the stressed person uses restraint to tackle the &#x2018;stressor&#x2019; or the agent causing the stress.1 The social support that is sought for receiving advice, assistance, or information. This can be called problem-focused coping. Those in distress may also seek social support for emotional reasons such as moral support, sympathy, or understanding. This may also be discussed under the head of emotion-focused coping.3&#xD;
&#xD;
Coping strategies showed that individual differences, environmental factors (social support and work demand), and situational characteristics acted as predictors of self-report measures of coping that include general coping, direct copying, and suppression.5 Studies have shown that the quality of social relationships improves physical and mental health and increases lifespan.&#xA0; The nine &#x201C;aspects of association&#x201D; of Bradford Hill which are the strength of association, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy have been originally used to evaluate hypothesized relationships between occupational and environmental exposures and disease outcomes. This causal inference has been put to use by later researchers into the effect of social isolation on the mental state of people.6&#xD;
&#xD;
Studies on stress and the college student have been undertaken which have reported a strong relationship between stress and college students.7-9 Stress is a mental or physical phenomenon and is a result of one&#x2019;s interaction with the environment. The existence of stress depends on the existence of the stressor.10 &#xA0;When stressful events take control of the situation, an individual afflicted by it becomes disorganized, disoriented and as a consequence less able to cope.11 The perception of the individual determines whether or not the stressor causes physical or psychological stress symptoms in the individual.12 Extensive research have been carried out on stress and found out that, stress is associated with how an individual appraises situations and the coping strategies adopted. 13, 14&#xD;
&#xD;
The current research aims to highlight the mental state of college students deprived of their usual peer groups and its resultant impact on their mindset, their stress levels, and the coping strategies employed by them.&#xA0; The methodology employed is the test-retest approach.&#xA0;&#xA0; &#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
A survey was conducted among the college students of the city (all girls) in April 2020 employing a self -administered questionnaire via Google forms. The students were administered the same questionnaire in July 2020, after a gap of three months. This survey aimed to check if the students missed their daily interaction with their class peers, did they feel stressed, what were the reasons they felt afraid about and what was their mindset regarding this unexpected social isolation. The study was to understand the emotional state of the students after having been socially distanced from their friends for a prolonged period. The questions were grouped under four clusters and had questions relating to their mindset regarding missing of friends, their understanding of loneliness, the psychological impact resulting from this situation, and the coping strategies they were employing to tackle the situation. &#xD;
&#xD;
1. Cluster of questions regarding Missing friends &#xD;
&#xD;
i) Do students feel left out and lonely when they haven&#x2019;t seen their friends for a while? &#xD;
&#xD;
ii)&#xA0; Do they miss their friends?&#xA0; &#xD;
&#xD;
iii) Will they be able to talk with friends like before? &#xD;
&#xD;
2. Cluster of questions on understanding Loneliness &#xD;
&#xD;
i) Do students think their feeling of loneliness is a matter of concern? &#xD;
&#xD;
ii) Does the thought that they may not meet friends for some time frighten them? &#xD;
&#xD;
3. Cluster of questions regarding Psychological Impact &#xD;
&#xD;
i) Do you often have unnatural fears like you are going to die? &#xD;
&#xD;
ii) Do negative thoughts fill your mind? &#xD;
&#xD;
iii) Do you feel like you&#x2019;re going crazy? &#xD;
&#xD;
iv) Do you sleep well?&#xD;
&#xD;
4. Cluster of questions regarding coping strategies&#xD;
&#xD;
i) How do they motivate themselves?&#xD;
&#xD;
ii) Does meditation help in relieving stress? &#xD;
&#xD;
iii) This also shall pass &#x2013; is this a sign of positive thinking or unnatural optimism? &#xD;
&#xD;
Data Analysis&#xA0; &#xD;
&#xD;
The test- and retest responses were analyzed to check if there were any significant changes in&#xD;
&#xD;
the behaviour and attitude of the respondents from the time the first questionnaire was carried &#xD;
&#xD;
out, to the time the second questionnaire was administered. The questionnaire was&#xD;
&#xD;
conducted to the same set of respondents after a gap of eight weeks. Comparative Analysis&#xD;
&#xD;
of two sets of data is represented in fig 1. &#xD;
&#xD;
&#xD;
&#xD;
From the given graphs in fig 1, we can see that nearly 50% of the students are not frightened and on the other hand there is an increase of 3% in the bar &#x2018;sometimes&#x2019; which shows an increase in the number of students who are frightened when they have the thought of not being able to meet their friends.&#xA0; Similarly from the questionnaire, we could also see that feeling of loneliness is gradually increasing from the responses received which indicate that nearly 70% of the students are worried and concerned about being alone. &#xD;
&#xD;
&#xA0; &#xA0;&#xA0;&#xD;
&#xD;
These graphs show that, although at times of difficulties students interest in making plans for their future haven&#x2019;t reduced, which means students are highly motivated when they positively think about their future.&#xA0; And in graph 2 we can notice that there is a drastic increase in the bar&#x201D; better times in the past &#x201C;which shows students are trying to motivate themselves by also thinking about their past. Nearly 60% of the students have said sometimes they feel relieved when they do meditation as per the responses received from the questionnaire, we can also notice the increase in the number of students in the column &#x201C;sometimes&#x201D; from the responses, which shows that the students are gradually becoming stress-free and it&#x2019;s a kind of positive development. Many have agreed with &#x201C;yes&#x201D;, but still if we have a deeper look at the responses we can notice that at first, nearly 70% of the students are positive about the concept of &#x201C;THIS ALSO SHALL PASS&#x201D; and in graph 2 we can see that only 60% of the students have agreed &#x201C;yes&#x201D;, this shows the decrease in their level of positivity and hope. Almost 60% of the students have said that they haven&#x2019;t experienced unnatural fears like they are going to die and Some students have preferred not to answer this question which can also be considered in either way that they were ignorant of their fears or they were trying to suppress their fears.&#xD;
&#xD;
&#xD;
&#xD;
In both, the graphs, For almost 60% of the students have said that they haven&#x2019;t experienced unnatural fears like they are going to die and Some students have preferred not to answer this question which can also be considered in either way that they were ignorant of their fears or they were trying to suppress their fears. We can also see from the responses received that only 30% of the students have said &#x201C;no&#x201D;, which shows remaining 70% of them are feeling crazy more often and sometimes. But if we have a deeper look at these graphs we can also see that there is a slight increase in the number of people who have said &#x201C;never&#x201D;, which shows the moderate increase in the behaviour of students. From the first set of data, it is shown that nearly 50% of the students have agreed to &#x201C;sometimes&#x201D; that is sometimes they do have their minds filled with negative thoughts but if we look at the second set of data, it&#x2019;s nearly 86% of the students have agreed to &#x201C;sometimes&#x201D; and &#x201C;never&#x201D; with this we can say that the students are changing progressively by occupying themselves with positivity. On comparing the responses received, we can easily find out the stress level of students since it deals with lack of sleep, unfortunately, we can see that nearly 80% of the students are suffering from lack of sleep and if we notice we can see that it has a steady increase in the rate of 3%. &#xD;
&#xD;
&#xA0; &#xA0; &#xA0;&#xD;
&#xD;
These graphs show the feel of loneliness faced by the students when they are not around their friends. When we compare these graphs we can see that their&#x201D; fear of not being able to talk with their friends like before&#x201D; and &#x201C;their feeling of loneliness &#x201C;have increased from graph 1 to graph 2 as shown in fig 4. Both the graphs are similar, we can see that the fear of not being able to go outside haunts nearly 40% of the students than any of the other stress factors. But still, some of them have said parental pressures and not being able to see their friend&#x2019;s causes more stress.&#xD;
&#xD;
&#xA0;&#xA0;&#xD;
&#xD;
This graph shows the comparison of group 2 from both the datasets, in this we can see that students have said sometimes they do feel relieved from stress when they meditate. From this we can say that before the students were more positive about the concept of &#x201C;this shall also pass&#x201D; and now they are slowly losing their positive hope in this concept. &#xD;
&#xD;
&#xA0; &#xA0;&#xA0;&#xD;
&#xD;
This shows that students feel motivated by thinking about their future in a progressive way which also makes them plan their future instead of feeling sick and trapped. In this graph, the most stressful factor according to students is not being able to move outside, which is quite unfair for students since their lifestyle is designed that way, it can be considered to be a natural thinking process of students to be wanting to go out and explore things. &#xD;
&#xD;
Comparing these two datasets, we can say that there is a slight deviation in data_2 compared to data_1. Respective deviations in the following parameters, there is a negative increase in the parameter &#x201D;feeling of loneliness is a matter of concern&#x201D;. There is a positive attitude among students in the parameter &#x201C;meditation helps in relieving stress&#x201C;. There is a negative impact in the parameter &#x201C;The concept &#x2013; This also shall pass &#x201C; among students. There is a Positive increase in the variable &#x201C; feeling crazy&#x201D;. The parameter &#x201C; negative thoughts &#x201C; has a positive increase. The parameter &#x201C; Do you sleep well &#x201C; shows a negative increase. The group of variables that deals with &#x201C;missing friends &#x201C;is increased negatively.&#xD;
&#xD;
&#xA0;The following hypotheses are proven:-&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	Prolonged periods of peer deprivation will induce the feeling of loneliness among students.&#xA0; &#xD;
	&#xD;
	&#xD;
	Social isolation will make students suffer unknown fears. &#xD;
	&#xD;
	&#xD;
	Social isolation will affect the sleep patterns of students.&#xD;
	&#xD;
	&#xD;
	Not being able to go out and socialize causes stress among students&#xD;
	&#xD;
	&#xD;
	Meditation reduces levels of stress among students. &#xD;
	&#xD;
&#xD;
&#xD;
The hypothesis that &#x2018;Social isolation will induce fear of dying among students.&#x2019; has not been proven from the analysis of the two sets of data.&#xD;
&#xD;
The insights obtained from a comparison of the two sets of data collected will provide a framework to understand the mental state of these young minds and also see what kind of remedies can be suggested for alleviating their stress levels. It will also suggest recommendations for the authorities and those in power to make decisions to take corrective and alleviative measures so that the future leaders will benefit from any positive social changes that may arise. &#xD;
&#xD;
&#xA0;Recommendations &#xD;
&#xD;
Some measures that could be possible remedies:&#xD;
&#xD;
&#xD;
	&#xD;
	They could use the technique of mindfulness. &#xA0;Being mindful makes it easier to become fully engaged in activities, and creates a greater capacity to deal with adverse events. By focusing on the here and now, many people who practise mindfulness find that they are less likely to get caught up in worries about the future or regrets over the past, are less preoccupied with concerns about success and self-esteem. Mindfulness means acceptance of their experiences and not avoidance.&#xD;
	&#xD;
&#xD;
&#xD;
2. Peer group interaction and laughter sessions will greatly alleviate the feeling of social isolation. Good friends are good for health, friends prevent loneliness and increase your sense of belonging and purpose. Improve your self-confidence and self-worth and reduce stress levels. &#xD;
&#xD;
3. They could be encouraged to involve in physical activity. Exercise of any kind that encourages some physical activity has beneficial effects. Exercise and physical activity are associated with better quality of life and health outcomes. Medical evidence suggests that the human brain produces a variety of chemicals such as dopamine (reward), endorphins (pain relief)and serotonin (relaxation). Moderate exercise increases attention and academic performance Studies show that endorphins released may help in overcoming social anxiety.&#xD;
&#xD;
4. Help them identify stressors &#xD;
&#xD;
Training the students to identify stressors it will give them the ability to eliminate causes of stress and thus alleviate its effects to some extent. The survey highlighted some of these factors that caused them stress.&#xA0; Ways of handling stressful situations differ from person to person. Coping strategies differ according to situational demands and situational environmental situations. The survey respondents seemed to have some idea of their stressful situations and also managed to control their mood swings from developing into extreme mood disorders. &#xD;
&#xD;
Limitations of the study &#xD;
&#xD;
The survey was limited to college students of a particular city and only female students. There could be differences in the attitudes of the respondents had been male students. Another limitation could be recall bias as the same set of questions were given within a gap of some few weeks. Familiarity with the questions may have coloured their thinking. Similarly, some students may have deliberately hidden their real thoughts or given exaggerated details regarding their stress levels or they may have underrated or over rated their handling of coping strategies. Further research may be conducted on male students or how students outside the city viewed the similar situation.&#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
The phenomenon of stress continues to receive increasing attention from various fields such as medicine, counselling, psychologists and educational managers. When young minds are not able to meet up with friends as they used to just a few weeks back, they need to understand their problems on a larger scale. It is a not narrow problem affecting only a small circle of people. It is a global problem. The world is facing many allied challenges that include poverty, hunger, deprivation of education,&#xA0;&#xA0;&#xA0; and climate change. These issues have to be tackled both by the government and by individuals. &#xD;
&#xD;
The authors feel that teachers who have direct contact with the student community are uniquely positioned because of their networking with students almost daily. They can help by providing the necessary emotional support by just being there and offering support when needed.&#xD;
&#xD;
Compliance with Ethical Standards&#xD;
&#xD;
Acknowledgements&#xD;
&#xD;
Not applicable.&#xD;
&#xD;
Authors&#x2019; contributions &#xD;
&#xD;
The author(s) read and approved the final manuscript.&#xD;
&#xD;
Funding &#xD;
&#xD;
Not applicable. &#xD;
&#xD;
Research involving human participants and/or animals&#xD;
&#xD;
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. &#xD;
&#xD;
Competing interests &#xD;
&#xD;
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.&#xD;
&#xD;
&#xA0;Informed consent&#xD;
&#xD;
Verbal informed consent was obtained before the collection of data. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3651</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3651</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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Prevalence of Pulmonary Mycoses Among the Clinically Suspected Cases of Pulmonary Tuberculosis in a Tertiary Care Hospital&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>36</FirstPage><LastPage>40</LastPage><AuthorList><Author>Gerard Rakesh J</Author><AuthorLanguage>English</AuthorLanguage><Author> Margaret Theresa J</Author><AuthorLanguage>English</AuthorLanguage><Author> Durga Bhavani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Pulmonary mycosis is a fungal infection of the lungs caused by either endemic or opportunistic fungi or a combination of both. They comprise a large group of fungal diseases, the etiologic agents are potential pathogens among the immunocompromised or debilitated patients. Objective: The study aims to identify the occurrence of pulmonary mycoses in clinically suspected cases of pulmonary tuberculosis .by isolating the fungi and identifying the various fungi causing pulmonary mycoses. Methods: Two hundred sputum samples were collected from 100 patients who were clinically suspected to have pulmonary tuberculosis. Acid Fast staining was performed to identify the presence of Acid Fast Bacilli (AFB). Potassium hydroxide (KOH) mount also performed separately to examine the presence of fungal elements. Gram stain was performed to identify the presence of bacteria and fungi elements. All the samples were cultured on Sabouraud&#x2019;s Dextrose Agar (SDA) slants to study the morphology of the fungal colony. A germ tube test was performed to identify Candida albicans. Lacto Phenol Cotton Blue tease mount preparations were made to identify the morphological feature of fungal components in culture. Results: The results were analyzed and various types of pathogens were detected. Out of 100 patients, 29 showed positive reports. Among the 29 cases, eight were positive for AFB, while fungus as a primary etiological agent was detected in 10 patients. Fungus as a secondary etiological agent was detected in 4 patients [AFB with fungus]. Bacteria as the primary cause of pulmonary infection were detected in 7 patients. The isolated fungi as the primary pathogen in clinically suspected cases of pulmonary tuberculosis were Candida species in 6% and Aspergillus species in 4% of patients. Conclusion: Pulmonary mycosis may be a primary infection in non-tuberculosis cases or co-infection in pulmonary tuberculosis. Therefore Pulmonary mycoses can be easily misdiagnosed and mistreated as pulmonary tuberculosis. Investigation for fungal cause in clinically suspected cases of pulmonary tuberculosis will prevent this type of misdiagnosis and management. The present study indicates that fungal aetiology should also be sought in all clinically suspected pulmonary tuberculosis patients.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Pulmonary tuberculosis, Fungal infection, Pulmonary mycoses, Candidiasis and Aspergillosis</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The common fungal infection of the lung is Pulmonary mycosis which can be caused by either endemic or opportunistic fungi or a combination of both.1,2 Pulmonary mycoses are found to be cosmopolitan in distribution. Fungal organisms are highly pathogenic in immunocompromised or debilitated patients.3 Patients with tuberculosis are usually immunocompromised, hence these patients are at high risk of developing superadded fungal infections.4 Species of Candida and Aspergillus are classical examples of opportunistic pathogenic fungal organism among patients with tuberculosis. Several study reports suggested that Candida albicans be the most common fungal agent.5&#xD;
&#xD;
Data on worldwide incidence and prevalence of pulmonary mycoses is fragmentary. Fungal infections in the lung often pose a difficult diagnostic challenge due to the lack of any pathognomonic clinical syndromes and characteristic radiological features. Mycobacterium tuberculosis (MTB) is the causative organism of pulmonary tuberculosis, which is aerobic, acid-fast bacillus and can infect one-third of the world&amp;#39;s population.6 In recent days the incidence of people getting exposed and becoming sick is stable or gradually decreasing worldwide. Because of low socioeconomic status and overpopulation in our country, an increase in new cases is being documented every year. The incidence and prevalence of fungal infections among pulmonary tuberculosis patients in India and other developing countries hence the data remain unexplored and neglected. Therefore this neglect has to be seen as a major call for concern. A country like India has an enlarging population of patients with Pulmonary tuberculosis either Clinical or subclinical infection. It is essential to carry out the differential diagnosis since the radiological characteristics of pulmonary mycosis are very similar to that of pulmonary tuberculosis thereby making the disease easily misdiagnosed as tuberculosis. Thus, they may suffer from avoidable complications of unwarranted chemotherapy. In the present study we aimed to identify the occurrence of pulmonary mycoses and various fungal the organism causing pulmonary mycoses in clinically suspected cases of pulmonary tuberculosis.&#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
Study design: Cross-sectional study&#xD;
&#xD;
Study area: Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry&#xD;
&#xD;
Duration of study: January 2018 and September 2019.&#xD;
&#xD;
Study sample: Two hundred sputum samples were collected from 100 patients who were clinically suspected to have pulmonary tuberculosis.&#xD;
&#xD;
Inclusion criteria: Patients presented with signs and symptoms of pulmonary tuberculosis &#xD;
&#xD;
Exclusion criteria: Pediatric age group (who are not able to produce sputum) and patients with extra pulmonary diseases.&#xD;
&#xD;
Ethical clearance: We have taken institutional ethics committee learance before the commencement of the study.IEC Ref: SVMCH/IEC/2016/4.&#xD;
&#xD;
Procedure: A total number of 100 patients clinically suspected of pulmonary tuberculosis attending Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry were included in this study. &#xD;
&#xD;
Specimen collection: Two sputum samples, from the patients (early morning and spot) were collected into sterile wide neck universal containers as per the RNTCP guidelines.&#xA0; A total of 200 samples were collected from 100 patients who were clinically suspected to have pulmonary tuberculosis. None of the participants had been placed on antifungal therapy.&#xD;
&#xD;
Microscopic Examinations &#xD;
&#xD;
Acid Fast staining was carried out. A smear was made from each of the sputum samples and was stained by the Ziehl-Neelsen technique as per the Revised National TB control programme (RNTCP) guidelines. The stained slide was examined under oil immersion objective for the presence of Acid Fast Bacilli. The results were recorded and grading was done as per the grading system for AFB.&#xD;
&#xD;
Potassium hydroxide (KOH) mount: With the use of Pasteur&#x2019;s pipette, a large drop of 10% KOH was placed on the centre of a clean glass slide. A small portion of the sputum is transferred into the KOH drop with a sterile wire loop and mixed well. The preparation is flattened under a coverslip, placed in a moist chamber and kept at room temperature for 30 minutes. The slide is then examined under low power and high power (10x and 40x objectives) for the presence of fungal elements. The presence of any filament,&#xA0; pseudohyphae or fungal elements were documented.&#xD;
&#xD;
Gram stain: Smears were made from the most purulent or mucopurulent part of each sputum samples and Gram stain was performed. Stained smears were examined for the presence of any bacteria or fungi. The size, shape and arrangement of fungal elements were documented. In the case of any Gram-positive yeast like-cells, the presence or absence of pseudohyphae were also noted. The Grams reaction on bacteria was also recorded.&#xD;
&#xD;
Culture on Sabouraud&#x2019;s Dextrose Agar (SDA):&#xA0; Irrespective of the outcome of the sputum microscopy, all sputum samples were cultured for the characterization of mycotic agents. Sputum samples were streaked on to SDA slants and placed in a BOD incubator. Following incubation, the tubes were examined every day for a week and twice a week from the second week onwards for the growth of fungus.&#xD;
&#xD;
Cultural identification: After appropriate incubation, the colony morphology, the rate of growth, surface, the texture of the colony and any pigmentation on the surface and reverse of the colony on SDA tubes were observed macroscopically and recorded. The isolates were subjected to Gram stain and lactophenol cotton blue mount (LPCB) tease mounts were studied microscopically. The significant fungal isolates recovered on culture were identified to the species level using standard mycological procedures. For Candida species, a Germ tube test was performed to identify the Candida albicans. Aspergillus species were identified with the various morphological features observed on Lacto Phenol Cotton Blue tease mount, the colony characters and pigment productions on culture.&#xA0; No fungal growth until 6 weeks were reported as negative for fungal growth.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
A series of 200 Sputum samples were collected from100 patients who were clinically suspected to have pulmonary tuberculosis. The age and sex-wise distributions showed 59 of them were males and the remaining 41 of them were females. Details of distributions were shown in Figure 1.&#xD;
&#xD;
&#xD;
&#xD;
On analysis of the results, different types of pathogens were detected. Among the 100 patients, 29 were positive for microbial infections. Eight patients showed positive for AFB alone, while fungus was isolated as the etiological agent in another 10 patients. In yet another group, Fungus was isolated as a secondary etiological agent in 4 wherein both AFB and fungus were detected shown in Figure 2.&#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; &#xA0;&#xA0;&#xD;
&#xD;
Bacteria as the primary cause of pulmonary infection were observed in 7 cases. The fungi isolated as the primary pathogen in clinically suspected cases of pulmonary tuberculosis included were Candida species and Aspergillus species. Candida species were isolated in 6 patients, whereas Aspergillus species were isolated in 4 patients. Aspergillus species comprised of Aspergillus flavus in 2 cases and Aspergillus niger in 2 cases. Whereas Candida albicans were isolated in 4 patients and Non-Candida Albicans species were seen in 2 cases. It was found that patients in whom sputum sample with AFB was detected and fungi were recovered in culture as a secondary pathogen, included Candida species. Candida albicans was isolated in 3 cases and Aspergillus niger in1 patient.&#xA0; As shown in Table: 2&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Fungal infections of the lungs are important infective processes that are being encountered more and more often in day today&#x2019;s practice. Data on worldwide incidence and prevalence of Pulmonary mycoses is fragmentary. Aspergillus and Candida&amp;#39;s species are more common pathogens causing pulmonary mycoses in clinically suspected cases of pulmonary tuberculosis.7&#xD;
&#xD;
Shadzi and Chadeganipour in their study reported that among the 43 patients with tuberculosis, the patients were predisposed with 7.3% yeast infections and 0.4% Aspergillosis infection.8Fortunately, we only encounter a few of these pathogenic fungi. With extensive usage of various broad-spectrum antibiotics,&#xA0; chemotherapy agents,&#xA0; immunosuppressive drugs and with increased incidence of several respiratory diseases including chronic obstructive pulmonary disease, lung cancer and tuberculosis, the chances of encountering these diseases are steadily increasing.9&#xD;
&#xD;
Though treatment is difficult, nevertheless, the results are encouraging. Hence, it is all the more important today to know these diseases well so that we can manage them scientifically. Diseases like opportunistic fungal infections, if diagnosed early can be treated effectively to prevent progression to the fibrotic stage and reduce the number of respiratory cripples. Gemoets et al in his study suggested that a tendency for pulmonary tuberculosis to develop a more devastating course when it was associated with an invasion of&#xA0; fungi which increased the virulence of tuberculosis.10&#xD;
&#xD;
Out of 100 clinically suspected pulmonary tuberculosis patients, pulmonary mycoses was noted in 14 patients (14%). Pulmonary mycoses were more likely in female patients (9%) when compared to male patients (5%). It was observed that fungal infections were commonly seen in elderly patients aged more than 50 years of age. Further, it was also noted the Primary pulmonary mycosis was significantly higher (10%) in the age group above 50 years when compared to secondary pulmonary mycosis which was only( 4%). &#xD;
&#xD;
The present study demonstrated that Candida and Aspergillus species constitute the main fungi causing pulmonary mycosis and these findings are consistent with reports of Biswas et al and Khalidi et al.11,12 As per the present study, Candida albicans seems to be the frequent isolate.&#xA0; Among the fungal isolates in clinically suspected pulmonary tuberculosis patients. This finding related to the occurrence following previously published reports by Njunda et al and Jha et al.13,14 Tuberculosis infection manifest with a wide spectrum of clinical conditions resulting from multisystem involvement producing varied clinical features due to opportunistic infections. Mycotic infection is an important co-infection in such patients. Active mycosis is an independent marker of advanced immunosuppressive patients, which can accelerate the clinical course of tuberculosis. &#xD;
&#xD;
The occurrence of pulmonary tuberculosis in the present study was 12% in the study population, of which the occurrence of pulmonary tuberculosis as primary pathogen seen in 8% of patients and the remaining 4% of patients was as the combination of pulmonary tuberculosis along with pulmonary mycosis. The relationship between fungus and tuberculosis infection has been studied earlier. It was reported that 24% of cases of opportunistic fungal infections were present in tuberculosis patients.15 This was strongly proved by the study of Shome et al.16 and Bansod et al.17 who reported 18% and 40%.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Pulmonary mycosis can be a primary infection in non-tuberculosis cases or co-infection in pulmonary tuberculosis cases. It can be caused by either endemic or opportunistic fungi or a combination of both pulmonary mycoses can be easily misdiagnosed and mistreated as pulmonary tuberculosis. Investigation for fungal cause in clinically suspected cases of pulmonary tuberculosis will prevent misdiagnosis and mismanagement of cases. Of late emergence of various types of drug resistance strains among the Mycobacterium tuberculosis (MDR&#x2013;TB, XDR&#x2013;TB, XXDR&#x2013;TB) is documented. Hence the unwarranted chemotherapy in non-tuberculosis cases will curtain the emergence of drug-resistant strains. The present study indicates that fungal aetiology should also be sought in all clinically suspected pulmonary tuberculosis patients.&#xD;
&#xD;
ACKNOWLEDGEMENT: Authors acknowledge greatly the scholars whose articles are cited and included in references of this manuscript and also to authors,&#xA0; editors and publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. We are sincerely indebted to all the patients who made this study possible. &#xD;
&#xD;
Informed Consent: The patient was informed and taken written consent was obtained before the initiation of the study.&#xD;
&#xD;
Sources of funding: No funding&#xD;
&#xD;
Conflict of interest: There is no conflict of interest from our side for this study.&#xD;
&#xD;
AUTHOR&#x2019;S CONTRIBUTIONS&#xD;
&#xD;
Dr. J. Gerard&#xA0; Rakesh: Designed the study, protocol writing and manuscript preparation&#xD;
&#xD;
Dr. J. Margaret Theresa: Manuscript review and guided the research work.&#xD;
&#xD;
Ms. Durga Bhavani: Sample documentation and protocol writin&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3652</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3652</Fulltext></URLs><References>1. Meersseman W, Lagrou K, Maertens J, Wijngaerden EV. Invasive aspergillosis in the intensive care unit. Clin Infect Dis 2007;45(2):205-16.&#xD;
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2. Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Resp J 2007;30(4):782-800.&#xD;
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3. Jasmer RM, Nahid P, Hopewell PC. Latent tuberculosis infection. New Engl J Med 2002;347(23):1860-6.&#xD;
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4. Babita SS, Prabhat K. Prevalence of mycotic flora with pulmonary tuberculosis patient in a tertiary care hospital. Int J Contemp Med Res 2016;3(9):2563-4.&#xD;
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5. Kali A, Charles MP, Noyal MJ, Sivaraman U, Kumar S, Easow JM. Prevalence of Candida co-infection in patients with pulmonary tuberculosis. Aus Med J 2013;6(8):387.&#xD;
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6. Chadeganipour M, Shadzi S, Dehghan P, Bijary J. The incidence of opportunistic fungi in patients suspected of tuberculosis. Mycoses 2000;43(7?8):269-72.&#xD;
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7. Buthia T, Adhikari L. Pulmonary mycoses among the clinically suspected cases of pulmonary tuberculosis. Int J Res Med Sci 2015;3(1):260-268.&#xD;
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8. Shadzi S, Chadeganipour M. Isolation of opportunistic fungi from bronchoalveolar lavage of compromised hosts in Isfahan, Iran. Mycopathologia 1996;133(2):79-83.&#xD;
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9&#xA0; Latha R, Sasikala R, Muruganandam N, Babu RV. Study on the shifting patterns of Non-Candida Albicans Candida in lower respiratory tract infections and evaluation of the CHROMagar in the identification of the Candida species. J Microbiol Biotechnol Res 2011;1(3):113-119.&#xD;
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10. Greer AE, Gemoets HN. The coexistence of pathogenic fungi in certain chronic pulmonary diseases: with especial reference to pulmonary tuberculosis (a preliminary report). Dis Chest 1943;9(3).&#xD;
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11. Biswas D, Agarwal S, Sindhwani G, Rawat J. Fungal colonization in patients with chronic respiratory diseases from the Himalayan region of India. Ann Clin Microbiol Antimicrob 2010;9(1):28.&#xD;
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&#xA0;12. Buthia T, Adhikari L. Pulmonary mycoses among the clinically suspected cases of pulmonary tuberculosis. Int J Res Med Sci 2015;3(1):260-268.&#xD;
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13. Njunda AL, Ewang AA, Kamga LH, Nsagha DS, Assob JC, Ndah DA, Kwenti TE. Respiratory tract Aspergillosis in the sputum of patients suspected of tuberculosis in Fako division-Cameroon. J Microbiol Res 2012;2(4):68-72.&#xD;
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14. Jha BJ, Dey S, Tamang MD, Joshy ME, Shivananda PG, Brahmadatan KN. Characterization of Candida species isolated from cases of lower respiratory tract infection. Kathm Univ Med J 2006;4(3):290-294.&#xD;
&#xD;
15. Babita SS, Prabhat K. Prevalence of mycotic flora with pulmonary tuberculosis patient in a tertiary care hospital. Int J Contemp Med Res 2016;3(9):2563-2564.&#xD;
&#xD;
16. Shome SK, Upreti HB, Singh MM, Pamra SP. Mycosis associated with Pulmonary Tuberculosis. Ind J Tub 1976;23:64-68. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;17. Bansod S, Rai M. Emerging of Mycotic infection in patients infected with Mycobacterium tuberculosis. World J Med Sci 2008;3(2):74-80. &#xD;
&#xD;
&#xA0;&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Morphometric Analysis of Human Adrenal Glands of Hanging and Poison Suicidal Death Cases in Different Age Group&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>41</FirstPage><LastPage>47</LastPage><AuthorList><Author>K. Manivannan</Author><AuthorLanguage>English</AuthorLanguage><Author> Kafeel Hussain</Author><AuthorLanguage>English</AuthorLanguage><Author> H.R. Krishna Rao</Author><AuthorLanguage>English</AuthorLanguage><Author> R. Sasikumar</Author><AuthorLanguage>English</AuthorLanguage><Author>  D. Rama Manohara Reddy</Author><AuthorLanguage>English</AuthorLanguage><Author> P. Janaki Raman</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adrenal gland, Hanging, Poison, Stress, Suicide</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Suicide is the outcome of complex interactions of biological, psychological, and environmental factors. It is an enormous public health problem in the United States and all around the world. Each year over 30,000 people in the United States and nearly 900,000 people worldwide die by suicide, making it one of the leading causes of death.1,2&#xD;
&#xD;
It is the leading cause of death among teenagers and adults 15 to 49 years of age ranked among the top 13 causes of death for individuals of all ages worldwide by World Health Organization (WHO)3 and the National Safety Council rates it sixth in the United States.4&#xD;
&#xD;
Eighty-four per cent of suicides occur only in India and China in the world.5 The World Health Organization reported that about 170,000 people die from suicide in India. However, India&#x2019;s National Crime Records Bureau (NCRB) &#x2013; which report official suicide rates based on police reports &#x2013; estimated only 135,000 suicides in the year 2017.5 Worldwide, more than 9 million deaths are annually reported of suicide, 20% are Indians, for 17% of the world population. Suicide is one of the three leading causes of death among people aged between 15&#x2013;44 years in some countries and the second-leading cause of death aged between 10&#x2013;24 years; these figures do not include the suicide attempts, which are up to 20 times more frequent than completed suicide.6&#xD;
&#xD;
Adrenal glands (AG) are a pair of endocrine glands yellowish-brown in colour due to their content of lipids which are important for the sustainability of life to provide the general physiological organization of the organism in the body.AG also being known as adrenals, suprarenal or suprarenal gland is just due to its locations related to the kidneys.7,8&#xD;
&#xD;
AG are triangular-shaped endocrine glands located on the posterior wall of the abdomen on the antero-superior aspect of the upper end of each kidney at the L1 vertebrae level. Each gland measures 5 cm in length, 3 cm in breadth, 1 cm in thickness and 5 gm weight.9-11 Right adrenal gland (RAG) is a pyramid-shaped gland that is located close to the inferior vena cava (IVC) which connected by the right adrenal vein and is in strong contact with the uncovered area of the liver. The left adrenal gland (LAG) is semilunar shaped and slightly longer and wider compared to the right one. It is neighbored by the abdominal aorta and the cardiac end of the stomach. The anterior surface of the&#xA0; gland is related to the pancreas, splenic artery and with spleen partially in the Lower part &#xD;
&#xD;
The shape and structure of the glands can change due to many diseases. Clinical studies have shown that stress plays an important role in affecting adrenal gland structure and function. In particular, adrenal gland size is partially regulated by adrenocorticotropic hormone (ACTH) stimulation12, which is known to regulate stress corticosterone levels during the hypothalamic-pituitary-adrenal (HPA) axis activation due to acute physical or mental stress.13 Elevation of plasma cortisol level and enlargement of adrenals have been found in those who suffer from chronic stress and in depressed patients14, and increases in adrenal weight have been found in individuals who have committed suicide.15&#xD;
&#xD;
The present study aims to analyze the morphometric changes in the dimensions of adrenal glands such as length, breadth, thickness and weight in hanging which belongs to chronic stress sudden death and poison which belongs to chronic stress and delayed death after intake of poison. This study will be useful for forensic surgeons, Forensic Pathologist and the Medico-legal fraternity to determine the changes in adrenals.&#xA0; &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The analytical comparative study was done after approval by the institutional human ethical committee at PES institute of medical sciences and research, Kuppam, Chittoor district. A total of 186 suprarenal glands obtained from 93 autopsy cadavers those belongs to hanging (52 cases) and poison (41 cases) and age between 20 to 50 years were included in this study and divided into three age groups such as 20-30 yrs (43 cases), 31-40 yrs (26cases) and 41-50 yrs (24 cases) when undergone postmortem examination in Sri Venkateswara hospital, Tirupati, Chittoor district, Andhra Pradesh in the years 2018 and 2019. The usual dissection kit was used to clean and dissect the adrenal gland specimens after stored in 10% formalin for preservation and fixation for up to twelve to twenty-four hours to prevent autolysis, to reduce the shrinkage and distortion (IHEC no-21).&#xD;
&#xD;
The length,&#xA0;&#xA0; breadth, thickness of the right and left adrenal glands were measured with Vernier calliper and the weight of the glands were checked with a digital weighing machine with an accuracy of 0.1mg(ShimadzuAY220 Analytical balancer max&#xA0; 220gm min&#xA0; 10mg, Mettler-Toledo India Private Limited Mumbai e=1mg&#xA0; d=0.1mg)after dissecting the suprarenal glands meticulously by removing the surrounding fat and fascia.&#xA0; The lengths of both right and left adrenal glands were measured at the base of the gland (Figure 1), the part which is related to kidneys. The breadth of the right adrenal gland was measured from apex to base (Figure 2). The breadth of the left adrenal gland was measured at the level of the middle of the gland.&#xA0; The thickness of the glands was measured at the level of the hilum of both glands to maintain the uniformity where the suprarenal vein is coming out of the glands (Figure 3). The weight was measured with the digital weighing machine with an accuracy of 0.1mg (Figure 4). &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Inclusion Criteria&#xD;
&#xD;
Both genders of suicidal (Hanging and poison) death cases&#xD;
&#xD;
3 Age group 20-30 years, 30-40 years and 40-50years&#xD;
&#xD;
Time of autopsy in between 12-24 hours after death&#xD;
&#xD;
Exclusion Criteria&#xD;
&#xD;
Adrenal abnormalities &#xD;
&#xD;
Chronic debilitating illness&#xD;
&#xD;
Decomposed autopsy cases&#xD;
&#xD;
Pregnant women &#xD;
&#xD;
Accident cases&#xD;
&#xD;
Burns&#xD;
&#xD;
Age group less than 20 and more than 50&#xD;
&#xD;
Commence of autopsy less than 12 hrs and more than 24 hrs.&#xD;
&#xD;
&#xA0;Statistical Analysis &#xD;
&#xD;
An Independent t-test was performed using the Statistical Package for Social Sciences (SPSS) for Window version 21.0 software. Values of p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3653</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3653</Fulltext></URLs><References>&#xD;
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	US Public Health Service. The Surgeon General&#x2019;s call to action to prevent suicide. Washington, DC: US Public Health Service; 1999.&#xD;
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	Bertolote JM, Fleischmann A. Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry 2002;1(3):181&#x2013;185.&#xD;
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	National Crime Records Bureau. Accidental Deaths and Suicides in India. New Delhi: Government of India; 2008.&#xD;
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	World Health Organization Report. Suicide prevention. ; 2009 accessed 13.08.10.&#xD;
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	Yvonne M Ulrich-Lai, Helmer F Figueiredo, Michelle M Ostrander, Dennis C Choi, Wiiliam C Engeland,&#xA0; James P Herman.&#xA0; Chronic stress induces adrenal hyperplasia and hypertrophy in a subregion-specific manner. Am J Physiol Endocrinol Metab 2006; 291:965-73. &#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Adjunct Effect of Kinesiotaping on Adhesive Capsulities of Shoulder Joint&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>48</FirstPage><LastPage>53</LastPage><AuthorList><Author>Neha Deshmukh</Author><AuthorLanguage>English</AuthorLanguage><Author> Milind Kahile</Author><AuthorLanguage>English</AuthorLanguage><Author> Neha Chaudhary</Author><AuthorLanguage>English</AuthorLanguage><Author> Shweta Panchbhudhe</Author><AuthorLanguage>English</AuthorLanguage><Author>  Vasant Gawande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Adhesive Capsulitis, Kinesio Taping, End range mobilization, Movement with mobilization</Keywords><Fulltext>Introduction &#xD;
&#xD;
The shoulder is a unique anatomical structure with an extraordinary range of motion that allows us to interact with our environment A loss of mobility of this joint will cause significant morbidity. Adhesive capsulitis is a poorly understood musculoskeletal condition that can be disabling both physically and mentally. Although adhesive capsulitis of the shoulder is a self-limiting disorder that resolves in 1-3 years, some studies report range between 20% and 50% of patient with adhesive capsulitis suffers long term ROM deficits that may last up to 10 years1. Current findings report that patients presenting with shoulder dysfunction have an approximately 50 this opportunity of being diabetic. By understanding the knowledge of the high prevalence of shoulder dysfunction among people with diabetes will urge clinical practitioner to screen patients with shoulder pain for diabetes. Early diagnosis and prompt management of diabetes are understood to scale back the danger of musculoskeletal complications. Monitoring for signs of musculoskeletal complications is often a useful component of comprehensive diabetes care. Alarming high prevalence of shoulder dysfunction and the other way around will alert the clinical practitioners for early detection and management to realize better shoulder function. Diabetic care programs must include screening, prevention, ketoacidosis, foot ulcer, pancreatitis and rehabilitation strategies for shoulder dysfunction.2-5 There are various measures to manage the adhesive capsulitis of the shoulder joint such as Steroid injection with or without physical therapy, Physical therapy with interscalene block or local anaesthesia, distension arthrography, closed manipulation arthroscopic release or open release.6,7 But limited researchers are available to support the use of the above treatment. Kinesio taping is gaining popularity these days due to its comfort provided in functional activities. KT was designed to mimic the qualities of human skin. It has roughly the same thickness as the epidermis and can be stretched between 30% - 40% of its resting length longitudinally. KT is considered a safe technique that has minimal side effects, which may facilitate musculoskeletal rehabilitation by reducing the discomfort. It is a unique and non-invasive approach for the treatment of musculoskeletal injuries. KT will assist the body to returns to normal function through its application onto the skin. The primary effect of tape application is usually superficial. The success of KT depends on two factors, firstly the proper evaluation of the patient&#x2019;s condition and, the proper application of the KT technique. When these two factors are combined, an effective treatment modality can be achieved. Kase et al have proposed several benefits of the application of Kinesio tape. The application of KT provides positional stimulus through the skin, align fascial tissues, create more space by lifting fascia and soft tissue above the area of pain/inflammation, and provides sensory stimulation to assist or limit motion. It also assists in the removal of oedema by directing exudates toward the lymph duct8. There is no high-level evidence to support or refute many of the commonly used treatments for adhesive capsulitis of the shoulder joint. And also there is less evidence to prove the beneficial effect of various treatment regimes on pain and ROM in adhesive capsulitis of the shoulder joint with a combination of the treatment strategies. The use of any treatment regimen alone is limited in the adhesive capsulitis of the shoulder joint. Hence this condition is always treated with a combination of treatment strategies. Also, there is little information available from randomized clinical trials to support the use of a combination of the mobilization techniques and other approaches like KT for treating the adhesive capsulitis of the shoulder joint. The use of KT in treating shoulder impingement was well studied. But there is paucity of recommending the use of KT in treating the adhesive capsulities of the shoulder joint. Adhesive capsulities of shoulder joint have proven adverse effect on person&#x2019;s quality of life. Although AC affects the physical function of an individual, there are various studies showing its impact on the mental status.6,7,8 Researchers have found that the mental function of subjects with adhesive capsulitis was lower when compared to age-matched controls. The adding effects of physical and mental status adversely affect the quality of life. The scale used in the present study to calculate the effect of adhesive capsulitis on the functional status of the patient is widely considered as a valid measure to observe pain relief, passive motion, and patient&#x2019;s satisfaction. UCLA [University of California- Los Angeles] scale is precise to effectively follow the progress of individual patients in the clinic setting. Despite its frequent use in research, no studies have evaluated either the reliability or the validity of measurement obtained with the shoulder scale9. Studies also revealed that the UCLA score shows more favourable results when compared with other scales. The salient feature of UCLA is; it is relatively easy to complete and also have objective measures10. Thus in the present study, we aim to find out the effect of Kinesio taping on the function of the individuals diagnosed with adhesive capsulitis of the shoulder joint. &#xD;
&#xD;
Need for Study:&#xD;
&#xD;
&#xA0;The hallmark of adhesive capsulitis of the shoulder is a global decreased in ROM and shoulder pain. The pain is often described as a poorly localized and deep ache. The pain may radiate proximally or distally from the shoulder joint and also can radiate towards the scapular distally from the shoulder joint and also can radiate towards the scapular and interscapular region. Weakness is often related to pain or concomitant tendinopathy. All these symptoms lead to hampered and restricted daily activities. This certainly indicates that shoulder dysfunction directly impacts the person&amp;#39;s quality of life.&#xD;
&#xD;
&#xA0;Objective:&#xD;
&#xD;
&#xA0;To determine the effect of Kinesio taping on pain and function in adhesive capsulitis of shoulder joint. &#xD;
&#xD;
Procedure:&#xD;
&#xD;
The ethical clearance was obtained to conduct a randomized control trial on 30 individuals diagnosed with adhesive capsulitis of the shoulder joint from the institutional ethical committee. The institutional physiotherapy OPD was targeted to obtain the individuals for carrying out the study. Simple random sampling by using the lottery method was used to group the individuals. Dependent variables were pain and functions, were as mobilization and Kinesio taping technique were the independent variables. Both genders with age between 40-65yrs were included and history of any shoulder surgery before 12 weeks, healing/ unhealed fracture around the shoulder girdle, healing/ unhealed soft tissue injury around shoulder girdle and presence of malignancy or any infective condition around shoulder girdle were excluded.11&#xD;
&#xD;
15 individuals in the first group were treated with the mobilization technique.ERM:10-15 repetition of Grade IV mobilization11, MWM: 3 sets of 10 repetitions, with 1 min rest between sets12. The remaining 15 were given Kinesio taping to check the adjunct effect along with mobilization techniques.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Intervention Duration was 6weeks (3 sessions per week) and the result in a change of function on the UCLA scale was observed during the period and also over the period ( Figure 1).&#xD;
&#xD;
Results:&#xD;
&#xD;
A total of 30 subjects with a diagnosis of stage II or III adhesive capsulitis of the shoulder joint were recruited for the study to find the additional effect of Kinesio taping along with ERM and MWM. For the statistical test p &lt; 0.05 was considered as statistically significant. Statistical software STATA version 10.0 was used for statistical analysis. Out of the total 30 subjects, 19 were female and 11 were male. The mean age in group A was 51.13&#xB1;7.03 and for the group, B was 53.4&#xB1;5.81 years. In the current study, the continuous variables were pain on VAS, functional score on the UCLA scale. The mean score of these variables was assessed at 3 different time interval, on Day 1, after 3 weeks and after 6weeks of intervention. Both the groups showed a highly significant reduction in pain score when compared at different time interval i.e. after 3rd weeks and after 6th weeks of intervention by using one way repeated measure ANOVA. In Group A at end of the 3rd week, the pain score was 5.26&#xB1;1.22 and for Group B the pain score was 4.13&#xB1;1.06. And at the end of the 6th week the pain score in group A was 3.8&#xB1;1.14 and in Group B was 3.06&#xB1;0.88. Comparison of pain was done between Group A and Group B over the period by using the Wilcoxon Rank Sum test. After 3 weeks of intervention, the reduction was highly significant in Group B compared to Group A.&#xD;
&#xD;
Over day 1 to 3 weeks of intervention the average difference in the pain score of Group A was 1.06&#xB1;1.04 and Group B was 2.26&#xB1;1.16. Over day 1 to 6 week&#x2019;s period, the average difference in the pain score of Group A was 2.53&#xB1;1.35 and in Group B was 3.33&#xB1;1.11. And over 3 weeks to 6 weeks period the average difference in pain score of Group A was 1.06&#xB1;0.73 and Group B was 1.46&#xB1;1.24. Improvement in functions was also significant with the UCLA score at the different period ( Table 1 and 2).&#xD;
&#xD;
&#xD;
&#xD;
Discussion:&#xD;
&#xD;
The purpose of this randomized controlled trial was to know functional activity improvements and efficacy of the Kinesio taping as an adjunct to movement with mobilization and end range mobilization in adhesive capsulitis of the shoulder joint in reducing pain, improving range of motion and the shoulder functional activity. &#xD;
&#xD;
Diagnosed cases of adhesive capsulitis are associated with painful movement and functional deficit and physical therapy is often the first choice for conservative management. In terms of improving shoulder mobility, the evidence suggests that patient receiving the manual therapy intervention for adhesive capsulitis demonstrated improvement.13&#xD;
&#xD;
Various physical therapy approaches have been suggested for shoulder musculoskeletal disorder like impingement syndrome, adhesive capsulitis, and rotator cuff injury. This includes manual therapy, electrotherapy, acupuncture, and exercise therapy.&#xD;
&#xD;
Several disease-specific systematic reviews examining the efficacy of physical therapy negate the effect of electrotherapeutic modalities and support the utilization of manual therapy and exercises13.&#xD;
&#xD;
Manual therapy mainly emphasizes the use of various kind of mobilization techniques in regaining the range of motion and reducing pain thus improving the functional activity in subjects with adhesive capsulitis of the shoulder joint 14,15.&#xD;
&#xD;
Both the genders were included in the study and most of the subjects reported with symptoms were in the age group of 50-59 years. A total of 30 subjects were evaluated and treated with a diagnosis of adhesive capsulitis of the shoulder joint.&#xD;
&#xD;
After the data collection, it was found that the numbers of the female subject were more than their counterparts. The female: male ratio in both groups was 3:1. A sample survey done by various researchers had found that the incidence of adhesive capsulitis is common in females than in males16.&#xD;
&#xD;
A Majority 70% of the subjects included in the study had dominant shoulder involvement. Overuse of the shoulder is one of the predisposing factors for tendinitis which can progress to adhesive capsulitis. &#xD;
&#xD;
The current study also shows a significant relationship between diabetes mellitus and the occurrence of adhesive capsulitis of the shoulder joint. In the study, 56.6%subjects were diagnosed with cases of diabetes mellitus. The finding of the present study can be correlated by the study done by Milgrom et al. who found that 29.3% of subjects diagnosed with adhesive capsulitis had Diabetes mellitus.17 &#xD;
&#xD;
In the present randomized controlled trial Group A was treated with End range mobilization (ERM) and Movement with mobilization (MWM). To achieve the primary goal, Group B was given KT in addition to ERM and MWM. At the end of the intervention protocol, both the groups were statistically analyzed.&#xD;
&#xD;
As the pain was the major complaint of the subjects, pain evaluation at the end of the 6th week showed a significant reduction in both the groups (p&lt; 0.0001) as compared to pre-intervention pain assessment. The reduction of pain was uniform from 0-3 weeks and 3-6 weeks in Group A. Group B showed a sudden reduction in pain in the initial 3 weeks of application of KT as an adjunct to ERM and MWM. Further rate of reduction was gradual which was similar to the reduction in Group A during the 3-6 weeks of intervention. When both groups were compared over the period, Group B showed a significant reduction of pain in the initial 3 weeks of intervention than in Group A and a non-significant difference in pain during later 3-6 weeks of intervention. This reduction of pain in Group B can be attributed to the application of KT.&#xD;
&#xD;
The effect provided by KT is due to the modulation of pain via pain gate control theory. It has been proposed that KT stimulate the neuromuscular pathway via increased afferent feedback. Under the gate control theory, an increase in afferent stimulus through large-diameter nerve fibres can serve to mitigate the input received from small-diameter nerve fibres conducting nociception6.&#xD;
&#xD;
In this study, the basic muscle techniques that are inserted to origin was used along with a mechanical correction. Mechanical correction is positional. It does not attempt to keep the tissue or joint in a fixed position. It provides a stimulus perceived by the mechanoreceptor and is used to assist in positioning the muscles, fascial tissue or joint to stimulate the senses. This results in the body&#x2019;s adaptation to the stimulus. Mechanical correction via KT can also be used as functional support without losing the AROM.18&#xD;
&#xD;
The studies conducted by Djordjevic and Kamat et al.19 also showed a significant reduction in pain and improvement in ROM with combined MWM and KT. They also discussed that the effects of MWM can be maintained further via taping and self MWM, which may further enhance its potential long-lasting effect. It was also stated that taping can help in maintaining joint position and can increase proprioceptive awareness.&#xD;
&#xD;
As the original idea of MWM techniques, that is, correcting the positional fault in the malaligned painful joint. The application of KT can sustain the corrected joint position for a longer time.19,20&#xD;
&#xD;
Another outcome measure in the present study was AROM and PROM. Both the groups showed improvement in the ROM. Group B showed marginally greater improvement, but it was not a statistically significant improvement in an intragroup comparison over the period. Marginal improvement in Group B can be attributed to the relief of pain provided by KT. As proposed by Kaya et al. &#xA0;KT provides continuous pain gating and proprioceptive awareness that improves motor recruitment.21&#xA0;KT also guides the shoulder through an arc of improved glenohumeral motion, which reduces mechanical irritation of the involved soft tissue structures thus improving both active and passive ROM.&#xD;
&#xD;
The reduction of pain and improvement in AROM and PROM in both the groups were also ascribed to ERM and MWM.&#xD;
&#xD;
ERM is the small amplitude rhythmic oscillatory movement given to the joint at its end range. These small amplitude oscillatory movements are used to stimulate the mechanoreceptor that may inhibit the transmission of the nociceptive stimuli at the spinal cord or brain stem level11,21.&#xD;
&#xD;
This study can be correlated with the research done by Kumar et al. who proposed that mobilization of the shoulder must be added to the supervised exercise program to achieve goals of reducing pain, improving ROM, and function, in adhesive capsulitis.22&#xD;
&#xD;
Small amplitude gliding movement of the joint is used to cause synovial fluid motion. That causes the nutrients exchange and thus prevents the painful effect of stasis when a joint is painful and motions are restricted.&#xD;
&#xD;
The malposition of one bony partner concerning its opposing surface may result in limited motion or pain. With MWM correction of the positional faults results in the reduction of pain and improving the range of motion.23&#xD;
&#xD;
The non-stretch gliding or distraction techniques applied using MWM prevent the restriction effect of immobility which causes pain and dysfunction. It is considered that further improvement in pain reduction can be achieved through the application of pain-free passive overpressure at the end of the range of motion (ROM) during MWM procedures.19,20&#xD;
&#xD;
It is also suggested that improving function and reducing pain after MWM may be due to the promotion of active movement in this technique, which may engage additional proprioceptive tissue such as the Golgi tendon organ activated by a tendon stretch.6&#xD;
&#xD;
Joint motion applied using ERM and MWM stimulates biological activity by moving synovial fluid which brings nutrients to the avascular articular cartilage of the joint surface. Extensibility and tensile strength of the articular and periarticular tissues are also maintained by the joint motion.&#xD;
&#xD;
The results of the current study can be correlated with the study done by Yang et al. and Vermeulen et al. who found ERM and MWM are effective for increasing mobility and reducing pain in subjects with frozen shoulder syndrome. The proposed mechanism by which ERM and MWM increase the range of motion (ROM) is through stretching of the joint capsule and the surrounding tissues.11,12&#xD;
&#xD;
Normal tissue regeneration and remodelling depends on mechanical stimulation during the repair process. This mechanical environment can be provided by ERM and MWM. This helps in improving&#xD;
&#xD;
the tissues overall mechanical and physical behaviour such as tensile strength and flexibility. ERM and MWM are used to stretch and elongate the shortened tissues improving the ROM and reducing abnormal stresses on the body.&#xD;
&#xD;
The reduction of pain and improved ROM in the present study may also be the effect attributed by the superficial healing modality which was given before the manual therapy and KT for 10 min. The application of superficial heat produces local physiological changes which resulted in therapeutic effects like the relief of pain ( pain gate mechanism, reducing muscle spasm)and improvement in ROM (tissue extensibility).&#xD;
&#xD;
The significant reduction in pain and improved AROM and PROM contributes to improving the functioning of the shoulder joint which was assessed by the UCLA score in the current study. The UCLA score shows significant improvement in both groups. Intergroup comparison between both the groups over the period showed marginally higher improvement Group B in initial 3 weeks of intervention and then the improvement in both the groups was similar.&#xD;
&#xD;
Functional disability and pain are related to each other and hence, these components of quality of life are in an indirect relationship with sleep disturbance which has a direct relation with pain and functional disability24. Several studies related to shoulder joint were reported.25 Articles on different parameters of related condition were reviewed.28.&#xD;
&#xD;
The attributed effect of KT along with ERM and MWM which reduces the pain and improve the ROM significantly caused better functioning of the shoulder thus improvement in the UCLA score.25-28&#xD;
&#xD;
It can be concluded from the present study that the application of KT as an adjunct helped to alleviate pain, improve ROM and functioning of the shoulder joint. But this improvement was seen only in the early part of the intervention i.e. from the initial day to 3 weeks with consistent improvement in both groups from 3 weeks to 6 weeks of intervention.&#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
The study was aimed to know the functional improvement in adhesive capsulitis by using KT as an addition to ERM and MWM which shows a significant improvement after 3rd week of treatment. And KT also serves as a good combination along with manual therapy technique to improve functional activity in patients. &#xD;
&#xD;
CLINICAL IMPLICATION:&#xD;
&#xD;
The present study clinically implies that the application of KT along with ERM and MWM can be useful for treating the adhesive capsulitis of the shoulder joint than ERM and MWM only. KT should be added to the intervention regimen while treating the adhesive capsulitis of the shoulder joint. KT may be helpful in subjects where immediate effects on pain, restricted ROM and functioning are required.&#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=3654</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3654</Fulltext></URLs><References>&#xD;
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	Manske R, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Reviews in Musculoskeletal Med. 2008;1(3-4):180-189. 2.&#xD;
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	&#xA0;Wani S, Mullerpatan R. Prevalence of shoulder dysfunction among Indian people with type II diabetes. Int J Diab Devp Count. 2015;35(3):386-386. &#xD;
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	Kamble A, Ambad RS, Padamwar M, Kakade A, Yeola M. To study the effect of oral vitamin d supplements on wound healing in a patient with diabetic foot ulcer and its effect on lipid metabolism. Int J Res Pharm Sci. 2020;11(2):2701-2706.&#xD;
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	Thelen M, Dauber J, Stoneman P. The Clinical Efficacy of Kinesio Tape for Shoulder Pain: A Randomized, Double-Blinded, Clinical Trial. J Orthop Spor Phys Ther. 2008;38(7):389-395. &#xD;
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	Roddey T, Olson S, Cook K, Gartsman G, Hanten W. Comparison of the University of California&#x2013;Los Angeles Shoulder Scale and the Simple Shoulder Test With the Shoulder Pain and Disability Index: Single-Administration Reliability and Validity. Phys Ther. 2000;80(8):759-768.&#xD;
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	Romeo A, Mazzocca A, Hang D, Shott S, Bach B. Shoulder Scoring Scales for the Evaluation of Rotator Cuff Repair. Clin Orthop Rel Res. 2004;427:107-114.&#xD;
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	&#xA0;Vermeulen H, Obermann W, Burger B, Kok G, Rozing P, van den Ende C. End-Range Mobilization Techniques in Adhesive Capsulities of the Shoulder Joint: A Multiple-Subject Case Report. Physical Ther. 2000;80(12):1204-1213.&#xD;
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	Yang J, Chang C, Chen S, Wang S, Lin J. Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial. Phys Ther. 2007;87(10):1307-1315.).&#xD;
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	Camarinos J, Marinko L. Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review. J Manual &amp; Manipulative Ther. 2009;17(4):206-215.&#xD;
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	Tasto J, Elias D. Adhesive Capsulities. Sports Med Arthroscopy Rev. 2007;15(4):216-221.&#xD;
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	Harma G, Aseer P, Sai P, Venkatesh N. Effects of positional coracohumeral ligament stretching on the size of calcium deposits in adhesive capsulitis. J Health Sci. 2020.&#xD;
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	&#xA0;Sheridan M, Hannafin J. Upper Extremity: Emphasis on Frozen Shoulder. Orth Clin North Am. 2006;37(4):531-539.&#xD;
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	Milgrom C, Milgrom Y, Radeva-Petrova D, Jaber S, Beyth S, Finestone A. The supine apprehension test helps predict the risk of recurrent instability after a first-time anterior shoulder dislocation. J Shoul Elb Surg. 2014;23(12):1838-1842.&#xD;
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	Colaco C. Frozen shoulder: adhesive capsulitis. Bri Med J. 1981;283(6303):1402-1402.&#xD;
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	Jordjevic O, Vukicevic D, Katunac L, Jovic S. Mobilization With Movement and Kinesiotaping Compared With a Supervised Exercise Program for Painful Shoulder: Results of a Clinical Trial. J Manipul Phys Ther. 2012;35(6):454-463.&#xD;
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	Shukla M, Goyal M. Effect of maitland mobilization and conventional physiotherapy exercises in osteoarthritis knee: a comparative study. Int J Physiot Res. 2018;6(6):2952-2956.&#xD;
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	Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheum. 2010;30(2):201-207.&#xD;
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	Kumar A, Kumar S, Aggarwal A, Kumar R, Das P. Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulities. ISRN Rehabilitation. 2012;2012:1-8.&#xD;
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	Kamat SD. Efficacy of mobilization with movement and Kinesio taping versus mobilization with movement and conventional exercises in patients with shoulder impingement: a comparative study. MPTh thesis, Rajiv Gandhi Univ Health Sci. 2012;3(1): 123-126.&#xD;
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	Fernandes M. Correlation between functional disability and quality of life in patients with adhesive capsulitis. Acta Ortop Brasil. 2015;23(2):81-84.&#xD;
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	Singh R. Singam A. Comparison between Supraclavicular and Interscalene Brachial Plexus Block in Patients Undergoing Shoulder Surgery. J Datta Meghe Inst Med Sci Univ. 14, no. 3 (2019): 175&#x2013;78. &#xD;
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	Khobragade S. Naqvi S. Dhankar W, Jungade S. Impact of K-Taping on Sacroiliac Joint Pain in Women after Full-Term Normal Delivery. J Datta Meghe Inst Med Sci Univ 2019;14(4): 352&#x2013;55. &#xD;
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	Meshram, P., A. Pawaskar, and A. Kekatpure. &#x201C;3D CT Scan-Based Study of Glenoid Morphology in Indian Population: Clinical Relevance in Design of Reverse Total Shoulder Arthroplasty. J Clin Orthop Trau. 2020; 11: S604&#x2013;9. &#xD;
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	Saoji KK, Gawande V, &#xA0;Dulani R. A Comparative Study of Disability and Pain Assessment by Shoulder Pain and Disability Index (Spadi) Score in Patients of Adhesive Capsulitis Treated by Hydrodilatation with and without Corticosteroids. Int J Curr Res Rev.2020; 12,(14): 35&#x2013;40. &#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Efficient Neural Recording Amplifier for Brain Machine Interface&#xD;
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&#xA0;&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>54</FirstPage><LastPage>57</LastPage><AuthorList><Author>Gunda Akanksha</Author><AuthorLanguage>English</AuthorLanguage><Author> Kaipa Sahithi</Author><AuthorLanguage>English</AuthorLanguage><Author> Lavanya Maddisetti</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: In recent years, neural system study has become a fruitful approach in diagnosing neurological diseases. Brain signals being at very low potentials pose a difficulty to study them. Fault analysis of those signals may lead to improper diagnosis of the diseases. So, amplification of the brain signal is required. The amplified signal is prone to noise. Objective: To meet the limitations of the neural acquisition system a novel design for ultra-low noise neural recording amplifier is discussed in this paper. Methods: Characterization of transistors is the technique used to design the amplifier. The amplifier is designed in a standard 0.18&#xB5;m Complementary metal oxide semiconductor process (CMOS). Results: The amplifier achieved a gain of 43.6dB with a total power consumption of 26.29&#xB5;W and input-referred noise of 313.6pVrms.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Brain-machine interface, Neural amplifier, Operational transconductance amplifier, Band pass filter, Input referred noise, Gain</Keywords><Fulltext>Introduction&#xD;
&#xD;
Ease of recognition of neural syndrome is made possible by following the procedural and standard methods such as cortical stimulation or transcranial stimulation. Similar to pacemakers the cortical simulation is nothing but the insertion of electrodes into the cortical areas of the brain which is in contrast to the deep brain stimulation which inserts the electrodes into deeper parts of the brain. But the transcranial stimulation just collects the neural information through the electrodes implanted of the scalp.1,2 All these approaches can be used to assist with the recovery of patients who suffered from motor neuron syndromes and neurological defaults. And these approaches also help paralyzed patient move a computer cursor by thoughts alone.3,4 But these approaches are limited to large equipment so a modern approach is made into practice which overcomes the limitation of cortical stimulation. The modern technique is nothing but the implantation of chip/IC into the cortical areas of the brain.5 The chip/IC implanted is nothing but the neural recoding IC. The critical part of the neural recording IC is the neural recording amplifier (NRA) which is solely responsible for the ease of analysis of neural signals.6 The main aim of the neural recording amplifier is to strengthen the neural signal which is at a low potential to ease the analysis. &#xD;
&#xD;
The setup of the implantable neural acquisition system is shown in figure1.7 The system consists of an internal unit and an external unit. The internal unit consists of a front-end processing stage that amplifies and digitizes neural signals from recording electrodes. The digitized neural data from the front-end processing stage is then processed by a digital signal processing module on the internal unit before the processed neural data is transmitted to the external unit via a wireless data telemetry system. The external unit receives the neural data and relays it to a remote device such as a computer. Due to the stringent requirement of less noise in the signal the goal of the paper is to decrease the noise. Chopper stabilization is a technique used to reduce the flicker noise components in the amplifier at low frequencies but it requires additional circuitry.8,9 Additional circuitry increases the area and also increases power consumption. The chopper technique also reduces the input impedance which leads to attenuation of the input neural signal.10 P-type metal oxide semiconductors are responsible for reducing flicker noise.11 So, the differential pair used in the design is a p-type metal oxide semiconductor. As the neural acquisition system is to be operated at low potentials, due to decrease in supply voltage power consumption will be increased.12 So noise power trade of is maintained in the circuits designed nowadays. The presented work outperformed the previous work in terms of noise-power trade-off.&#xD;
&#xD;
Material and Methods&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Amplification plays a major role in the analysis of the neural signal because the original signal occurs at a very low potential and small frequency. So, the proper choice of amplifier is to be done to achieve the design requirements. Amongst the variety of amplifiers available Operational Trans-conductance Amplifier (OTA) best suited for the neural signal analysis because the circuit can be stabilized or controlled by the input bias current. By this, it best fits the applications it is designed for. An Operational Transconductance Amplifier is a differential amplifier whose output current is controlled by input voltage sources. Thus, it is also called a voltage-controlled current source. Thus, the OTA amplifies the neural signal which is suitable for diagnosis. Even though the required amplification is achieved there may be some loss of information or adding additional information which may lead to errors in the diagnosis. So, not only the selection of amplifiers, the configuration of the amplifier must be done efficiently. So, a Bandpass filter (BPF) is integrated along with the designed OTA so that the loss or gain of erroneous information will not affect the original signal. The Bandpass filter is also used to adjust the neural signal between respective frequencies, which may be very helpful during the reverse treatment. The schematic of the overall neural amplifier is shown in figure 2. The design procedure of the OTA and the Band Pass Filter is altered to achieve more effective results. The design procedure is explained in the preceding section.&#xD;
&#xD;
The circuit schematic of the OTA is shown in figure 3.13 The OTA consists of 18 transistors and each transistor has its importance which contributes to the overall gain of the amplifier. Overall transistor sizing and circuit modelling are based on the transconductance and bias current of the circuit. The gain and transconductance are related as &#xD;
&#xD;
gm =2&#x3C0;.fUG.CL&#xD;
&#xD;
Where fUG is the unity-gain bandwidth and CL is the load capacitance.&#xD;
&#xD;
fUG (unity-gain bandwidth): The closed-loop gain and unity-gain bandwidth is related as &#xD;
&#xD;
fUG=k.ACL.fL&#xD;
&#xD;
where ACL is the closed-loop gain and its value is 20dB and the value of k is chosen to be 2. fLis the frequency of the input signal and the input signal range of bandwidth is 5.32kHz. &#xD;
&#xD;
CL (load capacitance): The load capacitance is placed to insert a pole in the frequency response, which is due to the resistor-capacitor combination at the output of the amplifier. The resistor mentioned here is a virtual resistance shown by the amplifier at the output. Here we assumed a large value of capacitance i.e., 1nF. Considering all these the transconductance of the amplifier is obtained to be 251uS. &#xD;
&#xD;
Characterization of the transistors&#xD;
&#xD;
Characterizing is done to know the unknown parameter by considering a key parameter as a reference, here transconductance is considered as the reference. In our design length is fixed to 1&#xB5;m. The combination of M1 and M2 is said to be a differential pair. These are constructed using P-type Metal Oxide Semiconductor transistors. PMOS is responsible to eliminate flicker noise (1/f noise). The width of the transistor is obtained to be 9um.M3 and M4 merely act as resistors so the width is the same as that of differential pair.M5 and M6 act as tail transistors so current is divided equally among them and thereby the widths of these transistors are same, and these are again characterized using above procedure. The current flowing from Ibias to the current source is the same as that of Mb2 and Mc2. Current flowing in Mb1 and Mc1 is twice as that of current in differential pair. The transistors M7,M8,M9,M10,M11,M12&#xA0;form the second stage and thus the gm for this is again 251uS and the respective widths are obtained. The widths and lengths of all the transistors obtained by characterization are shown in Table 1.&#xD;
&#xD;
From table 1, it is clear that all the transistors are in the saturation region. On setting the width of transistors as in the above table, the gain obtained is 53.2dB. The power consumption is 26.295uW. As discussed earlier to reduce the noise a BPF is integrated into the designed OTA to limit the noise. The BPF not only limits the noise but is also used to maintain the neural signal bandwidth. &#xD;
&#xD;
RESULT&#xA0;AND DISCUSSION&#xD;
&#xD;
The BPF is integrated as the closed-loop configuration to the OTA. After integrating the BPF noise is reduced to the greater extents. The transistors used in the feedback path act as high pass filters and the transistors used at the input side act as low pass filters. The noise after using a BPF is 313.9pVrms. The power remains the same because band-pass filter transistors operate in the sub-threshold region and do not consume much power. &#xD;
&#xD;
In the above graph, the first signal is the output voltage and the second signal is the power signal. For the voltage graph, the X-axis is time(ms) and the Y axis is voltage (v).&#xA0; For the power graph, the X-axis is time(ms) and the Y axis is watts(mW). figure 4 displays the transient response of the designed OTA with BPF which shows the potential of the output signal and the power consumption. The gain of the amplifier with BPF was observed to be 43.9dB.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In figure 5, the first graph is the phase graph and the below shows the gain graph. The X and Y-axes for the phase graph is time (ms) and degrees respectively. The X and Y-axes for the gain graph is time (ms) and gain in dB respectively. The input-referred noise of the OTA with BPF is 313.6pVrms. The noise analysis is shown in figure 6. Here, the X-axis is the frequency in hertz and the Y-axis is the noise factor.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Thus, the limitation to cortical stimulation is solved by using neural recording IC, and an effective way to design a low noise neural amplifier (the major part of neural recording IC) is discussed. The circuit parameters are modelled accordingly and a noise power trade-off is also maintained. The optimized design is applied to achieve the required gain by modelling transconductance. The high noise immunity is obtained by using a BPF and also the signal obtained is in the range of Local Field Potential frequencies. The overall gain of the neural recording amplifier obtained is 43.9 dB with a power consumption of 26. 29&#xB5;W and the input-referred noise obtained is 313.6pVrms.&#xD;
&#xD;
Acknowledgements: This research project was carried out at the Center for Advanced Computing Research Laboratory (C-ACRL), Vardhaman College of Engineering. The authors would like to thank the management and faculty for their constant support throughout.&#xD;
&#xD;
Source of funding: NIL&#xD;
&#xD;
Conflict of interest: NIL&#xD;
&#xD;
Individual author&#x2019;s contribution:&#xD;
&#xD;
Author1 carried out the electrical parameters performance studies such as gain, designed the OTA and drafted the manuscript. &#xD;
&#xD;
Author2 carried out the bandpass filter design, participated in the high noise immunity studies and helped to draft the manuscript. All authors read and approved the final manuscript.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3655</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3655</Fulltext></URLs><References>1. Mavoori J, Jackson A, Diorio C, Fetz E. An autonomous implantable computer for neural recording and stimulation in unrestrained primates. J Neurosci Methods 2005;148(1):71-7.&#xD;
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2. Guillory KS, Normann RA. A 100-channel system for real-time detection and storage of extracellular spike waveforms. J Neurosci Methods 1999;91(1-2):21-9.&#xD;
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3. Wessberg J, Stambaugh CR, Kralik JD, Beck PD, Laubach M, Chapin JK, et al. Real-time prediction of hand trajectory by ensembles of cortical neurons in primates. Nature 2000;408(6810):361-365.&#xD;
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4. Chapin JK, Moxon KA, Markowitz RS, Nicolelis MA. Real-time control of a robot arm using simultaneously recorded neurons in the motor cortex. Nat Neurosci 1999;2(7):664-70.&#xD;
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5. Sarpeshkar R, Wattanapanitch W, Arfin SK, Rapoport BI, Mandal S, Baker MW, et al. Low-power circuits for brain-machine interfaces. IEEE Transact Biomed Circ Syst 2008;2(3):173-83.&#xD;
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6. Majidzadeh V, Schmid A, Leblebici Y. Energy-efficient low-noise neural recording amplifier with enhanced noise efficiency factor. IEEE Transact Biomed Circ Syst 2011;5(3):262-71.&#xD;
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7. Punekar G, Gonuguntla V, Yellappa P, Choi JR, Vaddi R. A Low-power Low-noise Open-loop Configured Signal Folding Neural Recording Amplifier. In 2018 International SoC Design Conference (ISOCC) 2018 Nov 12 (pp. 99-100). &#xD;
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8. Tasneem NT, Mahbub I. Design of A 52.5 dB Neural Amplifier with Noise-Power Trade-off. In2019 IEEE 62nd International Midwest Symposium on Circuits and Systems (MWSCAS) 2019 Aug 4 (pp. 921-924). &#xD;
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9. Enz CC, Temes GC. Circuit techniques for reducing the effects of op-amp imperfections: autozeroing, correlated double sampling, and chopper stabilization. Proceedings of the IEEE. 1996 Nov;84(11):1584-614.&#xD;
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10. Samiei A, Hashemi H. A Chopper Stabilized, Current Feedback, Neural Recording Amplifier. IEEE Solid-State Circ Lett 2019;2(3):17-20.&#xD;
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11. Harrison RR, Charles C. A low-power low-noise CMOS amplifier for neural recording applications. IEEE J Solid-state Circ 2003;38(6):958-65.&#xD;
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12. Udaiyakumar R, Sankaranarayanan K, Valarmathy M. Study on leakage power reduction techniques and its impact on 16 nm CMOS circuits. Int J Curr Res Rev 2012;4(4):149-158.&#xD;
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13. Wattanapanitch W, Fee M, Sarpeshkar R. An energy-efficient micropower neural recording amplifier. IEEE Transact Biomed Circ Syst 2007;1(2):136-47.&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study of Complications Arising Due to Peripherally Inserted Central Catheters in Oncological Settings: Single Centre Experience in North India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>58</FirstPage><LastPage>61</LastPage><AuthorList><Author>Javid Muzamil</Author><AuthorLanguage>English</AuthorLanguage><Author> Imran Nazir Salroo</Author><AuthorLanguage>English</AuthorLanguage><Author> Showkat Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Musharaf Bashir</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: In a haemato-oncological setting, a long term drug delivery route is very much needed. Peripherally inserted central catheters (PICC) are used for this purpose. Objective: This study was aimed to observe the complications associated with PICC insertion. Methods: This was a prospective observational study over one year in the Department of Medical Oncology at Khyber Superspecialty hospital, Srinagar, India. A total of 200 subjects participated in this study. The data was collected concerning disease, catheter dwell time, and complications. USG guided or unguided PICCs were inserted. The position of PICC was confirmed. PICC line was then fixed with stat lock. Complications associated with this procedure were noted. Out of 200 patients enrolled, 60% (120/200) were males and 40% (80/200) were females. Unguided PICC was inserted in 90% and USG guided in 10% of participants. Unguided procedures were done in 2 minutes with an average blood loss of 2 ml. Results: Around 5% reported pain within 24 hours and 2.5% reported fever beyond 24 hours. The average dwell time for a single PICC was 5 months. 35% developed line fracture which was correctable. Only 3% developed serious complications viz; CABSI (Catheter-associated bloodstream infections) in 2.5% and thrombosis in 0.5%. Conclusion: PICCs are safe and can be used for extended periods. Unguided PICCs were placed in most of the participants without any major complications. From this study, it appears that PICCs are safe to use with low thrombotic and infectious complications. The most common complications were line fracture, pain and fever.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> PICC, USG, CABSI, CVC, Catheter, Thrombosis</Keywords><Fulltext>Introduction&#xD;
&#xD;
Prolonged treatment and frequent administration of chemotherapeutic drugs, blood and blood products with supportive care is the cornerstone of cancer patient care.1 For this purpose, central venous access devices (CVAD) such as Chemo-port (CP) and peripherally inserted central catheters (PICC) are being used.2 Central venous catheters (CVC) were introduced in the 1980s and they are in use since then.3 The cost of these devices and maintenance is a crucial factor, especially in low-income countries.4,5 This study was aimed to assess the advantages and complications involved with PICC over one year.&#xD;
&#xD;
Material and Methods&#xD;
&#xD;
After getting the clearance from Institutional Ethics Committee this prospective study was done at Khyber super speciality hospital, Srinagar, J&amp;K, India. For this study, we enrolled 200 patients who required chemotherapy beyond 4 months. In this study males were more in number than females with a male to female ratio of 1.5:1. Only PICCs with a one-way valve [Bard 4F Groshong] were used. After all antiseptic precautions, USG guided or unguided PICCs were inserted depending upon visualization of upper arm veins. All PICCs were put after cleaning the local area and after giving 0.5ml 2% lignocaine.&#xA0; The position of PICC was confirmed and the length was adjusted at the angle of Louis with the use of a guidewire. Normal saline [10 ml] flush was used and the patient was asked to report any hissing sound or cold sensation from the ipsilateral ear, which was confirmed by x-ray chest. PICC line was then fixed with stat lock. The long-term complications associated with the procedure were noted. The average time for the procedure varied between guided and unguided. It was 2 min in unguided and 10 min in USG guided. &#xD;
&#xD;
Results&#xD;
&#xD;
Depending upon the access of veins, USG guided or unguided PICC was inserted. Average blood loss was more in USG guided PICC insertion as shown in Table 1. USG guided insertion of PICC is shown in Figure 1. The disease profile of patients in this study is shown in Figure 2. Most patients had carcinoma stomach followed by carcinoma colon. PICCs were used for various purposes such as prolonged chemotherapy, parenteral nutrition, blood transfusion and for delivering fluids and antibiotics in infections as shown in Figure 3. In this study, it was observed that around 90% of USG guided PICC insertions perceived some degree of pain as shown in Figure 4. Post-procedure 24-hour complications were either pain or thrombophlebitis. Local site pain was reported by 5% of patients and thrombophlebitis in 7.5%. No patient reported fever within 24 hours. Only 2.5% of patients reported fever after 24 hours within 1 week, which was uncomplicated. Delayed complications (beyond 4 months) occurred in few patients, which needed premature removal as shown in Figure 5. &#xD;
&#xD;
Discussion&#xD;
&#xD;
In an Intensive Care Unit (ICU) placement of CVC is the most common procedure to be performed. The safety of this procedure has been enhanced by the addition of ultrasonographic guidance.6 Literature shows that USG (ultrasonography) guided CVC leads to lesser failed attempts and complications.7 PICCs provide long-term intravenous access for delivering antibiotics, blood products, chemotherapy and nutrition.7 PICCs have gained popularity as it has lesser risks than CVCs.8 In a prospective study, Gowardman et al.9 studied 410 critically ill patients who required CVC placement. They compared colonization and CABSI rates at various sites where CVC was placed and they observed that colonization was higher at the internal jugular [HR 3.64; 95% CI 1.32-10.00; p=0.01] and femoral [HR 5.15; 95% CI 1.82-14.51; p=0.004] sites than at the subclavian vein. They also observed that CVCs were less colonized in females than in males [HR 0.49; 95% CI 0.26-0.89; p=0.02]. They concluded that colonization was influenced by the site of placement of PICCs and gender.&#xA0;Norwood et al.10 conducted a prospective observational study in trauma patients who received CVCs to determine the rates of CABSI. They observed that the rates of CABSI were 5% [5/1000 catheter days] and 1.5% [1.51/1000 catheter days], respectively. Moreover, subclavian PICCs were in place longer than femoral or internal jugular PICCs (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3656</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3656</Fulltext></URLs><References>&#xD;
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	Jordan K, Feyer P, Holler U, Link H, Wormann B, Jahn F. Supportive Treatments for Patients with Cancer. Dtsch Arztebl Int 2017;114(28): 481-87.&#xD;
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	&#xD;
	Babu KG, Babu MCS, Lokanatha D, Bhat GR. Outcomes, cost comparison, and patient satisfaction during long-term central venous access in cancer patients: Experience from a Tertiary Care Cancer Institute in South India. Indian J Med Paediatr Oncol 2016; 47(4):232-38. &#xD;
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	Jain SA, Shukla SN, Talati SS, Parikh SK, Bhat SJ, Maka V.A retrospective study of central venous catheters GCRI experience. Indian J Med Paediatr Oncol 2013; 34(4): 238-41. &#xD;
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	Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health Qual Life Outcomes 2018;16:198.&#xD;
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	Gonzalez R, Cassaro S. Percutaneous Central Catheter (PICC). Treasure Island (FL); Stat Pearl Publishing: 2020 Jan.&#xD;
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	&#xD;
	Baviskar AS, Khatib KI, Bhoi S, Galwankar SC, Dongare HC.Confirmation of endovenous placement of central catheter using the ultrasonographic &#x201C;bubble test&#x201D;. Indian J Crit Care Med 2015;19(1):38-41.&#xD;
	&#xD;
	&#xD;
	Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: A randomized, prospective study.&#xA0;Ann Emerg Med 2006; 48:540&#x2013;47.&#xD;
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	&#xD;
	Smith RN, Nolan JP. Central venous catheters. BMJ 2013; 347: f6570.&#xD;
	&#xD;
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	Gowardman JR, Robertson IK, Parkes S, Rickard CM. Influence of insertion site on central venous catheter colonisation and bloodstream infection rates. Intensive Care Med 2008; 34:1038-45.&#xD;
	&#xD;
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	Norwood S, Wilkins HE, Vallina VL. The safety of prolonging the use of central venous catheters: A prospective analysis of the effects of using antiseptic bonded catheters with daily site care. Crit Care Med 2000;28:1376-82.&#xD;
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	Kim HJ, Yun J. Safety and effectiveness of central venous catheters in patients with cancer: Prospective observational study. J Korean Med Sci 2010;25:1748-53.&#xD;
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	Kumar AH, Srinivasan NM, Thakkar JM. A prospective observational study of the outcome of central venous catheterization in 100 patients. Anaesth Essays Res 2013; 7:71-5.&#xD;
	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Ergonomic Evaluation of Street Vendors as Determined by Rapid Entire Body Assessment Method&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>62</FirstPage><LastPage>66</LastPage><AuthorList><Author>Samiksha Sathe</Author><AuthorLanguage>English</AuthorLanguage><Author> Mrunal Baxi</Author><AuthorLanguage>English</AuthorLanguage><Author> Neha Chaudhary</Author><AuthorLanguage>English</AuthorLanguage><Author> Varsha Pawar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Swapnil Bhirange</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Musculoskeletal conditions are prevalent and their impact is pervasive. They are the most common cause of severe long-term pain and physical disability affecting the psychosocial status of affected people as well as their families and caretakers. In all occupations, incorrect working posture is the most important cause of musculoskeletal disorders. Objective: This study aimed to evaluate the work postures of street vendors using the Rapid Entire Body Assessment (REBA) method. Methods: Cross-sectional study was conducted. Work postures were assessed in 60 street vendors by employing the REBA method. Stratified sampling was used. Data were analyzed using Pearson&#x2019;s correlation and regression analysis was tested using SPSS software. Results: The results show that 71% of vendors had a high risk of developing musculoskeletal disorder.No significant relationship was found between age and REBA score (p= 0.1142, Pearson&#x2019;s correlation 0.2). The relationship between years of work experience and REBA score was also not significant (p =0.2463, Pearson&#x2019;s correlation 0.15). However, regression analysis revealed that trunk, upper arm and lower arm postures were mainly contributing to the REBA score, putting Street vendors at high risk of developing a musculoskeletal disorder. Conclusion: From this study, we concluded that task performed by the majority of street vendors possess a high risk of developing work-related musculoskeletal disorder requiring immediate measures. No relation was found between age and REBA score as well as years of work experience and REBA score. Trunk, upper arm and lower arm postures were influencing more to REBA scores.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Rapid Entire Body Assessment, Ergonomic evaluation, Work-related musculoskeletal disorders, Body posture,  Street vendors</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Improper body posture and long hours in front of these terminals can result in many health hazards, including fatigue and musculoskeletal disorders (MSDs). It has been stated that MSDs are the most common occupational health problem.1 The occupational disease is also known as occupational overuse syndrome covers pathological conditions aroused by prolonged work, exertion, interaction with harmful factors inherent in materials, equipment or working environment. Some diseases are caused by etiological factors inherent in circumstances in which workers work. Bad posture, repeated physical effort or psychological stresses are contributing factor for occupational diseases.2,3 The risk of work-related musculoskeletal disorders predominantly low back pain is because of long work hours and strenuous activities3. Poor working condition and the absence of strategies for work injury prevention are responsible for the increase in work-related musculoskeletal injuries. It is the most common injury faced at the workplaces in both developed and developing countries.4 Musculoskeletal disorders are the most common self-reported work-related illness and the leading cause of disability of people during the working years. This is also responsible for lost earnings, medical payments.1&#xD;
&#xD;
Today hawking is an imperative origin of employment for an expansive number of urban poor as it requires low aptitudes and small financial contribution. Comprehensively characterized, a road merchant is an individual who offers merchandise or facilities available to be purchased to the general population without having an unalterable developed structure however with a portable mobile stall or with an impermanent static structure.5 The number of road merchants in the nation is assessed at around 10 million. A few investigations gauge that road merchants comprise around 2 % of the populace of the city. Road merchants have poor government disability and their working condition in the city open them to an assortment of security and medical problems. The SNDT-ILO research on Mumbai found that around 85 % of road sellers complained of issues identified with stress.5&#xD;
&#xD;
Street vendors work includes twisting, bending, pushing heavy loads over the mobile cart, long-standing and long working hours.6 An ergonomic risk assessment can fundamentally identify the danger of occurrence of the musculoskeletal issue the initial phase in checking for MSDs is an ergonomic evaluation, which can take various forms, for example, Rapid whole Body Assessment [REBA].7 Since the time REBA has been presented, it demonstrated its incentive for postural evaluations of employments in a few word-related settings, including development industries8,9, supermarket staffs10, cloth manufacturers11, engine motor assembly industries12, firemen and crisis restorative professionals13, sawmill laborer14 and in medical clinic settings.15 The present investigation expected to recognize ergonomic hazard evaluation by observational strategy, REBA, as far as loading scores dependent on examination of the working attitude taken from Street merchants with portable stalls.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This cross-sectional study was carried out in Nagpur, Maharashtra by observation. The checklist was examined by the investigator. A stratified sampling method was used to recruit the participants. Inclusion criteria include participant&#x2019;s age 18-60 years. All males and females vendors, at least 1 year of work experience. Exclusion criteria were any postural deformities like scoliosis, kyphosis, and any history of recent injury/trauma or accident. Spinal surgery or any other surgery in any part of the body, limb length discrepancy, retired, pregnant females. Informed consent was obtained by the participants. Demographic data such as age gender, educational status and working experience, working hours each day were also recorded. &#xA0; Postures were analyzed by the REBA method. Each vendor&#x2019;s body posture at the time was carefully observed (at least for 10 minutes). The worst and most frequent body postures were selected and according to the angulation of each body part, a score was given to the head, neck, body, upper limbs and lower limbs. The REBA worksheet is divided into two body segments,&#xA0; these sections are labelled as section A and section B. Section A covers the neck, trunk, and leg. The arm and wrist are covered in section B. Group A (Trunk, Neck and Legs) postures are scored first, then score Group B (Upper Arms, Lower Arms, and Wrists) postures for left and right. For each region, there is a posture scoring scale and additional adjustments which need to be considered and accounted for in the score.7&#xD;
&#xD;
The scores were recorded in the second part of the checklist and the interpretation of the final REBA score was carried. Because REBA has different coding systems for different body parts and the possible minimum and maximum scores for each body part are different, it was not possible to determine the most badly postured body part ( Table1).&#xD;
&#xD;
&#xD;
&#xD;
RESULTS&#xD;
&#xD;
The study was carried out on 60 street vendors in Nagpur, Maharashtra. Considering the gender, 32% of participants were females and 68% were males. The mean age of the vendors was 38.56&#xB1;7.60 years. Mean work experience is 17.36&#xB1;6.37 ( Figure 1 and Table 2).&#xD;
&#xD;
Considering the body posture (REBA score), the risk of developing musculoskeletal disorders among vendors was seen as following. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Relation between age and REBA score was analysed using the Pearsons correlation test. Data analysis revealed no significant relationship between age and REBA score (p= 0.1142, Pearson&#x2019;s correlation 0.2).&#xA0;The relationship between years of work experience and REBA score was also not significant (p =0.2463, Pearson&#x2019;s correlation 0.15) (Table 3).&#xD;
&#xD;
This implies gender and years of work experience do not impact REBA, however, regression analysis shows that trunk, upper arm and lower arm was a significant predictor for risk level. This explained that if trunk, upper arm and lower arm posture is improved then the level of risk of musculoskeletal disorder will be reduced. Loading and forward bend postures to mobilize the stall has been shown to put the back, upper arm and lower arm in critical postures. These postures contribute to the higher scores in respective sections and over again to the final REBA score.&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Musculoskeletal Disorders are a common health problem responsible for the major cause of disability. This includes economic loss affecting at the individual level, organizational level as well as societal level.16 &#xA0;A study done on shopkeepers in Dhaka showed the prevalence of 51% for low back pain amongst shopkeepers.6 Results showed that the majority of vendors were exposed to a high risk of developing a work-related musculoskeletal disorder. Physical work requirements that in the scientific literature have been specifically identified with LBP include heavy physical work, manual handling of materials, regular bending.17 A cross-sectional investigation to depict prevalence and attributes of musculoskeletal symptoms in an extensive French working population using a Nordic questionnaire showed that the prevalence of the musculoskeletal disorder in women were 83.8%.18 A study done on vegetable vendors concluded that the prevalence of low back pain in vendors is high.19 A bulletin released by WHO states that low back pain is associated with working bad postures such as bending forward heavily with one&#x2019;s trunk, bending and twisting simultaneously with one&#x2019;s trunk, a bent and twisted posture for long periods, and making repetitive movements with the trunk.20 Persistent standing at work has been appeared to be related to various conceivably grave health outcomes, for example, lower back and leg pain, cardiovascular issues, weariness, distress etc.21&#xD;
&#xD;
One of the fundamental necessity for assessing work exercises is postural investigation. The danger of musculoskeletal injury related to the recorded position can be valuable in actualizing change in the working practices, with regards to full ergonomic work environment assessment. The hazard assessment contains different factors, for example, the labourer&amp;#39;s collaboration, their size, the surrounding condition, other manual handling processes&#x2019; recurrence, the accessibility of resources and equipment and the workers&#x2019; capacity to recognize when a task is past his capacity and request help.21 REBA gives a fast and simple measure to evaluate a variety of working stances for the danger of WMSDs. It separates the body into areas to be coded independently, as per movement planes and offers a scoring framework for muscle action all through the whole body, inertly, dynamically, quick-changing or in an unsteady way and where manual handling may happen which is indicated as a coupling score as it is critical in the loads handling but may not generally be utilizing the hands. REBA likewise gives an action level with an indication of significance and requires minor materials.21&#xD;
&#xD;
Ergonomic intervention to reduce musculoskeletal disorders includes engineering improvements which include rearranging, modifying, redesigning equipment. Mechanization of the stalls to reduce the musculoskeletal strain is possible. In areas, where mechanization is not possible, ergonomically correct measures to avoid musculoskeletal disorders, are to be taken. Limited evidence till now is available in this area to know the risk of musculoskeletal disorders among street vendors. &#xD;
&#xD;
Behavioural and personal changes function by attempting to reduce the harmful effect of the risk factor by training in precise practice or improving the capability of worker (fitness and exercise programme). Personal protective equipment is intentional to work by putting a barrier in place between hazard and person.22,23 Studies on measurement of health indices and blood and body parameters were reported.24-26 Several studies on health issues of street vendors and Migrants were reported.27,28 Further research can be done to evaluate the effect of different Ergonomic intervention on the risk of developing a musculoskeletal disorder. The study has limitations that weight carried by the street vendors on their mobile stalls was not considered while assessing.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
From this study, we concluded that task performed by the majority of street vendors possess a high risk of developing work-related musculoskeletal disorder requiring immediate measures. No relation was found between age and REBA score as well as years of work experience and REBA score. Trunk, upper arm and lower arm postures were influencing more to REBA scores.&#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=3657</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3657</Fulltext></URLs><References>&#xD;
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	Gangopadhyay B. A study on the prevalence of upper extremity repetitive strains among the handloom weavers of West Bengal. J Human Ergo 2003;32:17-22.&#xD;
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	Durlov S, Chakrabarty S, Chatterjee A. Prevalence of low back pain among handloom weavers in West Bengal, India. Int J Occupational Envt Health 2014;20(4):333-339.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Students&#x2019; Perception Regarding the Conventional First MBBS Practical Examination&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>67</FirstPage><LastPage>70</LastPage><AuthorList><Author>Veena Vidya Shankar</Author><AuthorLanguage>English</AuthorLanguage><Author> Komala N</Author><AuthorLanguage>English</AuthorLanguage><Author> Shailaja Shetty</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Objective Structured Practical Examination, Viva voce, Competency, Assessment, Evaluation, Feedback</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The assessment of MBBS phase I under Rajiv Gandhi University of Health Sciences(RGUHS), Karnataka, India has two components - theory and practical. The theory assessment is uniform among all students and the majority of the questions are in the structured format to ensure objectivity. But this is not so in the case of the practical examination. A good practical evaluation has to include the criteria of objectivity, uniformity, validity, reliability &amp; practicability.1&#xD;
&#xD;
The Conventional practical examination as per the Rajiv Gandhi University of Health Sciences(RGUHS), Karnataka, India consists of spotters, surface marking, discussion of gross specimens and histology slides. Even though the spotters are conducted for different batches on different days, the assessment level is more or less uniform among the batches. However, a small element of subjectivity may be present. The surface marking can be made objective by using a proper checklist. The discussion of gross specimens and histology slides in the present scenario has a major subjective component. Hence, feedback was administered to the students to obtain their perceptions regarding the factors which influenced the practical examination. The feedback analysis obtained may throw light on the objectivity, validity and reliability of the practical examination.&#xA0; This study aims to evaluate the various factors influencing the MBBS phase I practical examination from the student perspective. This may serve as a crucial factor to enhance the standard of assessment in the educational program.2,3&#xD;
&#xD;
MATERIALS AND METHODS: &#xD;
&#xD;
The present study is a cross-sectional study, conducted for 3 years at M.S.Ramaiah Medical College, Bengaluru. The sample size was 120 first-year Medical and Dental undergraduate students per year who gave their consent to be a part of the study. The students who did not consent were excluded. The procedure and the intent of the feedback were explained to the students. The feedback of students regarding the University practical assessment was obtained by using a structured questionnaire. The questionnaire consisted of nineteen questions based on five points Likert&#x2019;s scale and two open-ended questions. The respondents&#x2019; agreements/disagreements were noted. The feedback was taken from 478 undergraduate medical &amp; dental students after the RGUHS practical examinations. Each question was analysed on Likert&#x2019;s scale and the percentages were tabulated. &#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
The questionnaire was validated using methods like Face validation and&#xA0;Content validation.&#xD;
The data was tabulated in a Microsoft Excel datasheet, frequencies and percentages have been calculated using the SPSS software. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
Analysis of the questionnaire &#xD;
&#xD;
82% &amp; 77% of students have agreed that the assessment is fair &amp;uniform respectively. 38.5% have felt the practical assessment to be stressful while 41.3% felt it was not stressful, however, 19.5% of them were unsure of it. Around 63% to 69% of students felt luck, chance factors and humble nature influenced their scores. 60% to 63% have indicated the examiner related factors influenced their scores (Table 1). On average, 72.5% of students felt that the number, type, complexity of questions by different examiners could affect their scores. An average of 56.6% of students has indicated that there was no gender, nationality or regional bias influencing their scores. 76.8% and 53.1% reflected that communication skills and dressing skills had an impact on their practical assessment. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Analysis of open-ended questions&#xD;
&#xD;
The common repetitive feedback response from the students were as tabulated below. The existing pattern of practical examination has been appreciated by the students in many ways despite its subjectivity. The good conduct of the examination, adequate time, uniform &amp; fair assessment was acknowledged by some of the students. &#xD;
&#xD;
Chance factors and their role&#xD;
&#xD;
The following were the possible chance factors (Table No 2) that the students felt had a role in the practical examination assessment thereby making the examination system more subjective than being objective. &#xD;
&#xD;
&#xD;
&#xD;
Stress factors and their role&#xD;
&#xD;
The students have stated the following factors responsible for stress during the practical examinations (Table 3)&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The feedback analysis hints at a need for the examination to be more objective. The scheduling of the practical examinations should be student-friendly with adequate time for preparations. The pattern of examination should stress uniformity with equal time and similar questions for all students. Emphasis should be made on the good quality of slides &amp; specimens. More importance to be given to formative and continuous assessments than only the final assessment. The practical assessment pattern should be more skill-oriented on a check list basis. Guidelines to be laid down to the examiners to avoid bias of any category. The Competency-Based Medical Curriculum (CBME) aims at solving most of the deficiencies of the traditional practical examination. With the introduction of CBME, the focus in assessment is going to shift from assessment of learning to assessment for learning and formative feedback will be a crucial factor for competency development.4&#xD;
&#xD;
Objective Structured Practical&#xA0; Examination (OSPE) a better choice as an assessment technique over the Traditional Practical Examination as it improves students&#x2019; performance in a laboratory exercise.1&#xA0; Objective structured practical examination (OSPE) to be a significantly high scoring and preferred method of examination as compared to the Traditional Practical Examination (TDPE) in the assessment of laboratory component and viva voce of Physiology.2 Pass percentage was higher by viva voce but high percentages and distinctions were by OSPE. Viva-voce needs to be continued as it is the only assessment tool that evaluates communication skills, power of explanation, interpretation, and confidence level and retention abilities of students.2 Objective structured practical examination increases the objectivity and reduces subjectivity compared to conventional viva.5&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The students have felt the traditional practical examination to be fair, uniform, with no bias to a certain extent, yet stressful with chance factors such as luck, humble nature, dressing style, communication skills influencing their scores. It has also been reflected that examiner related factors also influence the student scores. The new competency-based medical curriculum has incorporated alternate methods of evaluation which will provide fair and consistent techniques for evaluating the students. A feedback if taken on the practical component of the competency-based assessment will reflect the advantages/disadvantages over the traditional assessment.&#xD;
&#xD;
ACKNOWLEDGEMENT: Our sincere thanks to Mrs Radhika, a Statistician, for the guidance in statistical analysis. The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. &#xD;
&#xD;
SOURCE OF FUNDING: Nil&#xD;
&#xD;
CONFLICT OF INTEREST: Authors declare that they do not have any conflict of interest&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3658</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3658</Fulltext></URLs><References>&#xD;
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	Nigam R, Mahawar P. Critical Analysis of performance of MBBS students using OSPE &amp; TDPE - A Comparative Study. Natl J Community Med 2011; 2 (3):322-324.&#xA0; &#xD;
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	Rehman R, Syed S, Iqbal A, Rehan R. Perception and performance of medical students in objective structured practical examination and viva voce. Pak J Physiol 2012;8(2):33- 36.&#xD;
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	Abraham RR, Raghavendra R, Surekha K, Asha K. A trial of objective structured practical examination at Melaka Manipal Medical College India. Adv Physiol Edu 2009; 33(1):21&#x2013;23.&#xD;
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	Lockyer J, Carpaccio C, Chan MK, Hart D, Smee S, Touchie C, et al. Core principles of assessment in competency-based medical education. Med Teach 2017;39(6): 609-616. &#xD;
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	Sabnis AS, Bhosale Y. Standardization of evaluation tool by comparing spot, unstructured viva with objective structured practical examination in microanatomy.&#xA0; Int J Med Clin Res 2012; 3(7):225-228.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Protocol on Endotracheal Tube Suctioning among ICU Staff Nurses&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>71</FirstPage><LastPage>75</LastPage><AuthorList><Author>Vaishali Tembhare</Author><AuthorLanguage>English</AuthorLanguage><Author> Seema Singh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: It is understood that ET suctioning has several complications. Despite this, the method of suctioning the ET persists without adequate justification for the specific methods used. Suctioning is a high-risk procedure that can lead to hypoxemia, vomiting, cardiovascular dysfunction, inflammation, atelectasis, increased intracranial pressure, and can also cause tracheal mucosal lesions. Those can be complications can be prevented by implementing the protocols regarding Endo-tracheal tube suction. Objective: The aim of this research is to assess staff Nurses&#x2019; current experience of Endo-Tracheal suctioning before introducing the protocol as well as to determine whether or not the protocol is successful. Methods: One Group Pre Test &#x2013;Post Test Design,the study was conducted in ICU&#x2019;s of selected hospitals among staff nurses. Results: It has been found that the Endo-tracheal suctioning protocol has been observed effective in improving knowledge and practice of Staff Nurses working in ICU.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><Fulltext>Introduction&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Endo-tracheal tube suctioning is a procedure that is done for the purpose to remove the pulmonary secretions mechanically by using a suction device. It helps to keep the airway patent. All the clients who are having Endotracheal tubes need to remove secretions through the Endotracheal tube by the suction procedure.1 Why the patients develop complications such as tachycardia or bradycardia, increase or decrease blood pressure, pain, discharge, and decrease arterial oxygen saturation? Is it avoidable by following certain guidelines/standard protocol? This was the question in mind while thinking about researching this topic.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Endotracheal suctioning (ETS) is one of the most common supporting prevention in intensive care units (ICU) to suction overage respiratory secretions and improve respiratory function.12 The research study was carried out to assess the skills and experience of pre-training and post-training 48 cardiovascular intensive care unit nurses to develop best practice recommendations for different suction methods in patients with Endo-tracheal tube. It was concluded that the staff nurses had complied with standard practice training.2 A scientific study examined the efficacy of tracheal suction by direct observation, and the technical information was evaluated using a self-administered questionnaire. The research finding evaluated that the staff nurses working in ICU have more theoretical knowledge than suction practical skills.3&#xD;
&#xD;
The research investigated nurses&amp;#39; experience and expertise in conducting tracheal suction. Twenty-eight nurses were observed using reports from non-participants and standardized observation schedules. The study showed that most subjects (n=14) were not to do the Endo-tracheal tube suction procedure properly, this was stated by the participant. The average knowledge percentage and practical experience were 11.1 and 10.3(maximum score20). The research findings stated the low level of awareness regarding the suction procedure. This research finding recommends the support, education, and training of the staff nurses on the Endotracheal suction procedure.4 For data collection, a standardized questionnaire was used to gather information and an observational checklist to determine the score of the practice. The research was performed using concise and inferential statistics&#xD;
&#xD;
Unfortunately, when it comes to suction failure, the vast number of ICU errors goes unnoticed, which raises morbidity, mortality and thus increases patient stay in the hospital. Scheduling of education and regular training session is suggested to improve the quality of treatment to eliminate incidents or complications with these sentinels.8 In India, few experiments were carried out to determine the outcome of the nurse and the patient as a whole in terms of the suction technique. This work aimed at developing and applying suction techniques by &#xA0;giving training to the staff nurses in small groups and then studying the outcomes of nurses and patients.5 Adverse effects such as hypoxemia, pneumothorax, reduced blood flow, pain, and discomfort were also associated with ETT suction.6 Endotracheal Suctioning used to remove secretions from the central airways and stimulate the cough reflex.13 Although the evidence-based review of literature in the medical field does not always state to agree on best practices to balance advantage over risk. The following guidelines are made by respiratory therapists and researcher:&#xD;
&#xD;
&#xD;
	&#xD;
	Suction should be done only when it is indicated to avoid the risk of an adverse event.7&#xD;
	&#xD;
	&#xD;
	Pre-oxygenation with 100% oxygen is mandatory to avoid hypoxia.7&#xD;
	&#xD;
	&#xD;
	Using low-pressure volume unless otherwise needed. The preferable suction pressure is between 80 to 120mmofHg, Except where the secretion does not react.8&#xD;
	&#xD;
	&#xD;
	Selection of correct sized suction catheter is mandatory.9 According to the respiratory therapist; a suction catheter with an external diameter of less than 50 % of the inner diameter is recommended. This will allow for efficient aspiration.7&#xD;
	&#xD;
	&#xD;
	Examine the advantages and disadvantages of open and closed suctioning methods.&#xD;
	&#xD;
	&#xD;
	The literature recommends the closed suction system for convenience and speed.&#xD;
	&#xD;
	&#xD;
	Researchers recommend continuous suction, otherwise, there is a risk of alveolar collapse.7&#xD;
	&#xD;
	&#xD;
	Perform the suction gradually with a low suction pressure as it can cause mucosal damage, bleeding and even vagal stimulation and Bradycardia. 9&#xD;
	&#xD;
&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Research approach: One Group Pre Test &#x2013;Post Test Design&#xD;
&#xD;
Study settings:&#xA0; ICU of selected hospitals&#xD;
&#xD;
Population: ICU staff-nurses &#xD;
&#xD;
Sample: Registered &#xA0;&#xA0;ICU Staff Nurses of selected hospitals.&#xD;
&#xD;
Sample Size: 30. &#xD;
&#xD;
Method Of Sampling: Convenient sampling method.&#xD;
&#xD;
Criteria for Inclusion: Staff nurses working in ICU for more than one 1year, who gave consent for participation in the study and working rotation wise in 3 shifts&#xD;
&#xD;
Exclusion Criteria: Staff Nurses working in ICUwho cannot communicate in Marathi and English, staff nurses who have participated in similar research.&#xD;
&#xD;
Data collection method: Structured interview &amp; observation checklist.&#xD;
&#xD;
Ethical Approval: Ethical approval were obtained from the institutional ethical committee of Datta Meghe Institute of medical sciences deemed to be university, Sawangi Meghe, Wardha (Ref. No-DMIMS(DU)/IEC/2018-19/7806).&#xD;
&#xD;
Statistics: The use of a paired t-test was done to evaluate the effectiveness of the Endo-tracheal tube suction protocol.&#xD;
&#xD;
And the Chi-Square test was used for assessing the association of selected demographic variables with knowledge and practice regarding Endotracheal tube suction value.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Table No. 2 shows that 26.67 The proportion of pre-test nurses had less than the average score of information, 66.67 % of the pre-test staff nurses and 10% of post-test staff nurses had an average knowledge score and 6.67 % of them had above-average knowledge score in pre-test and 90 % in post-test. &#xD;
&#xD;
The minimum score of knowledge in the pretest was 6 and in the post-test, it was 11, the maximum knowledge score in the pretest was 13 and in the post-test, it was 15.&#xD;
&#xD;
The mean knowledge score in the pretest was 8.80&#xB1;1.74 and in post-test it was 13.20&#xB1;1.21 and the mean percentage of knowledge score in the pre-test was 58.66&#xB1;11.66 and in post-test it was 88&#xB1;8.09.&#xD;
&#xD;
&#xD;
&#xD;
Table 3 shows that 50% of pre-test staff nurses had below-average practice scores, 46.67% of pre-test staff nurses, and 10% of post-test staff nurses had average practice scores, and 3.33% had above average practice score in the pre-test and 90% in post-test. The minimum practice score in the pretest was 7 and in the post-test, it was 11, the maximum practice score in the pretest was 21 and in the post-test, it was 15.&#xD;
&#xD;
The mean practise score in the pretest was 10.60&#xB1;2.85 and in post-test it was 13.20&#xB1;1.21 and the mean percentage of practice pre-test score was 53&#xB1;14.29 and the post-test score was 88&#xB1;8.09.&#xD;
&#xD;
&#xD;
&#xD;
Table 4 depicts the pretest and post-test awareness ratings of staff nurses employed in ICU concerning suction of the Endo-tracheal tube. Mean, standard deviation, and values of mean difference are compared &amp;the student&#x2019;s paired test is applied at a 5% level of significance. The tabulated value for n=30-1 was 2.05 i.e. 29 degrees of freedom. For the overall awareness score of staff nurses, which is the statistically appropriate standard of importance, the measured &#x2018;t&#x2019; value i.e. 14.96 is much higher than the tabulated value at a meaning standard of 5%. It is therefore interpreted statistically that the protocol on Endotracheal tube suctioning among ICU staff nurses was found effective in improving the knowledge of the ICU staff nurses. So the H1 was accepted.&#xD;
&#xD;
&#xD;
&#xD;
Table 5 shows the comparison between the pre-test and post-test practice score of ICU staff nurses on Endotracheal tube suction.&#xD;
&#xD;
Meanwhile, standard deviation and mean differential values are compared and the student&amp;#39;s paired non-test is applied at a 5% meaning level. The tabulated value for n=30-1 i.e. 12.04 is much higher than the tabulated value at a 5% level of significance for the overall practice score of staff nurses which is a statistically acceptable level of significance. Hence it is statistically interpreted that the new protocol on overall practice regarding Endotracheal tube suctioning among staff nurses working in ICU found effective. Because of that H1 was accepted.&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Endo-tracheal suction is a technique aimed at preserving the patency of airways by mechanically removing the secretions retained in the lungs, particularly in clients with implanted manual airways. Patients admitted to ICU also need to be tested for suction requirements. When on a mechanical ventilator these patients may be susceptible to various problems. Because of the complexity of Endotracheal suctioning, patients should be screened for suction needs because this is an invasive, complicated procedure that needs to be done with a fair prescription. After all, it can damage the patient. The reviews have shown that ventilator-associated pneumonia is the commonest complication of Endotracheal suction among the intubated patients on a ventilator and it is up to 47% of all types of infections reported in intensive care units. It is important for this procedure that the nurse is aware of the different methods of Endotracheal Suction and is focused on appropriate scientific evidence. The present research adopted an experimental approach involving thirty nursing staff employed in ICU with one group Pre Test Post Test Design. The results of this research indicate that, in all areas of the information questionnaire and observational checklist, the mean post-implementation information score and practice score was statistically more than the pre-test awareness score and practice score as obvious from the &amp;#39;to test (</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3659</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3659</Fulltext></URLs><References>1. American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Resp Care 2010;55(6):758&#x2013;764.&#xD;
&#xD;
2. &#xD6;zden D, G&#xF6;rg&#xFC;l&#xFC; RS. Development of standard practice guidelines for open and closed system suctioning. J Clin Nurs 2012;21(9&#x2013;10):1327&#x2013;38.&#xD;
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4. Varghese. Exploratory study on the knowledge and skill of critical care nurses on endotracheal suctioning [Internet]. [cited 2020 Oct 3]. http://www.nabh.ind.in/article.asp?issn=2319&#xD;
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5. Seals L. 7 Tips For Successful Endotracheal (ET) Suctioning [Internet]. Avanos Medical Devices. 2018 [cited 2020 Oct 3]. Available from:https://avanosmedicaldevices.com/respiratory-health/patient-experience/7-tips-for-successful-endotracheal-suctioning/&#xD;
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12. Cicekci F, Ozturk A, Kara I. Investigation of the Efficiency of Endotracheal Aspiration by Sheep Lung Modeling: Experimental Study. Int J Curr Res Rev 2018;10(5):23-29.&#xD;
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13. Kumar J, Prem V. Chest physiotherapy for atelectasis in neonate with pulmonary hemorrhage- a case report. Int J Curr Res Rev 2010;02(1):28-31.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Indian Obesity parameters on Asthma Control Among Patients Attending Tertiary Care Centre&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>76</FirstPage><LastPage>82</LastPage><AuthorList><Author>Vimal Raj R</Author><AuthorLanguage>English</AuthorLanguage><Author> Pajanivel R</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The impact of abdominal obesity as defined by Indian obesity parameters on asthma symptom control has not been evaluated in detail. Objective: To correlate asthma symptom control with body mass index and waist circumference. Methods: Asthma patients who attended the outpatient department or were admitted to our tertiary care hospital between June 2018 and May 2019 were investigated for asthma severity, asthma symptom control, and correlated with the obesity parameters, including waist circumference, based on Indian and WHO criteria. Results: Of the 110 patients, 56.3% (62 patients) were female. There was a significant worsening of asthma symptom control among overweight and obese patients, diagnosed using Indian Body Mass Index (BMI) classification, as compared to those with normal BMI (p = 0.04). But when the WHO BMI classification was used, the correlation was not statistically significant (two-tailed p-value = 0.10; Fisher&#x2019;s exact test). Patients who were classified obese as per Indian criteria had an 8 times more risk of having uncontrolled /partly controlled asthma as compared to those with normal Indian BMI (p = 0.027; OR= 8.42; 95% CI = 1.2 - 55.42). Partly controlled or uncontrolled asthma was noted in 93.3% (56/60) of those patients, who had normal waist circumference as per WHO criteria but were diagnosed with abdominal obesity as per Indian criteria. Conclusion: Waist circumference is a simple but important parameter to be assessed among obese asthmatics. Indian BMI and waist circumference parameters are found to be better in assessing asthma symptom control among our population than World Health Organization standards.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Asthma, Abdominal obesity, Body mass index, Leptin, Spirometry, Waist circumference</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
In India, approximately 30-65% of the adult urban population are either overweight, obese or have abdominal obesity.1 The rising prevalence of metabolic syndrome and cardiovascular diseases (CVD) in the Indian subcontinent has a direct relationship with the rising prevalence of obesity and overweight.1 Asian Indians have a higher percentage of body fat, abdominal adiposity at lower or similar body mass index (BMI) levels as compared to Caucasians.1Obesity is a proven risk factor in the development of asthma.2Compared to adults with normal BMI, asthma is more prevalent among obese2,3 and obesity increases the incidence of asthma by 2.0 - 2.3fold in children and adults respectively.3,4 As they exhibit a different (eg: less atopic) inflammatory phenotype,5 obese asthmatics often have poorly controlled asthma.6,7 Excess abdominal fat may be an important risk factor for asthma, but measures of central obesity have been assessed in only a handful of studies.8-10&#xD;
&#xD;
No study to date has evaluated the prevalence of abdominal obesity among asthmatics in the Indian population using Indian Obesity parameters and their implications on asthma control. Hence it is done as an explorative study.&#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
Patients&#xD;
&#xD;
Between June 2018 and May 2019 all patients above the age of 18 years, attending outpatient department / admitted under Pulmonary Medicine with cough, breathlessness, chest tightness, and history of wheeze that vary over time and in intensity (along with previously diagnosed asthmatics) were enrolled for the study after their spirometry is suggestive of asthma and if they satisfied the BMI or Abdominal obesity criteria of 2009 Asian Indian-specific overweight, obesity and abdominal obesity consensus statement.1 Written informed consent was obtained from all patients. Those who are in exacerbation, pregnant women, and patients who were unable to perform spirometry were excluded from the study.&#xD;
&#xD;
Procedure &#xD;
&#xD;
The diagnosis of asthma was based on the Global Initiative for Asthma (GINA) guidelines 2018 wherein cough, chest tightness, shortness of breath, and wheezing are considered as the characteristic symptoms along with variable expiratory airflow limitation defined as reduced FEV1/FVC and &gt;12% and &gt;200 ml increase in FEV1 from the baseline, after administration of 200 - 400 mcg of salbutamol or equivalent, while performing spirometry.11 Spirometry was performed using a reusable turbine sensor spirometer (MIR Spirobank II&#xAE; basic, Italy). Spirometric severity was classified as per the European Respiratory Society/American Thoracic Society (ERS/ATS) lung function tests interpretation 2005.12 The patients were classified as having mild, moderate, moderately severe, severe, and very severe asthma based on the following FEV1 cut-offs: &gt; 70%, 60-69%, 50-59%, 35-49% and less than 35% respectively.&#xD;
&#xD;
Weight (kg) and Height (cm) were measured and BMI was derived from the weight in kilogram upon height in metre.2 Waist circumference (WC) was measured using non-stretchable flexible tape in the horizontal position, at the midpoint of the iliac crest and the lowermost rib, at the end of normal expiration, in the fasting state, with the subject standing erect and the observer by the side.Normal BMI range as per the 2009 Asian-Indian Obesity consensus statement was 18.0-22.9 kg/m2, overweight: 23.0-24.9 kg/m2 and obesity: &gt;25 kg/m2. Abdominal obesity was defined in the consensus statement as WC above 80 cm in females and 90 cm in males1 in contrast to the WHO defined criteria of&gt; 88 cm in females and &gt;102 cm in males.13 Normal BMI range defined by WHO is between 18.5 and 24.9 kg/m2. BMI above 30 kg/m2 is defined as obesity while the intermediate category is defined as overweight.14&#xD;
&#xD;
Asthma Control was assessed using the 2018GINA classification of asthma symptom control over the last 4 weeks. It comprises of 4 clinical parameters namely, more than twice per week daytime asthma symptoms, any night waking due to asthma, more than twice per week reliever medication requirement for symptoms, and any activity limitation due to asthma, wherein the patients have to convey whether they experience any of the symptoms or no symptom at all (1 point for every symptom present). Based upon the outcome they were categorized as having well-controlled (none of the parameters of clinical worsening was present), partly controlled (1-2 of the parameters), or uncontrolled asthma (3-4 of the parameters). In a newly diagnosed case willing to participate in the study, BMI/WC measurement was done on day 1 along with spirometry while the GINA assessment tool was used after a 4 week follow up period. Among the patients who were already on follow up with the institute, the first visit during the study period was considered for assessing the previous 4 weeks symptom control along with BMI / WC calculation and spirometry was performed during the study period. All new patients were initiated on either Dry Powder Inhaler (DPI) or Metered Dose Inhaler (MDI) therapy &#xB1; spacer. The treatment comprised of Inhaled Corticosteroid (ICS) &#xB1; LongActing Beta2 agonist (LABA) with either ShortActing Beta2 Agonist (SABA) or low dose ICS/Formoterol as a reliever, as per GINA guidelines.11 The study was conducted in line with the Declaration of Helsinki and was approved by the Institutional Human Ethics Committee, Sri Balaji Vidyapeeth, Pondicherry, India. &#xD;
&#xD;
Statistical analysis &#xD;
&#xD;
We have used IBM SPSS ver. 16.0 (IBM Co., Armonk, NY, USA). Multiple logistic regression analyses and Fisher&#x2019;s exact test were done to compare the correlation between asthma symptom control, asthma severity, and various parameters like BMI, WC, etc. p-value &lt; 0.05 was considered to be statistically significant.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Data obtained from one hundred and ten asthmatics were analyzed. The baseline data of the patients are given below (Table 1). The mean age of all the patients was 40.3 &#xB1; 9.81 years. The number of female patients was slightly higher than males [62 (56.3%) vs 48 (43.7%)]. While the mean weight of the patients was 70.05&#xB1; 10.07 kg, the mean height was 157.75 &#xB1; 8.04 cm. The mean BMI of the patients was 28.2 &#xB1; 4.01, which is obesity, according to the Indian BMI criteria whereas World Health Organization&#x2019;s (WHO) classification defines it as overweight (25 -29.9 kg/m2). The mean FEV1/FVC of the study population was &lt; 70% (68.59 &#xB1; 10.74), in which the FVC was fairly preserved (82.27 &#xB1; 13.22) while the % predicted FEV1 was less than 60% (58.48 &#xB1; 11.6).&#xD;
&#xD;
BMI vs Asthma Control&#xD;
&#xD;
Classification of patients based on both Indian and WHO BMI criteria and their asthma symptom control is given in Table 2. More than three-fourths of the patients were obese as per the Indian BMI classification (78.17%). Among them, nearly two-thirds (73 patients,66.36%) had either partially controlled or uncontrolled asthma symptoms whereas, only 13 patients (11.81%) had well-controlled asthma. In the overweight category, 14 (12.72%) had partly controlled or uncontrolled asthma while only 5 (4.54%) had well-controlled asthma. As per the Indian BMI classification, 5 patients were in the normal BMI (18.0-22.9 kg/m2) category but were included in the study due to abdominal obesity (WC &gt; 80 cm in females and 90 cm in males). Among them, 3 had well-controlled asthma and 2 had partly controlled/uncontrolled asthma. The difference in the asthma symptom control among different BMI categories was found to be statistically significant which implies that overweight and obese individuals (Indian classification) had either partly controlled/uncontrolled asthma during the last 4 weeks (two-tailed p-value = 0.042; Fisher&#x2019;s exact test).In contrast, while applying WHO BMI criteria, the poor asthma control noted among73 patients (66.35%) within the overweight and obese population was not statistically significant (two-tailed p-value = 0.105; Fisher&#x2019;s exact test).&#xD;
&#xD;
Indian overweight individual has 4.2 times higher chances of having partly controlled/uncontrolled asthma as compared to the normal BMI individual, but it was not statistically significant (p = 0.172; OR= 4.2; 95% CI = 0.54 &#x2013; 32.96). Similarly, a patient who is obese as per Indian criteria has an 8 times more risk of having uncontrolled /partly controlled asthma as compared to a patient with normal Indian BMI (OR= 8.42; 95% CI = 1.28-55.42) (Figure 1).&#xD;
&#xD;
Waist Circumference vs Asthma Control&#xD;
&#xD;
Out of the 110 patients, 104 (94.5%) had either partially controlled or uncontrolled asthma symptoms (Table 3). Sixty (54.5%) patients had normal waist circumference as per WHO criteria. Among them, though 56patients (93.3%) had partly controlled or uncontrolled asthma, it was not found to be statistically significant (Fisher exact test, two-tailed P value = 0.69) (Figure 2). &#xD;
&#xD;
The severity of asthma vs Asthma Control:&#xD;
&#xD;
Even in patients with fewer symptoms, FEV1&lt; 60% predicted has a high risk of exacerbations as per GINA guidelines. In our study, 48 patients (43.63%)had FEV1&lt; 60%. Out the 48, 44 (91.66%) had poor asthma symptom control (partly controlled/uncontrolled) (Table 4). Even among those 62 patients (56.36%) who had FEV1 &gt; 60% predicted, only 17 (27.42%) patients had well-controlled asthma while the rest (45 patients, 72.58%) had either partially controlled or uncontrolled asthma. The poor asthma control noted among patients with FEV1 &lt; 60% (moderately severe, severe, and very severe obstruction, as per ATS / ERS lung function test interpretation, 2005) was found to be statistically significant (two-tailed p-value = 0.0141, Fisher exact test) (Figure 3). The odds of asthmatics with low FEV1 predicted (&lt; 60% predicted) having poor asthma control are 4 times more than those who have FEV1 predicted &gt;60% (OR= 4.16; 95% CI = 1.3 to 13.33), thereby highlighting the importance of regular spirometric assessment among asthmatics, complimenting clinical evaluation.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
While there are studies that assessed the relationship between abdominal obesity and asthma control15, there is hardly any study that considered the Indian waist parameters and their impact on asthma severity and asthma symptom control among the Indian population. Though the difference in body fat percentage of Asians, increased risk factors for type 2 diabetes mellitus and cardiovascular diseases were appreciated by WHO, as of now, only different cut-offs points for taking action were suggested by the WHO as the available data do not necessarily indicate one clear BMI cut-off point for all Asians for overweight or obesity.16Hence it is imperative to provide clinical research data to make informed decisions regarding the region and ethnicity-specific BMI and abdominal obesity cut off points and their impact on major clinical disease entities like asthma, cardiovascular diseases, type 2 diabetes mellitus, etc.&#xD;
&#xD;
Concerning BMI and asthma control as per GINA 2018 assessment tool, we have found that the risk of having poor asthma control is high among the obese and overweight patients (OR = 4 and 8 for overweight and obese patients respectively) as compared to those with normal BMI, as per Indian criteria. The results were similar to a study by Mosen et al. which showed that obese individuals with persistent asthma were more likely to have worse asthma control than those with normal BMI, as per WHO standards.6 But they didn&amp;#39;t find any correlation between overweight individuals and adverse outcomes like asthma control, asthma-related admissions, etc. Jesus JPV et al. in their study had similar results.17 In their study they used WHO BMI cut-offs whereas abdominal adiposity was assessed using International Diabetes Federation criteria based on South Asian parameters for Central and South Americans (&gt; 90cm for males and &gt; 80 cm for females).16&#xD;
&#xD;
Lv et al. in their study found out that abdominal adiposity correlated with poorer asthma control among uncontrolled asthmatics.19 They used the waist-to-height ratio for abdominal adiposity assessment. Another study from Japan stated that only the abdominal visceral fat area assessed by computed tomography (CT) of the abdomen showed a negative association with the Asthma Quality of Life Questionnaire in males.10 We used waist circumference for the assessment of abdominal obesity as it was proposed along with waist-hip ratio (WHR), by the WHO in their expert consultation on abdominal obesity.13 A recently concluded meta-analysis on asthma and abdominal obesity considered studies using waist circumference only as this was found to be the method used in all the analyzed studies, whereas only a few studies used WHR and the waist-to-height ratio along with WC.20 Though abdominal CT might appear to be a better test in predicting the abdominal adiposity, the practical possibilities of doing the imaging in all asthmatics and the advantage of point of care measurement of waist circumference makes WC the method of choice for assessing abdominal adiposity. All the above studies including the meta-analysis stress that abdominal obesity is an independent marker to be considered while measuring the anthropometric values of an asthmatic in a hospital, as they have a significant positive correlation with asthma symptom control. &#xD;
&#xD;
There was no significant impact of gender on asthma control (two-tailed p-value = 0.81). This was contrary to the studies where they have found that females tend to have a worse perception of the day and night time symptoms than males.21-23 They also tend to report more night awakenings as compared to males. But the meta-analysis by Jiang et al. showed no gender predilection towards asthma and abdominal obesity.20 This was similar to our study where even though 51 out of 62 female patients reported partly controlled / uncontrolled asthma as against 38 of 48 male patients, it was not statistically significant. &#xD;
&#xD;
The limitations of our study are, first, the study population was from a single geographical area and hence there is a risk in extrapolating to other Asian populations. While that is the real purpose of the study (to study the specific population &#x2013; Indian, which lacks sufficient data), we cannot apply the results, at present, to other ethnic groups. Second, being a cross-sectional study, we did not assess the impact of any intervention, like weight loss, on the patient&#x2019;s symptom control and spirometric parameters as earlier studies have found an improvement in asthma control after weight loss.24,25 Third, the entire study population was Obese as per Indian classification (either BMI or WC criteria), and thus the results should not be extrapolated for asthmatics with normal BMI and WC.&#xD;
&#xD;
Conclusion &#xD;
&#xD;
To conclude, Indian BMI parameters have a significant correlation with asthma symptom control as compared to WHO defined global criteria. Abdominal obesity assessment by waist circumference is a simple procedure that is promising to have a significant impact on the assessment of obese asthmatics among the study population if Indian parameters are applied. Studies among other Asian populations with similar abdominal obesity risk profiles are needed to give the necessary impetus for precise BMI and abdominal obesity cut-offs points for the Asian population.&#xD;
&#xD;
ACKNOWLEDGEMENTS: We would like to thank Dr. MD Ziaul and Dr. Chandrajith C&#x2013; Post Graduates of our Department and Ms. Ranjitha Rajagopalan &#x2013; Intern, for their technical support throughout the study period.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Financial support: Sri Balaji Vidyapeeth Faculty Intramural Research fund&#xD;
&#xD;
Authors&#x2019; Contribution:&#xD;
&#xD;
Vimal Raj R: Concept and design of the study, conducted the study, Analysis and Interpretation, Drafting the manuscript&#xD;
&#xD;
Pajanivel R: Design of the study, conducted the study, Analysis, and Interpretation, Drafting the manuscript for intellectual content&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Figure 1: Relationship between Asthma control and Obesity, as per Indian BMI parameters. The probability of having partly controlled /uncontrolled asthma among obese individuals, as defined by Indian obesity criteria is found to be significant (p = 0.027; OR= 8.42; 95% CI = 1.28-55.42) but no significant difference was noted in the overweight population (p = 0.172; OR= 4.2; 95% CI = 0.54 &#x2013; 32.96). &#xA0;Based upon 4 clinical parameters, asthma control was categorized as follows: well-controlled (none of the parameters of clinical worsening were present); partly controlled (1-2 of the parameters); uncontrolled asthma (3-4 of the parameters).&#xD;
&#xD;
&#xD;
&#xD;
Figure 2: Relationship between Asthma control and patients with normal WC, as per WHO criteria (but has abdominal obesity as per Indian criteria). The value was not statistically significant. (Fisher exact test, two tailed p value = 0.69). &#xD;
&#xD;
&#xD;
&#xD;
Figure 3: Relationship between severity of asthma, based on spirometric indices and asthma control. The grouping into mild/moderate vs moderately severe/severe/very severe was based on the predicted FEV1 cut off 60% which is a risk factor for future exacerbations, as per GINA guidelines. The difference in asthma control between these two groups is found to be statistically significant (p = 0.0141; OR= 4.16; 95% CI = 1.3 to 13.33).&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3660</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3660</Fulltext></URLs><References>1. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-170.&#xD;
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2. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med 2007;175(7):661-666. &#xD;
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3.Chen YC, Dong GH, Lin KC, Lee YL. Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: a systematic review and meta-analysis. Obes Rev 2013;14(3):222-231. &#xD;
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4. R&#xF6;nmark E, Andersson C, Nystr&#xF6;m L, Forsberg B, Jarvholm B, Lundback B. Obesity increases the risk of incident asthma among adults. Eur Respir J 2005;25(2):282-288. &#xD;
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5. Camargo CA Jr, Sutherland ER, Bailey W, Castro M, Yancey SW, Emmett AH, et al. Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans. Curr Med Res Opin 2010;26(7):1629-1635. &#xD;
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6. Mosen DM, Schatz M, Magid DJ, Camargo CA Jr. The relationship between obesity and asthma severity and control in adults. J Allergy Clin Immunol 2008;122(3):507-511.&#xD;
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7. Sutherland ER, Goleva E, Strand M, Beuther DA, Leung DY. Body mass and glucocorticoid response in asthma. Am J Respir Crit Care Med 2008;178(7):682-687. &#xD;
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8. Appleton SL, Adams RJ, Wilson DH, Taylor AW, Ruffin RE, North West Adelaide Health Study Team. Central obesity is associated with nonatopic but not atopic asthma in a representative population sample. J Allergy Clin Immunol 2006;118(6):1284&#x2013;1291. &#xD;
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9. Chen Y, Rennie D, Cormier Y, Dosman J. Sex specificity of asthma associated with objectively measured body mass index and waist circumference: the Humboldt study. Chest 2005;128(4):3048&#x2013;3054.&#xD;
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10. Goudarzi H, Konno S, Kimura H, Makita H, Matsumoto M, Takei N, et al. Impact of Abdominal Visceral Adiposity on Adult Asthma Symptoms. J Allergy Clin Immunol Pract 2019;7(4):1222-1229.&#xD;
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11. Global Initiative for Asthma Global Strategy for Asthma Management and Prevention, 2018. [cited 2018 Apr 20]. Available from www.ginasthma.org.&#xD;
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12. Pellegrino R, Viegi G, Brusasco V, Crapo R, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26(5):948-968.&#xD;
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13. World Health Organization. Waist circumference and waist-hip ratio report of a WHO expert consultation, Geneva, 8-11 December 2008. Geneva, World Health Org., 2011.&#xD;
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14. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Tech Rep Ser 2000;894:i-xii, 1-253.&#xD;
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15. &#xD6;zbey &#xDC;, U&#xE7;ar A, &#xC7;ali? AG. The effects of obesity on pulmonary function in adults with asthma. Lung India 2019;36(5):404-410.&#xD;
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16. WHO Expert Consultation. Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-163.&#xD;
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17. Jesus JPV, Lima-Matos AS, Almeida PCA, Lima VB, Mello LM, Souza-Machado A, et al. Obesity and asthma: clinical and laboratory characterization of a common combination. J Bras Pneumol 2018;44(3):207-212.&#xD;
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18. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23(5):469-480.&#xA0;&#xD;
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19. Lv N, Xiao L, Camargo CA Jr., Wilson SR, Buist AS, Strub P, et al. Abdominal and general adiposity and level of asthma control in adults with uncontrolled asthma. Ann Am Thorac Soc 2014;11(8):1218-1224.&#xD;
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20. Jiang D, Wang L, Bai C, Chen O. Association between abdominal obesity and asthma: a meta-analysis. Allergy Asthma Clin Immunol 2019;15(1):16.&#xD;
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21. McCallister JW, Holbrook JT, Wei CY, Parsons JP, Benninger CG, Dixon AE, et al. Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers. Respir Med 2013;107(10):1491-1500. &#xD;
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22. Zillmer LR, Gazzotti MR, Nascimento OA, Montealegre F, Fish J, Jardim JR. Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities. J Bras Pneumol 2014;40(6):591-598. &#xD;
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23. Ciprandi G, Gallo F. The impact of gender on asthma in the daily clinical practice. Postgrad Med 2018;130(2):271-273. &#xD;
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24. Dias-Junior SA, Reis M, de Carvalho-Pinto RM, Stelmach R, Halpern A, Cukier A. Effects of weight loss on asthma control in obese patients with severe asthma. Eur Respir J 2014;43:1368&#x2013;1377.&#xD;
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25. Juel CT, Ali Z, Nilas L, Ulrik CS. Asthma and obesity: does weight loss improve asthma control? a systematic review. J Asthma Allergy 2012;5:21-26.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Review on Importance of Snana (Bathing) in Dincharya According to Ayurveda&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>83</FirstPage><LastPage>86</LastPage><AuthorList><Author>Sonali Bhoyar</Author><AuthorLanguage>English</AuthorLanguage><Author> Arshiya Khan</Author><AuthorLanguage>English</AuthorLanguage><Author> Saroj Tirpude</Author><AuthorLanguage>English</AuthorLanguage><Author> Nikhil Dhande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Ayurveda is the basic science of life. The goal of Ayurveda is to maintain the health and cure of the illness. To achieve one such goal of maintaining health one should adopt to follow the procedure of daily regimen as described in Ayurveda. These daily routine regimens have good physiological effects on appropriate functioning of the body system thereby maintaining a normal equilibrium of three doshas i.e. Vata, Pitta and Kapha, Sapta Dhatus (seven tissues), Mala(waste products of the body) and the Agni (power of digestion) and prime importance of daily routine is to keep away diseases. In ayurvedic daily routine includes Snana (bath) as one of the important regimen which is to be performed every day in the morning after Abhyanga, Vyayama, Mardana and Udvartana. Its prime role is to maintain health. Its importance in maintaining health is discussed in various ayurvedic texts. . But still, its whole importance and practical utility do not fully recognize. Hence efforts are made to explain Snana &amp; its benefits in detail as described in Ayurvedic literature.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Dinacharya, Snana, Health, Bath</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Ayurveda is the very important basic science of life to maintain the health of healthy persons and curing diseases of ill.1 A long healthy life is a demand as well as a wish of every being since antiquity. Therefore everyone should always follow those procedures which keep them healthy always. Dinacharya is known as a daily routine and should be followed as mentioned in ayurvedic texts to maintain health. Dinacharya explains various duties which should be followed systematically and scientifically from one day to the next. Dinacharya helps to establish balance in one&#x2019;s body constitution. It also regularizes a person&#x2019;s biological clock, aids digestion, absorption and assimilation and generates self-esteem, discipline, peace, happiness and longevity.2 In Mahabharat, five types of Saucha (cleanliness) are mentioned. They areas Mana, Karma, Kala, Sharir and Vaka Saucha. Gita and Vasistha Samhita also mentioned two types of Sauchaas Bahya Saucha (External cleanliness)and Abhyantara Saucha (Internal cleanliness). Here external cleanliness is to keep the body clean by Snana, etc while internal cleanliness is to keep the mind free.3 The cleanliness is necessary for the health, growth and development of the body. &#xD;
&#xD;
Snana is one of the important regimens described in Dinacharya &amp; mentioned by various Acharyas of Ayurveda and other ancient literature of India. Snana (Bathing) is one of the forms of cleaning our body. If done in the proper manner, it will be a therapeutic preventive and rejuvenating ritual for the body, mind and soul. There is no doubt that good baths clean and rejuvenate our body like Rasayana. Bathing helps you and makes you ready for the whole day activities. As per Ayurveda, regular bathing keeps the body and &#xA0;mind healthy, fresh, energetic and rejuvenated for the day to day activities. We take bath daily as a formality and as a routine part of our daily schedules. &#xD;
&#xD;
The method, benefits &amp;duration of Snana along with different types of Snana have been perfectly mentioned in our samhitagranthas. By considering the explanation which is described in our classics regarding Snana in our Dinacharya, we can surely say that Snana is an important and unique concept explained amongst the various regimens of Dinacarya.&#xD;
&#xD;
Snana should be done every day as explained in manusmruti (Snanam Samachareth Nithyam).4 Acharya Charaka says that Snana is the best way to remove fatigue (Snanam Shramaharaanam Shreshtam).5 cleanliness is necessary and beneficial for the health, growth and development of the body. Snana is the best form of cleaning explained.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Snana is one of the regimens that is to be done daily and which removes Mala, Sweda, and helps the individuals to attain health &amp; wealth. Snana is purifying, libidinal stimulant and gives longevity as explained by charak.6 It removes fatigue, sweat and dirt from the body. Taking bath is auspicious, enhances virility, longevity, strength, compactness and Ojas.&#xD;
&#xD;
Matra of Snana7&#xD;
&#xD;
Matra of Snana is not mentioned anywhere but from one of the classical reference, we get the information that Snana should be performed like Gajavata Snana (bath like an elephant) which means that amount of water used to take bath should be more enough to clean the whole body. According to modern science, 140-150 litres per person for daily purpose and it include bathing.7&#xD;
&#xD;
Time of Snana &#xD;
&#xD;
Acharyas have mentioned that one should take bath early in the morning8. Among Dinacharyas, Snana is explained after the procedure of Vyayama as there will be Ayasa (tiredness) after Vyayama and Snana helps to relieve the Ayasa.&#xD;
&#xD;
Ideal place for Snana &#xD;
&#xD;
According to manusmruti, one should perform Snanadaily in Nadi (river) near the temple, Tirthasthana (sacred places), Tadaga (ponds), Sarahasu, Garta and Prastravana.&#xD;
&#xD;
Classes of Snana - There are 3 classes of Snana8 &#xD;
&#xD;
1. NityaSnana &#x2013; Normal bathing when at home on a daily routine. &#xD;
&#xD;
2. NaimittakaSnana &#x2013; Special occasional snana like the death of a relative, hair cut etc &#xD;
&#xD;
3. KamyaSnana &#x2013; Bath has taken for special vows undertaken like in a temple tank etc. &#xD;
&#xD;
Types of Snana9&#xD;
&#xD;
According to YagnavalkyaSmrti, there are seven types of Snana. They are as follows; &#xD;
&#xD;
1. MantraSnana - Snana did by pronouncing Auponishadi Mantra is called as Mantra Snana &#xD;
&#xD;
2. BhoumaSnana- Snana by smearing &amp; rubbing the whole body with mud is called BhoumaSnana &#xD;
&#xD;
3. AgneyaSnana- Snana did by applying bhasma (ash) i.e. burnt powder of cow dung is called as AgneyaSnana &#xD;
&#xD;
4. VayavyaSnana- Snana with dust which arises while the cow is walking is called as VayavyaSnana &#xD;
&#xD;
5. DivyaSnana- Snana which is done in sun rays or the glare of the sun combined with rain is called as DivyaSnana&#xD;
&#xD;
6. VarunaSnana- Snana performed in river water is called as VarunaSnana&#xD;
&#xD;
7. ManasaSnana- Only thinking about the sacred soul is called as ManasaSnana&#xD;
&#xD;
Benefits of Snana&#xD;
&#xD;
According to Acharya Charak Snana acts as a purifying, libido stimulant and prolongs life. It helps relieving fatigue, removes sweating and dirt from the body. It promotes strength and endurance in our body.10 Taking bath regularly is auspicious, increases virility, longevity, strength, compactness and Ojas of the body. It helps in curing tiredness, sweat and impurities of the body.11 It takes away sleep, burning sensation, tiredness, sweat, itching, thirst and impurities. It&#x2019;s also good for the heart and purifying all organs and gives satisfaction. &#xD;
&#xD;
According to Sushrut acharya, regular Snana helps to relieve burning sensation, exertion, and perspiration removes itching and thirst. Snana is acting as a Hridya (good for the heart), removes dirt, stimulates all the sense organs and mitigates stupor and sins. It provides satisfaction, enhances virility, purifies the blood and improves our digestive power.12 According to Acharya Vagbhata, regular Snana enhances digestive power, libido stimulant and life promoter. It also brings an increase in strength of the body. It removes somnolence, fatigue, sweating, dirt and bodily heat. It removes itching, increases the appetizing power, allays thirst and destroys drowsiness and sin.13 &#xD;
&#xD;
According to Yogratnakara, properties of regular Snana are like - relieves one from all types of unwholesome and of sinful acts, destroys the effects of bad dreams and nightmares, helps too remove all dirt and dust of the body), enhancement of colour and complexion of skin helps in beautification of body, brings pleasant or gives freshness to the body. Improves the digestive fire. Improves sexual vigour and libido of an individual, relieves one from fatigue.14 &#xD;
&#xD;
According to Bhavprakasha, even rubbing the entire body with a cloth just after bathing improves colour and complexion of the skin, removes itching and various illness of skin.15,16 &#xD;
&#xD;
According to Kalyanakaraka, a bath enhances satisfaction, strength, Luster, health, long life, the normalcy of the humours and smoothness and also increases gastric fire. It also develops the interest to eat i.e. creates appetite.&#xD;
&#xD;
Health Benefits of having sheeta Jala Snana (Bath with cold water)17,18 &#xD;
&#xD;
Bathing with Sheeta Jala (cold water) improves eyesight and also stimulate agni that helps in the process of digestion if it will be taken in proper time. Bathing with cold water cures Raktapitta (bleeding disorders). Bathing with extremely cold water, especially during the winter season, leads to the aggravation of Kapha and Vatadosha. The sight of a person is rejuvenated by taking cold water to the head at the time of bathing. &#xD;
&#xD;
Health Benefits of having Ushna Jala Snana (Bath with warm water)- &#xD;
&#xD;
A bath with Ushna Jala (warm water) increases the strength of an individual and lowers the increased Vata and Kapha dosha.19 Ushna Jala Snana increases the strength of the body except for the head. It indicates that hot water should not be used for a head bath. It should use for bath only the portion down the clavicle level. If it is done then it decreases the strength and also leads to harmful effect on eyes, hairs and heart.20 According to Sushruta, during aggravation of Kapha and Vata dosha, one can use a lukewarm water bath for the head as medicine.21 Warm water bath should be avoided during summer since they imbalances Pitta dosha. The warm bath has stimulation action on the skin and reflex, it also excites the heart and circulation. . &#xD;
&#xD;
Contraindications of Snana&#xD;
&#xD;
Bathing is contraindicated for persons suffering from Arditha(facial palsy), Atisara (diarrhoea), Aadmana (distension of abdomen), Pinasa (rhinitis), Ajeerna (indigestion), Bhuktavat (immediately after taking food), Jwara (fever), Karna Shoola (earache), Anila(Vata), Arochak (anorexia) and also persons suffering from Netra(eye), Aasya (oral), Karna (ear) Rogas (diseases).21&#xD;
&#xD;
Rules for taking a bath&#xD;
&#xD;
A bath should be taken in the morning and should be before the morning meal. Bathing should be done with Luke warm water except the head, rubbing the entire body with cloth early after bathing helps Improves lustre, removes itching and disorders of the skin. Always changed the dress after bath, sleep, while going out of the house and for worshipping gods. Bathing entering into reservoirs of water and sleeping should not be done naked. While taking bath in a well or pond built by others, bathing should not be done without taking out a handful of mud from the floor five times (taking out mud signifies digging the well for ourselves and making the well by own. This was another ancient custom).22-24&#xD;
&#xD;
Baths fixed on special occasions&#xD;
&#xD;
Many peoples on the country side use a paste consisting of gram flour, mustard oil and turmeric powder and rub it on the body before bath. One who baths with Amlaka water in which Amlaka fruits are soaked always will surely get free from wrinkled skin and grey hairs and lives hundreds years.22 Few of the related studies were reviewed.25.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Snana plays an important role in maintaining health. It&#x2019;s also a part of customs and rituals in Indian tradition. It is an act of purification not only for physical body but also for the mind. It is also necessary for internal purification. Bathing is not only required for the cleanliness of skin but also for its action on the internal organs as it helps to regulate proper circulation. It is one of the preventive modality for maintaining the overall health of the individual . When Vata and Kapha doshas are get vitiated lukewarm water can be used for head bath. Otherwise taking a head bath with hot water is injurious to the eyes and cold water is good for the eyes. Hot water applied to the head weakens the strength of sense organs. Snana has a promotive, protective and curative and positive effect on the body. Hence we can say that it must be practised as a prophylactic measure to attain its benefits and maintaining health.&#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=3661</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3661</Fulltext></URLs><References>1. Murthy Srikantha (Ed). KR Agnivesha, Charaka Samhita, Sutrasthana chapter-30, shloka-1 volume- I, Chaukhmbha Surbharathi Prakashan , Varanasi (India), page no 447.&#xD;
&#xD;
2. SushrutaSamhita by AmbikaduttaShastri, ChikitsaSthana, chapter 24/.3. 127. Chaukhamba Sanskrit Sansthan, Varanasi, 2007. &#xD;
&#xD;
3. Mapdar A. Approach of Disease Prevention, Health Preservation and Health Promotion w.s.r to Dinacharya. Int J Ayur Pharma Res 2015;3(9):62-70.&#xD;
&#xD;
4. Panda NC. Manusmruti. B.K.P Publication. 2nd Edition, Vol 1, 2014.&#xD;
&#xD;
5. Murthy Srikantha (Ed). Agnivesha, Charaka Samhita, Sutrasthana chapter-25, shloka-40, volume- I, Chaukhmbha Surbharathi Prakashan , Varanasi (India), pg 372.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
6. Murthy Srikantha (Ed). Agnivesha, Charaka Samhita, Sutrasthana chapter-5, shloka-94 volume- I, Chaukhmbha Surbharathi Prakashan , Varanasi (India). 101.&#xD;
&#xD;
7.&#xA0; Samgandikashinath; Swasthasudha, 1st edition; 2nd chapter. 46 &#xD;
&#xD;
8. Snana Vidhi- Holy River Bath- A vedic Karma. https://www.speakingtree.in/blog/snana-vidhi---holy-river-bath---a-vedic-karma cited on 18/10/2018.&#xD;
&#xD;
9. Samgandi Kashinath; swastha Sudha; 1st edition; 2nd chapter; 46&#xD;
&#xD;
10. Tripathi B, Pandey GS (Ed). Charak Samhita, Sutra Sthana. Chaukhamba Surbharti Prakashan, 2007. Chapter 6, Verse 6 page No. 146 &#xD;
&#xD;
11. Murthy Srikantha (Ed). Agnivesha, Charaka Samhita, Sutrasthana chapter-5, shloka-94, volume- I, Chaukhambha Surbharti Prakashan , Varanasi (India) &#xD;
&#xD;
12. Shastri A (Ed). Sushruta Samhita by Ambikadutta, Chikitsa Sthana, chapter 24/ 57, Page 135. Chaukhamba Sanskrit Sansthan, Varanasi, 2007 &#xD;
&#xD;
13. Tripathi B (Ed). Ashtanga Hridaya. Sutra Sthana, Chapter 2, Verse No. 16 Page 32; Chaukhambha Prakashan, Varanasi 2009. &#xD;
&#xD;
14. Tripathi I, Tripathi SD. (Ed). Yogratnakara. Chaukhamba Krishnadas Academy, Varanasi: 2nd edition; 2007; Nityapravrittiprakaramaha; shloka-70-79;51-52.&#xD;
&#xD;
15. Mishra B, Bhavaprakash, English translation-Murthy Srikantha.KR. ChaukhambaKrishnadas academy, Varanasi; volume-1; Edition-Reprint 2011; Chapter-5; Shloka-71-78;87.&#xD;
&#xD;
16. Tripathi I, Tripathi SD. (Ed). Yogratnakara with Vaidyaprabha. Chaukhamba Krishnadas Academy, Varanasi: 2nd edition; 2007; Nityapravritti prakaramaha;shloka-70-79:51-52.&#xD;
&#xD;
17. Shastri A (Ed). Sushruta. SushrutaSamhita. 2nd edition. Varanasi: Chaukhamba Sanskrit Sansthan, 2007. ChikitsaSthana24/59-61:135.&#xD;
&#xD;
18. Tripathi I, Tripathi SD. (Ed). Yogratnakara. Chaukhamba Krishnadas Academy, Varanasi: 2nd edition; 2007; Nityapravritti prakaramaha;shloka-70-72:51-52. &#xD;
&#xD;
19. Tripathi I, Tripathi SD. (Ed). Yogratnakara, ChaukhambaKrishnadas Academy, Varanasi: 2nd edition; 2007; Nityapravrittiprakaramaha;shloka-73:52.&#xD;
&#xD;
20. Tripathi B (Ed). Ashtanga Hridaya. Sutra Sthana, Chapter 2/17:32 Chaukhambha Prakashan, Varanasi 2009. &#xD;
&#xD;
21. Tripathi I, Tripathi SD (Ed). Yogratnakara, Chaukhamba Krishnadas Academy, Varanasi: 2nd edition; 2007; Nityapravrittiprakaramaha, shloka-77;51. &#xD;
&#xD;
22. Mishra B, Murthy Srikantha KR (Ed). Bhavaprakash Chaukhamba Krishnadas Academy Varanasi; volume-1; 2011; Chapter-5; Shloka-71-78: 86-87 &#xD;
&#xD;
23. Deshpande MA, Deshpande AM. Preventive Measures for COVID 19 through Dincharya and Rutucharya Mentioned in Ayurvedic Text. Int J Res in Pharm Sci 2020;11(1):239&#x2013;45. &#xD;
&#xD;
24. Khatib M, Sinha A, Gaidhane A, Simkhada P, Behere P, Saxena D, et al. A systematic review on the effect of electronic media among children and adolescents on substance abuse. Int J Community Med 2018;43(5): S66&#x2013;72. &#xD;
&#xD;
25. Murray CJL, Abbafati C, Abbas KM, Abbasi M, Abbasi-Kangevari M. Abd-Allah F, et al. Five Insights from the Global Burden of Disease Study 2019. Lancet 2020;396(10258):1135&#x2013;59. &#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Power, Autonomy and Emotional Well-Being in Later Life: A Qualitative Study in Rural Assam, India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>87</FirstPage><LastPage>90</LastPage><AuthorList><Author>Nitish Gogoi</Author><AuthorLanguage>English</AuthorLanguage><Author>Shashank Yadav</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Aged, Autonomy, Emotional Well-being, Power, Qualitative Study, Rural</Keywords><Fulltext>Introduction&#xD;
&#xD;
Power and autonomy have always been a major element of emotional well-being among the aged population in a traditional society like India. Traditionally, India has a unique family system where three or four generations lived in the same household. The family in India joint in nature where elderly people lived with more respect and honour and it was believed that they are resourceful and more knowledgeable person. They are also enjoying autonomy and decision making responsibility within the family. Under their responsibility, the functions of the family were smoothly run. The young generations also abiding by the values and responsibilities given by their elderly parents or grandparents. Under the guidance of older generations, the young generations were able to find a meaningful path in their life. The solidarity was very strong across the generations. And it contributed to aggrandize the life satisfaction and well-being of both generations. However, in the past three decades, many changes have been taken place in traditional family values cause by modernization, urbanization and mostly migration of the young generation in search of various job opportunities hampered the traditional family values. It is also predicted that with the increasing demand for workforce participation the relationship across generations become more materialistic than ever before and have weakened the intergenerational bonds and structure and functions of the family as well. Nowadays, in India due to the loss of their autonomy and power within the family, the elderly people are surviving, and on the other hand, protesting and opposing attitudes become common among the young generations and it increases the gap between generations. In this changing scenario, the old people become isolated and faced difficulties to cope with the changing situations and get marginalized. Various issues and challenges coming up with the rapid changes in family relations. With the breakdown of generational solidarity, the level of depression has been increasing among the older generations and due to intergenerational conflict, the problem of loneliness arises as to the major threat to the emotional/ mental and physical well-being of elderly people. There are many instances where loneliness leads to suicides among the older generations. Thus, the older generation is eventually losing their authority and power within their intergenerational family relation. And it has a great impact on the overall well-being of elderly people. The present paper is an attempt to assess the impact of authority and power on the emotional well-being of the aged population living in a traditional rural cultural context. Furthermore, throughout the study, an attempt has also been made to observe the impact of modernity and changing social values and its impact on family solidarity and integration and the emotional well-being of elderly people.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
The study has been done from November 2019 to January 2020 in the Dibrugarh district of Assam, India. Total three villages i.e., Genichuk, Hahoyal and Bogoritoliya have been selected purposefully and an abductive research strategy has been prepared for this study with its tools and techniques in collecting and analysing data. Abductive research strategy&#x2019;s starting point is the social world of social actors being investigated, their social construction of reality and their meaning giving process to their social world. For the study total of 15 respondents (comprised of 8 aged males and 7 aged females) has been selected in the age group of 60 and above from the selected villages and conducted qualitative in-depth interviews. Their narratives have been recorded with their verbal and written consent. In the next phase total of 3 focus group discussions (FGDs) have been organized and given full opportunities to share their experiences and perspectives on the investigated topic. An active non-participant observation has also been made during the whole study. Finally, Narrative Analysis (NA) has been done to analyse the data. Narrative inquiry refers to a subset of qualitative research designs in which stories are used to describe human action. The term&#xA0;narrative&#xA0;has been employed by qualitative researchers with a variety of meanings.[i] Thus narrative inquiry can be an approach that is most relevant to understanding the experiences, actions, motivations, and life journeys of people who are challenged by health, disability, trauma, change, adaptation, loss, or other significant life challenge.[ii]&#xD;
&#xD;
Results and Discussion&#xD;
&#xD;
Emotional Well-being in Later Life: The Role of Autonomy and Power&#xD;
&#xD;
There is always a strong correlation between power, autonomy and emotional well-being. A person with full autonomy can determine his/her potentiality, feel free to do whatever they wanted to do and able to evaluates their &#x2018;self&#x2019; by personal standards. Therefore, the elderly&#x2019;s emotional well-being has been measured by their autonomy and power within intergenerational relation with the help of a question, &#x201C;Do you feel that autonomy and power in family help to foster your emotional well-being?&#x201D; And it was revealed that all the respondent has been enjoying more or less autonomy and power as head of the family and it fosters their emotional well-being. No one has reported conflict-related to autonomy and decision making in their family matters. They have always been receiving priority while taking any decision by their younger children. Budhiram Dutta, a 65 years aged male respondent from Genichuk village happily narrated that:&#xD;
&#xD;
&#x201C;I am very happy to say that I have been enjoying full autonomy and power in my family. As ahead of the family, it&#x2019;s my privileged to have such respect from my children and other family members. It&#x2019;s not like that I am controlling their autonomy and freedom, but this is just the matter of respect and privileged that fosters my emotional well-being in later part of my life&#x201D;.&#xA0; &#xD;
&#xD;
It was also observed that aged person with full autonomy and power were more likely to report strong emotional well-being as compared to the elderly with less autonomy and power. However, socio-economic background such as economic dependency, health, co-residence etc., has also been played a significant role in the construction of their emotional well-being. Our study reveals that aged those who are in the age group of 60 to 65 with the good economic condition and with excellent health were enjoying more autonomy and power than those who are in the age group of 80 and above with no income and poor health. Few respondents have been enjoying less autonomy and power within the family. However, they have reported an alternative standpoint in the construction of their emotional well-being. They are of the view that they just need emotional ties among family members and children and they need emotional support in their later life. For them, strong family ties and bonding is the core instrument to nurture emotional well-being than autonomy and power. For instance, Kuhiram Das, a 76 years old aged male respondent from Bogoritoliya village narrated that:&#xD;
&#xD;
&#x201C;What is more important for me is strong family ties and bonding among my family members. Yes, of course, as ahead of the family I wants to hold my family in my hand but the more I grow the more I feel that strong solidarity among family members is more important than my power and autonomy in my family&#x201D;. &#xD;
&#xD;
Therefore, their family background and family environment have also made a serious impact on their emotional well-being. In a study, it was reported that there was a significant direct effect of living environment on the relationship between parents and children and has an indirect effect on attitudes towards ageing.[iii] Similarly, another study also reported that the quality of the family relationship has been greatly influencing by the positive change in the living environment. A positive living environment improves both life satisfaction and the quality of the family relationship.[iv] Therefore, it can be said that the residential environment can be an important element of positive family relationship and the emotional well-being of elderly people.&#xD;
&#xD;
However, gender differences have been observed throughout the study. Because it was the aged male who wants more power and autonomy in their family than their female counterparts. During the interview, it was the aged male who is more vocal about their family. The existing gender power structure has also been reflected during the interview with female respondents. They are less likely to speak in their family, but significantly, more likely to have strong bonding with their children. Almost all the aged female respondents are of the view that they just need love, care, and attention from their children and other family members. For love and care works more than medicines. Pushpeswari Dutta, a 69 years old female respondent from Hahoyal village narrated that:&#xD;
&#xD;
&#x201C;What I need from my children are more love, care and some kindness and that&#x2019;s enough for me to foster my emotional well-being than autonomy and power. Although, I am enjoying autonomy and power as ahead of the family that does not matter for me if there is no love and respect in that power&#x201D;.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Moreover, all the respondents are of the view that both instrumental and expressive support from the family members is a significant element of emotional well-being. However, in many studies, it was found that parents want to minimize the amount of support received from children as it increases their dependency on children and hence they wanted to avoid the stigma of being a &#x2018;burden&#x2019;.[v] For instance, a study on the &#x2018;Public perception of care giving&#x2019; reported that old parents don&#x2019;t want to be a burden on their children. Respondents believe that they want to be independent as long as their functional capacity permits. And it was also revealed that older parents mostly prefer to live by themselves than with their children&#x2019;s families or in other institutions like old age home.[vi]&#xD;
&#xD;
Paradoxes of Modernity&#xD;
&#xD;
The changing social values and rapid transformation in the family structure has a serious impact on the overall well-being of the aged population in India. There was a time when elderly people were taken care of by their children or other family member and they have lived a healthy life within the family. But nowadays with increasing materialistic values the young generation today holds the attitudes toward elderly as economically unproductive and hence some children even don&#x2019;t hesitate to send their aged parents to old age home or other institution. India Aging Report of 2017 presenting four challenging aspects of ageing in India- First, according to the report, discrimination and neglect towards women, and dependence on others lead to the Feminization of Aging. Also, the loss of a spouse hurt the well-being of elderly women. Due to the dependence on others the older women, today lived in a vulnerable situation than older men. Because the young children today don&#x2019;t show their willingness to take care of their old and economically unproductive parents. Secondly, in comparison to other developed countries, the majority of the older population live in villages with poor transportation and communication facilities i.e., Ruralization of the Elderly.&#xA0; Though the modern means of medical technology has been increasing in India still the elderly in India are living in rural areas far away from the advanced medical facilities. The income insecurity, quality health care, isolations are more vulnerable to rural elder than their urban counterparts. Third, the report said that the number of older women increasing than older men in India due to the early marriage and loss of a spouse in their mid-life i.e., it is projected that India will have more than 80 plus women and hence the older women become survivor within the family. Finally, in India like other countries in the world, the young generations are migrated for workforce participation and it had a significant impact on intergenerational family relations.[vii] It is not always true that the migration of the younger generation harms the well-being of elderly people. Even according to the report the migration of younger generations enhances the well-being through monetary support to elderly parents in need. However, it also leads to the problems of loneliness among elderly parents.&#xA0; &#xD;
&#xD;
In the present study, throughout the focus group discussions (FGDs) full liberty has been given to the respondents to share and discuss their views regarding the changing family values and their impact on their emotional well-being. Significantly most of the respondents think that they have to go with the changing social values although they don&#x2019;t like modern mores and values in their family and society as well. Some are of the view that they are losing their autonomy and power due to modern ways of lifestyle and habits embedded by their younger children. Whereas, some female respondents are of the view that sometimes they have to adjust to the decision taken by their children as otherwise, it will create conflict between them. Pravat Dutta, from Hahoyal village, shared his experiences and narrated that:&#xD;
&#xD;
&#x201C;Sometimes we have to listen to our children and other family members&#x2019; needs and attitudes and have to adjust with their modern values. Although we are still practising our old age traditions sometimes we also have to sacrifice them for the sake of our younger generations. Because it helps to maintain peaceful family environment&#x201D;.10,11&#xD;
&#xD;
All the respondents think that their children may not like their controlling attitude. Significantly, it was observed that the elderly with highly rigid attitudes had problems in adjustment with their children, and had less interaction or no interaction with children. Conflict occurs between generations due to the different attitudes towards societal values. In a study, it was reported that differences in interest, likes, dislikes, differences in attitude and lifestyle are the root cause of the generation gap. It was found that protesting and opposing attitudes were common among the youths and they prefer to live with their own chosen will.[viii]&#xD;
&#xD;
Conclusion: Towards a Healthy Aging&#xD;
&#xD;
The findings of the present study suggest that future study should give its importance on the socio-economic background of the aged population in the study of family relation. Because the pattern of exchange of both instrumental and expressive support was varied according to the socio-economic variables of the respondents. However, power and autonomy have been identified as significant indicator of emotional well-being in later life. All the elderly in the present study have been showing higher morale, mostly experiencing a very friendly environment within their family. They have been taken care of by their children, have a friendly interaction with children and getting proper attention from their children. In addition to this, old age is also known as the second childhood where they required some love, care, and attention and it makes them very happy. Therefore, for the emotional well-being of elderly people, the young children, as well as the other family members, should try to make the aged friendly environment within the family. Family members, children should give some autonomy to their aged parents to live their life according to their desire. Every family indeed have some conflict regarding family matters when the aged parent remains rigid in their mindset and do not accept the lifestyles, radical views, and modernity followed by their young children. But sometimes the young generation should agree with the decision taken by their aged parents keeping in mind the aged parent&#x2019;s cultural context of life.&#xD;
&#xD;
Acknowledgement: I would like to thank my M. Phil supervisor, Dr. Shashank Yadav, for his critical comments and observations on the earlier version of the manuscript.&#xD;
&#xD;
Conflict of Interest: I don&#x2019;t have any conflict of interest.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3662</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3662</Fulltext></URLs><References>&#xD;
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11. Ramamurti PV. Intergenerational Relations, in: K. R. Gangadharan (Eds.), Aging in India: Emerging trends and Perspectives, Heritage Hospital, Hyderabad, 2002; 24-26.&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Ethics and Narratives: An Analysis of Commercials of Patanjali Ayurveda&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>91</FirstPage><LastPage>97</LastPage><AuthorList><Author>Aleem Khan</Author><AuthorLanguage>English</AuthorLanguage><Author> Subhash Kumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Advertising is used as an effective tool to promote various products and ideas in the desired economic goals. In contemporary time digital media has been used as a powerful medium, it has the potential of reaching millions of consumer. In such conditions, advertisers have influenced society through embedded content such as dialogues, text and visual narratives. These Deceptive practices in advertising have created challenges for regulatory bodies. Although the Advertising Standard Council of India (ASCI,1985) were formulated various codes of conduct to control misleading advertisements. In this paper, commercials of Patanjali Ayurveda, an Indian consumer goods company that has reached new heights in the international market has been studied. Objectives: This study aims to analyse the narratives of TV commercials of Patanjali products, to examine the ASCI codes and ethics in advertisements of Patanjali and the audience perception about the Patanjali advertisements. Methods: Keeping the study objectives in view, the authors adopted a narrative analysis method for examining the content of selected advertainments. The questionnaire was administered through a google form. A random sample from the target audience group was selected for the study. Results: A total of one hundred and eighteen respondents responded to the survey. In which 44% and 49% of respondent feel that Patanjali has used patriotic and cultural themes for promoting their products. 51% of respondent feel that boycotting the other products is not justified and 21% of respondents think that linking patriotism in the marketing of goods is beneficial, 45% of respondents believe that it is not justified. The majority of respondent believes that promoting negative sentiments in advertising practices is not good for the country&#x2019;s social fabric and economic goals. Conclusion: The study has found that the cosmetic and dairy products ads had included misleading content in the narratives; the emotions of patriotism and faith have been used for the economic benefit of Patanjali by using a national icon, symbols and false claims in their advertisements. They appreciated social stereotypes and unfairly targeted competitive MNCs through the ads narratives. it promotes unfair competition in the market. Also, some advertisements of the Patanjali products has violated the ASCI codes and fined for harmful and misleading content by the regulatory bodies. Although such ads were banned for airing on television, all these ads continue to exist on digital media under the name of Patanjali Ayurveda and ASCI is failed to ban such ads on Digital media platforms.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Patanjali, Advertising, Content, ASCI, Ethics, Agenda</Keywords><Fulltext>&#xD;
INTRODUCTION&#xD;
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The Oxford dictionary explains advertisement as a public announcement of goods to promote sales and the primary objective of advertising is to sell something through persuasion. Today, these commercials have become an important social and economic force in the world.1 After globalization advertising industry has expanded in a very progressive manner and has kept pace with the growth of multinational companies in India. It has a far-reaching influence on the social, cultural and moral values of the society.2 It has come across innumerable images, audios, text for various products. The excessive use of various forms of media for the promotion of Goods and services cannot be ignored in our day to day lives. Advertisements affect our life to a large extent and it is necessary to develop an understanding of the effective relationship between promotional messages and consumers, be would undertake some social responsibility in the sending messages.3 Goldman has opined that advertising as a major social and economic institution, strives to maintain cultural hegemony by providing us with socially constructed ways of seeing about the world. According to Ewen and Ewen, &#x201C;advertising not only sells us the product or services but it also indirectly tells us ways, to understand the world&#x201D;.4&#xD;
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There are numerous instances where advertisements have mislead with hidden propaganda and false claims through TV and digital media platforms. So, the government has established professional organization like ASCI&#xA0; (The Advertising Standards Council of India) as a non-statutory tribunal, as its executive aim is to receive complaints about misleading advertisements and create a self-regulatory mechanism of ensuring ethical advertising practices for the industry&#x201D;.5 It exercises the influence in motivating advertisers to self-regulate by observing honesty and truthfulness in the content and fair promotional practices among advertisers.6&#xD;
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In this context, Patanjali Ayurveda &#x201C;a leading herbal and ayurvedic product manufacturer has been included in the top three advertisers in television until 2017. In the same year, Patanjali significantly ramped up its online presence, it has created advertising narratives in regional language for different states.7 The channel name &#x2018;Patanjali Ayurveda&#x2019; on YouTube which is started in July 2014 has more than 96.000 subscribers and reached 3 million views in the first month of 2017; and after collaboration with Google, it has climbed to 15 crore views. It also started an online campaign for boycotting foreign products with the &#x201C;Go swadeshi (indigenous) movement&#x201D;. Acharya Balkrishna CEO of Patanjali Ayurveda told &#x2018;The print&#x2019; in an interview that &#x201C;the company had consciously reduced its TV ads and plane to give more focus on digital media and we are planning to increase more spends on digital media in some months&#x201D;.8 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; The ASCI guidelines have been overlooked many times by the Patanjali Ayurveda Ltd. In December 2016 it was fined Rs 11 lakhs for &#x201C;misbranding and putting up misleading advertisements&#x201D; of their products in the District Court of Haridwar, Uttarakhand, India. The products were found to be in &#x201C;violation of Section 52 (misbranding) and Section 53 (misleading advertisement) of Food Security norms and section 23.1 (5) of Food Safety and Standard (packaging and labelling) Regulation&#x201D;.9 The researcher like Morden found that the basic function of &#x201C;Television commercial is to create awareness about the goods and services so that viewers of the advertisement can take the rational decision from their mind.10 Advertising is always a subject of monitoring because healthy and fair practices among the companies are the primary objective of ASCI (Advertising council of India).2&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The book &#x201C;Advertising and sales promotion&#x201D; explain the typical form of untruths in the advertisements which have exaggerated facts, misinterpretation, false claim, unfair comparison etc. she states that today the numbers of unethical and obscene advertisements are increasing instead of decreasing, the government is not in favour to regulate advertisements by his enforcement.11&#xD;
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Hence, the study has tried to analyse the commercials of Patanjali Ayurveda. &#xD;
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	To review the commercials of Patanjali product. &#xD;
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	To analyse the narratives of cosmetic, dairy product advertisements.&#xD;
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	To examine the violations of ethics in the advertisement of Patanjali products.&#xD;
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The questions for this study as follows &#xD;
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&#x2022;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Did Patanjali advertisements use misleading content?&#xD;
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&#x2022;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Is there any agenda in advertising content?&#xD;
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&#x2022;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Did Patanjali commercials follow the advertising ethics?&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; The Bogdan Nichfor States that &#x201C;Advertising is a tool of mass communication and Its content and performed functions are not yet defined in generally recognized theory&#x201D;.13 So, the study, deal with Affective response theory which focuses on the emotional response that advertising content can generate. It refers, &#x201C;consumers and their preferences are based on pleasure, feelings and emotions which arise from exposure to the message, the objective characteristics of the product playing a less important role in this direction&#x201D;.14 The Agenda-setting theory of McCombs and Donald Shaw opined that &#x201C;media sets the agenda for the masses. This theory suggested that media do not tell people &#x2018;what to think&#x2019;, but they may tell people &#x2018;what to think about.15&#xD;
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MATERIALS AND METHODS&#xD;
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The research work is analytical. It has used primary as well as secondary data for analysis. A close-ended questioner was administered through a Google form, A random sample method used for primary data collection from the target audiences to get viewers insight on commercials, that is provide a quantitative description of the Patanjali Ads pattern. In Qualitative nature, research was used narrative analysis technique as Coulter and Barone to understand the Pattern of Patanjali advertisements.16,17 Suitable multivariate techniques were used for data analysis. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The secondary data for the research is largely based on information that is already available and accessible from television, web media, news, articles, blogs etc. Advertisements that have been used for content analysis are selected from the official website of Patanjali Ayurveda and YouTube channel. &#xD;
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&#x2022;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the qualitative procedure, Patanjali advertisements were selected by purposeful sampling to analyse and understand the advertisement content (text, language, images, narration).&#xD;
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&#x2022;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the quantitative technique, a study has chosen 120 students as a sample size (Male and Female). The random sample is used for the collection of 120 responses of undergraduate students from Manipal University Jaipur and a close-ended questionnaire was used for data collection.&#xA0; 98% of respondents come from the 18 to 24 years of age group.&#xA0; The questionnaire was administered through a Google form. A total of 119 students were responded to the survey.&#xD;
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Data analysis and Interpretation&#xD;
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	&#xA0;Judiciary and Regulatory Proceedings against Patanjali Advertisement&#xD;
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In Sep 2017 Delhi High court stopped the airing of Patanjali&amp;#39;s &#x2018;Chyawanprash&#x2019; ads when competitor brand Dabur accused that the commercial of Patanjali disparaged his product.18 &#xA0;Former Minister of State for Information and Broadcasting Rajyavardhan Rathore told the Lok Sabha in a written reply that &#x201C;the government has received 33 complaints from April 2015 to July 2016 against Patanjali ads.19 As per the findings of the consumer complaints council (CCCI), ASCI and the department of consumer affairs has informed the Legislation assembly that 25 out of 33 complained against Patanjali advertisement were considered to violation of Advertising Standards Council of India codes&#x201D;.12,19&#xD;
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	Distribution of Patanjali Ads&#xD;
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A report of the Broadcast Audience Research Council (BARC)20 mentioned that Patanjali Ayurveda had stepped its advertising promotion, and became among one of the top three brands&#xA0; (2017).&#xD;
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In the BARC report (Broadcast Audience research council provides reports on TV audience measurement) the total distributions of Patanjali Ads on the News Channel are 84 %. Figure (1) Indicate the total distribution of Patanjali advertainments on different media outlets. Thus, Patanjali has used news channels as an effective tool for his Business Marketing.&#xD;
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Interpretation and analysis of Patanjali Advertisements -&#xD;
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	Patanjali Beauty Product Advertisement.&#xD;
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In the below-mentioned figure (2) Patanjali&#x2019;s advertisement for its &#x2018;Soundarya skincare product&#x2019; begins with two sisters, Saundarya and Aishwarya, the narration describes them as, Saundarya ( a girl) &#x201C;Paramparaon ka Paalan karne wali (follows old traditions and cultures)&#x201D;, Aishwarya (another girl) &#x201C;badass, wannabe type girl&#x201D;. The ad goes on to establish that Saundarya received more and more compliments while Aishwarya tries more make-up to hide her blemished skin. Young boys and girls praise Saundarya for her beautiful skin while the same group of people ridicule and shame Aishwarya because she is using cosmetics products of another brand. she upset with the acne on her face. due to the state of her skin, college mates make poke fun at her beauty.&#xD;
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The words &#x2018;bindass and wannabe type girl&#x2019;, &#x201C;which is usually a colloquial Hindi term for &#x2018;carefree&#x2019;, as something negative, shades of sexiest, this advertisement not only mocks women but also implies that being &amp;#39;carefree and cool&amp;#39; is bad&#x201D;.22 The advertisement is centred on its regressive nature, the ad claims that people seem to look down upon women who are not traditional and didn&#x2019;t use Patanjali product are &#x2018;wannabe type or uncultured girl&#x2019;. These ads broadcast at a time when other brands across the market are making attempts to create progressive ads that break gender and racial stereotypes. While these ads have portrayed girls using Patanjali product as modest, beautiful and have cultured values whereas other girls who have not used this Patanjali product are &amp;#39;carefree&amp;#39;, &amp;#39;immodest&amp;#39; and &amp;#39;uncultured&amp;#39;. This ad promotes moral policing and insulting the woman&amp;#39;s freedom of choice. The narrative, visuals of the ad are violating the ASCI codes.&#xD;
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	In the above figure (3) Patanjali &#x2018;Dant Kanti&#x2019; toothpaste ads, the advertiser claims that India is suffering from foreign enemies who are establishing their businesses or investing in our country and extracting money from our country.&#xA0; Furthermore, the advertisement appeals, "Just like crores of &#x201C;Deshbhakt&#x201D; (Patriotic) Indians, shopkeepers and customers in the country who are aware of this foreign economic atrocity should give priority to Patanjali&amp;#39;s products in their shops to contribute in the service of the country, using Patanjali products will help in fulfilling the dreams of Mahatma Gandhi, Bhagat Singh etc. Opposite to this, the promoter of Patanjali claims that profits earned from the sale of products are accrued in the account of any person. However, the CEO of Patanjali Ayurveda limited Balkrishna owns 94 per cent of the shares of Patanjali Ayurveda Limited. Forbes magazine listed Balkrishna as India&#x2019;s 25th richest individuals in 2018-19.&#xA0; As the advertisement states that people should use Patanjali products like &#x2018;other Deshbhakts (patriots)&#x2019;. It raises a question mark on the nationalism of every Indian citizen as if, who do not use Patanjali products, are the supporters of Britishers. Its means they exploiting patriotic sentiments of the masses by advisements for sheer profit. This ad is a clear violation of the ASCI code because it leads to unfair and unethical competition in the market.&#xD;
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	Patanjali Ad on &#x2018;Independence Day&#x2019;.&#xD;
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This ad (Figure 4) recreates a scene from pre-independence India with a black-white clip depicting the Swadeshi movement on Boycott of foreign products by our freedom fighters for Independence The ads suddenly zoom to India&amp;#39;s map where three crosses projecting out in three directions and between the crosses the words E, I and Co. It depicted the East India Company which subsequently paved the way for British colonial rule in India. During the visuals narrator of the ad baba Ramdev starting his appeal (Which have a false claim and misleading content), &#x201C;Videshi companiya hamare desh ke liye bahut hi khatarnak hain kyunki desh ka dhan desh ke bahar lekar ja rahi hain or desh me koi bhi bada kaam charity ka nhi karti hain , in sabka vikalp hai Patanjali ka satvik swadeshi abhiyan&#x2019; (Translation: Foreign brands are very dangerous for our country because they are exporting our own mony to abroad and even they are not doing any charity in the country, using of Patanjali product are the only solution for the problem); they narrate, &amp;#39;Patanjali ka profit kisi vyakti vishesh ke liye nahi balki charity ke liye hai, Aaj Azadi ke 71 saal baad bhi China, US, UK jaisi companiyan loot kar rahi hain&#x2019;.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The Patanjali brand has been aggressively portrayed its indigenous identity and pitching multinational companies as &#x201C;thieves&#x201D; in their ads. Patanjali has compared its global rivals to the East India Company and portrayed MNCs as a symbol of colonisation and oppression of Britishers. He appealed to achieve complete freedom or &#x201C;swaraj&#x201D; from them.&#xA0; The advertisement states that MNCs are the same way, as &#x201C;East India Company enslaved and looted us, multinational companies are still doing the same by selling soap, shampoo, toothpaste, cream, powder and similar daily items at an exorbitant price&#x201D;. Patanjali doing his business for charity purposes without making any profit. When this ad was aired on TV, the Christian community protested against Patanjali for uses religious symbols like the Cross in their ad and portray Christians as outsiders.23 This type of commercial elements degrades other cultures and provoke sentiments to spread hatred in the majority of people against minorities. This kind of ads has affected the morale and the secular fabric of India.&#xD;
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	Patanjali &#x2018;Cow Ghee&#x2019; Ads. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the below-mentioned Advertisement (figure- 5) Baba Ramdev explicates some of the facts regarding cow and their sacredness and benefits i.e. Population, ghee production and consumption. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The voice-over adds, &#x201C;Nirantar ho Rahi Goukashi (cow slaughter) Ke Karan Kuch Log Sochte hen Ki Itne bade Paimane par Ghee Kaise Tayyar ho rha hai? Desh me 12 crore Gai haain. Translation of VO is (Due to continuous slaughtering of cow peoples thinks how they are being produced Ghee at such a large scale because there is only 102 million cow in India). Another Patanjali Ad emphasises, &#x201C;Patanjali Ghee Apnaye, Gou Mata ko Katal Khano me Jaane se Bachayein (use Patanjali Ghee and stop the holy cow from slaughtering&#x201D;). Through the narrative of the advertisement, Baba Ramdev is spreading propaganda about cow slaughtering and facts related to the cow population. Whereas the Government statics&#x2019; official data about the cow population according to the National Dairy Development Board (2012) census is 267.6 Million (Approx.: 26.7600000 crores.24 This ad targets a particular community that are involved in the Cattle business. now India is suffering from a &#x2018;Mob lynching&#x2019; kind of attacks. It also coerces the viewers to use and purchase Patanjali ghee to save the &#x2018;Holy cow&#x2019; from other communities. it is a direct violation of ASCI codes.&#xD;
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Questionnaire Results&#xD;
&#xD;
A close-ended questionnaire was used for the data collection through the Google form.&#xD;
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Demographic characteristics of respondents &#xD;
&#xD;
All respondents (120) were students pursuing graduation in journalism at Manipal University Jaipur. The data indicate the pattern of Patanjali advertisement, preferences of both consumer and advertiser. It also presents the audience perception of the Patanjali advertisements.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3663</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3663</Fulltext></URLs><References>&#xD;
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	Ohri R. Baba Ramdev&amp;#39;s Patanjali teams up with Facebook, Google for online advertisement push. 2017, Aug 3. Viewed on October 2019 Retrieved from https://economictimes.indiatimes.com/industry/cons-products/fmcg/baba-ramdevs-patanjali-teams-up-with-facebook-google-for-online-advertisement-push/articleshow/59889332.cms?utm_source=contentofinterest&amp;utm_medium=text&amp;utm_campaign=cppst.&#xD;
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	Chandna H. Why Baba Ramdev&#x2019;s Patanjali ads have gone missing from your TV. 2017, October 29, Viewed on September 2019. Retrieved from https://theprint.in/economy/why-baba-ramdevs-patanjali-ads-have-gone-missing-from-your-tv/140962/. &#xD;
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	Indian Express. Ramdev&#x2019;s Patanjali fined Rs 11 lakh for putting up misleading advertisements. Viewed on September 2019. Retrieved from https://indianexpress.com/article/india/ramdevs-patanjali-fined-rs-11-lakh-for-putting-up-misleading-advertisements-4427776/.&#xD;
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	Delhi High Court. Delhi High Court stops Patanjali from airing Chyawanprash ads after Dabur complains. Viewed on September 2019. Retrieved from https://www.businesstoday.in/current/corporate/delhi-high-court-patanjali-chyawanprash-tv-ads-advertisement-dabur/story/259919.html.&#xD;
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	Economic Times. 25 Patanjali ads found violating advertising code. Viewed on September 2019. Retrieved from https://retail.economictimes.indiatimes.com/news/food-entertainment/personal-care-pet-supplies-liquor/25-patanjali-ads-found-violating-advertising-code/53460522 .&#xD;
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	Times Now. Baba Ramdev&amp;#39;s Patanjali to Sue ASCI. Viewed on September 2019. Retrieved from https://www.youtube.com/watch?v=H0j_jrXax9U.&#xD;
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	Indian express. Patanjali&#x2019;s latest cosmetics ad is all shades of sexist, and cringeworthy. Viewed on September 2019. Retrieved from https://indianexpress.com/article/trending/voice/patanjali-saundarya-latest-ad-sexist-is-all-shades-of-sexist-and-cringeworthy-4520709/.&#xD;
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	Anand K. Christians Are Angry with Baba Ramdev for &amp;#39;Misusing&amp;#39; the Cross in a Patanjali Ad. 2017, Aug 15. Viewed on September 2019. Retrieved from http://www.indialivetoday.com/a-patanjali-advertisement-showing-the-cross-as-representing-foreign-products-have-christians-upset/20284.html.&#xD;
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	PTI. Patanjali products popularity causes discomfort among int&amp;#39; rivals. Viewed on 23 July 2019. Retrieved from https://www.theweek.in/wire-updates/business/2019/07/23/nrg37-ukd-patanjali.html.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Hospital Hygiene in the Training Program of the Higher Institute of Nursing Professions and Techniques of Health&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>98</FirstPage><LastPage>102</LastPage><AuthorList><Author>Nadia Chamkal</Author><AuthorLanguage>English</AuthorLanguage><Author> Lahcen Bandadi</Author><AuthorLanguage>English</AuthorLanguage><Author> Khadija Ounine</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The prevention of hospital infections remains an important part of nursing work. To promote infection control, several studies have highlighted the role of hospital hygiene in basic training. Objective: This study aims to describe the aspects of hospital hygiene in the training program of the Higher Institute of Nursing Professions and Techniques of Health. Methods: Descriptive and analytical study was conducted to explore the hospital hygiene place in the basic curricula. All modules contained in the curricula of student nurses (five options), health technicians (six options) and midwife were analyzed. A grid designed for this purpose was used to identify themes linked to hospital hygiene discipline. Results: The findings of this study revealed that the hospital hygiene learning was planned only as themes among different common and disciplinary modules. The most important was attributed to patient hygiene and sterilization as principal elements of safety care. While other themes such as hand hygiene, protective personal equipment, medical waste management rarely occur. Conclusion: In all option programs, hospital hygiene themes are envisaged, but scattered in different modules. We propose a transversal hospital hygiene module in all option programs. This allows global learning and thus the integration of knowledge and the development of skills required.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Hospital Hygiene, Prevention and Control infection, training program, Higher Institute of Nursing Professions  and Techniques of Health</Keywords><Fulltext>Introduction&#xD;
&#xD;
Care Safety and quality is a primary objective of all health system.1 this objective can only be achieved by adopting good practices to prevent risks. The infection transmissions among patients, professionals and family constitute the major risk whatever the care services. To prevent and control these infections, hospital hygiene as a medical discipline constitutes a relevant intervention guaranteeing quality and healthcare safety.2 This discipline takes into account the clinical, microbiological and epidemiological infection aspects, care organizations, hospital equipment maintenance, environmental management and personnel protection.3 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the nursing field, the prevention of hospital infections remains an important part of nursing work.4,5 The hospital hygiene nursing includes the analysis, the organization, the provision of nursing care and the care evaluation.6 For this reason, the nursing students who will be the future nurses are in the needs of hospital hygiene knowledge. Thus, to promote infection control, several studies have highlighted the role of hospital hygiene in basic training to equip staff with the skills required in this area,7&#x2013;10 because the educational background is one of the factors influencing compliance with good practices.11 Hence, imparting and inculcating knowledge on hospital waste management improved their practices in hospitals.12 in this line, training workshops on biomedical waste management has shown promising results in practising biomedical waste management.13 In the same, kelcivoka et al. reported that the lack of compliance with hand hygiene standards among students leads to poor compliance among health care professionals in practice.14 However, the results of the Ward et al study showed that clinical supervisors perceive gaps in nursing student&#x2019;s theoretical knowledge of infection prevention and control. They also noted the inability of students to appropriately apply infection control precautions in the clinical environment.15 Thus, special attention has been paid to the quality of teaching and learning in terms of hospital hygiene for nursing students so that they, as future professionals, can meet the requirements of infection control in healthcare facilities.10,16,17 &#xA0;One study has investigated the teacher&amp;#39;s perception of the integration of hospital hygiene in the nursing training program.16 some authors have examined the satisfaction of nursing students regarding hospital hygiene teaching.18,19 While others have analyzed the content program to research the place according to hand hygiene only as hospital hygiene theme.14 However, there is a concern to study the importance given to all hospital hygiene themes in nursing student programs, which is the purpose of this study.&#xD;
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Materials and Methods&#xD;
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To explore the hospital hygiene place in the training program a descriptive and analytical study was conducted. The study took place in an institute of nursing and technics health in Morocco. It offers training in various options as a speciality. Twelve option programs have been studied: Five nursing care option programs (polyvalent nurses, anaesthetist nurses, emergency nurses, neonatal nurse and psychiatric nurses), six technician health options programs (laboratory, radiology, nutrition, pharmacy, statistics and health and environment) and finally midwife option program. The modules, as enshrinement units, of the nursing, health technicians and midwife student program, were analyzed. &#xD;
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Data was collected using a grid designed for this purpose. It consists of two axes, the first aims to determine the option title, module title.&#xA0; The second allows identifying the learning objectives, hospital hygiene themes as well as teaching/ learning methods. The hospital hygiene themes were identified by reviewing the literature. They are as follows:&#xA0; nosocomial infections; hand washing; personnel hygiene (body and cloths), personnel protective equipment (gloves, aprons and/or gowns, mask and eye protection), accident with exposure to blood, vaccination; patient hygiene, prophylactic antibiotic, isolation, the screening for bacterial carriage; decontamination, disinfection and sterilization and environmental hygiene (water, air and food at the hospital, surfaces disinfection, medical waste and the linen management). &#xD;
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To conduct this study, authorization has been obtained from the Director of the Higher Institute of Nursing Professions and Technics Health has been obtained.&#xA0; &#xD;
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Results &#xD;
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The analysis of the nursing care, midwife programs revealed a hospital hygiene teaching divergence (Table 1).&#xA0; Such as a chapter for the midwife and three nursing care options with detailed themes only for a single nursing care option: the nosocomial infections mechanisms, the surveillance and prevention organization of the nosocomial infections, the hospital waste typology and the management methods. Whereas, in the others option programs, the teaching of hospital hygiene is mentioned only as fragmented themes in different modules. &#xD;
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The theme of personal hygiene (body and the clothing), is mentioned in midwife and three nursing care options curricula.&#xA0; Nevertheless, the personal protective equipment has not been described. It is noted the presence of some elements refer to risks, accidents at work and occupational diseases have also been described in the two nursing care options program. However, the vaccination and accident with exposure to blood themes do not appear in the curricula. &#xD;
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The results highlighted the priority addressed to the patient preparation, comfort and hygiene theme. It&#x2019;s an integral part of all nursing care and midwife option programs. However, the isolation techniques, the screening for bacterial carriage and the antibiotic prophylactic use are not registered. It is noticed that in the midwife and all nursing care options program, the material treatment and sterilization theme is included in both theoretical and practical modules. The content theme is only detailed for one option, which identified the concepts (disinfectant, pre- disinfection, and sterilization, the stages of the sterilization process and the control tools). Also, the teaching of this theme is reinforced through clinical teaching. Which, allow the student to contextualize, and decontextualize the knowledge acquired in the academic environment. &#xA0;This module is planned for the first year in all nursing care and midwife program before clinical placement. &#xD;
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The results show various elements addressed to the knowledge of environmental hygiene theme in nursing care programs, such as collective hygiene, control diseases vectors, waste sorting and treatment, pollution control and professional environment hygiene. Whereas, medical waste management has appeared in one nursing care option of nursing car and midwife programs. However, the others aspects of the environmental hygiene theme (air and water at hospital, surface disinfection, linen management) are not detected in all programs.&#xD;
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Regarding the teaching of food hygiene, it is planned for the midwife and almost all the nursing care options as part of a nutrition common module. &#xD;
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Table 2 illustrates hospital hygiene Themes in health technician programs. It shows that sterilization, food hygiene, occupational risks are the most occur themes targeted. For example, the sterilization theme is provided as part of a nursing care module for one option or integrated with disciplinary modules for the other options. On the other hand, the professional risks, environmental risks and accident prevention themes are included in a module shared by all health technician option programs focusing on quality, safety and risk management.&#xD;
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Other themes are only mentioned for one or two options such as the infectious risks, the care risks, personal protective equipment, hand washing, surgical hand disinfection and medical waste management. Finally, the results show that only one health technician option program offers a module titled hospital hygiene which contains the hospitals&amp;#39; hygiene measures, the prevention and the fight against nosocomial infections.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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Concerning learning objectives, the results indicate that only some hospital hygiene themes are targeted by specific learning objectives, such as material sterilization in all nursing care, health technician and midwife options programs, personal hygiene theme (body and clothing) and prevention of nosocomial infections in one option program. On the other hand, a general objective relating to occupational health and environmental protection is expected to develop, either a chapter titled hospital hygiene, or themes relating to occupational risks and occupational accidents without be associated with healthcare settings. On the other hand, some objectives target safety and occupational risks, however, the care risks are translated by learning objective in one health technician option program. Also, this last comprehend the objectives targeted hand washing, food hygiene and medical waste.&#xD;
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Concerning the teaching didactics, it can not be evaluated for the hospital hygiene themes. Because the teaching methods are planned for all the content module. Thus, the most common educational methods are interactive presentation, preliminary lecture, collective lecture, group work, questioning and discussion. Other methods are also specified such as role-plays, case studies, demonstration, simulation, and audio-visual teaching. &#xD;
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Discussion&#xD;
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The results show that the training programs provide hospital hygiene teaching as fragmented and isolated themes scattered in different modules. Consequently, the handwashing and rubbing theme is indicated only in one option program. In this sense, Kelc?&#xB4;kova et al have noted the absence of the concept of hand washing or handwashing techniques in the nursing student program.14 The study conducted by Mahmood et al showed the importance of improving the current training programs targeting hand hygiene practices among nursing students.20 Also, the lack of knowledge is perceived by nursing students as a constraint to the observance of hand washing.14,21 This may hurt the knowledge and compliance among health care professionals.14 &#xD;
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The personal hygiene theme is considered an important measure to prevent hospital infection.22 Nevertheless, the theme relating to body and clothing hygiene is absent in the health technician option programs. This might limit the knowledge among this category. In this order, one previous study revealed that 66.5% of medical students were dissatisfied with the hygiene course received during their training. And identified the insufficient knowledge of clothing hygiene among this population.23 In contrast, the personal protective equipment (PPE) theme is detected in one health technician option program. While it should be an essential component of nursing and midwifery programs in that these future professionals will be for the strong call to provide care that requires specific (PPE). In another context, the nurse students had qualified the education of (PPE) and hand hygiene as extremely superficial.24 One study had explained the poor knowledge among nurse students in term of PPE and Hand hygiene by insufficient infection control in training courses.18 Thus, reinforcing infection prevention education in the nursing program is important.19&#xD;
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This study revealed that all nursing care, midwife and health technicians programs studied include the themes related to professional risks and occupationally diseases. These results are consistent with those found by kelcivoka et al which highlighted the frequent presence in nursing curricula documents of concepts such as prevention of communicable diseases and nurses safety of disease transmissible.14 Nevertheless, the vaccination and accident with exposure to blood are not signalled. These themes constitute an important protective measure to take into consideration in education,7,17 such as exposure to blood as potentially influencing factor protect.7 and nursing students should have vaccination knowledge before they can practice.17 &#xD;
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As regards the patient theme, his preparation and hygiene constitute the most important hospital hygiene measure present in all nursing care and midwife programs. However, the finding illustrates the absence of isolation and antibody therapy. Whereas this last is identified within the important purpose themes of education.16 Concerning the isolation, the previous finding showed that the nurse students acknowledge its importance in their education.19 Moreover, other authors suggest more training on infection control measures because their finding revealed the poor knowledge among nursing student about the isolation precaution of pulmonary tuberculosis infection.25&#xD;
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The most theme described in all programs studied is equipment sterilization. Furthermore, the learning objective linked to this theme is expressed by highlighting the safety and quality of care. Similarly, the previous finding revealed that the concepts of the disinfection process are detected frequently in the nursing program.14 As regards the environmental hygiene theme, the finding indicates that medical waste management is signalled only in three option programs. In this sense, several authors have reported that knowledge of medical waste management among nursing students is poor.12,26 Therefore, the nursing curriculum should give proper importance to medical waste management.26 Also, it is identified as an important purpose of education.16 However, this study has noted the absence of water, air and food at the hospital, surfaces disinfection, and linen management in all programs studied. While the immediate environment can cause wound contamination either from ambient air or contaminated surfaces.27 Also, contaminated surfaces contribute to the&#xA0; infection transmission risk&#xA0; and healthcare-associated infections.28&#x2013;30&#xD;
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The single module titled hospital hygiene is included in one option of health technician programs as a Hygiene specialist. This module should be integrated into all nursing care, midwife and others health technician option programs. In fact that, it&#x2019;s important to standardize the course content of hospital hygiene.16 In other contexts, the important place is given to Hospital hygiene in the nursing student training program through the presence of modules directly related to this discipline.23,31 Also, the Health Technician programs incorporate a module concerning the quality approach. Which should be integrated into others nursing care and midwife programs, because the use of different tools such as protocols, procedures, evaluations, audit and traceability.3 allow continuous improvement of the care provided to patients and therefore guaranteed quality of care.&#xD;
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On the other hand, the analysis of the programs reveals the opportunity to acquire knowledge in nosocomial infections prevention through different modules planned in all programs studied such as microbiology, epidemiology, communicable and notifiable diseases. These modules were qualified as an important course of training of specialities related to Infection Control/ Hospital Hygiene.32 Thus, the thoughtful application of knowledge of microbiology allows preventing of infections, especially those emerging like SARS/COVID-19 by decontextualization, for example, the skill of adapting the practice of personnel protective equipment.17,33 Besides, the notifiable diseases require the vigilance of professionals and therefore contribute to nosocomial infections prevention.34&#xD;
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Conclusion &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In all option programs, hospital hygiene themes are envisaged but scattered in different modules. One option program out of twelve, have a module titled hospital hygiene. We suggest harmonizing hospital hygiene learning in all option programs through a transversal module. This list should cover all hospital hygiene themes: nosocomial infections, epidemiology, microbiology, basic hygiene, vaccination and accident with exposure to blood, patient hygiene, isolation and Antibio-therapy, disinfection/ sterilization, environmental hygiene, and quality demarche. Therefore, global teaching-learning allows to development of skills in hospital hygiene. Besides, a course about care techniques and hygiene should be intended in midwife and nursing care programs.&#xD;
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Conflicts of Interest: &#xD;
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No conflicts of interest&#xD;
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Funding: &#xD;
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No funding source&#xD;
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Acknowledgements&#xD;
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I would like to thank the Director of ISPITSR&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3664</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3664</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; World Health Organization. Patient safety: a global health priority. 2019. https://www.who.int/patientsafety/en/&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Extraction of Features from ECG Signal&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>103</FirstPage><LastPage>109</LastPage><AuthorList><Author>Ibrahim Patel</Author><AuthorLanguage>English</AuthorLanguage><Author> A. Sandhya</Author><AuthorLanguage>English</AuthorLanguage><Author> V. Sripathi Raja</Author><AuthorLanguage>English</AuthorLanguage><Author> S. Saravanan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Significant features of the ECG signal include the P wave, the QRS complex (A combination of the Q wave, R wave and S wave, the &#x201C;QRS complex&#x201D; represents ventricular depolarization.) and the T wave. This paper focuses on the identification of the P wave and T wave Because of their low amplitude; it is difficult to identify the position of the P and T waves. Objective: Present an algorithm for the detection of QRS (A combination of the Q wave, R wave and S wave), T and P waves of ECG. The extraction will require auxiliary investigations in many methodological aspects. The key gain of this method of detection is that the long-term ECG signal takes less time Methods: Feature Extraction is performed for each subject to shape distinctive, customized signatures. Preprocessing removes or suppresses noise from the raw ECG signal. The elimination of baseline wandering and noise reduction is one of the most common issues. Discrete Wavelet Transform is employed to remove the noise. High-frequency components of the ECG signals reduce as lower information is removed from the original signal. When the lower info is eliminated, the signal is clearer and the noise disappears when noise is defined by components of high frequency picked up in the transmission pathways. Results: The QRS complex was detected which is based on the maximum slope threshold. The ECG data files were used to test this QRS detection method. Based on the information of the identified QRS complexes, the P waves and the T waves can also be detected. From these waves, we are identified amplitude and intervals of ECG data files Conclusion: In this thesis, present an algorithm for the detection of QRS, T and P waves of ECG. The extraction will require auxiliary investigations in many methodological aspects. The key gain of this method of detection is that the long-term ECG signal takes less time.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>QRS complex, 20 ECG samples, Heartbeats, PR intervals, R-R interval, Pre ventricular contraction</Keywords><Fulltext>INTRODUCTION&#xD;
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The Electrocardiogram reflects the electric expression of contractile cardiac operation. It is a map of the orientation and degree of electro-activity induced by atria and ventricles depolarization and repolarization.1 As cardiac failure is one of the biggest causes of death in the country, the significance of electrocardiography is notable. According to the location, height, cardiac anatomy, age and other influences, an ECG differs from individual to person.2 There is broad proof of the highly familiar properties of cardiac electrical activity which are suitable for evaluation and treatment. The ECG is marked by a repeated P, QRS, T and U wave series with each rhythm. The QRS complex, attributable to human ventricular depolarization is the most striking waveform. A standard ECG heartbeat wave consists of a P wave, a QRS and a T wave. Fig.1 defines the specific model of a healthy ECG heartbeat signal that has the features P, Q, R, S, J, T and U and various intervals including QT, ST and PR intervals Figure 1.3,4&#xD;
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A variety of strategies for detecting ECG characteristics have been developed by the researchers. Recently the valuable method to evaluate a non-stationary signal has shown that the wavelet transformations. Also when high frequency and low-frequency noises are present, the ECG signal can be calculated in a fairly correct manner with the transforming wavelet technology. Among current wavelet approaches, we have used real dyadic wavelet transformation due to its fast time-setting properties and its easy calculations (continuous, dyadic, orthogonal, biorthogonal). Discrete Wavelet Transform (DWT) can be used in the study of non-stationary ECG signal, using a strong method.&#xD;
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LITERATURE SURVEY&#xD;
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Using wavelet transform and help vector machines, Zhao suggested a function extraction technique. A new approach to feature extraction for accurate identification of heart rhythm was proposed in the paper.4 Classification scheme consists of three parts, namely data preprocessing, feature extraction, and ECG signal classification.5 To achieve the feature vector of ECG results, two separate feature extraction methods are implemented together. The wavelet transform is used to obtain the transform coefficients as the features of each section of the ECG. To get hold of the temporal configurations of ECG waveforms, autoregressive modelling (AR) is often used at the same time. Finally, to distinguish various ECG heart rhythms, a support vector machine (SVM) with a Gaussian kernel is used. The overall precision of 99.68 % was obtained by the results of computer simulations presented to assess the efficiency of the proposed solution.&#xD;
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A function extraction process using Discrete Wavelet Transform (DWT). To perform the classification task, they used a discrete wavelet transform (DWT) to extract the relevant details from the ECG input results.3 Their planned study involves the following: procurement of data modules, pre-processing, beat identification, retrieval of features and classification. The Wavelet Transform (DWT) in the function extraction module is programmed to resolve the issue of non-stationary ECG signals. It was generated by translation and dilation operations from a single generating mechanism named the mother wavelet. Using DWT in function extraction, since it has a varying window scale, large at lower frequencies and narrow at higher frequencies, can contribute to an optimum frequency resolution in all frequency ranges. The DWT characterization would provide the morphological variations of the ECG waveforms with stable characteristics.&#xD;
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After signal retrieval from the compressed data, it has been found that the network not only compresses the data but also improves the quality of the retrieved ECG signal concerning the elimination of high-frequency interference present in the original signal. With the implementation of an artificial neural network (ANN) the compression ratio increases as the number of ECG cycles increases.6&#xA0;&#xA0; &#xD;
&#xD;
T-wave abnormalities can be assessed without the&#xA0;need for T-wave endpoint identification. The wavelet transformation is a new promising technique in non-invasive electro&#xA0;cardiology providing&#xA0;improved methods for&#xA0;late potential detection.7 Thakor et al.8 observed that the peaks&#xA0;of QRS complexes&#xA0;flatten and P-and T-waves containing&#xA0;lower&#xA0;frequencies become more visible. Martinez et al.9 used the ECG to measure the heart&#x2019;s electrical conduction system. It picks up electrical impulses generated by the depolarization of cardiac tissue and translates into a waveform. The waveform is then used to measure the rate and regularity of heartbeats, the presence of any damaged tissue in the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker. An ECG produces a pattern reflecting the electrical activity of the heart and usually requires a trained clinician to interpret the graph. Sasikala et al.1 &#xA0;gives information regarding the rhythm of the heart, whether that impulse is conducted normally throughout the heart, or whether there is any irregularity in the functioning of heart A typical ECG tracing of the cardiac cycle (heartbeat) consists of a P wave, a QRS complex, a T wave, and a U wave (which is normally invisible in 50 to 75% of ECGs because it is hidden by the T wave and upcoming new P wave). The baseline of the electrocardiogram is measured as the portion of the tracing following the T wave and preceding the next P wave and the segment between the P wave and the following QRS complex (PR segment). In a normal healthy heart, the baseline is equivalent to the isoelectric line (0mV) and represents the periods in the cardiac cycle when no currents are flowing towards either the positive or negative ends of the ECG leads. The ST segment remains close to the isoelectric line as this is the period when the ventricles are fully depolarized and thus there is no scope for the current flow in the ECG leads.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Denoising methods &#xD;
&#xD;
Huang&amp;#39;s data-driven Empirical mode decomposition (EMD) method was initially proposed for the study of ocean waves and found immediate applications in biomedical engineering. The main advantage of EMD is that the basic functions are derived directly from the signal itself. Hence the analysis is adaptive, as opposed to the Fourier analysis, where the basic functions are fixed sine and cosine waves.&#xD;
&#xD;
This method&amp;#39;s central idea is the process that breaks down a given signal into a sum of intrinsic mode functions (IMF), those basic building blocks that make up complex time series data.&#xD;
&#xD;
A signal must satisfy two criteria to be an IMF:&#xD;
&#xD;
(1) The average number of points and the number of zero crossings are either equal or differ by one at most.&#xD;
&#xD;
(2) The upper and lower envelopes mean zero.&#xD;
&#xD;
The first criterion is equivalent to the narrow-band requirement. The second criterion is necessary to ensure that the instantaneous frequency does not have unnecessary variations caused by asymmetric waveforms. The signal must have at least one maximum and one minimum to be effectively decomposed into IMFs to allow use of EMD. Because of these two definitive IMF requirements, the sifting process for extracting an IMF from a given X(t) signal is described as follows:&#xD;
&#xD;
Two smooth spines are constructed connecting all the maxima and minima of X(t) to get its upper envelope, Xhigh(t), and its lower envelope, Xlow(t);&#xD;
&#xD;
&#xD;
&#xD;
The process is repeated for d(t) until the resulting signal, C1(t), the first IMF, satisfies the criteria of an intrinsic mode function. The residue R1(t) = X(t) - C1(t)&#xA0; is then treated as new data subject to the sifting process as described above, yielding the second IMF from R1(t); At the end of this process, the signal X(t) can be expressed as follows:&#xD;
&#xD;
&#xD;
&#xD;
Where K is the number of IMFs, RK(t) denotes the final residue (signal trend), and Ci (t) are nearly orthogonal to each other, and all have zero means.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
Proposed method&#xD;
&#xD;
To extract information from the ECG signal, the raw ECG signal processing can be roughly divided by functionality into two stages: pre-processing and extraction as shown in Figure 2.&#xD;
&#xD;
Feature Extraction is performed for each subject to shape distinctive, customized signatures. The purpose of the extraction feature process is to select and keep relevant information from the original signal. The extraction stage of the function extracts diagnostic information from an ECG signal. The Stage of Preprocessing removes or suppresses noise from the raw ECG signal.&#xD;
&#xD;
The ECG signal primarily includes noises of different forms, including frequency interference, baseline drift, and electrode touch noise, polarizing noise, muscle noise, internal amplifier noise and motor artefacts. Artefacts are the noise induced by the movements of electrodes to the ECG signals. The elimination of baseline wandering and noise reduction is one of the most common issues in ECG signal processing.&#xD;
&#xD;
Wandering in the Baseline is one of the noise artefacts affecting ECG signals. We use median filters (200-ms and 600-ms) to eliminate the ECG signal base drift.&#xA0; The method will be as follows:&#xD;
&#xD;
&#xD;
	&#xD;
	The initial ECG signal is processed using a 200-ms broad median filter to eliminate QRS complexes and P waves.&#xD;
	&#xD;
	&#xD;
	Next, the resulting signal is processed with a 600-ms long median filter to eliminate T waves. The signal resulting from the operation of the second filter includes the ECG signal baseline.&#xD;
	&#xD;
	&#xD;
	&#xA0;A signal with the removal of the baseline drift can be obtained by subtracting the filtered signal from the original signal.&#xD;
	&#xD;
&#xD;
&#xD;
The Wavelet Transform is a time-scale representation that has been successfully used in a wide range of applications, especially in the compression of signals. Recently, wavelets have been applied to various Electro cardiology issues, including data compression, late ventricular potentials analysis, and the identification of ECG characteristic points.&#xA0; The Wavelet Transformation is a linear operation that breaks down the signal into a variety of frequency-related scales and analyzes each scale with a certain resolution.&#xD;
&#xD;
The resulting ECG signal after elimination of baseline wandering is more stable and visible than the initial signal. Many other forms of noise, however, can still affect the ECG signal extraction function. Discrete Wavelet Transform is employed to remove the noise. By applying the Wavelet Transform, this first decomposes the ECG signal into many sub-bands, then modifies each wavelet coefficient by adding a threshold function and finally reconstructs the denoted signal. The high-frequency components of the ECG signal reduce as lower information is removed from the original signal. When the lower information is eliminated, the signal is clearer and the noise disappears when noise is defined by components of high frequency picked up in the transmission pathways. &#xD;
&#xD;
Detection of QRS is one of the fundamental problems of electrocardiographic signal analysis. The QRS complex consists of three characteristic points within a single heart cycle denoted as Q, R, and S. The QRS complex is considered the electrocardiogram&amp;#39;s most striking waveform and is thus used as a starting point for further study or compression schemes. The detection of the QRS complex is based on the Wavelet Transform&amp;#39;s modulus maxima. The QRS complex produces two modulus maxima with opposite signs which are shown in figure 3 with a zero-crossing between them. Therefore identification laws (thresholds) refer to the ECG signal&amp;#39;s Wavelet Transform.&#xD;
&#xD;
The QRS complex&amp;#39;s most energy is between 3 Hz and 40 Hz. The Fourier transform of the wavelets&amp;#39; 3-dB frequencies shows that the bulk of the QRS complexes energy resides between 23 and 24 scales, with the highest at 24 The energy decreases if the scale is greater than 24 and the energy of the motion artefacts increases for scales greater than 2.6&#xA0;But we chose to use characteristic scales from 21 to 24 for the wavelet to detect complex QRS.&#xD;
&#xD;
The waves of Q and S are waves of high frequency and low amplitude and their energies are predominantly small-scale. So, with WT, the detection of these waves is achieved on a low scale. By utilising scale 22, the onset and offset of the QRS complex are observed. The beginning and termination of the first maximum module before and after the maximum module pair within a time window was sensed from the maximum module pair of the R wave. These lead to points of QRS onset and offset.&#xD;
&#xD;
Generally, the P wave consists of the modulus maxima pair with opposite signs and its onset and offset corresponds to this pair&amp;#39;s onset and offset. This pair of maxima modulus is checked within a window before the QRS complex starts. The search window begins at 200 ms before the QRS complex begins, and ends with the QRS complex beginning. The ultimate module is a fixed point (the slope of will be equal to zero). The zero-crossing of the maxima pair between the modulus corresponds to the P wave point.&#xD;
&#xD;
To find the starting point, a backward search is performed from the point of the maximum module on the left of the zero-crossings to the start of the search window until a point is reached where the maximum module is equal to or less than 5%. This point is identified with the beginning of the wave P. Similarly, a forward search is carried out from the point of the maximum module on the right side of the zero-crossing to the end of the search window until a point is reached where the maximum module (minimum module) is equal to or less than 5 %. This point is labelled with the P wave offset,&#xD;
&#xD;
The T-wave corresponds to the repolarization of the ventricular heart. The first situation is a standard T-wave. The wave shown in Figure 4 has a large amplitude, so it won&amp;#39;t be difficult to identify, but this amplitude may decline to a very small magnitude. The standard methods in this case will have a very difficult time pointing out the exact location of the T-wave. The second situation has the same issues as the first one, but here the T-wave has inverted. This makes detection difficult for certain methods that do not use the signal modules. Present in the third situation an upward or downward T-wave. Another issue that can occur with all of these situations is bad T-wave positioning. It is also centred near the QRS-complex or the P-wave. It makes distinguishing the two complexes complicated.&#xD;
&#xD;
A normal T wave and its transformation clearly show a maxima pair of modulus with opposite signs. The T wave is located between the two modulus maxima at zero-crossing. The energy of the T wave is conserved primarily between scales 23 and 24.&#xD;
&#xD;
So moving away from the dyadic scales and selecting scale 10 for the wavelet transform was more fitting. The next step consists of the search for modulus maxima. We analyze a signal at a scale of 10 and search for a maximum module greater than a threshold. This threshold is determined between two R-peaks by using the root mean square of the signal. If the same sign includes two or more modulus maxima, the largest one is picked. If one or more modulus maxima have been located, the direction and character of the T wave can be determined.&#xA0; The zero-crossing of the maxima pair between the modulus corresponds to the T wave point.&#xD;
&#xD;
The T wave carries similar characteristics to the P wave. The maximum modulus corresponds to the maximum slopes between the T peak start and the T peak offset. The hunt for the onset of the T wave is performed between the corresponding T wave&amp;#39;s first module maxima and the QRS offset. For the P wave, the detection procedure is the same, except that the search window follows the QRS complex. The onset of the T wave is known to be the same as the offset of the QRS complex continuing.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xA0;&#xA0; &#xD;
&#xD;
In this thesis, the QRS complex was detected which is based on the maximum slope threshold. The ECG data files were used to test this QRS detection method. Based on the information of the identified QRS complexes, the P waves and the T waves can also be detected. From these waves, we are identified the amplitude and intervals of ECG data files. The ECG signal was taken. It is shown in Figure 5. The signal has 7200 samples.&#xD;
&#xD;
As it is suffering from baseline drift, therefore smoothing function was required to remove it. The ECG signal after baseline drift elimination is shown in figure 6. The discrete wavelet transform was used for noise removal of the ECG signal. The Discrete Wavelet Transform (DWT), which is based on sub-band coding, was found to yield a fast computation of wavelet transform. The second level discrete wavelet transform of the signal is shown in figure 7.&#xD;
&#xD;
The QRS complex is known as the electrocardiogram&amp;#39;s most striking waveform and is thus used as a starting point for further study or compression schemes. It is represented in Figure 8. The QRS complex identification is based on the Wavelet Transform&amp;#39;s modulus maxima. Two modulus maxima with opposite signs are generated by the QRS complex, with a zero-crossing between them. In general, the P wave consists of a pair of modulus maxima with opposite signs, and its onset and offset correlate to this pair&amp;#39;s onset and offset. This pair of modulus maxima is checked for within a window before the QRS complex begins. It is seen in Figure 9. The search window begins 200 ms before the QRS complex begins and finishes with the QRS complex starting.&#xD;
&#xD;
The T wave has characteristics similar to the P wave. The modulus maxima correspond to the maximum slopes between the onset of the T peak, and the offset of the T peak and is shown in the below Figure 10. The search for the onset of the T wave is carried out between the first modulus maxima corresponding to the T wave and the QRS offset. The detection procedure is the same as that for the P wave, except that the search window follows the QRS complex. From finding features of ECG signals we can calculate standard ECG intervals QT interval, ST interval, PR interval. QT interval encompasses the time from the beginning of ventricular depolarization to the end of ventricular repolarization.PR interval encompasses the time from the beginning of the P wave to the start of the QRS complex.&#xD;
&#xD;
The Mean &#xD;
&#xD;
For a data set, the mean is the sum of the observations divided by the number of observations. It identifies the central location of the data, sometimes referred to in English as the average. The mean is calculated using the following formula. &#xD;
&#xD;
&#xD;
&#xD;
The Standard Deviation &#xD;
&#xD;
The most popular indicator of variability, calculating the distribution of the data collection and the relation of the mean to the rest of the data, is the standard deviation. If the data points are similar to the mean, implying that the answers are reasonably uniform, so there would be a slight standard deviation. Conversely, if several data points are far from the mean, suggesting that the answers have a broad range, then the standard deviation would be high. If all the data values are identical then zero would be the standard deviation. Using the same formula, the standard deviation is determined.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0; Where, Y = Individual score, M = Mean of all scores, N = Sample size (number of scores).&#xD;
&#xD;
Extraction of these parameters can be used to detect the following problems:&#xD;
&#xD;
&#xD;
	&#xD;
	Atrial fibrillation &#xD;
	&#xD;
	&#xD;
	Ventricular fibrillation &#xD;
	&#xD;
	&#xD;
	Complete heart block &#xD;
	&#xD;
	&#xD;
	Pre ventricular contraction &#xD;
	&#xD;
	&#xD;
	Left bundle branch block &#xD;
	&#xD;
	&#xD;
	Normal sinus rhythm&#xD;
	&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In this thesis, present an algorithm for the detection of QRS, T and P waves of ECG. The extraction will require auxiliary investigations in many methodological aspects such as selecting the choice of different parameter and intervals to improve the clinical utility. This processing of biomedical signals culminated in the discovery of certain cardiovascular disorders dependent on ECG signal diagnosis. Therefore, medical experience to diagnose a range of cardiovascular diseases in humans compares the estimation of amplitude and intervals obtained in the proposed system with the ground reality. For ECG Classification, Examination, Diagnosis, Authentication and Recognition results, the information collected about the R Peak and QRS complex is very useful. For beat detection and the calculation of heart rate by R-R interval estimation, the QRS complex is often used. This data can also act as an input to a device that facilitates automated diagnosis of the heart. The detector&amp;#39;s overall sensitivity is improving. The key gain of this method of detection is that the long-term ECG signal takes less time.&#xD;
&#xD;
FUTURE SCOPE&#xD;
&#xD;
ECG signal plays a vital role in diagnosing various cardiac disorders so it is useful to extract the features of ECG signal. Many time domain and frequency domain methods are used for feature extraction which has their advantages and limitations. The future work focuses on the fact that the different techniques used for extracting the features must provide high accuracy and should be fast and easy to implement. The electrocardiogram (ECG) is a non-invasive and the record of variation of the biopotential signal of the human heartbeats. The ECG detection which shows the information of the heart and the cardiovascular condition is essential to enhance the patient living quality and appropriate treatment. The ECG features can be extracted in the time domain or the frequency domain. The extracted feature from the ECG signal plays a vital in diagnosing cardiac disease. The development of accurate and quick methods for automatic ECG feature extraction is of major importance. Some of the features extraction methods implemented in previous research. Every method has its advantages and limitations. The future work primarily focuses on feature extraction from an ECG signal using more statistical data. Besides the future enhancement on utilizing different transformation technique that provides higher accuracy in feature extraction. The parameters that must be considered while developing an algorithm for feature extraction of an ECG signal are the simplicity of the algorithm and the accuracy of the algorithm in providing the best results in feature extraction.&#xD;
&#xD;
ACKNOWLEDGEMENT: The authors gratefully acknowledge the management of B V Raju Institute of Technology, Narsapur, Telangana, India for their constant support and encouragement extended during this research.&#xD;
&#xD;
Conflict of interest, financial support should be mentioned&#xD;
&#xD;
&#xD;
	&#xD;
	No financial support involved in this article.&#xD;
	&#xD;
	&#xD;
	No Human or Animal study involved in this article.&#xD;
	&#xD;
&#xD;
&#xD;
Conflict of interest and Source of funding: Nil&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3665</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3665</Fulltext></URLs><References>&#xD;
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	Sasikala P. Extraction of the P wave and T wave in Electrocardiogram. Int J Comp Sci &#xA0;Infor Technol 2011;2(1):489-493.&#xD;
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	Akay M. Detection and Estimation Methods for Biomedical Signals. CA: Academic Press, San Diego, 1996.&#xD;
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	Tamil EM,&#xA0;Kamarudin NH, Salleh R, Idris MY, Noor NM, Tamil NM. Heartbeat Electrocardiogram (ECG) Signal Feature Extraction. In proceedings of CSPA,1112-1117. &#xD;
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	Zhao C. ECG Feature Extraction and Classification Using Support Vector Machines. &#xA0;International Conference on Neural Networks and Brain 2005;2:1089-1092.&#xD;
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	Thakor NV, Webster JG, Tompkins WJ. Estimation of QRS complex power spectra for design of a QRS filter&#x201D;. IEEE Trans Biomed Engi 1984;31:702&#x2013;705&#xD;
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	&#xD;
	Saxena SC, Sharma A, Chaudhary SC. Data compression and feature extraction&#xA0;of ECG signals. Int J Syst Sci 1997; 28(5):483-498.&#xD;
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	Ahlstrom ML, Tompkins WJ. Digital filters for real-time ECG signal processing using microprocessors. IEEE Trans Biomed Engi 1985;32:708&#x2013;713.&#xD;
	&#xD;
	&#xD;
	Thakor NV, Webster JG, Tompkins WJ. Estimation of QRS complex power spectrum for design of a QRS filter. IEEE Trans Biomed Engi 1984;31(11):702-706.&#xD;
	&#xD;
	&#xD;
	Martinez JP, Olmos S, Laguna P. Evaluation of an ECG Waveform Detector On The QT Database. Comp Cardiol 2000;27:81-84.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Salivary Lead Levels in Mixed Unstimulated Saliva of Children and its Correlation with Dental Caries&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>110</FirstPage><LastPage>114</LastPage><AuthorList><Author>Aditi Mathur</Author><AuthorLanguage>English</AuthorLanguage><Author> Anmol Mathur</Author><AuthorLanguage>English</AuthorLanguage><Author> Vikram Pal Aggarwal</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Dental Caries, Saliva, Lead, Children</Keywords><Fulltext>Introduction&#xD;
&#xD;
The widespread use of an organic lead compound, in the form of a tetra-alkyl derivative, as a gasoline (petrol) additive has resulted in the lead as a major environmental pollutant. Also, its use for many years in house painting has left a legacy of potential lead poisoning, particularly causing a risk to children when they live in old houses in deprived urban areas. In many developed countries efforts are being taken to reduce lead levels in the environment but lead continues to be a significant environmental pollutant in developing nations.1&#xD;
&#xD;
Epidemiological studies have reported an association between excess of lead in the environment with an increased incidence of caries. Higher lead concentration in dentine than in enamel and the highest lead concentration was in the area of circum-pulpal dentin.2,3 A decline in the lead in caries away from the pulp.3 The equivalent levels of lead content in individual match-paired impacted and erupted third molars4 suggest that Pb enters the tooth from the bloodstream.5,6 However, higher lead content was found in surface enamel than in the enamel&#x2013;dentine junction, implying that part of the lead accumulation in enamel may be acquired at the post-eruptive period from the oral environment.3,7 &#xD;
&#xD;
Many studies have been carried out to find the association between dental caries with blood lead concentrations and tooth lead content, however not much has attempted to correlate salivary lead levels with dental caries. The salivary glands represent a clearance organ for lead in the bloodstream. It has been suggested that saliva may be a significant route in the accumulation of lead on the enamel.8 More importantly, the lead concentration in saliva (PbSa) is closely related to the unbound plasma fraction and intracellular level and thus reflects the internal lead level that can exert effects on human organs.9,10&#xA0; &#xD;
&#xD;
Hence there was a felt need to undertake the present study to assess the correlation between the salivary lead level and dental caries in both primary and permanent dentition among children.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
This was a cross-sectional, in-vivo analytical study done on 60 children belonging to 3-5 and 12-14 years of age groups, selected from the outpatient department of Pedodontics and Preventive Dentistry of Dr R. Ahmed Dental College &amp; Hospital. Approval from the institutional ethics committee was taken prior. Patients with no underlying medical conditions and no history of medications, which can alter the salivary flow rate, were selected for the study. Children belonging to the age group of 3-5 years and 12-14 years were selected to specifically study the effect of salivary lead on both primary and permanent dentition. Intraoral examination was done and the patients were categorised into the low caries group (deft/ DMFT less than 2) and high caries group(deft/DMFT more than 5)&#xD;
&#xD;
The scheduled date and time of saliva collection was intimated to the subjects as well as to their parents. The subjects were advised to refrain from intake of any food or beverages (except water) one and a half hour before saliva collection on the scheduled day.11 Saliva collection was always scheduled between 9 am to 11 am to standardize saliva collection time and minimize the effect of the circadian rhythm. Within this stipulated time, it was scheduled to collect saliva from an average of six subjects per day.&#xD;
&#xD;
On the day of saliva collection, the children were asked to perform regular oral hygiene procedure after breakfast (1.5 hours before collection) and during this period children were not allowed to eat or drink. Children were seated on dental chairs and 5 cc of unstimulated saliva was collected in special tubes using the method described previously.12 In this method, the child was asked to pool the saliva in the floor of the oral cavity and asked to spit intermittently. No exogenous stimulation was used and every effort was made to obtain as nearly as possible the resting secretion of a salivary gland. The salivary samples were transported within an hour in a Thermo insulated box. Estimation of salivary lead was done by Atomic Absorption Spectrophotometer (Model: Analyst 200, Perkin Elmer) using the air acetylene flame. &#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
Student t test is being used using the SPSS software version 22 IBM Corp. Released 2013. IBM SPSS Solutions for Windows, Version 22.0. Armonk, NY: IBM Corp. p values is being calculated to test any association between the low and high caries groups among different age groups.&#xD;
&#xD;
Results&#xD;
&#xD;
The study sample according to table 1 consisted of 60 children selected randomly from the outpatient department, according to the inclusion criteria. These children selected comprised of two age groups 3-5 years and 12-14 years, which represented the two dentitions, they were further classified into two categories according to their caries status but in equal numbers [n=15] to allow a valid comparison. The two groups were formulated as follows.&#xD;
&#xD;
1) Group A: Consisted of samples with age group 3-5 years.&#xD;
&#xD;
&#xA0;Category I): deft score less than 2 and Category II): deft score more than 5.&#xD;
&#xD;
2) Group B: Consisted of samples with age groups 12 -14 years&#xD;
&#xD;
Category I): DMFT score less than 2. and Category II): DMFT scores more than 5.&#xD;
&#xD;
The mean salivary lead concentration in table 2 computed for Group A is 1.4 &#xB5;g/l for low caries and 2.9 &#xB5;g/l for high caries category. Among Group B, the values computed are 1.7 &#xB5;g/l and 2.8 &#xB5;g/l for the low and high caries category respectively. The values for mean salivary lead concentration are higher in the high caries category of both the age groups, but a statistically significant difference is achieved only in Group A.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The role of trace elements as an indirect or contributing factor in the dental caries process has been a subject of interest. The null hypothesis was rejected which stated no effect of salivary lead on dental caries. Lead has shown a direct effect on the mineral phase of calcifying tissues.13 The proposed mechanism for this effect is that lead interferes with the enzymes for extracellular matrix proteinases involved with amelogenesis.14 It has been postulated that lead is first adsorbed to hydroxyapatite crystals and later take positions within the structure.15 Levels of lead as high as 4,000 ppm have been found in the outer layers of enamel.7 In the oral cavity, high levels of lead can damage the acinar cells of the parotid gland, resulting in altered salivary secretion of protein, calcium and lysosomal enzyme N- acetyl-b-D-glucosaminidase (NAG).16 &#xA0;Lead poisoning can impair normal salivary function with xerostomia (dry mouth) being one of the first recognized clinical symptoms of lead poisoning. 17&#xD;
&#xD;
In the present study, lead could not be detected in six of our samples for those detected salivary lead levels were in the range of 1- 5 &#xB5;g/l. Lead in the concentration of 2.4 &#xB1; 0.13 &#xB5;g/l in whole saliva samples of the adult population of Detroit, Michigan.8 The mean salivary lead levels in lead-exposed workers and reported the mean value of 7.7&#xB5;g/l.18 A mean concentration of 1.07 &#xB1; 1.31 &#xB5;g/l in children of age 7-9 years.19 Much higher levels are reported by some authors, 44 &#xB5;g/l by Brudevold in 1977 7 34 &#xB5;g/l for parotid samples by DiGregorio et al.20 and 55&#xB5;g/l for the whole saliva by P&#x2019;an.21 It has been proposed that earlier studies carried the risk of being compromised by contamination artefacts. 22 A mean salivary lead concentration in the range of 0.0014 mg/l for the low caries group and 0.0029 mg/l for the high caries group was detected among the children of age group 3-5 years. In children of age 12-14 years mean values were 0.0017 mg/l and 0.0028 mg/l for the low and dental caries group respectively. &#xD;
&#xD;
A significant difference was obtained in salivary lead concentrations in 3-5 year age group children but not among the children of 12-14 years. In both age groups, the mean lead concentration was higher in children with high caries index. Our results are following the study conducted by Nriagu J et al. 8 in the year 2006. They found a weak but significant association with salivary lead as well as blood lead concentrations with dental caries. Caries promoting the effect of lead is also supported by a study from Brudevold.7 They found that a group of children with high enamel lead content had higher caries scores than children with low lead enamel content. Gil et al.23 demonstrated that tooth lead concentration was an independent risk factor for caries. In the Third National Health and Nutrition Examination Survey (NHANES III), Moss et al.24 reported a significant association between blood lead exposure and caries prevalence on both primary and permanent teeth in children aged 5&#x2013;17 years.&#xD;
&#xD;
Youravong 25 correlated blood lead levels with DMFS and defs of children aged 6-11 years. In their study defs but not DMFS correlated with blood lead levels. On the contrary, any association between caries and childhood lead exposure in their retrospective cohort study conducted in the year 2000 is not detected.26 Similar results were found in a study where the average values of lead in the low caries group and high caries group were found to be&#xA0; 2.84 mcg/l and 8.0 mcg/l, respectively.27&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Oral health caregivers should be made aware of the risk factors for caries progression beyond the traditional risk factors for caries and consider those risks in caries risk assessment. Lead possibly plays a role in the development of caries by modifying host susceptibility and hence there is a wide scope to conduct further research to understand the exact mechanism.&#xD;
&#xD;
Conflict of interest: No conflict of interest to report. &#xD;
&#xD;
Source of Funding : Nil&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3666</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3666</Fulltext></URLs><References>1. Anderson RJ, Davies BE, James PM. Dental caries prevalence in a heavy metal contaminated area of the west of England. Br Dent J 1976;141:311-314.&#xD;
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2. Grobler SR, Rossouw RJ, Kotze TJ, Stander IA. The effect of airborne lead on lead levels of blood, incisors and alveolar bone of rats. Arch Oral Biol 1991; 36:357-360.&#xD;
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3. Purchase NG, Fergusson JE. Lead in teeth: the influence of the tooth type and the sample within a tooth on lead levels. Sci Total Environ 1986; 52:239-250.&#xD;
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4. Bercovitz K, Laufer D. Systemic lead absorption in human tooth roots. Arch Oral Biol 1992;37:385-387.&#xD;
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5. Anderson RJ, Davies BE, Nunn JH, James PM. The dental health of children from five villages in North Somerset concerning environmental cadmium and lead. Br Dent J 1979;147:159-61.&#xD;
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6. Davies BE, Anderson RJ. The epidemiology of dental caries concerning environmental trace elements. Experientia 1987;43:87-92.&#xD;
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7. Brudevold F,&#xA0; Aasenden R, Srinivasan BN, Bakhos Y. Lead in Enamel and Saliva, Dental Caries and the Use of Enamel Biopsies for Measuring Past Exposure to Lead. J Dent Res 1977; 56:1165-1171.&#xD;
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8. Nriagu J, Burt B,&#xA0; Linder A,&#xA0; Ismail A,&#xA0; Sohn W. Lead levels in blood and saliva in a low-income population of Detroit, Michigan. Int J Hyg Environ Health 2006;209:109-121.&#xD;
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9. Mandel ID. The diagnostic uses of saliva. J Oral Pathol Med 1990;19:119-125.&#xD;
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10. Giannobile WV, McDevitt JT, Niedbala RS, Malamud D. Translational and clinical &#xD;
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&#xA0;&#xA0;&#xA0; applications of salivary diagnostics. Adv Dent Res 2011;23(4):375-380.&#xD;
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11. Jorma O. Tenovu O. Human saliva: Clinical chemistry and microbiology. CRC Press; 1989;2(4):23-26.&#xD;
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12. Collins LMC, Dawes C. The Surface Area of the Adult Human Mouth and Thickness of the Salivary Film Covering the Teeth and Oral Mucosa. J Dent Res 1987;66:648-653.&#xD;
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13. Kato Y, Takimoto S, Ogura H. Mechanism of induction of hypercalcemia and hyperphosphatemia by lead acetate in the rat. Calcif Tissue Res 1977;24:41-61.&#xD;
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14. Kim YS, Ha M, Kwon HJ, Kim HY, Choi YH. Association between Low blood lead levels and increased risk of dental caries in children: a cross-sectional study.&#xA0;BMC Oral Health 2017;17(1):42.&#xD;
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15. Bhatnagar VM. The preparation, x-ray and infra-red spectra of lead apatites. Arch Oral Biol 1970;15:469-480.&#xD;
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16. Abdollahi M. Dehpour AR. Fooladgar M. Alterations of rat submandibular gland secretion of proteins, calcium and N-acetyl-b-D-glucosaminidase activity by lead. Gen Pharmacol 2001;29:675&#x2013;680.&#xD;
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17. Nriagu JO.&#xA0; Lead and Lead Poisoning in Antiquity. 1983 Wiley, New York.&#xD;
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18. Koh D,&#xA0; Ng V, Chua LH,&#xA0; Yang Y,&#xA0; Ong HY,&#xA0; Chia SE. Can salivary lead be used for biological monitoring of lead-exposed individuals? Occup Environ Med 2003;60:696&#x2013;698.&#xD;
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19. Ogboko B. Cadmium and Lead Concentration in Saliva of Children in Ceres District of South Africa. J Basic Appl Sci Res 2011;1(8):825-831.&#xD;
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20. DiGregorio GJ, Ferko AP, Sample RG, Bobycock E, McMichael R, Chernick WS. Lead and daminodeluvinic acid concentrations in human parotid saliva. Toxicol Appl Pharmacol 1974;27:491-493.&#xD;
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21. Pan&#xA0; AYS.&#xA0; Lead levels in saliva and blood.&#xA0; J Toxicol Environ Health 1981;7:273-280.&#xD;
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22. Settle&#xA0; DM, Patterson CC. Lead in albacore: guide to lead pollution in Americans. Science 1980;207:1167-1176.&#xD;
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23. Gill F,&#xA0; Facio A,&#xA0; Villanueva E, Perez ML, Tozo R, Gill A. The association of tooth lead content with dental health factors.&#xA0; Sci Total Environ 1996;192:183-191.&#xD;
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24. Moss ME, Lanphear BP, Auinger P. Association of dental caries and blood lead levels. JAMA 1999;281:2294-2298.&#xD;
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25. Youravonga N, Chongsuvivatwong V, Geater AF, Dahlen G, Teanpaisan R. Lead associated caries development in children living in a lead-contaminated area, Thailand. Sci Total Environ 2006;361:88-96.&#xD;
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26. Campbell JR, Moss ME, Raubertas RF. The association between caries and childhood lead exposure. Environ Health Perspect 2000;108(11):1099-1102.&#xD;
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27. Choudhari S, Parmar G. Salivary Lead Level As A Biomarker For Dental Caries -A Cross-Sectional Clinical Study. Int J Rec Sci Res 2018;9(1):23644-23648.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Co-relation between Hip Axis Length and Femoral Neck-Shaft Angle with Body Mass Index of Indian Population: A Radiological Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>115</FirstPage><LastPage>119</LastPage><AuthorList><Author>Lopamudra Nayak</Author><AuthorLanguage>English</AuthorLanguage><Author> Pratima Baisakh</Author><AuthorLanguage>English</AuthorLanguage><Author> Sitansu Kumar Panda</Author><AuthorLanguage>English</AuthorLanguage><Author>  Prafulla Kumar Chinara</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Proximal femoral geometry plays an important role in the prediction of hip fractures as it provides mechanical strength to the femur. Objective: To find out the relationship between body mass index (BMI) and femoral morphometry in the study population. Methods: This is an observational cross-sectional study in 168 patients where parameters such as hip axis length(HAL) and femoral neck-shaft angle(FNSA) were measured by using a dual-energy X-ray absorptiometry scan. BMI was calculated by taking the weight and height of the patients. The relationship of proximal femoral morphometry with different groups of BMI (Normal, Pre-obese and Obese group)has been studied by using the Karl Pearson correlation coefficient (r). Results: The mean age, height, weight, HAL, FNSA, and BMI of the study population were found to be 58.72 years, 160.15 cm, 64.38 kg, 104.14 mm, 128.51&#xB0;, and 26.89 kg/mt2 respectively. In the normal group, the BMI has a low level of positive correlation with HAL (r=0.484) and a moderate level of correlation with FNSA (r=0.413). In the pre-obese group, the BMI has a low level of positive correlation with HAL and FNSA (r=0.404 &amp; 0.473 respectively). In the obese group, BMI has a moderate level of positive correlation with HAL and FNSA (r=0.501 &amp; 0.507 respectively). Conclusion: The present study established a positive correlation between proximal femoral morphometry and BMI.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Proximal femur morphometry, Hip axis length, Femoral neck-shaft angle, Body mass index</Keywords><Fulltext>Introduction&#xD;
&#xD;
Fractures particularly hip fractures are major health problem in terms of disability, death, and medical cost. This morphology of the proximal femur is one of the important risk factors regardless of bone mass and bone strength.1 Since middle of the 19th century the morphology of the proximal femur, specifically the relationship between its different parts with the proximal shaft is a subject of interest and debate in literatures.2 There are lots of differences in skeletal components among populations and these variations are related to genetic and environmental factors (geography, diet, lifestyle). There are variations in human skeletal measurements that determine the racial characteristics of the populations. The shape of bones and different skeletal measurements, both anatomically and radiologically, can offer a guide to clinicians for the determination of fracture risks. The risk of hip fracture can be predicted by different factors like body mass index (BMI), bone mineral density (BMD), the direction and severity of the fall, muscle strength, femoral morphometry, family history, body habitus and lifestyle factors.&#xD;
&#xD;
As the femoral head supports the entire weight of the body and is involved in different activities, it shows that morphometry of the proximal femur has a great contribution to femoral neck strength. The biomechanical properties of the proximal femur depend on the length and width of the femoral neck.3 The typical morphology of the proximal femur and the muscle balance around the hip joint are important factors that help in weight-bearing.4 Different morphometric parameters like hip axis length (HAL), femoral neck axis length (FAL), femoral neck-shaft angle (Q angle), femoral neck width (FW), femoral head width (HW) and intertrochanteric width (TW) provide mechanical strength to the proximal femur. These parameters provide resistance of bone to impact and higher values are being found in races with a high incidence of hip fracture.5 Previously many studies have been carried out to find different risk factors of hip fracture and that helps to identify those at risk and accordingly preventive measures are taken.6,7 The present study was carried out to find out the correlation of hip axis length and femoral neck-shaft angle with the bone mass index of the study population. &#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
The present study was an observational cross-sectional study carried out on 168 patients irrespective of sex, attending various outpatient department of a tertiary care hospital and coming to the Department of Radiology for radiography. The sample size was calculated by using the formula n = NX/[(n-1)E2+X], taking a 95% confidence interval and 5% standard error. The subjects were selected after written informed consent was obtained from the participants. The samples were collected by the non-probability sampling method using haphazard (convenience) samples. The total study population was divided into three groups by using WHO classification criteria (Table-1). This study design was approved by the institutional ethical committee (IEC letter number:235/09/01/2013). The exclusion criteria for the study population were, patients with metabolic bone diseases, bilateral hip fracture, having a history of fracture due to osteoporosis, malignancy, renal failure, terminal illness, psychiatric illness, and severe dementia Age, sex, height, and weight were measured for all the patients. Morphometric indices of the upper end of the femur such as HAL and FNSA were measured by dual-energy X-ray absorptiometry (DEXA) scan by using LUNAR XR 1000 scanner. The equipment used for the study were being updated regularly for standardization of reading. The BMI was calculated as per WHO guideline, by using the formula.&#xD;
&#xD;
&#xD;
&#xD;
Using the above equation, BMI was calculated until the second decimal value.&#xD;
&#xD;
&#xD;
&#xD;
Radiographic assessment &#xD;
&#xD;
The radiography of the proximal femur was taken in a supine position with 15&#x2013;30&#xB0; of internal rotation of hips. With a film focus distance of 100cm, the beams were centred in the symphysis pubis. To measure different morphometric parameters 15 inch&#xD7;12inch size films were used. A longitudinal line was drawn over the film, and few perpendicular lines 1 cm apart were drawn on that longitudinal line. The film was placed over radiograms to facilitate accuracy and consistency of measurements and points of desired measurements were marked over lines. For uniformity of sample, in all patients skiagrams of the left femur were taken. Following parameters were taken for measurement in all patients (Figure 1).&#xD;
&#xD;
&#xD;
	&#xD;
	Hip Axis Length in mm (HAL): From the base of the lateral part of the greater trochanter up to the inner pelvic brim.&#xD;
	&#xD;
	&#xD;
	Femoral Neck-Shaft Angle in degree (FNSA): Angle between neck and shaft of the femur.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
The data collected in the process were analysed through statistical tools and techniques as explained in the methodology using IBM SPSS 24.0 statistics, SPSS South Asia private limited. The correlation of BMI with femoral morphometric parameters has been studied by using Kal Pearson&#x2019;s correlation coefficient (r). The level of correlation depends upon &#x2018;r&#x2019; value which lies between -1 to +1. If r0.5 but 0.7 but  0.8, the correlation is of very high level. &#xD;
&#xD;
Results&#xD;
&#xD;
The mean age, height, weight, HAL, FNSA and BMI of the study population were found to be 58.72, 160.15cm, 64.38 kg, 104.14mm, 128.51 degrees and 26.89 kg/m&#xB2; respectively (Table-1). In the sampled population 39.8% of subjects were in the pre-obese group, 28.5% in the normal BMI group and 31.5% were in the obese group (Table 2). The comparison of proximal femoral morphometry in different BMI group was represented in Table 2. In the obese and pre-obese group, there was a significant increase in mean values of all parameters as compared with the normal BMI group (P65yrs) is also reported.24,25 As BMI is associated with body weight &amp; BMD, decreased body weight may be associated with decreased bone mass and increases the fracture risk.6,7,9 But in the present study osteoporotic patients were excluded from the study population. The present study coincides with the study by Bhattacharya et al on the Indian population that demonstrates a moderate to the high level of correlation between BMI and femoral neck axis length, hip axis length, head width, femoral neck width, neck-shaft angle in normal and obese BMI individuals. Femoral morphometric measurements related to different races are worth obtaining the validity of risk factors for a fractured hip. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
The present cross-sectional study found a significant correlation between BMI and proximal femoral morphometry, hip axis length and femoral neck-shaft angle. Both the parameters should be evaluated together for better prediction of fracture risk in an individual and can help clinicians in choosing the proper size prosthesis during hip arthroplasty.&#xA0; &#xD;
&#xD;
Acknowledgement: Authors are grateful to all the patients, doctors and persons those who helped, with the collection of the data for the study. The authors also acknowledge the help of the institute for permitting to carry out the study. We are also grateful to the researchers and publishers whose articles are referred to in the present article.&#xD;
&#xD;
Conflicts of interest: Authors have no conflicts of interest &#xD;
&#xD;
Source of funding: nil&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3667</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3667</Fulltext></URLs><References>&#xD;
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	Gregory JS, Testi D, Stewart A, Undrill PE, Reid DM, Aspden RM. A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture. Osteoporosis Int 2004;15:5-11.&#xD;
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	Cooper AA, Boston MA, Lilly and Wait. Treatise on Dislocations and Fractures of the joints. Philadelphia : Blanchard and Lea, 1851. &#xD;
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	Testi D, Cappello A, Chiari L, Viceconti M, Gnudi S. Comparison of logistic and bayesian classifiers for evaluating the risk of femoral neck fracture in osteoporotic patients. Med Biol Eng 2001;39:633-7. &#xD;
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	Liu JM, Zhao HY, Ning G, Zhao YJ, Zhang LZ, Sun LH, et al. Relationship between body composition and bone mineral density in healthy young and premenopausal Chinese women. Osteoporos Int 2004;15:238-42.&#xD;
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	Irdesel J, Ari I. The proximal femoral morphometry of Turkish women on radiographs. Eur J Anat 2006;10(1):21-26.&#xD;
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	Faulkner KG, Cummings SR, Black D, Palermo L, Gluer CC, Genant HK. Simple measurements of femoral geometry predict hip fracture: the study of osteoporotic fracture. J Bone Miner Res 1993;8:1211-7.&#xD;
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	Boonen S, Koutri R, Dequeker J, Aerssens J, Lowest G, Nijs J et al. Measurements of femoral geometry in type I and type II osteoporosis: differences in hip axis length consistent with heterogeneity in the pathogenesis of osteoporotic fractures. J Bone Miner Res 1995;12:1908-1912.&#xD;
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	Alonso CG, Curiel MD, Carranza FH, R.&#xA0;Cano RP, P&#xE9;rez AD: Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women. Osteoporosis Int 2000:11:714&#x2013;720.&#xD;
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	Faulkner KG, Mc Clung M and Cummings SR. Automated evaluation of hip axis length for predicting hip fracture. J Bone Miner Res 1994;9:1065-70.&#xD;
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	Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, Giavaresi G. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int 2002;13: 69-73.&#xD;
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	Rosso R, Minisola S. Hip axis length in an Italian osteoporotic population. Br J Radiol 2000;73:969-972.&#xD;
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	Wheeler RL,&#xA0;Hampton AD,&#xA0;Langley NR. The effects of body mass index and age on cross-sectional properties of the femoral neck. Clin Anat.&#xA0;2015; 28(8):1048-57. &#xD;
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	Nissen N, Hauge EM, Abrahamsen B, Jensen JEB,&#xA0; Mosekilde L, Brixen K. Geometry of the Proximal Femur concerning Age and Sex: a Cross-Sectional Study in Healthy Adult Danes. Acta Radiologica 2005;46(5):514-518.&#xD;
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	Hemenway D, Feskanich D, Coldits GA. Body height and hip fracture: a cohort study of 90000 women. Int J Epidemiol 1995;24:783-786.&#xD;
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	Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE, Hong CP, et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women&amp;#39;s Health Study. Arch Intern Med 2000;160(14):2117-28&#xD;
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	Young Y, Myers AH, Provenzano G. Factors associated with time to first hip fracture. J Aging Health 2001;13(4):511-526.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Perspectives of Students and Teaching Faculty Members Towards the New MBBS Curriculum in a Tertiary Care Hospital in Chennai&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>120</FirstPage><LastPage>126</LastPage><AuthorList><Author>Preetha Selva</Author><AuthorLanguage>English</AuthorLanguage><Author> Rithikaa M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The medical council of India has released a new curriculum for medical undergraduate students titled &#x201C;Competency-based UG Curriculum for the Indian Medical Graduates&#x201D;. This curriculum which bestows outcome-based strategy is implemented to improve the quality of medical education thereby providing more efficient future doctors. Objectives: To assess the knowledge, attitude and perspectives of students and teaching faculty members of our institution towards the newly implemented MBBS curriculum. Methods: A pre-validated questionnaire in the form of electronic form submission was sent to all the participants online based on inclusion criteria during the study period. The responses were assessed and analyzed. Results: Out of the 885 students and faculty members altogether who had received the questionnaire, only 594 had participated and given their opinions. The knowledge, attitude and perspectives of the participants towards the new curriculum were assessed. Conclusion: The new curriculum is specially designed to make the medical graduates&#x2019; workplace ready and competent. Therefore, to keep up with the global standards, we cannot procrastinate from the implemented curriculum as it is the need of the hour. The awareness, advantages, necessity and outcomes of competency-based medical education can be improved by conducting sensitization programs such as curriculum implementation support programs for all the teaching faculty members. Since, it is difficult to cope up with the sudden transition to the newly implemented curriculum, as it requires tedious planning, downtime, manpower, and changes in the teaching-learning process a hybrid approach can be considered in which the newly implemented CBME curriculum is incorporated into the existing conventional curriculum. This slow transition can allow time for better designing and implementation of the new curriculum as it would provide sufficient breathing space to analyze the advantages and better acceptance of the CBME curriculum among the faculty members which may lead to the evolution of robust change in the quality of medical education.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Medical education, Curriculum-based medical education, Knowledge, Attitude, Perspectives, Questionnaire</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The medical education system is the mainstay of the health care sector which is deflected from its prime purpose of providing effective medication management due to lack of skilled medical faculty members and technicians and reduced quality and quantity of research in the field.1 Hence after a long period of twenty-one years, the Medical Council of India (MCI) has released a new curriculum for medical undergraduate students titled "Competency-based UG Curriculum for the Indian Medical Graduates."2This curriculum designed&#xA0;for college kids&#xA0;pursuing M.B.B.S was enacted in India from August 2019&#xA0;which incorporates&#xA0;three volumes of 890 pages in total. According to the new curriculum, at the end of the course, an MBBS student must acquire a total of 2939 competencies.3 Resultantly, the MCI aims to provide scholars with a much better learning perspective by integrating the medical curriculum.&#xD;
&#xD;
Early Clinical Exposure (ECE), Curriculum Implementation Support Program (CISP), Attitude Ethics and Communication Module (AETCOM), and Foundation Course are the quintessence of the new curriculum which is introduced of late. The quality of teaching at the grass-root&#xA0;level and collaborative studies in the backdrop with the clinical correlation of the disease is improved by Horizontal and Vertical combination of teaching in the newly implemented curriculum. It also helps to overlap the syllabus in various phases.&#xD;
&#xD;
Medical Education Unit (MEU) could be a forum where all staffs of the Medical College including pre-clinical, para-clinical and clinical faculty members meet and contribute their knowledge through guest lectures and continued medical education. It includes faculty development programs (FDP) also.&#xD;
&#xD;
The primary intention of the Foundation Course which is introduced to the students within the first two months of the primary year of MBBS&#xA0; incorporates orienting the undergraduates to all aspects of the medical college ambience; equipping them with certain fundamental yet significant skills required for patient care and enhancing their communication, language, computer, and learning skills; providing an opportunity for peer and faculty interactions and overall responsiveness to the varied learning methodologies.&#xD;
&#xD;
Effective communication with the patients remains the key to success for medical professionals. The most defining characteristics of a medical student are his communication skills. A healthy patient-doctor relationship has a crucial role in the diagnosis, treatment and also satisfaction of the patient. The communication is expected to be sensitive, effective, respectful, informative, and should be adequate.&#xD;
&#xD;
Problem-based learning (PBL) encompasses a great contribution to improving knowledge and learning skills and developing interpersonal communication and presentation skills. Assessment plays an important part in the new curriculum. MCI has forced to implement the Competency-based Medical Education (CBME) which focuses on the required and observable ability in real-life situations. Evaluation in an exceedingly Competency-based Medical Education focuses on enhancing learning as an ongoing process so that the faculty can spot it, make alternative measures and provide better learning opportunities to the students for their betterment. Various methods that can be followed to assess the students are through multiple-choice questions, case-based discussions, Theory tests, viva voce, skill assessment, OSCE, OSPE, seminars, assignments etc.4 Hence, the main purpose of implementing the new U.G curriculum is to give importance to all the three domains like cognitive, affective and psychomotor domain than focusing on cognitive domain alone as per old curriculum pattern. &#xD;
&#xD;
Though the CBME is speeding up worldwide and is a glaciated transition in the existing approach to medical teaching and education, there may be a few limitations in implementing the same at the institutional level. It needs a shaping of teaching-learning structure and process to a great extent to shift from teacher-centred to a more student-centred curriculum and meet the requirements of lifelong learning which is a main competency of the new curriculum.5 The faculty members may be overwhelmed by this sudden change as there is a lot of effort to be put by them to redefine the teaching-learning methodology, integrate with other pre, para and clinical staff members and put scheduled timetable for the students based on competencies in the curriculum, constructing specific learning objectives and heuristic evaluation with productive feedback, designing logbooks and portfolios. This would require a lot of manpower, workforce and material to be carried out effectively.6 Though the students may be motivated to gain an understanding of medicine as they are exposed to the clinical side in the form of early clinical exposure right after completing their high school they may also face a few challenges which go neglected and are overlooked.&#xD;
&#xD;
Since this curriculum is being recently introduced and there are only a very few studies done on the same we felt the need to assess the knowledge, attitude and perspectives of students and teaching faculty members of our institution towards the newly implemented MBBS curriculum considering the aforementioned issues. In the present study we aimed to assess the knowledge, attitude and perspectives of undergraduate medical students and teaching faculty members concerning the newly implemented MBBS curriculum &#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Study Design: Questionnaire-based study&#xD;
&#xD;
Study Place &amp; Duration: The study was conducted for a period of 4 months starting from March to July 2020 in Saveetha medical college and hospital&#xD;
&#xD;
Sample Size: All the teaching faculty members and students of Saveetha medical college were included in the study. &#xD;
&#xD;
Ethical committee approval number: SMC/IEC/2020/03/258&#xD;
&#xD;
Study Population:&#xD;
&#xD;
Inclusion criteria: All the phase I M.B.B.S students (CBME Batch), 2nd, 3rd, 4th-year M.B.B.S students and students doing their internship and teaching faculty of pre-clinical, para-clinical and clinical subjects of our colleagues who have volunteered to participate in our study and filled the written informed consent were included in our study.&#xD;
&#xD;
Exclusion criteria: Teaching faculty members and students who did not give informed consent to participate in the study were excluded.&#xD;
&#xD;
Procedure&#xD;
&#xD;
The study was carried out only after getting approval from the Institutional Ethics Committee. The questionnaire of our study was validated and approved by two faculty members of Professor cadre who are members of the Medical Education Unit (MEU) and Curriculum Implementation Support Program (CISP) for their expertise. The informed consent form with a brief summary of the purpose of our study was circulated to all the teaching faculty members and M.B.B.S students of our college. After giving written informed consent they were allowed to answer the validated questionnaire which was shared online in the form of google response forms. The responses recorded were then assessed and evaluated. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0; &#xA0;Results&#xD;
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Out of the 885 students and faculty members altogether who had received the questionnaire, only 594 had participated and given their opinions. The gender distribution and profession of the participants are shown in Figure 1. &#xD;
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&#xD;
&#xD;
The responses to the questionnaire based on knowledge, attitude and perspectives are shown below. Likert scale was used for a few questions in the questionnaire.7&#xD;
&#xD;
The responses for the question Assessment is a vital component of competency-based medical education (CBME) to improve the learning skills of the student is depicted in fig 2. 18.8% and 58.1% of the participants strongly agreed &amp; agreed that assessment is important respectively.&#xD;
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Discussion&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Out of the 885 total number of faculty members and students studying Bachelor of Medicine and Bachelor of Surgery in our college and hospital only 594 of them who gave voluntary written informed consent were included in the study. The electronic submission of the response to the validated questionnaire to assess the knowledge, attitude and perspectives of the participants was collected and analyzed.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The response was more from phase I students who are currently in the newly implemented curriculum based medical education (CBME) batch and 2nd-year MBBS students equally compared to pre-final, final and students working as interns. Since phase I students are currently in the newly implemented curriculum batch they would be more aware and interested to answer the questionnaire related to the same. As we are teaching the 2nd year MBBS students currently, increased interaction and communication with them may be the reason for more response from these set of students. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Though the list of faculty members in the clinical department is far more than the para and preclinical faculty members list, the relative response rate is low from the clinical faculty staffs. This may be because of more academic and professional socialization with the pre-clinical and para-clinical staff members making them respond better to our study.&#xD;
&#xD;
Knowledge:&#xD;
&#xD;
Among the 594 participants in our study, 102(17.1%) of them were not even aware of the new MBBS curriculum. They mostly comprised the final year students, interns and busy consultants working in the clinical side who are more involved in providing patient care than teaching the students. 538 (90.5%) agreed that Early clinical exposure is a boon to budding doctors. Only 427 (71.8%),249 (41.9%), 168 (28.2%) and 365 (61.5%) of them knew that foundation course, yoga and meditation have been brought up in the curriculum, MCI has added the curriculum committee, CSC (curricular subcommittee) and AIT (alignment and integration team) to oversight the curriculum at the institutional level, Forensic medicine has been shifted to the 6th semester and phase II students have 2 semesters instead of 3 respectively. This shows that the complete knowledge of faculty members and students towards the new curriculum is only to a limited extent. To increase the same, the faculty members should be encouraged and stimulated to enrol and participate in faculty development programs and Curriculum Implementation Support Program (CISP) which are being organized and conducted periodically in our institution. This will provide a framework and basic insight into the new curriculum put into effect from August 2019. 8 398(67.1%) of them felt that early clinical exposure (ECE) will allow the students to recognize the basic science in diagnosis, patient care and treatment. Hence they agree with the action taken by the Medical Council of India to introduce ECE in the Indian medical curriculum thus reducing the line of demarcation between preclinical and clinical subjects. This will enable the students to attain firsthand experience in clinical skills thus improving the clinical educational quality. &#xD;
&#xD;
Attitude:&#xD;
&#xD;
18.8% and 58.1% of the participants strongly agreed &amp; agreed that assessment is an important component of competency-based medical education (CBME) to improve the learning skills of the student respectively. The remaining participants who disagreed were mostly the phase I students who are currently pursuing the new curriculum. This is obviously because the students are scared and reluctant to overcome the obstacle of attending assessments which involves intense preparation and hard work. Presumably, they also do not want to accept the fact that they are being judged and feel that faculty members become more biased towards students who perform well and are superior at memorization. 9 This issue can be solved by conducting assessments in the form of objective structured clinical examination (OSCE)/objective structured practical examination (OSPE), multiple-choice questions, Quiz and scores based on student&#x2019;s day to day activities. This will circumvent the need for assessments in the form of theory examination and also generate interest and enthusiasm among the students to prepare for the same. They also invigorate higher-order thinking among the medical students. 10&#xD;
&#xD;
452, 538 and 424 participants agreed and strongly agreed that the new curriculum will boost up the enthusiasm of students to set their professional career from the beginning, Electives will provide opportunities for students to acquire diverse learning experiences and CBME will improve quality and standards of health management system in coming years respectively. This shows the faculty members and students benevolence to the much needed reform in medical curriculum in the form of Competency Based Medical Education (CBME). Majority of the participants also felt that the revised curriculum should have been implemented earlier to maximize the benefits of the same which focus on the graduate to master and excel in his profession. This would have provided a set of more competent medical practitioners committed to excellence, responsible and accountable to patients and functioned professionally as this type of education focuses mainly on outcome-based strategy. 11&#xD;
&#xD;
Perspectives:&#xD;
&#xD;
485 (193+292), 468 (389+79) and 498 (402+96) participants agreed that AETCOM (attitude, ethics and communication) is necessary for a doctor, Vertical and horizontal integrations make the student understand the topic better and Problem based learning(PBL) enhances the knowledge in a specific area at micro-level respectively. However, only 320 participants felt that early clinical exposure (ECE) improves overall understanding, interaction and problem-solving skills. 265 participants remained neutral to this question. As the majority of them felt that ECE is essential and should be employed only for selected topics; despite being unnecessary for all medical topics they require more manpower and are time and energy-consuming. Incorporating early clinical exposure only for topics that are deemed necessary can be followed initially to circumvent the sudden change in CBME and give enough time to weigh the pros and cons of the same.&#xA0; 12,13&#xD;
&#xD;
330 (55.65%), 426 (71.8%) and 467 (78.6%) of participants felt that 360? impact evaluation would contribute to creating a better doctor to the society, implementation of the new curriculum in MBBS would be most helpful to achieve roles and goals of Indian medical graduate (IMG) at a stipulated time and prefer the newly revised curriculum over the previous one respectively. Only 55.65% of the participants felt that 360? impact evaluation would contribute to creating a better doctor to the society because they felt that all-round impact evaluation was not only time-consuming but also unnecessary as Medicine is an ongoing learning practice. Knowledge, attitude and skills the graduate has on the field of specialization he finally chooses and his experience, commitment and heavy competition in the medical field will as a matter of course make him a better doctor.14,15 78.6% of participants preferred the new curriculum over the previous one which is a welcome sign for the successful outcome of the revised CBME implemented.&#xA0; &#xD;
&#xD;
Conclusion&#xD;
&#xD;
The knowledge, attitude and perspectives of teaching faculty members and M.B.B.S students were validated and assessed using a questionnaire. The awareness, advantages, necessity and outcomes of the competency-based medical education can be improved by conducting sensitization programs and curriculum implementation support programs for all the teaching faculty members. Since, it is difficult to cope up with the sudden transition to the newly implemented curriculum, as it requires tedious planning, downtime, manpower, and changes in the teaching-learning process a hybrid approach can be considered in which the newly implemented CBME curriculum is incorporated into the existing conventional curriculum. This slow transition can allow time for better designing and implementation of the new curriculum as it would provide sufficient breathing space to analyze the advantages and better acceptance of the CBME curriculum among the faculty members which may lead to the evolution of robust change in the quality of medical education. &#xD;
&#xD;
Acknowledgement: We are extremely thankful to the faculty members and students of our college who gave their willingness and participated in the study by answering the questionnaire. We thank the members of the Institutional Ethics Committee for giving us the approval to conduct the study. We are also thankful to Professors of the General Medicine and Anatomy Department for their expertise invalidating our questionnaire. &#xD;
&#xD;
Conflict of Interest: None Declared&#xA0; &#xD;
&#xD;
Funding source: No funding source &#xD;
&#xD;
Authors contribution: I st author:&#xA0; The questionnaire for the study was prepared and validation and approval of the same was obtained from the experts in the field of medical education and ethics committee. The manuscript was prepared and sent for publication under the journal guidelines.&#xD;
&#xD;
2nd author: The response for the questionnaire was collected from the students of different phases and the faculty members of the clinical and non-clinical departments of the institution.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3668</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3668</Fulltext></URLs><References>&#xD;
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	Medical Council of India: Competency-Based under Graduate Curriculum.&#xA0;2019. [Last accessed on 2019 Feb 02]. https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum.&#xD;
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	Kumar R. The tyranny of the Medical Council of India&amp;#39;s new (2019) MBBS curriculum: Abolition of the academic discipline of family physicians and general practitioners from the medical education system of India. J Family Med Prim Care 2019;8(2):323-325. &#xD;
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	&#xA0;Chari S, Gupta M, Gade S. The early clinical exposure experience motivates first-year MBBS students: A study. Int J Educ Sci 2015 ;8(2):403-5.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Robust Morphological Deep Net Method for Image Segmentation Using Clustering (Retinal Image Segmentation Using Deep Net)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>127</FirstPage><LastPage>131</LastPage><AuthorList><Author>Kaur M</Author><AuthorLanguage>English</AuthorLanguage><Author> Kamra A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The segmentation of retinal blood vessel now a day is one of the most important factors which decides the performance of a Computer-aided design (CAD) based system. Segmentation is the process of extracting the region of interest i.e. the disease in the image. The boundaries of retinal blood vessels need to be segmented accurately as an eye surgeon cannot be able to predict the area of disease in case segmentation not done accurately. Objective: This proposed method aims to segment retinal blood vessels using morphological operation which robustly extract the feature. The final image is obtained by using distance-based clustering. Results: The proposed method had shown an accuracy of more than 98.15% and the images are enhanced as the peak signal to noise ratio (PSNR) value is more than 50. Conclusion: The proposed method is efficient in contrast with various existing techniques.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Segmentation, Clustering, Morphological, PSNR, MSE, Accuracy</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Artificial neural networks with more than two hidden layers are called a deep neural network. Deep neural networks have various architectures depending on their types of connections between layers or operations performed in a layer or unit types in a layer. For example, a multi-layer perceptron has feed-forward connections while a Recurrent Neural Network (RNN) has recurrent connections which provide previous signals to be processed along with the current signal during the training. A Convolution Neural Network (CNN) has convolution layers, performing Convolution between input data and a series of feature detectors. On the other hand, a Deep Belief Net (DBN) has stochastic units and connections between layers are directed from the top layer to the bottom layer.1-3&#xD;
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These networks have been applied to a range of problems from image analysis to language processing. Deep learning has been found very successful at image segmentation, with very extensive examples of object, human or semantic segmentation in natural image.1 To date, there have been limited attempts at organ segmentation in medical images, such as brain part segmentation from MRI images and cell segmentation from microscopy.2,3 Applications of deep networks to retinal vessel segmentation have also started to appear in recent years.3 One key advantage of using a deep network in medical image segmentation can be the adaptation of the method to segment new data, acquired by a different acquisition system, by only retraining the network. In contrast, traditional methods require the adaptation for the segmentation of new data, often entailing the redesign of features according to the new dataset or searching for optimum parameters. On the other hand, the training of a deep network can be challenging in terms of collecting large amounts of labelled data, and this can be viewed as the biggest disadvantage of this method.4-6&#xD;
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MATERIALS AND METHODS &#xD;
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DataSet Used&#xD;
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We have used a clinical dataset obtained from Dr.Ramesh&amp;#39;s Super Eye Care &amp; Laser Center, which contains 1800 images, for diabetic Retinopathy.&#xD;
&#xD;
Algorithm for Proposed Method&#xD;
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(Cross Modality for feature extraction)&#xD;
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Step 1: START&#xD;
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read_image (I)&#xDF; Retinal Image &#x3B5; (D,N,M)&#xD;
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I &#xDF; exp (I)&#xD;
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Step 2: Initialize Population &#xE0; P&#xD;
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For &#x2200; p generate N feasible solutions for Ii&#xD;
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Step 3: Compute mean (I (Ii) for I &#x3B5; N&#xD;
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Loop &#xD;
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for&#xA0; i=1 to N &#xE0;Selection&#xD;
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Select the best two from the population (I1 &#xB4;, I2 &#xB4;)&#xD;
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Crossover and Mutation &#x2200; I&#xD;
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I&#xE0;[I features ]&#xD;
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Step 4: Set I&#xDF; K-classifier &#xD;
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Define Hyperparamter or Set C= empty&#xD;
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Step 5: Divide all pixels with equal distribution &#xD;
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&#xA0;&#xA0; for fold Ki-in K-fold&#xD;
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	Set Ki as the test set&#xD;
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	Do distance computation and features selection &#x2200; I in the loop&#xD;
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	Loop whilceKfold &#x2260; NULL&#xD;
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Set Kfold&#xE0; K-2 fold&#xD;
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Evaluate Model performance &#xD;
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Compute PSNR &#xDF; MSE &#x3B5; I&#xD;
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End.7,8 &#xD;
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In this current work, the cross-modality learning approach is explored for vessel segmentation because it considers the solidarity of label pixels from the same class during the segmentation. Also, this approach suits the nature of the problem as explained below. Fundus image patches can be viewed as noisy versions of vessel masks. Figure 1 shows a fundus image patch and its possible vessel mask. &#xD;
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As seen from the figure, the relation between these fundus image patches and their vessel masks is not so complicated, when compared with the relation between the samples of audio and video data in previous applications of cross-modality learning.9,10 In an unrealistic case, even a linear mapping between fundus images and their vessel maps can be possible if the noise level is really low, virtually zero, for fundus images. Because of this similarity, a shared representation learned between fundus images and their vessel masks can react to the characteristics of both data modalities by highlighting the main structures of interest, blood vessels, at the same time.11&#xD;
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The implementation of this approach can be achieved with a generative learning method, such as through using a generative morphological operation (Figure 2). Why a generative learning method is selected can be explained by two reasons. The first is because both generative learning and cross-modality learning require a good representation of the input data. The second is that the features learned during the generative training of a DBN, which can also be called pre-training, can be manipulated to obtain useful features for cross-modality learning.12&#xD;
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Morphological operations help in smoothening the images and extract the features from the image. The feature extraction is done to preserve the original and the true expected shape of the retinal blood vessel. The various operations are applied as dilation and erosion operations are applied together for edge detection once the threshold is predicted dynamically. The process of dilation is used to separate the pixels from each other. For all the clip window similar pixels the matrix of 1&#x2019;s is formed and not none matching the matrix of 0&#x2019;s is formed by which the boundaries can be predicted. The process of erosion will remove the extra boundary pixels to left the user with a crisp idea of the boundary and dimensions. The quality of the mage will be evaluated based on MSE and PSNR. The MSE is the mean square error which is calculated by subtracting the final image from the original. 2,13,14 The PSNR value is computed as:&#xD;
&#xD;
PSNR = 10log10 [I2 / MSE] &#x2026;&#x2026;.. (1)&#xD;
&#xD;
where I range from 0 to 255. &#xD;
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RESULTS AND DISCUSSION&#xD;
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In this section, the performance of the proposed network is evaluated on the CLINICAL dataset. After examining the segmentation performance of the proposed method on the best and the worst-case images, the performance will be compared with that of state of the art methods.&#xD;
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Table I tabulates the overall performance of the proposed network on the CLINICAL dataset concerning the evaluation criteria. Also, the highest and lowest performances based on the maximum and minimum accuracies are shown. As understood from this Table, there is not too much difference between the performance metrics of the best and the worst cases based on accuracy. The proposed network obtained its best and worst performances respectively on the 19th and the 3rd images. These images were also reported as having the best and the worst performances in recent studies using supervised methods.7,15,16 In the Binearization of these vessel probability maps, the average threshold value was found to be 0:1305-0:0432 (average standard deviation). Generated vessel probability maps and binary vessel maps for these images can be found by visual examination of Figure 3. &#xD;
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In this Figure, the discrimination of the optic disc from blood vessels in both binary maps (best and worst cases) is performed well, despite the similarity of its border to blood vessels regarding contrast levels. Also, inhomogeneous illumination over fundus images and poor contrast of blood vessels do not seem to cause any disruption in the detection of even tiny blood vessels. On the other hand, the proposed network seems to be sometimes misled by pathologies in fundus images and can sometimes respond to these pathologies as if they are a part of blood vessels. This can be observed in the red circular region in the binary vessel map corresponding to the worst case in the same figure. The proposed network was also seen to mistakenly respond to a fraction of cotton wool spots. Although these responses seem weaker than or almost the same as those of neighbourhood capillaries in the related probability map, some pathological responses appear in the final binary map because of a very low threshold. Also, readers should be aware that the CLINICAL dataset contains random diabetic and non-diabetic fundus images, so it can also be a factor affecting the performance of the network on pathological images. The performance of the proposed network produced a larger AUC value, surpassing the performance of another state of the art deep networks proposed.17-19 Regarding other evaluation metrics, the performance of the proposed method is comparable with the performances of the previous methods. Among them, Author in is the closest to the proposed one: both used a cross-modality learning approach for vasculature segmentation, and both used fully connected networks.20 However, the ways the methods are trained to vary. In the proposed network, the weights in each layer are initialized with weights learned with the probabilistic training of RBMs. However, Li et al. network is a traditional fully connected network with a modification, where the first layer of their network is initialized by the weights learned by training a de-noising autoencoder. The other two layers were initialized by sampling from a normal distribution. Also, the number of hidden layers used in the networks is different (Figure 4). &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
In-vessel segmentation, recently, deep learning approaches have presented more successful results than other approaches.21 This leads me to use a deep network for vasculature segmentation. Although the general tendency in vasculature segmentation is the classification of each pixel in a fundus image as a vessel pixel and a non-vessel pixel, the consideration of spatial connectivity of label pixels in the output of the network has been observed to increase segmentation performance. In this, the spatial connectivity of label pixels is considered by generating vessel masks for given input image patches as a result of complying with the cross-modality learning approach. To improve spatial connectivity of label pixels further, the feature extraction of the proposed is improved with a de-noising, which was found to result in more probability responses to vasculature to the image background.22 Although this effect may not be considered as an improvement regarding segmentation, where probabilities over a threshold would be labelled with the same class, the same effect can be valuable for the robustness of the proposed tracking method (Table I, II and III).&#xD;
&#xD;
The enhanced segmentation is found to be versatile in terms of applicability to different tasks by slightly modifying its architecture and without significantly changing the way of training the network. When it is used as it is, the network performed comparable or better on the segmentation of low-resolution images, when compared with similar methods.23 &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
As day by day, the number of patients and the necessity of vessel segmentation is increasing. The main reason is to exactly segment the boundaries of the disease to act and treat the patient properly. The segmentation of the blood vessels is done using the RGB separation initially and converting the image in greyscale. The morphological operations are applied to the images to extract the features by which our proposed robust method will segment the retinal blood vessels accurately. The distance-based clustering is used to classify the pixels according to their position, area and intensity to allocate each pixel in the correct cluster. The proposed method had shown an accuracy of more than 98.15% and the images are enhanced as the PSNR value is more than 50. The proposed method is efficient in contrast with various existing techniques. In future, the authors can classify the images based on the segmented retinal blood vessels images. &#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
The authors are grateful to Dr.Ramesh&amp;#39;s Super Eye Care &amp; Laser Center, Ludhiana, Punjab, India for providing us with the clinical dataset of retinal images of patients. The authors are also thankful to IKG PTU, Kapurthala, India for providing us with the opportunity to carry out this research work.&#xD;
&#xD;
This work was supported in my research work&#xD;
&#xD;
Financial Support: None&#xD;
&#xD;
Conflict of interest: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3669</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3669</Fulltext></URLs><References>[1] Revathy R. Diabetic Retinopathy Detection using Machine Learning. Int J Eng Res 2019;9(06):8036&#x2013;8048.&#xD;
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[15]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sadikoglu F, Uzelaltinbulat S.Biometric Retina Identification Based on Neural Network. Procedia Comput Sci 2016; 102:26&#x2013;33.&#xD;
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[16]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Alyoubi W L, Shalash W M, Abulkhair M F. Diabetic retinopathy detection through deep learning techniques: A review. Informatics Med Unlocked 2020;20:170-177.&#xD;
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[17]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Colomer A, Igual J, Naranjo V. Detection of early signs of diabetic retinopathy based on textural and morphological information in fundus images. Sensors (Basel) 2020;20(4):1&#x2013;21.&#xD;
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[18]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mateen M, Wen J, Nasrullah N, Sun S, S. Hayat S.Exudate Detection for Diabetic Retinopathy Using Pretrained Convolutional Neural Networks. Complexity 2020;2020(4):1&#x2013;11.&#xD;
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[19]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Islam SM, Hasan MM, Abdullah S. Deep Learning-based Early Detection and Grading of Diabetic Retinopathy Using Retinal Fundus Images. arXiv 2018;23(12):1&#x2013;13.&#xD;
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[20]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Bhupati A. Transfer Learning for Detection of Diabetic Retinopathy Disease Research Project MSc Data Analytics School of Computing National College of Ireland Supervisor?: Dr . Catherine Mulwa.2020.&#xD;
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[21]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Jin Q, Meng Z, Pham D, Chen Q,&#xA0; Wei L, Su R. DUNet: A deformable network for retinal vessel segmentation. Knowledge-Based Syst&#xA0;&#xA0; 2019;178(8):149&#x2013;162.&#xD;
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[22]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Raju PV, Varma PK, Nagaraju G. A Dynamic Approach for Exudates Detection in Diabetic Retinopathy Images Using Clustering. Int J Pure Appl Math 2018;119(18):751&#x2013;765.&#xD;
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[23]&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mondal S S, Mandal N, Singh A, Singh K K.Blood vessel detection from Retinal fundus images using GIFKCN classifier. Procedia Comput Sci 2019;167:2060&#x2013;2069&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>30</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Histopathological Evaluation of Appendicectomy Specimens in a Teaching Institute-A Cross-Sectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>132</FirstPage><LastPage>136</LastPage><AuthorList><Author>Supreet Singh Sodhi</Author><AuthorLanguage>English</AuthorLanguage><Author> Samriddhi Juneja</Author><AuthorLanguage>English</AuthorLanguage><Author> Basanagouda K Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Sunita B  Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Zuha Kadir Sange</Author><AuthorLanguage>English</AuthorLanguage><Author> Z N Patvegar</Author><AuthorLanguage>English</AuthorLanguage><Author> Nikethan B</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Appendicitis, Histopathology, Appendicectomy, Carcinoid tumour, Suppurative appendicitis, Enterobius vermicularis</Keywords><Fulltext>Introduction&#xD;
&#xD;
The appendix is considered to be a vestigial, small, tube-like organ placed under the ileocaecal junction. Appendicitis is the inflammation of the appendix. Its importance in surgery is due only to its propensity for inflammation which results in appendicitis.&#xA0; The most common mechanism is obstruction of the lumen from various etiological factors that leads to increased intraluminal pressure. Common causes of obstructive nature are: faecolith, calculi, foreign body, tumour, worms, diffuse lymphoid hyperplasia and non-obstructive causes include vascular occlusion and inappropriate diet. The lifetime risk of appendicitis in the human population is approximately 7%.1 In developing countries, the incidence of appendicitis is increasing probably due to the adoption of western diets, which include, low-fibre content, pre-processed meat and high fructose sugar.2 Even with the availability of superior technology and imaging devices, there is difficulty in the identification of appendicitis.3Histopathological examination is of vital importance for the pathological diagnosis of inflammation of the appendix. Unusual findings such as incidental tumours, granulomatous lesions or helminths noted in the appendix highlight the importance of the pathological analysis of every single resected specimen of the appendix. The present study was conducted to assess the histopathological findings and correlate with the clinical profile which may help in better diagnosis and management of appendicitis.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
This cross-sectional study was conducted on 616 surgically resected specimens of appendix clinically diagnosed as appendicitis at the Department of Pathology, D. Y. Patil Medical College, Kolhapur, Maharashtra, between 2015 and 2019. The clinical profile like age, sex, clinical symptoms of the patients were recorded from the requisition forms and clinical case files which were revived from the departmental records section. All the appendix specimens and their respective blocks and slides were retrieved from departmental archives to be included in the study. Detailed microscopic evaluation was performed after recovering the slides. Statistical Analysis was done using MS excel.&#xD;
&#xD;
Results &#xD;
&#xD;
A total of 616 appendectomy specimens were received which included all specimens having undergone appendectomy as elective or emergency procedures. Out of the 616 specimens received 371(60.22%) were males and 245(39.77%) were females. The male: female ratio was 1.5:1. 47.1% of the male samples and 55.8% of the female samples were of chronic appendicitis. Appendicitis cases were seen ranging from 7 years to 68 years of age with a mean age of 31 years in females. Appendicitis cases were seen ranging from 8 years to 88 years of age with a mean age of 29 years in males. Clinically, all the cases presented with pain in the abdomen or localized pain in right lower abdomen.&#xD;
&#xD;
Out of the total number of specimens, 285(45.96%) samples belonged to the age group 21-30 years. The majority of acute appendicitis (44.2%) and a majority of chronic appendicitis (49%) were also seen in the age group 21-30 years. About84% of the cases belonged to the age group of fewer than 40 years (Table 1).&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
The average length of the specimens was 5.70cm ranging from 1cm to 10cm. The length of the appendix of acute appendicitis ranged from 5cm to 10cm. The average length of the specimen of acute appendicitis was 5.9cm. The length of the appendix of acute on chronic appendicitis ranged from 2cm to 9cm. The average length of the specimen of acute on chronic appendicitis was 5.83cm. The length of the appendix of chronic appendicitis ranged from 1 cm to 10 cm. The average length of the specimen of chronic appendicitis was 5.63cm. The length of the appendix of acute suppurative appendicitis ranged from 5cm to 10cm. The average length of the specimen of acute suppurative appendicitis was 5.7 cm. About 95 (15.3%) samples were of acute appendicitis. 314 (50.6%) samples were of chronic appendicitis, 155 samples (25%) had an acute on chronic appendicitis and 52 (8.3%) samples had acute suppurative appendicitis. The perforation rate was 1.1% out of all the samples received. Perforation was more common in females as compared to males. Among chronic appendicitis, two specimens were of the granulomatous lesion and one was of Enterobius infestation. Among acute appendicitis, 1 specimen was of acute gangrenous appendicitis.&#xD;
&#xD;
One specimen (0.1%) of the total specimens was that of a carcinoid appendix in a 40-year-old female patient diagnosed after appendectomy. The mesoappendix was 5cm long, with 0.9 cm growth located on the appendiceal tip, cut section grossly was yellow. Histopathological examination of the specimen (Figure1) revealed ulcerated mucosa, enlarged lymphoid follicles in sub-mucosa, small mononuclear cells arranged in the acinar and insular pattern seen in sub-mucosa and muscular layer, indicating carcinoid tumour. Figure 1 shows a Microscopic cross-section of appendiceal carcinoid tumour with the characteristic nested pattern. The gross specimen of acute suppurative appendicitis (figure 2) showed a tense wall and the microscopic section shows inflammatory fluid accumulation. Figure 3 shows the microscopic cross-section of the granulomatous appendix. Two cases of granulomatous lesions in the resected specimen of the appendix were observed. The section studied from the appendix showed mucosal ulceration, caseation necrosis and numerous transmural epithelioid granulomas composed of epithelioid cells, multinucleated giant cells and lymphocytes. Mononuclear infiltration is also seen in muscular and serosa. Features are suggestive of granulomatous appendicitis probably of tuberculous aetiology. On Ziehl-Neelsen staining the section was negative for acid-fast bacilli. No follow-up record was available of serological tests. A solitary case of chronic appendicitis was also confirmed with the parasitic infestation of Enterobius vermicularis. A plano-convex, D-shaped egg can be seen (Figure 4). Gangrenous appendectomy specimen with irregular and the congested external surface was received with obliterated lumen and haemorrhage. The microscopic section shows transmural necrosis along with acute inflammatory infiltrates. Figure 5 shows acute gangrenous appendicitis gross and microscopic section. None of the cases showed foreign bodies or secondaries in the appendix. Gangrenous appendectomy specimen with irregular and congested external surface was received with obliterated lumen and haemorrhage. Microscopic section shows transmural necrosis along with acute inflammatory infiltrates.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xD;
&#xD;
Appendectomy is the most frequently performed abdominal surgery in the western world. More than one-third of all emergency abdominal surgeries are accounted for as appendectomies.4 Its increasing rate in the developing countries can be associated with the adoption of western diet patterns of pre-processed foods, low fibre contents, high fructose sugar snacks and increased consumption of oils. A study in South Korea done by Lee et al. showed an overall incidence of appendectomy of 13.56 per 10,000 population per year, which was found to be greater than those observed in developed western countries.5 Our study showed 84% of the cases occurred in individuals less than 40 years of age in correspondence with other studies.5,6 In concordance with both developed and developing countries most affected age group was 21 to 30 years of age.5 Male to female ratio in our study is 1.5:1 which are comparable to studies of United Kingdom7 and Kemran-Iran.8 The un-equal male to female ratio may be due to the unequal access in rural healthcare setups and socio-cultural stigmas of trivialization of symptoms felt by the female population, or it may be due to females being misdiagnosed with obstetric and gynaecological abdominal pain. There is the observation of a 1.1% perforation rate with slight female preponderance. It is significantly lower from older studies9 indicating the advancement in both imaging and treatment modalities. Whereas recent contemporary studies of Saudi Arabia10 indicate similar perforation rates. The low perforation rate might be due to appropriate and early clinical diagnosis by a physician and the prompt decision to surgically resect the appendix by the surgeons indicating a better overall prognosis.10 Perforation is more common in children due to lack of self-awareness and elderly individuals with immuno-compromised comorbid conditions. &#xD;
&#xD;
Our study indicated a higher frequency of chronic appendicitis cases (50.6%) followed by acute appendicitis (15.3%). While no cause has been established for the higher number of chronic cases, it can be associated with decreased self-awareness and education in the sample population towards non-specific abdominal pain. It can also be associated with the changing dietary habits and socioeconomic status of the population. Carcinoid tumours arise from the neuroendocrine enterochromaffin cells of the diffuse neuroendocrine system throughout the gastrointestinal tract.11 Appendiceal carcinoid tumours are rare neuroendocrine neoplasms that usually appear as benign growth, while some tumours may be able to metastasize.12In our study we found a single specimen (0.1%) of benign carcinoid appendix consistent with findings of other studies.13&#xD;
&#xD;
Appendectomy is typically a satisfactory treatment for carcinoid tumours less than 1cm in size, and right hemicolectomy is adopted when size is more than 2 cm. Treatment of carcinoid tumours measuring 1&#x2013;2 cm and/or accompanied by mesoappendiceal invasion remains controversial, with a more radical approach used in younger patients.13Granulomatous lesion in the appendix is an uncommon pathology of varied aetiology including tuberculosis, inflammatory bowel disease, sarcoidosis, parasites and fungi.14 Two specimens (0.32%) amongst the total samples showed a granuloma formation, the incidence of which is comparable to other studies.15 Variation in aetiology may differ due to differential geographical distribution. The granulomatous lesion is found to be more common in young males. The parasitic infestation was found only in one of the cases. In earlier times it was considered to be one of the most important causes of luminal obstruction but its incidence has reduced significantly indicating better sanitation of the population as well as easy availability of anti-helminthic drugs. Specimen of a 62-year-old male patient diagnosed with acute gangrenous appendicitis was received in bits of sizes ranging from 3 cm to 0.75cm with overall black discolouration. It showed features of transmural necrosis and haemorrhage microscopically. The aetiology can be traced back to untreated luminal blockage, rupture and atherosclerosis in elderly patients. It can be safely resected and followed by prophylactic use of third-generation cephalosporin antibiotic coverage.&#xD;
&#xD;
Imaging can minimize delay in surgical treatment and also reduce the risk of appendiceal perforation.16 Imaging techniques have been used to study the association between the gross length of the specimen and its propensity for perforation. In our study, we equate the length and the histological diagnosis. The average length of the specimens was 5.70 cm ranging from 1cm to 10cm. Establishing a correlation between an enlarged appendix with appendicitis will not aid in an accurate diagnosis and may jeopardize optimal care of patients presenting with non-specific acute abdominal pain.17 C reactive protein is a contributory marker in acute appendicitis but comes with the drawback of being nonspecific.18 &#xD;
&#xD;
Conclusion&#xD;
&#xD;
It is inadvisable to use length as a diagnostic aid for the prospective treatment of appendicitis. Histopathological examination of a resected appendix specimen confirms the type of appendicitis as well as identifies aetiology, while also revealing any other incidental pathology that may include a carcinoid tumour, granulomatous lesion or parasitic infestation which may require specific medications, surgical interventions or follow-ups. &#xD;
&#xD;
Acknowledgement: "Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed."&#xD;
&#xD;
Conflict of interest: NIL.&#xD;
&#xD;
Source of funding: NIL.&#xD;
&#xD;
Authors contributions: Supreet Singh Sodhi: Data collection and preparing the draft.&#xD;
&#xD;
Samriddhi Juneja: Data collection and preparing the draft.&#xD;
&#xD;
Basanagouda K Patil: Data analysis and preparation of tables. &#xD;
&#xD;
Sunita B Patil*: Conceived the presented idea, writing of the manuscript and interpretation.&#xD;
&#xD;
Zuha Kadir Sange: Data collection.&#xD;
&#xD;
Z N Patvegar: Conceived the presented idea and critical revision of the draft.&#xD;
&#xD;
Nikethan B: Critical review of the draft&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3670</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3670</Fulltext></URLs><References>1. Kumar V, Abbas A, Aster J, Turner JR. The Gastrointestinal tract, In Kumar, Abbas, Fausto (eds). Robbins and Cotran Pathologic basis of disease. 8th Edn. Saunders: Philadelphia; 2010;870-871.&#xD;
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2.&#xA0; Walker ARP, Segal I. Appendicitis: an African perspective. J Res Soc Med 1995; 88:616-619. &#xD;
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3. Shreshta R, SR Ranabhat SR, Tiwari M. Histopathological Analysis of Appendectomy specimens. J Pathol Nepal 2012;215-216.&#xD;
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4.&#xA0;&#xA0; Edino ST, Mohammed AZ, Ochicha O and Anumah M; Appendicitis in Kano, Nigeria: a 5-year review of the pattern, morbidity and mortality. Ann Afr Med 2004; 3:38-41.&#xD;
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5. Lee JH, Park YS, and Choi JS; The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data. J Epidemiol 2010;97. &#xD;
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6. Noudeh YJ, Sadigh N, Ahmadnia AY. Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. Int J Surg 2017;97. &#xD;
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7. Omiyale AO, Adjepong S.&#xA0; Histopathological correlations of appendectomies: a clinical audit of a single centre. Ann Transl Med 2015.&#xD;
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8. Nabipour F.&#xA0; Histopathological Feature of Acute Appendicitis in Kerman-Iran from 1997 to 2003. Am J Environ Sci 2005;1(2):131.&#xD;
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9. Rao PM, Rhea JT, Rattner DW, Venus LG, and Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 1999;344.&#xD;
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10.&#xA0; Jat MA, Al-Swailmi FK, Mehmood Y, Alrowaili M, Alanazi S. Histopathological examination of appendicectomy specimens at a district hospital of Saudi Arabia. Pak J Med Sci. 2015;893.&#xD;
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11. Pinchot SN, Holen K, Sippel RS, and Chen H; Carcinoid Tumours. Oncologist 2008 Dec;13(12):1255-69.&#xD;
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12. Parks SK, Muir KR, Al Sheyyab M, Cameron AH, Pincott JR, Raafat FR, et al. Carcinoid tumours of the appendix in children 1957&#x2013;1986: Incidence, treatment and outcome. BJS Society 1993.502-504. &#xD;
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13. Goldblum JR. Rosai and Ackerman&amp;#39;s Surgical Pathology. 2012;Vol2;11thEd. Cambridge, MA. Elsevier. &#xD;
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14. Tucker ON, Healy V, Jeffers M, Keane FBV. Granulomatous appendicitis. Surgeon 2003;1(5):286-9. &#xD;
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15. Gaffar BA.Granulomatous diseases and granulomas of the appendix. Int&#xA0;J Surg 2010 Feb;18(1):14-20.&#xD;
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16. Wise SW, Labuski MR, Kasales CJ, Blebea JS, Meilstrup JW, Holley GP, et al. Comparative assessment of CT and sonographic techniques for appendiceal imaging. Am J Roentgenol 2001 Apr;176(4):933-41.&#xD;
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17. Gwynn LK. Appendiceal enlargement as a criterion for clinical diagnosis of acute appendicitis: is it reliable and valid? J. Emerg. Med 2002;9. &#xD;
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18. Ramrao LY, Gajbhiye V, Vaidya VP, Akther MJ, Mangesh Padmawar M. Role of C Reactive Protein in Acute Appendicitis: A Cross-Sectional Study. Int J Cur Res Rev 2020;12 (20):66-69.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study to Find Out the Correlation of Mobile Phone Addiction with Anxiety, Depression, Stress and Sleep Quality in the College Students of Surat City&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>137</FirstPage><LastPage>142</LastPage><AuthorList><Author>Sonali Tanmay Choksi</Author><AuthorLanguage>English</AuthorLanguage><Author>Nipa Patel</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Smartphones are an important part of adolescent&#x2019;s life. Smartphone addiction is a common worldwide problem among adults, which might negatively affect their mental and physical wellbeing. Objective: Examine the relationship between mobile phone use and mental health by measuring the levels of depression, anxiety, stress and sleep quality among college students of Surat city. Methods: A cross-sectional study was conducted on a total of 100 numbers of college students. Data were collected by 3 Self-reported questionnaires including depression, Anxiety and Stress scale (DASS), Insomnia was assessed using Athens Insomnia Scales (AIS), and Smartphone addiction scale - Short version (SAS-SV). Results: Statistical analysis indicates that 27% of students were addicted to the smartphone. Stress, anxiety, depression and sleep quality have a positive significant correlation with smartphone addiction (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mobile phone addiction, Adolescents, Sleep quality, Depression, Anxiety, Stress</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Mobile phone use has become a necessity, due to widespread availability.1 Addiction to smartphone usage is a common problem among adults worldwide which is manifested as excessive usage of phones, while engaged in other activities such as studying, driving, social gatherings and even sleeping.2 However, many people don&#x2019;t realize that addiction to the smartphone is a serious issue leading to a negative effect on the person&#x2019;s thoughts, behaviour, tendencies, feelings, and sense of well-being.3 In particular, it can be a risk factor for depression, loneliness, anxiety and sleep disturbances.4 Recent types of research have shown that the use of the mobile phone is associated with headaches, neurovegetative dystonia, irritability, sleep disorders, fatigue, and dizziness.5-9&#xD;
&#xD;
Even though there are numerous evidence that shows positive/useful examples of mobile phone use (mostly smartphones) in medicine, education, and other fields10-14, Due to high degree of Internet use leads to addiction and behavioural changes.15&#xD;
&#xD;
Even though there are no discrete diagnostic criteria for smartphone addiction, it includes areas of behavioural addiction (i.e., gambling, internet gaming).16 This type of addiction is more common in adults who have more negative effects because it is a sensitive period with the occurrence of many physiological, psychological and social changes.17,18 Addiction is manifested in various forms such as tolerance, lack of control, withdrawal, mood modification, conflict, lies, excessive use and loss of interest.19 Most common issues which are proven include stress, anxiety, depression, attention deficit, insomnia or other sleep quality-related issues and effect on academic performance&#xD;
&#xD;
&#x201C;Depression&#x201D; derives from the word &#x201C;depressed&#x201D; in Latin, means pressing down, suffering, exhausted, woeful, sorrowful, discouraged, and deaden.19 Depression is one of the most common mental disorders in young people and causing severe disruptions in psychosocial and academic functioning.19 Many studies have revealed a positive correlation between smartphone addiction and depression; however, all these studies were conducted in specific populations. Demirci K confirmed females were more prone to develop smartphone addiction compared to males20, while Augner C et al concluded an association between stress, low emotional stability, female gender, young age and depression with mobile addiction.21 Yen C, confirmed that adolescents with significant depression due to phone addiction are more likely to develop four or more behavioural symptoms.22 This positive correlation with depression is alarming. So, reasonable usage of smartphones is advised, especially among younger adults, as they have a higher risk of depression19 so in this study, we are going to focus on the effect of smartphone addiction in adults as they are more prone to get smartphone addiction.&#xD;
&#xD;
The origin of the word &#x201C;anxiety&#x201D; is &#x201C;anxiety&#x201D; in Greek, meaning &#x201C;worry, fear, curiosity&#x201D;. In other words, anxiety is a mood, experienced in the face of danger resulting externally.26 According to Aydemir anxiety is a reaction that is unconscious and unknown by a person and that occurs against internal threats.23 Various epidemiological studies have revealed that its prevalence in adolescent psychiatry is the highest.24 Many kinds of research proved the correlation between &#x201C;depression and anxiety&#x201D;. According to classical theory, anxiety and depression do not differ from each other and may exist together.25 So in this study effect of smartphone addiction on depression and anxiety are studied together&#xD;
&#xD;
The word &#x201C;stress&#x201D; is a Latin word, which refers to a warning sign on the health and peace of people,26 Stress is a result of external conditions; it can result from the perspective of events of individuals.26 various studies show the high, medium and low correlation between stress and excessive mobile phone use.26-28 so to strengthen the literature about stress and mobile phone use in adults we have added stress component in our study along with depression and anxiety.&#xD;
&#xD;
Insomnia is diagnosed based on the patient&amp;#39;s subjective perception of unsatisfactory sleep quantity and/or quality. So, for the diagnosis of insomnia impaired sleep quality is given equal importance as that of reduced sleep quantity. 29 It is proven that mobile phone use in bed at night negatively impacts sleep outcome,30-32 this is due to the disturbances in circadian rhythm and sleep quality due to the exposure to bright light from electronic devices.32-35 In the present study we have focused on the overall effect of mobile phone addiction with insomnia rather than the use of mobile phone only while sleeping.&#xD;
&#xD;
Nowadays, adolescents are likely to use mobile phones for more hours per day, which can lead to different psychological and physiological problems. Even though the use of the mobile phone has been proven positive in many areas like medicine, e-learning, social media marketing, entertainment etc. but when the use of the mobile phone becomes addictive it leads to a negative effect on different components of health. So this study has been conducted to correlate mobile phone addiction with stress, anxiety, depression and insomnia in young adults. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
&#xD;
	&#xD;
	Study design: Co-relation study&#xD;
	&#xD;
	&#xD;
	Study population: 18 to 23 years old adult students of S.P.B physiotherapy college, Surat.&#xD;
	&#xD;
	&#xD;
	Sample size: 100&#xD;
	&#xD;
	&#xD;
	Sampling Technique: Convenient Sampling&#xD;
	&#xD;
	&#xD;
	Inclusion criteria:&#xA0;&#xA0;&#xA0;&#xA0; 1) Students who agreed to participate in the study.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Minimum use of mobile phone &gt;1 hour/day.&#xD;
	&#xD;
	&#xD;
	Those who use the smartphone with an active internet connection.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Exclusion criteria:&#xA0;&#xA0;&#xA0; 1)Incomplete response on following scales: &#xD;
	&#xD;
	&#xD;
	SAS - sv , &#xD;
	&#xD;
	&#xD;
	DASS - 21 &#xD;
	&#xD;
	&#xD;
	AIS.&#xD;
	&#xD;
&#xD;
&#xD;
2) Who didn&amp;#39;t give their informed consent.&#xD;
&#xD;
3) Known case of other psychological disorders.&#xD;
&#xD;
&#xD;
	&#xD;
	Outcome measures :&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Depression, Anxiety and Stress scale-21 [DASS] 36&#xD;
	&#xD;
	&#xD;
	Athens Insomnia scale [AIS] 37&#xD;
	&#xD;
	&#xD;
	Smartphone addiction scale - Short version [SAS - sv] 38&#xD;
	&#xD;
&#xD;
&#xD;
Procedure for data collection&#xD;
&#xD;
One hundred college students (19 males and 81 Females) whose age ranged from 18 to 23 years participated in the study. Participation in the study was voluntary and informed consent was taken before participation. They were selected by convenient sampling. All the subjects were explained about this study and about the questionnaires that were to be filled before the participation. 3 Questionnaires i.e DASS-21 (depression anxiety stress scale), AIS (Athens insomnia scale) and SAS-SV (Smartphone addiction scale-short version) were then handed out amongst the students of SPB Physiotherapy college and collected after being filled. &#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Data analysis was done using SPSS 20 and frequency distribution. P-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3671</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3671</Fulltext></URLs><References>&#xD;
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	&#xD;
	Harwood J, Dooley J, Scott A, Joiner R. Constantly connected &#x2013; the effects of smart devices on mental health. Comput Hum Behav 2014;34:267&#x2013;72.&#xD;
	&#xD;
	&#xD;
	Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing; 2013.&#xD;
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	&#xD;
	Gao Y,&#xA0;Li A, Zhu T,&#xA0;Liu X,&#xA0;Liu X. How smartphone usage correlates with social anxiety and loneliness. Peer J 2016;4:e2197.&#xD;
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	Al-Khlaiwi T, Meo SA. Association of mobile phone radiation with fatigue, headache, dizziness, tension and sleep disturbance in Saudi population. Saudi Med J 2004;25:732&#x2013;736. &#xD;
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	Chiu CT, Chang YH, Chen CC, Ko MC, Li CY. Mobile phone use and health symptoms in children. J Formos Med Assoc 2015;114:598&#x2013;604.&#xD;
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	Melton BF, Bigham LE, Bland HW, Bird M, Fairman C. Health-related behaviors and technology usage among college students. Am J Health Behav 2014;38:510&#x2013;518. &#xD;
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	Roosli M, Moser M, Baldinini Y, Meier M, Braun-Fahrlander C. Symptoms of ill health ascribed to electromagnetic field exposure&#x2014;A questionnaire survey. Int J Hyg Environ Health 2004;207:141&#x2013;150.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Does BMI affect the Academic Performance of Adolescents? A Comparative Study between the Government and Private Schools of Madurai District, Tamil Nadu, India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>143</FirstPage><LastPage>148</LastPage><AuthorList><Author>B. Bhuvaneswari</Author><AuthorLanguage>English</AuthorLanguage><Author> S. Parameshwari</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: This study examined the prevalence of overweight, obesity and the association between BMI and Academic performance in Indian school-going adolescents. Methods: A school-based cross-sectional study was carried out in various government and private schools of Madurai District, Tamil Nadu, India to identify the prevalence rates of overweight and obesity among urban schoolgoing adolescents studying in fifth to twelfth classes of both genders. A pre-tested questionnaire was used to elicit information on family and individual characteristics. Height and weight were measured and BMI was calculated. Results: Overall prevalence of overweight and obesity was found to be 1.66 % and 5.05% respectively. The mean BMI of both genders showed a significant decrease with age. Amongst genders, girls had higher mean BMI values within each age group. Statistical results reveal that the changes in body mass index were highly related to academic performance in both of the school setups at a 1% level of significance(Private Schools - &#x3C7;2 = 2.470; Government Schools - &#x3C7;2 =20.051 p&#x2264; 0.00). Conclusion: Academic performance as an adolescent has significant implications for future adult health and social well-being; therefore, understanding factors that contribute to academic achievement are vital for the future success of these adolescents.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Prevalence, Obesity, Adolescent, School going, Academic Performance</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The last quarter of the twentieth century has seen childhood obesity emerging as an epidemic in developed countries and a cause of concern worldwide as it is being reported in significant numbers from nations previously considered poor or developing. Still, it is observed that 30% of obesity begins in childhood and out of that 50-80% become obese adults.1 While the prevalence and factors associated with adolescent overweight and obesity in the developed world have been well documented, the same is not true for the developing world.2 India being a country of a diverse population, it has regions still struggling with the burden of malnutrition, but at the same time, there are rapidly emerging population sub-groups that are falling into the trap of affluence related problems.3&#xD;
&#xD;
The two areas of greatest interest in studies that have attempted to link school performance and health are diet and physical activity. Although the impact of diet and nutrition on school performance in developing countries is difficult to assess and can be confounded by socioeconomic status, school factors and other variables4, there is growing and convincing evidence for a link between diet and academic performance in countries with advanced economies. Research has shown that malnourished children or children who eat unhealthy diets, for example, manifest several behaviours that can interfere with learning and academic performance.5,6 To address these concerns, this study was designed to explore the longitudinal associations of Body Mass Index on academic performance among School going adolescents of Madurai District, Tamil Nadu, India and to the best of our knowledge, no such study has been conducted in this area earlier.&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
Study Area and Sample Size &#xD;
&#xD;
Madurai District in Tamil Nadu, India is one of the major cities of Tamil Nadu and&#xA0;25th most populated city&#xA0;in India.7Madurai has been a known academic centre for Tamil Culture, arts, Literature, music and dance for centuries. Hence, it was selected as a study area based on the author&#x2019;s research direction on identifying the overweight and obesity prevalence and its association with Academic performance.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; A cross-sectional study was carried out from February to April 2018 upon school children of both sexes, aged 13-18 years, from the Madurai District, Tamil Nadu, India. The sample size was statistically determined using power calculations. The sample size was calculated using the formula n = N*X / (X + N &#x2013; 1), where, X = Z&#x3B1;/22&#xA0;&#xAD;*p*(1-p) / MOE2. Z&#x3B1;/2&#xA0;is the critical value of the Normal distribution at &#x3B1;/2 (e.g. for a confidence level of 95%, &#x3B1; is 0.05 and the critical value is 1.96), MOE is the margin of error, p is the sample proportion, and N is the population size.&#xA0; Note that a Finite Population Correction has been applied to the sample size formula.8 With Margin of Error: 1.47%, Confidence Level: 99%, Sample Proportion: 50%, the Sample Size for the above-mentioned population is 7657. For better convenience, the sample size has culminated to 7660.&#xD;
&#xD;
Informants &#xD;
&#xD;
Six Government &amp; Government-aided schools and five private schools have been chosen for the study. In all eleven schools, 7660 subjects were screened for the prevalence of overweight and obesity, which included 5339 school children from Government and Government aided schools, 2321 school children from private schools. 6.71 % (514) of children fall under the overweight and obesity category, whereas the rest of them falls either in the normal or underweight category. Out of 5339, 63 (1.17%) children were overweight and 233 (4.36 %) were obese in Government and Government aided Schools (5.53 %) whereas 64 (2.75 %) were overweight and 154 (6.63 %) were obese out of 2321 children from private schools (9.38 %). These 514 school going children were considered as respondents to elicit further information (Figure 1).&#xD;
&#xD;
Questionnaire&#xD;
&#xD;
A pre-tested, Semi-Structured and validated questionnaire was provided in both English and local language-Tamil. The required information was elicited through the direct interview method. Socio-Demographic data were collected in the form of gender, age, educational qualification, monthly household income and occupation of the informant. Socioeconomic status was assessed using the Kuppuswamy scale, a standardized scoring system for the urban Indian population.9The people interviewed were representing both urban and rural lifestyles.&#xD;
&#xD;
The questionnaire included both the open and closed questions, which inquired about the informant&#x2019;s individual characteristics like residence, type of school, religion, type of family, family history and dietary habits. Students were asked to self-report their average grades (%) obtained in their previous examination. Children were interviewed about the father&#x2019;s occupation in the presence of the school teacher. The help of the school teacher was also taken if the child had any problem in explaining the father&#x2019;s occupation. During data collection, the school authorities were asked to accompany us to the respective classes. An initial pilot study was undertaken with 10 informants; the questionnaire and its components were discussed with the informants to determine whether they found any aspect of the questionnaire difficult. After minor revisions, the final questionnaire was used for the survey.&#xD;
&#xD;
Measures&#xD;
&#xD;
Body Mass Index&#xD;
&#xD;
Since BMI values are sensitive to changes in fat distribution and the development of muscle during puberty, we calculated and used a BMI z-score for each student&#x2019;s age within the 2- year spread in the age of our study population.10&#xD;
&#xD;
A child was labelled as underweight when BMI was less than or equal to the fifth percentile; labelled as overweight when BMI exceeded the eighty-fifth percentile and labelled as obese when BMI exceeded the ninety-fifth percentile for that age and sex. &#xD;
&#xD;
For labelling a child as underweight, normal, overweight or obese, the frequencies of BMI cutoffs relative to the National Centre for Health Statistics (NCHS)/World Health Organization (WHO) reference data (CDC Charts) 11 were used.&#xD;
&#xD;
Academic Performance&#xD;
&#xD;
Academic performance was measured as the aggregate percentage of marks scored in subjects such as Language, Mathematics, Science, and Social Studies. All students took the same tests in school and the scores which ranged from 0 to 100 were extracted from the school records at the end of each grade.&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
The data obtained through the questionnaire were coded, classified and entered into MS Excel sheets for further statistical analysis. Data recorded were analyzed using SPSS version 21.0. Descriptive statistical techniques were used to provide a summary of data in the form of mean, median and standard deviation for almost all the quantitative data. The Association between the Socio-demographic characteristics across the BMI and Academic Performance were performed using cross-tabulation: Chi-square test. Descriptive statistical analysis was used to present the general details and responses.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Table 1 represents the sample of 514 students comprising 310 females and 204 males.&#xA0; There were more girls than boys (60.78 vs. 39.22 %) in the total sample. Of the total 310 females, 210 (41.55 % of total students) and 100 (19.23% of total students) were from government and private schools, respectively. Similarly, of a total of 204 males, 82 (15.76 % of total students) and 122 (23.46% of total students) were from government and private schools respectively. In Government Schools, the largest group (24.48%) comprised of 13-14 years old and the smallest (11.35%) of 15-16 years old. Similarly, in private schools, the largest group (31.15%) comprised of 13-14 years old and the smallest (4.62%) of 17-18 years old.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table 2 shows the prevalence of overweight and obesity among school-going adolescents.&#xA0; In Government Schools, 49 girls were overweight and 167 girls were obese when compared with 28 overweight and 68 obese girls from Private schools. Similarly, In Government Schools, 13 Boys were overweight, 67 boys were obese when compared to 37 overweight and 85 obese boys from Private schools. An association of BMI with both gender and schools (Government and Private) was statistically significant (p5%). In the present study, overweight and obesity were found to be 1.66% and 5.05%, respectively, together constituting 6.71% for overweight/obesity. Furthermore, it is higher than that of studies found in various parts of India such as Lucknow city, Delhi, and Wardha.12,13,14This might be because of the inclusion of children from both rural and urban areas studying in government and private schools in contrast to other studies where they have included only rural areas or Government schools.&#xD;
&#xD;
In the present study, the mean body mass index (BMI) of both genders showed a significant decrease with age. Between genders, females had higher mean BMI values within each age group. The reason for this finding may be attributed to the fact that in children, BMI changes physiologically (substantially) with age and sex. Mahajan et al. reported that the mean BMI of both genders showed a significant increase with age in Shimla city which is in contrast to the results of the present study. This may also be due to the difference in age group and the place of the study. But, the similarity was found in the gender description, as females had higher mean BMI Values than Males.15 Similar findings have also been reported by Misra et al.16 and Kunwar et al.17 Higher prevalence of obesity among adolescent girls may be linked to early attainment of puberty as compared to boys. Post pubertal adolescent girls in the socio-cultural milieu of developing countries like ours have very low levels of physical activity that is mainly restricted to household chores. Their participation in outdoor games and other health-enhancing physical activities are much less as compared to boys.&#xD;
&#xD;
The present study results revealed a strong association between the Body Mass Index and Academic Performance in both the school sectors. Literature regarding the BMI-academic performance, the relationship remains equivocal. BMI or obesity is negatively associated with academic performance among schoolchildren in some studies.2,19Others (adjusted with other forms of fitness) have indicated no significant association.18,20 Some studies have demonstrated that cognitive ability is influenced by obesity and the likelihood of being obese is influenced by the quality of nutrition.21 Obesity has also proven to lead to mental and emotional problems, such as anxiety and depression.22 There is some potential explanation for reveres association between student grades average and BMI: firstly, as proven in previous studies, there is a significant correlation between high BMI and depression that could strongly affect student performance.23,24 Noting that, a study in North Korea on 405 students confirmed that, psychological problems in overweight and obese student are the major cause of poor school performance rather than their body image.25 Besides, obese students are mostly less physically activated which lead them to experience lower school performance compared with normal BMI students.26-29 Numerous studies have been performed across the United States on whether or not physical fitness levels have a significant positive correlation with academic achievement.30-33&#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Obesity continues to be the most important preventable risk factor for lifestyle diseases. The prevalence of overweight and obesity among school-going adolescents has increased when compared with the previous studies. To mitigate the risk of overweight and obesity, adequate physical activity and Healthy dietary practices should be promoted not only among school-going children but also teachers and parents who motivate and help to implement behavioural changes among adolescents. It is highly recommended to allocate regular class hours on healthy food habits and lifestyle which will, in turn, help them to understand health-related problems and diseases. Parents should be educated on overweight and obesity problems not only for their children but also for themselves. Children should also be encouraged to play outdoor games and sports irrespective of their gender to maintain a healthy lifestyle.&#xD;
&#xD;
Acknowledgements: The authors gratefully acknowledge the generosity of those who responded to the questionnaire for this study.&#xD;
&#xD;
Competing Interests: The authors have declared that no competing interests exist.&#xD;
&#xD;
Author Contribution: We declare that all of the authors mentioned in the article have contributed equal efforts in this research and also for the submission of the article.&#xD;
&#xD;
Funding support: The authors declare that they have no funding support for this study.&#xD;
&#xD;
&#xD;
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	&#xD;
&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Retinopathy Associated with Hyperviscocity Syndrome&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>149</FirstPage><LastPage>151</LastPage><AuthorList><Author>Sadafnaz Sabah</Author><AuthorLanguage>English</AuthorLanguage><Author> Abdul Waris</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Asghar Rizvi</Author><AuthorLanguage>English</AuthorLanguage><Author> Mohd Rameez Reza</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Hyperviscosity syndrome is clinically manifested by oronasal bleeding, retinal haemorrhages, and variable neuro-logical symptoms. The most reliable clinical manifestations of serum hyperviscosity are visual disturbances and oronasal bleed. Its early recognition is important as it constitutes important morbidity and may lead to blindness. Case presentation: Herein, we present a case of a newborn female on day 3 of life who presented with lethargy, poor feeding, tachypnoea and cyanosis. Dilated fundoscopy showed extensive mid-peripheral retinal haemorrhages with dilated and tortuous retinal veins. The patient was investigated and haematocrit, blood counts, and bilirubin level was found to be raised due to hyperviscosity of blood. The patient was managed with phototherapy haemodilution to decrease blood viscosity which resulted in the uneventful recovery of the patient with normal blood count, haematocrit and other lab values. On follow up after two weeks, ophthalmoscopy showed normal retinal vessels with few retinal haemorrhages. Discussion: We describe a unique case of retinopathy associated with hyperviscosity syndrome. The retinal changes as seen in our case were due to increased haematocrit and blood viscosity. As there are scarcely a few studies about retinopathy associated with hyperviscosity syndrome, this case illustrates the prompt and accurate diagnosis of hyperviscosity syndrome for the institution of appropriate therapy.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mucosal bleeding, Visual abnormalities, Serum hyperviscosity</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The classic triad of hyperviscosity includes mucosal bleeding, visual abnormalities, and neurological abnormalities. The most reliable clinical manifestations of serum hyperviscosity are visual disturbances and oronasal bleed. Whenever hyperviscosity is suspected, ophthalmoscopy should be performed. Retinal haemorrhages with dilation and tortuosity of retinal veins may be seen as seen in our case. Prompt diagnosis of hyperviscosity syndrome from the eye examination enables the institution of appropriate therapy. There are scarcely a few studies about retinopathy associated with hyperviscosity syndrome. Early recognition is important as it constitutes important morbidity and may lead to blindness.&#xD;
&#xD;
CASE PRESENTATION&#xD;
&#xD;
A newborn female weighing 3.0 kg at term to a 27-year young healthy primigravida developed lethargy with poor feeding, tachycardia, tachypnoea and cyanosis on day 3 of life. The baby was intubated and kept on ventilatory support. The cyanosis was improved after three days and the baby was extubated. The patient also developed hypocalcaemia, hypoglycaemia and two episodes of seizures which were managed conservatively. The essential ocular findings were retinal haemorrhages in the mid-peripheral retina with dilated and tortuous retinal veins in OD [Figure 1] and OS [Figure 2] which was evaluated with indirect ophthalmoscopy and scleral depression. Optic disc was found to be normal. Relevant investigations were done. The haemoglobin level was 24 gm/dl. The haematocrit was 68%. The white cell count was 17100 /cu mm (differential count: Neutrophils 72.1 %, lymphocytes 19.5%, monocytes 8.4 %) and platelet count was172000/cu mm. Bilirubin level was 5.7 mg/dl. Renal functions and liver function test was mildly deranged.&#xA0; The electrocardiogram was normal and an x-ray examination of the chest was also normal. Ultrasonography of the skull was found to be normal. The patient was managed with haemodilution of blood which showed remarkable symptomatic improvement and thus stabilisation of the patient. The patient was given phototherapy treatment following which there was considerable improvement in jaundice. On follow up after two weeks, the fundus examination showed normal blood vessels with no dilation and tortuosity. Also, the retinal haemorrhages were found to be decreased in OD [Figure 3] and OS [Figure 4]. On investigations, haematocrit, blood counts and bilirubin level were found to be normal which was previously increased. Thereafter baby showed an uneventful recovery with normal growth and development on further follow-up.&#xD;
&#xD;
TREATMENT AND OUTCOMES&#xD;
&#xD;
The patient was managed with haemodilution and was followed up after two weeks. After one week of treatment, there was a remarkable improvement in HVS-induced retinal changes promptly. Vision improved remarkably and retinal haemorrhages were resolved with normal retinal venous diameter. Haematocrit level reduced to 48% with normal haemoglobin, and bilirubin counts. The patient improved symptomatically. The patient came for follow up after two weeks with normal ocular findings. Also, the fundus showed no pathologies.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
HVS was described by JanWaldenstrom in his original 1944 report of 2 patients with macroglobulinemia.1 Bleeding, usually skin and mucosal, is known to be the most common manifestation of HVS. However, blurred vision, headache, vertigo, dizziness, nystagmus, deafness, and ataxia also occur in HVS.2-4 Patients with severe hyperviscosity syndrome may present with confusion, dementia, stroke, or coma. However, heart failure and other cardiovascular signs are less common.2,5-9 All the symptoms associated with polycythaemia and hyperviscosity are common to many neonatal disorders. In a study, the symptoms suggestive of polycythaemia included lethargy in 15%, refusal of feeds in 13%, respiratory distress in 10%, hypoglycaemia in 10.8%.9 Incidence of hypoglycaemia may be as high as 40%.10&#xA0; Patients with hyperviscosity syndrome have an increased blood volume because of an expanded plasma volume. This plasma volume expansion correlates with the rise in relative serum viscosity. Also, hyperviscosity syndrome is unlikely unless the serum viscosity is greater than 4.2,5,7-9 Viscosity levels in HVS vary significantly between patients. However, viscosity values correlate closely with signs and symptoms in the same patient (&#x201C;symptomatic threshold&#x201D;).2,4,5-9 We can diagnose HVS from the physical examination by the funduscopic finding of marked retinal venous engorgement resembling hot dogs on a string (i.e., &#x201C;sausaging&#x201D;).4,5-9,11 Haemorrhages, microaneurysms, exudates, papilledema, and an appearance indistinguishable from central retinal vein occlusion may be seen in later stages. Early diagnosis of hyperviscosity syndrome from the eye examination enables the institution of appropriate therapy (i.e. plasmapheresis).2,4,11-13 Urgent plasmapheresis using a cell separator should be carried out for patients experiencing visual symptoms to reduce the likelihood of blindness from retinal haemorrhages/retinal detachment.14 Plasmapheresis can also reverse HVS-induced retinal changes promptly, including reducing the retinal venous diameter and increased venous blood viscosity.15 The retinal examination findings correlate with the symptomatic threshold for HVS.In the case of neonates, an asymptomatic baby with polycythaemia can be managed by keeping the baby well hydrated with increased maintenance fluid requirements to prevent hyperviscosity. Any baby with polycythaemia who is symptomatic should have a partial exchange transfusion if the peripheral venous haematocrit is more than 65%. Asymptomatic infants with peripheral venous haematocrit between 60-70% can usually be managed by increasing fluid intake and repeating the haematocrit in 4-6 hours. Most neonatologists perform an exchange transfusion when the peripheral venous haematocrit is above 70% in the absence of symptoms, but this is controversial.16 In our case, haemodilution of blood resulted in stabilisation of the patient with remarkable improvement in hyperviscosity induced retinal changes. The long-term outcome in infants with asymptomatic hyperviscosity whether treated or untreated remains controversial.17&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
We describe a unique case of retinopathy associated with hyperviscosity syndrome. The retinal changes as seen in our case were due to increased haematocrit and blood viscosity. However, the haemodilution of blood resulted in remarkable improvement in hyperviscosity induced retinal changes.&#xA0;As we know, prompt diagnosis of hyperviscosity syndrome from the eye examination enables the institution of appropriate therapy so, early recognition is important as it constitutes important morbidity and may lead to blindness.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3673</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3673</Fulltext></URLs><References>1. Singh S, Narang A, Bhakoo ON. Polycythaemia in newborn. Indian Pediatr 1990;(27):349-52.&#xD;
&#xD;
2. Mehta J, Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost 2003;(29):467-471.&#xD;
&#xD;
3. MacKenzie MR, Babcock J. Studies of the hyperviscosity syndrome: II. Macroglobulinemia. J Lab Clin Med 1975;85(2):227-234.&#xD;
&#xD;
4. Stone MJ. Waldenstro&#xA8;m&#x2019;s macroglobuli emia: hyperviscosity syndrome and cryoglobulinemia. Clin Lymphoma Myeloma 2009;9(1):97-99.&#xD;
&#xD;
5. Fahey JL, Barth WF, Solomon A. Serum hyperviscosity syndrome. J Am Med Assoc. 1965;192(6):120-123.&#xD;
&#xD;
6. Perry MC, Hoagland HC. The hyperviscosity syndrome. JAMA 1976;236(4):392-393.&#xD;
&#xD;
7. Bloch KJ, Maki DG. Hyperviscosity syndromes associated with immunoglobulin abnormalities. Semin Hematol 1973;10(2):113-124.&#xD;
&#xD;
8. MacKenzie MR, Lee TK. Blood viscosity in Waldenstro &#xA8;m&#x2019;s macroglobulinemia. Blood. 1977;49(4):507-510.&#xD;
&#xD;
9. MacKenzie MR, Brown E, Fudenberg HH, et al. Waldenstro&#xA8;m&#x2019;s macroglobulinemia: correlation between expanded plasma volume and increased serum viscosity. Blood. 1970;35(3):394-408.&#xD;
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&#xA0;10. Wiswell TE, Cornish JD, Northam RS. Neonatal polycythaemia: frequency of clinical manifestations and other associated findings. Pediatrics 1986;(78):26-30.&#xD;
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&#xA0;11. Stone MJ, Pascual V. Pathophysiology of Waldenstro &#xA8;m&#x2019;s macroglobulinemia. Haematologica 2010;(95):359-364.&#xD;
&#xD;
12. Schwab PJ, Fahey JL. Treatment of Waldenstrom &#xA8;m&#x2019;s macroglobulinemia by plasmapheresis. N Engl J Med 1960;263(2):574-579.&#xD;
&#xD;
13. Solomon A, Fahey JL. Plasmapheresis therapy in macroglobulinemia. Ann Intern Med 1963;58(5):789-800.&#xD;
&#xD;
&#xA0;14. Thomas EL, Olk RJ, Markman M, et al. Irreversible visual loss in Waldenstro&#xA8;m&#x2019;s macroglobulinaemia. Br J Ophthalmol 1983;67:102-106.&#xD;
&#xD;
15. Menke MN, Feke GT, McMeel JW, et al. Ophthalmologic techniques to assess the severity of hyperviscosity syndrome and the effect of plasmapheresis in patients with Waldenstro&#xA8;m&#x2019;s macroglobulinemia. Clin Lymphoma Myeloma 2009;9(1):100-103.&#xD;
&#xD;
16. Goorin AM. Polycythaemia. In: John P Cloherty, Ann R Stark, editors, 4th ed. Manual of neonatal care. Lippincott Raven 1998;466-70.&#xD;
&#xD;
17. Bada SH, Korones SB, Wilson WM. Asymptomatic syndrome of polycythemia hyperviscosity. Effects of plasma exchange transfusion. J Pediatr 1992;120:579-85.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Regenerative Endodontic Treatment in Bilateral Dens Evaginatus Teeth - Interesting Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>152</FirstPage><LastPage>156</LastPage><AuthorList><Author>Sivadas Ganapathy</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpa Hiremath</Author><AuthorLanguage>English</AuthorLanguage><Author> Vaishnavi Vedam</Author><AuthorLanguage>English</AuthorLanguage><Author> Abhishek Jeyaraj</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aim: The current report presents an interesting case scenario that describes the management of immature bilateral second premolar with Dens Evaginatus (DE) that developed pulp necrosis and symptomatic apical periodontitis. Case Report: An 10yrold healthy Chinese boy presented to the AIMST Paediatric clinic with the complaint of intermittent pain and fluid discharge from the buccal sulcus of a permanent mandibular left first premolar and permanent mandibular right first premolar for the past 1&#xBD; years. Upon intraoral examination and appropriate radiographic investigations, a diagnosis of pulp necrosis with symptomatic apical periodontitis was made for both teeth. The patient was explained regarding the aberrant tooth morphology and periapical condition. The treatment option of regenerative endodontic procedure was performed on the patient Discussion: DE is an anomaly presented as an outward projection of the tooth with a tubercle on the occlusal surface exhibiting outer enamel coverage, dentinal core and varying amounts of the pulp tissue. Complications usually increase in a developing young permanent tooth causing an interruption in the root formation root completion and closure, and sometimes periapical inflammation which can further delay a normal root development. Planning a preventive prophylactic restoration of such teeth to maintain the haemodynamic of the pulp and normal development of the root is a better option. This case was managed using Mineral Trioxide Aggregate (MTA) in regenerative endodontic treatment (RET) which resulted in continued root growth. Long term follow-up was recorded successfully. With past literature and the present case, it is safe to conclude that the revascularization of the tooth is progressing successfully for both teeth. Conclusion: Chronic apical periodontitis due to dens evaginatus requires special treatment strategies to eliminate the infection especially in young permanent teeth. Based on the results of the present case, it can conclude that Regenerative endodontic treatment is an ideal treatment method for Dens Evaginatus with an immature permanent tooth with apical periodontitis/ abscess.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Dens evaginatus, Pediatricendodontics, Young permanent teeth, Endodontics, Case report</Keywords><Fulltext>Introduction&#xD;
&#xD;
Dens evaginate (DE) is an anomaly that is described as the outward projection of the tooth that appears as a tubercle on the occlusal surface with a dentinal core, outer enamel coverage and varying amounts of the pulp tissue. The synonyms for dens evaginatus includes odontoma of the axial core type, evaginatus odontoma, occlusal enamel pearl, occlusal tubercle, tuberculum anomalous, interstitial cusp, tuberculated cusp, Leong&#x2019;s premolar, talon cusp. Different types of DE include smooth, grooved, terraced and ridged, as classified by Lau in 1955.1 This condition is predominantly found on the occlusal surface of mandibular premolars and lingual surface of anterior teeth (mainly maxillary lateral incisors).2 Prevalence of DE ranges from 1% to 4%3; with 2% prevalence among the Asian population4 and that higher rates were reported among the Chinese population (1.29%&#x2013;3.6%). Dens Evaginatus occurs with a bilateral, symmetric distribution and a slight female predilection.5&#xD;
&#xD;
The clinical significance of DE is the possible interference with occlusion. This traumatic occlusion may result in fracture of tubercle of micro exposure of the pulp resulting in pulpitis the sequel of which ranges from irreversible pulpitis to cellulitis and osteomyelitis in severe case.6&#xD;
&#xD;
The current case describes the management of immature bilateral second premolar with DE that developed pulp necrosis and symptomatic apical periodontitis. This case was managed using regenerative endodontic treatment (RET) which resulted in continued root growth (maturogenesis).&#xD;
&#xD;
Case presentation&#xD;
&#xD;
A 10 yr old healthy Chinese boy presented to the AIMST Paediatric clinic with the chief complaint of intermittent pain and fluid discharge from the buccal sulcus of a permanent mandibular left first premolar (tooth 35) and permanent mandibular right first premolar (tooth 45) for the past 1&#xBD; years. On intraoral clinical examination, the permanent mandibular left first premolar was caries-free with peculiar occlusal anatomy. There was a protruding mass in the mid?occlusal surface, identified as dens evaginatus. [Figure 1] On the buccal gingiva, a small 2 cm &#xD7; 2 cm bluish, fluctuant swelling was noticed. On probing through the gingival margin, straw-coloured fluid discharge was noticed, denoting a cystic pathology with a probing depth of 6 mm. An intraoral periapical radiograph (IOPA) showed a periapical,&#xA0; 2 cm &#xD7; 2 cm well?circumscribed radiolucency on the root apex on permanent mandibular left first premolar. An almost similar finding was seen clinically and radiographically on the permanent mandibular right first premolar tooth. permanent mandibular right first premolar had exhibited internal resorption. The apices of both permanent mandibular left first premolar and permanent mandibular right first premolar were open with widened periodontal ligament space. Pulp vitality test was found to be negative for both teeth. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made for both permanent mandibular left first premolar and permanent mandibular right first premolar. [Figures 2 and 3] permanent mandibular left first premolar was found to have a midfoot radiolucency suggestive of internal resorption. The patient was explained regarding the aberrant tooth morphology and periapical condition. The treatment option of regenerative endodontic procedure was explained to the patient and consent was obtained before treatment. &#xD;
&#xD;
In the first visit, local anaesthesia (Scandonest 2% L, Mepivacaine hydrochloride 2% with levonordefrin 1:20,000) was administered and the tooth was isolated using a rubber dam (Coltene). Access opening was completed on permanent mandibular right first premolar. Once access was gained, canals were irrigated gently and copiously with sodium hypochlorite (1.5%, 20mL/canal, 5 min). This was followed by irrigation with saline (20mL/canal, 5 min). Once the canals were dried with paper points low concentration of triple antibiotic paste (mixture of 1:1:1 ciprofloxacin: metronidazole: minocycline to a final concentration of 1-5 mg/ml) was placed into the canal using a syringe. The mixture was placed below the cement enamel junction to minimize crown staining. This was followed by a sealing pulp chamber with a dentin bonding agent. 3-4mm of a temporary restorative material (Cavit&#x2122;) was used to seal the chamber. The patient was recalled after 3 weeks to assess the response to initial treatment. The absence of signs/symptoms of persistent infection indicated resolution of infection to the triple antibiotic mixture placed intracanal. In the second appointment after administering local anaesthesia (Scandonest 2% L, Mepivacaine hydrochloride 2% with levonordefrin 1:20,000) and the tooth was isolated. Canals were copiously irrigated with saline (20mL/canal, 5 min) to flush out the canal contents. After drying the canal with the paper point, bleeding was introduced into the canal system by over-instrumenting (induced by rotating a pre-curved K-file at 2 mm past the apical foramen). The bleeding was stopped at a level that allows for 3-4 mm of restorative material. Approximately at 3 mm distance MTA (Angelus) was placed over the canals and pulp chamber followed by the placement of wet cotton pellets on the top of the MTA after blood clot formation. A layer of glass ionomer (Fuji IX&#x2122;, GC) flows gently over the capping material and light-cured for 40 s. the same protocol followed for permanent mandibular right first premolar was used for management of permanent mandibular left first premolar too. In the second appointment of management of permanent mandibular left first premolar the internal resorption lesion was found to increase radiographically suggestive of failure of treatment. So it was decided to remove the MTA and repeat the triple antibiotic dressing for 3 weeks. Later after inducing bleeding the MTA was placed so that it reached the internal resorption region. [Figures 4 and 5] This was done so that the material placed would help reduce the resorption and improve the root closure. The patient was recalled after 3, 6, 9, 12 months [Figures 6 and 7] and thereafter every six months for follow-up. The patient is being recalled regularly to see clinically and radiographically for continued root closure. &#xD;
&#xD;
Discussion&#xD;
&#xD;
Dens evaginate (DE) is an uncommon dental anomaly documented since 1925. It occurs primarily in Asians as a protrusion of a tubercle from occlusal surfaces of posterior teeth, and lingual surfaces of anterior teeth. Tubercles have an enamel layer covering a dentin core containing a thin extension of pulp. The potential serious complication of dens evaginatus is that it is highly prone to fracture of the extension resulting in pulp exposure. Complication increases in a developing young permanent tooth causing a crucial interruption in the root formation and subsequently roots completion and closure. Exposure of the pulp due to fracture or wear off of the DE can result in pulp necrosis and periapical inflammation, which can further delay a normal root development. Hence, it is an excellent idea to plan a preventive prophylactic restoration of such teeth to maintain the haemodynamics of the pulp and normal development of the root. &#xD;
&#xD;
The aetiology of this condition remains unknown; however causative event leading to dens evaginatus malformation may be determined by multifactorial inheritance, i.e. combining both primary polygenetic with some environmental factors. Dens evaginatus originates during the morph differentiation stage of tooth development. The majority of cases reported indicate that dens evaginatus is an isolated anomaly rather than a primary part of any syndrome. But literature reveals that Dens evaginatus sometimes occurs together with a generalized syndrome. It is not reported as an integral part of any specific syndrome, although it appears to be more prevalent in patients with Rubinstein-Taybi Syndrome7, Mohr Syndrome (oral-facial-digital II Syndrome)8 Sturge-Weber Syndrome (encephalo-trigeminal angiomatosis)9, and in Ellis-van-Creveld Syndrome10&#xD;
&#xD;
The presented case is not attached to any such syndrome and hence it is safe to assume that he had a multifactorial inheritance as a causative factor. The presented case is of a Malaysian Chinese descendant which has a 5.2% prevalence in dens evaginates cases. According to the Schulze classification, the presented case was Type V in which a tubercle arising from the occlusal surface obliterated the central groove. According to the classification given by Levitan and Himel, it was Type VI because of necrotic pulp and immature apex. For decades the conventional treatment for immature permanent teeth has been the traditional apexification techniques or the use of an artificial apical barrier method with mineral trioxide aggregate (MTA). However, studies have shown that in the long term these teeth are prone to root fracture as neither of these methods can increase the root thickness or the root length. &#xD;
&#xD;
The presented case had intermittent pain and fluid discharge from the buccal sulcus of the mandibular right and left the first premolar. Therefore it was decided to open the access for tooth 34 on the first visit followed by pulp extirpation, debridement and disinfecting the canal with triple antibiotic paste. Triple antibiotic paste (TAP) containing metronidazole, ciprofloxacin and minocycline has been used widely as a root canal medicament due to its antimicrobial effects in endodontic regenerative procedures.11 Systemic antibiotic therapy depends on the patient&#x2019;s compliance in taking a specific dosage regimen, the absorption of these drugs by the gastrointestinal system, the transportation&#xA0;via&#xA0;the blood circulatory system. Therefore, local application of antibiotics within the canal may be a more effective model for delivering the drug. TAP is effective in disinfecting necrotic infected pulps, thereby a suitable environment for vital tissue regenerative processes. In a retrospective study, Bose&#xA0;et al.&#xA0;suggested that regenerative endodontic treatment with TAP and calcium hydroxide has more significant effects in increasing the root length than either the non-surgical root canal treatments or MTA apexification. Also, dentin thickness increased with TAP application during the treatment as compared with the calcium hydroxide or formocresol.12&#xD;
&#xD;
On the second visit (20 days later), the canal was revisited, inspected for necrotic tissues and cleaned with saline. The canal was dried thoroughly to induce bleeding. Lovelace&#xA0;et al.&#xA0;showed that the evoked-bleeding step in regenerative procedures after disinfection with TAP stimulates the increase of undifferentiated stem cells into the canal space from the periapical region. These cells help in the pulp regeneration process after effective disinfection. Therefore, TAP disinfected root canals had a significantly fewer chance of having a periapical lesion, and greater chances of gaining root length and wall thickness.&#xD;
&#xD;
The formed blood clot provides a scaffold where various stem cells from apical regions, such as bone marrow mesenchymal stem cells, stem cells from apical papilla (SCAP), stem cells from periodontal ligament (SCPL), etc., can get implanted. Placement of Mineral Trioxide Aggregate over the induced clot is extremely crucial for the success of the RET as most often the blood clot could have limited growth factors and needs to be well protected from any external stimuli which might either dislodge the clot or contaminate it. There close monitoring is advised.13&#xD;
&#xD;
In the presented case the patient was monitored clinically and radiographically monitored every 6 months for 18 months duration. For the permanent mandibular right first premolar, the same protocol was followed that was used for permanent mandibular left first premolar.&#xA0; The radiographic examination of the treated teeth permanent mandibular left first premolar and permanent mandibular right first premolar revealed continued root development and apical closure at 18 months after treatment. As the months progressed an increase in the root length of both permanent mandibular left first premolar and permanent mandibular right first premolar was observed radiographically. The apical third of the tooth started forming into a narrow apex initiating a root closure. Using MTA over the clot is indeed an important and crucial step for safely protecting the scaffold tissue from external factors. With this evidence, it is safe to conclude that the revascularization of the tooth is progressing successfully for both teeth.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Chronic apical periodontitis due to dens evaginatus requires special treatment strategies to eliminate the infection, especially in young permanent teeth. Every dentist must be aware of the existence of such dental anomaly and their treatment. Based on the results of the present case, it can conclude that Regenerative endodontic treatment is an ideal treatment method for Dens Evaginatus with an immature permanent tooth with apical periodontitis/ abscess. Besides, patients should also be made aware of the risks of the treatment and long term follow-ups. Observing the successful outcome of the present case, it is advised that early detection and careful treatment planning are needed to prevent further complication of the condition.&#xD;
&#xD;
Acknowledgement: Nil &#xD;
&#xD;
Conflicting Interest: Nil&#xD;
&#xD;
Source(s) of support: Nil&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3674</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3674</Fulltext></URLs><References>1. Levitan ME, Himel VT. Dens evaginatus: Literature review, pathophysiology, and comprehensive treatment regimen. J Endod 2006;32:1-9.&#xD;
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2. Echeverri EA, Wang MM, Chavaria C, and Taylor DL. Multiple dens evaginatus: diagnosis, management, and complications: case report. Pediatr Dent 1994;16(4):314-317.&#xD;
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3. Stecker S and DiAngelis AJ. Dens evaginatus. A diagnostic and treatment challenge. J Am Dental Assoc 2002;133(2):190-193.&#xD;
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4. Dankner E, Harari D, and Rotstein I. Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth.Oral Surgery, Oral Med Oral Pathol Oral Radiol Endod 1996; 81(4):472-475. &#xD;
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5. Hill FJ and Bellis WJ. Dens evaginatus and its management. Br Dent J 1984;156(11):400&#x2013;402.&#xD;
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6. Jerome CE, Hanlon Jr RJ. Dental anatomical anomalies in Asians and Pacific Islanders.Journal of the California Dental Association 2007;35(9):631&#x2013;636.&#xD;
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7. Gardner DG, Girgis SS. Talon cusp: a dental anomaly in the Rubinstein-Taybi syndrome. Oral Surg Oral Med Oral Pathol 1979;47:519-521.&#xD;
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8. Goldstein E, Medina JL. Mohr syndrome or oral-facial-digital II: report of two cases. J Am Dent Assoc 1974;89:377-382. &#xD;
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9. Chen RJ, Chen HS. Talon cusp in the primary dentition. Oral Med Oral Surg Oral Pathol 1986;62:67-72.&#xD;
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10. Hattab FN, Yassin OM, Sassa IS. Oral manifestations of Ellis-van Creveld syndrome (Chondroectodermal Dysplasia): Report of two siblings with unusual dental anomalies. J Clin Pediatr Dent Winter 1998;22(2):159-163. &#xD;
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11. Zahed M, Jafarzadeh H, Shalavi S, Yaripour S, Sharifi F, Kinoshita JI. A Review on Triple Antibiotic Paste as a Suitable Material Used in Regenerative Endodontics. Iran Endod J&#xA0;2018;13(1): 1&#x2013;6. &#xD;
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12. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures.&#xA0;J Endod 2009;35(10):1343&#x2013;1349.&#xA0; &#xD;
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13. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after the clinical regenerative endodontic procedure.&#xA0;J Endod 2011;37(2):133&#x2013;138. &#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Public Health Measures for Pertussis Immunization in Pregnancy- A Rationalized Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>157</FirstPage><LastPage>161</LastPage><AuthorList><Author>Sahoo PK</Author><AuthorLanguage>English</AuthorLanguage><Author> Sahoo G</Author><AuthorLanguage>English</AuthorLanguage><Author> Kar B</Author><AuthorLanguage>English</AuthorLanguage><Author> Kar D</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhuyan R</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acellular pertussis vaccine (aP), Maternal immunization, Pertussis, GMC (Geometric Mean Concentration), Safety  and immunogenicity, Serious adverse event (SAD), Tdap vaccine, Whole-cell pertussis vaccine (wP).</Keywords><Fulltext>Introduction &#xD;
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Globally pertussis (Whooping Cough) is acknowledged as a significant cause of morbidity and mortality in young infants. A significant number of morbidity and mortality due to pertussis infection is noticed in infants of &lt; 3 months of age.1 Despite being a vaccine-preventable disease and the existence of high coverage of effective immunization programmes, the disease continues to be one of the least controlled infections affecting all age groups and also a public health concern.2 &#xD;
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As per the estimate of the World Health Organisation (WHO) 50 million cases and 30,000 deaths approximately occur throughout the world every year.2 The disease burden was reported to be the greatest in early infancy (among both unvaccinated and under-vaccinated infants) and teenagers.3-5 An estimated 5.1 million pertussis cases occurred globally in 2014 in infants resulting in 85,900 deaths. Low and middle-income countries having low vaccination coverage were worst affected with more than 80% of cases and 95% of deaths.5,6 Due to a less robust surveillance system, the true picture of disease burden in these countries is not estimated perfectly. However, despite&gt; 95% vaccine coverage in resource-rich nations, pertussis is still a very poorly controlled vaccine-preventable disease.7-10 &#xD;
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Pertussis, caused by the bacterium Bordetella pertussis, is endemic in all countries. Despite effective vaccination programmes and high vaccine coverage achievement, epidemic cycles do occur every 2-5 years (typically 3-4 years).11 The reported rate of pertussis incidence in early infancy ( below 3 months ) per 1 lakh infants was 235 in the USA in 2017, 1368 in Pakistan and 4800 in South Africa in 2016.4,5,12 Out of reported 15,662 cases in 2019 in the USA, 1202 cases occurred under 6 months of age and age incidence per 1 lakh cases was 62.5, the highest in all age groups.13 Incidence and death rates due to Pertussis Outbreaks which occurred in California and Canada in 2010, Washington State in 2012 and Italy in 2012 and 2014 were highest in early infancy.14 Death due to pertussis almost exclusively occur in infants below the age of 3 months and out of these 76% of deaths are in the age group of &lt; 2 months.15,16&#xD;
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In India, during the year 1987, 2011 and 2017 the reported incidence of pertussis cases were 1,63,000,39,091 and 23,779 respectively. In 2017, states like MP, Jharkhand, Assam, UP, West Bengal and UT Dadra &amp; Nagar Haveli reported the maximum cases and 6 deaths only.17 Due to under-reporting the actual number will be much more taking into consideration of low vaccination coverage with primary and booster doses of diphtheria, pertussis and tetanus (DPT) vaccine in the country. The data on pertussis infection and disease are very much deficient in adolescents and adults. Actual Bordetella pertussis infection rates in the community, causing typical pertussis disease in infants and children, is not available.18&#xD;
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Pathogen &#xD;
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Bordetella pertussis is a tiny, fastidious Gram-negative coccobacillus and infects the ciliated epithelial cells of the respiratory tract in human beings. Adjusting to the environmental conditions the Bordetella species alter their phenotype and express virulence factors like pertussis toxin (PT), pertactin (PRN) filamentous haemagglutinin (FHA), fimbriae (FIM) type 2 and type 3, lipooligosaccharide (LPS), adenylate cyclase toxin (ACT) and tracheal cytotoxin (TCT). Though the pathogenesis of pertussis is not clear, FHA, PRN and FIM facilitate attachment to the epithelial cells and PT, TCT and ACT permit evasion of host immune factors destroying the epithelial cells.2 &#xD;
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The available data suggest the evolution of strains with time with different isolates in the pre and post-vaccination era. Moderate changes have been detected in the genomic sequences of PT, FIM and PRN in the circulating strains2. Circulation of antigen-deficient isolates of PRN has been observed in areas where aP vaccine is used.19 However, to date there is no evidence of less effectiveness of vaccines against different B.pertussis allelic variants.2 &#xD;
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Mode of transmission&#xD;
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Through droplets transmission, pertussis spreads from infected to healthy individuals. In its early catarrhal stage, the organism is very much contagious with a secondary attack rate of almost 90% in non-immune household contacts.12 Though infectivity diminishes rapidly after the catarrhal stage, the possibility of transmitting infection for 3 weeks or more, persists following the onset of typical coughing attacks. Adolescents and adults are the remarkable sources of transmission to unvaccinated young infant contacts. In a systematic review of the identified source of infection in infants below the age of 6 months, it was observed that the contacts in the family contributed 74%-96% of cases.20 The pooled analysis demonstrated that out of the household contact cases, 39% (95%, CI: 33%-45%) were mothers, 16% (95%, CI: 12%-21%) were fathers and 5% (95%, CI: 2%-10%) were grandparents.2&#xD;
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Acellular Pertussis Vaccine&#xD;
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The use of whole-cell pertussis (wP) vaccine caused a decline in morbidity and mortality of pertussis. Public anxiety regarding the safety of wP vaccines and increased concerns on the frequently encountered local side-effects forced the researchers to develop acellular pertussis (aP) vaccines in Japan in 1981. Later in 1986, the vaccine was licensed in the US and at present is in use in developed countries.21 wP vaccines were replaced by vaccines due to the added advantage of significant lesser side-effects. The reproducible production process, use of purified antigens and removal of lipopolysaccharides (LPS) and other parts of the bacterial cell wall during purification of soluble antigenic material, is another significant added advantage. These vaccines contain one or more of the separately purified antigens like pertussis toxin (PT), pertactin (PTN), fimbrial hemagglutinins 2 and 3 (FIM type 2 and type 3), filamentous hemagglutinin (FHA). Vaccines differ from one another both in the number and quantity of antigen components and the bacterial clone used for primary antigen production, purification and detoxification methods, incorporated adjuvants and the use of preservatives like thiomersal.2 The efficacy and duration of protection offered by Tdap vaccines are similar to that of whole-cell vaccines.18&#xD;
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Evolution of pertussis vaccination in pregnancy&#xD;
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Most of the morbidity and mortality, on account of pertussis disease, occurs in infants below the age of 3months1. Vaccination of neonates with pertussis vaccine starts at 2 months of age when 1st dose of DTaP/DTwP vaccination is initiated, the earliest possible vaccination being at 6 weeks of age in developing countries.22 Thus a window of significant vulnerability to contract infections from family members and care givers does exist. 19-23 The infant would be protected against pertussis infection during the first months of life through the effective transplacental transmission of maternal antibodies against pertussis disease. Ordinarily, these transplacentally acquired antibodies are detected at least up to 6-8 weeks of birth when the 1st dose of immunization is usually started but the antibody concentration required to protect against pertussis infection is not known.18 Cocooning approach to vaccinating previously unimmunised family members, caregivers and women in the postpartum period with Tdap vaccine to provide a protective cocoon of immunity around the neonate was initiated following the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommendations in 2006.24, 25&#xA0; However, the cocooning approach with high coverage which requires multiple doses for parents and family members as a minimum proved challenging and was not cost effective.2 Studies demonstrate the inherent limitations in adopting the cocooning approach as a stand-alone prevention strategy against pertussis in infants. However, it is still a recommended component in the multi-prong strategy to lessen pertussis disease burden.25 To provide protection both for the mother and the neonate during the earliest weeks of life, in June 2011, the ACIP recommended administering a dose of Tdap to all pregnant women after 20 weeks of gestation.26 ACIP, again in 2013, issued its updated recommendation that irrespective of prior history of vaccination with Tdap vaccine, one dose of Tdap vaccine must be administered during each pregnancy, the timing being between 27-36 weeks of gestation. However, maternal immunization may safely be executed at any time during pregnancy, if the situation warrants conditions like wound management, pertussis outbreaks or other life-threatening circumstances where the protection requirement supersedes the benefit of immunization during 27-36 weeks of gestation.27 From 2013, other reported evidence suggest in favour of Tdap vaccination during the later part of the second or early part of the third trimester with at least 2 weeks gap between vaccination and delivery.28&#xD;
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The rationale of pertussis vaccination in pregnancy&#xD;
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Definite evidence exists regarding the effectiveness of maternal pertussis immunization in reducing infection in infants in first few months after birth, the most vulnerable high risk period of pertussis morbidity and mortality. First, maternal immunization is recognized as an ideal dual strategy offering direct protection of the infant through maternal antibody induction and transplacental transfer to infants for protection from birth in one hand and indirect infant protection through prevention of infection and transmission of maternal infection on the other. Second, theoretically Tdap, being an inactivated vaccine can pose no concern on safety in pregnant ladies. Third, pertussis is not identified to create more morbidity in women during pregnancy. So Tdap can be administered in the later part of pregnancy thus avoiding concerns regarding interference with fetal development or associated pregnancy loss, much common in the 1st trimester. Another added advantage of vaccination towards the later part of pregnancy is that maternal antibodies are highest due to highly efficient placental transport from approximately 34 weeks of gestation. Theoretically, this timing optimizes maternally derived antibodies level in neonate for more sustained protection. Fourth, Tdap induces the production of maternal antibodies of the immunoglobulin G1 subclass which in turn are transported transplacentally both actively and passively to the neonate. Fifth, these antibodies are required to persist for a short period only in the neonate for protection against fatal and severe infant disease till the first dose of the primary series vaccination is administered and the infant builds his immune system.29 Sixth, in situations where maternal immunization is not fully protective, infants born to Tdap vaccinated pregnant women demonstrated significantly less morbidity, including risk of hospital and intensive care unit admission if they suffer from pertussis.27&#xD;
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Vaccination safety in pregnancy&#xD;
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Several studies regarding the safety and immunogenicity of vaccines in different age groups have established better tolerance and lower adverse event rate than wP vaccines. Studies conducted on Tdap vaccination in pregnancy did not reveal increased adverse events in any form including pregnancy loss or poor neonatal outcome.29 In 2011, the US adopted to vaccinate Tdap unvaccinated pregnant women, with Tdap vaccine irrespective of the interval from prior tetanus toxoid containing vaccine administration.31 Later this was updated to administer Tdap during the third trimester of every pregnancy.27 After a pertussis epidemic, causing several infant casualties, the United Kingdom adopted Tdap vaccination in pregnancy in 2012 and other countries followed later.29&#xD;
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Since the original US recommendation of 2011, several studies reported on the evaluation of Tdap maternal immunization safety. Munoz FM et al. in a randomized, double-blind, placebo-controlled study, demonstrated no Tdap-associated serious adverse events in mothers and infants.30-32 A similar predominantly short-lived post-vaccination adverse event was reported in 52 women who received Tdap and 51 women who received TT during pregnancy in a randomized control study in Vietnam by Hoang HT et al. without any occurrence of Tdap-associated SAE.33-36 In an observational cohort study. Donegan et al reported no evidence of increased risk of early or late stillbirth in Tdap vaccinated pregnant women after vaccination.34 Concomitant administration of influenza vaccination with Tdap in pregnancy did not result in the increased incidence of adverse events or untoward birth outcome.35 Tdap being a combination vaccine with tetanus and diphtheria toxoids, concern arose that frequent use of TT may cause adverse events. However, Sukumaran et al. In a retrospective cohort study did not find any significant differences in rates of adverse events or poor birth outcomes.36&#xD;
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The immune response following immunization&#xD;
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The Us Phase 1-2 study demonstrated that Tdap immunization was immunogenically resulting in 5.6-fold greater GMC of pertussis toxin (PT) antibodies both in mothers and infants at birth with pregnant ladies, vaccinated with Tdap during pregnancy than those who did not receive the vaccine.33 In another cohort study, infant cord samples at delivery taken from 312 women, vaccinated with Tdap during 3rd trimester of pregnancy as per the required norm, reported GMC to PT to be 47.3 IU/ml whereas in 314 women without Tdap vaccination in pregnancy it was 12.93 IU/ml only (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3675</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3675</Fulltext></URLs><References>&#xD;
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	&#xA0;Robinson CL, Romero JR, Kempe A, Pellegrini C, Advisory Committee on Immunization Practices. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger&#x2014;United States, 2017. MMWR. Morb Morta Weekly Rept. 2017; 66(5):134.&#xD;
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	Skoff TH, Kenyon C, Cocoros N, Liko J, Miller L, Kudish K, Baumbach J, Zansky S, Faulkner A, Martin SW. Sources of infant pertussis infection in the United States. Pediatrics 2015; 136(4): 635-641.&#xD;
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	&#xA0;Updated recommendation for use of tetanus toxoid,reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women-Advisory Committee on Immunization Practices (ACIP), 2012. Centers for Disease Control and Prevention (CDC). Morbidity Mortal Week Rep. 2013; 62: 131-135.&#xD;
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	&#xA0;Update on Immunization and Pregnancy: Tetanus, Diphtheria and Pertussis Vaccination. Committee on Obstetric Practice and Immunization and Emerging Infections Expert Group, No. 718, September 2017, www.acog.org&gt;articles&gt;2017/19.&#xD;
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	Tessier E, Campbell H, Ribeiro S, Fry NK, Brown C, Stowe J, et al. Impact of extending the timing of maternal pertussis vaccination on hospitalized infant pertussis in England, 2014-2018. Clin Infect Dis. 2020: doi: 10.1093/cid/ciaa836.&#xD;
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	&#xA0;Sawyer M, Liang JL, Messonnier N, Clark TA. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women&#x2014;Advisory Committee on Immunization Practices. Morbid Mortal Week Rep 2013; 62(7): 131.&#xD;
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	Hoang HT, Leuridan E, Maertens K, Nguyen TD, Hens N, Vu NH, et al. Pertussis vaccination during pregnancy in Vietnam: Results of a randomized controlled trial. Vaccine 2016;34:151-159.&#xD;
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	&#xA0;Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational study. Br Med J 2014;349:4219&#xD;
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	Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. J Am Med Assoc 2015;314(15):1581-1587.&#xD;
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	&#xA0;Healy CM, Swaim L, Rench M, Harrison M, Martin M, Baker CJ. Third-Trimester Tdap Immunization Elicits Substantial Pertussis Toxin Immunoglobulin G in Neonates. In Open Forum Infectious Diseases 2015 Dec 1 (Vol. 2, No. suppl_1). Oxford University Press.&#xD;
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	Cherry JD. Editorial commentary: the effect of Tdap vaccination of pregnant women on the subsequent antibody responses of their infants. Clin Infect Dis 2015;61(11):1645-1647.&#xD;
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	&#xA0;Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Donegan K, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014;384(9953):1521-1528.&#xD;
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	&#xA0;Dabrera G, Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012&#x2013;2013. Clin Infect Dis 2015;60(3):333-337.&#xD;
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	&#xA0;Eberhardt CS, Blanchard-Rohner G, Lema&#xEE;tre B, Boukrid M, Combescure C, Othenin-Girard V, et al. Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis. Clin Infect Dis 2016; 62(7): 829-836.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pentalogy of Cantrell: A Rare Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>162</FirstPage><LastPage>165</LastPage><AuthorList><Author>Soumya Jain</Author><AuthorLanguage>English</AuthorLanguage><Author> Akhita Singhania</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajasbala P Dhande</Author><AuthorLanguage>English</AuthorLanguage><Author> Ayushi Jain</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Pentalogy of Cantrell is a rare, congenital disorder characterized by lower sternal defects, diaphragmatic defect, pericardial defect, supraumbilical abdominal wall abnormalities, and/or intracardiac defects. The collective defects result from the failure of either differentiation or migration of mesenchymal or mesodermal structures during the embryonic phase of development. Mortality of the disease complex is high, and treatment, when appropriate, revolves around the surgical correction of the associated defects. Objective: This article presents a case of pentalogy of Cantrell and examines the literature to report the most current evidence relative to embryology and pathophysiology. Methods: Case report was gathered from the OPD medical records and is provided as it occurred. The literature was searched for evidence of best management strategies as well as care implications for families. Results: A newborn was delivered at 20 weeks&#x2019; gestation secondary to termination of pregnancy. Prenatal ultrasonography identified an abdominal wall defect, diaphragmatic hernia, sternal defect, ventricular septal defect, kyphoscoliosis and club foot. Examination immediately after delivery confirmed prenatal findings and a diagnosis of pentalogy of Cantrell was assigned. Conclusion: Pentalogy of Cantrell is a syndrome inclusive of five anomalies: a midline, upper abdominal wall disorder; lower sternal defect; anterior diaphragmatic defect; diaphragmatic pericardial defect, and congenital abnormalities of the heart. The pathogenesis of this condition is unclear, with associations being common and extremely challenging treatment. Prognosis and outcome of the condition depend on the type of pentalogy of Cantrell and the cardiac anomalies associated with it. Diagnosis can be made reliably by antenatal ultrasound during the first trimester. In this case report, we describe a fetus of undetermined sex who had the typical features of the very rare pentalogy of Cantrell. Patients with the diagnosis of pentalogy of Cantrell should receive antenatal counselling relative to mortality and morbidity risks. An interprofessional approach in the immediate timeframe after delivery facilitates timely diagnostics and offers families prompt confirmation of antenatal findings.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Abdominal, Cardiac, Defect, Diaphragm, Pentalogy</Keywords><Fulltext>INTRODUCTION &#xD;
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Thoraco-abdominal ectopia cord is or pentalogy of Cantrell 1, is one of an extremely rare multiple congenital malformation syndrome and was first described in 1958 by James R. Cantrell et al. It comprises of the following five characteristics: a) midline, upper abdominal wall abnormality (e.g. omphalocele, gastroschisis), b) defect in the lower sternum (i.e. cleft sternum or absent sternum), c) anterior diaphragmatic defect (i.e. hypoplastic diaphragm, anterior diaphragmatic hernia), d) pericardial abnormality (e.g. ectopia cordis) and e) congenital abnormalities of the heart (e.g. tetralogy of Fallot, ventricular septal defect, atrial septal defect). Complete pentalogy is very rarely found, with a frequency of approximately 1 incidence per 65, 000&#x2013;100, 000 live births and because of the different variants encountered, there are also less severe cases described in the literature.&#xD;
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Pentalogy of Cantrell has a very high mortality rate despite significant improvements in neonatal surgery. The prognosis for patients depends mostly on the severity of cardiac malformation with up to 95% mortality when ectopia cordis is present.2&#xD;
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CASE REPORT &#xD;
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Twenty-four-year-old, female, primigravida came for an anomaly scan at 20 weeks of gestation.&#xD;
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On ultrasound, there was a large anterior abdominal wall with herniation of liver, stomach and bowel loops outside the abdominal cavity suggesting omphalocele (figure 1), the heart was lying outside the thorax indicating ectopia cordis with associated lower sternal defect and ventricular septal defect (figure 2)&#xD;
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There was associated bilateral clubfoot and kyphoscoliosis of the spine (Figure 3 and 4)&#xD;
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There was also the presence of 2 vessel cord noted (Figure 5). The patient then underwent medical termination of pregnancy and gross specimen showed herniation of liver, stomach, bowel suggesting omphalocele and heart lying outside the thoracic cavity suggestive of ectopia cordis and associated bilateral club foot (Figure 6).&#xD;
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DISCUSSION&#xD;
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Pentalogy of Cantrell (PC) is a deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a diaphragmatic pericardium defect, congenital intracardiac abnormalities, and a defect of the lower sternum. &#xD;
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Incidence of the PC varies from 5.5 to 7.9 per million live births. The constellation of defects observed in PC is attributed to abnormalities in the intraembryonic mesoderm differentiation during embryogenesis at approximately 14 to 18 days after fertilization [2]. It is thought to result from abnormal migration of the sternal anlage and myotomes in the early 6th to 7th week of gestation, however, the exact pathology behind is still not clear.3&#xA0; &#xD;
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The diaphragmatic and pericardial defects result from abnormal development of the septum transversum, whereas the sternal and abdominal wall defects are most likely related to impaired migration of mesodermal structures.2 Pentalogy of Cantrell is a rare congenital anomaly, the pathogenesis of which has not been adequately elucidated. &#xD;
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Every case of PC may not necessarily present with all five originally described defects and thus have different variants with various degrees of severity, Toyama 3 suggested a classification scheme for PC which consisted of three classes: Class I &#x2013; certain diagnosis &#x2013; includes cases with all five defects present; Class II &#x2013; probable diagnosis &#x2013; includes cases with four defects (with the presence of intracardiac and abdominal wall defects); Class III &#x2013; incomplete diagnosis &#x2013; includes cases with various combinations of defects (but with the presence of sternal defect).4 According to the above classification, Our case possibly belongs to Class II.&#xD;
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Familial cases have been described, suggesting probable recessive inheritance. There is one case report of PC with consanguineous parents. In our case, there was no consanguinity.2&#xD;
&#xD;
The pentalogy of Cantrell is often associated with ectopia cordis (EC) which also in itself is an extremely rare congenital heart defect characterized by complete or partial displacement of the heart outside the thoracic cavity. According to the heart location, there are four types of EC namely: cervical, cervicothoracic, thoracic and thoracoabdominal.&#xD;
&#xD;
Intracardiac anomalies associated with the PC include ventricular septal defect (100% of cases), atrial septal defect (around 53% of cases), tetralogy of Fallot (around 20% of cases), valvular or infundibular pulmonary stenosis (around 33% of cases), and ventricular diverticulum (around 20% of cases). Other anomalies may be present alongside PC, these include the following: 1) asplenia described by Ludwiq et al. 2) tetralogy of Fallot, gallbladder agenesis and polysplenia &#x2013; described by Bittmann et al. ; 3) trisomy 18 &#x2013; described by Hou et al. 4) central nervous system anomalies like craniorachischisis &#x2013; described by Polat et al. 5)bilateral cleft lip and palate &#x2013; described by Jafarian et al. 4&#xD;
&#xD;
With prenatal ultrasonography, the pentalogy of Cantrell can be diagnosed in the first trimester of pregnancy itself. Our case was reliably diagnosed antenatally despite the late presentation of the mother to the antenatal clinic at 20 weeks gestation. The visualization of fetal anomalies can be enhanced by the use of prenatal magnetic resonance imaging (MRI).&#xD;
&#xD;
After birth, echocardiography is essential one of the essential investigations to be done for the diagnosis of associated cardiac anomalies. In our case, echocardiography was not done due to the refusal of all investigations by the parents. Conventional Radiography and sonography can be used to diagnose other features of the pentalogy of Cantrell and its associated anomalies. Unfortunately, small defects of the diaphragm and pericardium can be extremely difficult to diagnose accurately. In these patients and cases of possible surgical intervention, an MRI might be useful. Additional anomalies have been reported in some infants with pentalogy of Cantrell. Such anomalies include cleft lip, cleft palate, malformation (dysplasia) of the kidneys, a fluid-filled mass or sac in the head or neck area (cystic hygroma), limb defects (club feet, absent bones in the arms or legs) and birth defects of the brain and spinal cord (neural tube defects).5Our case had a club foot and Scoliosis of the spine (deformity of the spine)6 which are frequently described.&#xD;
&#xD;
Treatment of PC is challenging, and the outcome depends on the size of the abdominal wall defects, ectopia cordis and other associated heart defects. The treatment consists of corrective or palliative cardiovascular surgery, correction of ventral hernia and diaphragmatic defects and correction of associated anomalies.2&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In conclusion, the Pentalogy of Cantrell is a very rare constellation of congenital anomalies that can be reliably diagnosed antenatally and prognosis depends on the type of PC and associated cardiac anomalies. The parents should be given complete counsel on the understanding and prognosis of this condition.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
&#xA0;I acknowledge the immense help received from the scholars whose articles are cited and included about this article. I&#x2019;m grateful to authors/editors/publishers of all those articles and journals from where the literature for this article has been reviewed and discussed. &#xD;
&#xD;
ETHICAL APPROVAL: The ethical committee of the Faculty of Medicine in Datta Meghe Institute of Medical Sciences (Deemed to be University )approved this case study. Informed consent was taken from the patient. &#xD;
&#xD;
FUNDING: None&#xD;
&#xD;
CONFLICT OF INTEREST: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3676</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3676</Fulltext></URLs><References>&#xD;
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	Alagappan P, Chellathurai A, Swaminathan TS, Mudali S, Kulasekaran N. Pentalogy of Cantrell. Indian J Radiol Imaging 2005;15(1):8&#xD;
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	Kheir AE, Bakhiet EA, Elhag SM, Karrar MZ. Pentalogy of Cantrell: case report and review of the literature. Sudanese J Paediatr 2014;14(1):85.&#xD;
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	&#xA0;Wahab S, Sahoo B, Mittal S, Khan RA. Prenatal diagnosis of pentalogy of Cantrell in a case with craniorachischisis. Curr Pediatr Res 2017;21:8-10.&#xD;
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	Mendaluk T, Mo?cicka A, Mrozi?ski B, Szymankiewicz M. The incomplete pentalogy of Cantrell&#x2013;A case report. Pediatria Polska 2015;90(3):241-24&#xD;
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	National Organization for Rare Disorders (NORD); 2011. Pentalogy of Cantrell . rarediseases.org&#xD;
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	Bilodi AK, Gangadhar MR. Gastroschsis associated with other anomalies &#x2013; A case report. Int J Curr Res Rev 2012;04(18):171-175.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Questionnaire Survey on Usage of Aerosol Boxes: An Indian perspective&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>166</FirstPage><LastPage>170</LastPage><AuthorList><Author>Akhya Kumar Kar</Author><AuthorLanguage>English</AuthorLanguage><Author> Ayya Syama Sundar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The barrier method is one of the most effective methods to control the spread of infectious diseases. Objectives: Intubation and extubation are aerosol-generating procedures and to safeguard from getting the infection in a pandemic situation like SARS-COVID19, the aerosol boxes are popular among health care workers. This questionnaire survey was carried out on the anesthesiologist resident doctors working in various medical colleges across India to identify the views of front-line professionals&#x2019; on the worth of the aerosol boxes during various procedures. Methods: This survey was conducted on 153 respondents with asking 25 questions regarding various usage of aerosol boxes related to intubation, extubation and sterilization. Gender and experience of more than 10 intubations were sought to find out whether it has any influence on the overall decision making. Statistical analysis was done with SPSS, chi-square tests used for categorical variables. Results: Out of 153 participants 64.5% of respondents were female and 35.5% were males. 49.3% had more than 10 intubation experience with the boxes. Mask ventilation was difficult for 91% and intubation was difficult for 98% of respondents. 90% of respondents were against the use of the box for difficult intubations. More experienced one was in favour of selectively removing the mask while intubation (P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Intubation, Tracheal Extubation, SARS Coronavirus, Aerosol containment box, Aerosol generation</Keywords><Fulltext>Introduction&#xD;
&#xD;
The barrier method is one of the most effective methods to control the spread of infectious diseases. Face shields, masks, respirators, hand gloves, leg covers, personal protective equipment (PPE), even isolation chambers act as a barrier to non-infectious individuals from getting infected. Continuous use of such form of barriers useful to protect from getting infected but simple barriers like masks, shields, PPE are disposable which cause much environmental pollution and isolating critical patients not always possible. Anaesthesiologists are at risk as there is a high possibility of breach of the barrier while doing high-risk aerosol-generating procedures from the close appropriation of patients like intubation and extubation. With the current pandemic of SARS-COVID19 it&#x2019;s assumed that the viral load plays a significant role in getting a severe infection,1 physical barrier in the form of aerosol boxes gained much importance (FIGURE-1) for doing aerosol-generating procedure. The first of its kind was described by a Taiwanese doctor.2 The average dimension of those aerosol boxes are being 52*52 which fits the head end of patients on the operating table. The box has 2 openings towards the anaesthesia machine end for the operator&#x2019;s hand insertion and another circular opening in the side for assistance. With gaining popularity over the boxes many modifications attempted over the past months with regard to the changing the shape of the opening, location of the opening, creating additional hole for assistance, changing the material for disposable use, sloping of the top part of the transparent glass for better visibility and was effective to varying extents in addressing the short comings of the initial design.3-6 However, the aerosol boxes have many limitations too. As these are new things to adapt it takes some time to get skilled to do safe procedures with this box. Delay in airway management is common with these boxes making the patient prone to desaturation during the induction phase of anaesthesia.7 The visibility is an issue with fogging of head shields, spectacles and the refractory error it adds to the problems. Difficult hand-eye coordination increases the user inconvenience as the hand movement is limited inside the boxes. Alignment of the head for intubation is also an issue. The aerosol boxes were thought to decrease the use of PPE which were scanty at the time these boxes started in use however contamination of the head end of the patient is a real problem with the use of it. With the difficulties of airway management with boxes and limited space inside the box area, more patient parts in the head-end, come to contact with the anesthesiologist, contaminating the surface. Aerosol boxes are thought to help to reduce the spread of aerosol during extubation, their use has never been evaluated. Acceptance of the aerosol box for intubation in ICU is uncertain due to added challenges of managing critical patients and set up as well. With a limited no of randomised control trials, we thought a questionnaire would be the best guide at present regarding the usefulness and shortcomings of the aerosol boxes. The primary objective of the study is to collect the majoritarian view concerning the use of aerosol boxes and problems associated with them based on their personal experience. &#xD;
&#xD;
Materials and methods&#xD;
&#xD;
This survey was undertaken among anaesthesiologist resident doctors in various medical colleges across India. As it is a questionnaire-based survey, ethical approval was not required. The survey group were residents with experience of more than 2 years of experience. For clarity of thought and understanding, while answering, the questions were framed in simple terms. The replies were sought with google forms sent to individuals through their mobile contact no. To prevent bias while answering the messages, they were asked not to communicate with anyone else regarding these questions before filling in the suitable replies. The answers were converted to spreadsheets and graphs and verified for the results. &#xD;
&#xD;
A total of 25 questions was posted to anaesthesia post-graduate resident doctors across various medical colleges in India. Each question had multiple choices out of only one answer supposed to select. Some questions were framed in such a way that, multiple answers possible however it was not allowed to do so with an intent to find the majoritarian view. Years of experience in anaesthesia, age and gender were asked in the questionnaire to identify their influence if any on the overall decision making. Less than 10 intubation attempts with the aerosol boxes are placed in a separate category as their answers may not represent the true outcome. Out of the respondents&#x2019; experience, they were asked to comment on gross suggestions regarding the aerosol box use. Safety of using the aerosol boxes being carried out by asking for frequency of desaturation or complication incidences while managing the airway. Using the aerosol boxes for extubation and use in ICU were specifically sought to find out views regarding its usefulness. &#xD;
&#xD;
The sample size was calculated using Statistical Software G Power 3.1.9.2. We Calculated the no of resident doctors being approximately 6000 based on the admissions and assumed 50% of them either have availability or have done at least 5 incidences of airway management with aerosol box. With a power of 80% and an alpha error of 0.05 and considering a moderate effect size of 0.55, the sample size was calculated to be 143. However, considering the possibility of improper entries 150 entries were sought.&#xD;
&#xD;
Statistical analysis was performed using IBM SPSS (version 20, IBM, I. The categorical variables were expressed as frequencies with percentages. The Chi?square test was used to assess the distribution of observed variables. P &lt; 0.05 was considered statistically significant.&#xD;
&#xD;
Results&#xD;
&#xD;
A total of 153 respondents took part in the survey. Out of which 64.5% were female and 35.5% were male. Respondents with experience of 10 or more intubations with aerosol box constituted 49.3%. With strict institutional guideline, a significant no of residents had exposure to more intubations with the aerosol box (P=0.005). A total of 38.2% of respondents believed that the aerosol boxes useful in protecting against the spread of the virus while others either not sure or not convinced regarding its worth. Despite the view of the difficulty in mask ventilation (91%) and intubation (98%) at some point of the procedure,71% recommend using the box for mask ventilation and 77% were in favour to use it for easy intubation. However, for difficult intubation, there seems to be a consensus among 90% of respondents against using the aerosol boxes (Figure 2). Significant female respondents (FIGURE-3) were against the use of aerosol boxes for difficult intubation situations (P=0.001) as compared to males. A total of 68% of respondents had experienced patient desaturation during intubation at some point in time. Crisis needing for frequent removal of the box for intubation was experienced by 18% of respondents (Table 1), whereas removal was significantly rare in male residents (P=0.03). Limited hand movement inside the box (38.2%) and visibility (32.9%) were considered as a major reason for difficult airway situation, however, the former was found to be a majoritarian view with less experience than the latter, (Table 2) which was the common view of the more experienced respondents with more than 10 intubation attempts (P=0.007). Early fatigue was a complaint by 44.6% of the respondents with 27% complained so in occasional situations. Probably due to the difficulties in airway management 52% of respondents were in favour to use the box while mask ventilation and electively remove it while intubation (Table 3). This opinion was significant among the most experienced ones rather than the other group with having lesser experience (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3677</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3677</Fulltext></URLs><References>[1] Zheng S, Fan J, Yu F. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study: BMJ 2020;369:1443.&#xD;
&#xD;
[2] Everington K. Taiwanese doctor invents device to protect US doctors against coronavirus. 2020. https://www.taiwannews. com.tw/en/news/3902435 (accessed 28/04/2020).&#xD;
&#xD;
[3] Asokan K, Babu B, Jayadevan A. Barrier enclosure for airway management in COVID?19 pandemic. Indian J Anaesth 2020;64:153-154.&#xD;
&#xD;
[4] Singh B, Singla SL, Gulia P. Aerosol containment device for use on suspected COVID?19 patients. Indian J Anaesth 2020;64:154-156.&#xD;
&#xD;
[5] Gupta V, Sahani A, Mohan B et al. Negative pressure aerosol containment box: An innovation to reduce COVID-19 infection risk in healthcare workers. J Anaesthesiol Clin Pharmacol 2020;36:144-147.&#xD;
&#xD;
[6] Vijayaraghavan S, Puthenveettil N. Aerosol box for protection during airway manipulation in covid?19 patients. Indian J Anaesth 2020;64:148-149.&#xD;
&#xD;
[7] Begley JL, Lavery KE, Nickson CP, et al. The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study: Anaesthesia 2020;75:1014&#x2013;1021.&#xD;
&#xD;
[8] Brewster DJ, Chrimes N, Do TB, et al. Consensus statement: Safe airway society principles of airway management and tracheal intubation specific to the COVID?19 adult patient group. Med J 2020;212:472-481.&#xD;
&#xD;
[9] Chin AWH, Chu JTS, Perera MRA, et al. Stability of SARS?CoV?2 in different environmental conditions. medRxiv 2020. doi: https://doi.org/10.1016/ S2666?5247(20)30003?3.&#xD;
&#xD;
[10] Matava CT, Yu J, Denning S: Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: Implications for COVID-19. Can J Anaesth 2020;67(7):902-904.&#xD;
&#xD;
[11] Ortega R, Nozari A, Canelli R. More on barrier enclosure during endotracheal intubation. N Engl J Med 2020:382. &#xD;
&#xD;
[12]. Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth 1998;80:767-775.&#xD;
&#xD;
[13] Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centred, retrospective, observational study. Lancet Respir Med 2020;8(5):475&#x2013;481.&#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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Current Issue Updates&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>01</LastPage><AuthorList><Author>Dr. Sachin Ingle</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract/><AbstractLanguage>English</AbstractLanguage><Keywords/><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3678</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3678</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>8</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>April</Month><Day>25</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Advances in the Study of Kaposi&#x2019;s Sarcoma in Human&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>171</FirstPage><LastPage>177</LastPage><AuthorList><Author>Mohammad Salim</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Kaposi sarcoma (KS) is a kind of cancer that is widespread all over the world. This is for the first time discovered by Hungarian physician and dermatologist Moritz Kaposi in 1872 as a skin tumor. The name Kaposi sarcoma was coined to honour of the discoverer. Kaposi sarcoma is caused by the Kaposi sarcoma herpesvirus (KSHV). This is soft tissue cancer of blood vessels and lymphatic system developing purplish-red coloured lesions mostly in mouth, face, nose, genitals, and the lower extremities. The KSHV is easily transmitted either sexually or via the act of parturition vertically. There are 4 types of Kaposi&#x2019;s sarcoma distributed globally such as chronic or European, endemic or African, transplant-associated or iatrogenic and AIDS-related or epidemic. Italians using topical steroids are more prone to have this type of cancer. The KSHV has been isolated in almost all cases of Kaposi&#x2019;s sarcoma cancer. KS is composed of spindle shaped cells and inflammatory mononuclear cells. These cells grow faster and survive for a longer period of time. The various stages of Kaposi&#x2019;s sarcoma are maculonodular stage, infiltrative stage, florid stage and disseminated stage. The KSHV has also been found to be associated with two other lymphoproliferative diseases such as primary effusion lymphoma (PEL) and multicentric Castleman&#x2019;s diseases. Kaposi&#x2019;s sarcoma is an outcome of viral infection. As this is not a curable disease, it can often be treated for many years. And, public awareness about KS can only save the lives properly. However, currently, the drug used to treat Kaposi&#x2019;s sarcoma are thalidomide, bevacizumab, and sirolimus.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Human Herpes Virus-8, Kaposi Sarcoma, Cancer</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Moritz Kaposi was a Hungarian physician and dermatologist who described a kind of skin tumor initially in 1872 that received his name later as Kaposi sarcoma (KS).1 In fact, it was Sternberg who gave the name as Kaposi sarcoma in 1912.2 But, it took nearly more than 100 years we discovered the causal organism of Kaposi&#x2019;s sarcoma as HHV-8 in 1994.3 This is a kind of indolent angioproliferative spindle cell tumor cancer developed from endothelial and immune cells under the skin and soft tissues caused by the human herpes virus-8 or Kaposi&#x2019;s sarcoma herpesvirus (KSHV).3-5 KS is a multicentric vascular tumor of mesenchymal origin derived due to the hyperplasia affecting the blood vessels developing on soft tissues in multiple areas of the entire body at once.6-10&#xD;
&#xD;
Further, as the Kaposi&amp;#39;s sarcoma herpesvirus (KSHV) is easily transmitted either sexually via blood and saliva or vertically through parturition, the act of childbirth from mother to her baby;11-17 it may lie dormant or replicated to cause cancer in human. This has usually been observed that the persons who are immunocompetent can carry the load of KSHV without any problem, but it triggers the Kaposi&amp;#39;s sarcoma in immunocompromised individuals. This is most commonly developed in either immunodeficient or the patients kept under immunosuppressant medications.18,19 The present review on Kaposi&#x2019;s sarcoma is prepared in the light of recent researches done so far in the field of viral origin of cancer. In the present review, clinical presentation, histopathology, stages and the types of Kaposi&#x2019;s sarcoma with the treatment of the same disease have been discussed as under : &#xD;
&#xD;
Clinical Presentation &#xD;
&#xD;
Clinically, there are four types of Kaposi&amp;#39;s sarcoma developed in human as chronic or European, endemic or African, transplant-associated or iatrogenic and AIDS-related or epidemic Kaposi&amp;#39;s sarcoma.20,21 The diagnosis of Kaposi&#x2019;s sarcoma is based on the visual inspections of characteristically colored, cutaneous, non-itchy, painless and even non dangerous spots appeared on skin. These spots are red or purple on white skin and blue brown or black on dark skin. These lesions are found on face including nose, around the eyes, ears and lips; oral cavity including gingiva, palate, tongue and buccal mucosa and the lower extremities or lower limbs. Early on, these lesions are usually painless but when bleed or ulcerated over time become painful. Most specifically the lesions present in the areas of legs or groin may cause the feet to swell moving very painfully.19-23 &#xD;
&#xD;
Further, these lesions are also found on some internal organs, especially on the lungs and the gastrointestinal tract. If the virus infects the lungs, it often quickly gets worse, causing respiratory failure and death.22 Similarly, the infection taking place in digestive system shows no symptoms at all except the pain in the stomach until it becomes very advanced. In an advanced stage, intestinal obstruction, bleeding and bloody stool may come out during defecation. But, despite all these complications, a patient suffering from gastrointestinal Kaposi sarcoma looks like as normal as was being before 5 years of infections. It means that even after 5 years of diagnosis a person with KSHV looks like a normal average person. And, it all happens due to the differential medications provided to the patient that often responding well in time.23-25 &#xD;
&#xD;
In addition, the patients suffering from Kaposi&#x2019;s sarcoma may also show some associated symptoms such as swollen lymph nodes, cough, fever, fatigue, loss of appetite, weight loss, edema in foot, nausea, painful stomach, and vomiting. Similarly, the KS life-threatening conditions may also occur as difficult swallowing, intolerable belly pain with bloody defecation, intestinal blockage, severe swelling in upper and lower limbs, face or scrotum, severe coughing and the shortness of breath.24 &#xD;
&#xD;
Sometimes, the lesion of KS also arises as a systemic inflammatory condition due to the physical stimuli precisely at the site of trauma such as injury, surgical or other wounds is characteristically known as koebner&#x2019;s phenomenon. The etiopathology of this phenomenon is not yet known. Although, this is a rare phenomenon in connection with KS; the koebnerization has also been documented in several other skin diseases, including vitiligo, psoriasis, lichen planus, and viral warts.25&#xA0; &#xD;
&#xD;
Histopathology of the Disease&#xA0; &#xD;
&#xD;
The histopathology of Kaposi&#x2019;s sarcoma shows red cells in slit like spaces formed by atypical spindle cell proliferation of endothelial and associated inflammatory cells. These cells grow faster and survive for a longer period of time. The KSHV has been isolated in almost all the cases of Kaposi&#x2019;s sarcoma cancer.5,26,27 The KSHV proteins in cancer cells and Periodic-acid-Shiff (PAS) reagent positive hyaline bodies are also seen in the cytoplasm.9,28&#xD;
&#xD;
Stages of Kaposi&#x2019;s sarcoma &#xD;
&#xD;
Depending upon whether the Kaposi&#x2019;s sarcoma is localized, external, internal, or immunosuppressed, there have been various attempts to classify the stages of Kaposi&amp;#39;s sarcoma.26,29,30-32 On the basis of lesions in lymph nodes, the stages of disease distribution and the clinical pace of progression, the Kaposi&#x2019;s sarcoma is further diagnosed histologically as under: &#xD;
&#xD;
Stage I&#xA0; Maculonodular stage &#xD;
&#xD;
Small macules and nodules are confined to appear only on the lower extremities. &#xD;
&#xD;
Stage II&#xA0; Infiltrative stage &#xD;
&#xD;
The plaques are formed on the same lower extremities. Sometimes, they are still associated with small nodules. &#xD;
&#xD;
Stage III&#xA0; Florid Stage &#xD;
&#xD;
Often ulcerated angiomatous multiple plaques and nodules are found.&#xD;
&#xD;
Stage IV&#xA0; Disseminated Stage&#xA0; &#xD;
&#xD;
Multiple angiomatous nodules and plaques extending beyond the lower extremities.&#xD;
&#xD;
Types of Kaposi&#x2019;s sarcoma &#xD;
&#xD;
Epidemiologically, the Kaposi&#x2019;s sarcoma can primarily be categorized into four types ranging from minimal mucocutaneous lesions to extensive organ involvement. The different types of KS are based on different populations it captured in, but changes within the KS Cells are more or less similar20. They are of four types given as under:&#xD;
&#xD;
&#xD;
	&#xD;
	Sporadic, classic (Mediterranean), European, chronic type of Kaposi&#x2019;s sarcoma. &#xD;
	&#xD;
	&#xD;
	Endemic, African Lymphadenopathic type of Kaposi&#x2019;s sarcoma. &#xD;
	&#xD;
	&#xD;
	Transplant associated (Iatrogenic) Immunocompromised Kaposi&amp;#39;s sarcoma. &#xD;
	&#xD;
	&#xD;
	Epidemic, AIDS related Acquired Immuno deficient Kaposi&#x2019;s sarcoma.33-38&#xD;
	&#xD;
&#xD;
&#xD;
Sporadic, classic (Mediterranean), European, chronic type of Kaposi&#x2019;s sarcoma&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
This type of KS is primarily occurred in the eastern European population, Ascanajee Jews and Mediterranean descent.39-42 Elderly men with weak immunity between 50 to 70 years of age are more affected than female.37 Chronic Kaposi&#x2019;s sarcoma usually has silent, protracted or indolent course and is usually limited to the skin. It slowly progresses over many years and often is not the cause of death. As this is non-aggressive and slow growing KS, the lesions do not grow as quickly, and new lesions do not develop as often. They have solitary, one or more lesions on legs ankles or soles48. Italians using topical steroids are more prone to have this type of cancer.34 Skin lesions are mostly found on the distal lower extremities or lower limbs. This form of disease rarely has lymph node, mucous membrane or visceral involvement. Oral mucosa is sometimes affected. In addition, the visceral lesions are usually asymptomatic and discovered only by autopsy. Clinically, gastrointestinal bleeding may occur. Approximately, one third of same KS patients may also develop another malignancy in future as non-Hodgkin lymphoma.43-47 &#xD;
&#xD;
Endemic, African, Lymphadenopathic type of Kaposi&#x2019;s sarcoma &#xD;
&#xD;
This is an endemic African type of Kaposi&amp;#39;s sarcoma mainly found in males under the age of 40, mostly in countries of Malawi, Uganda, Swaziland, Zambia and Zimbabwe.49 Quite a good number of children of both sexes (approximately 70%) before attaining the age of puberty have also been reported to develop the KS with absolute mortality within three years. It has also been observed that in all these cases, only visceral nodes were affected. The cutaneous lesions were all absent in children but may appear in adults. The malaria and malnutrition prevalent in the region have also been reported to play some role in developing the KS as it weakens the children&#x2019;s immunity severely.50-55&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Transplant associated (Iatrogenic), Immunocompromised Kaposi&#x2019;s sarcoma &#xD;
&#xD;
Kaposi&#x2019;s sarcoma is also developed in those who have undergone solid organ transplantation receiving immunosuppressive therapy like the excessive use of cyclosporin A medication.55,56 It usually develops within two years of organ transplantation. This is an aggressive type of cancer affecting the lower distal extremities, visceral organs, and lymph nodes. However, the individuals born with congenital immunodeficiency are not at the elevated risk of developing Kaposi&#x2019;s sarcoma.57-60 Recently, a new drug named sirolimus has given rather better results acting as antitumor and immunosuppressant both at a time.45 As this kind of KS affects the people who have had undergone organ transplantation taking immunosuppressive drugs to slow down their immune system, this is now being observed that lowering the dose of immunodrugs makes the KS lesions either go away or get smaller. The greater the immunosuppression, the more extensive and aggressive KS will be.46-48&#xD;
&#xD;
Epidemic, AIDS-related Acquired Immunodeficient Kaposi&#x2019;s sarcoma&#xD;
&#xD;
Another type of Kaposi&amp;#39;s sarcoma is a type of cancer that people with AIDS often get. Here KS is an AIDS defining condition. It means that an HIV positive person suffering from KS is definitely has progressed to AIDS. But, on the other hand, a person having been suffering from KS may not be suffering from AIDS. KS can also develop in an otherwise healthy person as well.49 This is clinically most aggressive and common opportunistic malignancy in HIV patients worldwide, occurring mostly in Africa and the USA. In the 1980s, AIDS related KS was very common in the USA. Similarly, this has also been one of the most common cancers in Uganda and Zambia, especially in children. The risk groups are gay and heterosexual men and women. But, it remains prevalent amongst men who have sex with men.19,50-52 All of them were HIV positive. But, now a very different type of Kaposi&#x2019;s sarcoma has also been developing in male homosexuals who are HIV negative. &#xD;
&#xD;
Since the KSHV is an oncogenic virus, the AIDS related KS has gained much attention due to its abnormal pathogenicity in human. It has been observed that at least three genes are responsible for the cause of KS in AIDS patient. They are named as ORF71, ORF72, and ORF73. With both localized and disseminated cutaneous involvement, the AIDS related KS often initially involves the lymph nodes, which is later on disseminated to various parts of the viscera. Generally, the pulmonary and gastrointestinal mucocutaneous lymph nodes are involved.22,23 Oral Kaposi&#x2019;s sarcoma in acquired immunodeficiency syndrome have also been reported.57 In the early 1980s, KS was one of the most frequent malignancies reported in AIDS patient before the introduction of antiretroviral therapies.25 Further, in United States, treating the HIV patients with highly active antiretroviral therapy (HAART) has resulted in the fewer cases of AIDS associated KS but in rest parts of the world where HAART services are not easy to provide, KS in AIDS patients have advanced quickly.58 Kaposi&#x2019;s sarcoma has rarely been reported from India. The first case of AIDS related KS from India was reported in 1993, and since then only 16 cases have been reported.59-61 &#xD;
&#xD;
Treatment of the Disease&#xD;
&#xD;
Unfortunately, there is nothing available at present as treatment to kill the KSHV absolutely, instead of only alleviating the symptoms to slow down the disease progression. Similarly, there is no any routine method for identifying the KS in an individual except the antibody test.62-65 Nowadays, KS diagnosis in lesion specimens usually requires not only histological and immunohistochemical characterization but also HHV-8 detection using new molecular biology.25 Similarly, an oncologist and cancer expert can only identify the lesions present on the body. This is also quite unfortunate for us that sometimes a patient himself do not require any treatment as initially the lesions are otherwise painless. One of the oldest drugs to treat the lesions of Kaposi sarcoma is thalidomide. The drug has helped in shrinking the lesions of KS.66 But, as the drug has got some serious side effects, the other drugs like lenalidomide and pomalidomide are being studied for the same purposes.67-69 Angiogenesis inhibitors blocking the growth of blood vessels within tumors may also treat the lesions of KS. The drug named bevacizumab is one of them20. The other drugs like sirolimus and everolimus are being studied further.67-70&#xD;
&#xD;
Further, the treatment options are more or less found similar to those recommended for other types of cancer such as surgical excision70, radiation71, chemotherapy72, electrochemotherapy to use electric impulse in injecting the chemo drugs into tumors effectively73,74 such as vincristin75,76 vinblastin77, Vincaleucoblastin78, bleomycin76 and doxorubicin.76 Other treatment modalities are cutaneous cryosurgery79, cryotherapy in which the lesions are freezed using liquid nitrogen80, use of cytokine inhibitors68, immunotherapy including interferon, antiviral medications including Zidovudine, ganciclovir, Valganciclovir, cidofovir, and the topical application of alitretinoin gel (Panretin).80-85&#xD;
&#xD;
In addition, it has also been observed that some specific drugs commonly used for cancers are also being studied for use against Kaposi&#x2019;s sarcoma such as paclitaxel86, docetaxel87 and imatinib.88 Similarly, antiretroviral therapy has also been found to be the best way to treat the Kaposi&#x2019;s sarcoma. It has not only even clear up the skin lesions but to have lowered the cases simultaneously.89-91&#xA0; While infection of KSHV in human is estimated to account for nearly &gt;44000 new cancer cases and 20,000 deaths globally every year, their efforts to develop vaccines are limited.92-95&#xA0;&#xA0; &#xD;
&#xD;
Since Kaposi sarcoma is not a curable disease, it could be treated to a limited extent to control the symptoms. The choice of treatment modalities depends upon the extent of the disease. Though it often progresses slowly, KS can ultimately be fatal. One should always seek treatment for KS. Further, as the indolent KS appears usually in older people taking many years to develop and grow, many people die of some other parainfections before their KS becomes serious enough to be fatal. Similarly, as the AIDS related KS is now treatable and not a cause of death by itself, we should nothing more to worry about it except to be alert in the future.92-95 &#xD;
&#xD;
PERSPECTIVES&#xD;
&#xD;
Kaposi sarcoma is a rare, slow growing tumor cancer that develops underneath the skin with reddish-purple or blue-brown in colour lesions. These lesions are mainly found on the face, nose, legs, and around the anus. Some internal organs, especially the lungs and gastrointestinal tract are also affected. The gastrointestinal tract lesions are typically symptomless. Rarely, they may lead to bloody stools, pain, diarrhea or physical obstruction. But, the lung infection usually causes breathlessness due to blockage. A lung bleeding lesion may leak blood with mucus, which the individual then coughs up.96,97,98&#xD;
&#xD;
Kaposi&amp;#39;s sarcoma herpesvirus (KSHV) has been isolated in nearly all patients tumor suffering from the same cancer. This is spindle cell tumor thought to be derived from endothelial cell lineage. It arises as a cancer of lymphatic endothelium in vascular channels which are filled with blood cells giving the tumor its characteristic bruise - like appearance. The highly vascular network of KS tumor leaked R.B.C. in the surrounding tissues causing the tumor black in colour developing the inflammation and pain in the lesions.99-102&#xD;
&#xD;
Further, there are four types of Kaposi sarcoma that have so far been described in literature they are European or classic, endemic or African, transplant-associated and AIDS-related. Generally, it has been observed that Kaposi&amp;#39;s sarcoma is more linked to either immunocompromised patients infected with AIDS or had undergone organ transplantation taking immunosuppressive medications. The HHV-8 virus has also been found to be involved in producing some rare cancer like a blood cancer known as primary effusion lymphoma and multicentric Castleman disease.99-100 This is a sexually transmitted virus but can also be spread by some other ways also as direct contact through blood and saliva. Since, all forms of KS are manifested in the oral cavity; the KSHV is more easily being transmitted via saliva as well.16,17&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Cancer is an outcome of viral infection. It starts as a chronic inflammation (Kapositis) which ultimately produce Kaposi sarcoma. KS is a relatively large, linear double-stranded DNA tumor virus101 that transforms the cells in such a way that it multiplied indefinitely to live longer which eventually develops to form cancer, but it does not mean that all infected individuals will develop the cancer, appearing that some other factors are also required for it to develop.8,98 We opined, as the KS has a variable course and is not curable, it can possibly be treated and controlled symptomatically for a longer period of time. Finally, we should promote the public awareness using media for early detection and diagnosis of Kaposi&amp;#39;s sarcoma, especially in Africa.102 &#xD;
&#xD;
Abbreviations &#xD;
&#xD;
KSHV&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kaposi&#x2019;s sarcoma herpes virus &#xD;
&#xD;
AIDS&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Acquired immune deficiency syndrome&#xD;
&#xD;
KS &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kaposi&#x2019;s sarcoma &#xD;
&#xD;
PEL &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Primary effusion lymphoma &#xD;
&#xD;
MCD&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Multicentric Castleman&#x2019;s disease &#xD;
&#xD;
HHV&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Human herpesvirus &#xD;
&#xD;
PAS&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Periodic-acid-Shiff reagent &#xD;
&#xD;
HIV &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; -&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Human immunodeficiency virus &#xD;
&#xD;
HAART &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Highly active antiretroviral therapy &#xD;
&#xD;
RBC &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; - &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Red blood corpuscles&#xD;
&#xD;
DNA &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; -&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Deoxyribonucleic acid&#xA0; &#xD;
&#xD;
ACKNOWLEDGEMENTS: This piece of research work is dedicated to the memory of my maternal grandfather marhoom Hazi Mohammad Shakoor. The author acknowledges the help received from scholars whose articles are cited in references to this manuscript. The authors are also grateful to the institution concerned for providing us with necessary facilities during this research work.&#xD;
&#xD;
Financial support: No Financial support was granted during the course of this research work.&#xD;
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</References></Article></ArticleSet></xml>