<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Notice</b>:  Undefined index: issue_status in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>142</b><br />
<br />
<b>Notice</b>:  Undefined index: affilation in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>195</b><br />
<br />
<b>Notice</b>:  Undefined index: doiurl in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>198</b><br />
<br />
<b>Warning</b>:  Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>234</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<br />
<b>Warning</b>:  SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in <b>/home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php</b> on line <b>235</b><br />
<?xml version="1.0"?>
<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Influence of Emotional Intelligence on Occupational Stress of Health Care Professionals: A Letter to the Editor&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>01</FirstPage><LastPage>01</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=3749</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3749</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Acardiac Acephalic Fetus: A Rare Complication of Twin Pregnancy, A Case Report and Review of the Literature&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>05</LastPage><AuthorList><Author>K. Forci</Author><AuthorLanguage>English</AuthorLanguage><Author> M. H. Alami</Author><AuthorLanguage>English</AuthorLanguage><Author> E. Bouaiti</Author><AuthorLanguage>English</AuthorLanguage><Author> A. Mdaghri Alaoui</Author><AuthorLanguage>English</AuthorLanguage><Author> A. Thimou Izgua</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The acardiac acephalic fetus or twin reversed arterial perfusion (TRAP) sequence, is a rare complication specific to monochorionic twin pregnancy. It is characterized by the development of arterio-arterial and veno-venous anastomosis leading to one of the twins&#x2019; predominance. Objective: Our objectives are to describe this pathology and its etiopathogenic factors and emphasize the need for an early diagnosis and adapted therapeutic management to improve the prognosis of the pump twin. Clinical case study: We report the case of an acardiac fetus from a twin pregnancy of a 32 years old-patient, low socio-economic level. She was admitted at 40 weeks of amenorrhea according to the date of her last period, in the expulsion phase, giving vaginal birth to a first twin of normal appearance and then an acardiac fetus weighing 1000g. Presentation: In our study, the prevalence rate of TRAP is estimated at 1 in 44,000 births. Its diagnosis is based on Doppler ultrasound from the 1st trimester which allows visualizing the reversal of vascular flow in the acardiac recipient fetus and during the 2nd trimester, the MRI allows to confirm the diagnosis. In our case, the pregnancy was poorly followed, no ultrasound examination was performed and the diagnosis of the acardiac fetus was made at the time of delivery. Conclusion: An acardiac fetus is never viable. However, several complications can affect the transfusion twin, which underlines the importance of an early prenatal diagnosis allowing adequate therapeutic management to improve the prognosis of the healthy twin.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acardiac acephalic fetus, Twin pregnancy, Antenatal diagnosis, Complication, Prognosis</Keywords><Fulltext>Introduction&#xD;
&#xD;
Described for the first time by Benedetti in 1533, the acardiac acephalic fetus also named TRAP (twin-reversed arterial perfusion) sequence or acardius acarnius or acardiac mass is a rare and severe complication of monochorionic twin pregnancies.1,2 Its prevalence is estimated at 1/35000 births and affects 1% of monozygous twin pregnancies, the risk of recurrence is estimated at 1/10000.3,4 &#xD;
&#xD;
The TRAP sequence is characterized by the development of arterial-arterial and venous anastomosis between the two cord insertions leading to an inverted infusion via the umbilical artery of a twin and thus the predominance of one of the twins.3 Hemodynamic abnormalities are the cause on the one hand of the lack of development of cardiac structures with morphological abnormalities in the transfused fetus, and the other hand of the increase of myocardial work of the healthy fetus or pump.&#xD;
&#xD;
Perinatal complications of twin pregnancy with an acardiac fetus are dominated by heart failure of the healthy co-twin, polyhydramnios and prematurity.&#xA0;The prognosis of the healthy twin is fraught with high mortality with an estimated risk of perinatal death of 50-70%.5 The management of twin pregnancies with acardiac fetuses is based on the assessment of the prognosis of the healthy twin by early antenatal ultrasound and a therapeutic attitude of which aim is to improve the heart function of the pump fetus by prescribing digitalis or selective interruption of the circulation of the acardiac fetus. Our objectives are to describe this pathology and its etiopathogenic factors and emphasize the need for an early diagnosis and adapted therapeutic management to improve the prognosis of the pump twin.&#xD;
&#xD;
Clinical case study&#xD;
&#xD;
This is a 32-year-old pregnant woman, married, housewife, low socio-economic level, group 0+, second primitive gestation.&#xA0;The pregnancy was poorly followed with the realization of a single syphilitic serology that came back negative.&#xA0;The patient reports the notion of taking fenugreek and plants during the first trimester of pregnancy and the history of diabetes in the family, without the notion of inbreeding.&#xA0;Furthermore, she did not receive any iron or folic acid supplementation.&#xD;
&#xD;
Admitted at 40 weeks of amenorrhea (WA), in the expulsion phase with a ruptured water pocket, his general and clinical examination was without particularity.&#xA0;The delivery took place by natural childbirth giving birth to a first twin who had no abnormalities, then a dystocic extraction of an acardiac fetus in the form of an amorphous, oedematized mass, weighing 1000g, with a single lower limb, having 4 toes, and a trunk, without heart activity and head or upper limbs, with the presence of a short umbilical cord (Figure: 1). The deliverance was rapid with the expulsion of a single placenta evoking a monochorionic monoamniotic twin pregnancy.&#xD;
&#xD;
Discussion&#xD;
&#xD;
Multiple pregnancies are associated with a high risk of mortality and morbidity due to prematurity, cardiovascular and neurological complications.&#xA0;This risk is 3 to 5 times higher in the case of monochorionic twin pregnancy than in bichorionic pregnancies, this is probably due to fetoplacental vascular anastomosis.&#xD;
&#xD;
In the literature, the acardiac acephalic fetus is a rare complication, affecting one in 35,000 pregnancies, or 1% of all monozygous pregnancies.3,4 In our study the prevalence rate is estimated at 1 in 44,000 births.&#xA0;TRAP is more common in nulliparous women as in our case, and it is three times higher in monozygous triplets than in twins, with an incidence of chromosomal abnormalities of 9%.5&#xD;
&#xD;
The etiopathogenia of this entity is explained by several theories.&#xA0;Some say that it is the presence of primary cardiac dysmorphogenesis that causes the placental vascular anastomosis necessary for the development of the acardiac fetus, others think that it is the opposite;&#xA0;it is the presence of inverted vascular flow that will be the cause of heart atrophy.&#xA0;Nowadays, the association of the two theories with circulatory insufficiency of early-onset (8-12WA) and the occurrence of venous and arterial-arterial placental anastomosis is accepted. As a result, the acardiac fetus is a true parasite that receives blood from the pumping twin via the umbilical arteries in retrograde flow via anastomosis of the arterial-arterial and venous-venous plate.6,7 This oxygen-poor blood is responsible for the lack of development of the head, heart, and upper limbs of the acardiac twin, hence the twin-reversed arterial perfusion (TRAP) sequence name.8&#xD;
&#xD;
This phenomenon of twin reversed arterial perfusion was observed by U. Gembruch et al. on doppler ultrasound after the death of the transfusor twin at 25WA occurring as part of a transfusor-transfused syndrome of a biamniotic monochorionic twin pregnancy, without any congenital defects or heart defects detected in the two twins.&#xA0;This observation lasted 12 hours and then disappeared without repercussion on the living twin.9&#xD;
&#xD;
The role of prenatal ultrasound performed between 6 and 20 weeks old in the diagnosis of congenital malformations, in particular cardiac malformations, has been well evaluated and demonstrated by Lekshmi et al10. The diagnosis of the acardiac acephalic fetus is based on Doppler ultrasound from the 1st trimester which allows visualizing the reversal of vascular flow in the acardiac recipient fetus and during the 2nd trimester, the MRI allows to confirm the diagnosis. In our case, the pregnancy was poorly followed, no ultrasound examination was performed and the diagnosis of the acardiac fetus was made at the time of delivery. It was an acardius acephalus according to the classification of Napolitani and Schreiber (1960) which distinguishes 4 groups.11&#xD;
&#xD;
&#xD;
	&#xD;
	Acardius anceps: The head is poorly formed&#xD;
	&#xD;
	&#xD;
	&#xA0;Acardius acephalus: The head is absent&#xD;
	&#xD;
	&#xD;
	Acardius acormus: The presence of the single head&#xD;
	&#xD;
	&#xD;
	Acardius amorphous: Unrecognizable anatomy&#xD;
	&#xD;
&#xD;
&#xD;
Another classification differentiates&#xA0;:&#xD;
&#xD;
&#xD;
	&#xD;
	Cases where the heart is not completely formed: Hemiacardius &#xD;
	&#xD;
	&#xD;
	cases where the heart is absent: Holoacardius.&#xD;
	&#xD;
&#xD;
&#xD;
This is the second complication of vascular anastomosis of monochorionic placentas after transfusor-transfused syndrome,12 with a mortality rate for the healthy twin &#x201C;pump&#x201D; estimated at 50-70%.5 The risk of perinatal mortality of the pump twin may be due to congestive heart failure, polyhydramnios, and premature delivery. The rate of complication is proportional to the ratio of the weight of the parasitic twin to that of the pump twin.7,13 Thus, the mortality rate is 64% when the size of the acardiac fetus is greater than 50% of the size of the pump.&#xA0;When the acardiac twin exceeds 70% of the size of the pump twin, premature delivery reaches 90%,5 polyhydramnios 40%, and heart failure 30%.8 &#xD;
&#xD;
The therapeutic management in cases of acardiac fetuses is highly discussed and controversial.&#xA0;However, several authors opt for expectation from the beginning of pregnancy;&#xA0;with weekly monitoring by performing regular ultrasounds to monitor the state of growth, and look for signs of heart failure in the twin pump.13 Evolution can be normal without any complication.&#xA0;In case of hydramnios or heart failure in the pump twin, medical treatment is considered with indometacin, amniocentesis to reduce the volume of amniotic fluid and Digoxin to treat congestive heart failure in the pump fetus.&#xD;
&#xD;
Invasive therapeutic protocols are also proposed such as, stopping infusion of the acardiac twin by percutaneous radio frequency;&#xA0;reliable and effective technique despite the risk of premature membrane rupture according to the study of P. Cabassa et al.14 Other techniques are used, such as injecting thrombogenic products or sclerosing agents such as alcohol, which results in embolization of the umbilical cord of the parasitic twin.&#xD;
&#xD;
The ligature of the umbilical cord by thermo coagulation or laser coagulation under endoscopic or ultrasound guidance performed at the beginning of the 2nd quarter (from 18WA), was tested by K. Hecher et al on 60 cases with a success rate of 82%, and a survival rate of 80%, with 67% of cases survived beyond 36WA.15 Ultrasound-guided thrombosis of an umbilical cord artery and neonatal MRI surgery can be performed if the healthy twin shows signs of failure.5,8&#xD;
&#xD;
Conclusion&#xD;
&#xD;
In a monochorionic twin pregnancy, the diagnosis of acardiac twins must be suspected and detected early by antenatal Doppler ultrasound in the absence of cardiac structure or activity of one of the twins, and MRI, with regular follow-up for adverse prognosis factors in the healthy fetus so that an intervention can be planned early enough to avoid the onset of serious complications from the pump twin.&#xD;
&#xD;
Acknowledgements&#xD;
&#xD;
We would like to thank everyone who has contributed to this study. &#xD;
&#xD;
Ethical approval and consent to participate&#xD;
&#xD;
The Ethical Committee of Biological Research, Faculty of Medicine and Pharmacy &#x2013; Rabat, approved the study, n&#xB0;: 20/16. The oral consent to participate was obtained from the parents.&#xD;
&#xD;
Funding&#xD;
&#xD;
Not applicable&#xD;
&#xD;
Competing interests&#xD;
&#xD;
The authors declare that they have no competing interests.&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3750</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3750</Fulltext></URLs><References>&#xD;
	&#xD;
	Szatmari A, van den Anker JN, Gaillard JL. An acardiac infant: the extreme form of the twin-twin transfusion syndrome. Int J Cardiol. 1993;41(3):237-40. &#xD;
	&#xD;
	&#xD;
	Sullivan AE, Varner MW, Ball RH, Jackson M, Silver RM. The management of acardiac twins: A conservative approach. Am J Obstet Gynecol. 2003;189(5):1310-3.&#xD;
	&#xD;
	&#xD;
	Nigam A, Agarwal R, Saxena P, Barla J. Acardiac anceps: a rare congenital anomaly. BMJ Case Rep. 2014. &#xD;
	&#xD;
	&#xD;
	Khanduri S, Chhabra S, Raja A, Bhagat S. Twin Reversed Arterial Perfusion Sequence: A Rare Entity. J Clin Imaging Sci. 2015;&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688&#x2013;691.Chanthasenanont A, Pongrojpaw D. Acardiac Twin. J Med Assoc Thai. 2005; 88(11): 1721-4.&#xD;
	&#xD;
	&#xD;
	Ben Ali A, Ben Belhassen Z, Triki A, Karoui M, Guermazi. F&#x153;tus acardiaque - &#xE0; propos d&#x2019;une observation. Archives de P&#xE9;diatrie 2009;16(7):1070-1. &#xD;
	&#xD;
	&#xD;
	Shashidhar B, Kishore Kumar BN, Sheela R, Kalyani R, Anithae N. Twin reversed arterial perfusion (TRAP) Sequence: (Acardius Amorphous) a case report and review of literature. Int J Biol Med Res. 2012;3(1):1453-5. &#xD;
	&#xD;
	&#xD;
	Meenakshi KB, Mohana Priya N. A rare complication of monochorionic twin pregnancy: Twin-reversed arterial perfusion (TRAP) sequence. Med J Armed Forces India. 2015;71:114-115.&#xD;
	&#xD;
	&#xD;
	Gembruch U, Viski S, Bagamery K, Berg C, Germer U. Twin reversed arterial perfusion sequence in twin-to-twin transfusion syndrome after the death of the donor co-twin in the second trimester. Ultrasound Obstet Gynecol 2001;17:153-6 &#xD;
	&#xD;
	&#xD;
	Lekshmi ARV, Raju G, Chandrakumari K. Foetal Anomalies: Correlative Study of Sonography and Autopsy. Int J Curr Res Rev. 2021;13(2):143-147. &#xD;
	&#xD;
	&#xD;
	11. Anca FA, Negru A, Mihart AE, Grigoriu C, Boh&#xEE;l?ea RE, ?erban A. Special forms in twin pregnancy &#x2013; ACARDIAC TWIN/ Twin reversed arterial perfusion (TRAP) sequence. J Med Life. 2015;8:517-522. &#xD;
	&#xD;
	&#xD;
	Jayi S, Laadioui M, Laabadi K, Fdili FZ, Bouguern H, Chaara H, et al. Une complication rare de la grossesse g&#xE9;mellaire monochoriale: la s&#xE9;quence Twin reversed arterial perfusion (TRAP). Pan Afr Med J 2015;20:347. &#xD;
	&#xD;
	&#xD;
	Trabelsi K, Abdennadher W, Louati G, Kallel W, Khemiri H, Guermazi M, et al. Grossesse gemellaire compliqu&#xE9;e d&#x2019;un f&#x153;tus acardiaque facteurs pronostique et attitude therapeutique. J I M Sfax 2003;04:51-57. &#xD;
	&#xD;
	&#xD;
	14. Cabassa P, Fichera A, Prefumo F, Taddei F, Gandolfi S, Maroldia R, et al. The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature. Eur J Obstetr Gynecol Reprod Biol 2013;166:127&#x2013;132.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Web Based Suicide Prevention Application for Patients Suffering from Depression&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>06</FirstPage><LastPage>11</LastPage><AuthorList><Author>Khaw Ming Sheng</Author><AuthorLanguage>English</AuthorLanguage><Author> Sathiapriya Ramiah</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Depression is a mood disorder that causes one to have a persistent feeling of sadness and loss of interest. It is an ongoing issue that may lead the patient to have suicidal thoughts if not taken care of. According to the most recent findings, a lot of people in the current world are suffering from smiling depression which hard to handle with the traditional approach. Objective: This research aims to develop a platform to assist those who have depression to relieve their pain and express their emotion before it is too late. This research focuses on developing a web application with 4 major core features to tackle issues from a different approach. The first approach will be implementing a live chatbot to communicate and entertain the user. The second feature will be a chatroom as a platform for the user to express their feeling and chat with other people anonymously. Conclusion: A daily task program with a reward-redemption system will also be implemented to assist the user to improve their lifestyle and mental health. Lastly, an online consultation system is also included for the user to make an appointment with a psychiatrist or consultant. These different features will approach the user in different mental states and assist them with different approaches.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Depression, Mental Health, Web Application, Chatbot, Mental disorder, Suicide prevention</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Following the rapid growth of technology, more and more people prefer to communicate through the internet than talking with others in real life. People tend to hide their issues and problem and keep it themselves than express their feelings. This has caused the increase of mental health problems among adults increased from 10.7% in 1996 to 11.2% in 2006, to 29.2% in 2015.1 The prevalent rise is in Kuala Lumpur which is at 39.8%. This shows that there are more and more depressed people who needed a way to relieve their stress or someone to help and consult them. Hence the rising suicide rate has a very close relationship with the increase of mental health problems among adults. When the stress reached an unbearable amount, people will have a mental breakdown, some of them will seek help from others, some will release their stress and emotion and get back to life but some of them who didn&#x2019;t have a solid connection with people will tend to escape the reality by diving into the internet or even commit suicide. At that time, they hardly seek for help themselves. To overcome this situation, they need a platform that they can release their stress, split out their issues while discussing with other people in the same situation and the ability to seek professional help.&#xD;
&#xD;
RELATED WORK&#xD;
&#xD;
Current suicide prevention services that existed in the market remain in a very simple design with limited actual function. Most of them are just consist of stress test, suicide prevention hotline, and display some anti-suicide message or information. The idea of suicide prevention application emerged around 2012 which the amount of application starts to hit double digits in America.1 However, the content of most suicide prevention application 12 did not evolve with time. Which is the reason a new suicide prevention application with more interactive features is needed in current society.&#xD;
&#xD;
Suicide.org &#xD;
&#xD;
A traditional website that provides the contact number of all Malaysia&#x2019;s Suicide Prevention party. The website also contains detailed information about suicide and depression. Not only that, this website is easy to access by the public and has a huge community that supports it. However, Suicide.org is still a traditional website that consists of mostly text-based information. It also lacks features other than providing a suicide helpline or certain information.2&#xD;
&#xD;
A Friend Asks&#xD;
&#xD;
&#x201C;A Friend Asks&#x201D; is a free smartphone app that helps provide the information, tools, and resources to help people who may be struggling with thoughts of suicide. This application provides detail information about warning sign of suicidal people, useful features for the user to help others who has suicidal thoughts. It also has a direct connection to the local Suicide Prevention party. Furthermore, the application also includes a guide to handle suicidal thoughts.3&#xD;
&#xD;
MY3&#xD;
&#xD;
MY3 is another free mobile application that allows the user to stay connected with his/her friends and family. The user can create a safety plan and support system with the application. The application also provides a full-time online suicide prevention lifeline and is very easy to access by the public. However, this application target more specific user group which are veteran who suffer from trauma, people who have mood swing and people who have family or friends that will support them. It is more suitable for emergency usage and lack of related information about suicide and depression.4&#xD;
&#xD;
CHOSEN TECHNOLOGY &#xD;
&#xD;
Abraham Maslow once said, &#x201C;If the only tool you have is a hammer, you tend to see every problem as a nail.&#x201D; Hence, it is important to identify the right tool for this project. There is 5 major part of the project need to be identified before the development, which is a programming language, IDE, Framework and Database Management System.5 Each of them is chosen based on the suitability, requirement, project type, platform, target user group and accessibility. The chosen technologies are listed in Table 1. Detail explanation of the choice for the chosen technology will be discussed in the further section.&#xD;
&#xD;
&#xD;
&#xD;
PROGRAMMING LANGUAGE&#xD;
&#xD;
Due to the Suicide Prevention project is a web application, the best programming language to develop it will be C#. C# language is based on the current trend and is extremely powerful for developing an interoperable, scalable, and robust software application. C# language also includes built-in support to convert any component into a web service that can be invoked over the internet from any application that runs on any platform6. The second reason for choosing C# is because the suicide prevention web application will be developed in ASP.NET which is based on C#.&#xD;
&#xD;
INTEGRATED DEVELOPMENT ENVIRONMENT&#xD;
&#xD;
Suicide prevention project is a web application that requires a powerful IDE with the utilize of extensions hence the best IDE to use for its development will be Microsoft Visual Studio. The second reason for choosing Microsoft Visual Studio is because of its rock-solid intelligence6. It will save a lot of development time since it is very helpful when forgetting function parameter or objects name. Not only that, but the forum of visual studio is also extremely helpful which will promise that when faces with issues during the development of the project, it will be simple to seek solutions and fixes.2&#xD;
&#xD;
FRAMEWORK&#xD;
&#xD;
The chosen framework for the proposed suicide prevention web application is ASP.net. ASP.net is an open-source framework that widely used by the developer to develop web application related project. ASP.net is created by Microsoft which intended to assist the developer to create web app projects with its services and. NET. There are several reasons for choosing ASP.net as the framework to develop the proposed project. &#xD;
&#xD;
Firstly, ASP.net has some key advantages compared to other similar frameworks which are built-in windows authentication and pre-application configuration functions. These features considerably increase the security of web applications. With the built-in authentication features, it is very easy to create and manage user roles for the application. The built-in authentication system will generate concurrency stamps that consisted of random combination alphabet and numbers and then assign them to every registered user. Not only that, the built-in authentication system even offers double authentication and an external login system for the application. These features are easy to be implemented through ASP.net and ensure high-security standards of the application. &#xD;
&#xD;
ASP.NET has also consisted of a lot of features that ease the development of the application. ASP.net can add scaffolded codes into the project just by a click. These scaffolded codes are auto-generated codes based on the user-selected element. As an example, the user can create controller and view pages by adding the scaffolded code based on 22 the created model. In short, this feature is time-saving and provide a high level of consistency for the project development. &#xD;
&#xD;
ASP.net is very consistent and highly reliable as a framework. This is because ASP.net is cross-platform and it runs on Windows, Linux, Mac Operating System and even Docker. The application can be developed in a different kind of Operating system. It also has a complete base library for services and plugin to bused by the developer to increase the functionality of the project.3&#xD;
&#xD;
Finally, ASP.net is one of the best tools that can mix with HTML smoothly to generate dynamic web pages as the view of the application. With its MVC framework, the view, controller, and model are connected to produce output to the view while the data handling is secure and consistent. With ASP.net as the chosen framework for the development of the suicide prevention web application project, the web application will be highly reliable and secure.&#xD;
&#xD;
DATABASE MANAGEMENT SYSTEM&#xD;
&#xD;
Since the suicide prevention project is a web application that requires an on-demand scalable Database Management System, the best Database Management System to use for its development will be ASP.net local SQLDB. The second reason for choosing MySQL is because of its high performance and Round-the-clock Uptime7. It ensures the application can connect to the database at any time which is very critical to the suicide 25 prevention system since the user might use the application at any time. If the database is down, it will give a huge impact on the application credibility.&#xD;
&#xD;
SYSTEM DESIGN&#xD;
&#xD;
The proposed suicide prevention web application consists of four main features and several other minor functions. They are Chatbot, Chatroom, Daily Task and Appointment Booking. The web application also has an online shop for the user to redeem their points for an e-voucher.2,3&#xD;
&#xD;
Firstly, the Chatbot has its page while it stays on the screen as a floating widget at the lower right corner. The Chatbot can be used as a virtual companion to interact with while browsing the site. The Chatbot is interacting with the user through a preset intention mapping. Each of the user&#x2019;s input will be compared to find out the most appropriate reply that is logical while entertaining for the user. The development of the chatbot is to ensure it can entertain the user even though the user acknowledges that he/she was talking to a bot. On the main page of the Chatbot, the user can initiate the chatbot by clicking the get started button. Then, the Chatbot will greet the user and wait for the user&#x2019;s input. The user can also initiate the chatbot by clicking the floating chatbot widget.&#xD;
&#xD;
Next, a public Chatroom that allows the user to join that chat anonymously. The Chatroom is created by using third party services and embedded them into the web page. The chatroom is available for all type of roles of the user. When the user opens the chatroom for the first time, it will request the user for a nickname. After the user fills in their nickname, it will be used as the user&#x2019;s name in the chatroom. The chatroom is also able to open sub chatroom for the user to utilize. This will be used by the doctor for consultation purpose. The sub room can set the permission-based on &#x201C;rank&#x201D; which can be configured through the third-party site.3,4&#xD;
&#xD;
Not only that, but the Daily task page is also one of the core features of the suicide prevention web application. The daily task page will always display a list of tasks that designed to improve the user&#x2019;s lifestyle in terms of diet, living habit and mental care. The task from the list is managed by the admin and will be refreshed every 24hours. The daily task is design with a point system to motivate the user for participating themselves in it. By collecting enough points, the user can access the shop page to redeem e-voucher or other product that listed in the shop page. &#xD;
&#xD;
The last core feature for the user is the appointment booking system. The user can book an appointment with a consultant or psychiatrist online by book the consultation time posted by the consultant or doctor. The user can see the list of consultation time by selecting the create new at the appointment page. By booking the consultation slot, the doctor will also acknowledge the appointment has been made. The user could cancel the booked appointment anytime if they suddenly changed their mind.5-7&#xD;
&#xD;
Other than the four core features for the normal user, the web application also consisted of some hidden features for doctors and admin. For the doctor, they can access a page which calls the doctor page that contains two management action for them to manage their consultation time and appointment. They can publish, modify, and delete their consultation time while able to modify or cancel the booked appointment. For the admin, they can access the admin page that granted them three management actions.8 The admin can manage the daily task, doctors, and the product in the e-shop by creating a new entry, modify, view detailed information, or delete the entry from the database. The abstract architecture of the system shown in Figure 1.&#xD;
&#xD;
&#xD;
&#xD;
IMPLEMENTATION&#xD;
&#xD;
Main Page&#xD;
&#xD;
This is the main page of the proposed suicide prevention web application, Figure 2. The home page consisted of the project Logo, a brief description of the web application features, benefits for using the proposed system, speech from professionals and a feedback form.&#xD;
&#xD;
&#xD;
&#xD;
Chatbot Page&#xD;
&#xD;
The Chatbot Page is the first option on the Navigation bar after the user login their account. On this page, the user can interact with the chatbot by clicking the get started button once they reach the page. The chatbot also appears around the other page of the website as a floating widget. The user can talk to it whenever the widget is available, Figure 3.&#xD;
&#xD;
&#xD;
&#xD;
Chatroom Page&#xD;
&#xD;
The Chatroom Page is the second option on the Navigation bar after the user login their account. In this page, the user can join the public chatroom to chat with the others online. The user will be able to create a nickname before they join the chatroom. 6,7 This feature is to assure the user can participate in the conversation anonymously. The chatroom can also create multiple sub chatroom for a private conversation. This will be used for the consultation between the user and the doctor/consultant (Figure 4).&#xD;
&#xD;
&#xD;
&#xD;
Daily Task Page&#xD;
&#xD;
The Daily Task Page is the third option on the Navigation bar after the user login their account &#xA0;(Figure 5). On this page, the user can participate in the daily tasks. The randomized tasks will be refreshed every 24 hours. Every time, the user completes a task, they will get an award for a certain amount of points. The completed task will be disabled until the next cycle.7,8&#xD;
&#xD;
&#xD;
&#xD;
Shop Page&#xD;
&#xD;
The Shop Page is the fourth option on the Navigation bar after the user login their account, Figure 6. On this page, the user can redeem the e-voucher or other product with the points they earned on the daily task page. When the user redeemed an e-product, the system will display the voucher code for the user. However, if the user does not have sufficient point to redeem the product, an error message will be displayed to the user.7&#xD;
&#xD;
&#xD;
&#xD;
Consultation Page&#xD;
&#xD;
The Consultation Page is the last option on the Navigation bar after the user login their account for the normal user, Figure 7. On this page, the user can vi their booked consultation. The appointment will be displayed with the doctor&#x2019;s ID, doctor&#x2019;s name, date and time. The user can cancel the appointment anytime they want. The user can make a new appointment by clicking the create new entry button.6&#xD;
&#xD;
&#xD;
&#xD;
Appointment Page&#xD;
&#xD;
The Appointment Page is the page for the user to make an appointment with the doctor (Figure 8). The consultation slot will be prepared by the doctor and displayed in form of a list. The user just has to click the Book button to make the appointment with the doctor. The user can also search for the doctor&#x2019;s name to find the specific doctor.5,6&#xD;
&#xD;
&#xD;
&#xD;
Doctor Page&#xD;
&#xD;
The Doctor Page is hidden for the doctor to manage their consultation slot and appointment. On the page, the doctor has 2 different actions that can be done which are to Manage their consultation time slot and Manage their appointment. This page is protected by authentication to ensure the only doctor can access this page. Every access from another role will be denied by the system.8&#xD;
&#xD;
Admin Page&#xD;
&#xD;
The Consultation Time Management Page is one of the web pages that can be used by a Doctor to manage his/her consultation time slot. The doctor can click Create new entry to add a new consultation slot. The doctor can also modify, view detailed information, and delete the consultation time entry.7,8&#xD;
&#xD;
TESTING&#xD;
&#xD;
The testing phase is one of the most important phases for the development of any software project. During this phase, the system will be tested from its functionality to its security and even its user interface to ensure it reaches the expected quality. In the testing phase, the developer can obtain valuable feedback and test data from the testers of the user acceptance test. This feedback is very important to a developer because it might cover a certain part of the application that needs to be improved but did not notice by the developer. Based on the data collected from the Unit testing, each module of the suicide prevention system is functioning as expected. Meanwhile, the testers from the user acceptance test highlighted some minor issues of the system that can be improved such as the input validation, overall security, and suggestion for UI layout improvement.&#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
Throughout the development of the proposed suicide prevention web application, knowledge about how to handle people who have depressions and the correct way to approach them to assist them to come out from their depression has been gained and utilize in the development of the project. The objective of each core features of the suicide prevention application is well-planned and designed to reach the people who suffered from suicidal thoughts from a different angle. &#xD;
&#xD;
The gap or improvement that can be further addressed would be to improve and optimize the algorithm and vocabulary library of the chatbot to make it more intelligent and user friendly. As most of the current chatbot in the market are entertainment use, it would be interesting and informative research on how to maximize the capability of chatbot. In conclusion, this research has offered a chance to gain valuable experience and skills in the development of web application and understand more closely the issues of those who undergoing depression. &#xD;
&#xD;
ACKNOWLEDGMENTS&#xD;
&#xD;
The author would like to express his appreciation and acknowledge the support provided by individuals and volunteers which had greatly contributed to the success of this study. &#xD;
&#xD;
Conflict of Interest: None&#xD;
&#xD;
Source of Funding: None&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3751</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3751</Fulltext></URLs><References>&#xD;
	&#xD;
	Aguirre RT, McCoy MK, Roan M. Development guidelines from a study of suicide prevention mobile application. J Tech Hum Serv 2013;31(3):269-293. &#xD;
	&#xD;
	&#xD;
	Suicide.org, 2012; [Online]&#xD;
	Available at: http://www.suicide.org/hotlines/international/malaysia-suicide-hotlines.html&#xD;
	&#xD;
	&#xD;
	The Jason Foundation, A Friend Asks. 2014; App. [Online]&#xD;
	Available at: https://jasonfoundation.com/get-involved/student/a-friend-asks-app/&#xD;
	&#xD;
	&#xD;
	&#xA0;MY3 lets you stay connected when you are having thoughts of suicide.2014; [Online]&#xD;
	Available at: https://my3app.org/&#xD;
	&#xD;
	&#xD;
	Jayabalan M, Barakat ZA, Ramiah S. Data exchange model for classified advertisement using Android. &#xA0;IEEE Student Conference on Research and Development (SCOReD). 2015;13:266-271. &#xD;
	&#xD;
	&#xD;
	Ganesh GA, C# and its Features. 2001. Available at: https://www.c-sharpcorner.com/article/C-Sharp-and-its-features/&#xD;
	&#xD;
	&#xD;
	Smith A. The gold standard of IDEs. 2019;&#xD;
	Available at: https://www.trustradius.com/products/visual-studio-ide/reviews&#xD;
	&#xD;
&#xD;
&#xD;
Branson T. Major Advantages of Using MySQL.2016;8. Available at: https://www.datamation.com/storage/8-major-advantages-of-using-mysql.html&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Occupational Stress and Job Performance Among Nurses in a Teaching Hospital, in South-South, Nigeria&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>12</FirstPage><LastPage>17</LastPage><AuthorList><Author>Regina Etita Ella</Author><AuthorLanguage>English</AuthorLanguage><Author> Augusta Eleazer Agharandu</Author><AuthorLanguage>English</AuthorLanguage><Author> Easter Osuchukwu</Author><AuthorLanguage>English</AuthorLanguage><Author>  Patience Samson-Akpan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Literature indicates that nurses&#x2019; job performance in the health care system in Nigeria is deteriorating. Objective: To investigate the relationship between occupational stress and job performance among nurses in a tertiary institution in Nigeria. Methods: Descriptive (survey) design was adopted for the investigation. A purposive sampling technique was used to select two hundred and twenty-two (222) nurses from a population of 500. A reliable and valid occupational stress questionnaire constructed by the researchers was used in data collection. Questions were answered using simple percentages. Results: The results indicated that nurses experience occupational stress (91.0%); Identified stressors were workload (67.1%), inadequate motivation (64.9%), role conflict/ambiguity (54.5%) and poor working conditions (53.6%). Furthermore, it was revealed that occupational stress affected nurses&#x2019; performance of some of their caring duties. Conclusion: Nurses &#x2018;job performance was influenced by the identified stressors. Government should train more nurses, deploy them to clinical settings to reduce workload; staff should be adequately motivated, roles and responsibilities be clearly defined and working conditions made conducive at all times.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Nurses, occupational stress, Job Performance, Stressors, Teaching hospital, Stress indicators, Job performance indicators</Keywords><Fulltext>INTRODUCTION&#xA0;&#xA0; &#xD;
&#xD;
Job performance among nurses has been declining over the past years in the Nigerian health care industry. There is no denying that such poor job performance among nurses might be induced by Occupational stress (Job-related stress). The United Nations reasoned in this direction and thus labelled job-related stress as the 20th-century disease.1 The incidence of job-related stress in developing countries according is growing.2 Similarly, records show that job-related stress is a key factor in hampering job performance among nurses.3 Without overstating the obvious, nurses constitute a significant force in the health care delivery system. Given this knowledge they are exposed to rigorous training in various dimensions of patients&#x2019; care; such as physical caregivers, drug administrators, educators, counsellors, advocates, administrators, team players, not to say the least, in carrying out these, they are in recent times noted to be somehow poor in the discharge of these expected responsibilities. Could such observed poor performance to the causal factor of occupational stress? &#xD;
&#xD;
The most common form of stress in various organizations today is known as occupational stress.4 Occupational stress is one of the most important workplace health risks for nurses in developing countries, therefore understanding its impact on nurses&#x2019; job performance will help stakeholders to develop appropriate strategies to reduce occupational stress. Occupational stress has been defined as any discomfort which is felt and seen at an individual level and triggered by instances, events or situations that are too intense and frequent to exceed one&amp;#39;s coping capabilities.4 Occupational stress in this study is seen to be related to one&amp;#39;s job and often stems from pressures that do not align with a person&amp;#39;s knowledge, skills or expectations. In the health care setting, occupational stress claims to be negatively allied to job performance.5 Job performance is fulfilling assigned roles and responsibilities effectively. &#xA0;Nursing job performance reflects the quality of care delivered and consequently patient outcomes, therefore, poor job performance is considered a risk factor for patients&#x2019; safety. Ensuring good job performance of nurses is one key component for the provision of quality nursing care.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Various studies have linked occupational stress with job satisfaction.2,6,7 Only a few studies have considered occupational stress about nurses&#x2019; job performance. Stress whether from whatever source can have both positive and negative effects on a worker&#x2019;s job performance.6,8 Mild stress enhances performance when under pressure, acts as a motivator and helps to ensure safety when there are threats.&#xA0; Nevertheless, when there is devastating stress, it becomes damaging to individual mood and relationships resulting in numerous somatic and psychological health challenges culminating in poor job performance.9&#xD;
&#xD;
Nurses respond to occupational stress differently, some manifesting disorders such as ulcer, hypertension, stroke, heart attack, headache and cancer (physical response).10,11 Others may manifest emotional exhaustion, absenteeism, anxiety, frustrations, anger and feelings of inadequacy, helplessness/powerlessness, and feeling of leaving the job. All these responses may culminate in poor job performance. It is expedient therefore that, occupational stressors in the nursing work environment, their level of influence on nurses&#x2019; job performance be identified and possible remedies proffered. &#xD;
&#xD;
Some studies in Nigeria revealed that nurses experience occupational stress which could harm their job performance.12,13 Most studies have demonstrated workload, long working hours to be the most frequent stressors.8,11,14,15 A study on Stress and Coping Strategies among Undergraduates in a Tertiary Institution in Nigeria also revealed that workload contributed to stress during the clinical experience.6 Participants stated that their workload usually increased between eight to 14 hours due to pressure from both inpatients and outpatients, but more especially for in-patients who usually need more attention; to have to their beds made, be given bed bath, have their drugs/injections served, have their wounds dressed; all these activities, according to the respondents are carried out after participation in ward rounds, most often with only 2-3 nurses on duty to attend to 20-30 in-patients. &#xD;
&#xD;
A significant relationship between inadequate staffing and occupational stress was reported.12,15&#xD;
&#xD;
Inadequate staffing referred to having one qualified and experienced nurse on duty with 3-4 qualified but inexperienced nurses who may not be conversant with some complicated procedures.&#xA0; Role conflict and role ambiguity were also identified as stressors.8,13 The findings showed that 49% of nurses reported conflict with the doctors, 52% reported role ambiguity and conflict with supervisors and 53% conflict with peers.13 Conflicting multiple role demands contributed to the development of occupational stress.8 Similarly, a cross-sectional study observed role conflict and role ambiguity, especially when asked to represent their boss/colleague in an unfamiliar ward or environment.16 Respondents further stated that hard work was poorly rewarded, and that poor/lack of special incentive for them was a source of occupational stress. Studies have reported on the effect of occupational stress on workers in general and nurses in particular, resulting in poor performance of specific nursing duties.1,12,15,16 Another study reported effects such as nurses being prone to error in their clinical decision making and practices.1 A study in 3 private health care facilities in Accra, Ghana revealed a reduction in the productivity of 213 nurses, 95 (44.6%) of the nurses reported errors and wrong decisions in their performance.17&#xD;
&#xD;
Stress among employees does enhance their job performance in a positive manner.4 The study reported a significant positive relationship between employee stress and job performance (r = 0.348, P=0.0001). The findings suggest that as workers stress rises, their work performance is also likely to rise and vice versa. This assertion concludes on the premise that stress to an extent enhances job performance. This finding to some extent is in agreement with.18 The author asserted that an inverted u-type curve is used to depict the effect of stress on employee performance. Therefore, as stress rises, the performance of workers also rises.18&#xD;
&#xD;
Nurses are pillars of any health care system; hence it is important that factors that cause occupational stress and trigger poor job performance be identified and be judiciously attended to. Given that stressors differ with different settings, there is a need to explore them from the perspective of a tertiary institution. &#xD;
&#xD;
Therefore, this study seeks to:&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	Explore if Nurses in a Tertiary health institution in Port-Harcourt experience occupational stress?&#xD;
	&#xD;
	&#xD;
	Identify what factors are responsible for occupational stress among nurses in a tertiary health institution in Port-Harcourt.&#xD;
	&#xD;
	&#xD;
	Assess if occupational stress has any effects on the job performance of nurses in a tertiary health institution in Port-Harcourt.&#xD;
	&#xD;
&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A descriptive research approach was used to investigate the influence of nurses&#x2019; occupational stress on their job performances in a tertiary institution in South-South, Nigeria. The institution is a teaching hospital founded in 1980; located in the suburban city of Port Harcourt. It is saddled with the responsibility of teaching, clinical services and research. The hospital has 32 wards/units with a total of five hundred (500) nurses made up the target population. This constituted all nurses who were employed and were working at this hospital at the time of this study, as was obtained from the records department of the institution. 14 wards were randomly selected from the 32 wards. Accessible population constituted of all nurses on duty at each of the selected wards at the time of administration of the instrument. A sample of two hundred and twenty-two (222) was purposively selected from the accessible population. Only those: present at the time of data collection, who had spent 5years and above at this institution, who were nursing officers 1 and above, and who were willing to participate in the study met the inclusion criteria. Thus, participation was voluntary. &#xD;
&#xD;
Statistical analysis &#xD;
&#xD;
A self-administered questionnaire with a content validity index of 0.79 and a test-retest reliability coefficient of 0.81 was administered to the participants. Section C was constructed using a three (3) point scale with the options: HE (high extent), ME (moderate extent), LE (low extent). Section D on the other hand consisted of items with response options on the extent to which stress have affected or limited the performance of functions of nurses. The response options were also (HE, ME, and LE). Data were analysed using simple percentages&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Socio-demographic variables&#xD;
&#xD;
Sixty-three respondents (28.4%) were below 30years of age, 75(33.8%) were between 31-44years and 72(32.4%) were 45years and above.&#xA0; Two hundred and nineteen respondents(98.7%) were females, only three (1.3%) were males. The majority of the respondents (72.1%) had attained Nursing certificates while 27.9%had attained degree certificate in Nursing. Data for other socio-demographic variables are provided in Table 1.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Responses to research questions&#xD;
&#xD;
Research question 1&#xD;
&#xD;
Explored if Nurses in a Tertiary health institution in Port-Harcourt experience occupational stress. Data were collected using five items (1-5) in section B of the research instrument.&#xA0; The analysis of the data is as summarized in Table 2&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The responses in Table 2 show that 202 of the respondents equivalent to 91 per cent virtually experience all signs and symptoms of stress in carrying out their duties, 191 (86.0%) asserted that they become very restless and agitated when at work. 187 of the respondents (82.5%) opined they lack concentration in carrying out their nursing duties when at work, while 176 respondents (79.3%) maintained that they feel like quitting the nursing job because they are overworked 94 (42.3 per cent) respondents said they fall sick almost every month and this makes me absent from work frequently.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Given the number of items generated on this sub-scale of the instrument (the measure of the possibility of stress), and the cumulative responses of the sampled nurses to these items, 76.58 per cent are noted to have occupational stress. Being that this is significantly above the average of 50 per cent, it can therefore be concluded that the extent of occupational stress among nurses in this institution is significantly high. &#xD;
&#xD;
Research question 2&#xD;
&#xD;
This explored factors responsible for occupational stress among nurses. Data were generated using section C of the instrument. Five major factors listed were displayed for respondents to indicate the extent to which such stressors affect their performances. The summary of the responses obtained is as shown in Table 3.&#xD;
&#xD;
&#xD;
&#xD;
Workload, inadequate motivation, role conflict/ambiguity and poor working condition (tools, facilitates) respectively. Each of these contributes 67.1 per cent, 64.9 per cent, 54.5 per cent and 53.6 per cent measure as stressors respectively to the respondents. The vague definition of staff duties though a stressor on the other hand did not seem to pose significant stress to the nurses. Only 78 nurses (35.2%) see stress from this factor to be of high extent, 70 nurses (31.5%) and 74 nurses (33.3%) see stress from this factor to be of moderate extent, low extent respectively. It is therefore obvious that the major factors responsible for the development of stress among nurses in this tertiary institution are workload, inadequate staff motivation, role conflict and role ambiguity, and poor working condition/poor tools and or poor facilities.&#xD;
&#xD;
Research question 3&#xD;
&#xD;
This is exploring the effects of occupational stressors on nurses&#x2019; job performance. The responses in Table 4 reveal the extent to which stressors exerts influence on nurses&#x2019; job performance across some performance indicators of interest in this study. From the results, most of the respondents indicated that occupational stressors influenced their job performance to a large extent.&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The findings of this study confirmed the presence of occupational stress among nurses, and lend credence to the findings of other studies.1,8,11,12 From the results workload and poor staff motivation ranked highest, followed by role conflict/ambiguity, poor working conditions, and poor working conditions/tools as factors and extent to which they exert as stressors; except for the vague definition of staff duties. This finding corroborates that workload, lack of motivation and role conflict were factors that contributed to occupational stress.1,8 However, sources of occupational stress among nurses may vary among regions, countries, organizations, departments, nursing specialists and individuals. Implying that workload as a source of stress among nurses in this tertiary institution may not be a source of stress in another setting. The difference could be attributed to participants and the setting which in this study are nurses in a hospital setting against participants in a company setting that does not deal with sickness and human lives.&#xD;
&#xD;
The analysis of objective three revealed that stress exerts a high effect on nurses &#x2018;job performance. Nurses carry out several tasks in the discharge of their duties, it is worth noting that stress exerts a substantial effect on the extent to which nurses carry out such duties. As noted in this study, stress varies among nurses in the extent to which it affects their performances in various areas. From nine performance indicators listed, it is observed that stress impacts to a high extent the delivery of nursing services such as bed bathing of patients (68%), followed by wound dressing (67.1%0, then lifting of patients (57.6%), caring for patients (54.5%), taking of vital signs (53.2%), serving medication (51.4%), supervision of juniors (50.4%), bed making (49.1%) and carrying out of duty allocation (48.2%) respectively. The finding agrees that occupational stress tends to be negatively allied to job performance.5,13 In addition, occupational stress affects nurses&#x2019; job performance negatively and interferes with (productivity) quality nursing care.18&#xD;
&#xD;
Contrarily, other results showed that stress among employees does enhance their job performance in a positive manner.10 Their finding showed a significant positive relationship between employee stress and job performance (r = 0.348, sig. value=.000).10&#xA0; This indicates that as employee stress increases; their job performance also tends to increase and so on.&#xA0; This indicates that as employee stress increases, their job performance also tends to increase and vice versa. This assertion concludes on the premise that stress to an extent enhances job performance in an organization. This finding to some extent is in agreement with.6Theauthor&#x2019;s findings showed that an inverted u-type curve is used to depict the effect of stress on employee performance. Thus, as stress increases, the performance of employees also increases.6 However, went further to state that when stress becomes excessive, then the performance of employees also begins to decline. His finding invariably is in agreement that excessive stress is very harmful and detrimental to the employee well-being and their overall performance. This reversibly agrees with the findings of this study. However, the difference in the findings of this study and that of the previous study 10could be attributed to the different type of workers and setting. While the latter study dealt with company and company workers, whose job description may permit shifting/workload to a later time or date perceived as more convenient, this study&#x2019;s participants are nurses who deal with lives of patients and may be on their toes to restore life before closing or as the need arises.&#xD;
&#xD;
This study is limited to Port Harcourt, an urban setting and did not extend to other urban or rural areas. This may limit the generalizability of the findings across other settings.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Occupational stress as a common factor impacts negatively on nurses as they carry out their duties in health institutions. It is therefore expedient to identify occupational stressors and plan nursing activities to reduce stress. The study, however, concludes that there is a negative influence of occupational stressors which include work overload, lack of incentives, inability to manage multiple roles/lack of clearly defined roles, unconducive work environments on nurses&#x2019; job performance. It is recommended that Workplace policies that promote nurses&#x2019; autonomy reduce conflicting situations, the reward for hard work or more incentives and exemplary leadership/supervision is advocated. Implementation of the above recommendations will increase nurse&#x2019;s productivity, and quality nursing care.&#xD;
&#xD;
CONFLICT OF INTEREST: We hereby declare that there is no conflict of interest in this paper&#xD;
&#xD;
AUTHOR CONTRIBUTION: Regina Etita Ella (REE) conceived the idea and designed this study and edited the manuscript. Augusta Agharandu and Easter organized for ethical approval and data collection of the study.&#xA0; Professor Samson&#x2013;Akpan took the lead in data analysis, involving all the authors. All the authors revised and proofread the final manuscript before submission for publication.&#xD;
&#xD;
FUNDING: This research was conducted and funded by the personal contributions of the four authors. No external funding obtained.&#xD;
&#xD;
ETHICAL APPROVAL: Ethical approval was received from UPTH research Committee with approval number UPTH/ADM/90/S11/VOL X1/376. Consent was also received from the participants.&#xD;
&#xD;
ACKNOWLEDGEMENT: We are grateful to the University of Port Harcourt Teaching Hospital for giving us the ethical clearance to carry out the research. We also deeply appreciate all the Nurses of the hospital who participated in the study. We thank the Director of Nursing for her supporting role. We appreciate those who assisted in data collection for their invaluable contributions. Thank you all because without permission from UPTH and the willingness of Nurses to participate in this research will not have been possible.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3752</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3752</Fulltext></URLs><References>&#xD;
	&#xD;
	Onasoga OA, Osamudiamen OS, Ojo AA. Occupational stress management among nurses in selected hospital in Benin City, Edo state, Nigeria. Eur J Exp Biol. 2013;3 (1):473-81.&#xD;
	&#xD;
	&#xD;
	Faremi FA, Olatubi MI, Adeniyi KG, Salau OR. Assessment of occupational related stress among nurses in two selected hospitals in a city southwestern Nigeria. Int J Africa Nurs Sci. 2019;10:68-73.&#xD;
	&#xD;
	&#xD;
	Didehvar M, Zareban I, Jalili Z, Bakhshani NM, Shahrakipoor M, Balouchi A. The effect of stress management training through PRECEDE-PROCEED model on occupational stress among nurses and midwives at Iran hospital, Iranshahr. J Clin Diagn Res. 2016;10(10):LC01.&#xD;
	&#xD;
	&#xD;
	Amoako EP, Gyamfi OA, Emmanuel AK, David B. The effect of occupational stress on job performance at Aspet A. Company limited. Global J Arts Humanit Soc Sci. 2017;5(8):1-17.&#xD;
	&#xD;
	&#xD;
	Sharma P, Davey A, Davey S, Shukla A, Shrivastava K, Bansal R. Occupational stress among staff nurses: Controlling the health risk. Indian J Occup Environ Med. 2014;18(2):52. &#xD;
	&#xD;
	&#xD;
	Samson-Akpan PE, John ME, Edet OB, Ella RE. Stress and coping strategies among undergraduate nursing students in Calabar, Nigeria. J Nurs Health Sci. 2017;6(3):61-70. &#xD;
	&#xD;
	&#xD;
	Sahraian A, Davidi F, Bazrafshan A, Javadpour A. Occupational Stress among Hospital Nurses: Comparison of Internal, Surgical, and Psychiatric Wards. Int J Commun Based Nurs Midwif. 2013;1(4):182-90. &#xD;
	&#xD;
	&#xD;
	Ella RE, Asuquo E, Akpan-Idiok P, Ijabula IJ. Impact of job stress on nurses&#x2019; job satisfaction in a public hospital, Cross River State, Calabar, Nigeria. Int J Humanit Soc Sci Educ. 2016;3(9):57.&#xD;
	&#xD;
	&#xD;
	Help Guide, Stress causes and effect: tips for workplace stress reduction. 2016;&#xA0; &#xD;
	&#xD;
&#xD;
&#xD;
Available from http://www.helpguide.org/mental/work_stress_management.htm&#xD;
&#xD;
&#xD;
	&#xD;
	Faraji A, Karimi M, Azizi SM, Janatolmakan M, Khatony A. Occupational stress and its related demographic factors among Iranian CCU nurses: a cross-sectional study. BMC Res Notes. 2019;12(1):634.&#xD;
	&#xD;
	&#xD;
	Ladan MA, Khalid DS, Musa HA, Ogbeh M, Muhammad FL. Occupational stress among health professionals in Ahmadu Bello University Teaching Hospital (ABUTH), Shika, Zaria, Nigeria. West Afr J Nurs. 2014;25(1).24-36. &#xD;
	&#xD;
	&#xD;
	Armon MA, Lukpata FE, Abang V. Determinants of Nurses Job Stress in Critical Care Environment. A Case Study of Nurses in University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria. Int Profess Nursing J 2012;10(2), 66-72.&#xD;
	&#xD;
	&#xD;
	Mohite N, Shinde M, Gulavani A. Occupational stress among nurses working at Selected Tertiary Care Hospitals. Int J Sci Res. 2014; 3(6):999-1005.&#xD;
	&#xD;
	&#xD;
	Pretrsovan I, Pokhilenko I. Job satisfaction of Nursing Managers: Literature Review. Bachelors Thesis degree programme in Nursing, Social services, Health and Sports. 2015; JAMK University of Applied Sciences. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1026.1535&#xD;
	&#xD;
	&#xD;
	Edoho SA, Bamidele EO, Neji OI, Frank AE. Job Satisfaction among Nurses in Public Hospitals in Calabar, Cross River State Nigeria. Am J Nurs. 2015;4(4):231-237. &#xD;
	&#xD;
	&#xD;
	Nabirye RC, Brown KC, Pryor ER, Maples EH. Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. J Nurs Manag. 2011 Sep;19(6):760-8.&#xD;
	&#xD;
	&#xD;
	Shinde M, Anjum S. A textbook of Nursing Management. Sneha publication India (Dombivili). 2012&#xD;
	&#xD;
	&#xD;
	Blumenthal I. Services SETA. InEmployee assistance conference programme. 2003;Vol.2(2):pp. 5-21.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Determinants of Stunting and Wasting Among the Children Under Five Years of Age in Rural India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>18</FirstPage><LastPage>26</LastPage><AuthorList><Author>Abhay Gaidhane</Author><AuthorLanguage>English</AuthorLanguage><Author> Pratiksha Dhakate</Author><AuthorLanguage>English</AuthorLanguage><Author> Manoj Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Quazi Syed Zahiruddin</Author><AuthorLanguage>English</AuthorLanguage><Author>  Nazli Khatib</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpa Gaidhane</Author><AuthorLanguage>English</AuthorLanguage><Author> Sonali Choudhary</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Stunting, Wasting, SUW (severe underweight), SAM (severe acute malnutrition), MAM (moderate acute malnutrition),  Children under-5.</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Globally, 52 million children under five years are moderately or severely wasted (low weight for height). A report by UNICEF published in 2006 states that around 146 million children in developing countries are underweight - that is one out of every fourth child.1-3 One in four children under age 5 (165 million or 26 per cent in 2011) is stunted. Sub-Saharan Africa and South Asia are contributing to three-quarters of the world&#x2019;s stunted children.4 In 2011, five countries that count the highest numbers of stunted children were: India (61.7 million), Nigeria (11 million), Pakistan (9.6 million), China (8 million) and Indonesia (7.5million). Southern Asia reflected the highest prevalence of wasting where one in six children was found severely or moderately wasted. During this period, 25 million children in India were reported to be wasted.5,6 Despite global efforts for improving maternal and child health malnutrition among children remains a significant problem. In India, nearly 48%, 43%, and 20% of children under five years of age are stunted, underweight, and wasted, respectively. Out of these around one fourth are severely stunted.7 &#xD;
&#xD;
It is well documented that chronic undernutrition is associated with serious developmental and health impairment later in life which reduce the quality of life.2,8 Tragically, more than a third of child deaths and greater than 10% of the total global disease burden is attributed to maternal and child undernutrition, which includes underweight, stunting, wasting, and deficiencies of essential vitamins and minerals.4&#xD;
&#xD;
This study was conducted to find out the prevalence, socio-demographic, environmental and behavioural determinants for stunting and wasting among children under five years of age from rural areas of Wardha district.7,8&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
A cross-sectional study was conducted in the rural area of Wardha district. Data was collected from a sub-centre area comprising of 6 villages. Study participants were children under five years of age and the respondents were the mother of the eligible children. All children between one month to five years of age and residing in the study area were included after the written informed consent from their mother or parents. The study protocol was approved by the institutional ethics committee. Respondents were assured about the confidentiality of the information and its intended use for research purpose only.&#xD;
&#xD;
A structured questionnaire was used to collect data. A questionnaire was prepared in English and was then translated into Marathi and was back-translated into English. The questionnaire was pilot tested. Data on socio-demographic profile of the child, mother and household, information on environmental and behavioural determinants such as sources of water, sanitation, handwashing, water purification at household level and information regarding antenatal services received by mother and feeding practices were collected. &#xD;
&#xD;
After data collection, the child&#x2019;s height and weight were measured.&#xD;
&#xA0;Weight was recorded using a Digital weighing scale pretested for accuracy (Dr. Trust) with minimal clothes. The length of children up to the age of two years was measured with the child on the horizontal measuring scale (Infantometer). The height of children above 2 years of age was measured by using Stadiometer (Alive Stature-meter). Standing height was measured up to the nearest of 0.1 cm. The child was made to stand against the scale without shoes, heels together and shoulder buttocks and heels touching the vertical surface. Height was recorded with a headpiece touching the top of the head when the child was looking straight and arms naturally hanging by the sides.9,10 &#xD;
&#xD;
Data Analysis&#xD;
&#xD;
The main outcome variables were stunting and wasting. WHO growth charts for the boys and girls were used for classifying stunting and wasting. The child having a Z score for, height for age less than &#x2013;2SD was classified as &#x201C;moderate stunting&#x201D; and that with a Z score, less than -3SD was classified as &#x201C;severe stunting&#x201D;. Similarly, the child with a Z score for weight for height less than -2SD was considered as having moderate wasting and those with a score of less than -3SD was considered as having severe wasting. WHO Anthro tool was used to estimate the Z score.&#xA0; Association of various sociodemographic, environmental and behavioural determinants with stunting and wasting was assessed using the appropriate test of significance.11 &#xD;
&#xD;
RESULTS&#xD;
&#xD;
A total of 594 mothers child dyad were included in the study. Nearly 80% were of Hindu Religion and for most of the households (72.73%), annual income was in the range of Rs. 30000 to 50000. The average age of mothers was 29.3 (SD 6.2) years and the majority 94.6% were married at the age between 18 - 25 years, 31% were educated till 10th grade, nearly 80 % homemaker. Out of 120 working women, 6.4% were farm labourer. Among the children in this study, 300 (50.5%) were males, 294 (49.5%) were females. Nearly 99% of children were registered at Anganwadi Centres (AWC). Out of 302 children over 3 years of age, 25% attend AWC regularly and had an attendance of equal to or more than 80%.68 (11.4%) children were going to private playschool or preschool. More detailed characteristics of study participant are given in Table 1. &#xD;
&#xD;
Table 2 reveals that 256 (43.09%) children were stunted and 96 (16.16%) were severely stunted.&#xA0; A total of 122 (20.54%) children were wasted and 24(4.04%) were severely wasted. With regards to age group, nearly 46% in the age group of 3 to 6 years were stunted and 24% were wasted.&#xA0; The proportion of children with severe stunting and wasting were maximum in the age group of 1 to 3 years (Table 2). &#xD;
&#xD;
Out of 300 male children, a total of 122 (40.7%) were stunted and 42 (14%) had severe stunting, similarly 59 (19.67%) males children had wasting and 11 (3.7%) had severe wasting. Amongst 294 female children, a total of 134 (45.6%) were stunted and 54 (18.4%) had severe stunting, whereas a total of 63 (21.43%) had wasting and 13 (4.4%) had severe wasting. The proportion of children with stunting and wasting was the highest among the children born to women married early (14-17 years), illiterate women. 193 (41.1%) Children from the Hindu religion were stunted and 97 (20.64%) showed wasting (Table 3). &#xD;
&#xD;
55.8% of children of working women were stunted compared to 63.3% children of women who were homemaker and the difference was statistically significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3753</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3753</Fulltext></URLs><References>&#xD;
	&#xD;
	Young ME. From child development to human development. Investing in our children&#x2019;s future. The world Bank, Washington D.C. 2002:63-78. &#xD;
	&#xD;
	&#xD;
	Renuka M, Rakesh A, Babu NM, Santosh KA. Nutritional 22. status of Jenukuruba preschool children in Mysore district, Karnataka. J Res Med Sci 2011;1:12-7.&#xD;
	&#xD;
	&#xD;
	Farid-ul-Hasnain S, Sophie R. Prevalence and risk factors for Stunting among children under 5 years: a community-based study from Jhangara town, Dadu Sindh. J Pak Med Assoc 2010;60(1):41.&#xD;
	&#xD;
	&#xD;
	Badham J, Sweet L. Stunting: an overview. Sight and Life Magazine. 2010(3/2010):40-7.&#xD;
	&#xD;
	&#xD;
	UNICEF. Key facts and figures on nutrition. https://data.unicef.org/topic/nutrition/&#xD;
	&#xD;
	&#xD;
	Unicef. The state of the world&amp;#39;s children 2012: children in an urban world. social sciences; 2012 Mar. https://www.unicef.org/reports/state-worlds-children-2012.&#xD;
	&#xD;
	&#xD;
	Islam S, Goswami&#xA0;Mahanta&#xA0;T, Sharma&#xA0;R,&#xA0;Hiranya&#xA0;S. Nutritional Status of under 5&#xA0;Children&#xA0;belonging&#xA0;to&#xA0;Tribal&#xA0;Population&#xA0;Living&#xA0;in Riverine (Char) Areas of Dibrugarh&#xA0;District,&#xA0;Assam. Indian J&#xA0;Community Med 2014?39(3):169&#x2013;74.&#xD;
	&#xD;
	&#xD;
	Mandal GC, Bose K, Bisai S, Ganguli S. Undernutrition among integrated child development services (ICDS) scheme children aged 2-6 years of Arambag, Hooghly district, West Bengal, India: A serious public health problem. Italian J Public Health 2012;16(1).&#xD;
	&#xD;
	&#xD;
	Collins S, Yates R. The need to update the classification of acute malnutrition. Lancet 2003;362(9379):249.&#xD;
	&#xD;
	&#xD;
	UNICEF. Progress for children: a World fit for children: a statistical review. 2007. https://www.unicef.org/reports/progress-children-no-6.&#xD;
	&#xD;
	&#xD;
	Kant L, Gupta A, Mehta SP. Profile of Anganwadi workers and their knowledge about ICDS. Indian J Pediatr 1984;51(4):401-2.&#xD;
	&#xD;
	&#xD;
	International Institute for Population Sciences (IIPS),&#xA0; District Level Household and Facility&#xA0; Survey (DLHS-4), 2013-2014: Maharashtra. Available from-http://www.iipsindia.org/pdf/Directos_Report_2013-2014.pdf&#xD;
	&#xD;
	&#xD;
	Ricci JA, Becker S. Risk factors for wasting and stunting among children in Metro Cebu, Philippines. Am J Clin Nutr 1996;63(6):966-75.&#xD;
	&#xD;
	&#xD;
	Adel ET, Marie-Fran&#xE7;oise RC, Salaheddin MM, Najeeb E, Monem Ahmed A, Ibrahim B, et al. Nutritional status of under-five children in Libya; a national population-based survey. Libyan J Med 2008;3(1):13-9.&#xD;
	&#xD;
	&#xD;
	Fawzi WW, Herrera MG, Willett WC, Nestel P, El Amin A, Mohamed KA. The effect of vitamin A supplementation on the growth of preschool children in Sudan. Am J Public Health. 1997;87(8):1359-62.&#xD;
	&#xD;
	&#xD;
	Reyes H, P&#xE9;rez-Cuevas R, Sandoval A, Castillo R, Santos JI, Doubova SV, et al. The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study. BMC Public Health. 2004;4(1):57.&#xD;
	&#xD;
	&#xD;
	Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD. Poverty, child undernutrition and morbidity: new evidence from India. Bulletin of the World Health Organization. 2005;83:210-6.&#xD;
	&#xD;
	&#xD;
	Ergin F, Okyay P, Atasoylu G, Beser E. Nutritional status and risk factors of chronic malnutrition in children under five years of age in Aydin, a western city of Turkey. Turkish J Pediatr 2007;49(3):283.&#xD;
	&#xD;
	&#xD;
	Mittal A, Singh J, Ahluwalia SK. Effect of maternal factors on nutritional status of 1-5-year-old children in urban slum population. Indian J Comm Med 2007;32(4):264.&#xD;
	&#xD;
	&#xD;
	Briend A, Prinzo ZW. Dietary management of moderate malnutrition: time for a change. Food Nutr Bull 2009;30(3_suppl3): S265-6.&#xD;
	&#xD;
	&#xD;
	Sengupta P, Philip N, Benjamin AI. Epidemiological correlates of under-nutrition in under-5 years children in an urban slum of Ludhiana. Health Population Perspect Issues. 2010;33(1):1-9.&#xD;
	&#xD;
	&#xD;
	Dani V, Satav A, Pendharkar J, Ughade S, Jain D, Adhav A, Sadanshiv A. Prevalence of under nutrition in under-five tribal children of Melghat: A community-based cross-sectional study in Central India. Clin Epidemiol Global Health. 2015;3(2):77-84.&#xD;
	&#xD;
	&#xD;
	Sharif ZM, Ang M. Assessment of food insecurity among low-income households in Kuala Lumpur using the Radimer/Cornell food insecurity instrument&#x2013;a validation study. Malays J Nutr. 2001;7(1 &amp; 2):15-32.&#xD;
	&#xD;
	&#xD;
	Ejaz MS, Latif N. Stunting and micronutrient deficiencies in malnourished children. JPMA. 2010;60(543).&#xD;
	&#xD;
	&#xD;
	Bhavsar S, Hemant M, Kulkarni R. Maternal and environmental factors affecting the nutritional status of children in Mumbai urban slum. Int J Sci Res Pub. 2012 Nov;2(11):1-9.&#xD;
	&#xD;
	&#xD;
	Zere E, McIntyre D. Inequities in under-five child malnutrition in South Africa. Int J Equity Health 2003;2(1):7.&#xD;
	&#xD;
	&#xD;
	Anand A, Sahoo D. Household and Environmental Conditions Influencing Health and Survival of Children in Northern and Southern Regions of India. IUSSP International Population Conference 2013 At: Busan, Korea.&#xD;
	&#xD;
	&#xD;
	Saxena N, Nayar D, Kapil U. Prevalence of underweight, stunting and wasting. Indian Paediatr 1997;34:627-30.&#xD;
	&#xD;
	&#xD;
	Teshome B, Kogi-Makau W, Getahun Z, Taye G. Magnitude and determinants of stunting in children under five years of age in food surplus region of Ethiopia: the case of west gojam zone. Ethiop J Health Dev 2009;23(2):237-241.&#xD;
	&#xD;
	&#xD;
	Gurmu E, Etana D. Household structure and children&#x2019;s nutritional status in Ethiopia. Genus. 2013;69(2).&#xD;
	&#xD;
	&#xD;
	Baig-Ansari N, Rahbar MH, Bhutta ZA, Badruddin SH. Child&amp;#39;s gender and household food insecurity are associated with stunting among young Pakistani children residing in urban squatter settlements. Food Nutr Bull 2006;27(2):114-27.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Highlights on Synthetic, Natural, and Hybrid Cholinesterase Inhibitors for Effective Treatment of Alzheimer&#x2019;s Disease: A Review&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>27</FirstPage><LastPage>34</LastPage><AuthorList><Author>Kishor Danao</Author><AuthorLanguage>English</AuthorLanguage><Author> Yogesh Kodape</Author><AuthorLanguage>English</AuthorLanguage><Author> Debarshi Mahapatra</Author><AuthorLanguage>English</AuthorLanguage><Author> Sachin Borikar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Nilesh Karande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Alzheimer&#x2019;s disease (AD) is a progressive age-related neurodegenerative disorder and is the most common form of dementia among the elderly (65 years). The main pathological hallmarks of AD are the accumulation of amyloid plaques, or senile plaques, containing extracellular deposits of amyloid-&#x3B2; peptide (A&#x3B2;) and the presence of intraneuronal neurofibrillary tangles (NFTs), which result from hyperphosphorylated tau-protein. While preparing this review article, a huge collection of published literature from diverse pharmaceutical databases, life science databases, and medical databases such as PubMed, ScienceDirect, Google Scholar, etc. were explored and the literature was classified duly. The article focuses on various cholinesterase inhibitors obtained from diverse sources or categories such as established synthetic inhibitors (Physostigmine, Tacrine, Donepezil, Rivastigmine, Galantamine, and Metrifonate), novel synthetic inhibitors (Phenserine, Tolserine, Tesofensine, and Esolerine), natural inhibitors (Huperzine A, Neferine, Galangin, and Cardanol), synthetic hybrid derivatives (Donepezil and AP2238; Donepezil-Tacrine Hybrid; Tacrine-Ferulic acid Hybrid and Beta Carboline Derivatives; and Tacrine-8-hydroxyquinoline Hybrid), and new experimental synthetic analogues (Phenyl-5,6-dimethoxy-1-oxo-2,3-dihydro-1H-2-indenylmethanone and N-alkyl-7-methoxymatrine). This interesting piece of literature may serve as a readymade reference text material (particularly molecular-weight inhibitors) to the enthusiastic researchers (pharmacologists and medicinal chemists) working delicately in the area of AD. This study will positively open novel opportunities for research and futuristic pharmacotherapeutic application perceptive.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Alzheimer&#x2019;s, Natural, Hybrid, Synthetic, Inhibitor, Cholinesterase&#x2019;s</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Alzheimer&amp;#39;s disease (AD) is a progressive age-related neurodegenerative disorder and is the most common form of dementia among the elderly.1 It is generally diagnosed in individuals over the age of 65 years.2 The main pathological hallmarks of AD are the accumulation of amyloid plaques, or senile plaques, containing extracellular deposits of the amyloid-&#x3B2; peptide (A&#x3B2;) and the presence of intraneuronal neurofibrillary tangles (NFTs), which result from hyperphosphorylated tau-protein.3 Secondary,&#xA0; pathological hallmark of AD is the oxidation of lipids, proteins, and nucleic acids in neurons.4 The aetiology of AD is still unknown, but several factors have been suggested that appear to reduce the incidence of the disease.5&#xD;
&#xD;
Three main approaches have been taken: &#xD;
&#xD;
&#xD;
	&#xD;
	The first involves the reestablishment of neurotransmitters levels, with the inhibition of cholinesterases such as acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and monoamine oxidase (MAO) enzymes.6&#xD;
	&#xD;
	&#xD;
	The second one concerns neuroprotection where oxidative stress is considered to be an early event in the pathological cascade for the disease, suggesting the potential use of antioxidants to limit the effects of free radicals on nerve cells.7&#xD;
	&#xD;
	&#xD;
	The third approach deals with specific aspects related to AD, including the decrease in the production or aggregation of A&#x3B2; peptide, and inhibition of &#x3B3; and &#x3B2;-secretase enzymes which play a critical role in the amyloidogenic and tau protein pathways, among others. Intracellular NFT is made up of paired microtubule-associated protein tau helical filaments, which are abnormally hyperphosphorylated.8 The emphasis on studies that the protein deposition viz. oligomeric A&#x3B2; and P-tau.9 Researcher is eagerly viewing the contribution of A&#x3B2; and P-tau in AD. Also, they studied the expression of other essential brain proteins, and eventually how they cause neurodegeneration.10 However, to understand the mechanism of neurotoxicity and to ensure successful treatment, it is also important to discern how both A&#x3B2; and P-tau communicate.11 Various types of neurons deteriorate through the development of AD, and there is a deep depletion of forebrain cholinergic neurons, which is followed by a gradual decrease in acetylcholine.12 AChE is regulated by both the acetylcholine-synthesizing enzyme choline acetyltransferase (ChAT) and the acetylcholine-hydrolyzing enzyme AChE.13 To a large degree, therapies intended to reverse the cholinergic deficit are focused on the relevance of cholinergic activity in cognition. Despite the general reduction in AChE activity in the AD brain, current AD treatment is primarily based on AChE antagonists, which improve cholinergic transmission but have limited and intermittent therapeutic effects.14 For almost 50 years, it has been well known that the distribution of AChE molecular types in the AD brain is especially disturbed, but the physiopathological importance and consequent effects of these fascinating changes in AChE organisms remain unclear.15 A typical characteristic of AD neuropathology is an improvement in AChE levels around amyloid plaques and NFT, but the importance of this rise remains to be determined.16,17 &#xD;
	&#xD;
&#xD;
&#xD;
ADNI&amp;#39;s main successes were as follows:18-20&#xD;
&#xD;
&#xD;
	&#xD;
	Production in a multicenter environment of systematic techniques for clinical studies, positron emission tomography (PET), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) biomarkers; &#xD;
	&#xD;
	&#xD;
	Elucidation of trends, imaging transition frequencies, and biomarker measures of CSF in control subjects, patients with MCI, and patients with AD. CSF biomarkers are compatible with &#x3B2;-amyloid cascade and tau-mediated neurodegeneration theories for AD expected disease trajectories, while brain atrophy and hypometabolism levels show predicted trends, but show varying rates of change depending on area and seriousness of disease; &#xD;
	&#xD;
	&#xD;
	The evaluation of alternate medical categorization approaches. The best classifiers currently integrate optimal features from several modalities, including MRI, fluorodeoxyglucose-PET, CSF biomarkers and clinical trials; &#xD;
	&#xD;
	&#xD;
	In mildly symptomatic or even non-symptomatic subjects, &#x3B2;-amyloid, CSF biomarkers, and tau, as well as amyloid PET, can represent the earliest steps in AD pathology and are leading candidates for the detection of AD in its preclinical stages; &#xD;
	&#xD;
	&#xD;
	Improving the quality of clinical trials by recognizing the samples who are more likely to suffer imminent potential clinical deterioration by using more responsive outcome tests to minimize sample sizes. Baseline cognitive and/or MRI tests typically expected a better potential regression than other modalities, whereas the most successful outcome measures were found to be MRI measures of improvement; &#xD;
	&#xD;
	&#xD;
	Confirmation of the CR1, CLU, and PICALM AD risk loci and recognition of new nominee risk loci; &#xD;
	&#xD;
	&#xD;
	Worldwide influence in Europe, Asia, and Australia through the development of ADNI-like programmes; &#xD;
	&#xD;
	&#xD;
	Understanding the biology and pathobiology of normal ageing, MCI, and AD by combining ADNI biomarker data with ADNI clinical data to promote studies to address disputes regarding contradictory theories about AD etiopathogenesis, thus advancing efforts to identify disease-modifying ADNI drugs;&#xD;
	&#xD;
	&#xD;
	The construction of networks to allow all raw and processed data to be exchanged without embargo by interested science investigators worldwide. The ADNI research was expanded by a two-year 2009 Grand Opportunities grant and a renewal of the ADNI (ADNI-2) from October 2010 to 2016, with an additional 550 participants participating in the study.&#xD;
	&#xD;
&#xD;
&#xD;
PATHOPHYSIOLOGY&#xD;
&#xD;
Alzheimer&#x2019;s disease occurs due to the formation of senile plaque and neurofibrillary tangle in the brain (mostly hippocampus and cortex region), where the senile plaque is formed at the surface of the neuron and NFT is created inside the neuron.21 A senile plaque is formed by &#x3B2;-amyloid protein and NFT is formed by tau protein due to hyperphosphorylation. Amyloid precursor proteins are present on the surface of the neuron and are normally cut by the enzymes such as &#x3B2;-secretase and &#x3B3;-secretase enzyme and this cut part is referred to as &#x3B2;-amyloid.22 This is collected in forming a fibre-like structure called senile plaque. NFT is formed and the signal is transferred from soma to the synapse, further, the signal is transferred from a neuron which is made up of microtubules.23 These microtubules are stabilized by tau protein. In Alzheimer&#x2019;s disease, this tau protein becomes defective and removes from microtubules.24 The defective tau protein is assembling in neurons and formed filament. An abnormal accumulation of tau filament in neuron form NFT. Senile plaque and NFT are deposited at the synaptic junction due to a decrease the released and concentration of acetylcholine.25&#xD;
&#xD;
ESTABLISHED SYNTHETIC CHOLINESTERASE INHIBITORS&#xD;
&#xD;
&#xD;
&#xD;
Physostigmine is a carbamate ester and an indole alkaloid that was the first ChE inhibitor investigated for the treatment of AD. It was isolated from the seeds of Physostigma venenosum, a para-sympathomimetic plant alkaloid. The blood-brain barrier (BBB) can move through, has a short half-life, and a small therapeutic index. It also has several side effects such as nausea, vomiting, diarrhoea, dizziness, and headaches. It was previously used for glaucoma treatment and delayed gastric emptying. However, because of the above-listed drawbacks, the drug was not licenced and was discarded for AD use. With a lower side effect profile, the newer medications proved to be more successful.26&#xD;
&#xD;
&#xD;
&#xD;
Tacrine is a 1,2,3-triazole derivative that acts both as AchE and BuchE. It was first approved for the treatment of AD in 1993 for its efficacy on the ADAS-Cog and the global measure compared to placebo in phase-II and phase-III clinical trials. For AD subjects, it was found to be quite limited owing to poor tolerance and precipitation of a number of side effects including vomiting, nausea, diarrhea, dizziness, syncope, and seizures. Also, the route of administration and patient compliance were challenging due to 4-times a day dosing regimen as a result of a short half-life. In addition, patients under treatment with this drug are required to have periodic blood monitoring due to hepatotoxicity. Finally, believed to be caused by the preference for BuChE and the availability of less toxic, better-tolerated medications with a simplified dosing schedule, tacrine was discontinued.27&#xD;
&#xD;
&#xD;
&#xD;
Donepezil is a piperidine derivative that acts as a selective and reversible inhibitor of AchE. Donepezil was approved in 1996 for the treatment of mild-to-moderate AD. A high dose (23mg) formulation was approved for use for moderate to severe AD. It is well absorbed with a relative oral bioavailability of 100% and reaches peak plasma concentrations in 3-4 hrs. The elimination half-life is ~70 hrs and is approximately 96% bound to human plasma proteins. It is primarily metabolized by CYP450 isoenzymes 2D6 and 3A4 and undergoes glucuronidation. Donepezil is known to function not just at the level of the neurotransmitter, but even at the molecular and cellular level in virtually any stage involved in AD pathogenesis.28&#xD;
&#xD;
&#xD;
&#xD;
It is a carbamate derivative of reversible cholinesterase inhibitor that is selective for the central nervous system and is used for the treatment of AD. It is a small molecule and has easy BBB permeability which enables fantastic BuChE and AChE inhibitory properties. Rivastigmine was approved for the treatment of mild-to-moderate AD, &#xA0;in the year 2000 and has since gained approval for PAD after a trial with 699 patients. In capsular form, the drug has been assorting with side effects like nausea, vomiting, anorexia, and diarrhoea. In 2007, Rivastigmine was reformulated for delivery through a transdermal patch which resulted in significantly lowered GI side effects compared to the oral capsule. It is minimally metabolized by the CYP450 cytochrome system with weak binding to plasma proteins (~40%). The duration of ChE activity in cerebrospinal fluid is ~10 hrs after a 6-mg oral dose.29&#xD;
&#xD;
&#xD;
&#xD;
It is a benzazepine derivative obtained from norbelladine. It is found in Galanthus and Other Amaryllidaceae. Galantamine has been &#xA0;medicinal activity due to its sensitising action on nAChRs rather than general cholinergic stimulation due to cholinesterase inhibition. For the treatment of mild-to-moderate AD, it was accepted. A substantial increase in the ADAS-cog score of 3.3 points for the 16 mg/day group and 3.6 points for the 24 mg/day group was correlated with the administration of this medication, as well as a noticeable improvement in the physiological, emotional and functional symptoms of AD compared with placebo.30&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Metrifonate was originally developed for treating schistosomiasis but later found to be a long-acting irreversible ChE inhibitor. Chemically, it is dimethyl phosphonate (phosphonic ester) where the hydrogen atom attached to the phosphorous is substituted by a 2,2,2-trichloro-1-hydroxyethyl group. Although there was a low risk of side effects with short-term use, long-term uses caused respiratory paralysis and neuromuscular transmission dysfunction similar to a myasthenic crisis. As such, the FDA submission was halted and the clinical trials were discontinued during phase-III. However, show a robust therapeutic impact on ADAS-cog and other tests. However, before the further study of the relationship between metrifonate and neuromuscular disease is conducted, metrifonate is currently not an alternative for treatment with AD. Metrifonate is not an authorized for AD medication but demonstrates effectiveness that has been outweighed by safety hazards.31&#xD;
&#xD;
NOVEL SYNTHETIC CHOLINESTERASE INHIBITORS&#xD;
&#xD;
&#xD;
&#xD;
Phenserine is the phenyl carbamate derivation of physostigmine that has a dual effect due to the addition of methyl group on phenyl carbamate moiety by decreasing &#x3B2;-amyloid precursor protein and has a reversible AChE inhibition. It is less toxic than physostigmine and tacrine and has a rapid absorption rate. In elderly rats and dogs, increased learning and memory have also been demonstrated. Another, research on a dog found that phenserine increased learning and memory relative to dogs consuming the placebo group. During 2003-2004, 384 AD patients were enrolled at 10 mg and 15 mg twice daily doses in phase III clinical trial. Phenserine, however, did not substantially boost ADAS-cog scores relative to placebo.32&#xD;
&#xD;
Tolserine&#xD;
&#xD;
Tolserine only differs from Phenserine at the 2-methyl substitution on its phenyl carbamoyl moiety. The pre-clinical studies were initiated in the year 2000 and it showed 200-fold more selectivity against AChE vs. BuChE. Tolserine proved to be a highly potent inhibitor of human AChE compared to its structural analogues physostigmine and phenserine.33&#xD;
&#xD;
&#xD;
&#xD;
Tesofensine belongs to the phenyl tropane category. It inhibits the presynaptic uptake of serotonin, norepinephrine and dopamine neurotransmitters in both in vitro and in vivo studies. The compound increases the function of the neurotransmitters acetylcholine, noradrenaline, and dopamine, both of which are impaired in patients with AD. A decrease &#x3B2;-amyloid concentration was found in mice after the use of tesofensine which was thought to be a neuroprotective effect. Phase-IIA trials showed significant cognitive improvement in those with mild AD. However, Phase-IIB trials showed limited activity. Currently, tesofensine is being marketed as a drug against obesity.34&#xD;
&#xD;
Esolerine&#xD;
&#xD;
Esolerine, a cyclic alkyl carbamate and a tacrine derivative which has been identified as a very strong AChE inhibitor and significantly favoured AChE over BuChE. But, there are no published reports in humans, so it is difficult to identify potential risks and benefits in pre-clinical and clinical models.35&#xD;
&#xD;
NATURAL DERIVATIVES&#xD;
&#xD;
&#xD;
&#xD;
Huperzine-A (HupA) is a lycopodium alkaloid used for memory deficiency isolated from the Chinese medicinal herb Huperzia serrata. The plant is widely grown in China and several other regions of Asia. The famous Chinese Medicine tradition emphasizes this plant and its products in various herbal remedies owing to high selectivity, reversibility, and potent AChE inhibition action. It is often considered to be the drug of choice in China for the treatment of memory disorders. However, it has been noticed that the synthetic racemic mixture of HupA has less AChE inhibitory effect than the HupA of natural origin. For enhancing the potency and efficacy, Tacrine and donepezil have also been hybridised with HupA. Since the donepezil hybrid was less successful, the HupA-tacrine hybrids were called huprines (huprine Y and huprine X) have shown to be more effective in inhibiting the enzyme AChE in vitro than tacrine. Huprine Y and Huprine Z have shown better inhibitory activity than either of the parent drugs as well HupA with a higher oral bioavailability as compared to tacrine and donepezil. The improvement is more noticeable on working memory than reference memory as compared to donepezil and tacrine. In terms of inhibition functions, HupA is also found to be more active than tacrine, rivastigmine, and galantamine, although it has the least amount of BuChE activity.36&#xD;
&#xD;
&#xD;
&#xD;
Nelumbo nucifera is an aquatic plant with numerous medicinal properties. It has been recently observed that the stamens of this plant drastically improved the maze learning tasks in rats when fed for a specific duration. Few compounds have been identified as neferine, 5-O-methyladenosine, cycloartenol, vanilloloside, a &#x3B2;-cyclogeraniol diglycoside, p-hydroxybenzoic acid, etc. which demonstrated excellent non-competitive inhibition of AChE and BuChE which opened new avenues for treating AD.37&#xD;
&#xD;
Galangin&#xD;
&#xD;
&#xD;
&#xD;
Himatanthus lancifolius is a shrub that contains several indole alkaloids having several medicinal properties such as antimicrobial effects, gastroprotection, and the ability to affect the vascular and non-vascular smooth muscle responsiveness. The AChE inhibiting properties of ethyl acetate and dichloromethane extracts (containing 21 different flavonoids) have been in vitro studied where significant inhibition of the target was observed. Because of their free radical scavenging properties, flavonoids have been of considerable importance in AD science and care. Epidemiological data shows that higher flavonoid intake is associated with lower AD incidence. Galangin, a flavonol has demonstrated the highest inhibitory effects on AChE activity. However, it is unknown whether galangin binds to the AChE directly or has the same binding site as the ATCh substrate38. &#xD;
&#xD;
&#xD;
&#xD;
The cashew nut-shell liquid (CNSL) containing primary non-isoprenoid phenolic lipids (NIPL) components such as cardols, cardanols, anacardic acids, and methylcardols have been recognized as potential templates for the development of AChE inhibitors. The produced derivatives had electrical, hydrophobic, and structural properties that are required to act potentially as AChE molecules. The promising candidates for AD treatment have been identified from cardanols because of the abundance of the raw material source. Although, there are no human studies reported to date.39&#xD;
&#xD;
SYNTHETIC HYBRID DERIVATIVES&#xD;
&#xD;
&#xD;
&#xD;
AP2238 is the first published compound to bind with both the anionic sites of AChE. The inhibitory potency against AChE is comparable to donepezil, while its ability to contrast &#x3B2;-amyloid aggregation is higher. A sequence of donepezil and AP2238 hybrids was formed in which the donepezil idanone centre is bound to the AP2238 phenyl-N-methylbenzylamino moiety. A derivative in which the AP2238 phenyl-N-methylbenzylamino moiety was substituted by the AP2243 phenyl-N-methylbenzylamino moiety and a tetralone scaffold was replaced by the idanone ring. The hybrids showed improved inhibition of AChE-induced aggregation vastly when compared to the reference compounds.40&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Researchers engineered a new sequence of donepezil-tacrine hybrids, interacting concurrently at the periphery, active, and mid gorge binding sites of AChE. They are appealing because both compounds have known effectiveness and BBB permeability with rather distinct MOAs. They were tested for the ability to inhibit BuChE, AChE, and &#x3B2;-amyloid accumulation caused by AChE. The compounds are a mixture of donepezil and 6-chlorotacrine 5,6-dimethoxy-2-[(4-piperidinyl)methyl]-1-idanone molecules. All of the recent hybrids have proved to be incredibly potent inhibitors of hAChE. Both of the new compounds also displayed strong &#x3B2; amyloid aggregation inhibition and were found to be more active than the parent molecules.41&#xD;
&#xD;
Tacrine-Ferulic acid Hybrid and Beta Carboline Derivatives&#xD;
&#xD;
&#xD;
&#xD;
There were 3 &#x3B2;-carboline derivatives and 2 tacrine/ferulic acid combinations tested in vivo in 3-month-old female rats. The tacrine/ferulic acid hybrids exhibited stronger AChE inhibition and similar BuChE inhibition as compared with tacrine in vitro. However, neither compounds showed any therapeutic effects against scopolamine-induced cognitive deficits in vivo. Despite the promising in vitro information, none of the compounds is currently suitable for AChE inhibition against AD.42&#xD;
&#xD;
&#xD;
&#xD;
Both tacrine and tacrine 8-hydroxyquinoline derivative are known for ChE inhibition and decreasing &#x3B2;-amyloid concentrations, respectively. Recently, few novel tacrine-8-hdroxyquinoline hybrids have been synthesized and evaluated as possible therapeutic drugs for AD treatment where the hybrids were found to be more effective than tacrine against AChE and BuChE with low cell level toxicity and better BBB penetration.43&#xD;
&#xD;
NEW EXPERIMENTAL SYNTHETIC ANALOGS&#xD;
&#xD;
Phenyl-5,6-dimethoxy-1-oxo-2,3-dihydro-1H-2-indenylmethanone&#xD;
&#xD;
This series of synthetic analogues are currently under development because of targeted pharmacological development, class-specific hepatotoxicity, and known gastrointestinal side effects which may be avoided. The possibility of producing synthetic analogues is that as naturally derived ChEIs they will have the strength and BBB permeability or they may have unanticipated pharmacological properties. This phenyl-5,6-dimethoxy-1-oxo-2,3-dihydro1H-2-indenylmethanone series showed that the majority of the compounds had moderate AChE inhibitory activity.44&#xD;
&#xD;
N-Alkyl-7-methoxytacrine&#xD;
&#xD;
Tetrahydro amino acridine (THA) was the first AChEI developed, but dose-dependent but reversible liver toxicity was caused by using the drug. 7-methoxytacrine (7-MEOTA) is a much less toxic THA analogue that is pharmacologically similar to THA. The synthesized 7-MEOTA analogues presented in vitro human recombinant AChE (hAChE) and human plasmatic BuChE (hBuChE) enzyme inhibition which was compared to both THA and 7-MEOTA. The structure-activity relationship findings point at the C6-C7 N-alkyl chains for ChE inhibition.45&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
This vital review content largely underlined the synopsis of various causes of Alzheimer&#x2019;s disease including the pathogenesis. The article focuses on various cholinesterase inhibitors obtained from diverse sources or categories such as established synthetic inhibitors (Physostigmine, Tacrine, Donepezil, Rivastigmine, Galantamine, and Metrifonate), novel synthetic inhibitors (Phenserine, Tolserine, Tesofensine, and Esolerine), natural inhibitors (Huperzine A, Neferine, Galangin, and Cardanol), synthetic hybrid derivatives (Donepezil and AP2238; Donepezil-Tacrine Hybrid; Tacrine-Ferulic acid Hybrid and Beta Carboline Derivatives; and Tacrine-8-hydroxyquinoline Hybrid), and new experimental synthetic analogues (Phenyl-5,6-dimethoxy-1-oxo-2,3-dihydro-1H-2-indenylmethanone and N-alkyl-7-methoxytacrine). This interesting piece of literature may serve as a readymade reference text material (particularly the low molecular-weight inhibitors) to the enthusiastic researchers (pharmacologists and medicinal chemists) working in the area of Alzheimer&#x2019;s disease. This study will positively open novel opportunities for research and futuristic pharmacotherapeutic application perceptive.&#xD;
&#xD;
ACKNOWLEDGMENT&#xD;
&#xD;
The authors acknowledge the kind support of the college management for providing internet facilities for the literature review.&#xD;
&#xD;
CONFLICT OF INTEREST&#xD;
&#xD;
The authors stated No Conflict of Interest for the Publication of this review article in the Journal.&#xD;
&#xD;
FUNDING INFORMATION&#xD;
&#xD;
None acknowledged.&#xD;
&#xD;
AUTHOR CONTRIBUTION&#xD;
&#xD;
KRD: Supervise the literature survery and drafting and editing of the manuscript&#xD;
&#xD;
YK: Complete literature survey performed&#xD;
&#xD;
DKM: Made Chemical Structures, Wrote Structured Abstract, Drawn Graphical Abstract, Set References, Grammatical corrections&#xD;
&#xD;
SPB: Removed plagiarized contents and attended manuscript revisions&#xD;
&#xD;
UNM: Final reviewing of this manuscript and provided suggestions&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3754</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3754</Fulltext></URLs><References>1. Finch CE, Cohen DM. Aging, metabolism, and Alzheimer disease: review and hypotheses. Exp Neurol. 1997;143(1):82-102.&#xD;
&#xD;
2. Cutler NR, Sramek JJ. Review of the next generation of Alzheimer&amp;#39;s disease therapeutics: challenges for drug development. Prog Neuropsychopharmacol Biol Psychiatry. 2001;25(1):27-57.&#xD;
&#xD;
3. Moraros J. The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta?analysis. Depress Anxiety. 2017;34(3):217-26.&#xD;
&#xD;
4. Cummings J. Drug development in Alzheimer&#x2019;s disease: the path to 2025. Alzheimers Res Ther. 2016;8(1):39.&#xD;
&#xD;
5. Sramek JJ, Zarotsky V, Cutler NR. Review of drug development and therapeutic role of cholinesterase inhibitors in Alzheimer&amp;#39;s disease. Drug Dev Res. 2002;56(3):347-53.&#xD;
&#xD;
6. Kumar A, Singh A. A review on Alzheimer&amp;#39;s disease pathophysiology and its management: an update. Pharmacol Rep. 2015;67(2):195-203.&#xD;
&#xD;
7. Rosenberg RN. Genomics of Alzheimer disease: a review. JAMA Neurol. 2016;73(7):867-74.&#xD;
&#xD;
8. Jalbert JJ, Daiello LA, Lapane KL. Dementia of the Alzheimer type. Epidemiol Rev. 2008;30(1):15-34.&#xD;
&#xD;
9. Christensen H, Griffiths K, MacKinnon A, Jacomb P. A quantitative review of cognitive deficits in depression and Alzheimer-type dementia. J Int Neuropsychol Soc 1997;3(6):631-51.&#xD;
&#xD;
10. Cazarim MD., Perspectives for treating Alzheimer&amp;#39;s disease: a review on promising pharmacological substances. Sao Paulo Med J. 2016;134(4):342-54.&#xD;
&#xD;
11. Samanta MK, Wilson B, Santhi K, Kumar KS, Suresh B. Alzheimer disease and its management: a review. Am J Therapeut 2006;13(6):516-26.&#xD;
&#xD;
12. El Kadmiri N. Biomarkers for Alzheimer disease: Classical and novel candidates&#x2019; review. Neuroscience 2018;370:181-90.&#xD;
&#xD;
13. Folch J. Review of the advances in treatment for Alzheimer disease: strategies for combating &#x3B2;-amyloid protein. Neurolog&#xED;a. 2018;33(1):47-58.&#xD;
&#xD;
14. Whitehouse PJ. Neurotransmitter receptor alterations in Alzheimer disease: a review. Alzheimer Dis Assoc Disord. 1987;1(1):9-18.&#xD;
&#xD;
15. Giacobini E. Invited Review Cholinesterase inhibitors for Alzheimer&#x2019;s disease therapy: from tacrine to future applications. Neurochem Int. 1998;32(5-6):413-9.&#xD;
&#xD;
16. Mangialasche F. Alzheimer&amp;#39;s disease: clinical trials and drug development. Lancet Neurol. 2010;9(7):702-16.&#xD;
&#xD;
17. Anand P, Singh B. A review on cholinesterase inhibitors for Alzheimer&#x2019;s disease. Arch Pharm Res. 2013;36(4):375-99.&#xD;
&#xD;
18. Bolognesi ML. Melchiorre C. Alzheimer&amp;#39;s disease: new approaches to drug discovery. Curr Opin Chem Biol. 2009;13(3):303-8.&#xD;
&#xD;
19. Kaduszkiewicz H, Cholinesterase inhibitors for patients with Alzheimer&amp;#39;s disease: systematic review of randomised clinical trials. Br Med J. 2005;331(7512):321-7.&#xD;
&#xD;
20. West S, Bhugra P. Emerging drug targets for A&#x3B2; and tau in Alzheimer&amp;#39;s disease: a systematic review. Br J Clin Pharmacol. 2015;80(2):221-34.&#xD;
&#xD;
21. Cummings J, Lee G, Ritter A, Zhong K. Alzheimer&amp;#39;s disease drug development pipeline: 2018. Alz Dement Transl Res Clin Interv. 2018;4:195-214.&#xD;
&#xD;
22. Cummings JL, Morstorf T, Zhong K. Alzheimer&#x2019;s disease drug-development pipeline: few candidates, frequent failures. Alz Res Ther. 2014;6(4):1-7.&#xD;
&#xD;
23. Ng YP, Or TC, Ip NY. Plant alkaloids as drug leads for Alzheimer&amp;#39;s disease. Neurochem Int. 2015;89:260-70.&#xD;
&#xD;
24. Darvesh S. Inhibition of human cholinesterases by drugs used to treat Alzheimer disease. Alzheimer Dis Assoc Disord. 2003;17(2):117-26.&#xD;
&#xD;
25. Rosini M., Rational approach to discover multipotent anti-Alzheimer drugs. J Med Chem. 2005;48(2):360-3.&#xD;
&#xD;
26. Batiha GE. Physostigmine: A plant alkaloid isolated from Physostigma venenosum: A review on pharmacokinetics, pharmacological and toxicological activities. J Drug Deliv Therapeut. 2020;10(1-s):187-90.&#xD;
&#xD;
27. Sameem B, Saeedi M, Mahdavi M, Shafiee A. A review on tacrine-based scaffolds as multi-target drugs (MTDLs) for Alzheimer&amp;#39;s disease. Eur J Med Chem. 2017;128:332-45.&#xD;
&#xD;
28. Greig SL. Memantine ER., donepezil: a review in Alzheimer&#x2019;s disease. CNS drugs. 2015;29(11):963-70.&#xD;
&#xD;
29. Schneider LS. Systematic review of the efficacy of rivastigmine for patients with Alzheimer&amp;#39;s disease. Int J Geriatr Psychopharmacol. 1998;1(1):S26-34.&#xD;
&#xD;
30. Corey-Bloom J. Galantamine: a review of its use in Alzheimer&amp;#39;s disease and vascular dementia. Int J Clin Pract. 2003;57(3):219-23.&#xD;
&#xD;
31. Ringman JM, Cummings JL. Metrifonate: update on a new antidementia agent. J Clin Psychiatry. 1999;60(11):776-82.&#xD;
&#xD;
32. Winblad B. Phenserine efficacy in Alzheimer&amp;#39;s disease. J Alzheimers Dis. 2010;22(4):1201-8.&#xD;
&#xD;
33. Kamal MA, Greig NH, Alhomida AS, Al-Jafari AA. Kinetics of human acetylcholinesterase inhibition by the novel experimental Alzheimer therapeutic agent, tolserine. Biochem Pharmacol. 2000;60(4):561-70.&#xD;
&#xD;
34. Lehr T. Quantitative pharmacology approach in Alzheimer&#x2019;s disease: efficacy modeling of early clinical data to predict clinical outcome of tesofensine. AAPS J. 2010;12(2):117-29.&#xD;
&#xD;
35. Habtemariam S. Natural products in Alzheimer&#x2019;s disease therapy: would old therapeutic approaches fix the broken promise of modern medicines? Molecules. 2019;24(8):1519.&#xD;
&#xD;
36. Bai D. Development of huperzine A and B for treatment of Alzheimer&amp;#39;s disease. Pure Appl Chem. 2007;79(4):469-79.&#xD;
&#xD;
37. Jung HA. Selective cholinesterase inhibitory activities of a new monoterpene diglycoside and other constituents from Nelumbo nucifera stamens. Biol Pharm Bull. 2010;33(2):267-72.&#xD;
&#xD;
38. Seidl C. Acetylcholinesterase inhibitory activity of uleine from Himatanthus lancifolius. Zeitschrift f&#xFC;r Naturforschung C. 2010;65(7-8):440-4.&#xD;
&#xD;
39. Stasiuk M. Inhibitory effect of some natural and semisynthetic phenolic lipids upon acetylcholinesterase activity. Food Chem. 2008;108(3):996-1001.&#xD;
&#xD;
40. Rizzo S, Bartolini M, Ceccarini L, Piazzi L, Gobbi S, Cavalli A, et al. Targeting Alzheimer&#x2019;s disease: Novel indanone hybrids bearing a pharmacophoric fragment of AP2238. Bioorg Med Chem. 2010;18(5):1749-60.&#xD;
&#xD;
41. Alonso D, Medina M. Donepezil&#x2013;tacrine hybrid related derivatives as new dual binding site inhibitors of AChE. Bioorg Med Chem. 2005;13(24):6588-97. &#xD;
&#xD;
42. Fleck C. Investigation into the in vivo effects of five novel tacrine/ferulic acid and &#x3B2;-carboline derivatives on scopolamine-induced cognitive impairment in rats using radial maze paradigm. Arzneimittelforschung. 2010;60(06):299-306.&#xD;
&#xD;
43. Ferna?ndez-Bachiller MI. Novel tacrine&#x2212; 8-hydroxyquinoline hybrids as multifunctional agents for the treatment of Alzheimer&#x2019;s disease, with neuroprotective, cholinergic, antioxidant, and copper-complexing properties. J Med Chem. 2010;53(13):4927-37.&#xD;
&#xD;
44. Ali MA. Design, synthesis and evaluation of novel 5, 6-dimethoxy-1-oxo-2, 3-dihydro-1H-2-indenyl-3, 4-substituted phenyl methanone analogues. Bioorg Med Chem Lett. 2009;19(17):5075-7.&#xD;
&#xD;
45. Korabecny J. Synthesis and in vitro evaluation of N-alkyl-7-methoxytacrine hydrochlorides as potential cholinesterase inhibitors in Alzheimer disease. Bioorg Med Chem Lett. 2010;20(20):6093-5.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Pathological Surprise in a Non-Functioning Kidney&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>35</FirstPage><LastPage>37</LastPage><AuthorList><Author>Kundhavai Chandrasekaran</Author><AuthorLanguage>English</AuthorLanguage><Author> Lawrence D'&#xA0;Cruze</Author><AuthorLanguage>English</AuthorLanguage><Author> Sandhya Sundaram</Author><AuthorLanguage>English</AuthorLanguage><Author> K. Natarajan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Upper urinary tract urothelial carcinoma is rare and accounts for about 5-10% of urothelial carcinomas. Grossly it may arise anywhere between the renal calyces to the distal ureter. Case Report: We report a very rare case of a 65-year-old male whose clinical and radiological diagnosis was pyelonephritis and non-functioning kidney but it turned out to be an unusual presentation of the tumour involving the entire kidney mimicking renal cell carcinoma. The final diagnosis of a high grade invasive urothelial carcinoma with squamous differentiation was rendered on histopathology highlighting the very rare presentation. Conclusion: We report a rare case of high-grade urothelial carcinoma in a non-functioning kidney.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Kidney involvement, Pyelonephritis, Non-functioning kidney, Squamous differentiation, Upper urinary tract tumour,  Urothelial carcinoma</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Upper urinary tract urothelial carcinoma is relatively rare and accounts for about only 5-10% of urothelial carcinomas.1Grossly it may arise anywhere between the renal calyces to the distal ureter.1,2 The tumour is usually advanced at the time of diagnosis. we report a rare case of urothelial carcinoma of the upper urinary tract.&#xD;
&#xD;
CASE REPORT&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; We report a case of a 65-year-old male who presented with right-sided loin pain, decreased urine output and low-grade fever for a week. On examination, right renal angle tenderness was present. So with a clinical diagnosis of right pyelonephritis routine investigations were done. Urine examination showed 5-6 pus cells and urine culture showed E.coli growth. The patient had anaemia and hypoproteinemia.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; CT - KUB showed a perinephric fluid collection with the possibility of infective aetiology.CT guided urogram revealed a nonfunctioning kidney with renal abscess extending into perinephric fat. Right ureteritis and cystitis were also seen.DTPA Renogram could not visualise right kidney indicating loss of function of the right kidney and subnormal function of left kidney. So with the clinical and radiological diagnosis of pyelonephritis and non-functioning kidney, open right nephroureterectomy was performed and the specimen was sent for histopathological examination.&#xD;
&#xD;
PATHOLOGICAL FINDINGS&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The right kidney specimen measured 8.7 x 5.4 x 4.5 cm. Grossly, on the cut section, there was a grey white lesion involving the entire kidney and extending into the ureter and perinephric fat mimicking renal cell carcinoma. The lesion was grey-white, soft to firm in consistency with no areas of haemorrhage or necrosis. The corticomedullary junction could not be made out. On microscopy, the lesion was arising from ureter and infiltrating into renal pelvis and renal parenchyma and the perinephric fat with dysplastic changes in the ureter. The lesion was composed of tumour cells arranged in sheets and clusters with individual cells having moderate to abundant eosinophilic cytoplasm and pleomorphic nuclei. Atypical mitosis was also seen. Few areas showed a squamoid pattern with intercellular bridges. Resected ureter margins showed carcinoma in situ. The final diagnosis was pT4 pNx Grade 2 Moderately differentiated High-grade urothelial carcinoma with squamous differentiation.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; Repeat surgery - Right segmental ureterectomy with bladder cuff resection was done. Grossly it was a 3cm tumour beyond muscularis into periureteral fat. The diagnosis was pT3 pNx High grade invasive urothelial carcinoma.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Upper urinary tract urothelial carcinoma is rare. The most common presentation is hematuria(70-80%),3 and loin pain. The elderly age group is most affected and has a male preponderance.4 CT urogram is the preferred investigation and cystoscopy and ureteroscopy is preferred for taking biopsies.1&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Intratubular spread has a very important impact on staging.4 types of intratubular spreads are pagetoid, typical, florid, secondary invasion from the intratubular spread.2 High-grade tumours have extensive intratubular spread.2 Urothelial carcinoma histologically has tumour cells arranged in sheets, cords with individual cells having moderate to abundant eosinophilic cytoplasm, pleomorphic nuclei. According to the literature, squamous differentiation is more commonly seen than glandular differentiation in urothelial carcinoma.5 Squamous differentiation was associated with chronic inflammatory conditions like chronic pyelonephritis. Few studies have shown squamous differentiation associated with poor prognosis.6&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sometimes the low-risk patients are treated by kidney sparing surgery.7 However, the gold standard treatment for upper urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection.8 Majority of the patients with upper tract urothelial carcinoma present in higher grade and stage of the tumour. So the upper tract urothelial carcinoma has poor prognosis than the bladder tumour.9 Recurrences can occur in the bladder.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; We report a case of upper urinary tract urothelial carcinoma where the clinical diagnosis was pyelonephritis and non-functioning kidney but it turned out to be an unusual presentation of the tumour involving the entire kidney mimicking renal cell carcinoma but the final diagnosis was high grade invasive urothelial carcinoma with squamous differentiation.&#xD;
&#xD;
ACKNOWLEDGEMENT: The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. &#xD;
&#xD;
Conflict of interest: Nil &#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3755</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3755</Fulltext></URLs><References>1. Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, et al. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 2017;35(3):379?87.&#xD;
&#xD;
2. Sarungbam J, Kurtis B, Phillips J, Cai D, Zhang D, Humayun I, et al. Upper urinary tract urothelial carcinoma with intratubular spread. Am J Clin Exp Urol 2014;2(2):102?10.&#xD;
&#xD;
3. Qi N, Zhang J, Chen Y, Wen R, Li H. Microscopic hematuria predicts lower stage in patients with upper tract urothelial carcinoma. Cancer Manag Res 2018;10:4929?33. &#xD;
&#xD;
4. Wang LJ, Chou WC, Pang ST, Yang CW, Chuang CK, Chang YH, et al. Risk Stratification of Upper Urinary Tract Urothelial Carcinoma Patients for Survival Prediction: A Simple Summation Scoring Method. J Cancer 2018;9(13):2284?94.&#xD;
&#xD;
5. Mazzucchelli R, Scarpelli M, Galosi AB, Primio RD, Beltran AL, Cheng L, et al. Pathology of upper tract urothelial carcinoma with emphasis on staging. Int J Immunopathol Pharmacol 2014;27(4):509?16.&#xD;
&#xD;
6.Makise N, Morikawa T, Kawai T, Nakagawa T, Kume H, Homma Y, et al. Squamous differentiation and prognosis in upper urinary tract urothelial carcinoma. Int J Clin Exp Pathol 2015;8(6):7203?9. &#xD;
&#xD;
7. Leow JJ, Liu Z, Tan TW, Lee YM, Yeo EK, Chong YL. Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives. Onco Targets Ther 2020;13:1?15. &#xD;
&#xD;
8. Hutchinson R, Haddad A, Sagalowsky A, Margulis V. Upper tract urothelial carcinoma: special considerations. Clin Adv Hematol Oncol 2016;14(2):101?9.&#xD;
&#xD;
9. Qin C, Liang EL, Du ZY, Qiu XY, Tang G, Chen FR, et al. Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases: A retrospective cohort study. Medicine (Baltimore) 2017;96(21):e6945.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Solasodine with Coenzyme Q10 Supplementation Ameliorates High Fat Diet-Induced Metabolic Syndrome in Rats by Modulating Adipokines and Lipid Peroxidation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>38</FirstPage><LastPage>44</LastPage><AuthorList><Author>Kumar R</Author><AuthorLanguage>English</AuthorLanguage><Author> Khan MI</Author><AuthorLanguage>English</AuthorLanguage><Author> Prasad M</Author><AuthorLanguage>English</AuthorLanguage><Author> Badruddeen</Author><AuthorLanguage>English</AuthorLanguage><Author> Akhtar J</Author><AuthorLanguage>English</AuthorLanguage><Author> Swarnalata N</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Metabolic Syndrome (MS) is a group of disorders including abdominal obesity, glucose intolerance or insulin resistance, dyslipidemia, hypertension, lipid peroxidation, and pro-inflammatory states. Solasodine and Coenzyme Q10 are acknowledged as potent antioxidants that prevented oxidative stress; a critical risk factor for the progression of MS. Objective: To evaluate the potency of solasodine with coenzyme Q10 on high fat diet-induced metabolic syndrome in rats by modulating adipokines and lipid peroxidation. Methods: Out of six groups (n=6), one group as a control (normal) received a standard diet for 16 weeks, and the other five groups were administered with a high-fat diet (HFD) only or with pioglitazone, coenzyme Q10, Solasodine and Solasodine with coenzyme Q10, (SDQ10) for the last 4 weeks. Results: Animals feeding with HFD for 16 weeks exhibited a significant increase in body weight, total cholesterol, triglyceride, and a decrease in HDL-cholesterol as well as developed glucose intolerance. It also raised lipid peroxidation and leptin level as well as lowered reduced glutathione and adiponectin level. Treatment with a combination of solasodine and coenzyme Q10 effectively reversed the above paradigm of metabolic syndrome induced by a high-fat diet. Besides, treatment with SDQ10 reduced the lipid peroxidation and enhanced the reduced glutathione as well as normalized the levels of leptin and adiponectin. Conclusion: The combined supplementation of solasodine and coenzyme Q10 reversed the effect of HFD intake on lipid peroxidation and adipocytokine levels and improve the symptoms of metabolic syndromeA&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adiponectin, Dyslipidemia, Glucose Intolerance, Leptin, Oxidative stress</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Metabolic syndrome (MS) is a heaping of three or more disorders including abdominal obesity, glucose intolerance or insulin resistance, dyslipidemia, hypertension, lipid peroxidation, and pro-inflammatory states. Each of these understated disorders is a consequential risk factor that can lead to the development of heart disease and endothelial dysfunction. The increased high-calorie food intake and reduced energy expenditure due to a sedentary lifestyle contribute to the present rising popularity of obesity.1,2 Studies have exposed that HFD plays a critical role to intensify obesity, hyperglycemia, dyslipidemia, impaired insulin sensitivity or glucose intolerance, oxidative stress, and raised blood pressure, which is together clubbed as MS.3,4 Besides, adipose tissue-derived adipocytokines such as leptin and adiponectin are the important hormones that regulate body weight by regulating calorie intake and energy expenditure. Dysregulated secretion of these adipocytokines i.e. lower adiponectin and higher leptin may contribute to the progression of obesity and other metabolic disorders.5 Leptin inhibits appetite and decreased body mass by acting on the hypothalamus. However, a higher level of leptin was observed in most obese patients and animals but it fails to suppress feeding and decrease body mass, resulting in fat accumulation in adipose tissue as well as liver, muscle, and pancreas. This failure of leptin&amp;#39;s effect on body tissue is called leptin resistance which may lead to the progression of obesity and insulin resistance.6&#xD;
&#xD;
Solasodine (SD) is a principle aglycone (spiroketal) of solamargine and solasonine which are the most valuable steroidal glycoalkaloids, procured from different parts of solanaceous plants (family-Solanaceae).7 The earlier studies have exhibited that solasodine prevented lipid peroxidation (oxidative stress) and atherogenesis by reducing total cholesterol and LDL level in rats.8,9 Solasodine also contains several activities including anticancer, antiobesity, anti-inflammatory, antinociceptive, anticonvulsant, antifungal, immunomodulatory, and other activities on the central nervous system.10 In previous studies of acute toxicity, LD50 of SD was established as 2 g/kg in orally administered rats.11&#xD;
&#xD;
Besides, Coenzyme Q10 (Q10) is acknowledged as an intracellular antioxidant that protects mitochondrial membrane proteins by removing free radicals and preventing lipid peroxidation.12 Q10 may decrease hyperinsulinemia, hyperglycemia, hyperlipidemia, and blood pressure which are the important components of MS.13 The acute toxicity study is also reported that the LD50 of Q10 was greater than 20 g/kg, supports the safety of Q10 for oral consumption.14&#xD;
&#xD;
This study established that HFD intake for the 16 weeks leads to the onset of metabolic syndrome, through its effect on body weight, glucose tolerance, lipid profile, lipid peroxidation, and adipocytokines such as leptin and adiponectin level. This study also elucidates the potency of Solasodine with Coenzyme Q10 supplementation (SDQ10) against the HFD induced on lipid peroxidation and adipocytokine levels with improving the above paradigm of MS.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Test Chemicals&#xD;
&#xD;
A high-fat diet composed of (g/kg): Casein-250g, Cholesterol-10g, Lard-310g; dl-Methionine-3g, Yeast powder- 1g; Sodium chloride -1g; Pellet diet-365g was obtained from AIIMS, New Delhi. Solasodine and Coenzyme Q10 were obtained from Med Chem Express (LLC&#x2013;USA) and Sigma Chemical (St. Louis. Mo.). All the chemicals used were of analytical grade.&#xD;
&#xD;
Experimental animals&#xD;
&#xD;
Wistar albino rats of either sex weighing 150-170 g were selected for the study. All animals were acclimatized at standard room temperature and an adequate light schedule of 12hrs light and 12 hrs dark with food and water ad libitum. The experimental protocol was approved by the institutional animal ethical committee of KNIMT, Faculty of Pharmacy, Sultanpur (KNIMT/PHAR/IAEC/18/04). All experiments were performed as per the guidelines of CPCSEA.&#xD;
&#xD;
Experimental design&#xD;
&#xD;
The experiment was performed on rats divided into 6 groups randomly, each consisting of 5-7 animals. Group I as control was provided with a standard (normal) diet for 16 weeks. The HFD was given to the remaining five groups for 16 weeks. Group II continued to supply with HFD while group III was treated with pioglitazone (10 mg/kg, orally), group IV with Q10 (50 mg/kg, orally), group V with SD (50 mg/kg, orally), and Group VI with a combination of SD and Q10 i.e. SDQ10 (25 mg/kg of each; total 50 mg/kg, orally) in the last 4 weeks of study. All drugs were administered as a suspension prepared by 1% Carboxymethylcellulose.&#xD;
&#xD;
Measurement of Body, Organ Weights, and abdominal circumference&#xD;
&#xD;
Each animal&#x2019;s body weight was recorded before we begin our experiment &amp; then weekly during the entire period of the experiment by weighing balance. When the study period was over, the animals were sacrificed &amp; the weights of the liver, heart, and fat pad (adipose tissue) were measured. The abdominal circumference was measured every 4 weeks of the study periods.&#xD;
&#xD;
Oral glucose tolerance test (OGTT)&#xD;
&#xD;
After 16 weeks of HFD intake, OGTT was carried out in overnight-fasted animals by administration of glucose (2g/kg body weight) orally. Samples were taken before glucose administration and after glucose administration at 30, 60, 90,120 min respectively. The total area under the curve (AUC) in terms of mg/dl/h was calculated by the trapezoidal rule.15&#xD;
&#xD;
Biochemical estimation&#xD;
&#xD;
After 16 weeks of the study, Blood samples were taken from 12 hours of fasted animals via retro-orbital plexus and centrifuged at 2000 rpm for15 min to separate serum. Total cholesterol (TC) Triglycerides (TGs), and HDL-cholesterol in serum were determined by using Span diagnostic commercial kits. LDL and VLDL-cholesterol were also determined by using the formula of Friedelwald et al.16 The leptin and total adiponectin level were determined with rat leptin ELISA kit (BioVendor, Brno, Czech Republic) and adiponectin ELISA kit (Alpco diagnostics Salem, USA) respectively.&#xD;
&#xD;
The isolated liver was homogenized with phosphate buffer (pH7.4), and the homogenate was used for the estimation of lipid peroxidation (TBARS) and reduced glutathione (GSH) as antioxidant activity.&#xD;
&#xD;
Histopathology&#xD;
&#xD;
Isolated liver and heart tissue samples were kept in 10 % formalin neutral buffered solution, Section (5&#x3BC;m) were cut using rotary microtone and stained with hematoxylin &amp; eosin. The sections of all tissues were studied under an optical microscope to determine the level of tissue damage.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
All data were presented as mean &#xB1; S.E.M. To evaluate the differences among groups, one-way ANOVA followed by post hoc (Tukey&amp;#39;s) multiple comparison tests was used via Graph Pad Prism-8 computer program. The probability p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3756</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3756</Fulltext></URLs><References>&#xD;
	&#xD;
	Gregory JW. Prevention of Obesity and Metabolic Syndrome in Children. Front Endocrinol. 2019; 10(669):1-9.&#xD;
	&#xD;
	&#xD;
	Payab M, Ranjbar SH, Shahbal N, Qorbani M, Aletaha A, Aminjan HH et al. Effect of herbal medicines in obesity and metabolic syndrome: Asystemic review and meta-analysis of clinical trials. Phytother Res. 2019;17:1-20.&#xD;
	&#xD;
	&#xD;
	Xu RY, Wan YP, Tang QY, Wu J, Cai W. The effects of high fat on central appetite genes in Wistar rats: a microarray analysis. Clin Chim Acta 2008;397:96&#x2013;100.&#xD;
	&#xD;
	&#xD;
	Buettner R, Scholmerich J, Bollheimer LC. High-fat diets: modelling the metabolic disorders of human obesity in rodents. Obesity 2007; 15:798&#x2013;808.&#xD;
	&#xD;
	&#xD;
	Wu Q-M, Ni H-X, Lu X. Changes of adipokine expression after diabetic rats received sitagliptin and the molecular mechanism. Asian Pac J Trop Med 2016;9(9):893&#x2013;897. &#xD;
	&#xD;
	&#xD;
	Handjieva-Darlenska T. and Boyadjieva N. The effect of high-fat diet on plasma ghrelin and leptin levels in rats. J Physiol Biochem 2009;65(2):157&#x2013;164.&#xD;
	&#xD;
	&#xD;
	Hussain T, Gupta RK, Sweety K, Khan MS, Hussain MS, Arif Md, et al. Evaluation of the antihepatotoxic potential of Solanum xanthocarpum fruit against antitubercular drugs induced hepatopathy in experimental rodents. Asian Pac J Trop Biomed 2012: 454-60.&#xD;
	&#xD;
	&#xD;
	Sharma T, Airao V, Panara N, Vaishnav D, Ranpariya V, Sheth N, et al. Solasodine protects rat brain against ischemia/reperfusion injury through its antioxidant activity. Eur J Pharmacol. 2014;725:40-46. &#xD;
	&#xD;
	&#xD;
	Dixit VP, Varma M, Mathur NT, Mathur R, Sharma S. Hypocholesterolaemic and antiatherosclerotic effects of Solasodine. (C27H42O2N) in cholesterol-fed rabbits. J Phytother Res 1992; 6(5): 270-273. &#xD;
	&#xD;
	&#xD;
	Patel K, Singh RB, Patel DK. Medicinal significance, pharmacological activities, and analytical aspects of Solasodine: A concise report of current scientific literature. J Acute Dis 2013;23:92-98. &#xD;
	&#xD;
	&#xD;
	Chauhan K, Sheth N, Ranpariya V, Parmar S. Anticonvulsant activity of Solasodine isolated from Solanum sisymbriifolium fruits in rodents. Pharm Biol 2011;49:194-199. &#xD;
	&#xD;
	&#xD;
	Kettawan AT, Takahashi R. Kongkachuichai, &#xA0;Kishi T, Okamoto T. Protective Effects of coenzyme Q10 on Decreased Oxidative Stress Resistance Induced by Simvastatin. J Clin Biochem Nutr 2007; 40: 194&#x2013;202.&#xD;
	&#xD;
	&#xD;
	Singh RB, Rastogi,&#xA0;Rastogi V,&#xA0; NiazMA,&#xA0; MadhuSV,&#xA0;Chen M.et al.&#xA0; Blood pressure trends, plasma insulin levels and risk factors in rural-urban elderly populations of north India. Coronary Art Dis 1997; 8: 463&#x2013;468.&#xD;
	&#xD;
	&#xD;
	Fu X, Ji R, Dam J. Acute, subacute toxicity and genotoxic effect of CoQ10 in mice and rats. Regul Toxicol Pharmacol 2009; 53:1&#x2013;5.&#xD;
	&#xD;
	&#xD;
	Liu J, Zhang HJ, Ji BP, Cai SB, Wang RJ, Zhou F. A diet formula of Puerariae radix, Lycium barbarum, Crataegus pinnatifida, and Polygonati rhizome Alleviates insulin resistance and hepatic steatosis in CD-1 mice and HepG2 cells. Food Funct 2014;5(5):1038-49.&#xD;
	&#xD;
	&#xD;
	Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499&#x2013;502.&#xD;
	&#xD;
	&#xD;
	Amin KA, Nagy MA. Effect of Carnitine and herbal mixture extract on obesity induced by high-fat diet in rats. Diabetol Metab Synd 2009;12:1:17.t&#xD;
	&#xD;
	&#xD;
	Nammi S, Sreemantula S, and Roufogalis BD. Protective effects of ethanolic extract of Zingiber officinale Rhizome on the Development of Metabolic Syndrome in High-Fat Diet-Fed Rats. Basic Clin Pharmacol Toxicol 2009;104:366&#x2013;373.&#xD;
	&#xD;
	&#xD;
	Kim CM, Yi SJ, Cho IJ, and Ku SK. Red-Koji Fermented Red Ginseng Ameliorates High Fat Diet-Induced Metabolic Disorders in Mice. Nutrients 2013;5:4316-4332.&#xD;
	&#xD;
	&#xD;
	Honors MA, Hargrave1 SL, and Kinzig KP. Glucose Tolerance in Response to a High-Fat Diet Is Improved by a High-Protein Diet. Obesity 2012; 20(9):1859-65.&#xD;
	&#xD;
	&#xD;
	Kumar P, Bhandari U, and Jamadagni S. Fenugreek Seed Extract Inhibit Fat Accumulation and Ameliorates Dyslipidemia in High Fat Diet-Induced Obese Rats. Bio Med Research Int 2014;5:1-11.&#xD;
	&#xD;
	&#xD;
	Zhou CJ, Huang S, Liu JQ, Qiu SQ, Xie FY, Song HP, et al. Sweet tea leaves extract improves leptin resistance in diet-induced obese rats. J Ethnopharmacol 2013;45:386&#x2013;392.&#xD;
	&#xD;
	&#xD;
	Barnea M, Shamay A, Stark AH, Madar Z. A high-fat diet has a tissue-specific effect on adiponectin and related enzyme expression. Obesity 2006;14(12): 2145&#x2013;2153.&#xD;
	&#xD;
	&#xD;
	Hotta K, Funahashi T, Arita Y, Takahashi M, Matuda M. Plasma concentration of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients. J Clic Endocrinol Metab 2001;86:1930&#x2013;1935.&#xD;
	&#xD;
	&#xD;
	Milan G, Granzotto M, Scarda A, Calcagno A, Pagano C. Resistin and adiponectin expression in visceral fat of obese rats effect of weight loss. Obes Res 2002;10(11):1095&#x2013;1103.&#xD;
	&#xD;
	&#xD;
	Milagro FI, Campion J, Martinez JA. Weight gain induced by high-fat feeding involves increased liver oxidative stress. Obesity 2006;14:1118&#x2212;1123.&#xD;
	&#xD;
	&#xD;
	Malam PP, Amin AJ, Zala AC, Navadiya VM, Patel D, Patel DA. Study of oxidative stress parameters in type-II diabetes mellitus and their correlation with blood glucose level. Int J Cur Res Rev 2016;8(13):31-34. &#xD;
	&#xD;
	&#xD;
	Ganesan K, Sukalingam K, and Xu B. Solanum trilobatum L. ameliorate Thioacetamide-Induced Oxidative Stress and Hepatic Damage in Albino Rats. Antioxidants 2017;6(68):1-10.&#xD;
	&#xD;
	&#xD;
	Panchal SK,&#xA0; Poudyal H, Iyer A, Nazer R, Alam MA, Diwan V, et.al. High-carbohydrate, High-fat Diet-induced Metabolic Syndrome and Cardiovascular Remodeling in Rats. J Cardiovasc Pharmacol 2011;57(5):611&#x2013;624.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Seizure Aetiology in Paediatric Patients: A Tertiary Healthcare Centre-Based Review of Magnetic Resonance Imaging&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>45</FirstPage><LastPage>48</LastPage><AuthorList><Author>Supriya Chagdal</Author><AuthorLanguage>English</AuthorLanguage><Author> Ranjit Ambad</Author><AuthorLanguage>English</AuthorLanguage><Author> Tejas Sadavarte</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhushan N. Lakhkar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Children with epilepsy vary from adults not just in terms of their seizure clinical symptoms, but also in terms of aetiology. In aetiology, primary generalised epilepsy is considered hereditary, whereas most localization-related epilepsy has arisen as a consequence of a cerebral insult. Latest advances in brain imaging have contributed to the detection of more children of the origin of seizures. Objective: Using magnetic resonance imaging to study the etiological characteristics of seizures in paediatric patients. Methods: 150 paediatrics patients under the age of 12 years with a generalized or partial seizure disorder or absence seizures were assessed in this hospital-based review. The patients underwent MRI scanning. Final diagnosis on radiological characteristics and in inconclusive cases was made; follow-up MRI and therapeutic response were diagnosed. Results: Anoxia and hypoxic-ischaemic encephalopathy were found to be the most prevalent aetiology in 46 patients (41.8%), accompanied by cortical developmental malformations in 22 patients ( 20%), miscellaneous causes in 14 patients (12.7%), and infection in 8 patients (7.4%). Six patients (5.5 percent) had phakomatosis. There were 4 patients each (3.6 per cent) with mesial temporal sclerosis and hereditary metabolic disorders and neoplasm. Only two patients (1.8 percent) had vascular triggers. Conclusion: Management must determine the cause of the seizure. MRI has been a versatile instrument in the imaging of paediatric seizure patients.&#xD;
&#xD;
&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Pediatric patients, Seizures, Magnetic resonance imaging, Anoxia and hypoxic-ischaemic encephalopathy</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Seizures result from the discharge of a community of neurons that is overly synchronous and prolonged. Children with epilepsy, particularly infants, vary not only in the clinical manifestations of their seizures but also in the aetiology and reaction to antiseizure medication from adults. In aetiology, primary generalised epilepsy is considered hereditary, whereas most localization-related epilepsy has arisen as a consequence of a cerebral insult. Epilepsy related to localization is said to be more prevalent in developing countries. Latest advances in brain imaging have contributed to the detection of more children of the origin of seizures. Magnetic resonance imaging (MRI) gives correct and subsequent localization and histological character of lesions. MRI is the technique of choice in partial seizures to determine the underlying cause.1,2 It increases the rate of detection of such intracranial lesions, in particular those of vascular origin and meninges.3,4. The present research was performed to test the magnetic resonance imaging of the brain in the treatment of paediatric seizure disorder. In their effort to obtain a more precise method of discovering the essence of pathologies, the detection of etiological characteristics is of great benefit to both physicians and neurosurgeons.5,6 Centered on MRI results, the present research was conducted to study the etiological features of seizures in paediatric patients.7,8&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
150 paediatric patients with seizures referred to the MRI brain in a tertiary health centre were examined in this hospital-based prospective retrospective review. For this report, ethical approval was received from the institution&amp;#39;s Research Committee and Ethical Committee. &#xD;
&#xD;
Inclusion criteria&#xD;
&#xD;
Both, paediatric patients (under 12 years of age) had a generalised or partial seizure or absent seizure disorder. Ethical committee clearance no DMIMS (DU) / IEC I 2020-21/9024.&#xD;
&#xD;
Exclusion criteria&#xD;
&#xD;
Patients unfit for MRI is deemed contraindicated for MR imaging concerning anaesthesia. Patients that are not able to get an MRI. The bad general state of a life support patient.&#xD;
&#xD;
The parents/accompanying relatives received informed written consent. Full clinical background, history of birth and vaccination, family history, and previous patient history is noted. The points noted were seizure form, disease duration, and any related complaints. Physical test results have been noted for evidence of any neuro-cutaneous stigma and full CNS (Central nervous system) examination results. Routine blood studies have been observed, such as complete blood profile, liver and renal function checks, blood glucose levels, blood electrolyte levels, as recommended by the doctor. Other laboratory parameters have been conducted, such as biochemical leuko-dystrophy levels, serological infection tests, Cerebrospinal fluid (CSF) review. Electroencephalogram (EEG) and computed tomography&#xA0;(CT) scan results, if completed, have been reported. There were few instances of EEG documentation that correlated with imaging findings. For ferromagnetic objects, all patients were screened. MRI scanning was performed on patients (Philips Achieva 1.5 tesla, 16 channel). Adequate sedation was provided by the anaesthetist when necessary. Conventional MR imaging was conducted using aircraft sequences T1 weighted (TE 8.0ms, TR 480 ms), T2 weighted (TE 102.9 ms, TR 4780 ms), and FLAIR (TE 92.2 ms, TR 8002 ms), as shown below. In selected cases, post gadolinium (dose0.1mmol / kg) enhanced MRI was performed in the axial, coronal and sagittal planes based on non-contrast or clinical suspicion findings. The axial output of DWI and GRE (Gradient Recalled Echo) in all situations. MR spectroscopy, MR venography and MR angiography, including TOF, were performed as needed. The final diagnosis was based on radiological and inconclusive cases; the diagnosis was made by MRI follow-up and reaction to treatment. Brain MRI results have been confirmed and documented.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Out of a total of 150 patients included in the report, 58 males and 24 females were 0-3 years of age, 24 males and 6 females were 4-6 years of age, 14 males and 10 females were 7-9 years of age, while 6 males and 8 females were 10-12 years of age. In our sample, the overall age group for male and female patients was 0-3 years, followed by 4-6 years. 110 patients (73.3 %) had positive MRI findings out of 150 patients surveyed, while 40 patients (26.7%) had regular MRI without detectable lesions. Various forms of seizure disorders have been categorised according to ILAE guidelines. Out of 150 patients, 102 (68 %) had generalised seizures, 36 (24 %) had focal seizures, while 12 (8 %) had an unexplained onset. In our study, generalised seizures were the most common type of seizure. The study included 46 patients (41.8 %) with anoxia and hypoxic-ischemic encephalopathy (HIE). Cortical developmental malformations (CDM) were next found in 22 patients ( 20%), followed by miscellaneous causes in 14 patients (12.7%), and 8 patients (7.4%) were infected. Six patients (5.5 %) had phakomatosis. Four patients (3.6 %) each had Mesial temporal sclerosis and hereditary metabolic disorders and neoplasm. There were only two patients with vascular causes (1.8 %). Therefore, in our research, the most prevalent aetiology was anoxia and hypoxic-ischemic encephalopathy, accompanied by cortical development malformations. The correlation between lesions and age was not statistically important. 110 patients with seizures had an irregular MRI in our study. The most common aetiology in the 0-3 age group was anoxia and HIE in 26 patients (41.9 %), followed by cortical growth malformations in 10 patients (14.7 %). In 8 patients, miscellaneous causes were seen (12.9 %). Anoxia and HIE and malformations of cortical development were seen in 8 patients in the age group of 4-6 years (33.3 %) each. The most common aetiology in the 7-9 age group was anoxia and HIE in 10 patients (62.5%). The most common aetiology in the 10-12 age group was anoxia and HIE, cortical developmental malformations, phakomatosis and miscellaneous causes in 2 patients (25 %) each. Therefore, in our research, the most common aetiology in infants and young children (0-3 years) and older children of the age group (7-9 years) was anoxia and HIE, while in the age group (4-6 years), anoxia and HIE and cortical growth malformations were common causes. No single common cause was found within the age group (10-12 years).&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
For seeking an appropriate cure, the detection of the cause of seizures is important. MRI has emerged as a versatile method in the assessment of patients with central nervous system disorders, with its high spatial resolution, excellent intrinsic soft-tissue contrast, multi-planar imaging capacity, and lack of ionising radiation. In our sample of 150 patients, 69.3 per cent had generalised seizures, the highest number of patients. Our study coincides with the study performed by Rasool A et al, in which generalised seizures were the main type of seizures in as many as 42% of patients4. Our study also coincides with the Chaurasia et al study, in which generalised seizures accounted for 76.7 per cent of the highest number of patients seen.9 In this study, 110 patients (73.3 %) of a total of 150 patients had abnormal MRI outcomes. Our analysis is comparable with the study performed by Kuzniecky et al in which MRI revealed anomalies in 84 % of patients.10 In our research, MRI anomalies were observed in 88.9 per cent of patients with focal seizures, 70.6 per cent of patients with generalised seizures, and 50 per cent of patients with uncertain onset. Our study is similar to the study by Khodapanahandeh et al, in which an essential association between abnormal neuro-imaging and focal seizure was found.11 Of the 150 patients included in our study, 110 (73.3%) had an irregular MRI. Out of 110 patients, 62 (56.4%) were in the 0-3 year age range, with anoxia and HIE being the most common aetiology seen in 26 (41.9%) patients. Cortical developmental malformations were also prevalent in this age group, occurring in 10 patients (13.5%) accompanied by miscellaneous causes in 8 patients (12.9%). Of the 110, 24 patients (21.8 %) in the 4-6 age group, anoxia and HIE and cortical developmental malformations were frequent causes in this age group and 33.3 % were seen in 8 patients each. Out of 110, 16 patients (14.5 %) were in the 7-9 age group. The most common aetiology seen in 10 patients (62.5 %) was anoxia and HIE in this age group. Out of the 110 patients (7.3%) in the 10-12 age group, no single typical aetiology was found in this age group. Our study corresponds well with the Khreisat W H study in which children with seizures below the age of 2 years were tested for aetiology in the age range of 0-3 years.12 Perinatal asphyxia seen in 55 % was the most common etiological factor observed in this study, followed by CNS infection in 15 %, central nervous system defects in (9 %), head trauma in (8 %), congenital and family disorders in (8 %) and prematurity in (5 %). Our thesis also correlates well with the previous analysis (n=31).13 In 35 %, hemorrhagic in 26 %, metabolic disruptions and cerebral dysgenesis in 16 % and uncertain in 23 %, seizure aetiology was found to be hypoxic-ischemic. In neonatal seizures, the MRI observed a remarkably high frequency of brain lesions. Nearly half of these were of prenatal origin and hypoxic and/or hemodynamic causes which essentially be due to pathogenesis. Our study coincides with the Dur&#xE1;-Trav&#xE9; et al. study, which reported children between 1 month and 15 years of age at the time of epilepsy diagnosis. White-matter lesions (27.6%), volume loss (19.6 %), grey-matter lesions (19.6 %), and ventricular enlargement (12 %) were the most common anomalies. In our sample, 41.8% of patients had anoxia and hypoxic-ischaemic encephalopathy, accompanied by cortical developmental malformations that were seen in 20 % of patients. 12.7 % of patients suffered from multiple causes. Infection constituted 7.4 % of patients followed by phakomatoses in 5.5 % of patients. Mesial temporal sclerosis, hereditary metabolic disorders and neoplasms accounted for 3.6% of patients, and vascular causes accounted for 1.8% of patients, with the least common aetiology. Out of 15 patients in the NK Rollins et al study, five patients had focal ischaemic cerebral hemispheric and/or basal ganglia and brain stem damage. Six patients had diffuse cerebral oedema, of which five had oedema of the basal ganglia; one had oedema of the brain stem. 14. One patient with venous infarcts had superior sagittal sinus thrombosis. Three patients had MRI studies that were regular. The MRI was positive in 68 % of patients. The study showed hypoxic-ischemic aetiology in 35 %, hemorrhagic aetiology in 26 %, metabolic disorders and cerebral dysgenesis in 16 % and unknown cause in 23 % as the main cause of seizures.15 Our analysis is comparable to the above studies and demonstrates the most common aetiology in paediatric seizure disorder as hypoxic-ischemic encephalopathy.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Management must determine the cause of the seizure. MRI has emerged as a versatile method in the imaging of paediatric patients with seizures due to high spatial resolution, excellent intrinsic soft-tissue contrast, multi-planar imaging capability and lack of ionising radiation. To conclude, we found that neuro-imaging, especially MRI, played an incredible role in the etiological diagnosis of childhood seizures. Good neurological symptoms and symptomatic seizures were closely associated. Positive EEG results are also correlated significantly with idiopathic seizures. Finally, in the future, a large prospective study is required to assess and validate the findings and interpretation produced in this study.&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. &#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3757</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3757</Fulltext></URLs><References>&#xD;
	&#xD;
	Kleigman R. Nelson Text Book of Pediatrics. 19th ed. New Delhi: Elsevier; 2011. Seizures in childhood; pp. 1993&#x2013;2009.&#xD;
	&#xD;
	&#xD;
	Treiman D. Management of refractory complex partial seizures: Current state of the art. Neuropsychiatr Dis Treat. 2010;6:297&#x2013;308.&#xD;
	&#xD;
	&#xD;
	Vaidya SV, Aneesh MK, Mahajan SM, Dhongade HS. Radiological assessment of meniscal injuries of the knee on magnetic resonance imaging. Int J Curr Res Rev. 2020;12(15):98-102.&#xD;
	&#xD;
	&#xD;
	Mohabey A, Gupta S, Gawande V, Saoji K. A study on the correlation of magnetic resonance imaging and arthroscopy in evaluation of anterior cruciate ligament injury in cases of acute traumatic haemarthrosis of knee: A prospective study. Int J Curr Res Rev. 2020;12(14):14-17.&#xD;
	&#xD;
	&#xD;
	Atlas S. Magnetic Resonance Imaging of the Brain and Spine. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. pp. 2&#x2013;14. pp. 307&#x2013;39.&#xD;
	&#xD;
	&#xD;
	Varma A, Meshram RJ, Darvhekar N, Patel Z, Damke SG, Taksande A. Study of clinical profile of neonatal seizures in a NICU of rural central India. Int J Res Pharm Sci. 2020;11(4):5603-5607.&#xD;
	&#xD;
	&#xD;
	Chaudhary KS, Phatak SV. Choroidal Melanoma in a Young Patient Ultrasonography and Magnetic Resonance Imaging. J Datta Meghe Inst Med Sci Uni. 2019;14(2):106&#x2013;8.&#xD;
	&#xD;
	&#xD;
	Paul V, Kashikar S. Role of magnetic resonance imaging in the evaluation of low backache: Examining the disease spectrum. J Datta Meghe Inst Med Sci Uni. 2020;15(1):98-107.&#xD;
	&#xD;
	&#xD;
	Rasool A.&#xA0; Role of electroencephalogram and neuroimaging in first onset afebrile and complex febrile seizures in children from Kashmir. J Pediatr Neurosci. 2012;7(1):9-15.&#xD;
	&#xD;
	&#xD;
	Chaurasia R, Singh S, Mahur S, Sachan P. Imagingin pediatric epilepsy: spectrum of abnormalities detected on MRI. J Evol Med Dent Sci. 2013;19(2):3377-3385.&#xD;
	&#xD;
	&#xD;
	Kuzniecky R. Magnetic resonance imaging in childhood intractable partial epilepsies: Pathologic correlations. Neurology 1993;43:681&#x2013;687.&#xD;
	&#xD;
	&#xD;
	Khodapanahandeh F.&#xA0; Neuroimaging in children with first afebrile seizures: to order or not to order. Arch Iran Med 2006;9(2):156&#x2013;8.&#xD;
	&#xD;
	&#xD;
	Khreisat W. Clinical profile of epilepsy during the two years of life. Pak J Med Sci 2006;22:55-9.&#xD;
	&#xD;
	&#xD;
	Leth H.&#xA0; Neonatal seizures associated with cerebral lesions shown by magnetic resonance imaging. Arch Dis Childhood Fetal Neonat. 1997;77(2): F105-F110.&#xD;
	&#xD;
	&#xD;
	Rollins N. The role of early MR in the evaluation of the term infant with seizures. Am J Neuroradiol. 1994;15(2):239-48.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Coexistent Xanthogranulomatous Cholecystitis and Carcinoma Gall Bladder: A Diagnostic Dilemma: One Year Study at a Tertiary Care Centre&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>49</FirstPage><LastPage>52</LastPage><AuthorList><Author>Aiffa Aiman</Author><AuthorLanguage>English</AuthorLanguage><Author> Zubaida Rasool</Author><AuthorLanguage>English</AuthorLanguage><Author> Nuzhat Samoon</Author><AuthorLanguage>English</AuthorLanguage><Author> Duree Mateen</Author><AuthorLanguage>English</AuthorLanguage><Author>  Meesa Zargar</Author><AuthorLanguage>English</AuthorLanguage><Author> Rukhsana Akhtar</Author><AuthorLanguage>English</AuthorLanguage><Author> Mir Yasir</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Xanthogranulomatous cholecystitis is an uncommon variant of chronic cholecystitis that can present with marked gall bladder thickening or as a mass lesion mimicking a malignant neoplasm. Rarely it may be associated with carcinoma gall bladder, hence a thorough sampling is needed to exclude carcinoma gall bladder. Objective: To analyse the coexistence of xanthogranulomatous cholecystitis and carcinoma gall bladder. Methods: A one-year study was carried out in the department of pathology, from 1st November 2018 to 31st October 2019; in which the carcinoma gall bladder specimens were analysed grossly and microscopically and an association of carcinoma gall bladder with xanthogranulomatous cholecystitis was analysed. Results: A total of 30 cases of carcinoma gall bladder were reported of which 3 cases showed coexisting xanthogranulomatous cholecystitis. Conclusion: The coexistence of xanthogranulomatous cholecystitis and carcinoma of the gallbladder may present a diagnostic dilemma. Due to the overlapping clinical, radiological and gross findings. Although rare the possibility of a coexisting tumour needs to be excluded, for which immunohistochemical markers may be done.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adenocarcinoma gall bladder, Xanthogranulomatous cholecystitis, Carcinoma gall bladder, Granulomatous inflammation, Perineural invasion, Giant cells</Keywords><Fulltext>Introduction&#xD;
&#xD;
Xanthogranulomatous cholecystitis (XGC) is an unusual focal or diffuse destructive inflammatory process of the gall bladder, representing between 0.7 and 13.2% of all gallbladder diseases.&#xB9; &#xA0;Christensen and Ishak were among the first to describe this entity as a pseudotumor of the gallbladder (fibroxanthogranulomatous cholecystitis) with an unusual, destructive type of inflammation, desmoplasia, pericholecystic infiltration and hepatic involvement.2 &#xA0;It is used to describe the lesion which results when lipids from the bile in the lumen of the gall bladder enter the wall of the organ and induce a granulomatous inflammation.3 The malignant potential of XGC is controversial and the relationship between XGC and gall bladder carcinoma (GBC) is unclear. Simultaneous XGC and GBC have been reported in some series with incidences ranging from 2% to 7.5%respectively.4,5 While others has reported the incidence between 0.2% to 35.4% of cases.6-8&#xD;
&#xD;
MaterialS and MethodS&#xD;
&#xD;
A one-year study was carried out in our department from 1st November 2018 to 31st October 2019, in which the carcinoma gall bladder specimens were analysed grossly and microscopically and an association of carcinoma gall bladder with xanthogranulomatous cholecystitis was seen. A total of 30 cases of carcinoma gall bladder were seen of which 3 cases showed coexisting xanthogranulomatous cholecystitis.&#xD;
&#xD;
Case 1: A 55-year-old female presented with pain upper abdomen radiating to the back along with jaundice. USG was suggestive of a gall bladder mass. CECT was done which showed an asymmetric enhancing mural thickening involving the body of the gall bladder. LFT depicted hyperbilirubinemia with serum bilirubin of 5.5mg/dl. Intraoperatively a solid mass was seen in the body and fundus of the gall bladder not infiltrating the adjacent liver.&#xD;
&#xD;
On gross examination, the resected gall bladder measured 9x2.5 cm with external surface haemorrhagic and roughened. On C/S grey-white to yellow growth identified measuring 3x2.5 cm. The growth was 1.5 cms from the surgical cut end (Figure 1).&#xD;
&#xD;
Microscopically a well-differentiated adenocarcinoma was seen infiltrating into the perimuscular connective tissue (pT2). The background showed aggregates of foamy macrophages with occasional foreign body giant cells, few spindles shaped elongated macrophages, plasma cells and lymphocytes, suggestive of xanthogranulomatous cholecystitis (Figure 2).&#xD;
&#xD;
Case 2: A 50-year-old male presented with pain upper abdomen. USG showed a mass in the body of the gall bladder. CECT showed an eccentric circumferential enhancing thickening in the mid-body of the gall bladder. Intraoperatively a thickened firm polypoidal mass was seen involving the fundus and body of the gall bladder. Serum bilirubin was 2.8 mg/dl.&#xD;
&#xD;
Gross examination of the resected specimen showed a polypoidal growth measuring 2x2 cm in the body of the gall bladder. C/S through the growth was grey-white infiltrating into the muscularis. The growth was 4 cm from the gall bladder and 5 cm from the liver resection margin. Serial sections through the attached liver tissue were unremarkable.&#xD;
&#xD;
Microscopy revealed a moderately differentiated adenocarcinoma limited to the gall bladder wall however going beyond muscularis propria (pT2). The gall bladder resection margin showed high-grade dysplasia and the hepatic resection margin was free of tumour. Lymphovascular invasion was seen, however, there was no perineural invasion. Few sections from the growth revealed large round macrophages with pale granular cytoplasm, foreign body giant cells and chronic inflammatory cell infiltrate which were indicative of a background of xanthogranulomatous cholecystitis. Immunostaining for CK 7 was positive in the malignant glands (Figure 3).&#xD;
&#xD;
Case 3: A 60-year-old male presented with a one-week history of jaundice, anorexia and upper abdominal pain. Serum bilirubin was 6.7 mg/dl. CECT showed a circumferentially enhancing growth in the fundus and another growth in the mid-CBD along with cholelithiasis. Intraoperatively a growth was identified in the fundus of the gall bladder and another growth in the gall bladder neck.&#xD;
&#xD;
On gross examination, the fundus of the gall bladder showed a friable yellow-brown area and the neck of the gall bladder showed a grey-white circumferential growth. In addition, multiple calculi were identified in the gall bladder.&#xD;
&#xD;
Microscopically sections from the fundus showed features of xanthogranulomatous cholecystitis while those from the neck showed moderately differentiated adenocarcinoma limited to the wall of the gall bladder (pT1) (Figures 4 and 5)&#xD;
&#xD;
Results and Discussion&#xD;
&#xD;
In this study, we describe the clinicopathological features of coexisting &#xA0;xanthogranulomatous cholecystitis and adenocarcinoma of the gall bladder. Xanthogranulomatous cholecystitis is an uncommon form of chronic cholecystitis characterized by a focal or diffuse destructive inflammatory process, with varying proportions of fibrous tissue, acute and chronic inflammatory cells and accumulation of lipid-laden macrophages in areas of inflammation.1 &#xD;
&#xD;
The pathogenesis of this lesion is not well understood, although it is believed that a rupture of the Rokitansky-Aschoff sinuses with extravasation of bile in the interstitial tissues and consequent xanthogranulomatous inflammatory reaction is the initial causes.9,10,11 This theory is supported by the frequent finding of bile and mucus in the lesion, and by the occasional finding of a focus of XGC with a disrupted sinus.2,3,10 Gallbladder carcinoma might provide a route for bile to enter the stroma more readily than in chronic cholecystitis or cholelithiasis because of the greater tissue destruction associated with it, thus explaining the coexistence of these two conditions.12 &#xD;
&#xD;
Xanthogranulomatous cholecystitis often mimics a gallbladder carcinoma, leading to a diagnostic dilemma. XGC distorts the outline of the gallbladder, forms adhesions with adjacent tissues, and participates in fistula formation.3 This may cause misdiagnosis as gallbladder carcinoma on preoperative evaluation and at laparotomy; in particular, XGC may look like a malignant neoplasm on ultrasonography.13,14&#xD;
&#xD;
Preoperatively and intraoperatively, it is difficult to diagnose this entity and the final diagnosis is usually based on histological examination of the resected specimen. The malignant potential of XGC is controversial and highly disputed.1,6,7,8 The association of XGC and GBC is a matter of discussion. According to some authors, it may simply be that XGC and adenocarcinoma are both complications of cholelithiasis and cholecystitis of a particular duration or degree, or that tissue disruption by a carcinoma facilitates the entry of bile into the stroma.12&#xD;
&#xD;
The association between XGC and gallbladder cancer has been shown in the literature in small case series and some single case reports. An Indian study reported that only 0.2% of patients with XGC have associated GBC.6 On the other hand, is an American study, among 40 cases of XGC, five [12.5%] also had GBC.10&#xA0; In the United Kingdom, a study of 31 patients with XGC revealed carcinoma in three [9.7%] patients.8 In a Japanese study, 10% of XGC patients also had GBC.1 In a Mexican study, XGC was associated with carcinoma in five cases (3%) among a total of 182 cases of XGC. According to the authors of that study, the inflammatory reaction followed by an associated immunologic cellular response may produce the appearance of cellular changes that degenerate into carcinoma.1 In our study we encountered 3 cases of coexisting XGC and carcinoma gallbladder out of 30 cases of GBC in one year accounting for an incidence of 10%. This correlates most with the Japanese study.&#xD;
&#xD;
The possible association of XGC and GBC carries a risk of diagnostic confusion. Pathologists might fail to notice the presence of GBC when it is associated with florid XGC. Furthermore, the existence of florid XGC may lead to errors in determining the exact stage of the malignant spread of GBC as macrophages can be confused with tumour cells.12&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The coexistence of XGC and carcinoma of the gallbladder may present a diagnostic dilemma. Due to the overlapping clinical, radiological and gross findings of xanthogranulomatous cholecystitis and carcinoma of the gall bladder, Definitive diagnosis of XGC relies on extensive sampling and thorough microscopic examination of the surgical specimen. Although rare, the possibility of a coexisting tumour needs to be excluded, for which immune-histochemical markers like CD 68 for xanthomatous cells and CK 7 for neoplastic glands may also be used in addition to routine H&amp;E staining.&#xD;
&#xD;
Acknowledgement: 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;
Conflict of Interest: Nil&#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
Authors Contribution: Aiffa Aiman conceived the idea and wrote the manuscript with support from Nuzhat Samoon and Duree Mateen.&#xA0; Zubaida Rasool helped supervise the project. Meesa Zargar and Rukhsana Akhtar assisted with the photography.&#xA0; Mir Yasir helped in data compilation and correspondence with the journal.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3758</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3758</Fulltext></URLs><References>&#xD;
	&#xD;
	Guzman-Valdivia G. Xanthogranulomatous Cholecystitis: 15Years&#x2019; Experience. World J Surg 2004;28:254-7.&#xD;
	&#xD;
	&#xD;
	&#xA0;Christensen AH, Ishak KG. Benign tumours and pseudotumors of the gall bladder. Report of 180 cases. Arch Pathol 1970;90:423-32.&#xD;
	&#xD;
	&#xD;
	Roberts KM, Parsons MA. Xanthogranulomatous cholecystitis: a clinicopathological study of 13 cases. J Clin Pathol 1987;40:412-417.&#xD;
	&#xD;
	&#xD;
	&#xA0;Parra JA, Acinas O, Bueno J, Guezmes A, Fernandez MA, Farinas MC. Xanthogranulomatous cholecystitis: Clinical, sonographic, and CT findings in 26 patients. Am J Roentgenol 2000;174:979-83.&#xD;
	&#xD;
	&#xD;
	Solanki RL, Arora HL, Gaur SK, Anand VK, Gupta R. Xanthogranulomatous cholecystitis (XGC): A clinicopathological study of 21 cases. Indian J Pathol Microbiol 1989;32:256-60.&#xD;
	&#xD;
	&#xD;
	&#xA0;Dixit VK, Prakash A, Gupta A, et al. Xanthogranulomatous cholecystitis. Dig Dis Sci 1998;43:940-2.&#xD;
	&#xD;
	&#xD;
	Lee HS, Joo KR, Kim DH, et al. A case of simultaneous xanthogranulomatous cholecystitis and carcinoma of the gallbladder. Korean J Intern Med 2003;18:53-6.&#xD;
	&#xD;
	&#xD;
	Houston JP, Collins MC, Cameron I, et al. Xanthogranulomatous cholecystitis. Br J Surg 1994;81:1030-9.&#xD;
	&#xD;
	&#xD;
	Roberts KM, Parsons MA. Xanthogranulomatous cholecystitis: a clinicopathological study of 13 cases. J Clin Pathol 1987; 40:412&#x2013;417.&#xD;
	&#xD;
	&#xD;
	Goodman ZD, Ishak KG. Xanthogranulomatous cholecystitis. Am J Surg Pathol 1981;5:653&#x2013;659.&#xA0;&#xD;
	&#xD;
	&#xD;
	Christensen AH, Ishak KG. Benign tumours and pseudotumors of the gallbladder. Arch&#xA0;&#xA0;&#xA0; Pathol Lab Med 90:423&#x2013;4321970.&#xD;
	&#xD;
	&#xD;
	&#xA0;Benbow EW. Xanthogranulomatous cholecystitis associated with carcinoma of the gallbladder. Postgrad Med J 1989;65:528-31.&#xD;
	&#xD;
	&#xD;
	Bluth EI, Katz MM, Merritt CRB, Sullivan MA, Mitchell WT. Echographic findings in xanthogranulomatous cholecystitis. J Clin Ultrasound 1979;7:213-214.&#xD;
	&#xD;
	&#xD;
	Gockel HP. Xanthogranulomatose cholezystitis. Fortschr Rontgenstr 1984;140:223-224.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Zebrafish: A New Emerging Model of Experimental Pharmacology&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>53</FirstPage><LastPage>58</LastPage><AuthorList><Author>More SM</Author><AuthorLanguage>English</AuthorLanguage><Author> Layar A</Author><AuthorLanguage>English</AuthorLanguage><Author> Darade S</Author><AuthorLanguage>English</AuthorLanguage><Author> Shahu A</Author><AuthorLanguage>English</AuthorLanguage><Author> Kushwaha N</Author><AuthorLanguage>English</AuthorLanguage><Author> Kharwade RS</Author><AuthorLanguage>English</AuthorLanguage><Author>  Mahajan UN</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Zebrafish as the new emerging model is used to detail the study of the zebrafish, Taxonomy, Developmental stages of zebrafish. The various experimental model is used in the detection of the various function in the body, while In Vivo and In Vitro study, both studies are done under appropriate environment and proper procedure. Our present study mainly developing and testing medicines and vaccines for humans and other animals, studying how animals and human bodies function, Assessing the safety of chemicals such as pesticides for their possible effect on human health or the environment. In Pharmacological screening, various disease and disorder can be studied from the major disease which shows the better result in pharmacological screening. Teratogenicity is the most useful study as the embryo develops outside the body and the study of the embryo is done through the microscope. The other major property of zebrafish is the regeneration of the heart where the cardiovascular disease in the regeneration of the heart is studied. In Type-2 Diabetes Mellitus, the different test is studied to examine the abnormalities produce in the blood of zebrafish and the various effect of the drug which control the blood glucose level in the blood of zebrafish.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Zebrafish, Teratogenicity, Animal model, Pharmacological screening</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Experimental Pharmacology is the study of the interaction between the leaving organism and the chemicals that affect normal or abnormal biochemical function. Experiment Pharmacology mainly deals with the drug which is either man-made or endogenous molecule which examines the biochemical or physiological effect. The discovery of new drug or detail study of existing is also coming under experimental pharmacology.1,2&#xD;
&#xD;
In-vivo Study&#xD;
&#xD;
The word In Vivo comes from Latin which means &#x201C;Within the leaving&#x201D;. In the controlled environment experiments and observation is taken on the living tissue of the whole leaving organism. Any drug discover lead to the clinical trial or chemical testing in the appropriate condition is given in proper concentration of drug to the animals like rats, rabbit, fish and other animals after that human trial is performed.3&#xD;
&#xD;
In-vitro Study&#xD;
&#xD;
The word In Vitro comes from Latin that means &#x201C;Within the glass&#x201D;, which means the study is done outside the living organism The term in vitro in cell biology explain the technique which is performed in the controlled environment outside the body like in a test tube, Petri dishes or any other. The in vitro method is not much expensive as compared to the in vitro and gives quick result.4&#xD;
&#xD;
Experimental animals&#xD;
&#xD;
Experimental animals are the animals that we are used for our research purpose to determine the different activities of Drugs (Table 1). Mainly developing and testing medicines and vaccines for humans and other animals, studying how animals and human bodies function, Assessing the safety of chemical such as pesticides for their possible effect on human health or the environment.6&#xD;
&#xD;
&#xD;
&#xD;
Advantages of Zebrafish as organ model as compared to other model shown in Table 2 and following are the characteristics feature which makes zebrafish as the best model for experimental pharmacology.&#xD;
&#xD;
&#xD;
	&#xD;
	Small size&#xD;
	&#xD;
	&#xD;
	Rapid embryonic development&#xD;
	&#xD;
	&#xD;
	Short generation time&#xD;
	&#xD;
	&#xD;
	External fertilization and development&#xD;
	&#xD;
	&#xD;
	High fecundity&#xD;
	&#xD;
	&#xD;
	Optical transparency of embryos and larvae&#xD;
	&#xD;
	&#xD;
	Low husbandry cost&#xD;
	&#xD;
	&#xD;
	Fully sequenced genome sequence&#xD;
	&#xD;
	&#xD;
	High genetic homology with human&#xD;
	&#xD;
	&#xD;
	Orthologues genes between human and zebrafish&#xD;
	&#xD;
	&#xD;
	Large-scale mutagenesis&#xD;
	&#xD;
	&#xD;
	Transgenic models available&#xD;
	&#xD;
	&#xD;
	High-throughput genetic/drug screening&#xD;
	&#xD;
	&#xD;
	Direct administration of compounds to the medium of embryos&#xD;
	&#xD;
	&#xD;
	Genetic manipulations/engineering (forward and reverse genetics)&#xD;
	&#xD;
	&#xD;
	Excellent models for developmental toxicology studies.7,8&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
ZEBRAFISH ANIMAL MODEL CHARACTERISTICS&#xD;
&#xD;
Danio rerio, commonly it is also known as Zebrafish, belongs to the minnow family. To study fundamental biological questions, it is considered one of the most popular model organisms. It is a small 1 to 1.5 inches fish that can be grown easily in an aquarium. Genetic similarity with a human being (about 70-80%) Breed readily (nearly every 10 days) &amp; can produce 50 to 300 eggs at a time.9,10&#xD;
&#xD;
Taxonomy&#xD;
&#xD;
The zebrafish is a derived member of the genus Brachydanio, of the family Cyprinidae. Zebrafish are demonstrated by the phylogenetic tree of close species which is closely related to the genus Devario. Recent molecular studies have suggested that it should belong to the genus Brachydanio as &#x2018;Brachydanio rerio&#x2019;&#xD;
&#xD;
Developmental stages of Zebrafish (life cycle)&#xD;
&#xD;
In Figure 1 complete development stage with life cycle explain. Figure 2 shows the breeding method of zebrafish. Zebrafish lifecycle divided into four major periods. Embrio, larva, juvenile and adult. The full life cycle from fertilised egg to adult is a quick 90 days. Early development occurs at a rapid, but predictable rate when the embryos are raised at 28oC. 11,12&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
ZEBRAFISH : ANIMAL MODEL IN DIFFERENT DISEASE CONDITION&#xD;
&#xD;
Zebrafish as experimental animal model use in A) The Zebrafish Embryo Toxicity &amp; Teratogenicity, B) Cardiovascular disease, C) Type 2 Diabetes Mellitus shows in Figure 3.&#xD;
&#xD;
&#xD;
	&#xD;
	The Zebrafish Embryo Toxicity &amp; Teratogenicity&#xD;
	&#xD;
&#xD;
&#xD;
Teratogenicity is the abnormality in the fatal when drug administered to pregnant women, while in zebrafish it has recently emerged for the organism for genetic research &amp; vertebrate development. As the zebrafish have the major advantage in external development of embryo which allows direct observation through Stereo Microscope and also the teratogenic activity is directly seen from the microscope. The embryo Toxicity and Teratogenicity of the drug at what concentration is seen. 13,14&#xD;
&#xD;
Method&#xD;
&#xD;
After the breading period of zebrafish, the egg/embryo is collected and strain in a soft mesh sieve after that transfer it into a clean embryo medium. The evaluation of the egg/embryo is done by the embryo which is capable to survive, and the unfertilized egg/embryo is taken off. Incubate the egg at 28.5&#xBA;c for 2-3 hr the chorion (soft eggshell) is getting soften and it will get remove, observe under the stereo-microscope and completely remove corn is selected after that the selected embryo is transferred into a single well of multiwall tissue and it is filled with a drug to be tested at various concentration along with vehicle and warm the plate at 28.5&#xBA;c for 5 days, the development of the embryo is seen through a microscope at different period, the larva start movement at 3rd -4th day. The endpoint analysis is done period time 2nd -3rd&amp; 4th-day post-fertilization after complete analysis euthanize the larva by immersion of 1.2% sodium hypochlorite (bleach) solution for around 4-7days.13-16&#xD;
&#xD;
Teratogenicity is the abnormality in the physiological development of the fetus. In teratology, the zebrafish model shows the best model. Figure 4 shows the use of automatic video tracking to simultaneously assess multiple phenotypes in larval zebrafish. Panel (A) shows a 96?well holding plate to administer several compounds to larval zebrafish. Fish behaviours are recorded by an overhead camera, and images are processed through tracking software. Panel (B) showing an example of a swim trace. In this, the larval zebrafish stay close to the walls that are wall?hugging behaviour. Panel (C) showing an example of the swim pattern (opposite). In this, the larval zebrafish prominently explore the environment, involving the centre of the tank. 14,15&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Cardiovascular Disease (CVD)&#xD;
	&#xD;
&#xD;
&#xD;
Cardiovascular Disease involves the heart or blood vessels which include coronary artery disease, CVS include Heart Failure, Rheumatic Heart Disease, Abnormal Heart Rhythm. Approximately 17.9 million people died due to CVD in year 2016. The proper study of the heart, the mechanism of pathogenesis the animal model of cardiovascular disease is approach, for that the animal model which satisfy the need of regeneration of heart, the zebrafish have the property of regeneration of heart through its lifespan. From among animals the zebrafish is on priority for regeneration of heart. 16,17&#xD;
&#xD;
Heart regeneration in Zebrafish&#xD;
&#xD;
The zebrafish have the regenerative properties it can regenerate many organ &amp; tissues such as Retinal, Brain tissues, Fines, Spinal cord &amp; cardiac muscles. Like neonatal mice is also having the capacity for regeneration of the heart, but this property lost on the seventh day of birth&#xD;
&#xD;
The zebrafish contain the exceptional capacity of regeneration of heart after causing any ventricular injury, the blood starts clothing at the site of injury to stop the flow of blood, The platelets plug is formed at the site of injury which contains Thrombin receptor on the surface which binds to Thrombin molecule which is converted into the fibrinogen solution into Fibrin as the fibrin have the property of forming long strand of insoluble protein which cover the platelets. Fibrin Stabilizing Factor helps in harden and contract, further which is form cardiac muscle, it takes around 1-2 month for total regeneration of the heart.18,19&#xD;
&#xD;
Cryoinjury is an alternative method for the injury of the muscles that helps in proper image analysis through the Olympus Microscope. Cryoinjury is the death of cell and tissues due to the lowering of temperature. In this method of Cryoinjury, the fish is anaesthetized using tricaine solution (0.032% wt/vol) in freshwater after that the anaesthetized fish is placed on the foam for detection in the microscope, it should be the focus on the level of heart which is in between the operculum and the base of the fin, then with the help of forceps hold the body of fish and with the help microdissection scissors make a small ventricular cut. The apex and ventral part of the ventricle must be visible, the excess of water is removing by blotting with tissue then apply precooled cryoprobe to the ventricular surface to quickly freeze the portion. Figure 5 interpret the Blood collection method from adult zebrafish. (A) Zebrafish (adult) anesthetised. (B) Blood is collected by inserting the needle at the blood collection site and then gently the blood is collected. (C) Blood is expelled from the needle onto a clean piece of parafilm. (D) Afterword&#x2019;s the puncture site after blood collection is complete.20,21&#xD;
&#xD;
It should be stick to the ventricular surface and the heartbeat gets slower gradually for a particular period after that put the fish into the freshwater, the water is blown through the pipette near the gills, the movement of gills will start within&#xA0; 4-5 minutes and start swimming within 8-10 minutes. After the period the zebrafish is again dissected by making an incision to reach toward the heart, the heart is washed with FDB sol and fixed with 4% (wt/vol) overnight for imaging by comparing the image the regeneration of heart is seen.22&#xD;
&#xD;
&#xD;
&#xD;
C) Zebrafish Model for Type 2 Diabetes Mellitus&#xD;
&#xD;
In Type-II Diabetes Mellitus the body doesn&#x2019;t produce enough insulin and no loss of &#x3B2;-cell mass. Around 90% of the patient is of type 2 Diabetes Mellitus. The main cause is an abnormality in glucose receptor of &#x3B2;-cell so that they respond to the higher glucose concentration and reduce the sensitivity of peripheral tissue to insulin. In experimental animal, diabetes can be induced by overfeeding the glucose for around 3 months and the change in the concentration of glucose in the blood can be seen through the different test.23&#xD;
&#xD;
Methods&#xD;
&#xD;
Glucose tolerance test:&#xD;
&#xD;
In this type two tolerance test is performed&#xD;
&#xD;
A)&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Intraperitoneal glucose tolerance test i.e. (IPGTT)&#xD;
&#xD;
B)&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Oral glucose tolerance test i.e. (OGTT)&#xD;
&#xD;
Intraperitoneal glucose tolerance test in this test the fish were anaesthetized using ice water for around 5-minutes. 0.5 mg/g fish weight were injected Intraperitoneally and allow to recover after period interval 30, 90, 180 the blood is withdrawn through the proper instrument and blood glucose were determined at each time interval of 30, 90, 180.24,25&#xD;
&#xD;
Oral glucose tolerance test in this fish is first anaesthetized, micropipette with a small tip is used for the administration of glucose through the mouth at dose 1.25 mg/g fish weight and allow to recover for 30, 90, 180-time interval and that particular time interval the blood sample were collected and blood glucose level is determined. Figure 6 shows the blood collection method from adult zebrafish for interpretation of glucose level.&#xD;
&#xD;
Ins-EGFP image analysis&#xD;
&#xD;
Enhance Green Fluorescent Protein the zebrafish is overfeeding through a micropipette for 3 months and the night before the testing the experimental animal is kept fast and anaesthetize in a tank containing 500 ppm of 2-phenoxyethanol after anaesthetizing the experimental animal it is kept under the Olympus SZX7 microscope with Green Fluorescence Protein (GFP) filter. The image obtained is quantified in ImageJ software.&#xD;
&#xD;
The image is import and converts into a greyscale of red green blue( RGB). The RGB signal is split and the green signal is extracted, from that intensity of green fluorescent intensity from the pancreatic area is measure using pixel density. The intensity of fluorescence was converted into a percentage, the relative intensity of normal feed zebrafish is calculated for normal reading.26,27&#xD;
&#xD;
Metformin and glimepiride administration&#xD;
&#xD;
Metformin &amp; Glimepridin are the drug use for the control of high blood glucose. In type-2 diabetes the administration of metformin to Zebrafish through proper concentration of 20 &#xB5;M the concentration should be change daily. The blood sample was collected after 7 days of dose. Glimepiride is dissolved in dimethyl sulfoxide and make 500mm stock, dilute with fresh water up to 100 &#xB5;M after 24 hr the blood sample is collected and tested.28,29&#xD;
&#xD;
Figure 7 shows the Pathways of insulin secretion in the pancreas and insulin resistance in the liver of zebrafish and type II diabetes patients. Insulin secretion pathways in (a) zebrafish and (b) pancreatic beta cells of type II diabetes human patients. Pathways of insulin resistance in (c) zebrafish and (d) human hyperglycaemic liver. In this figure, red and blue denote genes with increased and decreased expression, respectively. Grey denotes genes that were not detected in the RNA-sea assay or DNA microarray technique. &#xD;
&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
As per the 3R principle i.e reducing waste, reusing and recycling resources and products, choosing to use things with care. Therefore Zebrafish can replace the most of the common animal model of various behavioural screening like a rat, mice, hamster as per the committee for control and supervision of experiments on animals (CPCSEA). According to CPCSEA zebrafish is more economical, easy to maintain and shows more convincing result than listed experimental animals. So it stands as an emerging model for pharmacological behaviour screening.&#xD;
&#xD;
CONFLICT OF INTEREST: None&#xD;
&#xD;
SOURCE OF FUNDING: None&#xD;
&#xD;
ACKNOWLEDGEMENT: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3759</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3759</Fulltext></URLs><References>1. Baker K, Warren K, Yellen G, Fishman M. Defective &#x2018;&#x2018;pacemaker&#x2019;&#x2019; current (Ih) in a zebrafish mutant with a slow heart rate. Proc Natl Acad Sci. 1997;94(6):4554&#x2013;4559.&#xD;
&#xD;
2. Barbazuk W, Korf I, Kadavi C, Heyen J, Tate S, Wun E, et al. The syntenic relationship of the zebrafish and human genomes. Genome Res. 2000;10(8):1351&#x2013;1358.&#xD;
&#xD;
3. Becker T, Wulliman M, Becker C, Bernhardt R, Schachner M. Axonal regrowth after spinal cord transection in adult zebrafish. J Comp Neurol. 1997; 377:577&#x2013;595.&#xD;
&#xD;
4. Beis D, Stainier D. In vivo cell biology: following the zebrafish trend. Trends Cell Biol.2006; 16 (10):105&#x2013;112.&#xD;
&#xD;
5. Boselli F, Vermont J. Live imaging and modelling for shear stress quantification in the embryonic zebrafish heart. Trends Cell Biol. 2010;12(8):105&#x2013;112.&#xD;
&#xD;
6. San Chi N, Shaw R, Jungblut B, Huisken J, Ferrer T. Genetic and physiologic dissection of the vertebrate cardiac conduction system. PLoS Biol. 2010; 6(5): e109.&#xD;
&#xD;
7. Curado S, Anderson R, Jungblut B, Mumm J, Schroeter E, Stainier D. Conditional targeted cell ablation in zebrafish: a new tool for regeneration studies. Dev Dyn 2007; 236:1025&#x2013;1035&#xD;
&#xD;
8. Fisher S, Grice E, Vinton R, Bessling S, McCallion A. Conservation of RET regulatory function from human to zebrafish without sequence similarity. Science 2006;3(12):276&#x2013;279.&#xD;
&#xD;
9. Chablais F, Veit J, Rainer G, Jaz&#xB4;win&#xB4;ska A. The zebrafish heart regenerates after cryoinjury-induced myocardial infarction. BMC Dev Biol. 2011;11(4):21-25.&#xD;
&#xD;
10. Frangogiannis N. The mechanistic basis of infarct healing. Antio Red Signal. 2006; 8(4):1907&#x2013;1939.&#xD;
&#xD;
11. Gonza&#xB4;lez-Rosa J, Mart V, Peralta M, Torres M, Mercader N. Extensive scar formation and regression during heart regeneration after cryoinjury in zebrafish. BMC Dev Biol. 2006;138:1663&#x2013;1674.&#xD;
&#xD;
12. Haack T, Abdelilah-Seyfried S. The force within endocardial development, mechanotransduction and signalling during cardiac morphogenesis. BMC Dev Biol. 2016; 143:373&#x2013;386.&#xD;
&#xD;
13. Jopling C, Sleep E, Raya M, Mart?&#xB4; M, Belmonte I. Zebrafish heart regeneration occurs by cardiomyocyte de-differentiation and proliferation. Nature 2010; 464:606&#x2013;609.&#xD;
&#xD;
14. Kalogirou S, Malissovas N, Moro E, Argenton F, Stainier D, Beis D. Intra-cardiac flow dynamics regulate atrioventricular valve morphogenesis. Cardi Res. 2014;104:49&#x2013;60.&#xD;
&#xD;
15. Kikuchi K, Holdway J, Major R, Blum N, Dahn R. Retinoic acid production by endocardium and epicardium is an injury response essential for zebrafish heart regeneration. Dev Cell 2011; 20:397&#x2013;404.&#xD;
&#xD;
16. Kikuchi K, Holdway J, Werdich A, Anderson R, Fang Y. Primary contribution to zebrafish heart regeneration by gata cardiomyocytes. Nature 2010;464:601&#x2013;605.&#xD;
&#xD;
17. Kim J, Wu Q, Zhang Y, Wiens K, Huang Y. PDGF signalling is required for epicardial function and blood vessel formation in regenerating zebrafish hearts. Proc Natl Acad Sci. 2010;107:17206&#x2013;17210.&#xD;
&#xD;
18. Kroehne V, Freudenreich D, Hans S, Kaslin J, Brand M. Regeneration of the adult zebrafish brain from neurogenic radialglia- type progenitors. Dev Acad Sci 2011;138:4831&#x2013;4841.&#xD;
&#xD;
19. Lam S, Wu Y, Vega V, Miller L, Spitsbergen J. Conservation of gene expression signatures between zebrafish and human liver tumours and tumour progression. Nat Biotechnol 2005;24:73&#x2013;75.&#xD;
&#xD;
20. Langheinrich U, Vacuum G, Wagner T. Zebrafifish embryos express an orthologue of HERG and are sensitive toward a range of QT-prolonging drugs inducing severe arrhythmia. Toxicol Appl Pharmacol 2003;193:370&#x2013;382.&#xD;
&#xD;
21. Kroehne V, Freudenreich D, Hans S, Kaslin J, Brand M. Regeneration of the adult zebrafifish brain from neurogenic radial glia-type progenitors. Dev Acad Sci. 2011;138:4831&#x2013;4841.&#xD;
&#xD;
22. Lam S, Wu Y, Vega V, Miller L, Spitsbergen J. Conservation of gene expression signatures between zebrafish and human liver tumours and tumour progression. Nat Biotechnol 2005; 24:73&#x2013;75.&#xD;
&#xD;
23. Langheinrich U, Vacuum G, Wagner T. Zebrafish embryos express an orthologue of HERG and are sensitive toward a range of QT-prolonging drugs inducing severe arrhythmia. Toxicol Appl Pharmacol 2003;193:370&#x2013;382.&#xD;
&#xD;
24. Milan D, Peterson T, Ruskin J, Peterson R, MacRae C. Drugs that induce repolarization abnormalities to cause bradycardia in zebrafish. Circulation 2003;107:1355&#x2013;1358.&#xD;
&#xD;
25. Porrello E, Mahmoud A, Simpson E, Hill J, Richardson J, Olson E. Transient regenerative potential of the neonatal mouse heart. Science 2011; 331:1078&#x2013;1080.&#xD;
&#xD;
26. Poss K, Keating M, Nechiporuk A. Tales of regeneration in zebrafish. Dev Dyn 2003; 22(6):202&#x2013;210.&#xD;
&#xD;
27. Smith KA, Joziasse IC, Chocron S, van Dinther M, Guryev V. Dominantnegative ALK2 allele associates with congenital heart defects. Circulation 2003; 11(9):3062&#x2013;3069&#xD;
&#xD;
28. Sehnert A, Huq A, Weinstein B, Walker C. Cardiac troponin T is essential in sarcomere assembly and cardiac contractility. Nat Genet 2002; 31:106&#x2013;110.&#xD;
&#xD;
29. Steed E, Boselli F, Vermont J. Hemodynamics has driven cardiac valve morphogenesis. Biochim Biophys Acta 2015;7 (17 B):1760&#x2013;1766. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Understanding the Time Dependent Transmissibility of COVID-19 Through Its Effective Reproduction Number (Rt)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>59</FirstPage><LastPage>64</LastPage><AuthorList><Author>See Jie</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajasvaran Logeswaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Over six centuries ago, the most fatal pandemic ever recorded in human history, the Black Death (The Plague), emerged with an estimated death toll of 75-200 million. At present, COVID-19 has surfaced causing over 5 million infected and 340 thousand deaths worldwide, with the numbers still rising. Objective: This paper focuses on the significance of the effective reproduction number (Rt ) in the epidemiology of SARS-CoV-2, to understand the time-dependent transmission pattern of this virus after intervention measures such as city lockdowns and social distancing. Studies done by various parties on estimating the Rt for different countries are discussed and interpreted. Results: It is found that all the countries studied still show an Rt of greater than 1, indicating that the COVID-19 outbreak is still ongoing. However, some countries are gradually keeping COVID-19 under control with a decreasing Rt after implementing intervention measures. Conclusion: COVID-19 is still spreading rapidly across the entire globe, and the soonest production of vaccines is expected to be early 2021, but it is estimated that it will take up to five years to be developed.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>COVID-19, SAR-Cov-2, Effective Reproduction Number, Time-Dependent Transmissibility</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
It was not long ago when the World Health Organization (WHO) declared the Coronavirus Diseases 2019 (COVID-19) outbreak a pandemic, and as of 23rd May 2020, there have been 5,346,876 confirmed cases and 340,869 deaths worldwide, covering 213 countries and territories.1 Firstly emerged as an epidemic on the 31st of December 2019 in Wuhan, Hubei Province in China, several Chinese scientists isolated and sequenced the genome of the virus.2 The virus was tentatively named by the WHO as the 2019 novel coronavirus (2019-nCoV) and later identified as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), causing the Coronavirus Disease 2019 (COVID-19). According to the COVID-19 can affect certain groups which include the older populations and individuals who suffer from underlying health conditions that COVID-19 hypothetically induces mild symptoms to other respiratory infections that exhibited an ability to generate severe diseases towards the affected group.3 &#xD;
&#xD;
It was further explained that a clear understanding of the epidemiology of the virus was still being elucidated and the estimation of basic reproduction number (R0&#xA0;) as well as effective reproduction number (Rt&#xA0;) was vital.&#xD;
&#xD;
Basic Reproduction Number (R0)&#xD;
&#xD;
In epidemiology, it is essential to estimate the actual or possible outbreaks of a particular disease, such as the Human Immunodeficiency Virus (HIV),4 Severe Acute Respiratory Syndrome (SARS),5 Tuberculosis (TB),6 and the recent Coronavirus Disease 2019 (COVID-19). The estimation of the possible outbreak during the start of an epidemic is usually represented by a parameter called Basic Reproduction Number (R0&#xA0;), which is widely used in assessing the transmissibility of pathogens as well as estimating the severity of the outbreak. R0&#xA0; is defined as the expected number of secondary cases directly generated by one case in a population, whereby all individuals are susceptible to infection without any deliberate intervention in disease transmission.7 R0&gt;1&#xA0; indicates the outbreak of a disease, whereas R0&#xA0;010&#xA0;Rt&#xA0; is commonly used to characterize pathogen transmissibility during an epidemic due to its time and situation specificity,11 that takes into account the decline in susceptible individuals (intrinsic factor) and control measures implementation (extrinsic factor).12 Rt&#xA0;&lt; 1 suggests that the disease outbreak has been brought under control at time t, whereas Rt&gt;1&#xA0;indicates that the outbreak is still ongoing. To bring an epidemic under control, the monitoring of Rt&#xA0;overtime provides feedback on the effectiveness of interventions and the importance to further intensify control efforts,13,14 given that the goal of intervention effort is to being Rt&#xA0;below the threshold value of 1 and subsequently close to 0 as soon as possible.&#xD;
&#xD;
Estimation of Rt&#xA0; for COVID-19&#xD;
&#xD;
The study in15 carried out R0&#xA0; and Rt&#xA0; estimations in South Korea, but the cases are split into: total, Sincheonji, except Sincheonji, Daegu-Gyeonbuk and except-Daegu-Gyeonbuk subgroups, to thoroughly understand the transmission patterns of major cluster cases in South Korea. The exponential growth model16 was first fitted on the R0&#xA0; values, followed by sensitivity analysis done on the exponential growth period. Due to the unknown generation time (GT) of COVID-19 at the time of the study, the serial interval was modelled using gamma distribution with mean &#xB1; standard deviation of 2.0 &#xB1; 1.0, 3.0 &#xB1; 1.5, 4.0 &#xB1; 2.0, 5.0 &#xB1; 2.5, and 6.0 &#xB1; 3.0 days, obtained by referring to the incubation period of two to 14 days. An initial R0&#xA0; for total cases was estimated to be around 3.4. However, the outcome of the sensitivity test suggests that the R0&#xA0; value is highly sensitive to the GT of COVID-19, hence the estimated R0&#xA0; might not be reliable as the GT used was just based on assumptions. After the Sincheonji mass infection incident, the health authorities of Korea implemented a series of intervention procedures, including active COVID-19 testing, isolation, social distancing, school closures and active surveillance. By applying the same method, the Rt&#xA0; was estimated and the result is illustrated in Figure 1. Although the Rt&#xA0; of total cases show a downward trend, both &#x201C;Except Sincheonji&#x201D; and &#x201C;Except Daegu-Gyeongbuk&#x201D; clusters were still fluctuating, suggesting the possibility of another mass infection if not dealt with carefully. Nonetheless, thanks to the intervention approach, Rt&#xA0; of most of the cluster groups gradually decreased. However, the estimated Rt&#xA0;maybe different from the actual Rt&#xA0;due to the unknown GT, Figure 1.&#xD;
&#xD;
&#xD;
&#xD;
The exponential growth rate (EG) and time-dependent (TD) methods were employed using local transmission cases observed in Germany, France, Italy and Spain from 20th February 2020 to 9th March 2020.17 Under the EG method, the exponential growth stage of the outbreak is first fitted using a Poisson regression model, under the assumption that the GT of COVID-19 follows a gamma distribution.18 The Rt&#xA0; is then calculated through the transformation of the EG rate. Through the TD method, Rt&#xA0; is computed by averaging the overall transmission networks that are compatible with the observed epidemic curve.18 The TD method takes into account the yet-unrecorded cases because it uses a Bayesian statistical framework. Both EG and TD methods are highly dependent on the value of the GT, measured by the onset time lag between primary and secondary causes. As this is difficult to obtain, GT is assumed to be equal to the incubation period of 5.8 days with a standard deviation of 2.6 days.20 Sensitivity analysis is then carried out using an incubation period of 4 days with a standard deviation of 2.4 days.21 From the results in Table 1 for the different models up until 9th March 2020, the Rt&#xA0; in all four countries were greater than two, indicating the progression of the COVID-19 outbreak. Stricter control measures are needed in these countries, especially France, Germany and Spain, to bring the pandemic under control. Besides that, lockdown measures had just been implemented in Italy and therefore Rt&#xA0; should be constantly monitored to understand the effectiveness of the measure. &#xD;
&#xD;
Some limitations of this study include that the models are highly dependent on the GT of COVID-19, which is relatively difficult to estimate. Further, the reported cases may be lower than the actual cases, which can affect the accuracy of the study. Despite the limitations, this study provides important findings of the transmissibility of COVID-19 in the four countries. The European Centre for Disease Prevention and Control (ECDC) should work closely with these countries, Table 1.&#xD;
&#xD;
&#xD;
&#xD;
In the Rt&#xA0; of COVID-19 for 32 countries outside of China with over 100 reported cases by 13th March 2020 were computed by applying the EG method [16]. Data on the daily reported new COVID-19 cases in these countries were used, alongside with assumption of mean serial interval of 4.7 days and standard deviation of 2.9 days.22, 23 Of these 32 countries, United States (2,294), France (3,671), Germany (3,675), Spain (5,232), Korea (8,086), Iran (11,364) and Italy (17,660) had more than 1,000 reported COVID-19 cases. Bahrain, Slovenia, Qatar, Spain, Denmark and Finland had Rt&#xA0;greater than four. The estimated Rt&#xA0; of all 32 countries as of 13th March 2020 are shown in Table 2. The Rt&#xA0; should be constantly monitored like some of the countries with relatively low Rt&#xA0; (</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3760</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3760</Fulltext></URLs><References>&#xD;
	&#xD;
		&#xD;
			&#xD;
			WHO. Coronavirus disease (COVID-2019) situation reports," 2020. [Online]. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. [Accessed 18 May 2020].&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Cohen J. Chinese researchers reveal the draft genome of the virus implicated in Wuhan pneumonia outbreak. Science Mag. 2020;11.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Adler SE. Why coronaviruses hit older adults hardest, 2020. [Online]. Available: https://www.aarp.org/health/conditions-treatments/info-2020/coronavirus-severe-seniors.html. [Accessed 19 May 2020].&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Velasco-Hernandez JX, Gershengorn HB, Blower SM. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Inf Dis. 2002;2(8):487-493.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Lipsitch M, Cohen T, Cooper B, Robins JM, Ma S, James L, et al. Transmission dynamics and control of severe acute respiratory syndrome. Science 2003;300(5627):1966-70.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Blower SM, Chou T. Modeling the emergence of the&amp;#39;hot zones&amp;#39;: tuberculosis and the amplification dynamics of drug resistance. Nat Med. 2004;10(10):1111-6.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Fraser C, Donnelly CA, Cauchemez S, Hanage WP, Van Kerkhove MD, Hollingsworth TD, et al. Pandemic potential of a strain of influenza A (H1N1): early findings. Science 2009;324(5934):1557-61.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Halloran ME, Haber M, Longini Jr IM, Struchiner CJ. Direct and indirect effects in vaccine efficacy and effectiveness. Am J Epidemiol 1991;133(4):323-31.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Fine PE. Herd immunity: history, theory, practice. Epid Rev 1993;15(2):265-302.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Cauchemez S, Bo&#xEB;lle PY, Thomas G, Valleron AJ. Estimating in real-time the efficacy of measures to control emerging communicable diseases. Am J Epidemiol 2006;164(6):591-7.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Cori A, Ferguson NM, Fraser C, Cauchemez S. A new framework and software to estimate time-varying reproduction numbers during epidemics. Am J Epidemiol 2013;178(9):1505-15012.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Nishiura H, Chowell G. The effective reproduction number as a prelude to the statistical estimation of time-dependent epidemic trends. InMathematical and statistical estimation approaches in epidemiology 2009; 103-12.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Anderson RM, Anderson B, May RM. Infectious diseases of humans: dynamics and control. Oxford university press; 1992 Aug 27.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature. 2006;442(7101):448-452.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Hwang J, Park H, Jung J, Kim SH, Kim N. Basic and effective reproduction numbers of COVID-19 cases in South Korea excluding Sincheonji cases. MedRxiv. 2020;11(4): 467-469.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Wallinga J, Lipsitch M. How generation intervals shape the relationship between growth rates and reproductive numbers. Proceedings of the Royal Society B: Bio Sci. 2007;274(1609):599-604.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Yuan J, Li M, Lv G, Lu ZK. Monitoring transmissibility and mortality of COVID-19 in Europe. Int J Inf Dis 2020; 95: 311&#x2013;315.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Wallinga J, Teunis P. Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures. Am J Epidemiol 2004;160(6):509-16. &#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Liu Y, Gayle AA, Wilder-Smith A, Rockl&#xF6;v J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 2020;13(3):56-60.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, et al. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data. J Clin Med. 2020;9(2):538.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New Eng J Med. 2020;382(18):1708-1720.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Kwok KO, Lai F, Wei WI, Wong SY, Tang JW. Herd immunity&#x2013;estimating the level required to halt the COVID-19 epidemics in affected countries. J Infect 2020;80(6):e32-33.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Nishiura H, Linton NM, Akhmetzhanov AR. Serial interval of novel coronavirus (COVID-19) infections. Int J Inf Dis 2020;13(4):983-986.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Shim E, Tariq A, Choi W, Lee Y, Chowell G. Transmission potential and severity of COVID-19 in South Korea. Int J Inf Dis 2020; 18(3):1421-1425.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Viboud C, Simonsen L, Chowell G. A generalized-growth model to characterize the early ascending phase of infectious disease outbreaks. Epidemiology 2016;15:27-37.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			You C, Deng Y, Hu W, Sun J, Lin Q, Zhou F, Pang CH, Zhang Y, Chen Z, Zhou XH. Estimation of the time-varying reproduction number of COVID-19 outbreak in China. Int J Hyg Envt Health 2020:113555.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Chowell G. Fitting dynamic models to epidemic outbreaks with quantified uncertainty: A primer for parameter uncertainty, identifiability, and forecasts. Infect Dis Mod. 2017;2(3):379-98.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Senapati A, Rana S, Das T, Chattopadhyay J. Impact of intervention on the spread of COVID-19 in India: A model based study. arXiv preprint arXiv:2004.04950. 2020 Apr 10.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility&#x2014;King County, Washington, March 2020. Morbidity and Mortality Weekly Report. 2020 Apr 3;69(13):377.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Flaxman S, Mishra S, Gandy A, Unwin HJ, Coupland H, Mellan TA, et al. Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in European countries: technical description update. arXiv preprint arXiv:2004.11342. 2020 Apr 23.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Fraser C. Estimating individual and household reproduction numbers in an emerging epidemic. PloS One. 2007;2(8):e758.&#xD;
			&#xD;
		&#xD;
		&#xD;
			&#xD;
			Le TT, Andreadakis Z, Kumar A, Roman RG, Tollefsen S, Saville M, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. 2020 Apr 9;19(5):305-6. &#xD;
			&#xD;
		&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Mining Plausible Antibacterial Targets Against Potato Pathogen Ralstonia solanacearum IPO1609 Through in Silico Subtractive Genomics Approach&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>65</FirstPage><LastPage>75</LastPage><AuthorList><Author>Gurunathan S</Author><AuthorLanguage>English</AuthorLanguage><Author> Dhamotharan R</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Ralstonia solanacearum IPO1609 (Rs IPO1609) is a gram-negative phytopathogenic bacteria that causes severe&#xA0;bacterial wilt disease in potatoes. Agricultural practices and agrochemicals are often ineffective solutions to control it. Identification of essential antibacterial targets in the phytopathogen could enable the design/development of suitable bactericides and&#xA0;eventually, control potato brown rot.&#xD;
&#xD;
Objective: To reveal prospective antibacterial targets in Rs IPO1609 utilizing subtractive genomics strategy coupled with differential pathway analysis, subcellular localization, virulent prediction and drug bank database screening.&#xD;
&#xD;
Methods: The study was designed to identify potential antibacterial targets in Rs IPO1609. Among the 4545 proteins present&#xD;
in the pathogen, non-orthologs cum non-paralogs were obtained and subjected to in silico comparative analysis against potato&#xD;
proteome to reveal non-homologous proteins present in the bacterium. Furthermore, the essentiality of these non-homologs for&#xD;
pathogen&#x2019;s survival was determined using DEG Database. Metabolic pathways involvement of the short-listed essential proteins&#xD;
was implemented using KAAS and virulent proteins were determined using MP3 web server analysis. Intracellular localization of&#xD;
essential virulent proteins determined using CELLO2GO &amp; PSORTb programs enable enlisting of plausible antibacterial targets.&#xD;
Results: Subtractive genomics-based approach revealed that a list of 136 proteins of Rs IPO1609 were potato non-homologs&#xD;
and essential. A total of 55 targets are involved in the unique biochemical pathways of the pathogen. Of 55, 29 proteins were&#xA0;found virulent. Furthermore, based on intracellular localization, 3 virulent proteins were identified as promising therapeutic targets.&#xD;
&#xD;
Conclusion: Among the 55 targets identified in this study, three proteins were found highly potential as antibacterial targets in&#xD;
Rs IPO1609 based on their metabolic pathway, virulence and intracellular localization properties. The outcome might be used as&#xD;
a design in genomics-based strategies to control bacterial phytopathogens.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Ralstonia solanacearum IPO1609, Antimicrobial targets, Subtractive genomics, Essential genes, Potato pathogen,  KEGG pathway</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Current strategies to manage bacterial plant diseases are becoming obsolete primarily due to deficiency in availability of suitable agrichemicals,1 resulting in an overall loss of twenty per cent (approx.) in plant productivity globally.2 Thus, forcing researchers to explore and identify novel agrichemicals to control bacterial phytopathogens. In today&#x2019;s era, computational approaches have massively supported modern medicinal drug discovery and development processes.3&#xA0; However, investigators express that in silico strategies are vital in exploring and understanding plant sciences too.4&#xA0; Few even predict applying computational protocols to decode phytopathogens, their molecular virulence factors and discover effective therapeutics to control them.5,6 &#xD;
&#xD;
Antimicrobial target discovery in today&#x2019;s post-genomics era is achieved by &#x2018;omics&#x2019; based approaches rather than by the traditional generic methods.7&#xA0; This strategy is also being explored against phytopathogens.1 Genomic data of several bacterial phytopathogens (draft/completed) generated by cutting-edge sequencing technologies are publicly accessible.1,2&#xA0; Thus, allowing investigators to implement computational strategies (especially in silico comparative, subtractive, and functional genomics) on these collected data to discover novel antibacterial targets.8&#x2013;11 &#xD;
&#xD;
Promising antimicrobial targets in a pathogen can be detected with an interesting approach known as &#x2018;Differential genome display&#x2019; or &#x2018;Subtractive Genomics&#x2019;.12 This approach filters gene(s) (or its protein products) essentially needed for the pathogen, but absent in the host organism (also termed as essential non-host homologous sequences) and thus, are regarded as worthy targets against the pathogen.13 Although experimental and computational strategies exists for essential gene-based target prediction, the latter is preferred as it involves less time, labour and economic.14,15 Computational target identification in human bacterial pathogens has been successfully implemented by several investigators.16&#x2013;23 However, only a few researchers have followed this strategy to recognize antibacterial targets in phytopathogens.8&#x2013;10&#xD;
&#xD;
Ralstonia solanacearum (Rs) is a heterogeneous group of bacterial phytopathogen causing the most devastating wilt disease globally in more than 450 economically important plants that include banana, tomato, potato, eggplant, groundnut and tobacco. This soil bacterium is gram-negative, aerobic, non-spore-forming motile bacilli and belongs to the ?-proteobacteria family. More than 140 Rs strains recognized worldwide are classified into five races (1, 2, 3, 4 and 5), six biovars (1, 2, 3, 4, 5 and 6) and four phylotypes (I, II, III and IV) based on their ability to infect different hosts, biochemical properties and geographical distribution,24&#x2013;26 respectively. The phylotypes are further subgrouped into different sequevars.24,25,27&#xD;
&#xD;
Rs IPO1609 strain is a race 3/biovar 2 isolate obtained from potato in Europe and has been recently classified as phylotype IIB sequevar 1 (IIB1) strain.&#xA0; In addition to being highly destructive among known Rs strains affecting potato and ability to adapt to highland temperatures, IIB1 are reported as highly dangerous potato pathogens because they cause asymptomatic latent infections.28&#xA0; A whole-genome sequence draft (20x) of Rs IPO1609 was established at Genoscope, France.29 During the sequencing process, only the final assembling step was not completed.&#xA0; Hence, these sequences were assembled to generate ten supercontigs (length of 4 to 3372 kb) and are deposited in NCBI GenBank (accession nos.: CU694431 - CU694438, CU914166 and CU914168). They are also accessible at iant.toulouse.inra.fr/bacteria/annotation/cgi/ralso.cgi.&#xA0; Over 99% of the 5.313 Mb genome sequence is covered by 6 supercontigs (each having &gt;10 kb length) alone. The genome seems to possess a high G+C content (average 60%).29&#xD;
&#xD;
The present work aims to utilize a subtractive genomics strategy on Ralstonia solanacearum IPO1609 (a potato brown rot causing pathogen) to reveal its prospective antimicrobial target candidates.&#xA0; Furthermore, employing differential pathway analysis, subcellular localization, virulent prediction and drug bank database screening on the plausible targets will identify novel therapeutic targets among them.&#xA0; Eventually, facilitating the discovery of suitable therapeutics to use against this important bacterial phytopathogen.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Data Collection&#xA0; &#xD;
&#xD;
All protein sequences of Ralstonia solanacearum IPO1609 were retrieved individually in Fasta format from http://iant.toulouse.inra.fr/bacteria/annotation/cgi/ralso.cgi. The whole Proteome of Solanum tuberosum (UP000011115) was obtained from UniProtKB database (http://www.uniprot.org/taxonomy/complete-proteomes). All essential genes associated with prokaryotes were downloaded from the Database of Essential Genes (DEG) version 15.2 (http://tubic.tju.edu.cn/deg/).30&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Mining Essential Proteins of Rs IPO1609 &#xD;
&#xD;
Exclusion of Paralogs and Orthologs&#xD;
&#xD;
CD HIT server analysis (http://weizhong-lab.ucsd.edu/cdhit_suite/cgi-bin/index.cgi?cmd=cd-hit)31 at 80% identity threshold21 was employed to screen duplicate proteins or paralogs present in the proteome of Rs IPO1609.&#xA0; Likewise, orthologs (i.e. protein sequences with </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3761</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3761</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0; Sundin GW, Wang N, Charkowski AO, Castiblanco LF, Jia H, Zhao Y. Perspectives on the Transition From Bacterial Phytopathogen Genomics Studies to Applications Enhancing Disease Management: From Promise to Practice. Phytopathology. 2016 Oct;106(10):1071&#x2013;82. &#xD;
&#xD;
2. &#xA0;&#xA0;&#xA0; Tiwari S, Awasthi M, Pandey VP, Dwivedi UN. Genomics Based Approaches towards Management of Plant Diseases with Emphasis on in silico Methods as a Prudent Approach. J Agri Sci Food Technol. 2017 May;3(3):39&#x2013;51. &#xD;
&#xD;
3. &#xA0;&#xA0;&#xA0; Taylor D. The Pharmaceutical Industry and the Future of Drug Development. In: Hester RE, Harrison RM, editors. Issues in Environmental Science and Technology [Internet]. Cambridge: Royal Society of Chemistry; 2015 [cited 2020 Jun 26]. p. 1&#x2013;33. Available from: http://ebook.rsc.org/?DOI=10.1039/9781782622345-00001&#xD;
&#xD;
4. &#xA0;&#xA0;&#xA0; Rhee SY, Dickerson J, Xu D. Bioinformatics and its Applications in Plant Biology. Annu Rev Plant Biol. 2006;57(1):335&#x2013;60. &#xD;
&#xD;
5. &#xA0;&#xA0;&#xA0; Shanmugam G, Jeon J. Computer-Aided Drug Discovery in Plant Pathology. Plant Pathol J. 2017;33(6):529&#x2013;42. &#xD;
&#xD;
6. &#xA0;&#xA0;&#xA0; Imam J, Singh PK, Shukla P. Plant Microbe Interactions in Post Genomic Era: Perspectives and Applications. Front Microbiol. 2016;7:1488.&#xD;
&#xD;
7. &#xA0;&#xA0;&#xA0; Lin J, Qian J. Systems biology approach to integrative comparative genomics. Expert Rev Proteom. 2007;4:107&#x2013;19. &#xD;
&#xD;
8. &#xA0;&#xA0;&#xA0; Katara P, Grover A, Sharma V. In Silico Prediction of Drug Targets in Phytopathogenic Pseudomonas syringae pv. phaseolicola: Charting a Course for Agrigenomics Translation Research. OMICS J Integr Bio. 2012 Dec;16(12):700&#x2013;6. &#xD;
&#xD;
9. &#xA0;&#xA0;&#xA0; Keshri V, Singh DP, Prabha R, Rai A, Sharma AK. Genome subtraction for the identification of potential antimicrobial targets in Xanthomonas oryzae pv. oryzae PXO99A pathogenic to rice. Biotechnology. 2014;4(1):91&#x2013;5. &#xD;
&#xD;
10. &#xA0; Prabha R, Singh DP, Ahmad K, Kumar SPJ, Kumar P. Subtractive genomics approach for identification of putative antimicrobial targets in Xanthomonas oryzae pv. oryzae KACC10331. Arch Phytopathol Plant Protect. 2019;52(7&#x2013;8):863&#x2013;72. &#xD;
&#xD;
11. &#xA0; Pucci MJ. Use of genomics to select antibacterial targets. Biochem Pharmacol. 2006;71(7):1066&#x2013;72. &#xD;
&#xD;
12. &#xA0; Huynen M, Dandekar T, Bork P. Differential genome analysis applied to the species-specific features of Helicobacter pylori. FEBS Lett. 1998;426(1):1&#x2013;5. &#xD;
&#xD;
13. &#xA0; Sakharkar KR, Sakharkar MK, Chow VTK. A novel genomics approach for the identification of drug targets in pathogens, with special reference to Pseudomonas aeruginosa. In Silico Biol (Gedrukt). 2004;4(3):355&#x2013;60. &#xD;
&#xD;
14. &#xA0; Itaya M. An estimation of minimal genome size required for life. FEBS Letters. 1995;362(3):257&#x2013;60. &#xD;
&#xD;
15. &#xA0; Kobayashi K, Ehrlich SD, Albertini A, Amati G, Andersen KK, Arnaud M, et al. Essential Bacillus subtilis genes. Proc Natl Acad Sci USA. 2003;100(8):4678. &#xD;
&#xD;
16. &#xA0; Hossain MU, Khan M, Hashem A, Islam MdM, Morshed MN, Keya CA, et al. Finding Potential Therapeutic Targets against Shigella flexneri through Proteome Exploration. Front Microbiol. 2016;7:1817. &#xD;
&#xD;
17. &#xA0; Shuvo MSR, Shakil SK, Ahmed F. Potential Drug Target Identification of Legionella pneumophila by Subtractive Genome Analysis: An In Silico Approach. Bangla J Microbiol. 2019;35(2):102&#x2013;7. &#xD;
&#xD;
18. &#xA0; Uddin R, Jamil F. Prioritization of potential drug targets against P. aeruginosa by core proteomic analysis using computational subtractive genomics and Protein-Protein interaction network. Comput Biol Chem 2018;74:115&#x2013;22. &#xD;
&#xD;
19. &#xA0; Sadhasivam A, Vetrivel U. Genome-wide codon usage profiling of ocular infective Chlamydia trachomatis serovars and drug target identification. J Biomol Struc Dynam. 2018;36(8):1979&#x2013;2003. &#xD;
&#xD;
20. &#xA0; Mondal SI, Ferdous S, Akter A, Mahmud Z, Karim N, Islam MdM, et al. Identification of potential drug targets by subtractive genome analysis of Escherichia coli O157:H7: an in silico approach. AABC. 2015:49. &#xD;
&#xD;
21. &#xA0; Shoukat K, Rasheed N, Sajid M. Subtractive genome analysis for in silico identification and characterization of novel drug targets in C. Trachomatis STRAIN D/UW-3/Cx. 2012;4. &#xD;
&#xD;
22. &#xA0; Barh D, Tiwari S, Jain N, Ali A, Santos AR, Misra AN, et al. In silico subtractive genomics for target identification in human bacterial pathogens. Drug Dev Res. 2011;72(2):162&#x2013;77. &#xD;
&#xD;
23. &#xA0; Vetrivel U, Subramanian G, Dorairaj S. A novel in silico approach to identify potential therapeutic targets in human bacterial pathogens. HUGO J. 2011;5(1&#x2013;4):25&#x2013;34. &#xD;
&#xD;
24. &#xA0; Peeters N, Guidot A, Vailleau F, Valls M. Ralstonia solanacearum , a widespread bacterial plant pathogen in the post-genomic era: Ralstonia solanacearum and bacterial wilt disease. Mol Plant Pathol. 2013;14(7):651&#x2013;62. &#xD;
&#xD;
25. &#xA0; Elphinstone JG. The current bacterial wilt situation: a global overview. In: Allen C, Piror P, Hayward AC, editors. Bacterial wilt disease and the Ralstonia solanacearum complex. APS press, Minnesota USA; 2005. p. 9&#x2013;28. &#xD;
&#xD;
26. &#xA0; Tahat MM, Sijam K. Ralstonia solanacearum: The Bacterial Wilt Causal Agent. Asian J Plant Sci. 2010;9(7):385&#x2013;93. &#xD;
&#xD;
27. &#xA0; Fegan M, Prior P. How complex is the &#x201C;Ralstonia solanacearum species complex&#x201D;? In: C. Allen, P. Prior, and C. Hayward, editor. Bacterial Wilt: the Disease and the Ralstonia solanacearum Species Complex. Am Phytopathol Soc Press, St. Paul, MN.; 2005. p. 449&#x2013;62. &#xD;
&#xD;
28. &#xA0; Guidot A, Elbaz M, Carr&#xE8;re S, Siri MI, Pianzzola MJ, Prior P, et al. Specific genes from the potato brown rot strains of Ralstonia solanacearum and their potential use for strain detection. Phytopathology. 2009;99:1105&#x2013;12. &#xD;
&#xD;
29. &#xA0; Salanoubat M, Genin S, Artiguenave F, Gouzy J, Mangenot S, Arlat M, et al. Genome sequence of the plant pathogen Ralstonia solanacearum. Nature. 2002;415(6871):497&#x2013;502. &#xD;
&#xD;
30. &#xA0; Luo H, Lin Y, Gao F, Zhang C-T, Zhang R. DEG 10, an update of the database of essential genes that includes both protein-coding genes and noncoding genomic elements: Table 1. Nucl Acids Res. 2014;42(D1):D574&#x2013;80. &#xD;
&#xD;
31. &#xA0; Huang Y, Niu B, Gao Y, Fu L, Li W. CD-HIT Suite: a web server for clustering and comparing biological sequences. Bioinformatics. 2010;26(5):680&#x2013;2. &#xD;
&#xD;
32. &#xA0; Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Bio. 1990 Oct;215(3):403&#x2013;10. &#xD;
&#xD;
33. &#xA0; Moriya Y, Itoh M, Okuda S, Yoshizawa AC, Kanehisa M. KAAS: an automatic genome annotation and pathway reconstruction server. Nucleic Acids Res. 2007;35:W182&#x2013;5. &#xD;
&#xD;
34. &#xA0; Gupta A, Kapil R, Dhakan DB, Sharma VK. MP3: A Software Tool for the Prediction of Pathogenic Proteins in Genomic and Metagenomic Data. Raghava GPS, editor. PLoS One. 2014;9(4):e93907. &#xD;
&#xD;
35. &#xA0; Yu NY, Wagner JR, Laird MR, Melli G, Rey S, Lo R, et al. PSORTb 3.0: improved protein subcellular localization prediction with refined localization subcategories and predictive capabilities for all prokaryotes. Bioinformatics. 2010;26(13):1608&#x2013;15. &#xD;
&#xD;
36. &#xA0; Yu C-S, Cheng C-W, Su W-C, Chang K-C, Huang S-W, Hwang J-K, et al. CELLO2GO: A Web Server for Protein subCELlular LOcalization Prediction with Functional Gene Ontology Annotation. Raghava GPS, editor. PLoS ONE. 2014 Jun 9;9(6):e99368. &#xD;
&#xD;
37. &#xA0; Chandra N. Computational approaches for drug target identification in pathogenic diseases. Exper Opin Drug Disc. 2011;6(10):975&#x2013;9. &#xD;
&#xD;
38. &#xA0; Hossain T, Kamruzzaman M, Choudhury TZ, Mahmood HN, Nabi AH, Hosen MdI. Application of the Subtractive Genomics and Molecular Docking Analysis for the Identification of Novel Putative Drug Targets against Salmonella enterica subsp. enterica serovar Poona. BioMed Res Int. 2017;2017:1&#x2013;9. &#xD;
&#xD;
39. &#xA0; Georrge JN, Umrania V. In silico identification of putative drug targets in Klebsiella pneumonia MGH78578. Ind J Biotechnol. 2011;10:432&#x2013;9. &#xD;
&#xD;
40. &#xA0; Sivashanmugam M, Nagarajan H, Vetrivel U, Ramasubban G, Therese KL, Narahari MH. In silico analysis and prioritization of drug targets in Fusarium solani. Med Hypotheses. 2015 Feb;84(2):81&#x2013;4. &#xD;
&#xD;
41. &#xA0; Allen C, Bent A, Charkowski A. Underexplored niches in research on plant pathogenic bacteria. Plant Physiol. 2009;150(4):1631&#x2013;7. &#xD;
&#xD;
42. &#xA0; Silver LL. Challenges of antibacterial discovery. Clin Microbiol Rev. 2011;24(1):71&#x2013;109. &#xD;
&#xD;
43. &#xA0; Galperin MY, Koonin EV. Searching for drug targets in microbial genomes. Curr Opin Biotechnol. 1999 Dec;10(6):571&#x2013;8. &#xD;
&#xD;
44. &#xA0; Folador EL, de Carvalho PVSD, Silva WM, Ferreira RS, Silva A, Gromiha M, et al. In silico identification of essential proteins in Corynebacterium pseudotuberculosis based on protein-protein interaction networks. BMC Syst Biol. 2016;10(1):103. &#xD;
&#xD;
45. &#xA0; Hosen MdI, Tanmoy AM, Mahbuba D-A, Salma U, Nazim M, Islam MdT, et al. Application of a subtractive genomics approach for in silico identification and characterization of novel drug targets in Mycobacterium tuberculosis F11. Interdiscip Sci Comput Life Sci. 2014 Mar;6(1):48&#x2013;56. &#xD;
&#xD;
46. &#xA0; Maranh&#xE3;o FCA, Pai&#xE3;o FG, Fachin AL, Martinez-Rossi NM. Membrane transporter proteins are involved in Trichophyton rubrum pathogenesis. J Med Microbiol. 2009;58(2):163&#x2013;8. &#xD;
&#xD;
47. &#xA0; Rodriguez GM, Smith I. Identification of an ABC Transporter Required for Iron Acquisition and Virulence in Mycobacterium tuberculosis. J Bacteriol. 2006;188(2):424&#x2013;30. &#xD;
&#xD;
48. &#xA0; Chen HD, Groisman EA. The Biology of the PmrA/PmrB Two-Component System: The Major Regulator of Lipopolysaccharide Modifications. Annu Rev Microbiol. 2013 Sep 8;67(1):83&#x2013;112. &#xD;
&#xD;
49. &#xA0; Butt AM, Nasrullah I, Tahir S, Tong Y. Comparative Genomics Analysis of Mycobacterium ulcerans for the Identification of Putative Essential Genes and Therapeutic Candidates. Carlow CK, editor. PLoS ONE. 2012;7(8):e43080. &#xD;
&#xD;
50. &#xA0; Sperandeo P, Martorana AM, Polissi A. Lipopolysaccharide biogenesis and transport at the outer membrane of Gram-negative bacteria. Biochimica et Biophysica Acta (BBA) - Mol Cell Biol Lipids. 2017;1862(11):1451&#x2013;60. &#xD;
&#xD;
51. &#xA0; Li Y-H, Tian X. Quorum Sensing and Bacterial Social Interactions in Biofilms. Sensors. 2012;12(3):2519&#x2013;38. &#xD;
&#xD;
52. &#xA0; Sintim HO, Smith JA, Wang J, Nakayama S, Yan L. Paradigm shift in discovering next-generation anti-infective agents: targeting quorum sensing, c-di-GMP signaling and biofilm formation in bacteria with small molecules. Future Med Chem. 2010 Jun;2(6):1005&#x2013;35. &#xD;
&#xD;
53. &#xA0; Clatworthy AE, Pierson E, Hung DT. Targeting virulence: a new paradigm for antimicrobial therapy. Nat Chem Biol. 2007;3(9):541&#x2013;8. &#xD;
&#xD;
54. &#xA0; Band V, Weiss D. Mechanisms of Antimicrobial Peptide Resistance in Gram-Negative Bacteria. Antibiotics. 2014;4(1):18&#x2013;41. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study on the Variations of Pterion in Human Crania in Odisha&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>76</FirstPage><LastPage>80</LastPage><AuthorList><Author>Singh G</Author><AuthorLanguage>English</AuthorLanguage><Author> Das S</Author><AuthorLanguage>English</AuthorLanguage><Author> Das SR</Author><AuthorLanguage>English</AuthorLanguage><Author> Patra M</Author><AuthorLanguage>English</AuthorLanguage><Author> Shamal SN</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Pterion is H shaped junction of sutures seen on norma lateralis where frontal, parietal, sphenoid and temporal bones meet. It has been described to be of four types &#x2013; Sphenoparietal, Frontotemporal, Stellate and Epipteric types. Its position has been described to be located 2.6 cm behind fronto zygomatic suture and 4 cm above the zygomatic arch. Objective: To assess the different types of pterion and to determine its exact location in dry adult human crania and to determine the variation in pteria between two sides and between males and females. Methods: This study was conducted in the Department of Anatomy, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha using 50 dried human crania with the aims to assess the different types of pterion and to determine its exact location and to determine the variation in pteria between two sides and between males and females. Results: The most common type of pterion was Sphenoparietal (80%) followed by Epipteric (10%), Stellate (10%) and Frontotemporal (0%) types. There was no side difference in the distance between pterion and frontozygomatic suture and between pterion and zygomatic arch. There was a gender difference (p-value =0.00033) in the distance between pterion and zygomatic arch. Conclusion: Pterion is an important anatomical region for neurosurgeons, anatomists, anthropologists and forensic experts.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Pterion, Crania, Sphenoparietal, Frontozygomatic suture, Zygomatic arch, Suture</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Knowledge of the anatomy of pterion is essential for accurate positioning of burr holes for evacuation of extradural haematomas. Craniotomy in the region of pterion is performed for surgical approach to anterior and middle cranial fossae.1 Variation in the location and shape of pterion has been reported to occur between the two sides, among individuals, between the two sexes and different races. But these data in the Odisha population is lacking.&#xD;
&#xD;
The pterion is a roughly H-shaped junction of sutures formed by the meeting of four bones i.e frontal bone, greater wing of sphenoid, parietal bone and squamous part of temporal bones. It is related closely to the anterior branch of the middle meningeal artery and lateral fissure of the cerebral hemisphere. The location of pterion corresponds to the anterolateral fontanelle which is seen in neonates and closes in the 3rd month of life after birth. It is located about 2.6 cm behind and 1.3 cm above the posterolateral margin of the frontozygomatic suture and about 4 cm above the midpoint of the zygomatic arch.1&#xD;
&#xD;
According to the classification given by Murphy, there are four types of pterion: Sphenoparietal type (Figure 1). The greater wing of the sphenoid and the anteroinferior angle of parietal bones join directly in this type of pterion. Frontotemporal type - Frontal and temporal bones contact directly in this type of pterion. Stellate type (Figure 2). The tips of all four bones join in this type of pterion which resembles a star-like an appearance. Epipteric type (Figure 3) One or more sutural bones are present between the anteroinferior angle of the parietal and the greater wing of the sphenoid in this type of pterion. This sutural bone is also called epipteric bone. The presence of epipteric bones is of little morphological significance. The presence of epipteric bones can be due to normal process or rapid expansion of cranium in cases of hydrocephalus or genetic causes.1,2&#xD;
&#xD;
This study was conducted with the aims to assess the different types of pterion and to determine its exact location in dry adult human crania and to determine the variation in pteria between two sides and between males and females. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A Cross-sectional observational study was conducted in the Department of Anatomy, Kalinga Institute of Medical Sciences. 50 human crania (100 pteria) of known sex i.e 40 male and 10 female, were used for the study. The pattern of pteria, their shape and variations between male and female were analyzed. The measurements were taken using a digital vernier calliper on the norma lateral side. The study was approved by Institutional Ethics Committee [IEC approval No. KIIT/KIMS/IEC/51/2019].&#xD;
&#xD;
Position of pterion was measured as the distance from bony landmarks such as Frontozygomatic suture (Figure 5) and the midpoint of the superior border of the zygomatic arch (Figure 4). Percentages of different morphological types of pterion such as Sphenoparietal type, Frontotemporal type, Stellate type and Epipteric type was evaluated. Variations in position and type were compared between both sides and between males and females. &#xD;
&#xD;
Inclusion Criteria: Adult dry human crania, No trauma/fracture/deformity, Sutures visible. Exclusion Criteria: Crania with evidence of trauma/fracture/deformity, Sutures fused and not visible.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Types&#xD;
&#xD;
The most common type of pterion was Sphenoparietal (80%) followed by Epipteric (10%), Stellate (10%) and Frontotemporal (0%) types shown in Table 1.&#xD;
&#xD;
Comparison between sides&#xD;
&#xD;
Distance between Pterion and Frontozygomatic suture on the right side was 29.5 &#xB1; 3.97 mm and on the left side, it was 28.3 &#xB1; 4.39 mm. There was no significant difference between both sides (p=0.15 shown in Table 2.&#xD;
&#xD;
Distance between Pterion and Midpoint of the upper border of the zygomatic arch was 38.11 &#xB1; 3.35 mm on the right side and 37.11 &#xB1; 3.38 mm on the left side. There was no significant difference between both sides (p=0.14) in Table 3. &#xD;
&#xD;
Comparison between gender&#xD;
&#xD;
The distance between pterion and frontozygomatic suture in males was 29.17 &#xB1; 4.34 mm and in females, it was 27.86 &#xB1; 3.53 mm. There was no significant difference between gender (p=0.21) in Table 2.&#xD;
&#xD;
The distance between pterion and Midpoint of the upper border of the zygomatic arch was 38.22 &#xB1; 3.25 mm in males and 35.25 &#xB1; 2.88 mm in females. There was a significant difference between the two sexes (p=0.00033) in Table 3. &#xD;
&#xD;
DISCUSSION &#xD;
&#xD;
In all studies of pterion conducted by investigators worldwide it has been found that the most common type of pterion encountered is sphenoparietal. Epipteric was the second common type in studies conducted by Praba (2012) and Sarvaiya (2019).4,8 Frontotemporal was the second common type in studies conducted by Oguz (2004), Kumar (2013) and Ukoha (2013) but is was the least common in Srinivasa&#x2019;s study (2016) in Table 4.3,5,6,7&#xD;
&#xD;
In our study, the most common type was Sphenoparietal similar to previous studies, followed by epipteric and stellate types in equal proportions. The minor variation in observation of other types may be due to geographical, racial and genetic factors. In all studies, there was no significant side difference in the distance between pterion and frontozygomatic suture and the distance between pterion and midpoint of the superior border of the zygomatic arch. In our study, there was a similar finding in Table 5.&#xD;
&#xD;
There was no significant gender difference in the distance between pterion and frontozygomatic suture but the distance between pterion and midpoint of the superior border of zygomatic arch showed significant differences between male and female (p=0.00033).&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The importance of pterion in neurosurgical interventions cannot be overlooked. Accessory sutural bone is important for radiologist and neurosurgeons while interpreting through x rays or surgical correction of a fracture.14 An anthropometric database of the different types and different positions of pteria can be made which will help anatomist, anthropologist and forensic experts in the field. Helmet manufacturing companies/Policymakers may take note of the position of pterion, as it is a common site of skull fracture in Road Traffic Accidents and manufacture of helmets for males and females of Odisha with appropriate size adjustments and additional soft padding over the region of pterion for extra protection can be done. &#xD;
&#xD;
Acknowledgement: We are grateful to the Head of the Department of Anatomy of Kalinga Institute of Medical Sciences for allowing me to use the skull bones for this study. We thank the technical staff of the Anatomy Department of Kalinga Institute of Medical Sciences for their assistance. We thank the authors, reviewers and publishers of all the articles which we have used for our reference. We immensely thank the Editorial Board Members and the Team of Reviewers of IJCRR for their valuable input and guidance because of which the manuscript could be brought to its final form.&#xD;
&#xD;
Conflict of interest: There is no conflict of interest.&#xD;
&#xD;
Funding source: NIL &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3762</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3762</Fulltext></URLs><References>1. Standring S, Gray&#x2019;s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Edinburg. Elsevier, Churchill Livingstone. 409-43.&#xD;
&#xD;
2. Thomas M. The Pterion in the Australian Aborigine. Am J Phys Anthropol. 1956;14(2):225-44.&#xD;
&#xD;
3. Oguz O, Sanli SG, Bozkir MG, Soames RW. The Pterion in Turkish male skulls. Surg&#xA0; Radiol Anat. 2004; 26(3):220-4.&#xD;
&#xD;
4. Praba AMA, Venkatramaniah C. Morphometric study of different types of pterion and its relation with a middle meningeal artery in dry skulls of Tamil Nadu. J Pharm Biomed Sci. 2012;21(04):1-4.&#xD;
&#xD;
5. Kumar S, Anurag, Munjal S, Chauhan P, Chaudhary A, Jain SK. Pterion its location and clinical implications &#x2013; A study compared. J Evol Med Dent Sci. 2013;2(25):4600-8. &#xD;
&#xD;
6. Ukoha U, Oranusi CK, Okafor JI, Udemezue OO, Anyabolu AE, Nwamarachi TC. Anatomic study of the pterion in Nigerian dry human skulls. Niger J Clin Pract. 2013;16(3):325-8.&#xD;
&#xD;
7. Srinivasa RY, Eswari AK, Swayam JS, Rajeswara RN. Morphology of Pterion. Int J Sci Res. 2016;5(8):650-1.&#xD;
&#xD;
8.Sarvaiya BJ, Chaudhari JS, Fichadiya NC. Morphometric analysis of pterion in the adult human dry skull of Gujarat region. Int J Anat Res. 2019;7(1.2):6204-10.&#xD;
&#xD;
9. Sunday AA, Funmilayo EO, Modupe B. Study of the location and Morphology of the Pterion in Adult Nigerian Skulls. Int Sch Res Notices. 2013;403937:1-4.&#xD;
&#xD;
10. Aksu F, Akyer SP, Kale A, Geylan S, Gayretli O. The Localization and Morphology of pterion in adult west Anatolian skulls. J Craniofac Surg. 2014;25(4):1488-91.&#xD;
&#xD;
11. Gindha GS, Mir NS, Agarwal R. Morphometric study of Pterion in dry human skull bone in North Indian Population. Hum Biol Rev. 2017;6(1):1-9.&#xD;
&#xD;
12. Kulkarni P, Sukre S, Muley M. Morphometric study of Pterion in dry adult human skulls. Int J Anat Res. 2017;5(3.3):4365-4368.&#xD;
&#xD;
13. Nayak G, Mohanty BB, Das SR. Morphometric study of Pterion and its clinical significance. Asian J Pharm Clin Res. 2017;10(10):142-4.&#xD;
&#xD;
14. Sudha R, Sridevi C, Ezhilarasi M. Anatomical variations in the formation of Pterion and Asterion in South Indian population. Int J Curr Res Rev. 2013;5(9):92-101.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Incidence and Factors Impacting Candiduria in Catheter-Associated Urinary Tract Infection in Tribal Patients of Medicine Intensive Care Unit in a Tribal-Dominated Tertiary Care Hospita&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>81</FirstPage><LastPage>86</LastPage><AuthorList><Author>Monalisa Subudhi</Author><AuthorLanguage>English</AuthorLanguage><Author> Jagatheeswary PAT</Author><AuthorLanguage>English</AuthorLanguage><Author> Susanta Kumar Sahu</Author><AuthorLanguage>English</AuthorLanguage><Author>  Sudhanshu Kumar Das</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Candiduria in catheter-associated urinary tract infection (CAUTI) is most challenging because of the emergence of extreme drug-resistant infections especially in critically ill patients of medicine Intensive Care Unit (MICU) in a tribal-dominated rural tertiary care centre. Objective: The study aims to find out the incidence, risk factors and their impact on candiduria in CAUTI in the tribal-dominated rural tertiary care centre. Methods: This prospective study was conducted in MICU of SLNMCH, Koraput(Odisha) from March 2019 to February 2020. It included confirmed cases of CAUTI, diagnosed as per standard Centre&#x2019;s for Disease Control National nosocomial infection and diagnosed cases of candiduria. Demographic and clinical data of these patients were collected. Under all aseptic conditions, urine was collected transurethral and sent for microscopy and culture and sensitivity to the microbiology laboratory. Results: In our study, the incidence of candiduria in CAUTI was 19.5%.These cases were more common in the tribal population (88.9%), female gender(75%), age more than 40 years and up to 60 years(62.5 %), duration of the catheter up to 7 days(62.5%), low socioeconomic status(62.5%) Staphylococcus aureus being the commonest associated microorganism(37.5%), followed by E coli(25%) and type 2 diabetes mellitus(50 %) being the most common morbidity. Conclusion: Our analysis precisely of this Tribal population, brings several important and unique findings(risk factors of multi-organ involvement) than other study and population, which will modify or add in the development of some new or update guidelines that might help critical care physicians in dealing with these patients on multiple organs support, and reduce morbidity, mortality in the ICU.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Catheter-associated urinary tract infection (CAUTI), Medicine Intensive Care Unit (MICU), Urinary tract infection (UTI),  Diabetes mellitus (DM), Sickle cell anaemia (SCA), Device associated infection (DAI)</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Catheter-associated urinary tract infections (CAUTI) is the most common hospital-acquired infection and account for about 80% of nosocomial infections.1 The important risk factors for CAUTI&#xA0; are ICU admissions, diabetes mellitus, female gender, increasing age, more duration of Transurethral indwelling urinary catheterization, broad-spectrum antibiotic therapy, associated infections.2,3 &#xA0;CAUTI in critically ill patients of medical Intensive Care units is becoming an increasing problem and common due to candida infections. Incidence of candiduria is about 10-20% of nosocomial infection. &#xD;
&#xD;
In MICUs, the incidence of candiduria is about 20% of UTI and second to E. coli.4 Candiduria is common in patients with transurethral indwelling urinary catheterizations in the MICU. Candida albicans is the most common yeast isolated in patients with CAUTI.5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There are three presentations of candiduria: (1) Colonization or contamination and usual presentations of candida, asymptomatic(most common presentation), (2) UTI- cystitis or pyelonephritis and (3) systemic infection mostly in critically ill and immunocompromised patients.6 The incidence of candida is about five to ten times in hospitalized patients than in the general population due to the presence of risk factors and still more in the critically ill patients of medical Intensive Care Centre. In hospitalized patients, the common cause of secondary healthcare-associated infection is catheter-related urinary tract colonisation. Candiduria is an unavoidable condition&#xA0; in&#xA0; 50% of cases, where catheterization is more than 5 days.7&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The indwelling urinary catheters are more commonly associated with biofilm formation in the mucosal surface and surfaces of catheters, consisting of complex enclosing microcolonies of candida Albicans, hyphae and pseudohyphae. Biofilms are usually resistant to antifungal therapy, for which the indwelling urinary catheters are to be removed or replaced or antimicrobial urinary catheters&#xA0; are to be used with the management of associated risk factors.2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; We know, what are the potential risk factors and pattern of the microbiological profile of CAUTI, in the ICU of Rural and Urban area tertiary care centres. But we do not have any knowledge or any recent studies describing the factors that influence candiduria in CAUTI in especially Tribal people. Unawareness, lack of health consciousness and living style, make them more prone to infection leading to more ICU admission, morbidity and mortality. Here we tried to explore the factors (demographic as well as risk factors ) responsible for more incidence and their influence on candiduria in&#xA0; CAUTI, which vary according to all this. So that, preventive strategies should be planned such as antifungal policy, a protocol for using the device, health awareness in the ICU to give quality health care and reduce morbidity and mortality in tribal people in the&#xA0; ICU of any hospital in Tribal area.&#xD;
&#xD;
The study aims to find out the incidence, risk factors and their impact on candiduria in catheter-associated urinary tract infection in Tribal patients of Medical intensive care unit in a tribal-dominated tertiary care centre.&#xD;
&#xD;
Materials and methods&#xD;
&#xD;
Study Design &#xD;
&#xD;
This prospective study was carried out in the Medical Intensive Care Unit of SriLaxmanNayak Medical College &amp; Hospital, from March 2019 to February 2020 with the institutional ethical committee approval (02/28.02.2019 ).&#xA0; &#xD;
&#xD;
Inclusion criteria&#xD;
&#xD;
1. MICU patients aged &#x2265; 18 years old. 2. All MICU patients with a transurethral indwelling catheter for &gt;48 hours. 3. Patients, who are willing to give, an admission urine sample following catheterization for culture and sensitivity to rule out preexisting UTI. 4. Patients having symptoms with microbiological confirmation of pyuria and presence of Candida spp. 5. Patients with risk factors as Diabetes mellitus and Sickle cell anaemia,6. Who is willing and signed the consent form to take part in the study. &#xD;
&#xD;
Exclusion criteria&#xD;
&#xD;
1. Patients with pre-existing UTI, 2. Presence of signs and symptoms of CAUTI within 2 calendar days of catheterization. 3. Patients who used antibiotics more than 2 weeks before the time of the study, 4. Risk factors other than DM and SCA.&#xD;
&#xD;
Study population &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study population was all adult patients, aged &#x2265;18 years, admitted to&#xA0; MICU with different complaints with an indwelling urinary Foley&#x2019;s catheter,&#xA0; more than&#xA0; 48 hours during their admission, in a&#xA0; Tribal tertiary care centre. between the study period from April 2019 to March 2020, developed features of symptomatic urinary tract infection following catheterization were enrolled in the study. It included confirmed cases of CAUTI, diagnosed as per standard Centre for Disease Control National nosocomial infection and diagnosed cases of candiduria.&#xD;
&#xD;
Sample collection &amp; Processing&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;Urine was collected transurethrally without disconnecting the closed drainage system at any point of time with a sterile needle and syringe and the distal 5 cm of the aseptically removed urinary catheter was cut and sent to the microbiology laboratory. The urine samples and the catheter were sent to the laboratory within 1h of collection. The urine samples were processed as microscopy, culture identification and antibiotic susceptibility testing by the routine standard laboratory procedure in the microbiology laboratory. Urine microscopy was performed on the centrifuged catheter urine specimen. Urine Culture was done with the standard cultured method as appropriate for urinary pathogens. A positive fungal culture was defined as isolation of fungi with &gt;10&#xB3; CFU/ml on a specimen collected at least 48 hrs after hospital admission and &gt;105 CFU/ml of urine in non-catheterized and catheterized samples, respectively. The specimens were cultured by a semi-quantitative method using Mac Conkey Agar and Blood Agar as culture medium. The plates were read after 24 hours of incubation for any growth[1].&#xA0; Based on colony morphology on 5% sheep blood agar and no growth on Mac Conkey agar, the colonies were suspected to belong to Candida species. Gram-stained smear showed Gram-positive budding yeast cell with pseudohyphae.&#xD;
&#xD;
Data collection&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Patient&#x2019;s demographic and clinical data as age, sex, nutritional status, underlying illness, the severity of the illness and device utilization (duration of catheterization ),&#xA0; signs and symptoms of sepsis were recorded. Detailed investigations were collected.&#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Microsoft Excel was used for data entry and analyzed with SPSS&#xA0; software version 20.0. For quantitative variable, median and for qualitative variable, frequency (percentage) were used to present the results. &#xD;
&#xD;
Results&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study was conducted in a 20 bedded medicine intensive care unit, over one year from April 2019 to March 2020 in a Tribal tertiary care centre. A total of 190 patients were exposed to an indwelling urinary catheter device for a total duration of&#xA0; 1712&#xA0; device days. Out of 190 catheterized patients, 46(24.2%) were diagnosed microbiologically as CAUTI with an incidence of 24.2%. Whereas, the&#xA0; DAI rate in 33 Tribal patients associated with CAUTI in our study, was 19.2 per 1000 device days with an incidence of 17.3%.Of these 46 cases of CAUTI, candiduria was present in 9 cases with an incidence of 19.5%. (Table 1).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; According to the type of patients who developed CAUTI due to Candiduria in our MICU, Tribals were 8 (88.9% ) and Nontribals were 1 (11.1%). ( Table-1) Female Tribal patients 6 (75%) were affected more as compared to males&#xA0; 2(25%). Whereas in age factor, tribal patients with candiduria in&#xA0; 1&#xA0; (12.5%) case under&#xA0; &gt;20-40 years, 6 (75%) cases in &gt;40-60 years and 1 (12.5% ) case in above 60 years old respectively. Depending upon the Socioeconomic status, most of the tribal patients&#xA0; 5 (62.5%)&#xA0; were under low socioeconomic status group than 2 (25%) in medium and 1(12.5%) in the high-status group (Table 2).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Over one year, in the trend in the microbiological profile of CAUTI&#xA0; in Tribal patients, the most common gram-positive pathogen was Staphylococcus aureus 10 (30.3%) followed by CONS 2(6.0%) and Streptococcus Pneumonae 2 (6.0%). Whereas in gram-negative bacilli , E. coli 8 (24.2%) were the most common pathogen followed by Klebsiella pneumonia 3 (9.0%), Pseudomonas aeruginosa 2 (6.0%) and Acinetobacter baumannii 1(3.0%) . Candida Albicans was the only common fungal pathogen accounting for 5(15.1%) (Table 3).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Duration of urethral catheterization up to 7 days were 6 cases (62.5%), more common&#xA0; in compared to duration more than 7 days and up to 14 days (37.5%, Table 4).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Length of&#xA0; ICU stay was another risk factor to develop candiduria in&#xA0; CAUTI in our study, according to which 5(62.5%) patients stayed for 7-14 days, 2 (25%) for less than 7 days and 1(12.5%)&#xA0; stayed for more than 14 days (Table 5).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Single infections with microorganisms were less common in 2 cases (22.2%) as compared to mixed infections with microorganisms in 6 cases (77.8%) associated with Candiduria in CAUTI (Table 6).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The bacterial pathogens isolated in our study, in association with candiduria in CAUTI&#xA0; were Staphylococcus aureus&#xA0; 3 cases (37.5%) the commonest organism followed by E.coli and Streptococcus pneumonia 2 cases (25%) in each &#xA0;(Table 7). &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Considering the risk factors associated with candiduria in Tribal patients, in the study, Type-2 Diabetes Mellitus in 4 (12.1%) cases, Sickle cell anaemia in 2 (25%) cases, Hypertension and Chronic kidney disease in 1(12.5%) cases each (Table 8).&#xD;
&#xD;
Discussion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Catheter-associated urinary tract infection is a common healthcare-associated infection especially on critically ill patients of medical intensive care units. Moreover the presence of risk factors like type 2 diabetes mellitus, use of broad-spectrum antibiotics, longer indwelling catheterization, increase the development of urinary tract infection in catheterized patients. Many times, opportunistic organisms like candida Albicans colonize on urethral catheters leading to Candida associated UTI and other complications like candiduria, a more dangerous condition as described by Kauffman et al.8&#xD;
&#xD;
The Incidence of CAUTI in our study was 24.2%, which was less than the findings of 29.55% in one study by Sawsan et al.9 In their study, they considered patients from both Ward and ICU, so their incidence was high because of the large sample size as compared to our study in MICU only. Where the incidence of CAUTI due to candiduria was 19.2%, more than the rate of catheter-associated candiduria&#xA0; 0.7% or 0.4 per 1000 device days in one study by Deorukhkar et al.10&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In our study, it was revealed that candida in CAUTI (19.5%) was the third most common organism next to staphylococci and E.coli, against the studies showing Candida albicans, the second commonest pathogen11&#xA0; and higher than the previous study showing 10%-15%.8,12 As like another study by Dan Pawader et al,13 Candida Albicans was also the most common candida spp identified in our study.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Female patients 6 (75%)cases were more affected in our study due to candiduria, as noted same by other studies.8,14 Candiduria in CAUTI was mostly present in the age group of more than 40 years and up to 60 years (75 %) compared to the young age group of Tribal people, which indicates increasing age is a risk factor, correlated well with the previous studies.5,8,14 Tribal low socioeconomic group was more involved (62.5%) due to their poor hygiene practice, living style and presence of risk factors such as DM and SCA.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The rise in increasing of CAUTI in critical care units is mainly because of not adopting meticulous aseptic precaution during catheter insertion, infrequent change of catheter and improper catheter care.15 The presence of indwelling urethral urinary catheter is the most important risk factor for the development of Candida in CAUTI.16&#xA0; Our study stated that most cases were present with the duration of catheterization up to 7 days (62.5%) correlated well with another study.7 In a French ICU study, the mean onset of candiduria after ICU admission was at 17 days, which was in 7 to 14 days in our study, indicates Candiduria occurs late in the hospital stay.17 It may be, because of the formation of biofilm in the mucosal surface and surfaces of catheters of the indwelling urinary catheter.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mixed infections with other microorganisms (75%) were more common as compared to the single candidal infections in Candiduria with CAUTI.3 Staphylococci (37.5%) was the most common associated microorganism, followed by E coli (25%), Streptococci (25%) and Klebsiella(12.5%). Our results in favour of some studies, where it was found that mixed-species biofilms consisting of&#xA0;C. Albicans&#xA0;and&#xA0;Staphylococcus epidermidis,&#xA0;a common agent of catheter-related infections. Scanning electron microscopy revealed numerous physical interactions between the common organisms staphylococci, Streptococci and both yeasts and hyphae in&#xA0; mixed-species biofilms.18,19&#xD;
&#xD;
Platt et al,20 in their study, documented, presence of diabetes as a risk factor for CAUTI due to two possibilities: an increased prevalence of perineal colonization by potential pathogens and an increased ability of the urine of some patients with diabetes to support microbial growth. In our study, Type 2 diabetes mellitus was an important risk factor for candiduria in CAUTI, accounting for 50 % of cases which correlates well with another previous study,7,9,13 followed by Sickle cell anaemia in 25% cases, Chronic kidney disease in 12.5% cases. Candiduria is a relatively rare finding in a structurally normal urinary tract.21 when kidneys are the most common site of disseminated candidiasis.22,23 Concomitant candidemia can occur in up to 8% of such patients.24&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; However some limitations of our study, first the study group was small and the results have to be confirmed with the larger study groups. Second, Candida isolates were not identified up to species level. Third, Antifungal susceptibility was not tested in our study. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; Candida Albicans is the most common cause of nosocomial fungal catheter-associated urinary tract infection (CAUTI). In the present study, Our analysis precisely of this Tribal population brings several important and unique findings(risk factors of multi-organ involvement) than other study and population, which will modify or add in the development of some new or updated guidelines that might help critical care physicians in dealing with these patients on multiple organs supports, in the ICU. With the knowledge of the antibiotic resistance pattern of these pathogens, a new antibiotic policy will be developed to start antifungal empirically, thereby reduce the length of ICU stay, morbidity and mortality in these Tribal patients in the MICU of Tribal tertiary care centre.&#xD;
&#xD;
We propose that a large clinical trial should be carried out over these population to investigate risk factors, the cause of mixed infection affecting multiple organs, the antifungal pattern and the prevention of Candiduria in CAUTI.&#xD;
&#xD;
Acknowledgement: The authors thank all the&#xD;
&#xD;
participants who have participated in the study.&#xD;
&#xD;
Funding: No funding sources&#xD;
&#xD;
Conflict of interest: No&#xD;
&#xD;
Authors contribution&#xA0;:&#xD;
&#xD;
Study conception, Design of methodology &amp; Intellectual content:&#xA0; Mrs Monalisa Subudhi,&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
Dr P.A.T. Jagatheeswary &amp; Dr Susanta Kumar Sahu,&#xD;
&#xD;
Acquisition, Analysis and Interpretation of data:&#xA0;&#xA0; Mrs Monalisa Subudhi, Dr Sudhanshu Kumar das.&#xD;
&#xD;
Drafting, Review, Editing of the manuscript: Dr Sudhanshu Kumar das, Mrs Monalisa Subudhi.&#xD;
&#xD;
Critical revision &amp; Final approval: Dr P.A.T. Jagatheeswary, Dr Susanta Kumar Sahu, &amp; Dr Sudhanshu kumar das .&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3763</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3763</Fulltext></URLs><References>&#xD;
	&#xD;
	Forbes BA, Weissfeld AS, Sahm DF. Diagnostic Microbiology, 13th edition, 2013; 919-930. &#xD;
	&#xD;
	&#xD;
	&#xA0;Device-associated module, Cauti: January 2014: available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf; 26.07.2014; 16:39. &#xD;
	&#xD;
	&#xD;
	&#xA0;Poudel CM, Baniya G, Pokhrel BM . Indwelling catheter-associated urinary tract infection. J Inst Med 2008;30:3.&#xD;
	&#xD;
	&#xD;
	Bagchi, Jaitely NK. Microbiological evaluation of CACTI in a tertiary care hospital. Peoples J SC. Res, 2015;&#xA0; 8.&#xD;
	&#xD;
	&#xD;
	Padawer D, Pastukh N. Catheter-associated Candiduria: Risk factors, medical intervention, antifungal susceptibility. Am J Infect Control 2015;e1-e4.&#xD;
	&#xD;
	&#xD;
	Tambyah PA, Maki DG. Catheter-Associated Urinary Tract Infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Int Med 2004;160:678-82.&#xD;
	&#xD;
	&#xD;
	Gould CV, Umscheid CA, Agarwal RK, Kuntz G, David A. Pegues and Health Care infection control practices advisory committee. Guideline for prevention of&#xA0; Catheter-Associated Urinary Tract Infection 2009. Infect Control Hosp Epidemiol 2010;31:319-26.&#xD;
	&#xD;
	&#xD;
	Kauffman CA. Candiduria. Clin Infect Dis 2005; 41: S371-S376.&#xD;
	&#xD;
	&#xD;
	Omer SA, Zahran FE, Ibrahim A, Sidahmed LA, Almulhim KG. Risk Factors for Catheter-Associated Urinary Tract Infections (CAUTI) in Medical Wards and Intensive&#xA0; Care Units (ICU). J Microbiol Res 2020;10(1):1-5&#xD;
	&#xD;
	&#xD;
	Deorukhkar SC, Saini S, Raytekar NA, Sebastian DM. Catheter-associated urinary tract Candida infection in intensive care unit patients. J Clin Microbiol Biochem Technol 2016;2(1):015-17.&#xD;
	&#xD;
	&#xD;
	Laupland KB,&#xA0;Bagshaw SM,&#xA0; Gregson DB,&#xA0;Kirkpatrick AW,&#xA0;Ross T,&#xA0;Church DL. ICU-unit acquired UTI in a regional critical caresystem. Crit . care 2005;9:R60-5.&#xD;
	&#xD;
	&#xD;
	Bukhari ZA. Candiuria: a review of clinical significance and management. Saudi J Kid Dis Transpl 2008;19(3):350-60.&#xD;
	&#xD;
	&#xD;
	Padawer D, Pastukh N. Catheter-associated Candiduria: Risk factors, medical intervention, antifungal susceptibility. Am J Infect Control 2015; e1-e4.&#xD;
	&#xD;
	&#xD;
	Achkar JM, Fries BC. &#xA0;Candida&#xA0;infections of the genitourinary tract. Clin Microbiol Rev 2010;23: 253-273.&#xA0;&#xD;
	&#xD;
	&#xD;
	Greene L, Marx J, Oriola S. Guide to the elimination of catheter-associated urinary tract infections (CAUTIs). The Association for Professionals in Infection Control and Epidemiology (APIC) Washington, DC; 2008&#xD;
	&#xD;
	&#xD;
	Bhayani P, Rawekar R, Bawankule S, Kumar S, Acharya S, Gaidhane A, Khatib MN. Profile of urinary tract infection in a rural tertiary care hospital: Two-year cross-sectional study. J Datta Meghe Inst Med Sci Univ 2019;14:22-6.&#xD;
	&#xD;
	&#xD;
	Bougnoux ME, Kac G, Aegerter P, d&#x2019;Enfert C, Fagon JY; CandiRea Study Group. Candidemia and candiduria in critically ill patients admitted to Intensive Care Units in France: Incidence, molecular diversity, management and outcome. Intensive Care Med 2008;34:292?9&#xD;
	&#xD;
	&#xD;
	Baillie GS, Douglas LJ. Role of dimorphism in the development of&#xA0;Candida albicans&#xA0;biofilms.&#xA0;J Med Microbiol&#xA0;1999;48:671&#x2013;679.&#xD;
	&#xD;
	&#xD;
	Jenkinson HF, Lala HC, Shepherd MG. Coaggregation of&#xA0;Streptococcus sanguis&#xA0;and other streptococci with&#xA0;Candida albicans.&#xA0;Infect Immunol&#xA0;1990;58:1429&#x2013;1436.&#xD;
	&#xD;
	&#xD;
	Platt R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection.&#xA0;Am J Epidemiol&#xA0;1986;124:977&#x2013;85.&#xD;
	&#xD;
	&#xD;
	Bukhary ZA. Candiduria: a review of clinical significance and management. Saudi J Kidney DisTranspl 2008;19: 350-360.&#xD;
	&#xD;
	&#xD;
	&#xA0;Fisher JF, Kavanagh K, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infection: Pathogenesis. Clin Infect Dis 2011;52 Suppl 6:S437?51.&#xD;
	&#xD;
	&#xD;
	&#xA0;Lehner T. Systemic candidiasis and renal involvement. Lancet 1964;2:1414?6. &#xD;
	&#xD;
	&#xD;
	Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000;30:14?8.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Millets of Cold Semi-Arid Regions: Vital Facts in Starch Content and Composition&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>92</FirstPage><LastPage>98</LastPage><AuthorList><Author>Madhulika Esther Prasad</Author><AuthorLanguage>English</AuthorLanguage><Author> Navin Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Ayyanadar Arunachalam</Author><AuthorLanguage>English</AuthorLanguage><Author>  Balwant Singh Rawat</Author><AuthorLanguage>English</AuthorLanguage><Author> Pankaj Gautam</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Nutritious grains such as millets, which are popular as candidates for diet diversification, have an inherent capability to thrive under adverse growth conditions of temperature. This review draws attention to the effect of cold temperature on macronutrients such as starch and amylose, in millets and related cereal grains. It focuses on the changes in starch biosynthesis mechanisms and the resulting influence on nutritional properties. It also describes how cold temperature is beneficial in increasing the concentration of amylose within starch granules that leads to health benefits for patients suffering from type 2 diabetes and cardiovascular ailments. Various studies on millets growing in hot semi-arid regions have been carried out, although, with a primary focus on their proximate composition and nutritional properties only. In this review, special attention has been drawn to the scarcely explored area of the effect of cold temperature on the growth of millets in cold semi-arid regions. With evidence to support the effect of cold temperature in increasing amylose content within starch granules, it is imperative to study millets thriving in high altitude semi-arid regions which exhibit very cold temperatures during growth (10-15&#xB0;C). We have also proposed studying the effect of cold temperature on starch biosynthesis in correlation to phytohormonal regulation of starch biosynthesis. Phytohormones are themselves controlled by temperature variations and may act upstream of starch biosynthesis to alter the accumulation of starch components such as amylose. Millet populations growing in cold semi-arid regions are potential candidates for revealing genetic diversity that exhibits higher amylose content.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Millets, Semi-Arid, Starch, Amylose, Cold Temperature, Phytohormones</Keywords><Fulltext>Introduction&#xD;
&#xD;
The world&#x2019;s dietary dependency on a mere 1% of the 250,000 consumable plant resources1, holds a clue for alleviating food and nutritional insecurity slowly making inroads in recent times. In the wake of Climate Change (CC) and soil erosion, the prevailing monocultural systems of agriculture have put food resources at risk2, and the need for conservation and sustainable use of crop diversity is all the more prominent.3 Diets dependent on a single cereal grain tend to be deficient in essential nutrients. It is imperative to diversify our cereal sources in the diet, to achieve both food and nutritional security. &#xD;
&#xD;
Millets are climate compliant staple grains that promise nutritional security.4 They are ancient grains originating from Africa and Eurasia, mainly grown in the dry semi-arid (hot and cold) regions of the developing world, and contributes to 97% of the world&#x2019;s total millet production.5 They are cultivated in hot as well as cold semi-arid regions, such as in the hilly tracts of the Himalayan ranges.6 Millet species are primarily divided into two categories, the major millets comprising of Pearl millet (Pennisetumglaucum) and Sorghum (Sorghum bicolor), and the minor millets comprising of Foxtail millet (Setariaitalica), Proso millet (Panicummiliaceum), Finger millet (Eleusinecoracana), Kodo millet (Paspalumscrobiculatum), Barnyard millet (Echinochloafrumentacea) and Little millet (Panicumsumatrense).7 Pearl millet and Foxtail millet is the most popularly cultivated species, with Pearl millet occupying 95% of the world&#x2019;s total millet production. Finger millet, grown in East Africa and Southern India, along with the other millet species is primarily region-specific. While Kodo millet is confined to the tropical regions of Africa, Barnyard millet, the fastest growing millet (6 weeks), along with Little millet is mainly grown in south-east Asia.5,8&#xD;
&#xD;
Nutritional Profile of Millets &#xD;
&#xD;
The millet grain is essentially made up of macronutrients, such as carbohydrates and proteins, as well as, micronutrients such as dietary fibre, proteins, fat, and phytochemicals. An average value of 7-12% protein, 15-20% dietary fibre, 65-75% carbohydrates and 2-5% fat, makes them nutraceuticals that provide a balanced source of energy and nutrition, especially in populations with special dietary requirements, such as for coeliac and diabetic patients.8 The different millet species are highly variable in their nutrient profile, with pearl millet containing higher protein (12-15%), finger millet containing higher calcium (300-350 mg/100 g) and lower fat percentages (2-5%), and the small millets rich in phosphorous and iron.8,9 The proteins of millet grains provide an excellent amino acids profile as well, as compared to other major cereal grains such as maize. Pearl millet is rich in niacin, and finger millet in sulphur-containing amino acids.8In their whole-grain form of consumption, the dietary fibre, phenolic compounds and micronutrients present in the seed coat also contribute to their superior nutritional value.10&#xD;
&#xD;
Millet Starch and its Composition&#xD;
&#xD;
Starch is the major macronutrient present in millet grains, making up about 65-75% of its grain weight, with a large proportion of this polysaccharide organized in millets as non-starchy dietary fibre which imparts a low glycemic index property to the grain.8 Millet grain carbohydrates accumulate as discrete water-insoluble granules of varying shapes and sizes that are species-specific.11 Grain endosperm is known to contain starch granules of three possibly different morphologies, the A, B and C-type of starch granules.12 The different types of granules vary considerably in their physiochemical properties, which depends on the type of glycosidic linkage that makes up the polymers within the granule.12 Starch granules are made up of two types of anhydro-glucose biomacromolecules, amylose, a predominantly linear glucan polymer with very few branches, and amylopectin, a highly branched polymer, along with minor quantities of protein within the granule.13 The synthesis of these amylose and amylopectin chains in starch granules of cereals, involves four classes of enzymes that utilize the nucleotide sugars translocated from leaves to storage organs, to synthesize starch within amyloplasts.14 Synthesis is initiated by the first class of enzymes, Adenosine Diphosphate (ADP)-Glucose Pyrophosphorylase (AGPase), which catalyzes the production of the glucose donor, Adenosine DiphosphateGlucose Pyrophosphatase (ADPG), from Adenosine triphosphate (ATP) and glucose-1-phosphate, already present in the amyloplasts. The ADP-Glucose produced then donates glucose units for elongation of amylose chains and amylopectin main chains, catalyzed by Starch Synthases (SSs), which are the second class of enzymes which extend the growing amylose and amylopectin main chains by addition of glucose units using &#x3B1;-1,4-linkages.14 Starch Synthases (SS) are of two types, soluble and granule bound. The Granule Bound Starch Synthase (GBSS), also known as the Waxy protein, is the only enzyme solely committed to synthesizing the amylose component of starch using &#x3B1;-1,4-linkages.15 The Starch Branching Enzymes (SBEs) introduce branch points in the growing amylopectin main chain and link it with a pre-synthesized glucan chain using &#x3B1;-1,6-linkages. The Starch Debranching Enzyme (DBE) trims the irregular amylopectin structure to produce an orderly branched amylopectin polymer.14 In cereal endosperm, the dry weight of starch within a granule is typically made up of 30% amylose and 70% amylopectin polymers.11&#xD;
&#xD;
Variation in Amylose Content within the Starch Granule&#xD;
&#xD;
The accumulation of amylose polymers in starch granules may vary according to the plant species, variety, plant organ, developmental stage of the organ, and the conditions of plant growth.16 Variation in the composition and ratio of amylose to amylopectin within the starch granule determines the area of applicability of the cereal grain. Amylose free (completely waxy) starch has uses in the adhesive, textile and corrugating industries, whereas starches with higher percentages of amylose (&gt;40%) are used in the paper and pulp industry (gums &amp; candies). Chemical modifications made to waxy starch have further diversified its application in the food industry.11 In previous studies, partially waxy (0-25% amylose) maize and wheat were used for the production of certain types of Asian noodles, e.g. Japanese noodles.17 Such modifications have opened new avenues for regulating the starch composition and incorporating uncommon grain into the daily diet like processed foods such as cakes/tortillas, noodles and pasta.18&#xD;
&#xD;
In recent years, considerable research has been focused on exploring and designing high-amylose starches for their significant role in maintaining good health.19An increase in amylose concentration reduces starch digestibility, rendering it resistant to digestion. This leads to lower postprandial insulin response and low glycemic index owing to increased enzyme resistance.20 On the basis of this digestibility of starch, it can be divided into available and unavailable carbohydrates. Unavailable carbohydrates or resistant starch is highly desirable for people suffering from obesity and associated diseases such as Type 2 diabetes and cardiovascular ailments.21&#xD;
&#xD;
The predominant cause of an increased amylose concentration is attributed to its regulation by Granule Bound Starch Synthase1 (GBSS1). The level of expression of GBSS1 is directly proportional to amylose accumulation.22 Reduction in the accumulation of amylose is a result of allelic variations in the GBSS1 gene that leads to its altered level of expression.23 The millet waxy gene contains 14 exons and 13 introns.24In foxtail millet, molecular analysis of landraces has identified the presence of transposable elements [transcriptionally silent information (TSI)-2 and TSI-7] in intron 1 or exon 3. These landraces with insertions of transposable elements were found to originate from geographically distinct regions25, thus indicating the presence of genetic diversity among landraces separated by geographical boundaries. In a study conducted for 113 foxtail millet accessions, molecular differences in the waxy gene were found to be due to single nucleotide polymorphisms. Studies on foxtail millet varieties have also identified insertions of multiple transposable elements into the waxy gene that alter the level of protein expressed.23,25 In a foxtail millet waxy landrace, Shi-Li-Xiang (SLX), re-sequencing identified SNPs that were then used as markers to sequence the GBSS1 gene and reveal insertions of transposable elements in the waxy allele.26 These studies indicate the presence of genetic polymorphisms in landraces growing in isolated geographical locations with adverse environmental conditions.&#xD;
&#xD;
The Effect of Temperature on Starch and Amylose of Cereal Grains&#xD;
&#xD;
Growth and metabolism in plants are greatly affected by environmental conditions. In addition to the effect of breeding practices or genotype differences, the nutritional content of the grain is also influenced by environmental factors, such as season, temperature, rainfall distribution and growth location. These factors are major determinants of grain structure and composition, which in turn influences properties such as starch functionality.27,28 Environmental factors are known to affect starch biosynthesis, composition and Physico-chemical properties.29 Changes in environmental conditions, which in many cases may be adverse or sub-optimal, affects the accumulation of starch polymers and changes the biochemical composition of the grain, which in turn alters its resulting nutritional potential.29 Studies on growth temperatures affecting grain development have revealed that it alters starch content and composition, including amylose content, amylopectin chain length distribution and the number and morphology of starch granules. One way in which temperature stress regulates plant growth is by altering either the expression level or the structure and activity of enzymes.29&#xD;
&#xD;
The effect of cold temperature on cereal starch biosynthesis is not as disruptive as high temperature. While on one hand, cold temperature results in poor physiology of plants, such as leaf yellowing and withering, on the other hand, it is known to enhance the level of certain nutrients within the cereal grain. Crops are grown at higher altitudes, experiencing cold temperatures have been found to have higher starch content.30 Cold favours a prolonged duration of starch accumulation or slower grain filling, culminating in a greater than 50% increase in yields of the grain starch as compared to grains developed at warmer climatic conditions. Starch accumulation on the other hand is slower when high temperatures act at the grain filling stage.31,32 Cooler days and cooler nights accelerate starch accumulation in developing grains as compared to hot days and cool nights, or hot days and hot nights, which tend to slow down the window of the starch accumulation process significantly. A peak in the transcript level of starch biosynthesis enzymes Adenosine diphosphate (ADP)-Glucose Pyrophosphorylase Small Subunit (AGPS) gene, Starch Synthase (SS) I to Starch Synthase III, Starch Branching Enzymes (SBE) I and II, and Granule Bound Starch Synthase (GBSS) has been observed to immediately precede this increase in starch accumulation.33, 34&#xD;
&#xD;
In addition to the effect on starch biosynthesis and accumulation, cold temperature also seems to influence the structure and composition of the starch product within the grain. Starches developed at cold temperature contain a greater proportion of B-type starch granules, while hot temperatures during the day and night favour the predominance of A-type starch granules.35 A-type starch granules contain a 6-9% increase in amylose content as compared to B-type granules. Based on the studies carried out on the effect of the size of the starch granule on starch quality and functionality, starches grown at colder temperatures exhibiting a higher proportion of B-type starch granules would have higher water absorption capacity35, owing to their larger surface area compared to volume, which also creates a more unstable crystalline structure within these granules. These starches, therefore, have more firmness and less stickiness in their cooked form, which is an indication of improved starch quality.36 The quality or palatability of the cereal grain also improves at close to 20&#xB0;C, due to better grain filling which is disrupted at temperatures higher than that.37&#xD;
&#xD;
Low temperature or cold seasons also tend to increase the amylose/amylopectin ratio within starch granules, while high temperatures decrease the amylose content.38,39In certain cases this increase or decrease is variety dependent. Although there have been fewer studies on cold temperature affecting starch functionality, it has been established that cold temperature promotes the accumulation of amylose polymers.40 Higher amylose content has been observed in cultivars when they are grown either during the coolest seasons of the year or at cooler locations.28,41,38 Extensive studies on the effect of cold temperature on millet starch are lacking, nevertheless, studies on wheat42, rice43,32 and maize44 have been carried out to reveal that the increase in amylose as observed at lower temperatures is due to enhanced GBSS1 enzyme activity.29 The amylose content in wheat and rice was found to be higher due to an increased GBSS activity, which was higher in rice grains grown at 15&#xB0;C compared to 25&#xB0;C.32 Similar increase in amylose content was reported in maize crops that experienced a higher number of colder days during growth.44 This marked increase in GBSS enzyme activity at lower temperatures is in contrast to other starch biosynthesis enzymes, which display a lower level of activity at low temperatures, indicating the significant role of Granule Bound Starch Synthase in increasing amylose concentration during growth at lower temperatures.43,32&#xD;
&#xD;
This temperature-dependent regulation of GBSS1 activity is post-transcriptional.45Efficient splicing in the leader sequence of the 5&#x2019; intron of GBSS1 is required for proper levels of amylose accumulation. Splicing of the GBSS1 intron is more efficient in the genotypes containing the GT-Single Nucleotide Polymorphism than in the genotypes containing the TT-SNP in the leader sequence leading to high amylose and low amylose phenotypes respectively.45 Lower temperatures between 10-18&#xB0;C increase the efficiency of splicing for the pre-mRNA of GBSS1, which leads to a higher accumulation of its transcript and protein levels.46&#xD;
&#xD;
On the other hand, heat stress acts on starch biosynthesis to reduce overall starch content by reducing the activity of SSs and AGPases in temperate cereal grains such as wheat47, at temperatures above 35&#xB0;C, whereas it negatively impacts the activity of SBEII in tropical cereal grains such as maize and rice, at temperatures exceeding 25&#xB0;C.48,49 Starch composition is also altered at temperatures above 30&#xB0;C, which reduces amylose content by 20% in maize and rice, but increases it in wheat by accelerating SS activity.33 A similar tend with amylopectin chain-length distribution was also observed in rice which had longer glucan chains38, in contrast to shorter chains of glucan observed in wheat at temperatures above 30&#xB0;C.50Heat is also known to affect shape, size, structure and fissuring of the starch granule. For example, the hot temperature during growth was found to cause a reduction in the size of starch granules for wheat and barley but an increase in the proportion of A-type starch granules.29,33&#xD;
&#xD;
The Influence of Plant Hormones on Starch Content &#xD;
&#xD;
The content of starch in cereal endosperm is influenced either directly or indirectly by factors other than temperature alone. Plant hormones, soil and nutrition, as well as, other growth factors such as light and CO2 levels have major implications on starch accumulation.51-53 Among these, starch accumulation in amyloplasts of storage organs is majorly controlled by plant hormones that act either synergistically or antagonistically to control the molecular mechanisms of nutrient biosynthesis.54 Some studies have verified the effect of phytohormones such as Abscisic acid (ABA), Cytokinins, Gibberellins, Auxin and Brassionsteroids on starch accumulation, and have found ABA to help increase starch accumulation by more than three folds. Yet again, this stimulus works by enhancing the expression levels and activity of crucial starch biosynthesis enzymes, SpAPL2 &amp; SpAPL3 (components of the ADP-Glucose Pyrophosphorylase (AGPase) starch biosynthesis enzyme) in this case.55 Auxin, on the other hand, represses the AGPase enzyme activity when acting at low concentrations, unlike cytokinin which stimulates it.56 During the early stages of brain development, cytokinin regulates starch accumulation by altering the design of the grain filling model and affecting the final percentage of starch within the grain.57&#xD;
&#xD;
Plant hormones are indirectly regulated by the environment to control starch biosynthesis and accumulation. Since the environment plays a crucial role in directing the regulation of hormonal levels in plants, it is important to analyze the role of climatic conditions while studying the relationship between phytohormones and starch accumulation.44 Water deficit, in general, has been seen to reduce starch content in wheat by reducing the activity of its biosynthetic enzymes, SSs, AGPases and GBSS. 58&#xA0; Auxin has been found to inhibit, and cytokinin to enhance the transcript levels of starch biosynthesis enzymes such as GBSS, SBE (Starch Branching Enzyme) and ADP-glucose pyrophosphorylase small subunit gene (AGPS).59 While these phytohormones affect the transcript levels of the enzymes responsible for starch biosynthesis, lower temperatures control phytohormone levels 60, to consequently influence downstream starch accumulation. For example, root cooling due to cold exposure has been found to decrease the endogenous levels of cytokinin in shoots and increase the levels of auxin (Indole-3-acetic acid)60, thus indicating a decrease in starch accumulation (Figure 1). This is mediated by inhibition or stimulation of starch biosynthesis enzymes including GBSS1, SBE and AGPS. Various such studies on cereal grains indicate that millet populations growing in cold semi-arid regions may have a different interplay of phytohormones and starch biosynthesis to alter starch and amylose content in a unique manner, when compared to growth at normal temperatures.&#xD;
&#xD;
&#xD;
&#xD;
Figure 1: The Effect of Cold Temperature on Phytohormones that Regulate Starch Biosynthesis. GBSS1- Granule Bound Starch Synthase 1; SBE- Starch Branching Enzyme; AGPS- ADP-Glucose Pyrophosphorylase.&#xD;
&#xD;
Moreover, the role of phytohormones in regulating starch content and biosynthesis in the cereal endosperm under conditions of lower temperature and water deficit has not been extensively explored. There is some evidence to indicate that an Abscisic Acid (ABA) mediated stress-signalling pathway is responsible for reducing the activity of starch biosynthetic enzymes such as SSs and SBEs during drought stress, however, GBSS activity is not affected in this ABA-dependent manner during drought stress.28 This indicates that GBSS activity may be influenced by some other upstream acting phytohormone to regulate its activity during cold or drought stress. &#xD;
&#xD;
This evidence indicates that crops growing at adverse conditions of temperature may exhibit differences in the content and composition of plant products due to up-regulation or down-regulation of plant hormones.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Nutritionally superior grains such as millets are also climate-compliant crops capable of withstanding adverse environmental conditions, including cold temperature. Cold temperature has a significant impact on grain properties such as starch content and composition. Moreover, cold exposure leads to fluctuations in the concentration of plant hormones that regulate starch biosynthesis genes. Therefore, millets growing in cold semi-arid regions exhibit altered starch content and composition in their grains, as compared to growth at normal conditions. Extensive research has been conducted on the proximate composition of millets from hot semi-arid regions, but research on millets from cold semi-arid regions is lacking. They need to be explored for their grain composition concerning climatic variations, as well as for their environmental adaptability, including parameters such as the endogenous level of hormones and its effect on grain starch. Studies on millets of cold semi-arid regions may unravel new germplasm with altered level of grain starch, amylose and protein. It will lead to a deeper understanding of cold temperature-mediated regulation of plant hormones for altered starch content and composition.&#xD;
&#xD;
Acknowledgements: 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: Financial support for this work has been provided by the Department of Science &amp; Technology (DST), Woman Scientist Scheme-A (WOS-A), Government of India.&#xA0;&#xA0; &#xD;
&#xD;
Conflict of Interest: The authors declare that there is no Conflict of Interest.&#xD;
&#xD;
Individual author&#x2019;s contribution:&#xD;
&#xD;
Madhulika Esther Prasad: Conceptualization, content curation, funding acquisition, writing of original draft, editing. &#xD;
&#xD;
Prof (Dr.) Navin Kumar: Conceptualization, funding acquisition, supervision, validation, review. &#xD;
&#xD;
Prof (Dr.) AyyanadarArunachalam: Conceptualization, supervision,expert advice, review. &#xD;
&#xD;
Dr. PankajGautam: Conceptualization,supervision, resource management, review.&#xD;
&#xD;
Dr.Balwant Singh Rawat: Conceptualization, Infrastructure,review.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3764</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3764</Fulltext></URLs><References>&#xD;
	&#xD;
	Hummer KE. In the footsteps of Vavilov: Plant diversity then and now. Hort Sci. 2015;50(6):784-8.&#xA0; &#xD;
	&#xD;
	&#xD;
	Wheeler T, Von Braun J. Climate change impacts on global food security. Science. 2013;341(6145):508-13.&#xD;
	&#xD;
	&#xD;
	Buchanan?Wollaston V, Wilson Z, Tardieu F, Beynon J, Denby K. Harnessing diversity from ecosystems to crops to genes. Food Energy Secur. 2017;6(1):19-25.&#xD;
	&#xD;
	&#xD;
	Rao DB, Bhaskarachary K, Arlene Christina GD, Sudha Devi G, Vilas AT, Tonapi A. Nutritional and health benefits of millets. ICAR_Indian Institute of Millets Research (IIMR), Rajendranagar, Hyderabad. 2017:112.&#xD;
	&#xD;
	&#xD;
	Singh RB, Khan S, Chauhan AK, Singh M, Jaglan P, Yadav P, et al. Millets as functional food, a gift from Asia to Western World. InThe Role of Functional Food Security in Global Health. Academic Press. 2019;457-468. &#xD;
	&#xD;
	&#xD;
	Sood S, Khulbe RK, Gupta AK, Agrawal PK, Upadhyaya HD, Bhatt JC. Barnyard millet&#x2013;a potential food and feed crop of the future. Plant Breeding 2015;134(2):135-47.&#xD;
	&#xD;
	&#xD;
	Taylor JR. Millets: their unique nutritional and health-promoting attributes. In Gluten-Free Ancient Grains. Woodhead Publishing. 2017;55-103. &#xD;
	&#xD;
	&#xD;
	Rao BR, Nagasampige MH, Ravikiran M. Evaluation of nutraceutical properties of selected small millets. J Pharm Bioall Sci. 2011;3(2):277.&#xD;
	&#xD;
	&#xD;
	Barbeau WE, Hilu KW. Protein, calcium, iron, and amino acid content of selected wild and domesticated cultivars of finger millet. Plant Foods Human Nutr. 1993;43(2):97-104.&#xD;
	&#xD;
	&#xD;
	Antony U, Sripriya G, Chandra TS. Effect of fermentation on the primary nutrients in finger millet (Eleusinecoracana). J Agricul Food Chem. 1996;44(9):2616-8. &#xD;
	&#xD;
	&#xD;
	Chibbar RN, Ganeshan S, Baga M. In planta novel starch synthesis. In Improvement of crop plants for industrial end uses. Springer, Dordrecht. 2007;181-208. &#xD;
	&#xD;
	&#xD;
	Seung D, Smith AM. Starch granule initiation and morphogenesis&#x2014;progress in Arabidopsis and cereals. J Exp Botany. 2019;70(3):771-84.&#xD;
	&#xD;
	&#xD;
	Banks W, Greenwood CT. Starch and its Components. Wiley; 1975.&#xD;
	&#xD;
	&#xD;
	Jeon JS, Ryoo N, Hahn TR, Walia H, Nakamura Y. Starch biosynthesis in cereal endosperm. Plant Physiol Bioche. 2010;48(6):383-92.&#xD;
	&#xD;
	&#xD;
	Shure M, Wessler S, Fedoroff N. Molecular identification and isolation of the Waxy locus in maize. Cell. 1983;35(1):225-33.&#xD;
	&#xD;
	&#xD;
	Shannon JC, Garwood DL. Starch: chemistry and technology. Academic Press, Orlando, FL. 1984:25.&#xD;
	&#xD;
	&#xD;
	Seib PA. Reduced-amylose wheats and Asian noodles. Cereal Foods World. 2000;45(11):504-12.&#xD;
	&#xD;
	&#xD;
	Kalai R, Mohan RJ. Standardization of Cereal and Pseudocereal Flour for Pittu Preparation. Int J Curr Res Rev. 2014;6(20):29.&#xD;
	&#xD;
	&#xD;
	Wang J, Hu P, Chen Z, Liu Q, Wei C. Progress in high-amylose cereal crops through inactivation of starch branching enzymes. Front Plant Sci. 2017;8:469.&#xD;
	&#xD;
	&#xD;
	Jenkins DJ, Leeds AR, Gassull MA. Viscosity and the action of unavailable carbohydrate in reducing the post prandial glucose and insulin levels. Proceedings of the Nutrition Society. 1977.&#xD;
	&#xD;
	&#xD;
	Kendall CW, Esfahani A, Jenkins DJ. The link between dietary fibre and human health. Food Hydrocol. 2010;24(1):42-8.&#xD;
	&#xD;
	&#xD;
	Wessler SR, Varagona MJ. Molecular basis of mutations at the waxy locus of maize: correlation with the fine structure genetic map. PNAS. 1985;82(12):4177-81.&#xD;
	&#xD;
	&#xD;
	Fukunaga K, Kawase M, Kato K. Structural variation in the Waxy gene and differentiation in foxtail millet: implications for multiple origins of the waxy phenotype. Mol Genet Genom. 2002;268(2):214-22. &#xD;
	&#xD;
	&#xD;
	Vinoth A, Ravindran R. Biofortification in millets: a sustainable approach for nutritional security. Front Plant Sci. 2017;8:29.&#xD;
	&#xD;
	&#xD;
	Kawase M, Fukunaga K, Kato K. Diverse origins of waxy foxtail millet crops in East and Southeast Asia mediated by multiple transposable element insertions. Mol Genet Genom. 2005;274(2):131-40.&#xD;
	&#xD;
	&#xD;
	Bai H, Cao Y, Quan J, Dong L, Li Z, Zhu Y, Zhu L, Dong Z, Li D. Identifying the genome-wide sequence variations and developing new molecular markers for genetics research by re-sequencing a landrace cultivar of foxtail millet. PloS One. 2013 Sep;8(9):e73514.&#xD;
	&#xD;
	&#xD;
	Cory AT, Gangola MP, Anyia A, Baga M, Chibbar RN. Genotype, environment and G&#xD7; E interaction influence (1, 3; 1, 4)-&#x3B2;-d-glucan fine structure in barley (Hordeumvulgare L.). J Sci Food Agricul. 2017;97(3):743-52.&#xD;
	&#xD;
	&#xD;
	Dang JM, Copeland L. Genotype and environmental influences on pasting properties of rice flour. Cereal Chem. 2004;81(4):486-9.&#xD;
	&#xD;
	&#xD;
	Thitisaksakul M, Jimenez RC, Arias MC, Beckles DM. Effects of environmental factors on cereal starch biosynthesis and composition. J Cereal Sci. 2012;56(1):67-80.&#xD;
	&#xD;
	&#xD;
	Petr J, Capouchova I, Maresova D. The effect of variety and site of cultivation on the content of starch in wheat. RostlinnaVyroba-UZPI (Czech Republic). 2001.&#xD;
	&#xD;
	&#xD;
	Keeling PL, Bacon PJ, Holt DC. Elevated temperature reduces starch deposition in wheat endosperm by reducing the activity of soluble starch synthase. Planta. 1993;191(3):342-8.&#xD;
	&#xD;
	&#xD;
	Umemoto T, Nakamura Y, Ishikura N. Activity of starch synthase and the amylose content in rice endosperm. Phytochemistry. 1995;40(6):1613-6.&#xD;
	&#xD;
	&#xD;
	Hurkman WJ, McCue KF, Altenbach SB, Korn A, Tanaka CK, Kothari KM, et al. Effect of temperature on expression of genes encoding enzymes for starch biosynthesis in developing wheat endosperm. Plant Sci. 2003;164(5):873-81.&#xD;
	&#xD;
	&#xD;
	Peng M, Hucl P, Chibbar RN. Isolation, characterization and expression analysis of starch synthase I from wheat (Triticumaestivum L.). Plant Sci. 2001;161(6):1055-62.&#xD;
	&#xD;
	&#xD;
	Chiotelli E, Le Meste M. Effect of small and large wheat starch granules on thermomechanical behaviour of starch. Cereal Chem. 2002;79(2):286-93.&#xD;
	&#xD;
	&#xD;
	Soh HN, Sissons MJ, Turner MA. Effect of starch granule size distribution and elevated amylose content on durum dough rheology and spaghetti cooking quality. Cereal Chem. 2006;83(5):513-9.&#xD;
	&#xD;
	&#xD;
	Jiang H, Dian W, Wu P. Effect of high temperature on the fine structure of amylopectin in rice endosperm by reducing the activity of the starch branching enzyme. Phytochemistry. 2003;63(1):53-9. &#xD;
	&#xD;
	&#xD;
	Asaoka M, Okuno K, Sugimoto Y, Kawakami J, Fuwa H. Effect of environmental temperature during the development of rice plants on some properties of endosperm starch. Starch-Starke. 1984;36(6):189-93.&#xD;
	&#xD;
	&#xD;
	Lu TJ, Jane JL, Keeling PL, Singletary GW. Maize starch fine structures affected by ear developmental temperature. Carbohyd Res. 1996;282(1):157-70.&#xD;
	&#xD;
	&#xD;
	Beckles DM, Thitisaksakul M. How environmental stress affects starch composition and functionality in cereal endosperm. Starch-Starke. 2014;66(1-2):58-71.&#xD;
	&#xD;
	&#xD;
	Aboubacar A, Moldenhauer KA, McClung AM, Beighley DH, Hamaker BR. Effect of growth location in the United States on amylose content, amylopectin fine structure, and thermal properties of starches of long grain rice cultivars. Cereal Chem. 2006;83(1):93-8.&#xD;
	&#xD;
	&#xD;
	Labuschagne MT, Elago O, Koen E. The influence of temperature extremes on some quality and starch characteristics in bread, biscuit and durum wheat. J Cereal Sci. 2009;49(2):184-9.&#xD;
	&#xD;
	&#xD;
	Ahmed N, Maekawa M, Tetlow IJ. Effects of low temperature on grain filling, amylose content, and activity of starch biosynthesis enzymes in the endosperm of basmati rice. Aus J Agricul Res. 2008;59(7):599-604.&#xD;
	&#xD;
	&#xD;
	Fergason VL, Zuber MS. Influence of Environment on Amylose Content of Maize Endosperm 1. Crop Sci. 1962;2(3):209-11.&#xD;
	&#xD;
	&#xD;
	Hirano HY, Eiguchi M, Sano Y. A single base change altered the regulation of the Waxy gene at the posttranscriptional level during the domestication of rice. Mol Biol Evol. 1998;15(8):978-87.&#xD;
	&#xD;
	&#xD;
	Larkin PD, Park WD. Transcript accumulation and utilization of alternate and non-consensus splice sites in rice granule-bound starch synthase are temperature-sensitive and controlled by a single-nucleotide polymorphism. Plant Mol Bio. 1999;40(4):719-27.&#xD;
	&#xD;
	&#xD;
	Keeling PL, Banisadr R, Barone L, Wasserman BP, Singletary GW. Effect of temperature on enzymes in the pathway of starch biosynthesis in developing wheat and maize grain. Funct Plant Bio. 1994;21(6):807-27.&#xD;
	&#xD;
	&#xD;
	Ohdan T, Sawada T, Nakamura Y. Effects of temperature on starch branching enzyme properties of rice. J Appl Glycosci. 2010;58(1):19-26.&#xD;
	&#xD;
	&#xD;
	Takeda Y, Guan HP, Preiss J. Branching of amylose by the branching isoenzymes of maize endosperm. Carbohydrate Res. 1993;240:253-63.&#xD;
	&#xD;
	&#xD;
	Matsuki J, Yasui T, Kohyama K, Sasaki T. Effects of environmental temperature on structure and gelatinization properties of wheat starch. Cereal Chem. 2003;80(4):476-80.&#xD;
	&#xD;
	&#xD;
	Liu Y, Fang Y, Huang M, Jin Y, Sun J, Tao X, et al. Uniconazole-induced starch accumulation in the bioenergy crop duckweed (Landoltiapunctata) II: transcriptome alterations of pathways involved in carbohydrate metabolism and endogenous hormone crosstalk. Biotechnol Biofuels. 2015;8(1):1-2.&#xD;
	&#xD;
	&#xD;
	Liu Y, Wang X, Fang Y, Huang M, Chen X, Zhang Y, et al. The effects of photoperiod and nutrition on duckweed (Landoltiapunctata) growth and starch accumulation. Indust Crops Products. 2018;115:243-9.&#xD;
	&#xD;
	&#xD;
	Mohedano RA, Costa RH, Belli Filho P. Effects of CO2 concentration on nutrient uptake and starch accumulation by duckweed used for wastewater treatment and bioethanol production. Revista Latinoamericana de Biotecnolog&#xED;a Ambiental y Algal. 2016;7(1):1-2. &#xD;
	&#xD;
	&#xD;
	Matthysse AG, Scott TK. Functions of hormones at the whole plant level of organization. InHormonal regulation of development II Springer, Berlin, Heidelberg. 1984;219-243. &#xD;
	&#xD;
	&#xD;
	Liu Y, Chen X, Wang X, Fang Y, Zhang Y, Huang M, et al. The influence of different plant hormones on biomass and starch accumulation of duckweed: A renewable feedstock for bioethanol production. Renewable Energy. 2019;138:659-65.&#xD;
	&#xD;
	&#xD;
	Akihiro T, Mizuno K, Fujimura T. Gene expression of ADP-glucose pyrophosphorylase and starch contents in rice cultured cells are cooperatively regulated by sucrose and ABA. Plant Cell Physiol. 2005;46(6):937-46.&#xD;
	&#xD;
	&#xD;
	Yang J, Peng S, Visperas RM, Sanico AL, Zhu Q, Gu S. Grain filling pattern and cytokinin content in the grains and roots of rice plants. Plant Growth Reg. 2000;30(3):261-70.&#xD;
	&#xD;
	&#xD;
	Ahmadi A, Baker DA. The effect of water stress on the activities of key regulatory enzymes of the sucrose to the starch pathway in wheat. Plant Growth Reg. 2001;35(1):81-91.&#xD;
	&#xD;
	&#xD;
	Miyazawa Y, Sakai A, Miyagishima SY, Takano H, Kawano S, Kuroiwa T. Auxin and cytokinin have opposite effects on amyloplast development and the expression of starch synthesis genes in cultured bright yellow-2 tobacco cells. Plant Physiol. 1999;121(2):461-70.&#xD;
	&#xD;
	&#xD;
	Veselova SV, Farhutdinov RG, Veselov SY, Kudoyarova GR, Veselov DS, Hartung W. The effect of root cooling on hormone content, leaf conductance and root hydraulic conductivity of durum wheat seedlings (Triticum durum L.). J Plant Physiol. 2005;162(1):21-6.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Mobile Phone Radiations on Male Fertility: An Update&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>99</FirstPage><LastPage>103</LastPage><AuthorList><Author>Senthil Kumar B</Author><AuthorLanguage>English</AuthorLanguage><Author> Ganesha Prasad K</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>For many decades, male infertility due to unknown aetiology remains an unresolved issue that includes factors such as environmental changes and lifestyle factors. Male fertility is affected when the exposure to radiations and other hazardous substances were intense. Radiations have a drastic detrimental effect on the process of spermatogenesis inside the testis. This current update review mainly focuses on the effects of mobile phone radiation, which may contribute to the cause of male infertility. Exploration into various studies done by researchers showed the detrimental effect of radiofrequency radiations on male fertility when exposed over a longer period. Many studies proved that the radiofrequency electromagnetic field (RF-EMF) affects male fertility by enhancing irretrievable changes in semen parameters. Some studies also disprove the above. The current update review will give a helicopter view of different findings and hypothesis stated by various authors. Further, an elaborated study on the effect of mobile phone radiations on male fertility was already started in the institution.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Male Infertility, Radiations, Hazards, Mobile phone, Radiofrequency radiations, Semen parameters</Keywords><Fulltext>Introduction&#xD;
&#xD;
Infertility had become one of the disorder that affects nearly 15% of couples of which 7.5% involves male infertility.1 Male infertility had turned to be an up to date downside problem because of abnormal semen characteristics. The semen quality has deteriorated in recent years worldwide. The majority of infertile or sub-fertile male showed either immotile sperm and/or DNA damage.2 The impact of mobile device radiation on male fertility is that the subject of recent interest and investigations.3 Cell phones are widely used among all age group people particularly adults and it&#x2019;s been noticed that people use them for long hours for various purposes. These phones emit radiofrequency electromagnetic waves (EMW), a low-level radiofrequency (RF), at a frequency that ranges between 800 and 2200 MHz.4 Men carry mobile phones in their pockets or in holders which are designed close to their procreative/reproductive organs. Thus, it&#x2019;s vital to predict the consequences of cell phone hazards on male fertility. Although several recent epidemiological studies have updated that prolong use of mobile phones could play a role in male infertility.5,6 Mobile phones would possibly influence the genital systems via EMW thermal and non-thermal effects and that they could interfere with normal spermatogenesis and end in a significant decrease in semen quality.7-9&#xD;
&#xD;
Electromagnetic fields and mobile phone radiations:&#xD;
&#xD;
Radiation will be characterized into ionized and non-ionized radiations. The non-ionizing radiations are of two forms: 1) Extremely low frequency (ELF) electromagnetic fields (EMFs), and 2) Radiofrequency (RF) EMFs - which are produced by wireless radio waves/microwaves products.10 The frequencies within the range of 100 kHz to 300 GHz refer to RF and represent solely the vicinity of the electromagnetic spectrum. The source of radiofrequency electromagnetic field (RF-EMF) exposure affects the semen parameters.&#xA0; The advanced technology of intermediate frequency had become another source of exposure to electro-magnetic fields. This specific frequency range falls between the low frequency (low frequency- 0.1 Hz&#x2013;1 kHz) and the radio frequency (RF) (10 MHz&#x2013;300 GHz).7 Harmful EMW emitted from cell phones could interfere with normal spermatogenesis and end up in a significant decrease in semen quality. Electromagnetic waves will have an effect on reproductive function through both thermal and non-thermal effects.7&#xD;
&#xD;
Epidemiological and experimental studies on mobile phone radiations&#xD;
&#xD;
Many studies showed the damaging effects of RF-EMR on Leydig cells, seminiferous tubules, and specifically, the spermatozoa were clearly defined.1 Though RF-EMR reduces androgen (testosterone) levels, impairs spermatogenesis and causes sperm DNA damage11, the connection between RF-EMR devices and male infertility remains polemical. The negative effects of cell phones on sperm parameters in 361 male is detected.11 Similarly, Fejes et al.6 showed the correlation statistics between the daily mobile phone usage duration and semen quality in 371 male. There are two more reports available that also added up the effect of cell phones on sperm motility in humans.6,12 Epidemiologic studies reported that mobile phone use has associations with some semen quality parameters, but the findings across these research studies are not entirely consistent and standard for all the examined semen parameters.12,13.&#xD;
&#xD;
Many epidemiological and experimental studies have reported that RF-EMWs have potential adverse effects on human health. They will interfere with nervous system function and cause headache, fatigue, impaired cognitive function, sleep disturbances and an increased risk of tumour14,15; it also affects the cardiovascular system and thus increases resting blood pressure.16 Recent epidemiologic (cross-sectional or prospective) studies have highlighted the role of mobile phone exposure on sperm motility, morphology and viability, suggesting a drastic reduction in male fertilization potentiality.22 These studies examined the relationship of mobile phone use and its impact on semen parameters and concluded that mobile phone use could cause a decrease in fertility.17&#xD;
&#xD;
Mobile phone radiations and male fertility&#xD;
&#xD;
Various studies have stated the effect of mobile phones on semen parameters. In one of the study, it has been proved that the semen parameters were abnormal when the mobile phones are carried in the pocket near the testicles.18 Similarly; Fejes et al.6 have suggested that the habit of carrying a mobile phone in pockets and speaking durations were negatively correlated with sperm count. In another study, Agarwal et al.11 had reported that as mobile phone usage duration keeps increasing, the quality of sperm decreases. In controversial to the above two reports, Mehmet et al. did not find any effect on the semen profile due to prolonged mobile phone usage and the habit of carrying a mobile phone in their pockets near testicles.19&#xD;
&#xD;
Effect of RF-EMF exposure on sperm parameters:&#xD;
&#xD;
Prolonged mobile phone usage has been found to decreases the progressive motile sperm count, motility and viability along with an increase of reactive oxygen species (ROS)which leads to abnormal sperm morphology.20,21 Recent studies added up that that Wi-Fi from laptops and computers may negatively affect sperm quality.22 EMF is found to be responsible for the decrease in fertilization rate23, reduced sperm count due to triggered apoptosis,24,25 reduced sperm quality26, hormonal changes within the testis6,11, developmental impairments in the embryonic period.27,28 Radio-frequency electromagnetic field exposure from mobile phones or alternative sources of microwaves adversely result in the decrease of the male fertilizing potential of spermatozoa. Many authors found that carrying mobile phones within the trouser pocket or on the belt pouches reduces sperm motility.29,30 Kesari et al. demonstrated that males who use mobile phones for longer duration exhibit inflated rates of abnormal sperm morphology.31&#xD;
&#xD;
The exposure to RF-EMF resulting in male reproductive organ pathologies including a decrease in sperm quality is probably due to oxidative stress so increasing free radical levels or superoxide ends up in a decrease in sperm motility and viability that is triggered by inflated concentrations of superoxides.21 Free radicals oxidize the membrane phospholipids extracellularly, thus resulting in reduced sperm viability and reduced impaired motility.32&#xD;
&#xD;
Studies proving that mobile phone radiation affects male fertility&#xD;
&#xD;
Wdowiak et al. 2007 had reported that there was a decrease in the percentage of sperms and their motility which depending on the frequency of mobile phones usage.33 Agarwal et al. 2008 found that the usage of cell phones resulted in a decrease in sperm count, motility, viability, and normal morphology and these changes in sperm cell parameters depends on the daily exposure to cell phones and thus independent of the initial semen quality.11 He additionally found that RF electromagnetic waves emitted from cell phones showed reduced sperm motility and viability, increased ROS level, minimized TAC of semen (ROS?TAC score).21 Gutschi et al. 2011 found that mobile phone usage by the male was related to increased abnormal sperm morphology and increased serum testosterone and decreased gonadotrophin levels with no changes in FSH, and prolactin.34 Rago et al. 2013 found that the utilization of mobile phone for more than 4 hours daily was associated with increased sperm cell DNA fragmentation.13 Yildirim et al. 2015 found that exposure to RF?electromagnetic radiation of mobile phone and wireless internet was related to decreased total motile sperm count, increasingly motile sperm.35 Zhang et al. 2016 found that cell phone use might negatively have an effect on sperm quality in men by decreasing the semen volume, sperm count thus impairing malefertility.36&#xD;
&#xD;
Studies disproving that mobile phone radiation affects male fertility&#xD;
&#xD;
In a study conducted by El-Healy et al. on 262 males, they had found that each patient&#x2019;s semen quality parameters did not show any difference among the mobile phone users depending on their daily use in minutes. However, the difference isn&#x2019;t significant and their study showed that who those use mobile phone for quite 60 minutes daily have lower semen volume, vitality and morphological index compared to those who used a mobile phone for less than 60 minutes per day.37 Gutschi et al. stated that the use of cell phones has no deleterious effect on total sperm count.34 In a cross-sectional study conducted by Rago et al. in 63 healthy and fertile men who visited the andrology centre, showed that none of the standard sperm parameters was altered in the semen analysis report as per the daily mobile phone usage in hours.13 Feijo et al. found that sperm parameters weren&#x2019;t considerably different in nonusers and users with increased mobile phone use and this study results are in line with the above authors.38&#xD;
&#xD;
Effects of the mobile phone carrying on pockets&#xD;
&#xD;
The effects of RF-EMR on the quality of the sperm parameters depending on the way of carrying mobile phones, on a sample of 52 men aged 18&#x2013;35 years showed that men who carried a mobile phone in their hip pockets or on their belts had a lower sperm concentration than men who do not carry a phone or who carried it elsewhere.29 Also, in a hospital-based study conducted by El-Healy et al. they found that men who carried their mobile phone in their hip pockets had lower sperm motility proportion compared to male keeping mobile phones in a waist pouch, shirt pocket or hands, however, the difference was statistically insignificant. These results go with the study result of Agarwal et al., who postulated that keeping the mobile phone in a hip pocket in speak mode may negatively have an effect on sperm and thus impair male fertility.21&#xD;
&#xD;
Effect of RF-EMF on sperm fertilization potential&#xD;
&#xD;
According to Falzone et al., a reduction in sperm head area and its acrosomal percentage was reported among exposed sperm when compared to unexposed controls sperm.39 Adding on to that the mean of zona&#x2013;bound sperm of the test hemizona and controls was significant respectively. Researchers further stated that though radiofrequency electromagnetic fields exposure failed to adversely affect the acrosomal reaction; it also had a remarkable effect on sperm morphology. Also, a drastic decrease in sperms binding to the hemizona was traced out. These results may indicate a major change of RF-EMF on sperm fertilization potential.39&#xD;
&#xD;
Potential confounders in correlation mobile phone effects on male infertility&#xD;
&#xD;
Various potential confounders, includes age factor, period of abstinence, tobacco and alcohol consumption, BMI, and beverages /fried food consumption, are thought to be valuable contributors to changes in semen quality in previous studies.40,41 In all the previous studies and the study was done by Zhang et al. age and lifestyle showed a strong correlation with semen quality; so, they ought to be adjusted to study the effect of other factors on semen quality.36 They conjointly analyzed the potential effects of the multiple sexual partners and use of condoms on semen quality, each of that was prompt to incline the sexually transmitted infections, thus inflicting changes in seminal parameters.42 However, they failed to notice the valid adverse relationship between them. Negative associations remained still after the adjustment of all the above confounders. Together, these studies indicate that certain aspects of mobile phone use might negatively have an effect on semen volume, sperm concentration and sperm count.36&#xD;
&#xD;
Oxidative stress &amp; DNA-damaged of spermatozoa due to RF-EMW&#xD;
&#xD;
The development of oxidative stress or disturbance in free radical metabolism by mobile phone radiation has been shown in very few animal studies. Chronic exposure to RF-EMW can decrease the activity of catalase enzyme, superoxide dismutase (SOD), an antioxidant, and so decrease total inhibitor capability, however, experimental studies designed to estimate the malonaldehyde level and SOD activity show conflicting results.43,44 Friedman et al. showed that RF-EMW stimulates cell membrane NADH oxidase enzyme in mammalian cells and cause the production of ROS.45 This could be attributed to a rise in the activity of spermatozoal NADH oxidase enzyme after RF-EMW exposure. Aitken et al. had shown that human spermatozoa possess a multiple cell membrane oxidoreduction system that shares similarities with transmembrane NADH oxidase enzyme.46 Activation of cell membrane NADH oxidase enzyme might cause the production of ROS. This will be detected by luminol-based luminescence since luminal measures both intra and extracellular ROS.47 In most of the studies, the pathology has been defined by loss of sperm motility and viability moreover because of the induction of ROS generation and DNA injury. The potential mechanisms were given thoughts through which RF-EMR might elicit various effects on spermatozoa, for which a sensitive model system was used. A mechanistic model during which RF-EMR exposure leads to defective mitochondrial function related to elevated levels of ROS production and results in anti-oxidative stress that may add on to the varying phenotypes determined in response to RF-EMR exposure was proposed. This model can offer new impetus to the researcher and stimulate research that allows confident assessment of the reproductive organ involved hazards due to mobile phone usage.48&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Mobile phone radiations and RF-EMF has a deleterious effect on various organs of the human body. The thermal and non-thermal effects of electromagnetic waves on reproductive functions remain an inconclusive issue. The radiations damaging the Leydig cells, seminiferous tubules and thus causing semen parameters alterations have to be kept in mind. The sperm quality deteriorates day by day in the male population due to mobile phone radiations. This area had to be thrown light and enormous research has to be done to change the idealistic view of the researchers. Awareness has to be created among adolescents to safeguard themselves from mobile phone radiations.&#xD;
&#xD;
Acknowledgement &#x2013; The authors wish to acknowledge the Vinayaka Mission&#x2019;s Research Foundation (Deemed to be University) for funding the project.&#xD;
&#xD;
Source of Funding &#x2013; Vinayaka Mission&#x2019;s Research Foundation Deemed to be University, Salem &#x2013; 636308, Tamil Nadu&#xD;
&#xD;
&#xA0;Conflict of Interest - Nil, &#xD;
&#xD;
Authors&#x2019; Contribution &#x2013; The first author compiled the article and the co-author helped in the literature review. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3765</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3765</Fulltext></URLs><References>1. La Vignera S, Condorelli RA, Vicari E, D Agata R, Calogero AE. Effects of the exposure to mobile phones on male reproduction: a review of the literature. J Androl. 2012;33:350-6.&#xD;
&#xD;
2. Schulte RT, Ohl DA, Sigman M, Smith GD. Sperm DNA damage in male infertility: etiologies, assays, and outcomes. J Assist Reprod Genet. 2010;27:3&#x2013;12.&#xD;
&#xD;
3. Igor Gorpinchenko, Oleg Nikitin, Oleg Banyra, Alexander Shulyak. The influence of direct mobile phone radiation on sperm quality. Cent European J Urol. 2014;67:65-71.&#xD;
&#xD;
4. Agarwal A, Singh A, Hamada A, Kesari K. Cell phones and male infertility: a review of recent innovations in technology and consequences. Int Braz J Urol. 2011;37:432&#x2013;454.&#xD;
&#xD;
5. Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988&#x2013;1989). Hum. Reprod. 1991;6:811&#x2013;816.&#xA0;12. Davoudi M, Brossner C, Kuber W. The influence of electromagnetic waves on sperm motility. Urol Urogynaecol. 2002;19:18&#x2013;22.&#xD;
&#xD;
6. Fejes I, Zavaczki Z, Szollosi J, Koloszar S, Daru J, Kovacs L, Pal A, et al. Is there a relationship between cell phone use and semen quality?. Arch Androl.2005;51:385&#x2013;393.&#xD;
&#xD;
7. Blackwell RP. Standards for microwave radiation. Nature. 1979;282:360.&#xD;
&#xD;
8. Cleveland RFS, David MU, Jerry L. Evaluating compliance with FCC guidelines for human exposure to radiofrequency electromagnetic fields. OST Bull. 1997;65:97&#x2013;100.&#xD;
&#xD;
9. Habash RWY. Bioeffects and Therapeutic Applications of Electromagnetic Energy, CRC Press, Tayler &amp; Francis Group, Boca Raton. 2008.&#xD;
&#xD;
10. Prausnitz S, Susskind C. Effects of chronic microwave irradiation on mice. Ire Trans Biomed Electron. 1962;9:104&#x2013;8.&#xD;
&#xD;
11. Agarwal A, Deepinder F, Sharma RK, Ranga G, Li J. Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertil Steril. 2008;89:124-8.&#xD;
&#xD;
12. Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertil. Steril. 2001;75:237&#x2013;248.&#xD;
&#xD;
13. Rago R, Salacone P, Caponecchia L, Sebastianelli A, Marcucci I, Calogero AE, et al. The semen quality of the mobile phone users. J Endocrinol Invest. 2013;36(11):970-4.&#xD;
&#xD;
14. Huber R, Graf T, Cote KA, Wittmann L, Gallmann E, Matter D, et al. Exposure to the pulsed high-frequency electromagnetic field during waking affects human sleep EEG. Neuroreport. 2000;11:3321&#x2013;3325.&#xD;
&#xD;
15. Lonn S, Ahlbom A, Hall P, Feychting M. Mobile phone use and the risk of acoustic neuroma. Epidemiology. 2004;15:653&#x2013;659.&#xD;
&#xD;
16. Braune S, Wrocklage C, Raczek J, Gailus T, Lucking CH. Resting blood pressure increase during exposure to a radio-frequency electromagnetic field. Lancet. 1998;351:1857&#x2013;1858.&#xD;
&#xD;
17. Baste V, Riise T, Moen BE. Radiofrequency electromagnetic fields; male infertility and sex ratio of offspring. Eur J Epidemiol. 2008;23:369&#x2013;77.&#xD;
&#xD;
18. Mailankot M, Kunnath AP, Jayalekshmi H, Koduru B, Valsalan R. Radiofrequency electromagnetic radiation (RF-EMR) from GSM (0.9/1.8 GHz) mobile phones induces oxidative stress and reduces sperm motility in rats. Clinics 2009;64:561&#x2013;565.&#xD;
&#xD;
19. Yildirim ME, Kaynar M, HuseyinBadem, Mucah?tCavis, Omer Faruk Karatas, Ers?nCimentepe. What is harmful for male fertility: Cell phone or the wireless internet? Kaohsiung J Med Sci. 2015;31:480-484.&#xD;
&#xD;
20. Guler I, Cetin T, Ozdemir AR, Ucar N. Turkey EMF report. Infor Technol Agency. 2013:47.&#xD;
&#xD;
21. Agarwal A, Desai NR, Makker K, Varghese A, Mouradi R, Sabanegh E, Sharma R. Effects of radiofrequency electromagnetic waves (RF-EMW) from cellular phones on human ejaculated semen: an in-vitro pilot study. Fertil Steril. 2009;92:1318&#x2013;25.&#xD;
&#xD;
22. Avendano C, Mata A, Sarmiento CS, Doncel G. Use of laptop computers connected to the internet through Wi-fi decreases human sperm motility and increases sperm DNA fragmentation. Fertil Steril. 2012;97:39&#x2013;45.&#xD;
&#xD;
23. Al-Akhras MA, Elbetieha A, Hasan MK, Al-Omari I, Darmani H, Albiss B. Effects of extremely low-frequency magnetic field on the fertility of adult male and female rats. Bioelectromagnetics. 2001;22:340&#x2013;4.&#xD;
&#xD;
24. Lee JS, Ahn SS, Jung KC, Kim YW, Lee SK. Effects of 60 Hz electromagnetic field exposure on testicular germ cell apoptosis in mice. Asian J Androl. 2004;6:29&#x2013;34.&#xD;
&#xD;
25. Kim YW, Kim SH, Lee JS, Kim YJ, Lee SK, Seo JN, et al. Effects of 60 Hz 14 &#x3BC; T magnetic field on the apoptosis of testicular cell in mice. Bioelectromagnetics. 2009;30:66&#x2013;72.&#xD;
&#xD;
26. Li DK, Yan B, Li Z, Gao E, Miiao M, Gong D, et al. Exposure to magnetic fields and the risk of poor sperm quality. ReproductToxicol. 2010;29:86&#x2013;92.&#xD;
&#xD;
27. Sharma A, Kesari KK, Saxena VK, Sisodia R. The influence of prenatal 10 GHz microwave radiation exposure on a developing mice brain. Gen Physiol Biophys. 2017;36:41&#x2013;51.&#xD;
&#xD;
28. Heynick LN, Merritt JH. Radiofrequency fields and teratogenesis. Bioelectromagnetics. 2003;6(1):174&#x2013;86. &#xD;
&#xD;
29. Kilgallon SJ, Simmons LW. Image content influences men&#x2019;s semen quality. Biol Lett. 2005;1:252&#x2013;5.&#xD;
&#xD;
30. Al-Bayyari N. The effect of cell phone usage on semen quality and fertility among Jordanian males. Middle East Fertil Society J. 2017;22:178&#x2013;82.&#xD;
&#xD;
31. Kesari KK, Behari J. Evidence for mobile phone radiation exposure effects on reproductive pattern of male rats: role of ROS. Electromagn Biol Med. 2012;31:213&#x2013;22.&#xD;
&#xD;
32. Kavindra Kumar Kesari, Ashok Agarwal, Ralf Henkel. Radiations and male fertility. Reprod Bio Endocrinol. 2018;16:118.&#xD;
&#xD;
33. Wdowiak A, Wdowiak L, Wiktor H. Evaluation of the effect of using mobile phones on male fertility. Ann Agric Environ Med. 2007;14:169-72.&#xD;
&#xD;
34. Gutschi T, Mohamad Al?Ali B, Shamloul R, Pummer K, Trummer H. Impact of cell phone use on men&#x2019;s semen parameters. Andrologia. 2011;43:312-6.&#xD;
&#xD;
35. Yildirim ME, Kaynar M, Badem H, Cavis M, Karatas OF, Cimentepe E, et al. What is harmful for male fertility: Cell phone or the wireless internet? Kaohsiung J Med Sci. 2015;31:480-4.&#xD;
&#xD;
36. Zhang G, Yan H, Chen Q, Liu K, Ling X, Sun L, et al. Effects of cell phone use on semen parameters: Results from the MARHCS cohort study in Chongqing, china. Environ Int. 2016;91:116-21.&#xD;
&#xD;
37. El- Helaly M, Mansour M. Cell phone usage and semen quality, hospital based study. Sch J Appl Med Sci. 2014;2:1978-1982.&#xD;
&#xD;
38. Feijo C, Verza Junior S, Esteves SC. Lack of evidence that radiofrequency electromagneticwaves (RF-EMW) emitted by cellular phones impact semen parameters of Brazilian men. Hum Reprod. 2011;26:139-140.&#xD;
&#xD;
39. Falzone N, Huyser C, Becker P, Leszczynski D, Franken DR. The effect of pulsed 900&#x2013;MHz GSM mobile phone radiation on the acrosome reaction, head morphometry and zona binding of human spermatozoa. Int J Androl. 2011;34:20&#x2013;26.&#xD;
&#xD;
40. Jensen TK, Swan SH, Skakkebaek NE, Rasmussen S, Jorgensen N. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol. 2010;171:883&#x2013;891.&#xD;
&#xD;
41. Jurewicz J, Radwan M, Sobala W, Ligocka D, Radwan P, Bochenek M, et al. Lifestyle and semen quality: role of modifiable risk factors. Syst. Biol Reprod Med. 2014;60:43-51.&#xD;
&#xD;
42. McCready KC, Halkitis PN. HIV serostatus disclosure to sexual partners among HIV-positive methamphetamine-using gay, bisexual, and other men who have sex with men. AIDS Educ Prev. 2008;20:15-29.&#xD;
&#xD;
43. Irmak MK, Fadillioglu E, Gulec M, Erdogan H, Yagmurca M, Akyol O. Effects of electromagnetic radiation from a cellular telephone on the oxidant and antioxidant levels in rabbits. Cell Biochem Funct. 2002;20:279&#x2013;83.&#xD;
&#xD;
44. Stopczyk D, Gnitecki W, Buczynski A, Markuszewski L, Buczynski J. Effect of electromagnetic field produced by mobile phones on the activity of superoxide dismutase (SOD-1) and the level of malonyldialdehyde (MDA)&#x2014;in vitro study. Med Pract. 2002;53:311&#x2013;4. &#xD;
&#xD;
45. Friedman J, Kraus S, Hauptman Y, Schiff Y, Seger R. Mechanism of short-term ERK activation by electromagnetic fields at mobile phone frequencies. Biochem J. 2007;405:559&#x2013;68.&#xD;
&#xD;
46. Aitken RJ, RyanAL, Curry BJ, Baker MA. Multiple forms of redox activity in populations of human spermatozoa. Mol Hum Reprod. 2003;9:645&#x2013;61.&#xD;
&#xD;
47. Aitken RJ, Buckingham DW, West KM. Reactive oxygen species and human spermatozoa: analysis of the cellular mechanisms involved in luminol- and lucigenin-dependent chemiluminescence. J Cell Physiol. 1992;151:466&#x2013;77.&#xD;
&#xD;
48. Houston BJ, Nixon B, King BV, De Iuliis GN, Aitken RJ. The effects of radiofrequency electromagnetic radiation on sperm function. Reproduction. 2016;152:263-276.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Parent Satisfaction with Phlebotomy Services at a Paediatric Hospital in East Delhi&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>104</FirstPage><LastPage>111</LastPage><AuthorList><Author>Arti Khatri</Author><AuthorLanguage>English</AuthorLanguage><Author> Shikha Sharma</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The phlebotomy service is the most common segment of the laboratory involved in direct patient contact. Satisfaction surveys are considered as reliable and valid tools for assessing the quality of medical care in the hospital. Given their childhood status, their parents are considered consumers of health care and thus represent the views of the patients. Data is scant regarding patient satisfaction with phlebotomy services, especially from a paediatric hospital. Objective: The aim of the present study was therefore to assess the parent satisfaction of phlebotomy services in a paediatric hospital of East Delhi. Methods: A total of randomly selected 265 outpatient guardians were interviewed by a 15-point predesigned questionnaire. Results: The overall satisfaction of patients towards hospital-based pre-laboratory services was satisfactory (86%). Concerning the environment of the phlebotomy room patients were relatively satisfied with the cleanliness of the blood drawing area, waiting time to get blood drawn and privacy during blood drawing. On the contrary, they were dissatisfied with the toilet accessibility and availability along with toilet cleanliness and comfort. Among the phlebotomy services rendered by the laboratory, patients were relatively satisfied with the number of needle stick attempts during blood drawing, availability of laboratory tests and courtesy/ respect of the phlebotomist. On the contrary, patients were highly dissatisfied with the availability of blood drawing room to put things and information provision about the bruise. Educational status was also significantly associated with the satisfaction rate of the respondents. Conclusion: Hospital administration and the laboratory department should strive more to enhance patients&#x2019; satisfaction, particularly in sanitation and location of the toilets in the hospital. Regular in-house training of phlebotomist focusing more on communication skills should be inculcated.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Phlebotomy, Customer satisfaction, Children, Survey, Quality tool, Dissatisfaction</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The phlebotomy service is the most common segment of the laboratory involved in direct patient contact. Patients may perceive the level of care they receive during separate phases of the phlebotomy to reflect the quality of care provided by the laboratory or hospital.1 The paediatric phlebotomist faces challenges and is responsible for performing an invasive procedure on one of the largest and most vulnerable age groups that can cause long-term negative effects, including fear and avoidance of healthcare as an adult.2 Studies have shown that young children and infants who experience frequent painful medical events have escalated pain sensitivity, maladaptive pain responses, and needle phobias that contribute to an increasing needle-phobic society.3-5 Due to these concerns the phlebotomy staff must be extra careful while dealing with patients who must be made comfortable before pricking. This requires the phlebotomist to be humble; able to answer all patient queries and can collect the sample in one prick with minimal discomfort. Long waiting time, poor communication, repeated pricks, bruising and other negative experiences may influence patient&#x2019;s perception of care.1 Patient satisfaction has been defined as the degree of congruency between a patient&#x2019;s expectations of ideal care and his/her perception of the real care(s) he receives.6 An important aspect for evaluating health services involves the measurement of patient satisfaction rates. A mismatch between the patient expectation and the service they receive leads to dissatisfaction. Monitoring patient satisfaction is an important and useful quality improvement tool for clinical laboratories in particular and health care organizations7 and is also required by laboratories to maintain their accreditations.8 The quality standards laid down by the National Accreditation Board of Hospitals (NABH) have also emphasized the patient&#x2019;s role in the improvement of laboratory services. Some important key indicators have been indicated by NABH which include waiting time for phlebotomy service to monitor the management, process and outcome especially patient satisfaction which are used as tools for continual improvement. Patient satisfaction surveys have been considered as reliable and valid tools for assessing the quality of medical care in the hospital considering the paediatric age group.9 Given their childhood status, their parents are considered as consumers of health care and thus represent the views of the patients.10 Satisfaction surveys can be conducted by various methods which include phone surveys, written surveys, group discussions or personal interviews. These surveys provide us satisfaction ratings.11 These&#xA0; ratings&#xA0; can help&#xA0; us&#xA0; to&#xA0; find weak areas&#xA0; such&#xA0; as&#xA0; lack&#xA0; of universal safety precautions, long waiting time, cleanliness of facility,&#xA0; location of the laboratory, toilet accessibility&#xA0; and&#xA0; availability, maintenance of privacy and confidentiality,&#xA0; the cost of the laboratory service etc. These were some of the reasons for patient&#x2019;s satisfaction related to clinical laboratory services as found in a few previous studies.1,12-16 The present study was therefore designed to find out satisfaction ratings along with deficient areas causing dissatisfactions among patients requiring phlebotomy services. There are very few studies that relate to patient behaviour and satisfaction from developing countries, as compared to the high volume of publications from developed countries. To the best of our knowledge, this is one of the first studies to assess parent satisfaction of phlebotomy services in a paediatric hospital. Considering these lacunae, the present study was therefore planned to assess the parent satisfaction of phlebotomy services in a paediatric tertiary care hospital. &#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The present cross-sectional study was carried out at Chacha Nehru Bal Chikitsalaya Hospital located in East Delhi from May to July 2020. Parents of children attending the Outpatient Department with phlebotomy services of Chacha Nehru Bal Chikitsalaya Hospital were the study population. Inclusion Criteria: -Parents of outpatients up to 12 years of age and requested for clinical chemistry, haematology and serology were included in the study. Exclusion Criteria: - Parents of patients referred or advised to the Intensive care unit or emergency with acute or chronic illness were excluded from the study since they are considered to be exceptional circumstances. The study was planned as a questionnaire-based survey; the study provided an insight into various problems faced by parents bringing their children to the hospital and their satisfaction rate.&#xD;
&#xD;
Sample size&#xD;
&#xD;
Sample size was calculated for each specific objective to get the maximum using a single population for objective one. The largest sample size for the patients was determined by using a single population formula considering the following assumptions: proportion of customer&#x2019;s satisfaction 94 % (taken from a previous study made on a patient&#x2019;s laboratory perception at the selected government hospital in East Delhi) 17 level of significance =0.05, margin of error (d) =3% and a non-respondent rate of 10%. Therefore, 265 patients were included in the study.&#xD;
&#xD;
The following formula was used for calculating the sample size:&#xD;
&#xD;
n = (Z &#x3B1; /2)2P (1- P)/d2&#xD;
&#xD;
Where:-&#xD;
&#xD;
n = the desired sample size&#xD;
&#xD;
P = Assuming patient satisfaction on clinical laboratories at East Delhi = 94% &#xD;
&#xD;
Z &#x3B1;/2 = Critical value at 95% confidence level of certainty (1.96)&#xD;
&#xD;
d = Assuming the margin of error between the sample and the population = 3%&#xD;
&#xD;
The calculated result is 241 and the total sample size required for the study with a non-response rate of 10% was found to be 265.&#xD;
&#xD;
Sampling Method&#xD;
&#xD;
The probability sampling method was utilized for the study. Every 4th parent was interviewed. This process was continued till the required sample size was collected.&#xD;
&#xD;
Tools of data collection&#xD;
&#xD;
Data was collected by using a structured, pre-tested and interviewer-administered questionnaire initially prepared in English and then translated to local language Hindi. The Hindi versions of the questionnaire were used for data collection.&#xA0; Data was collected by 6 trained data entry operators. Besides their socio-demographic characteristics, study participants were asked to rate each aspect of the phlebotomy service. &#xD;
&#xD;
The scoring was done by the typical five-level Likert scale: &#xD;
&#xD;
Score (1-5):- Poor-1, Fair-2, Good-3, Very good-4, Excellent -5&#xD;
&#xD;
Data Quality Assurance&#xD;
&#xD;
All the participants were asked to fill a questionnaire in the survey. These questionnaires were developed after referring to a validated published survey tool from the CAP Q Probes program.18 The patient&#x2019;s questionnaire was translated to Hindi and some questions were rephrased. The adaptation was done after ten persons from Chacha Nehru Bal Chikitsalya CNBC had validated and piloted the questionnaires. Parents of children undergoing phlebotomy were selected randomly and they were asked to give their feedback. Written informed consent was obtained from all the participants before they participated in the study after informing them about the objectives of the study.&#xD;
&#xD;
Data Analysis and Interpretation&#xD;
&#xD;
An appropriate statistical technique/method was used for data analysis. Descriptive parameters were presented as numbers and percentages. The poor and fair response was considered as dissatisfied whereas good, very good and excellent responses were considered as satisfied. The percentage of satisfaction or dissatisfaction was estimated by dividing the number of satisfied or dissatisfied responses by the total number of responses. The overall rate of satisfaction based on the Likert scale score was calculated as follows: (No. of poor rating &#xD7; 1) + (No. of good rating &#xD7; 2) +(No. of average rating &#xD7; 3)+ (No. of very good rating &#xD7; 4)+(No. of excellent rating &#xD7; 5) divided by the total number of ratings (1- 5)for the specific laboratory service. Internal consistency was checked using Cronbach&#x2019;s alpha coefficient and it has found to be 0.884 (Cronbach&#x2019;s alpha coefficient &gt; 0.7 is acceptable). Verbal and written consent was also obtained from the study participants before administering the questionnaire. The response of respondents was anonymous and data collectors informed respondents that they had full right to discontinue or refuse to participate in the study.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
A total of 265 subjects were included in the present study with a response rate of 100%. The mean (&#xB1;SD) age of the children was 7.3 &#xB1; 5.2 years ranging from 1 month to 12 years.&#xA0; The male: female sex ratio was 1.45:1. On evaluating the educational status of the parents it was observed that the majority 32.8% (N = 87) had primary education as shown in Table 1. On assessing the overall satisfaction of phlebotomy services 86% of the respondents were satisfied with the services they got, whereas 14% were dissatisfied with the phlebotomy services as shown in Figure 1. Figure 2 shows the evaluation of satisfaction rates of different parameters concerning the environment of the phlebotomy room. The highest three dissatisfaction rates were observed for the following parameters toilet accessibility and availability 38.1%, toilet cleanliness and comfort with a rate of 35.8% and comfort of chairs with a dissatisfaction rate of 15.1% respectively. Figure 3 shows the evaluation of satisfaction rates of different parameters concerning the phlebotomy process. The highest dissatisfaction rates were observed for the availability of the parameters of space in the blood drawing room to put things with a rate of 25.3 % followed by information provision about bruise with a dissatisfaction rate of 16.9 %. In Likert Scale, the overall mean rate of satisfaction of parents at CNBC Hospital for phlebotomy services was 3.49 out of a possible of 5. The mean rate of satisfaction for different aspects of phlebotomy ranged from 2.89 to 3.98. The lowest mean rating of satisfaction concerning the environment of the phlebotomy room was for toilet accessibility and availability and toilet cleanness and comfort with a mean rating of 2.89 and 3.01, respectively. Whereas the lowest mean rating concerning the phlebotomy process was for availability of place in the blood drawing room to put things and information provision about bruise with a mean rating of 3.15 and 3.36 respectively. The overall mean satisfaction score for phlebotomy services in the present study was 3.61 as shown in Table 2. There was no statistically significant association between gender and overall satisfaction rate (p = 0.052) (Table 3). But still, a slight difference was observed amongst the females who seemed to be more satisfied as compared to males (Figure 4). Still, the difference was not enough to cause any significant association with gender for the phlebotomy services to evaluate the satisfaction rate. Chi-square analysis was done to evaluate whether the level of patient&#x2019;s satisfaction had a relationship with explanatory variables. The analysis showed no significant relationship between gender and age towards phlebotomy services (p&gt;0.05). However, there was a significant relationship between educational status and level of patients&#x2019; satisfaction (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3766</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3766</Fulltext></URLs><References>&#xD;
	&#xD;
	Dawar R. Patient satisfaction of phlebotomy services in a tertiary care hospital. Int J&#xA0;&#xA0; Curr Res Aca Rev. 2015;3(6):35-38.&#xD;
	&#xD;
	&#xD;
	Young KD. Pediatric procedural pain. Ann Emerg Med. 2005;45:160 &#x2013;71.&#xD;
	&#xD;
	&#xD;
	Buskila D, Neumann L, Zmora E, Feldman M, Bolotin A, Press J. Pain sensitivity in prematurely born adolescents. Arch Pediatr Adolesc Med. 2003; 157:1079 &#x2013; 82.&#xD;
	&#xD;
	&#xD;
	Moadad N, Kozman K, Shahine R, Ohanian S, Badr LK. Distraction using the buzzy for children during an IV insertion. J Pediatr Nurs. 2016;31:64&#x2013;72.&#xD;
	&#xD;
	&#xD;
	Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Paediatrics. 2008;122(3):130 &#x2013;3.&#xD;
	&#xD;
	&#xD;
	Qadri SS, Pathak R, Singh M, Ahluwalia SK, Saini S, Garg PK. An assessment of patient&#x2019;s satisfaction with services obtained from a tertiary care hospital in rural Haryana. Intern J Collabo Res Internal Med Pub Health. 2012;4(8):1524&#x2013;1537.&#xD;
	&#xD;
	&#xD;
	Abera RG, Abota BA, Legese MH, Negesso AE. Patient satisfaction with clinical laboratory services at TikurAnbessa specialized hospital, Addis Ababa, Ethiopia. Patient Pref Adher. 2017;11:1181&#x2013;1188.&#xD;
	&#xD;
	&#xD;
	Georgieva E, Tsankova G, Kaludova V, Ermenlieva N. Patients&#x2019; satisfaction with laboratory services at selected medical diagnostic laboratories in Varna. J IMAB. 2014; 20(2):500&#x2013;501.&#xD;
	&#xD;
	&#xD;
	Torres J, Guo KL. Quality improvement techniques to improve patient satisfaction. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2004; 17:334-338.&#xD;
	&#xD;
	&#xD;
	Otani K, Kurts RS, Buroughs TE, Waterman B. Reconsidering models of patient&#x2019;s satisfaction and behavioural intentions. Health care Manag Rev. 2003; 28:7-14.&#xD;
	&#xD;
	&#xD;
	Oja PI, Kouri TT, Pakarinen AJ. From customer satisfaction survey to corrective actions in laboratory services in a university hospital.&#xA0; Int J Qual Health Care. 2006; 18(6):422-28.&#xD;
	&#xD;
	&#xD;
	Howanitz PJ, Cembrowski GS, BachnerP. Laboratory phlebotomy. College of American Pathologists Q-Probe study of patient satisfaction and complications in 23,783 patients. Arch Pathol Lab Med. 1991;115:867-72.&#xD;
	&#xD;
	&#xD;
	Mindaye T and Taye B. Patients&#x2019; satisfaction with laboratory services at antiretroviral therapy clinics in public hospitals, Addis Ababa, Ethiopia. BMC Res Notes. 2012;5:184.&#xD;
	&#xD;
	&#xD;
	Geletta T, Eyasu E, Mikias D, Shibabew A, Keneni E. Patients Satisfaction on Clinical Laboratory Services at Nekemte, Referral Hospital, Oromia Ethiopia. Food Sci Qual Manag. 2014;30.&#xD;
	&#xD;
	&#xD;
	Getachew R, Arka B, Hailu M and Edao A. Patient satisfaction with clinical laboratory services at TikurAnbessa specialized hospital, Addis Ababa, Ethiopia. Patient Pref Adher. 2017;11.&#xD;
	&#xD;
	&#xD;
	Zelalem T, Abiyu M, Haji K, and Getachew K. Clients and clinician satisfaction with laboratory services at selected government hospitals in eastern Ethiopia; BMC Res Notes 2013; 6:15.&#xD;
	&#xD;
	&#xD;
	Gupta A, Dwivedi T, Sadhana, Chaudhary R. Analysis of Patient&#x2019;s Satisfaction with Phlebotomy Services in NABH Accredited Neuropsychiatric Hospital: An Effective Tool for Improvement. J Clin Diagn Res. 2017;11(9):5-8.&#xD;
	&#xD;
	&#xD;
	College of American Pathologists: Laboratory accreditation program. Laboratory general checklist. Northfield GEN. 2011;20335:1-129.&#xD;
	&#xD;
	&#xD;
	Bhargava A, Thakur A, Mishra B, Taneja J, Dogra V, Loomba P (2012). Patient satisfaction survey of microbiological tests done in G.B. Pant Hospital. Inter J Health Care Qual Assu; 25(7): 555&#x2013;564.&#xD;
	&#xD;
	&#xD;
	Teklemariam Z, Mekonnen A, Kedir H, Kabew G. Clients and clinician satisfaction with laboratory services at selected government hospitals in eastern Ethiopia. BMC Res Notes 2013;6(15):1-7.&#xD;
	&#xD;
	&#xD;
	Million B, Seid A, Debela B, Derese D, Moges D, Misganaw B. HIV/AIDS patients satisfaction on ART laboratory service in selected Governmental Hospitals, Sidamma Zone, Southern Ethiopia. Sci J Public Health. 2013;1(2):85-90. &#xD;
	&#xD;
	&#xD;
	Pathak O, Taylor D, Kennedy MP, Virtue E, McDonald G. A multifaceted intervention improves patient satisfaction and perception of emergency department care. Int J Qual in Health Care. 2012;18(3): 238-45.&#xD;
	&#xD;
	&#xD;
	Oja PI, Kouri TT, Pakarinen AJ. From customer satisfaction survey to corrective actions in laboratory services in a university hospital. Int J Qual Health Care. 2006;18:422-8.&#xD;
	&#xD;
	&#xD;
	Adebasi YH, Ahmed MI. Patients&#x2019; satisfaction with medical services in the Qassim Area. J Clin Diagn Res. 2011;5(4):813-817.&#xD;
	&#xD;
	&#xD;
	Iliyasu Z, Abubarka SI, Abubarka S, Lawan UM, Gajida AU. Patient&#x2019;s satisfaction with services obtained at the Aminu Kano Teaching Hospital, Kano, Northern Nigeria. Niger J Clin Pract. 2010;13(4):371-378.&#xD;
	&#xD;
	&#xD;
	Sodani PR and Sharma K. Assessing patient satisfaction for investigative services at public hospitals to improve quality of services. Ethiop J Health Dev. 2011;2(3):405-408.&#xD;
	&#xD;
	&#xD;
	Abdosh B. The Quality of hospital services in eastern Ethiopia: Patient&amp;#39;s perspective. Ethiop J Health Dev. 2006;20(3):199-200.&#xD;
	&#xD;
	&#xD;
	Mekonnen A, Teklemariam Z, Kedir H, Kabew G. Patient Satisfaction with Laboratory Services in Selected Government Hospitals, Eastern Ethiopia. Harar Bull Health Sci. 2011;3:5-8.&#xD;
	&#xD;
	&#xD;
	&#xA0;Georgieva E, Tsankova G, Kaludova V, Ermenlieva N. Patients satisfaction with laboratory services at selected medical - diagnostic laboratories in Varna.&#xA0; J Integr Market Advis Board. 2014;20(2):500-501.&#xD;
	&#xD;
	&#xD;
	Fekadu A, Andualem M, Yohannes HM. Assessment of Clients&#x2019; Satisfaction with Health Service Deliveries at Jimma University Specialized Hospital. Ethiop J Health Sci. 2011;21(2):101-9.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Antifungal Efficacy of Commonly Used Endodontic Irrigating Solutions on C Albicans &#x2013; A Systematic Review&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>112</FirstPage><LastPage>116</LastPage><AuthorList><Author>Shruti Sudhakar Khade</Author><AuthorLanguage>English</AuthorLanguage><Author> Anita Babasaheb Tandale</Author><AuthorLanguage>English</AuthorLanguage><Author> Karishma Krishnakumar</Author><AuthorLanguage>English</AuthorLanguage><Author>  Sayali Anil Maral</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Microorganisms have a pivotal role in the induction and continuing of pulp and periapical pathosis. Objectives: To evaluate antifungal efficacy of commonly used endodontic irrigating solutions on reducing the CFU count of C Albicans in extracted human permanent teeth. Methods: The research question was formulated using the PICO strategy. A planned literature search was conducted by two personnel independently using MEDLINE, PubMed, EBSCO, Scopus, Google Scholar and manual search using College library. Resources were searched from 1st Sept 2009 to 31st August 2019 to identify appropriate studies. Inclusion and exclusion criteria were implicated to select articles. All cross-references lists were also selected. A systematic data extraction sheet was formulated. Results: A total of 101 articles were identified through the data base.13 articles were selected after thoroughly reading full texts and were assessed for eligibility. After going through these 13 articles, it came to notice that no endodontic irrigant has 100% antifungal properties. In many studies, it is evident that out of different concentrations of Sodium hypochlorite, 5.25% concentrated solution showed the best results. Conclusion: From this systematic review it can be concluded that although the antifungal activity of various endodontic irrigating solutions is checked by various authors, no single irrigant proves to be completely successful in reducing the count of candida.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Antifungal, Colony-forming units, Disinfecting agent, Extracted human teeth, Irritants, Microorganisms</Keywords><Fulltext>Introduction&#xD;
&#xD;
Microorganisms have a pivotal role in the induction and continuing of pulp and periapical pathosis. Among the predominant root canal microbiota, fungi play an important role in the failure of root canal treatment. Kakehashietal1 in a classic study proved that bacteria caused pulpal disease; however, numerous studies have revealed a possible role of fungi and more recently viruses in the incidence of endodontic infections. Literature has mentioned that Enterococcusfaecalis, Actinomyces, and Candida albicans were the most prevalent microorganisms associated with failed endodontic treatment. Their presence has been confirmed in dental plaque, dental caries, dentinal tubules, subgingival flora, and infected root canals. 2The genus&#xA0;Candida albicans&#xA0;(C. Albicans) is the most important and influential one. Sen et al found heavy fungal infections in 4 out of 10 teeth and suggested that Candida be considered a dentinophilic microorganism.3&#xD;
&#xD;
C. Albicansis a versatile microorganism. It exhibits a variety of virulence factors and degrades dentinal collagen. Candida can grow on the dentinal surfaces in the absence of oral tissue fluids and penetrates the dentinal tubules by its various growth patterns. Despite C. Albicans being an aerobic microorganism, it can survive in the harsh environment of the root canal, which primarily favours the growth of anaerobes is because of these unique qualities. C. Albicans has also been isolated in culture samples taken from mixed endodontic infections.4&#xD;
&#xD;
Waltimo et al5 showed that Candida species was resistant to calcium hydroxide; however, when combined with sodium hypochlorite or CHX it could provide a wide spectrum antimicrobial action with a long-lasting effect. The resistance of Candida to calcium hydroxide and its ability to penetrate dentinal tubules are possible reasons for its occurrence in cases of apical periodontitis.6 This raised the curiosity of researchers to look for the antifungal potency of endodontic irrigants.&#xD;
&#xD;
Sodium hypochlorite is one of the most commonly used irrigating solutions and is considered a gold standard. It has good antibacterial effects and tissue dissolving properties. But one of the biggest drawbacks of NaOCl is that it has low surface tension and hence it does not penetrate deep into dentinal tubules. This has led to the development of new irrigants which overcome this drawback. Chlorhexidine (CHX) is a biguanide with a wide antimicrobial spectrum that is effective against Gram-positive and Gram-negative bacteria as well as fungi.7,8&#xD;
&#xD;
There are some antibiotic-based root canal irrigation solutions in endodontics, as well. Adjunctive methods of disinfection like lasers, PDT are also used vividly. Attempts have been made to check the antifungal properties of irrigating solutions.Butthere is no one particular irrigant aiming at eliminating all micro-organism and resulting in successful endodontic treatment. Hence, the search for an ideal root canal irrigant to achieve the goal of disinfection of the canals from all microorganisms continues. 9,10 This systematic review aims to evaluate the antifungal efficacy of various endodontic irrigants on the basis of reduction of the CFU count of C Albicans on extracted human teeth.&#xD;
&#xD;
MATERIALS AND METHDOS &#xD;
&#xD;
This systematic review was done according to PRISMA guidelines.&#xD;
&#xD;
Eligibility Criteria&#xD;
&#xD;
Articles in the English language or those having a summary in English were selected. Studies published from 1st Sept 2009 to 31st August 2019 were chosen. In vitro studies done on Human extracted teeth evaluated by Colony Forming Unit were the main criteria while selecting the study. This systematic review included the articles in which methodology showed the use of endodontic irritants only and not a combination of these irrigants with any other material. Review, abstract, letter to the editor was excluded. In vivo studies were also excluded. &#xD;
&#xD;
Information source&#xD;
&#xD;
The internet source used to search papers for this study were: The National Library of Medicine(MEDLINE PubMed) and EBSCO HOST, Google Scholar, Google and manual search using DPU college library resources. All cross-references lists of the selected studies were screened for additional papers that could meet up the eligibility criteria. The databases were searched up to and including September 2019 using the search strategy.&#xD;
&#xD;
Study selection and strategy&#xD;
&#xD;
The databases were searched for relevant articles with title, abstract, keywords and their combination as follows: &#xD;
&#xD;
Antifungal OR Antibacterial AND Candida Albicans OR endodontic fungi AND irrigating solutions OR Endodontic irrigating solutions OR root canal irrigants OR dental irrigants OR Sodium hypochlorite OR Chlorhexidine AND Extracted Human Teeth OR Invitro study AND Colony Focal count OR CFU. The yielded articles were assessed further after securing full-text and eliminating duplicates. The titles and abstracts were thoroughly screened and they were either included or excluded based on the inclusion criteria. Articles wherein the antifungal efficacy of one or more endodontic irrigating solution/s was checked against candida Albicans on extracted human teeth and were evaluated by Colony Forming Unit were chosen.&#xD;
&#xD;
Data collection process&#xD;
&#xD;
A standard pilot form in the excel sheet was initially used and then those headings not applicable for the review were removed. A pattern of data extraction was done for an article and this was reviewed by an expert and finalized. This was followed for data extraction of all articles. The&#xA0; data extracted from the included studies were as follows:&#xD;
&#xD;
&#xD;
	&#xD;
	Title- Title of the article.&#xD;
	&#xD;
	&#xD;
	Author &#x2013; the name of the author.&#xD;
	&#xD;
	&#xD;
	Year of publication- the year in which the study was published.&#xD;
	&#xD;
	&#xD;
	Sample size- the number of extracted human teeth included in the study.&#xD;
	&#xD;
	&#xD;
	Intervention- names and quantity of irrigating solution used.&#xD;
	&#xD;
	&#xD;
	Technique &#x2013; materials and method used.&#xD;
	&#xD;
	&#xD;
	Results- results of the study.&#xD;
	&#xD;
	&#xD;
	Conclusion &#x2013; conclusion made from the study.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Study selection&#xD;
&#xD;
A total of 101 articles was identified through database searching. After reading titles, 64 articles were excluded as they did not match the inclusion criteria. Further 36 articles were assessed for any duplicate and seven articles were removed. The remaining 29 articles were then screened for abstract. After reading the full text of remaining 13 articles were selected and assessed for eligibility. These 13 articles were included in the study (Figure 1). The variables used to extract data i.e. study size, PICOS, methodology, irrigating solution, sample size, the method of preparation of the tooth, colony-forming unit, control used and others are mentioned.&#xD;
&#xD;
Discussion&#xD;
&#xD;
The major goal of root canal treatment is to prepare the canals free of any pathogenic organism to provide a long-lasting treatment of the tooth. Along with bacteria, fungi are also been found in canals of infected teeth or endodontically failed teeth.9 Very few have been evaluated for their antifungal efficacy. Hence the main aim of this systematic review was to discuss the antifungal activity of all the commonly used endodontic irrigants. Thirteen articles were extracted for this systematic review. Routinely used irrigants like NaOCl, CHX, saline, etc. were commonly used for comparison with other materials in the referred articles. Some herbal products like Morinda Citrofolia (MC), Triphala juice, Aloe vera extract, etc. were also tested for their antifungal effectiveness. Some supplementary techniques like laser, photodynamic therapy(PDT) and light-activated disinfection were also studied for their antifungal effectiveness. The studies that used extracted human teeth for the growth of candida and Colony Forming Unit to assess the reduction in the number of Candida were the only ones chosen for this systematic review.&#xD;
&#xD;
Sodium hypochlorite is one of the most commonly used irrigant in endodontics because of its cheap cost, ease of availability and majorly its tissue dissolving property. It is available in various concentrations of 0.2%, 0.5%, 2.5%, 3%, 5.25% and 6%. The efficacy of NaOCl also depends on its contact time, temperature and concentration. It has been demonstrated that C. Albicans is very susceptible to its action in 0.5% concentration within 10 s of contact time.2 Mohamadi et al2 in 2015 conducted a study to check the antifungal efficacy of sodium hypochlorite in three different concentrations (0.5%, 2.6%, 6%) with CHX (0.2%, 2%), MTAD, Chlor- Xtra, Hypoclean and Tetraclean. Antifungal activity of 6% NaOCl, Chlor-Xtra and 2% CHX was significantly greater than the rest of the irrigants. MTAD was introduced by Mahmoud Torabinejad and associated in the year 2003. It is a combination of 3% doxycycline, 4.25% citric acid and a surfactant. Mohamadi et al3 in 2010 conducted the first study comparing the effect of 1.3% NaOCl, 2% CHX, MTAD and Tetraclean as a final rinse against C.albicans. Similar to the study mentioned above, NaOCl and CHX had the highest Colony Forming Unit reduction with similar results. Tetraclean was found superior to MTAD. MTAD and Tetracleanboth are Doxycycline based irrigants. But Tetraclean was significantly more effective than MTAD because it has deeper penetrating ability due to low surface tension. There is only one study using Hypoclean and it has very low results compared to Tetraclean.9&#xD;
&#xD;
Propolis is also new biocompatible material in the market with good antibacterial properties. Awawdeh et al.11 checked its antifungal properties of MTAD, 3% NaOCl and 2% CHX and 30% Propolisin the presence and absence of smear layer. The results showed that Propolis was having 70% efficacy, NaOCl up to 90% while CHXupto95%. So, according to this study CHX was a more efficient antifungal agent than NaOCl, which is contrary to many studies considered in this systematic review. Also, no significant difference was seen in the reduction of colony count due to the presence or absence of smear layer according to this study.&#xD;
&#xD;
Clonidine hydrochloride (OCT) is a bipyridine derivative. OCT has been suggested as an alternative endodontic irrigant based on its antimicrobial effects and lower cytotoxicity. Tirali et al11 in 2011 evaluated the effectiveness of 5.25% NaOCl, 0.1% OCT and 2% CHX at different time intervals of 30 sec, one minute and five minutes as per the groups. It was noticed that 1 ml of 2% CHX for Five minute showed the highest antifungal activity followed by 5.25% NaOCl. 0.1% OCT showed the least antifungal activity. This proved that the more the exposure time of the irrigant, the more potent was the antifungal action. &#xD;
&#xD;
Zargar et al.13 conducted a study to evaluate the presence or absence of smear layer on the antifungal effect of irrigants at the time intervals of 5 minutes, 30 minutes and 60 minutes. Teeth were prepared. The smear layer was created in 50% (half)of the samples and its removal was done in half of the samples. They were infected with C.albicans. Irrigation with 2.61 % NaOCl, 0.2% CHX and 1% Povidone-iodine (PI) was done for five, 30 and 60 min. They concluded that removal of smear layer proved to be more effective in removing the fungi and 2.6% NaOCl was most potent followed by 2% CHX compared with1% PI.&#xD;
&#xD;
There is also a study where photodynamic therapy was used in adjunct to sodium hypochlorite by Bruna Paloma de Oliveria et al.14 In this study disinfection protocol used was as follows1% NaOCl, 5.25% NaOCl, 1% NaOCl+ PDT, 5.25% NaOCl+ PDT, saline + PDT. For PDT, methylene blue (15&#xB5;g/ml) remained in the root canal for two minutes, followed by irradiation with the diode laser. 5.25% NaOCl+ PDT resulted in the highest number of antifungal efficacies. Same antimicrobial effects were seen with 1% NaOCl and 1% NaOCl + PDT. Saline + PDT did not eliminate all microorganisms. This proves that PDT is an additional method for disinfection of canals followed by irrigation, but independently it cannot be much useful for disinfection. The above results coincided with a study conducted by Eldeniz et al.15 They evaluated the antifungal efficacy of light-activated disinfection (LAD/ PDT) in comparison with 2.5% NaOCl and 2% CHX and a new wound antiseptic, OCT. The result showed that the PDT group showed the least antifungal effect. 2.5% NaOCl showed the most antifungal effect followed by 2% CHX and OCT having a similar effect. &#xD;
&#xD;
Another adjunct for disinfection is lasers. Emelonay et al.16conducted a study to check the antifungal effect of Er, Cr: YSGG laser irradiation at different energy settings to eliminate C. Albicans, with or without 5.25% NaOCl. The specimens were divided into six treatment groupsofNaOCl1-W laser; 1-W laser, NaOCl 0.75-W laser, 0.75-W laser, NaOCl only and a group with no treatment. Although all the groups showed more or less reduction in the Colony Forming Unit count, there was no group showing complete eradication. Lasers when used alone were less effective. But when used in adjunct with NaOClshowed most antifungal action. &#xD;
&#xD;
Some authors use herbal preparation to check their effect on C.albicans. Choudhary et al.17 check the antifungal properties of Morinda Citrofolia(MCJ) and Triphala juice as endodontic irrigants. Out of the two, MCJ showed higher antifungal efficacy. The disadvantage of these two herbal products was they cause discolouration of teeth. A study by Valera M et al.10evaluated the antifungal properties of Aloe vera, Castor oil and Glycolic Ginger extract and compared them with 2.5% NaOCl and 2% CHX. Although Aloe vera has medicinal value and used as an antimicrobial and anti-inflammatory agent it was not able to reduce all the microorganisms. Despite the antimicrobial effects of Ginger, it didn&#x2019;t show an effective antifungal effect in the present study. The reason for poor results is attributed to lower concentrations used in the study. Castor oil has a literature background supporting its antimicrobial properties, biocompatibility etc. Castor oil is capable of removing debris similar to 1% NaOCl. This study completely removed the C Albicans.&#xD;
&#xD;
Juneja et al17 combined 1.3% NaOCl and MTAD and checked its antifungal efficacy comparing with 2.5% NaOCl, 2%CHX and Iodine potassium iodide(IKI). After comparing the above irrigants, it was found that there was a significant reduction in growth but there was no significant difference in the antifungal effect. Also, the CFU counts in the study showed that the antifungal substantivity of IKI was less. 2.5% naocl, 2%CHX showed the highest antifungal effect followed by 1.3% naocl/MTAD. The substantivity nature of CHX is because it absorbs the acidic proteins of hydroxyapatite and gradually releases them inactive cation form.18 Sedigh-Shams et al.19 compared the antifungal effect of Zatariamultiflora EO with that of NaOCl as an irritant for root canals infected with C Albicans.NaOCl was effective than Z multiflora EO with minimum fungicidal concentration.&#xD;
&#xD;
The study conducted by Chandra et al3 evaluated the antifungal efficacy of 5.25% NaOCl, 2%CHX and 17% EDTA as one subgroup.They compared the antifungal efficacy by adding Clotrimazole as an antifungal agent in another subgroup after irrigation. In the subgroup where irrigants were used without an antifungal agent, 5.25% NaOCl proved to be more potent than 2% CHX and 17% EDTA. When Clotrimazole was flushed in the canals after the irrigation, no difference was observed between NaOCl and CHX group and was more effective than 17% EDTA.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
C. Albicans is proven to be responsible for pulpal and periapaical infection. There have been attempts on the complete elimination of C.Albicans in-vitro. Various researchers have tried various irrigants to check their antifungal activity against C.Albicans. All irrigants were able to reduce the Colony Forming Unit count up to some extent. But no specific irrigant showed potent antifungal efficacy equal to NaOCl and CXH. NaOCl is a gold standard endodontic irrigant and is routinely used by the clinician. CHX also has potential antifungal efficacy. Its use as a final rinse will have potential antifungal results. Smear layer removal may aid in increasing the potency of irrigating solutions. The use of adjunctive techniques such as Lasers, PDT, etc. can lead to effective disinfection of root canals from C.Albicans. Although there are various improved irrigating solutions in the market, the search for an ideal root canal irrigating solution to eliminate all the micro-organism continues.&#xD;
&#xD;
Conflict of interest: None&#xD;
&#xD;
Acknowledgement: I would like to thank my Guide Dr Anita B. Tandale for her guidance and help throughout the course. I would also like to thank my colleagues Dr Sayali Maral and Dr. Karishma Krishnakumar for their help and support. &#xD;
&#xD;
Source of Funding: None.&#xD;
&#xD;
Authors&#x2019; Contribution: All the authors contributed equally&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3767</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3767</Fulltext></URLs><References>&#xD;
	&#xD;
	Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats.&#xA0; Oral Surg Oral Med Oral Path.1965;20(3):34&#x2013;35.&#xD;
	&#xD;
	&#xD;
	Mohammadi Z, Giordano L, Pallazi F. Evaluation of the antifungal activity of four solutions used as a ?nal rinse in vitro. Aust Endod J. 2013;39:31&#x2013;34.&#xD;
	&#xD;
	&#xD;
	Chandra S, Miglani R, M.R. Srinivasan, Indira R. Antifungal Efficacy of 5.25% Sodium Hypochlorite, 2% Chlorhexidine Gluconate, and 17% EDTA With and Without an Antifungal Agent. J Endod. 2010;36(4):675-678.&#xD;
	&#xD;
	&#xD;
	Siqueira JF, Sen BH. Fungi in endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:632&#x2013;41.&#xD;
	&#xD;
	&#xD;
	Waitomo TMT, Orstavik D, Siren EK, et al. In vitro susceptibility of Candida albicans to four disinfectants and their combinations. Int Endod J. 1999; 32:421&#x2013;9. &#xD;
	&#xD;
	&#xD;
	Waltimo T, Siren E, TorkkoH, Olsen I, Haapasalo M. Fungi in therapy-resistant apical periodontitis. Int Endod J. 1997; 30, 96 &#x2013;101. &#xD;
	&#xD;
	&#xD;
	Palazzi F, Morra M, Mohammadi Z, Grandini S, Giardino L. Comparison of the surface tension of 5.25% sodium hypochlorite solution with three new sodium hypochlorite-based endodontic irrigants. Int Endod J. 2012;45(2):129-35.&#xD;
	&#xD;
	&#xD;
	Mohammadi Z, Abbott PV. The properties and applications of chlorhexidine in endodontics. Int Endod J. 2009;42(4):288-302.&#xD;
	&#xD;
	&#xD;
	Mohammadi Z, Asgary S. Antifungal Activity of Endodontic Irrigants. Iran Endod J 2015;10(2):144-147.&#xD;
	&#xD;
	&#xD;
	Valera M, Maekawa L, Oleviera L, Jorge A, Carvalho C. In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals. J Appl Oral Sci. 2013; 21(2):118-23.&#xD;
	&#xD;
	&#xD;
	Awawdeh L, Jamleh A, Beitawi M. The Antifungal Effect of Propolis Endodontic Irrigant with Three Other Irrigation Solutions in Presence and Absence of Smear Layer: An In Vitro Study. Iran Endod J. 2018;13(2):234-239.&#xD;
	&#xD;
	&#xD;
	Tirali R, Bodur H, Sipahi B, Sungurtekin E. In vitro antimicrobial activity of Sodium hypochlorite, Chlorhexidinegluconate and OctenidineDihydrochloride in the elimination of microorganisms within dentinal tubules of primary and permanent teeth. Med Oral Patol Oral Cir Bucal. 2012;17(3):517-22.&#xD;
	&#xD;
	&#xD;
	Zargar N, Dianat O, Asnaashari M, Ganjali M, ZadsirjaS. The Effect of Smear Layer on Antimicrobial Efficacy of Three Root Canal Irrigants. Iran Endod J. 2015; 10 (3): 179-183.&#xD;
	&#xD;
	&#xD;
	Oliveira BP, AguiarC, Albuquerque M, Barros Correia&#xA0; A, Roca Soares M. The efficacy of photodynamic therapy and sodium hypochlorite in root canal disinfection by a single-file instrumentation technique. Photodiagn Photodyn Ther. 2015;05:004.&#xD;
	&#xD;
	&#xD;
	Eldeniz A, Guneser M, Akbulut M. Comparative antifungal efficacy of light-activated disinfection and octenidine hydrochloride with contemporary endodontic irrigants. Lasers Med Sci. 2015;30(2):669-75.&#xD;
	&#xD;
	&#xD;
	Onay E, AlikayaV, Seker E. Evaluation of Antifungal Ef?cacy of Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet Laser Against Candida albicans. Photomed Laser Surg. 2010;28(1):S73-78.&#xD;
	&#xD;
	&#xD;
	Choudhary E, Indushekar K, Saraf B, Sheoram N, Sardana D, Shekhar A et al. Exploring the role of Morindacitrifolia and Triphala juice in root canal irrigation: An ex vivo study. J Conserv Dent. 2018; 21(4): 443-449.&#xD;
	&#xD;
	&#xD;
	Juneja N, Hegde M. Comparison of the Antifungal Efficacy of 1.3% NaOCl/MTAD with Other Routine Irrigants: An Ex-Vivo Study. Intech Res Notices. 2014; 575748.&#xD;
	&#xD;
	&#xD;
	Sedigh-Shams M, Badiee P. In vitro comparison of antimicrobial effect of sodium hypochlorite solution and Zatariamultiflora essential oil as irrigants in root canals contaminated with Candida albicans. J Cons Dent. 2016;19(1):101-105.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of Computed Tomography of the Nose and Paranasal Sinuses in COVID-19 Patients with Anosmia: Our Experiences at a Tertiary Care Teaching Hospital&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>117</FirstPage><LastPage>121</LastPage><AuthorList><Author>Swain SK</Author><AuthorLanguage>English</AuthorLanguage><Author> Das S</Author><AuthorLanguage>English</AuthorLanguage><Author> Kar D</Author><AuthorLanguage>English</AuthorLanguage><Author> Das SR</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Olfactory dysfunction is a unique clinical presentation reported among coronavirus diseases 2019(COVID-19) patients. The exact pathophysiology for olfactory dysfunction in COVID-19 infections is poorly understood. Objective: To evaluate the anosmia in COVID-19 infections with help of computed tomography (CT) scan of the nose and paranasal sinus. Methods: This prospective study was performed in COVID-19 patients with symptoms of olfactory dysfunction. We evaluated the conductive etiologies of the anosmia with help of the CT scan of the nose and paranasal sinuses. Results: There were 62 patients with anosmia with COVID-19 infections included in this study. The age ranges of the study patients were 18 to 76 years with a mean age of 46.3&#xB1;14 years. Complete anosmia was found in 67.74% of cases and 82.25% of cases presented with sudden onset of olfactory dysfunction. Gustatory dysfunction or dysgeusia was found in 51.61% of the cases. There were no pathological lesions of the olfactory cleft in the CT scan of the nose and paranasal sinuses. Conclusion: Obstructive or conductive pathology in the sinonasal tract does not play a significant role in causing the anosmia in COVID-19 patients. We did not find much sinonasal pathology in the CT scan of the nose and paranasal sinuses in COVID-19 patients with anosmia.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Computed tomography, Anosmia, COVID-19 patients, Olfactory cleft</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The coronavirus disease 2019(COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) and currently presenting as a global threat.1 The common clinical manifestations in COVID-19 patients are fever, dry cough and dyspnea. Other additional clinical presentations include fatigue, headache, nausea, vomiting, myalgia, anosmia and dysgeusia.2 The olfactory dysfunction may be anosmia (complete loss of smell), hyposmia(partial loss of smell), phantosmia(sensing odour without any external stimulant) and parosmia(a change in the usual feeling of odour). Anosmia is a cardinal clinical manifestation found in a COVID-19 patient.3 Although SARS-CoV-2 of COVID-19 pandemic and SARS-CoV have similar genetic sequencing, pathogenesis and cellular entry, the olfactory dysfunction was not documented during the previous SARS-CoV epidemic.4 The pathogenesis for post-viral anosmia includes conductive, sensorineural and mixed etiologies. The sinonasal pathology may block the entrance of the odorants to the olfactory epithelium of the nasal cavity, so causing conductive olfactory dysfunction. So, treatment of the olfactory dysfunction may by obstructive sinonasal pathology or conductive pathology is different from the sensorineural loss. So, detailed history and clinical examinations are vital before evaluating the anosmia in the COVID-19 pandemic. The detailed clinical examination includes complete ear, nose and throat examination along with diagnostic nasal endoscopy. However, performing the diagnostic nasal endoscopy in COVID-19 patients is considered a high-risk procedure for viral transmission to health care professionals. So, the CT scan of the nose and paranasal sinuses is the investigation of the choice for studying the sinonasal pathology in COVID-19 patients with anosmia.5 In this study, we considered the computed tomography (CT) scan of the nose and paranasal sinuses as an alternative to the diagnostic nasal endoscopy for evaluating the etiopathology of the olfactory dysfunction.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This prospective study was done at a tertiary care teaching hospital attached to a 500 bedded COVID-19 hospital. This study was conducted between March 2020 to October 2020 and approved by the Institutional Ethical Committee (IEC) with the reference number of IEC/IMS/SOA/12.03.2020. The COVID-19 patients with anosmia attending the outpatient department were included in this study. The COVID-19 patients were confirmed by the reverse transcription-polymerase chain reaction (RT-PCR) assay of nasopharyngeal samples. Patients with age less than 18 years, previous history of smell abnormalities, neurological diseases, sinonasal surgery, endonasal neurosurgery and pregnant lady were excluded from this study. The sinonasal symptoms including smell status were evaluated subjectively with help of the questionnaires including different co-morbidities of the participants. The screening of the CT scan of the nose and paranasal sinuses with coronal views (Siemens, 64-channel) was performed for assessing the diseases of the nose and paranasal sinuses along with the status of the stomatal complex(OMC), ethmoidal sinuses, maxillary sinuses, sphenoid sinuses and olfactory cleft. The Lund-Mackay CT scan scoring was used for evaluating the nose and paranasal sinuses where 0 indicates normal, 1 partial and 2 indicates total opacity for the paranasal sinuses. The mucosal thickening and swelling at the olfactory cleft and ethmoidal sinuses are considered as obstructive olfactory dysfunction. Data were analyzed by SPSS and reports were reported as mean, standard deviation and percentage.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
There were 62 COVID-19 patients with anosmia included in this study. The age ranges of the study patients were 20 to 76 years with a mean age of 46.3&#xB1;14 years. There were 38 (68.29%) males and 24 (38.70%) females with male to female ratio of 1.58:1. The commonest morbidity associated with COVID-19 patients with anosmia was diabetes mellitus (30.64%) (Table 1). &#xD;
&#xD;
Out of the 62 patients, 42 (67.74%) presented with complete anosmia and 20 (32.25%) with partial anosmia (hyposmia). Along with anosmia, the COVID-19 patients presented with certain accompanying symptoms such as fever (17.74%), headache (16.12%), cough (24.19%), nasal obstruction (14.51%), rhinorrhea (9.67%) and fatigue (8.06%) (Table 2). &#xD;
&#xD;
Out of 62 patients, 51(82.25%) were presented with sudden onset of olfactory dysfunction. There were 32 patients (51.61%) who presented with associated taste disturbances.&#xA0; The involvement of the paranasal sinuses in the CT scan was analyzed as per Lund-Mackay score. Total Lund-Mackay score was 0 in 61(98.38%)&#xA0; and 1 in 1(1.61%) patients at the right side of the stomatal complex whereas&#xA0; 0 in 60 (90.77%) patients and 1&#xA0; in 2 (3.22%) patients on the left side of the stomatal complex (Table 3)&#xA0; There were no opacification or abnormalities at the olfactory cleft in any of the patients.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
COVID-19 is an infectious disease of the respiratory tract caused by a novel virus called severe acute respiratory syndrome coronavirus 2(SARS-Co-2) and primarily spreads from human to human by droplets which carry virus. Novel coronavirus disease 2019(COVID-19) was an outbreak which emerged in China in December 2019 and has rapidly spread into a global pandemic.6 There are varieties of clinical presentations reported since starting of the COVID-19 pandemic including the symptom of anosmia.7 This infection often causes respiratory symptoms and even causes respiratory distress and death.8 Rapid spread of the COVID-19 infections currently threatens the world and also the healthcare system. In the COVID-19 pandemic, many patients have reported an acute loss of smell and taste. The association between the smell and taste disturbances in COVID-19 patients may carry important implications towards future investigations for understanding the SARS-CoV-2 virus ability to overwhelm the host immune response. The sudden onset of anosmia or dysgeusia should be considered an important symptom in the international forum for early diagnosis of COVID-19 patients. In this study, 82.25% of patients were presented with sudden onset of olfactory dysfunction. These symptoms act as a biomarker in this pandemic for early isolation of the patient. The most efficient method for preventing the spread of the COVID-19 infection is the early identification of the symptoms like smell and taste abnormalities and isolation of the patient. Olfactory dysfunction is usually associated with poor quality of life. Now the early identification of COVID-19 patient is urgently needed to isolate the patient and control the spread of the infection.8 The exact pathophysiology for smell disturbances in COVID-19 infections is not clear. There are controversies regarding the aetiology of impaired smell in COVID-19 patients whether by infecting directly or by neurological disease or other infections or direct damage of the organ itself. There are two potential mechanisms for explaining the olfactory dysfunctions such as mechanical blockage of the olfactory function due to inflammation, as found in the olfactory cleft syndrome or neuro-epithelial injury occurred when the olfactory epithelium and sensory neurons damaged by the infections.9,10&#xA0;&#xA0; &#xD;
&#xD;
The explanations for olfactory dysfunction in the post-viral period are secretions, congestion and inflammatory changes in the mucosal lining of the sinonasal tract.11 The obstruction to the olfactory cleft or neurogenic invasion/involvement of the olfactory bulb in post-viral infections is also the explanation for the olfactory dysfunctions.12 So, the disturbances in the olfaction are mostly due to blockage of the airway, sensory deficits by neuroepithelial injury or damage to the olfactory bulb, olfactory tract or central olfactory tract including prefrontal lobe, septal nuclei, amygdala and temporal lobe.13 The neuroinvasive property of the SARS-CoV-2 might have a role in the pathophysiology of smell and taste disturbances.14 As the olfactory mucosa is found at the roof of the nasal cavity, a direct or indirect effect of the SARS-CoV-2 in situ may be another explanation for these clinical manifestations. Infections, inflammations and certain chemical agents have an impact on the dendritic processes at the olfactory epithelium by inflammatory cytokine release, so induces apoptosis of the olfactory neurons.15 SARS-CoV-2&#xA0;&#xA0; is also directly responsible for causing olfactory dysfunctions.16 In the current COVID-19 pandemic, the symptoms such as anosmia and ageusia are found as isolated symptoms or in association with other respiratory symptoms.17 In this study, 32 patients (51.61%) presented with taste disturbances out of the 62 COVID-19 patients with anosmia.&#xD;
&#xD;
Smell disturbances are often found in COVID-19 patients. These symptoms may be presented as the first and/or only symptoms by COVID-19 patients. Olfactory dysfunction due to diseases of the sinonasal mucosa has a high chance of recovery whereas the recovery of the olfactory dysfunction by sensorineural loss is uncertain or late recovery. So, the proper understanding of the exact mechanism for olfactory dysfunction is an important part of the treatment and prognostication of this symptom. The mucosal lining of the nasal cavity has high angiotensin-converting enzyme 2 (ACE2) receptor expressions, so permit for the route of the virus.18 Despite these findings, nasal symptoms are absent in the majority of the COVID-19 patients. In this study, nasal symptoms like rhinorrhea (9.67%), nasal block (14.51%) and sneezing (8.86%) were uncommon.&#xA0; One study documented that non-neuronal cells of the olfactory epithelium and non-olfactory neurons are the direct target of the SARS-CoV-2.18 The olfactory epithelium express genes involved for virus entry such as angiotensin-converting enzyme 2(ACE2) receptor and transmembrane protease serine 2 (TMPRESS2) whereas the sensory neuron of the olfactory area nor neurons of the olfactory bulb express these genes.19 The two proteins ACE2 and TMPRESS2 are needed for the host cell entry which facilitates replication, accumulation and binding of the SARS-CoV-2 and expressed in the sustentacular cells, receptor neurons of the olfactory neuro-epithelium which have a potential role in the loss of smell in COVID-19 patients.20 These reports explain that infection of the non-neural cell types in olfactory epithelium causes anosmia in COVID-19 patients.&#xD;
&#xD;
Now the early identification of COVID-19 patient is urgently needed to isolate the patient and control the spread of the infection. Performing the diagnostic nasal endoscopy in COVID-19 patients is vulnerable to the spread of the infections to other persons. Imaging like CT scan is useful imaging for proper assessment of the nose and paranasal sinuses There is almost very little research related to imaging in the COVID-19 patients with anosmia. A study of MRI in cases of isolated anosmia in COVID-19 patients reveals a normal olfactory bulb. In another study, no mucosal congestion was found in the olfactory cleft.21 One study of FDG PET/CT scan in COVID-19 patients with anosmia showed metabolic activity of the olfactory pathways where hypometabolism was seen in the left orbit-frontal cortex under the neutral olfactory condition which suggest an impaired neural function as an underlying cause for anosmia.22 In this study, the olfactory tract was not blocked by any sinonasal pathologies. &#xD;
&#xD;
Proper history taking, clinical examinations and imaging like CT scan and MRI are required for assessing the anosmia patients to rule out the underlying aetiology. Performing diagnostic nasal endoscopy for assessing the anosmia is a high-risk procedure during the COVID-19 pandemic as it often spread infections to health care professionals. So, imaging is useful for evaluating the nose and paranasal sinuses in COVID-19 patients with anosmia. Different imaging studies like CT scan and/or MRI are useful for assessment of the anosmia to confirm the underlying aetiology. In this study, we evaluated the COVID-19 patients with anosmia and performed a CT scan of the nose and paranasal sinuses to rule out the conductive mechanism for anosmia. We did not found significant pathologies like mucosal thickening or opacification at the sinonasal tract and olfactory region. In this study, clinical presentations like nasal obstruction were found in 14.51% and rhinorrhea found in 9.67%. So, this study favours the non-conductive mechanism such as sensorineural olfactory dysfunction as the important cause for anosmia in COVID-19 patients. The anosmia due to mucosal thickening or sinonasal obstructive pathology has a rapid recovery rate but in the case of neural pathology of the olfactory pathway, the recovery rate is uncertain or delayed. So, the exact understanding of the mechanism of anosmia in COVID-19 patients is an important prognostication and helpful for the treatment of this symptom in the current pandemic.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The coronavirus disease 2019(COVID-19) pandemic posed an overwhelming challenge for clinicians across the world in the last few months. The exact pathophysiology for the development of the anosmia in COVID-19 patients is still poorly understood. Diagnostic nasal endoscopy is not safe for routine assessment of the nose in COVID-19 patients with anosmia. The nasal endoscopy has a high risk for transmission of infections to health care professionals. CT scan of the nose and paranasal sinuses is very useful and safe for assessing the anosmia in COVID-19 patients and provides anatomical details in lieu of the diagnostic nasal endoscopy. As there was no significant obstructive or conductive pathology in the nose and paranasal sinuses found in this study among COVID-19 patients with anosmia, so certain therapies like steroids for treatment of the anosmia is questionable.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Funding: Nil&#xD;
&#xD;
Author Contributions: SKS: Concept, data collection and data analysis; SD: Data collection, data analysis; DK: Data collection and drafting the manuscript; SRD: Data collection.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3768</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3768</Fulltext></URLs><References>&#xD;
	&#xD;
	Swain SK, Agrawal R. Mastoid surgery: a high risk aerosol-generating surgical procedure in COVID-19 pandemic. Int J Otorhinol Head Neck Surg. 2020; 6(10):1941.&#xD;
	&#xD;
	&#xD;
	Xu YH, Dong JH, An WM, Lv XY, Yin XP, Zhang JZ, et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020;80:394-400.&#xD;
	&#xD;
	&#xD;
	Swain SK, Acharya S, Sahajan N. Otorhinolaryngological manifestations in COVID-19 infections: An early indicator for isolating the positive cases. J Sci Soc. 2020; 47(2):63.&#xD;
	&#xD;
	&#xD;
	Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395:565-74.&#xD;
	&#xD;
	&#xD;
	Busaba NY. Is imaging necessary in the evaluation of the patient with an isolated complaint of anosmia? J Ear Nose Throat. 2001;80(12):892-6.&#xD;
	&#xD;
	&#xD;
	Swain SK, Behera IC. Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic-A real challenge to the clinicians. Ind J Child Health. 2020;7(9):357-62.&#xD;
	&#xD;
	&#xD;
	Filatov AA, Sharma PP, Hindi FF, Espinosa PS. Neurological complications of coronavirus disease (COVID-19). Encephalopathy. 2020;12(3):e7352.&#xD;
	&#xD;
	&#xD;
	Swain SK, Das S, Padhy RN. Performing tracheostomy in intensive care unit-A challenge during COVID-19 pandemic. Sir Med J. 2020; 72(5):436-442.&#xD;
	&#xD;
	&#xD;
	Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microb Infect.&#xA0; 2020;9(1):386-9.&#xD;
	&#xD;
	&#xD;
	Gane SB, Kelly C, Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome. Rhinology 2020;10:1-4.&#xD;
	&#xD;
	&#xD;
	Li KY, Liu J, Xiao W, Wu Y, Ren YY, Wei YX. Characteristics of post viral olfactory disorder. Chinese J Otorhinolaryngol Head Neck Surg. 2016;51(11):838-41.&#xD;
	&#xD;
	&#xD;
	Yao L, Yi X, Pinto JM, Yuan X, Guo Y, Liu Y, et al. Olfactory cortex and olfactory bulb volume alterations in patients with post-infectious olfactory loss. Brain Imag Behav. 2018;12: 1355-62.&#xD;
	&#xD;
	&#xD;
	Vaira LA, Deiana G, Fois AG, Pirina P, Madeddu G, De Vito A, et al. Objective evaluation of anosmia and ageusia in COVID-19 patients: Single centre experience on 72 cases. Head Neck. 2020; 42 (6):1252-8.&#xA0; .&#xD;
	&#xD;
	&#xD;
	Bilinska K, Jakubowska P, Von Bartheld CS, Butowt R. Expression of the SARS-CoV-2 entry proteins, ACE2 and TMPRSS2, in cells of the olfactory epithelium: identification of cell types and trends with age. ACS Chem Neurosci. 2020; 11 (11):155-62.&#xD;
	&#xD;
	&#xD;
	Kim BG, Kang JM, Shin JH, Choi HN, Jung YH, Park SY. Do sinus computed tomography findings predict olfactory dysfunction and its postoperative recovery in chronic rhinosinusitis patients? Am J Rhinol Allergy. 2015;29 (2015):69-76.&#xD;
	&#xD;
	&#xD;
	Hwang CS. Olfactory neuropathy in severe acute respiratory syndrome: report of a case. Acta Neurol Taiwan. 2006; 15(1):26-8.&#xD;
	&#xD;
	&#xD;
	Vavougios GD. Potentially irreversible olfactory and gustatory impairments in COVID-19: indolent vs. fulminant SARS-CoV-2 neuroinfection. Brain Behav Immun. 2020; S0889-1591(20):30674-7.&#xD;
	&#xD;
	&#xD;
	Sungnak W, Huang N, B&#xE9;cavin C, Berg M, Queen R, Litvinukova M, et al. SARS-CoV- 2 entry genes are most highly expressed in nasal goblet and ciliated cells within human airways. Nat Med. 2020; 26:681-7.&#xD;
	&#xD;
	&#xD;
	Brann DH, Tsukahara T, Weinreb C, Marcela Lipovsek M, Koen Van den Berge K, Gong B, et al. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. BioRxiv. 2020. https://doi.org/10.1101/2020.03.25.009084.&#xD;
	&#xD;
	&#xD;
	Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Oto-Rhino-Laryng. 2020; 277:2251-61.&#xD;
	&#xD;
	&#xD;
	Karimi Galougahi M, Ghorbani J, Bakhshayeshkaram M, Safavi Naeini A, Haseli S. Olfactory bulb magnetic resonance imaging in SARS-CoV-2-induced anosmia: the first report. Acad Radiol. 2020; 27(6):892-3.&#xD;
	&#xD;
	&#xD;
	Karimi Galougahi M. Yosefi-Koma A, Bakhshayeshkaram M, Raad N, Haseli S. FDG PET/CT scan reveals hypoactive orbitofrontal cortex in anosmia of covid-19. Acad Radiol. 2020;27(7): 1042-43.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effective Method of Step-by-Step Control of Haemorrhage in Obstetrics Massive Bleeding in Obstetrics&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>122</FirstPage><LastPage>126</LastPage><AuthorList><Author>Yusupbaev Rustem Bazarbaevich</Author><AuthorLanguage>English</AuthorLanguage><Author> Goyibov Sanjar Salimovich</Author><AuthorLanguage>English</AuthorLanguage><Author>  Dauletova Mehriban Jarylkasynovna</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Obstetric haemorrhaging, Surgical hemostasis, Detachment of the normally located placenta, Placenta previa, Uterine  scar, Caesarean section</Keywords><Fulltext>INTRODUCTION&#xA0; &#xD;
&#xD;
Obstetric haemorrhaging is one of the pressing problems of modern obstetrics. According to WHO, obstetric haemorrhaging is the leading cause of maternal mortality in industrialized countries.8&#xA0; In the occurrence of obstetric haemorrhaging, especially in its outcome, the initial state of the organism and the nature of the somatic and gynaecological diseases carried or associated with it before or during pregnancy play an enormous role. Massive haemorrhaging during pregnancy and childbirth, especially in the presence of preeclampsia and anaemia, occurs against the background of the high sensitivity of the female body to haemorrhage and, in many cases, leads to a decrease in the quality of life in women of reproductive age and disability.1,2&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
&#xD;
According to the order of the Ministry of Health of the Republic of Uzbekistan No. 185 dated May 28, 2014. on regionalization of perinatal care, &#xA0;a network of perinatal centres has been established in Uzbekistan, which plays a major role in providing emergency obstetric care, including for obstetric haemorrhage and the introduction of new haemorrhage control technologies in perinatal centres where obstetric pathology is centralized.1,3 &#xA0;Reducing maternal mortality is an urgent task of the obstetric service. The annual analysis of maternal deaths indicates that the actions of the personnel involved in emergency care in cases of haemorrhage show a deviation from the recommended procedures for the treatment of haemorrhaging, underestimation of the patient&amp;#39;s condition, inadequate infusion - transfusion therapy, which ultimately leads to fatal consequences. The analysis of maternal mortality identified the human factor as one of the leading causes of mortality, as knowledge of protocols and algorithms is not always a guarantee that this knowledge can be activated at the right time, which is observed in many cases of maternal mortality.1,4,5 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0; Numerous domestic and foreign studies have shown a clear causal relationship between placental anomalies and caesarean sections and the presence of scars on the uterus. Placental factors dominate in the structure of the causes of fatal haemorrhage &#x2013; 20% placenta strongly attached, 10% placental Previa. Special attention should be paid to the fact that from year to year there is a steady increase in placental anomalies.6,7 According to various authors, the frequency of placenta previa ranges from 0.1% to 3%,3,8 in growth &#x2013; from 0.04% to 0.2% of all births.9,10&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Surgery to stop haemorrhage is a key to the successful management of many obstetric haemorrhages.8,9 However, the tactical and technical application of these methods in practice leaves much to be desired, which is associated with technical training. Therefore, the development of the most effective and technically simple methods to control haemorrhage is of great importance to reduce the manageable cause of maternal mortality.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A prospective study was conducted in a cohort of 36 pregnant women delivered by surgery a protocol for the treatment of obstetric haemorrhaging during cesarean section. The patients were divided into 2 groups according to the methods of intraoperative treatment. In group I (n-15), treatment of haemorrhage was carried out according to the proposed step-by-step control and treatment tactic, the second group (n-18) was treated according to the treatment protocol of haemorrhage adopted in the medical institution. The study design was case-control in a cohort group with operative delivery. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The inclusion criteria were: a cohort of patients at high risk of bleeding who underwent surgical intervention and performed haemorrhage during the surgery, need for additional surgical interventions to achieve hemostasis during the operation &#x2013; compression sutures, ligation of the main uterine vessels and internal iliac arteries, hysterectomy. &#xD;
&#xD;
&#xA0;&#xA0; The exclusion criteria were: medical history with planned hysterectomy of uterine fibroids, haemorrhaging linked to somatic diseases such as liver disease and malignant diseases of the blood and uterus. The proposed developed algorithm for step-by-step control and treatment of obstetric haemorrhage during delivery.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; Indications for step-by-step control and treatment tactic of haemorrhage:&#xD;
&#xD;
&#xD;
	&#xD;
	2 and 3 types of haemorrhage according to the developed method of bleeding gradation.&#xA0;&#xA0; &#xA0;&#xD;
	&#xD;
	&#xD;
	&#xA0;Germination or fused placenta in the uterine wall and beyond the uterus. &#xD;
	&#xD;
	&#xD;
	Instantaneous blood loss of more than 1500-2000 ml, or 25-35% of the volume of blood circulation.&#xD;
	&#xD;
	&#xD;
	Hemorrhagic shock, continuous haemorrhage of over 1500 ml and unstable hemodynamics.&#xD;
	&#xD;
	&#xD;
	Rupture of the uterus in the lower segment and hematoma of the retroperitoneal space and the broad ligament of the uterus and a combination of shock. &#xD;
	&#xD;
	&#xD;
	Relaparotomy against the background of continuing haemorrhage. &#xD;
	&#xD;
	&#xD;
	The absence of an experienced specialist capable of performing a complete hysterectomy and ligation of the internal iliac artery under the above conditions. &#xD;
	&#xD;
	&#xD;
	&#xA0;Need to attract related specialists &#x2013; surgeons, urologists, haematologists, etc. in the event of complications. The method of step-by-step control and treatment of haemorrhage is carried out in 3 stages.&#xD;
	&#xD;
&#xD;
&#xD;
Stage 1: Primary (standard haemorrhage relief: &#xA0;rapid initial assessment of Ps, &#xA0;arterial pressure, &#xA0;t- body, respiratory rate, diuresis, etc.), &#xA0;finding the cause and the source of haemorrhage, and developing hemostasis tactics,&#xA0; including surgical, &#xA0;for this purpose, &#xA0;three-level gradations of the type of haemorrhage, &#xA0;lower median laparotomy and temporary or permanent hemostasis were used, &#xA0;depending on the clinical situation and the doctor&#x2019;s experience. Hemostasis methods: Clamping of vessels over and pressing of the abdominal aorta. External womb tamponade for placental blocking: a tight external bind of the uterus with a sterile bandage from the lower segment to the bottom for blocking the bleeding source, manual pressing of the anterior wall of the uterus to the posterior wall. Internal uterine tamponade &#xA0;- the application of various elements of cylinder tamponade. &#xA0;Contusion of the placental bed by contracting Z with metallic and hemostatic sutures. Various compression sutures, ligation of the internal iliac artery, hysterectomy. &#xD;
&#xD;
Stage 2: Operative pause to stabilize the patient and to relieve shock and to deal with issues such as recovery of the volume of blood circulation, blood clotting capacity, visits of highly specialized doctors if necessary. The final third stage is aimed at final hemostasis with complete stabilization of the patient and assistance of a multidisciplinary team.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; To find the cause and source of hemorrhagic shock and differential diagnosis of haemorrhage, we used a three-level clinical and anatomical gradation of the bleeding source, developed during the study, depending on the blood supply to the pool of the internal and external iliac artery, which characterizes the types of obstetric haemorrhaging, which contributes to the optimal surgical technique of hemostasis. &#xD;
&#xD;
&#xD;
	&#xD;
	Type of haemorrhage - the source of bleeding from the uterine body area is more frequent at atonia the uterus and rarely at adnation of the placenta, the blood supply from the pool of the internal iliac artery. &#xD;
	&#xD;
	&#xD;
	&#xA0;Type of haemorrhage, lower segmental haemorrhage the isthmus of the uterus, lower segment of the uterus, at low placentation and partial placenta previa, the blood supply from the pool of the internal and partially external iliac artery. &#xD;
	&#xD;
	&#xD;
	&#xA0;Type of haemorrhage - localization of the haemorrhage: the cervix, the upper third of the vagina, area of parametric and retroperitoneal space, bleeding when the uterine main vessels are injured, forming peritoneal hematomas and in cases of rupture of the uterus. Blood supply is from the pool of the internal and external iliac artery.&#xD;
	&#xD;
&#xD;
&#xD;
We used the general clinical methods of the patient&#x2019;s examination and data of clinical-laboratory blood indicators, coagulation system. The methods for determining blood loss were visual in combination with the gravimetric method with the determination of the volume of blood circulation (weight X 7.7) and the table of the determination of blood loss class proposed in the national standard for the treatment of haemorrhage and hemorrhagic shock. &#xD;
&#xD;
&#xA0; To assess the extent of the effects detected and the benefits of the tested method, the following basic parameters of evidence-based medicine are applied: &#xD;
&#xD;
1. Relative reduction of the frequency of adverse outcomes (reduction of relative risk); &#xD;
&#xD;
2. Absolute reduction of the frequency of adverse outcomes (reduction of absolute risk); &#xD;
&#xD;
3. Risk ratio; &#xD;
&#xD;
4. The number of patients who need to be treated for a certain time to prevent one adverse outcome or achieve a beneficial effect in one patient; &#xD;
&#xD;
5. Odds ratio. They are calculated based on a standard "study connection table&#x201D; using several formulas.14 Statistical processing of research results was carried out by the program "STATISTICA6.0" with the calculation of the student&amp;#39;s criterion. The confidence criterion is p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3769</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3769</Fulltext></URLs><References>&#xD;
	&#xD;
	Voronin VK, Kozlov SV. Ligation of the main vessels of the uterus in obstetric bleedings taking into account anatomical and topographic variants of its blood supply. J &#xA0;Nau Obraz. 2002;3:162.&#xD;
	&#xD;
	&#xD;
	Golyanovsky AV, Mekhedko V, Kulchitsky DV. Complex prevention of complications in the case of repeated cesarean section. Ped Obstet Gynec. 2011;73(6):88-91.&#xD;
	&#xD;
	&#xD;
	Gorin VS, Zaitseva RK, Serebrennikova ES.Placental abnormalities: obstetric and perinatal aspects. Russ Bull Obst Gynec. 2010;6:26-31.&#xD;
	&#xD;
	&#xD;
	Ishchenko AA. Modern organ-preserving operations on the uterus during cesarean section. Moscow: Fed state Univ. 2010; 30.&#xD;
	&#xD;
	&#xD;
	Kulakov VI, Chernukha EA, Komissarova L. Cesarean section. Russ Bull Obstet Gynec. 2011;4: 36-38.&#xD;
	&#xD;
	&#xD;
	Kurzer MA, Lukashina MV, Panin AV. Kurtser is an ingrowth of the placenta. Organ-preserving operations. Quest Gynec Obst Perinat. 2009; 8(5): 31-35.&#xD;
	&#xD;
	&#xD;
	Latyshkevich OA. Placenta regrowth in patients with a scar on the uterus after cesarean section: Organ-preserving operations. Dis Moscow. 2015; 23(6): 133.&#xD;
	&#xD;
	&#xD;
	Makarov OV, Aleshkina VA, Savchenko TN. Problems of reproductive health. Obst Gynec. 2007;15(30):31-39.&#xD;
	&#xD;
	&#xD;
	Oppenheimer L. Clinical practical guide of the Association of obstetricians and gynaecologists of Canada: diagnosis and management of placenta previa. Obst Gynec. 2014;67:76-83.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	World Health Organization. WHO recommendations for the prevention of postpartum haemorrhage. Geneva: WHO. 2007. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study of Postoperative Complications with Use of Ultrapro&#xAE; Mesh in Inguinal Hernia&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>127</FirstPage><LastPage>131</LastPage><AuthorList><Author>Nilesh Prakash Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> SG Deshpande</Author><AuthorLanguage>English</AuthorLanguage><Author> Shahzad Bulsara</Author><AuthorLanguage>English</AuthorLanguage><Author>  Vaibhav Prakash Anjankar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Inguinal hernia is one of the commonest surgical conditions. Various surgical procedures are in vogue since ancient times for their repair. Mesh repair is one of the promising surgical techniques though it is reported with certain complications like foreign body reaction, pain, fistula formation, infection, migration, shrinkage, and recurrence etc. Traditional &#x201C;heavyweight&#x201D; meshes (like Prolene &#xAE;) are now a day&#x2019;s being replaced by partially absorbable lightweight meshes, that are less dense, apparently more physiological in their flexibility, and associated with less acute and chronic postoperative pain and discomfort. Objective: The present study was formulated to study the feasibility and efficacy of ULTRAPRO&#xAE; mesh in Inguinal Hernia Repair. We also tried to study postoperative complications with the use of Ultrapro&#xAE; Mesh. Methods: A total of 90 cases of hernias were included in the study after obtaining the written consent of the patients. Various parameters were noted down. Inclusion and exclusion criteria were followed. Operative technique and mesh implantation was performed. Results: 62.00% were right-sided hernias. Direct hernias were more common (48.89%) than indirect hernias (42.22%). The commonest co-morbidity found was hypertension in about 22.22% of patients. The pain was the commonest (23.33%) acute postoperative complication followed by tightness, serosa and cord oedema. Conclusion: Type I and III are more common Nyhus type of hernia. Marginally advantageous over heavyweight mesh eg: Prolene, concerning early postoperative complications. Wound hematoma and Infection were absent with the use of Ultrapro&#xAE; mesh. Chronic pain is less commonly seen with Ultrapro&#xAE; mesh as compared to other lightweight mesh. No recurrence was seen during the study period.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Aponeurosis, Complications, Hernia, Mesh, Subcutaneous</Keywords><Fulltext>Introduction&#xD;
&#xD;
Inguinal hernias are one of the most common conditions requiring surgery among abdominal wall hernia. Since the 19th century, when modern techniques for the repair of groin hernia were first described recurrence was a problem. At that period in the late 19th century, Bassini&#x2019;s repair which was developed became revolutionary that time for low recurrence rates.1 Traditional suture repair of inguinal hernia is replaced by routine tension-free mesh repair.2 In many countries, mesh repair became more prevalent than suture repair (such as Bassini&amp;#39;s, Darning, and Shouldice).3&#xD;
&#xD;
In the late 19th century, Bassini&#x2019;s repair was developed and became very popular at that time for low recurrence rates. It involved suturing of Bassini&#x2019;s triple-layer (internal oblique, transverse abdominis, fascia transversalis) to inguinal ligament with interrupted sutures and yielded recurrence rates of 5 to 15%.4 Many tissue-based repairs were developed. Mc Vays repair involves suturing of the triple layer to Coopers ligament.1 Shouldice repair achieved a recurrence rate below 2% but lost its popularity due to its technical difficulties and inconsistent results outside Shouldice clinic.5 &#xD;
&#xD;
Lichenstein in 1986 described the tension-free inguinal hernia repair with mesh.1 It becomes one of the most popular open technique for inguinal hernia repair due to the simplicity of repair, the decreased post-operative pain and decreased recurrence rates compared to tissue-based hernia repair.1,6,7&#xD;
&#xD;
Even so, Mesh repair is linked with complications like foreign body reaction, pain, fistula formation, infection, migration, shrinkage, and recurrence.8 Some of these complications are more commonly seen with certain types of meshes e.g. chronic pain necessitating re-operation, high recurrence and complication rate, all associated with the use of mesh plugs.2,9&#xD;
&#xD;
Traditional &#x201C;heavyweight&#x201D; meshes (like Prolene &#xAE;) are now a day&#x2019;s being replaced by partially absorbable lightweight meshes, that are less dense, apparently more physiological in their flexibility, and associated with less acute and chronic postoperative pain and discomfort2. Recently introduced in lightweight meshes is Ultrapro &#xAE;, a Monocryl &#xAE;Prolene &#xAE; -Composite monofilament lightweight mesh, which is designed for easier handling and better tissue integration to form a flexible &#x201C;scar mesh&#x201D;.2&#xD;
&#xD;
The major objective of the present study was to study the feasibility and efficacy of ULTRAPRO&#xAE; mesh in Inguinal Hernia Repair. We also tried to study postoperative complications with the use of Ultrapro&#xAE; Mesh.&#xD;
&#xD;
Materials and methods&#xD;
&#xD;
The present study was carried out in the department of Surgery over 28 months (August 2009 to December 2011). The study was started after obtaining an Ethical Clearance from Institutional Ethical Committee.&#xA0; Total 88 patients were operated on for hernia repair. Of these 88 patients, 2 patients underwent bilateral repair of their inguinal hernias. Thus, in all 90 inguinal hernias were repaired. Ethical approval was also obtained for the study (No. KBH/AUR/ECR/009)&#xD;
&#xD;
Inclusion criteria: &#xD;
&#xD;
All types of adult inguinal hernias (Nyhus type I to IV) which were nonobstructive, unilateral or bilateral either primary or recurrent hernias&#xD;
&#xD;
Exclusion Criteria&#xD;
&#xD;
&#xD;
	&#xD;
	Patients below the age of 20 years and small children with congenital hernias were excluded from the study. &#xD;
	&#xD;
	&#xD;
	All patients who presented with complications of inguinal hernia like strangulation were excluded from the study. &#xD;
	&#xD;
	&#xD;
	Patient with associated incisional hernias was excluded from the study. &#xD;
	&#xD;
	&#xD;
	The patient who was not ready for adequate follow up were excluded from the study.&#xD;
	&#xD;
&#xD;
&#xD;
Written informed consent was obtained from the Patients preoperatively after explaining the procedure and advantages and disadvantages of ULTRAPRO&#xAE; mesh repair.&#xA0; All the cases included in the study were thoroughly examined and posted for surgery. A proper preoperative procedure was followed like investigations, pre-anaesthetic check-up, physicians&#x2019; fitness etc. Preoperative antibiotics were not prescribed. All patients received a single dose of injection Cefuroxime 1.5 gm just before giving incision. &#xD;
&#xD;
Operative Technique&#xD;
&#xD;
Initial dissection: A standard inguinal incision was deepened down to the external oblique aponeurosis up to the superficial inguinal orifice respecting the iliohypogastric and ilioinguinal nerves to open the Inguinal canal. The spermatic cord was mobilized. In the indirect hernia, the sac was separated from the cord structures. Sac was incised and examined for its contents. Contents were reduced into the peritoneal cavity. Sac was then rotated and transfixed and ligated with a mersilk suture. Similarly, indirect hernia, sac along with its contents was reduced. &#xD;
&#xD;
Mesh implantation: Posterior wall was prepared for mesh implantation. Thorough hemostasis was achieved. The perioperative field was cleaned. Ultrapro&#xAE; mesh was rolled and placed over the posterior wall. The first suture was taken over the pubic tubercle, followed by the rest of the mesh. Vicryl 2-0 was used for the purpose. The lateral end of the mesh was split to accommodate the spermatic cord. Care was taken that the cord is not snuggly placed between the mesh. External aponeurosis was sutured with 2-0 vicryl with continuous sutures. The superficial ring was kept appropriately wide. A suction drain of appropriate size was placed over the external oblique aponeurosis layer. The subcutaneous layer was closed with vicryl 2-0 and skin was stapled.&#xD;
&#xD;
Postoperative management: The patient was kept nil by mouth and was advised bed rest till the anaesthesia effect is worn out completely. The foleys catheter was removed once the patient is ambulatory and simultaneously he/she was urged to go about early unrestricted activities. The drain was removed either during the hospital stay or on follow up. A prophylactic antibiotic was given for 2&#x2013;3 days. The patient&#x2019;s pain assessment was done on day three post-operatively and on follow up at day ten, one month and six months after the procedure. Pain assessment was done based on the Visual Analogue Scale. The patient was discharged with advice not to lift or push heavyweight.&#xD;
&#xD;
Results&#xD;
&#xD;
The observations and results of this study are mentioned as follows-&#xD;
&#xD;
Age-wise distribution of the patients: We divided all cases into age groups as mentioned in table 1. The youngest patient in the study was 28 years old male while the oldest was 82years old male. Maximum numbers of patients were found in the group of 51- 60 years (21 patients i.e. 23.33%). This group was followed by 61-70 years, 31-40 and 81-90 years giving a percentage of 21.11%, 20% and 16.66% respectively. The median age of patients in our study was 55 years.&#xD;
&#xD;
Side of hernia: Out of the 88 patients 55 patients were right-sided and 31 patients had a left-sided hernia. Two patients were operated on for bilateral Ultrapro&#xAE; mesh repair.&#xD;
&#xD;
Type of hernias operated: In our study; the majority of hernias operated were direct inguinal hernias (44 i.e. 48.89%). 38 cases i.e 42.22% were of indirect type while 8 were of combined type i.e pantaloons hernia.&#xD;
&#xD;
The extent of hernia: Out of the operated hernias 67 were incomplete and 23 were complete.&#xD;
&#xD;
Type according to Nyhus classification: We classified the hernias by Nyhus type due to its simplicity. Maximum hernias 38 (42.22 %) were Nyhus type I hernias, whereas Nyhus type II, III and IV constituted 10 (11.11%),37(41.11%) and 5 (5.55%) hernias respectively.&#xD;
&#xD;
Co-morbidities found in the patients: It was noticed that patients having associated comorbid conditions had increased hospital stay and were more prone to develop complications.&#xD;
&#xD;
Early (1 month) postoperative complication: Out of 90 hernia repairs in 88 patients, only two patients in our series had pain in the operative region that lasted for more than one month. Only non-steroidal analgesics sufficed to deal with this problem. No patient in our series developed a late infection or testicular atrophy. No recurrence was noted during the period of follow-up. This was consistent with the result of other series performed worldwide. The pain was noted in 2 patients (2.22%)&#xD;
&#xD;
Discussion&#xD;
&#xD;
Inguinal hernias are one of the most common cases encountered in surgical practice. In our study, we operated on 90 inguinal hernias on 88 patients.&#xD;
&#xD;
The mean age of the patient was 48.11years (range 28 &#x2013; 82 years). Holzheimer et al10 found the mean age of 48.4 years similar to our study. Similarly, Khan et al11, 12 had 48.78 years as mean age. The most common age group affected in our study was &#x201C;51-60 years&#x201D; affecting 23.33% of patients. This shows that middle-aged patients are more in the number who present to the hospital with an inguinal hernia irrespective of the duration that they were having a hernia.&#xD;
&#xD;
Inguinal hernia can present as direct, indirect or combined i.e Pantaloon&#x2019;s hernia. In our study, 42.22% of patients had the indirect type of hernia, 48.89% of the direct type hernia. George H Sakorafas et al13 from Athens had 55% as indirect hernia cases, 30% as direct ones and 15% as combined type. In the study by M. Smietanski et al.14 56% had indirect hernia while 39% had direct and 7% had the combined type of hernia. In our study direct type of hernia was more common rather than the indirect type, differing from other studies. This was because most of the patients belonged to age above 50 years at which abdominal wall weakness is found commoner than that in younger patients.&#xD;
&#xD;
In our study there were more number of right sided inguinal hernia i.e. 55 out of 90 operated cases while 31 of left side and 2 bilateral cases. Study by Nadim Khan et al also had more cases (53.6%) of right-sided hernia, left-sided in 41.1% and 5.4% as bilateral. The cause of preponderance of the right side is not known. It is postulated that as the right testis descends later than the left testis so right-sided processus vaginalis is patent for a longer time. Appendectomies were reported to be the cause of right-sided hernias which does not stand true in our study as only four patients had undergone previous appendectomies and all did not have the right sided presentation.&#xD;
&#xD;
Postoperative pain was assessed on day third, tenth, and one, six months after surgery. Visual Analogue Scale was used to assess the pain. In a study conducted by Holzheimer et al10, the majority i.e. 96% of patients had mild to moderate pain after hernia repair while only 4% of patients complained of severe pain. M. Smietanski et al also shows that with the use of Ultrapro&#xAE; mesh complaints of mild pain with slight discomfort, feeling of tightness (Visual Analogue Score VAS score less than 2) were found in only 8.2% of patients. Usoro et al2 studied on twelve patients, all were pain-free at the time of discharge. This shows that with the use of Ultrapro&#xAE; mesh and proper technique postoperative pain is minimum. Another randomized clinical trial by Smietanski et al showed that post-operative pain is less with lightweight mesh as compared to heavyweight mesh. &#xD;
&#xD;
Another complication, i.e seroma formation was seen in 4 (4.44%) patients in our study. Holzheimer et al.10 did not note a single case of seroma formation in their study. Nadim Khan et al had 3.6% patients with seroma in the lightweight mesh group and 3.5% patients in the heavy weight mesh group. Overall it seems that the occurrence of seroma formation is technique dependent and its incidence does not significantly change with the use of lightweight mesh.&#xD;
&#xD;
In this study, only 2.22% of patients complained of pain at the operative site that lasted for more than one month. There was no recurrence of hernia or testicular atrophy seen. R. Holzheimer et al10 noted mild pain at the site in 2% of patients after three months. Smietanski et al14,15 documented chronic pain in 10.3% of patients but only 2.8% were affected by their daily activities. The recurrent hernia was found in 1.6%. Recurrence was within one year. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
Inguinal hernia is a common problem seen during surgical practice. Inguinal hernias are more common in the middle ages than in young adults. The right side is more commonly affected than the left side. The incomplete hernia is more common than the complete type. Type I and III are more common Nyhus type of hernia. Acute pain was the most common early postoperative complaint followed by &#x201C;Sense of Tightness&#x201D;. Marginally advantageous over heavyweight mesh eg: Prolene, concerning early postoperative complications. Wound hematoma and Infection were absent with the use of Ultrapro&#xAE; mesh. Chronic pain is less commonly seen with Ultrapro&#xAE; mesh as compared to other lightweight mesh. No recurrence was seen during the study period. &#xD;
&#xD;
Inguinal hernias have only surgical treatment so patients should be advised to undergo surgery to avoid future complications like obstruction and strangulation. Mesh hernioplasty is the &#x2018;GOLD STANDARD&#x2019; for inguinal hernia as treatment and should be advised. Proper techniques and skilful surgery have shown good results with fewer complications so surgeons should learn them and teach effectively as well. Associated illness adversely affects the overall outcome of the patient so they should be given special attention. The latest guidelines and recommendations issued should be followed as they are based on studies of specialized centres managing a large number of patients. Postoperative counselling with instructions should be given to patients to avoid delayed complications at home. Ultrapro &#xAE; mesh has promising results concerning acute and chronic complications but its higher cost remains a restraining factor for its use.&#xD;
&#xD;
Conflicts of Interest: Nil&#xD;
&#xD;
Source of funding: None&#xD;
&#xD;
Acknowledgement: We would like to acknowledge the support received from all the patients. We also acknowledge the support and dedication of nursing and support staff without whom this project would not be possible. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3770</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3770</Fulltext></URLs><References>&#xD;
	&#xD;
	Mukthinath G, Shankar K and Bhaskaran A. A comparative study of postoperative complications of lightweight mesh and conventional prolene mesh in Lichtenstein hernia repair. Int J Res Med Sci. 2016;4:2130-4.&#xD;
	&#xD;
	&#xD;
	Usoro N, Agbor C, Emelike K and Bamidele A. Early Outcome of Inguinal Hernia Repair Using Ultrapro&#xAE; Mesh in University of Calabar Teaching Hospital, Nigeria. Int J Third World Med. 2007;6(2):1-7.&#xD;
	&#xD;
	&#xD;
	Schumpelick V and Klinge U. Prosthetic implants for hernia repair. Br J Surg 2003;90:1457-8.&#xD;
	&#xD;
	&#xD;
	Woods B and Neumayer L. Open repair of inguinal hernia: Evidence-based review. Surg Clin North Am. 2008;88:144-6. &#xD;
	&#xD;
	&#xD;
	Stephen HG, Mary TH, Kamal MFI. Surgical progress in inguinal and ventral incisional hernia repair. Surg Clin North Am. 2008;88:18. &#xD;
	&#xD;
	&#xD;
	Schofield PF. Inguinal Hernia: Medico-legal Implications. Ann R Coll Surg Engl. 2000;82:109-10. &#xD;
	&#xD;
	&#xD;
	Madden JL, Hakim S, Agrorogianuis AB. The anatomy and repair of inguinal hernias. Surg Clin North Am. 1971;51(6):1269-92. &#xD;
	&#xD;
	&#xD;
	Schumpelick V and Klinge U. The properties and clinical effects of various types of mesh used in hernia repair. Association of Great Britain and Ireland (Yearbook) 2001.&#xD;
	&#xD;
	&#xD;
	LeBlanc KA. Complications associated with the plug-and patch method of inguinal herniorrhaphy. Hernia 2001;5:135-8.&#xD;
	&#xD;
	&#xD;
	Holzhiemer RG. First results of Lichtenstein hernia repair with ultrapro mesh. 2004;9: 323-7.&#xD;
	&#xD;
	&#xD;
	Khan N. Early outcome of Lichtenstein technique of tension-free mesh repair for inguinal hernia. J Ayub Med Coll Abbottabad. 2008;20(4):50. &#xD;
	&#xD;
	&#xD;
	Khan N. comparative study b/w vypro and prolene mesh using Lichtenstein technique. Saudi J Gastroenterol. 2010;16(1):8-13.&#xD;
	&#xD;
	&#xD;
	Sakorafas GH. Open tension-free repair of inguinal hernias; the Lichtenstein technique. BMC Surg. 2001;1:3.&#xD;
	&#xD;
	&#xD;
	Smietanski M. Five-year results of a randomised controlled multi-centre study comparing heavy-weight knitted versus low-weight, non-woven polypropylene implants in Lichtenstein hernioplasty. Hernia. 2011;15:495&#x2013;501. &#xD;
	&#xD;
	&#xD;
	Smietanski M. Prospective cohort study to evaluate ultrapro mesh for lichtenstein inguinal mesh repair. Hernia. 2009;13:239-42.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Sitting Posture Identifier to Overcome Health Issues&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>132</FirstPage><LastPage>136</LastPage><AuthorList><Author>Jonathan Law Hui Hao</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajasvaran Logeswaran</Author><AuthorLanguage>English</AuthorLanguage><Author> Hema Latha Krishna Nair</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Bad sitting posture habits cause health issues such as headaches or discomfort in the back and can lead to expensive medical expenditure for correction or cure. Objective: This study proposes a system that can identify a person sitting posture to aid them in practicing good postural habit. Methods: The system, built using a Convolutional Neural Network, provides sitting posture feedback based on photographs taken via a developed mobile application. Result: Upon analysis of the dataset, it was found that many factors can influence and adversely affect the results. Examples include a curved back chair may indicate good sitting posture, or perhaps an extremely thick coat may affect the labelled person sitting posture in the image. Conclusion: Although inaccuracies may be introduced by the shape of clothes and accessories, the tool can be used as a self-improvement aid to practice good sitting posture&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Habits, Health issues, Sitting posture, AlexNet, Tensorflow</Keywords><Fulltext>Introduction &#xD;
&#xD;
This study aims to inculcate cost-effective preventive measures by using intelligent systems to identify bad sitting posture. With the use of everyday devices such as a mobile phone, one can detect sitting posture habit immediately by capturing or uploading an image to the application. &#xD;
&#xD;
Computer vision techniques are applied in this project to extract important information from the image. Techniques such as a saliency filter, edge detection or background subtraction can remove noise from the image and only return the important information of a person sitting from an image. As the input image will be sent from a mobile phone camera or webcam, the image will be a 2-dimensional image, giving no information of depth. Then a convolutional neural network is applied to extract features from the image and return a probability of a person practising a good or bad posture. 1 &#xD;
&#xD;
LITERATURE REVIEW &#xD;
&#xD;
There are many types of research done and techniques proposed in the field of detection using machine learning. Each technique has its pros, cons and variance in the expected result. Understanding the available options would be vital to achieving the targeted goal. A few essential components that are necessary for this project include methods of detecting posture, image pre-processing algorithms and commonly used training techniques for multi-label classification data. These are discussed below.&#xD;
&#xD;
Concept of Posture Detection &#xD;
&#xD;
The basic concept of posture detection is to determine a person&#x2019;s posture based on the collected data. The data can be in the form of visual data (e.g. image and video) or data from pressure sensors. Several methods have been used to detect human posture. Sensor-based detection was designed and tested in,1 where the researchers placed the force sensor on the cushion, and microcontrollers and circuits were designed to retrieve the data from the person sitting against the cushion. This allowed data to be collected, analysed and categorized. Unfortunately, this method is costly as it requires physical sensors and designing of circuit boards. &#xD;
&#xD;
Another group of researchers used flexible sensors that are inserted into clothes near core regions such as the knee and hip. 2 The method involves having the sensors transfer data through Bluetooth to their system. Based on the data that was transferred into the system, a rule-based algorithm will identify the subject&#x2019;s position. As Youngs, et al. recorded, the rule-based algorithm can accurately detect 88% of the 6 postures related to being in and around a bed.&#xD;
&#xD;
Training for Posture Detection&#xD;
&#xD;
After the data collection phase, training the model is essential for processing new information. As mentioned earlier, posture detection may be done using sensor data or images, which can be passed on as input for the training. Images will first be converted into arrays of data, then passed to a convolutional algorithm to train on.3 Sensor data will be trained with a regular network (e.g. feedforward backpropagation). Unlike fully connected neural networks, Convolutional Neural Network neurons iterate through the image and identify features in the image. A fixed image height and width would be required for the model to extract features. Depending on the image size and colour channel, computational power will be expensive.&#xD;
&#xD;
Feature Extraction&#xD;
&#xD;
There are a few methods proposed by various researchers to extract features from an image. One of the methods was to detect the important information by colour.4 However, the researcher stated that environmental lighting has a huge impact on the detection, and calibration is required frequently. The author also proposed a more sophisticated algorithm to detect features, known as Haar-like features that categorize subsections of an image based on the difference of the sum of each neighbouring pixel. The report also introduced the cascade classifier, which consists of several stages where an image will be passed through to be evaluated, and at each stage, the classifier will return a positive if the object is detected and negative otherwise. In the end, if an image that passed through all stages is positive, the algorithm will conclude that the object exists in the image.&#xD;
&#xD;
&#xA0;Object Detection Based on Histogram of Oriented Gradient (HOG)&#xD;
&#xD;
In the year 2015, the Journal of Korea Multimedia System published research that used Histogram of Oriented Gradient (HOG) to detect pedestrians in surveillance videos.5 The distribution of intensity gradient or edge directions are what object appearance and shape in an image are based on. HOG uses a sliding window approach, where the algorithm slides across the image with a detection window. The detection window will extract the HOG and apply a classifier to determine if the window contains the object that it is looking for. This classification scheme returns a binary result indicating whether the window consists of the object (i.e. 1) or not (i.e. 0).&#xD;
&#xD;
Another pedestrian detection system was built using Python and OpenCV&#x2019;s built-in HOG feature.6 The HOG was trained using a linear support vector machine (SVM). To further improve the detection, a non-maxima suppression was used to reduce multiple overlapping detected regions into a single region. As an example, the issue arises when 2 people walking together may result in the region being suppressed into 1 region. Therefore, an overlap threshold will be passed to the non-maxima suppression algorithm to correct such situations and provide better results.&#xD;
&#xD;
Image Enhancement Methods&#xD;
&#xD;
Several methods can be applied to enhance or restore an image. Histogram equalization is one of the effective methods to enhance the brightness of the image.7 This technique involves gathering the intensity value of the image pixels and then distributing the high-intensity values equally across the other pixels. This means that a dark image would be equalized to be brighter and conversely for a bright image.&#xD;
&#xD;
Another study demonstrated that histogram equalization with the above method would not be effective in images with a large variance in intensity.8 The default method of applying histogram equalization would affect the entire image pixel intensities as it takes every pixel in the image into its calculations. &#xD;
&#xD;
An alternative would be to use Contrast Limited Adaptive Histogram Equalization (CLAHE), which is a form of adaptive histogram equalization method. This algorithm divides the image into regions and equalizes the pixels within each region. Therefore, the pixel intensity values are only affected by the region values, converting dark regions to bright regions and vice versa. Once the conversion is complete, a border will exist between each region due to the difference in pixel intensity, therefore bilinear interpolation could be applied to smoothen the edges. Applying CLAHE to an image result in an image with its pixel values more evenly distributed.&#xD;
&#xD;
Multi-label Image Classification&#xD;
&#xD;
Multi-label image classification is a type of classification where one image can have multiple classes.9 This kind of classification is extremely useful when detecting multiple features from an image, e.g. movie genre based on a movie poster.&#xA0; A multi-label classification would use a softmax activation function, where the result for each label would be assigned a probability based on the weightage. On the other hand, a multi-class classification would use a sigmoid activation function, where only a binary result would be returned if the label is associated with the image. The sigmoid converts the values to 0 or 1 independent of what the other scores are, differing from softmax that takes other scores into account when assigning a probability to the labels.&#xD;
&#xD;
A major challenge for doing multi-label classification is data imbalance, a scenario where classes appear more frequently than others, resulting in biasness when training the model.9 Several techniques can be applied to overcome data imbalance, such as either upsampling or downsampling. Upsampling increases the dataset of classes that is less compared to others by augmenting existing images or adding new data. Downsampling decreases the dataset by dropping extra data. Both these methods would be a challenge for multi-label classification as one image may belong to 2 or more classes, hence using either method to overcome the data imbalance will affect other classes. For example, a movie poster genre may be drama and action, where dropping this data out due to excessive samples in drama class will reduce the samples for action class.&#xD;
&#xD;
AlexNet Convolutional Neural Network (CNN)&#xD;
&#xD;
AlexNet is a CNN architecture built by Alex Krizhevsky and was the winning entry in ILSVRC 2012.10 AlexNet consists of 5 convolutional layers and 3 fully connected layers. With multiple convolutional layers, interesting features can be extracted from an image. Overfitting is an issue faced by AlexNet, where the model memorizes features rather than learns it, resulting in the model performing extremely well with the existing (training) dataset but fails on unseen test data.&#xD;
&#xD;
To reduce overfitting, AlexNet architecture developers implemented a few improvements. The first method applies augmentation on the dataset. Mirroring and cropping are 2 types of augmentation that may be applied. Mirroring the image would introduce fresh data that has variance for the model to learn. Cropping an image from a larger image introduces pixels shifting, allowing the network to understand that minor shifts in pixels do not change the object in the image. By applying to crop, AlexNet managed to increase the dataset by the factor of 2048.&#xD;
&#xD;
Another method used by AlexNet is a dropout. Dropout would drop the neuron from the network, removing it from contributing to either forward or backward propagation. As a result, input would be passed through different network architecture, allowing the weight parameters to be more robust and the model does not get fixated easily. However, dropout would increase the iterations required by a factor of 2.10&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Tensorflow, a machine learning library was chosen to train the model. It has a large online community with available support documents and examples. Compared to PyTorch, a machine learning library by Facebook, a search on Google regarding building a CNN network architecture will return top results with explanations and tutorials using Tensorflow. Free training videos provided by Tensorflow can also be found on YouTube. Keras, the front-end framework for Tensorflow can be used to accelerate development time.11 Keras is designed with easy syntax, easy extension to other function plugins and detailed information for debugging. It is actively being developed by tech giants, which includes Google, Microsoft and Amazon. &#xD;
&#xD;
Apart from Keras, OpenCV will be used to process the input image. OpenCV is a computer vision library that consists of many functions to extract image information and process them. As the project involves processing the image and extracting information about the subject from an image, OpenCV can simplify the process with its built-in functions.&#xD;
&#xD;
Data gathering is essential for this project as it will serve as the training model input. The expected information from this will be a side view (i.e. profile) image of the participant sitting on a chair. To maintain privacy, the photo taken can exclude the face of the participant, as they may find it sensitive to send images of themselves. Besides allowing the participant to upload images of themselves, the observation method would be used with the participant&#x2019;s consent, where a photo of them sitting would be captured and saved for the model to train on. The photos that are captured and stored would not be used for any other purpose except as input to train the model. Based on the photos and a good sitting posture checklist, the sitting posture would be categorized as bad and good posture.&#xD;
&#xD;
Figure 1 is a screenshot of the system prototype. The prototype was designed using VueJS, a Javascript framework and the prediction model was trained using Tensorflow. As seen in the figure, four main steps are displayed on the main screen. The first section allows users to upload an image or capture the image with the system. After the first step action is performed, the system will open the second section and preview the uploaded image while it extracts regions with any humans that can be identified in the image. Once the system has managed to extract at least one human, the third section will preview the extracted image while the system starts estimating the posture. Finally, once the system has estimated the values for the posture in the extracted image, a score for each label will be displayed at the bottom, as shown in Figure 1.&#xD;
&#xD;
&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
Throughout the data gathering period, 90 images of people sitting were gathered and analyzed. 20 images were collected through submission via Google Form, and the remaining images were sourced from videos and posters online. Amongst the 20 images collected from Google Form, 2 of them were blurry and had to be discarded. Apart from that, participants had their image captured according to the guidelines, and therefore 18 of the images that were submitted were usable. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All the images collected were saved on Google Drive as a backup. A local copy was also kept on the machine to be used in training the model. Both sets of images were kept with proper access control permissions delegated to ensure that the images are only accessible by intended users. &#xD;
&#xD;
A variety of sitting postures were gathered and labelled accordingly, including cases of curved back and crossed legs. Figure 2 illustrates the frequency of each label that was assigned to the data gathered. Out of the 90 samples, 31 people were identified as having a curved backbone, followed by people whose both legs were not grounded. Having legs crossed came in as the third-highest. This label could be associated with a habit that people usually practice from a young. Having bent neck came in as the second last among the other labels. From the images gathered, this feature can be found in participants using their phones or working on a computer. The last label was people with buttocks not vertically aligned with their head, hence not sitting up straight.&#xD;
&#xD;
&#xD;
&#xD;
Environment influences of the background like outdoors and indoors, and floor types like carpet, grass or cement, vary among the images. The participants clothing varied from office attire to t-shirts, sports attire and jacket. Apart from the above variable, activities the participants were engaged in while the candid photo was taken included eating, using the phone, studying at a desk and using a computer or laptop.&#xD;
&#xD;
A large percentage of the images were gathered from online sources such as videos from YouTube and royalty-free images. YouTube videos of chiropractors demonstrating good and bad sitting posture were captured and added into the dataset. Some videos of sitting chair advertisement were also used.&#xD;
&#xD;
CONCLUSIONS &#xD;
&#xD;
In developing a sitting posture identifier application, the first consideration was that there were no previous researches readily found regarding the use of camera devices to detect a person&#x2019;s sitting posture. Therefore, data gathering for training the model was necessary. The second factor was to develop a model that has good accuracy with a small dataset. Upon analysis of the dataset, it was found that many factors can influence and adversely affect the results. Examples include a curved back chair may indicate good sitting posture, or perhaps an extremely thick coat may affect the labelled person sitting posture in the image.&#xD;
&#xD;
This work creates a model where it could serve as a framework or baseline for future development of projects with a similar aim. Real-time monitoring for sitting posture, or pre-assessment of a person&#x2019;s sitting posture could assist doctors and chiropractors in diagnosing patients quicker and more accurately than before. This work would also be beneficial to certain sectors like airlines and kindergarten. The system can be implemented in a long-haul flight, where people often suffer from back pain due to poor sitting posture. The system can be implemented in kindergarten to cultivate good sitting habits in kids.&#xD;
&#xD;
Acknowledgements&#xD;
&#xD;
The authors also wish to express gratitude to the management of Asia Pacific University of Technology &amp; Innovation (APU) for their support.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
The authors involved in the current study does not declare any competing conflict of interest.&#xD;
&#xD;
Funding and Sponsorship&#xD;
&#xD;
No fund or sponsorship in any form was obtained from any organization for carrying out this research work&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3771</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3771</Fulltext></URLs><References>&#xD;
&#xD;
	&#xD;
	Barba R, de Madrid &#xC1;P, Boticario JG. Development of an inexpensive sensor network for recognition of sitting posture. Int J Distrib Sens Net 2015;11(8):969237.&#xD;
	&#xD;
	&#xD;
	Cha Y, Nam K, Kim D. Patient posture monitoring system based on flexible sensors. Sensors. 2017;17(3):584.&#xD;
	&#xD;
	&#xD;
	Suhail A, Jayabalan M, Thiruchelvam V. Convolutional Neural Network Based Object Detection: A Review. J Crit Rev 2020;7(11):2020.&#xD;
	&#xD;
	&#xD;
	Soo S. Object detection using Haar-cascade Classifier. Institute of Computer Science, University of Tartu. 2014;2(3):1-2.&#xD;
	&#xD;
	&#xD;
	Nguyen TB, Nguyen VT, Chung ST. A Real-time Pedestrian Detection based on AGMM and HOG for Embedded Surveillance. J Korea&#xA0;Multimed Soc 2015;18(11):1289-301.&#xD;
	&#xD;
	&#xD;
	Chavan A, Yogamani SK. Real-time DSP implementation of pedestrian detection algorithm using HOG features. In 2012 12th International Conference on ITS Telecommunications. 2012;5: 352-355.&#xD;
	&#xD;
	&#xD;
	Acharya T, Ray AK. Image processing: principles and applications. John Wiley &amp; Sons; October 2005&#xD;
	&#xD;
	&#xD;
	Saalfeld S. Contrast Limited Adaptive Histogram Equalization. https://imagej.nih.gov/ij/plugins/clahe/index.html&#xD;
	&#xD;
	&#xD;
	Cevikalp H, Benligiray B, Gerek ON. Semi-supervised robust deep neural networks for multi-label image classification. Pattern Recogn 2020;100:107164.&#xD;
	&#xD;
	&#xD;
	Landola FN, Han S, Moskewicz MW, Ashraf K, Dally WJ, Keutzer K. SqueezeNet: AlexNet-level accuracy with 50x fewer parameters and </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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Efficacy of Push-Ups on a Fitness Structure Compared to that on the Ground on Upper Body Muscular Activation in Healthy Indian Males -&#xA0;A Comparative Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>137</FirstPage><LastPage>141</LastPage><AuthorList><Author>Vikas Malik</Author><AuthorLanguage>English</AuthorLanguage><Author> R Ramakrishnan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Conventional push-ups on the ground are recognized for fairly improving shoulder strength. A fitness structure has been developed for push up for improved muscle activation. Objective: The present study aimed to compare the activity of the shoulder and trunk muscles in two push-up positions: push-ups on the fitness structure vs standard push-ups on the ground. Methods: The study was a comparative study conducted among physically fit adult males in which 18 volunteers were recruited from physical training organization. Participants received instructions on proper push-up position and technique. Participants did 10 push-ups each and Electromyography (EMG ) measures were recorded on biceps, triceps, deltoid anterior and pectoralis major muscle. These participants were asked to initially complete push-ups on the fitness structure followed by push up on the ground. The recordings of push-ups under the two conditions were analysed and compared using an unpaired t-test. Results: The mean age of the study participants was 26.94 &#xB1; 1.259. The activity of shoulder and trunk muscles was better in the case of push-ups on the structure than on the ground. The difference in mean EMG readings of biceps muscle (11.133 &#xB1; 0.871 vs 7.346 &#xB1; 1.121) (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Electromyography, Push-up exercise, Muscle activation, Upper body workout, Upper body activation, Fitness structure</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Physical fitness is a state of well-being with a low risk of premature health problems and the energy to participate in a variety of physical activities.1 The conventional push-up is a fairly popular technique for improving muscle performance and assessing an individual&#x2019;s muscular endurance.2 Push-ups are admired for being simple to learn with the involvement of very little or no equipment.3 It is known to strengthen the upper body muscles, shoulder, arm and trunk to be precise.2 The other advantages being rehabilitating the shoulder, stabilization training of dynamic joints, and improving proprioceptive feedback mechanisms.4 Using Electromyographic (EMG) procedures, investigators have documented push-up as an effective method for activating muscles of the upper body.5 However, ground push-ups are also known to place much resistance on the trunk muscles, which can place a huge load on the lumbar vertebrae causing lower back pain.6 Changing the push-up position can affect the abdominal and vertebral muscles and lumbar angle and load.7 Also, it&#x2019;s been suggested that instead of the standard push-up, using different devices for push-ups can better improve upper extremity and core muscles of the body.8,9 It is valuable for athletes where strength training is essential, especially army professionals, bodybuilders and for many other individuals who are either recouping from any type of injury or wish to attain a certain level of fitness.10&#xD;
&#xD;
A fitness structure was designed to activate different upper body muscles.10 The fitness structure was designed to make it economical, simple to use and manufacture, and ideal for high strength training. However, the muscle activation and performance were not evaluated using the apparatus. Hence, the study was conducted to compare the activity of the upper body muscles in two push-up positions: push-ups on the fitness structure (experimental) vs standard push-ups on the ground (control). &#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
This was a comparative study conducted for a period of 2 months from June 2020- July 2020. Eighteen (18) Healthy males in the age range of 25 - 30 years who were physically fit with no upper extremity pathology within the past year were included in the study.&#xA0; Additionally, participants were required to engage in upper extremity resistance training including conventional push-ups at least twice a week for the past 3 months. The participants were excluded if they had upper back or upper extremity pain or if they had any recent surgeries. The study protocol was approved by the institutional ethical and review board before the commencement of the study.&#xD;
&#xD;
Volunteers were recruited through convenience sampling technique from physical training organization till the sample of 18 was reached. Written informed consent was taken from all the participants before the commencement of the study. The participants attended two programmes separated by a minimum of 48 hours. An orientation was held to educate the participants about the purpose of the investigation. The study participants signed informed consent before the start of the study. They received instructions on proper push-up position and technique.&#xA0; Once assured that the subjects could correctly perform the muscle tests and exercises, the sites for electrode placement were prepared by abrading the skin with fine sandpaper and cleansing the area with 70% isopropyl alcohol. Shaving of hair was performed if necessary. Initially, the participants performed push up on the fitness structure followed by standard push-ups on the ground. &#xD;
&#xD;
Data recording&#xD;
&#xD;
A surface electrode was used to determine the activation of muscles. The electrodes were applied unilaterally with no preference for left or right sides. Electromyography (EMG) data were collected using a NeuroScan EMG/NCV/EP (Innotech Medical (P) Ltd., Punjab, India). All EMG signals were amplified, band-pass filtered (20&#x2013;450 Hz), and sampled at 1,000 Hz. The position of placement of electrode is mentioned in Table 1 and Figure 1. &#xD;
&#xD;
Fitness structure&#xD;
&#xD;
The structure used in the study was an inverted U-shaped structure, 40? long and 5? high is grouted on a cement concrete prepared bed. This structure is supported by seven vertical supports made of the same material, again grouted on the concrete surface. Another 40? long galvanized iron pipe is welded to this structure 2? above the concrete surface. All joints are welded firmly on all sides. Located 2.5? away from this axis are 24 inverted U-shaped hand supports, placed at repetitive intervals of 1.5? -1.0? -1.5? from each other. These hand supports are 1.5? long and 2? high. They are made of steel and are 2? ? thick.10 (Figures 2 and 3)&#xD;
&#xD;
Procedure&#xD;
&#xD;
To standardize hand and leg placement between exercises, a point was marked, where participants placed their hands and legs both on the ground and the fitness structure. While exercising the participants were asked to keep the spine straight, and shoulders flexed 90&#xB0; relative to the trunk&#x2019;s longitudinal axis and elbows flexed 90&#xB0;. The investigator placed the Electrode first on the biceps muscle (one muscle at one time). The exercise began in the &#x201C;up&#x201D; position with the arms extended, forearms and wrists in the neutral position. After 1st round of 10 push-ups, EMG reading on biceps muscle was recorded. Next, the patient was asked to stand up and the electrode was attached to the triceps muscle. 10 push-ups were repeated on the structure and EMG values were noted down. The same procedure was again repeated for deltoid muscle and pectoralis muscles (Figures 2 and 3).&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Descriptive and inferential statistical analyses were carried out in the present study. Results on continuous measurements were presented on Mean &#xB1; SD and results on categorical measurement were presented in number (%). The level of significance was fixed at p=0.05 and any value less than or equal to 0.05 was considered to be statistically significant. Student t-tests (two-tailed, unpaired) was used to find the significance of study parameters on a continuous scale between two groups. The Statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data and Microsoft Word and Excel were used to generate graphs, tables etc. The ethical clearance was obtained from the institutional review board (no: TNPESU/R4/Ph.D./Feb-2017/08)&#xD;
&#xD;
Results &#xD;
&#xD;
The Mean age of the study participants was 26.94 &#xB1; 1.259 years. The Mean height of the study participants was 173.11 &#xB1; 4.764 and the mean weight was 70.06 &#xB1; 7.696 (Table 2). The activity of shoulder and trunk muscles was better in the case of push-ups on the structure than on the ground. The difference in mean Electromyography readings of biceps muscle (11.133 &#xB1; 0.8714 vs 7.346 &#xB1; 1.1210) (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3772</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3772</Fulltext></URLs><References>&#xD;
	&#xD;
	Polen ZK, Joshi S. Comparison of treadmill versus cycle ergometer training on functional exercise capacity in normal individuals. Int J Curr Res Rev. 2014;6(20):61.&#xD;
	&#xD;
	&#xD;
	Youdas J, Budach B, Ellerbusch J, Stucky C, Wait K, Hollman J. Comparison of muscle-activation patterns during the conventional push-up and perfect pushup&#x2122; exercises. J Streng Condit Res. 2010;24:3352-62.&#xD;
	&#xD;
	&#xD;
	Allen CC, Dean KA, Jung AP, Petrella JK. Upper body muscular activation during variations of push-ups in healthy men. Int J Exerc Sci. 2013;6(4):3.&#xD;
	&#xD;
	&#xD;
	Chulvi-Medrano I, Mart&#xED;nez-Ballester E, Masi&#xE1;-Tortosa L. Comparison of the effects of an eight-week push-up program using stable versus unstable surfaces. Int J Sports Phys Ther. 2012;7(6):586-94.&#xD;
	&#xD;
	&#xD;
	Kang D-H, Jung S-Y, Nam D-H, Shin S-J, Yoo W-G. The effects of push-ups with the trunk flexed on the shoulder and trunk muscles. J Phys Ther Sci. 2014;26(6):909-10.&#xD;
	&#xD;
	&#xD;
	Maeo S, Chou T, Yamamoto M, Kanehisa H. Muscular activities during sling-and ground-based push-up exercise. BMC Res Notes. 2014;7(1):1-7.&#xD;
	&#xD;
	&#xD;
	Contreras B, Schoenfeld B, Mike J, Tiryaki-Sonmez R, Cronin J, Vaino E. The biomechanics of the push-up. Streng Condit J. 2012;34:41-6.&#xD;
	&#xD;
	&#xD;
	Gottschall JS, Hastings B, Becker Z. Muscle activity patterns do not differ between push-up and bench press exercises. J Appl Biomec.h 2018:1-6.&#xD;
	&#xD;
	&#xD;
	Freeman S, Karpowicz A, Gray J, McGill S. Quantifying muscle patterns and spine load during various forms of the push-up. Med Sci Sports Exerc. 2006;38(3):570-7.&#xD;
	&#xD;
	&#xD;
	Calatayud J, Borreani S, Colado JC, Mart&#xED;n FF, Rogers ME, Behm DG, et al. Muscle activation during push-ups with different suspension training systems. J Sports Sci Med. 2014;13(3):502.&#xD;
	&#xD;
	&#xD;
	Malik V, Ramakrishnan R. Design and analysis of biceps and triceps muscle strengthening structure. Int J Adv Sci Technol. 2020;29(7):8476-89.&#xD;
	&#xD;
	&#xD;
	Gouvali MK, Boudolos K. Dynamic and electromyographical analysis in variants of push-up exercise. J Streng Condit Res. 2005;19(1):146-51.&#xD;
	&#xD;
	&#xD;
	Freeman S, Karpowicz A, Gray J, McGill S. Quantifying muscle patterns and spine load during various forms of the push-up. Med Sci Sports Exerc. 2006;38(3):570.&#xD;
	&#xD;
	&#xD;
	Kim Y-S, Kim D-Y, Ha M-S. Effect of the push-up exercise at different palmar width on muscle activities. J Phys Ther Sci. 2016;28(2):446-9.&#xD;
	&#xD;
	&#xD;
	Cogley RM, Archambault TA, Fibeger JF, Koverman MM. Comparison of muscle activation using various hand positions during the push-up exercise. J Streng Condit Res. 2005;19(3):628.&#xD;
	&#xD;
	&#xD;
	Snarr RL, Esco MR. Electromyographic comparison of traditional and suspension push-ups. J Human Kinet. 2013;39(1):75-83.&#xD;
	&#xD;
	&#xD;
	Sandhu JS, Mahajan S, Shenoy S. An electromyographic analysis of shoulder muscle activation during push-up variations on stable and labile surfaces. Int J Shoulder Surg. 2008;2(2):30.&#xD;
	&#xD;
	&#xD;
	Borreani S, Calatayud J, Colado JC, Moya-N&#xE1;jera D, Triplett NT, Martin F. Muscle activation during push-ups performed under stable and unstable conditions. J Exerc Sci Fit. 2015;13(2):94-8.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparative Antioxidant Study of Different Fruits and Vegetables Commonly Consumed in Odisha, India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>142</FirstPage><LastPage>145</LastPage><AuthorList><Author>Sahoo SK</Author><AuthorLanguage>English</AuthorLanguage><Author> Gangopadhyay A</Author><AuthorLanguage>English</AuthorLanguage><Author> Kar D</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhuyan R</Author><AuthorLanguage>English</AuthorLanguage><Author> Bose A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Reactive oxygen species produced in our body may result in the pathogenesis of different degenerative diseases like atherosclerosis, carcinogenesis, neurodegenerative diseases, ageing etc. Antioxidant-rich foods can protect us by neutralizing these free radicals reducing. Objective: This study determined the total flavonoid and phenolic content of various fruit and vegetable samples collected from a different region of Bhubaneswar, India. Methods: The methanolic extract of twelve fruits and vegetables were evaluated for their total phenolic content, total flavonoid content and antioxidant activity by DPPH scavenging assay. Results: The results showed high flavonoid and phenolic contents present in all the fruits and vegetable samples tested. These samples also exerted good antioxidant activity in the DPPH scavenging assay. There was a clear positive correlation between total flavonoid and phenolic content and a negative correlation between total flavonoid and phenolic content with IC50 value of DPPH radical scavenging assay based on the results. Conclusion: This work might be helpful to local consumers and nutritionists of the covered locality in selecting proper fruits and vegetables in their daily diet.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Oxidation, Diet, Flavonoid, Phenolic content, DPPH</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Reactive oxygen species (ROS) are produced in our body naturally as a byproduct of metabolism or by exposure to toxins.1 Our body&#x2019;s natural antioxidant system always remains vigilant to keep their amount in control.2 However, when ROS are produced in excess and not eliminated by the internal antioxidant system, they result in pathogenesis of different degenerative diseases like atherosclerosis, carcinogenesis, neurodegenerative diseases, including Parkinson&#x2019;s and Alzheimer&#x2019;s diseases, ageing etc.3,4 Previous studies have consistently shown that consumption of fruits and vegetables leads to prevention of many degenerative diseases due to presence of phytoconstituents like flavonoids and related phenolic compounds.5 Synthetic antioxidants reduce oxidation but have various adverse reactions.6 On the other hand, natural antioxidant-rich foods neutralize free radicals reducing the damage. Hence nowadays scientists recommend the inclusion of antioxidant-rich foods in our normal diet. The objective of this study was to analyze a comparative study of anti-oxidant models and determine the total flavonoid and phenolic content of extract of various fruit and vegetable samples collected from a different region of Bhubaneswar, India. The results of this study will guide the people of this region in the selection of the best vegetables and fruits for inclusion in their daily food habits.&#xD;
&#xD;
MATERIALS &amp; METHODS&#xD;
&#xD;
Materials&#xD;
&#xD;
Fruit and vegetable samples such as Orange (Citrus &#xD7; Sinensis), Banana (Musa acuminate), Apple (Podophyllum peltatum), Grapes (Vitis vinifera), Pomegranate (Punica granatum), Amla (Phyllanthus Emblica), Lemon (Citrus limon), Capsicum (Capsicum annum), Tomato (Solanum Lycopersicum), Karela (Momordica charantia), Green chilli (Capsicum annuum) and Carrot (Daucus carota) were randomly collected from local market of Bhubaneswar during December 2018 were store in a clean dry sterile bowl in the refrigerator until they were analyzed.&#xD;
&#xD;
Extract preparation&#xD;
&#xD;
Fruits and Vegetables were cleaned with distilled water. Blended dried samples were mixed with methanol (1:1) properly through agitation by magnetic stirrer in low rpm for 30 min at room temperature.&#xA0; The total mixture was filtered by a clean white cotton cloth. Refiltration was done by Whatman filter paper. Finally, a concentration of 0.5gm/ml for each extract was achieved by dilution with the solvent.7&#xD;
&#xD;
Total flavonoid content determination (TFC)&#xD;
&#xD;
50 &#xB5;g/ml concentration of each sample was prepared separately from the stock solutions.b1ml 2% ammonium chloride was added to each solution. Then total solutions were mixed properly by sonication and the absorbance was recorded at 434 nm using a UV-Visible spectrophotometer. For estimating the flavonoid content, a standard curve of quercetin in the concentration range of 20-50 &#xB5;g/ml was prepared. Total flavonoids were expressed as quercetin equivalents (&#xB5;g) per 100gram of extract.8&#xD;
&#xD;
Total phenolic content determination (TPC)&#xD;
&#xD;
50 &#xB5;g/ml concentration of each sample was prepared separately from 1mg/ml stock solution and mixed with 1.0 ml of Folin Ciocalteu reagent and 2.0 ml of 20% w/v sodium carbonate solution. Absorbance was recorded at 641 nm using a UV-Visible spectrophotometer. A standard curve of gallic acid was constructed in the concentration range of 50-250 &#xB5;g/ml. TPC was expressed as gallic acid equivalents (&#xB5;g) per 100gram of extract.8&#xD;
&#xD;
In-vitro antioxidant study of DPPH radical scavenging activity method&#xD;
&#xD;
50 &#xB5;g/ml conc of the sample was prepared separately from 1mg/ml stock solution. 1ml of different concentration of the sample was mixed with 500&#xB5;l of 0.004% w/v solution of 2,2-diphenyl-1-picryl-hydrazine-hydrate solution (DPPH) and 4 ml of methanol in sequence and then the absorbance of the sample was recorded at 516 nm using a UV-Visible spectrophotometer.9 Percentage of DPPH radical scavenging (IC50) for the samples were recorded using a calibration curve of quercetin using the following formula: &#xD;
&#xD;
% DPPH radical scavenging activity = (Abscontrol -Abssample)/Abscontrol &#xD7; 100, where Abscontrol and Abssample are the absorbance readings of the solvent (control) and sample respectively.&#xD;
&#xD;
Method Validation&#xD;
&#xD;
All the antioxidant methods were validated through wavelength selection, linearity, precision and % of recovery by standard spectrophotometric methods.10-12&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
All study was performed in triplicate and report presented as mean&#xB1;standard deviation format. ANOVA was done by Origin-pro software where P values less than 0.05 were considered for significance.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
The quantitative estimations of the total flavonoid and phenolics of the methanolic extracts of the different fruits are summarized in Figures 1 and 2 respectively. In our study, a considerable amount of flavonoid and phenolic compounds were found in the fruit and vegetable samples tested. The TFC values of fruits and vegetables ranged about 3.6-33.43 &#xB5;g of quercetin equivalents per 100 gm of the extract with karela having the highest content with banana being least (Figure 1). On the other hand, the TPC values of the tested samples varied from 9.2 &#xB5;g (Tomato) to 26 &#xB5;g (Amla) of gallic acid equivalents per 100 gm of extract (Figure 2). These samples also exerted good antioxidant activity in the DPPH scavenging assay (Figure 3). Banana has the highest IC50 value in the antioxidant study by DPPH radical scavenging assay, with tomato also having a similar high capacity of DPPH radical scavenging (Figure 3). However, both banana and tomato had low phenolic and flavonoid content. Amla, which is considered one of the best natural antioxidants, showed poor IC50 in the DPPH scavenging assay. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
These results indicated that the flavonoid and phenolic components in common fruits and vegetable have a major contribution to their antioxidant capacity. In most cases, greater TPC or/and TFC value of a fruit or vegetable resulted in better antioxidant capacity in DPPH radical scavenging assay. These findings are similar to previously reported literature which stated that the phenolic or flavonoid content makes an ingredient more potent as a functional or dietary antioxidant.13 These functional foods should be consumed regularly to prevent oxidative stress-related disease like ageing, cancer, neurodegeneration, cardiovascular diseases etc.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Our work aimed at comparison of total phenolic and flavonoid content of commonly consumed plant foods in Bhubaneswar (India) and correlated with antioxidant capacity by DPPH radical scavenging assay. To the best of our knowledge, this kind of work is the first time evaluated in this locality. The comparison of the results showed a positive correlation between total flavonoid and phenolic content and a negative correlation between total flavonoid and phenolic content with IC50 value of DPPH radical scavenging assay. This work would be very useful to local consumers and nutritionists of the covered locality in selecting proper fruits and vegetables in their diet. &#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
The authors are thankful to the authorities of Siksha O Anusandhan (Deemed to be University), Bhubaneswar for providing facilities for the successful completion of this research work.&#xD;
&#xD;
Author&#x2019;s contribution&#xD;
&#xD;
SKS &#x2013; Extraction and evaluation, preparation of the manuscript&#xD;
&#xD;
AG &#x2013; Extraction and evaluation, preparation of the manuscript&#xD;
&#xD;
DK&#x2013; Extraction and evaluation, preparation of the manuscript&#xD;
&#xD;
RB and AB&#x2013;Concept and planning, interpretation of results, preparation of the manuscript&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3773</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3773</Fulltext></URLs><References>&#xD;
	&#xD;
	Wiseman H, Halliwell B. Damage to DNA by reactive oxygen and nitrogen species: role in inflammatory disease and progression to cancer. Biochem J. 1996;313(1):17-29.&#xD;
	&#xD;
	&#xD;
	Birben E, Sahiner UM, Sackesen C, Erzurum S, Kalayci O. Oxidative Stress and Antioxidant Defense. World Allergy Organ J. 2012;5(1):9-19.&#xD;
	&#xD;
	&#xD;
	Uttara B, Singh AV, Zamboni P, Mahajan RT. Oxidative stress and neurodegenerative diseases: a review of upstream and downstream antioxidant therapeutic options. Curr Neuropharmacol. 2009;7(1):65-74. &#xD;
	&#xD;
	&#xD;
	Neeraj, Pramod J, Singh S, Singh J. Role of free radicals and antioxidants in human health and disease. Int J Curr Res Rev. 2013;5(19):14-22. &#xD;
	&#xD;
	&#xD;
	Harris PS, Ferguson LR. Dietary fibre: its composition and role in protection against colorectal cancer. Mutat Res. 1993;290(1):97-110.&#xD;
	&#xD;
	&#xD;
	Krishnaiah D, Sarbatly R, Bono A. Phytochemical antioxidants for health and medicine &#x2013; A move towards nature. Biotechnol Mol Biol Rev. 2007;1(4):97-104.&#xD;
	&#xD;
	&#xD;
	Sharui S, Xuming H, Munir HS, Arshad MA. Evaluation of Polyphenolics Content and Antioxidant Activity in Edible Wild Fruits. Bio Med Res Int 2019;2019:1381989.&#xD;
	&#xD;
	&#xD;
	Luzia DMM, Jorge N. Study of antioxidant activity of non-conventional Brazilian fruits. J Food Sci Technology. 2014;51(6):1167-1172.&#xD;
	&#xD;
	&#xD;
	Saha MR, Hasana SMR, Aktera R, Hossaina MM, Alamb MS, Alam MA, et al. In vitro free radical scavenging activity of methanol extract of the leaves of Mimusops elengi linn. Bangl J Vet Med. 2008;6(2):197-202.&#xD;
	&#xD;
	&#xD;
	Almeida MGJ, Chiari BG, Correa MA, Chung MC, Isaac V. Validation of an Alternative Analytical Method for the Quantification of Antioxidant Activity in Plant Extracts. Lat Am J Pharm. 2013;32(1): 90-95.&#xD;
	&#xD;
	&#xD;
	Hussain AI, Anwar F, Sherazi ST, Przybylski R. Chemical composition, antioxidant and antimicrobial activities of basil (Ocimum basilicum) essential oils depends on seasonal variations. Food Chem. 2008;108:986-995.&#xD;
	&#xD;
	&#xD;
	Isaac KA, Emmanuel O, Abraham YM, Francis MS, Francis AA, Linda MS. Development and validation of a radical scavenging antioxidant assay using potassium permanganate. J Sci Innov Res. 2016;5(2):36-42. &#xD;
	&#xD;
	&#xD;
	Shahidi F,&#xA0;Ambigaipalan P. Phenolics and polyphenolics in foods, beverages and spices: Antioxidant activity and health effects &#x2013; A review. J Funct Foods. 2015;18(B):820-897. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study of Lipid Profile, Atherogenic Indices and Carotid Intima-Media Thickness as Predictors of Cardiovascular Disease in Individuals with Prediabetes&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>146</FirstPage><LastPage>152</LastPage><AuthorList><Author>Mukesh Kumar Shrewastwa</Author><AuthorLanguage>English</AuthorLanguage><Author> Viyatprajna Acharya</Author><AuthorLanguage>English</AuthorLanguage><Author> Subhashree Ray</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Prediabetes is the forerunner of diabetes mellitus (DM) which is the harbinger of cardiovascular disease because of the covert change in biochemical parameters in the prediabetes state. Atherogenic indices have been utilized for evaluation of the possibility for cardiovascular disease advancement. This study was taken up to estimate the correlation between atherogenic indices, such as cardiac risk ratio (CRR), atherogenic coefficient (AC), and atherogenic index of plasma (AIP) with cardiovascular parameters in the pre-diabetic stage. Objectives: This study was taken up to analyze atherogenic indices (CRR, AC, and AIP) against CIMT (carotid intima-media thickness), which is a surrogate marker in cardiovascular diseases, in prediabetic individuals and find out the correlation between them. Methods: In this cross-sectional study, a total of 120 human individuals were taken among whom 60 were prediabetic individuals and 60 were healthy individuals who served as control. Atherogenic indices were estimated from routine lipid profile parameters and carotid intima-media thickness (CIMT) was determined by ultrasonography in all subjects. Results: There was a significant increase in atherogenic indices, that is, CRR(P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Atherogenic indices, Atherogenic coefficient (AC), Atherogenic index of plasma (AIP), Carotid intima-media thickness  (CIMT), Cardiac Risk Ratio (CRR), Small dense LDL-C (SdLDL-C)</Keywords><Fulltext>Introduction&#xD;
&#xD;
Diabetes Mellitus is one of the modern epidemics and as per International Diabetes Federation (IDF), the incidence of Type 2 (T2DM) will rise from 366 million in 2011 to 552 million by 2030, affecting one out of ten adults.1 In Europe, at least 131 billion dollars per year is spent on healthcare due to diabetes.2 A similar trend exists in South East Asian countries especially India, Nepal etc. The prevalence of DM will become double in people living in the urban area of developing countries in 2030 as compared to the year 2000 3. Prediabetic stage of diabetes is a longer phase, which is contemplated to be the harbinger and high-risk state for diabetes.4 &#xD;
&#xD;
Prediabetes can be defined as FBS in the range of 100-125 mg/dl.5,6 IFG and IGT constitute separate pathophysiological and biochemical and combinedly clinically known as &#x201C;Prediabetes&#x201D;.7,8 IDF evaluated that the worldwide prevalence of prediabetes was 318 million in the year 2015 and is forecasted to reach 482 million by the year 20409 and the same for Nepal was 10.3% in 2017.10 Prevalence of pre-diabetes: diabetes in Nepal is 19.5: 9.5%.11 Many studies have shown pro-atherogenic lipid profile in prediabetes leading to cardiovascular disease (CVD).12-14 Certain atherogenic indices have been formulated which can interlink the metabolic derangement of lipid fractions to clinical findings.15 The cardiac risk ratio (CRR)16, atherogenic coefficient (AC) which is Non-HDL-C: HDL-C correlates better than only LDL-C.17 Atherogenic index of plasma (AIP) is the logarithmic transformation of the curves that are created by dividing plasma triglyceride (TG) levels by the HDL-C levels and is a better risk predictor for CVD.18&#xD;
&#xD;
Carotid intima-media thickness (CIMT) indicates subclinical atherosclerosis and there is an increase in intima-media thickness (IMT) of both the coronary vascular bed and the peripheral arteries.19-21 CIMT is determined through measurement of the thickness of the common carotid artery by ultrasound and has been demonstrated as an independent predictor of cardiovascular risk.22 The study targeted to correlate lipid profile, atherogenic indices: CRR, AC and AIP and CIMT that may be an early marker of atherosclerosis in prediabetic subjects. &#xD;
&#xD;
Material and methods&#xD;
&#xD;
A cross-sectional observational study was planned in the department of Biochemistry, Nepalgunj Medical College, Kohalpur, Nepal.&#xA0; In this study, a total of 120 human individuals were included among which 60 were prediabetic individuals in 18&#x2013;55 years old of either gender and 60 were age and gender-matched control from community selected through a predesigned screening questionnaire from January 2019 to December 2019 in Banke district and having at least one of the main standard risk factors for DM like first degree relative with diabetes, Body mass index (BMI) &#x2265;25 kg/m2, women with GDM, PCOS, sedentary lifestyle and other clinical conditions associated with insulin resistance like severe obesity, acanthosis nigricans, etc. &#xD;
&#xD;
Ethical clearance was obtained from the Institutional Ethics Committee and written and verbal informed consent was obtained from all participants. Based on American Diabetes Association (ADA), the study subjects were diagnosed as prediabetic when fasting plasma glucose level was between 100&#x2013;125 mg/dL (IFG), and two-hour plasma glucose (after giving 75 g of glucose) level was between 140&#x2013;199 mg/dL (impaired glucose tolerance, IGT).&#xD;
&#xD;
Participants having cardiovascular disease, renal disease, T2DM, hepatic disease, acute or chronic inflammatory disease, prolonged illness, pulmonary tuberculosis, gout and arthritis, patients taking medicines that alter glucose and lipid metabolism and plasma TG&#x2265; 400 mg/dl were excluded from the study.&#xD;
&#xD;
SBP, DBP, Body mass index (BMI), Waist circumference (WC), Hip circumference (HC) and Waist-to-hip ratio (WHR) were measured by standard methods. The CIMT was calculated by using a high-resolution B mode ultrasonography system with an electrical linear transducer mid-frequency of 7.5 MHz. 7 ml of venous blood samples were taken from all subjects after overnight fasting of 12 hours and 3 days of the fat-free diet, and biochemical parameters were analysed by a fully automated analyzer by standard methods.&#xD;
&#xD;
Cardiac Risk Ratio was calculated as (CRR) = TC/HDL, Atherogenic coefficient was calculated as (AC) = non-HDL/HDLand atherogenic index of plasma was (AIP) = log TG/HDL, where the concentration of TG and HDL are in mmol/L. The entire data were expressed as mean &#xB1; standard deviation. The data were analyzed by using Statistical Package for Social Science version 16 (SPSS 16). The normal distribution of data was checked by using Kolmogorov-Smirnov (K-S) test and intergroup comparisons were analyzed by Student&#x2019;s T-test while the Mann-Whitney U test was used for the intergroup comparisons of skewed data. The categorical data were analyzed by using the Chi-square test. The correlation was studied by Pearson&#x2019;s correlation.&#xD;
&#xD;
Results&#xD;
&#xD;
The socio-demographic and biochemical characteristics of the studied individuals are depicted in Table 1. There was no statistically significant difference in age and gender between prediabetic and control groups, pointing that data were age and gender-matched. Participants of prediabetes had a statistically significant increase in the mean value of BMI (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3774</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3774</Fulltext></URLs><References>1. International Diabetes Federation (IDF). The global burden &#x2014; diabetes. http://www. idf.org/diabetes atlas/5e/diabetes.&#xD;
&#xD;
2. International Diabetes Federation (IDF). Diabetes atlas. http://www.idf.org/diabetesatlas/5e/europe? language=zh-hans. &#xD;
&#xD;
3. Sarah W, Gojka R, Anders G, Richard S, Hilary K. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047&#x2013;1053.&#xD;
&#xD;
4. Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: A systematic review of the evidence. J Am Coll Cardiol. 2010;55:1310&#x2013;1317. &#xD;
&#xD;
5. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care 2010; 33:S11-61. &#xD;
&#xD;
6. National diabetes data group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039-57. &#xD;
&#xD;
7. Mann DM, Carson AP, Shimbo D, Fanse V, Fox CS, Munter P. Impact of A1C screening criterion on the diagnosis of pre-diabetes among U.S adults. Diabetes Care 2010;33(10):2190-2195.&#xD;
&#xD;
8. The expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997;20(7):1183-97. &#xD;
&#xD;
9. International Diabetes Federation. IDF Diabetes Atlas, 7th ed.; International Diabetes Federation: Brussels, Belgium, 2015.&#xD;
&#xD;
10. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5(8):585&#x2013;596. &#xD;
&#xD;
11. Ono K, Limbu YR, Rai SK, Kurokawa M, Yanagida J, Rai G, et al. The prevalence of type 2 diabetes mellitus and impaired fasting glucose in the semi-urban population of Nepal. Nepal Med Coll J. 2007;9:154&#x2013;6. &#xD;
&#xD;
12. Grundy S.M. Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2012;59:635&#x2013;643. &#xD;
&#xD;
13. Kansal S, Kamble TK. Lipid profile in prediabetes. J Assoc Physicians India 2016;64:18&#x2013;21. &#xD;
&#xD;
14. Balgi V, Harshavardan L, Sahna E, Thomas S.K. The pattern of lipid profile abnormality in subjects with prediabetes. Int J Sci Study 2017;4:150&#x2013;153.&#xD;
&#xD;
15. Millan J, Pinto X, Munoz A, Zuniga M, Rubies-Prat J, Pallardo LF, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag. 2009;5:757&#x2013;765. &#xD;
&#xD;
16. Bafna A, Maheshwari RS, Ved RK, Sarkar PD, Batham AR. Study of atherogenic indices in nephritic syndrome. Int J Biol Med Res. 2012;3:2257&#x2013;2260.&#xD;
&#xD;
17. Deric M, Kojic-Damjanov S, Cabarkapa V, Eremic N. Biochemical Markers of Atherosclerosis. JMB 2008;27:148&#x2013;153.&#xD;
&#xD;
18. Onat A. Lipids, lipoproteins and apolipoproteins among Turks, and impact on coronary heart disease. Anadolu Kardiyol Derg. 2004;4(3):236&#x2013;245. &#xD;
&#xD;
19. Liu T, Meng XY, Li T, Zhang DY, Zhou YH, Han QF, et al. Rosuvastatinmay stabilize vulnerable carotid plaques and reduce carotid intima media thickness in patients with hyperlipidemia. Int J Cardiol. 2016;212:20&#x2013;21. &#xD;
&#xD;
20. Hemerich D, van der Laan SW, Tragante V, den Ruijter HM, de Borst GJ, Pasterkamp G, et al. Impact of carotid atherosclerosis loci on cardiovascular events. Atherosclerosis 2015;243:466&#x2013;468. &#xD;
&#xD;
21. Cure MC, Tufekci A, Cure E, Kirbas S, Ogullar S, KirbasA, et al.&#xA0; Low-density lipoprotein subfraction, carotid artery intima-media thickness, nitric oxide, and tumour necrosis factor-alpha are associated with newly diagnosed ischemic stroke. Ann Indian Acad Neurol. 2013;16:498&#x2013;503. &#xD;
&#xD;
22. Mookadam F, Moustafa SE, Lester SJ, Warsame T. Subclinical atherosclerosis: Evolving the role of carotid intima-media thickness. Prev Cardiol. 2010;13:186&#x2013;197. &#xD;
&#xD;
23. Huang S, Peng W, Zhao W, Sun B, Jiang X. Higher plasma C-reactive protein and lower plasma adiponectin are associated with increased carotid artery intima-media thickness in patients with impaired glucose regulation. Asian Biomed. 2017;7:399&#x2013;405.&#xD;
&#xD;
24. Dullart RPF, De Vries R, Van Tol A, Sluiter WJ. Plasma adiponectin is a marker of increased intima-media thickness associated with type 2 diabetes mellitus and with the male gender. Eur J Endocrinol. 2007;156(3):387-394. &#xD;
&#xD;
25. Ahsan S, Ahmed S, Ahmed SD, Nauman K. Status of serum adiponectin related to insulin resistance in prediabetics. J Pak Med Assoc. 2014; 64(2):184-8. &#xD;
&#xD;
26. Mahat RK, Singh N, Rathore V, Gupta Akashara, Shah RK. Relationship between Atherogenic Indices and Carotid Intima-Media Thickness in Prediabetes: A Cross-Sectional Study from Central India. Med Sci (Basel). 2018;6(3):55.&#xD;
&#xD;
27. Yang C, Sun Z, Li Y, Ai J, Sun Q, Tian Y. The correlation between serum lipid profile with carotid intima-media thickness and plaque. BMC Cardiovasc Disord. 2014;14:181. &#xD;
&#xD;
28. Nakamura H, Arakawa K, Itakura H, Kitabatake A, Goto Y, Toyota T, et al . Primary prevention of cardiovascular disease with pravastatin in Japan(MEGA Study): A prospective randomised controlled trial. Lancet. 2006;368:1155&#x2013;1163. &#xD;
&#xD;
29. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al . Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495&#x2013;1504. &#xD;
&#xD;
30. Gholi Z, Heidari-Beni M, Feizi A, Iraj B, Askari G. The characteristics of pre-diabetic patients associated with body composition and cardiovascular disease risk factors in the Iranian population. J Res Med Sci. 2016;21:20. &#xD;
&#xD;
31. Boden G, Laakso M. Lipids and glucose in type 2 diabetes: What is the cause and effect? Diabetes Care 2004;27:2253&#x2013;2259. &#xD;
&#xD;
32. McGarry JD. Banting lecture 2001: Dysregulation of fatty acid metabolism in the etiology of type 2 diabetes. Diabetes 2002;51:7&#x2013;18.&#xD;
&#xD;
33. Acharya V, Toora B D. A study of sdLDL-c and insulin resistance in apparently healthy South Indian obese young adults. IJCBR. 2015;2(1):41-47&#xD;
&#xD;
34. Gaal K, Tarr T, Lorincz H, Borbas V, Seres I, Harangi M, et al. High-density lipoprotein antioxidant capacity, subpopulation distribution and paraoxonase-1 activity in patients with systemic lupus erythematosus. Lipids Health Dis. 2016;15:60. &#xD;
&#xD;
35. Krauss RM. Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care 2004; 27:1496&#x2013;1504.&#xD;
&#xD;
36. Rosvall M, Persson M, &#xD6;stling G, Nilsson PM, Melander O, Hedblad B, et al. Risk factors forthe progression of carotid intima-media thickness over a 16-year follow-up period: The Malm&#xF6; Diet and Cancer Study. Atherosclerosis. 2015;239:615&#x2013;621. &#xD;
&#xD;
37. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106:3143&#x2013;3421.&#xD;
&#xD;
38. Singh M, Pathak MS, Paul A. A study on atherogenic indices of pregnancy induced hypertension patients as compared to normal pregnant women. J Clin Diagn Res. 2015;9:BC05&#x2013;BC08. &#xD;
&#xD;
39. Onat A, Can G, Kaya H, Hergenc G. Atherogenic index of plasma (log10 triglyceride/high-density lipoprotein-cholesterol) predicts high blood pressure, diabetes, and vascular events. J Clin Lipidol. 2010;4:89&#x2013;98. &#xD;
&#xD;
40. Dobiasova M. Atherogenic index of plasma [log(triglycerides/HDL-cholesterol)]: Theoretical and practical implications. Clin Chem. 2004; 50: 1113&#x2013;1115. &#xD;
&#xD;
41. Dobiasova M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: Correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FERHDL). Clin Biochem. 2001;34:583&#x2013;588. &#xD;
&#xD;
42. Dobiasova M. AIP-atherogenic index of plasma as a significant predictor of cardiovascular risk: From research to practice. Vnitr Lek. 2006;52:64&#x2013;71. &#xD;
&#xD;
43. Regmi P, Baral B, Raut M, Khanal MP. Atherogenic index of plasma for prediction of future cardiovascular disease in prediabetes and diabetes population. Atherosclerosis 2016; 252:e120. &#xD;
&#xD;
44. Thiyagarajan R, Subramanian SK, Sampath N, Trakroo M, Pal P, Bobby Z, et al. Association between cardiac autonomic function, oxidative stress and inflammatory response in impaired fasting glucose subjects: Cross-sectional study. PLoS ONE 2012;7:e41889. &#xD;
&#xD;
45. O&amp;#39;Leary D.H, PolakJF,Kronmal RA, Manolio TA, Burke GL,Wolfson Jr Sk. Carotid-artery intimaand media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14&#x2013;22. &#xD;
&#xD;
46. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation 2007;115:459&#x2013;467.&#xD;
&#xD;
47. Icli A, Cure E, Cure MC, Uslu AU, Balta S, Mikhailidis DP, et al. Endocan levels and subclinical atherosclerosis in patients with systemic lupus erythematosus. Angiology2016; 67: 749&#x2013;755. &#xD;
&#xD;
48. Altin C, Sade LE, Gezmis E, Ozen N, Duzceker O, Bozbas H, et al. Assessment of subclinical atherosclerosis by carotid intima-media thickness and epicardial adipose tissue thickness in prediabetes. Angiology 2016;67:961&#x2013;969. &#xD;
&#xD;
51. Touboul PJ, Grobbee DE, den Ruijter H. Assessment of subclinical &#xD;
&#xD;
atherosclerosis by carotid intima media thickness: Technical issues. Eur J Prev Cardiol. 2012;19:18&#x2013;24. &#xD;
&#xD;
52. Yildiz G, Duman A, Aydin H, Yilmaz A, H&#xFC;r E, Ma?gden K, et al . Evaluation of the association between the atherogenic index of plasma and intima-media thickness of the carotid artery for subclinical atherosclerosis in patients on maintenance hemodialysis. Hemodial Int. 2013;17:397&#x2013;405.&#xD;
&#xD;
53. Cure E, Icli A, UgurUslu A, Aydo?ganBaykara R, Sakiz D, Ozucan M, et al . The atherogenic index of plasma may be a strong predictor of subclinical atherosclerosis in patients with Beh&#xE7;et disease. Rheumatology 2017;76:259&#x2013;266. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of the Hepatoprotective Potential of Adiantum capillus Against Carbon Tetrachloride-Induced Hepatopathy in Rodents&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>153</FirstPage><LastPage>158</LastPage><AuthorList><Author>Raziuddin Khan</Author><AuthorLanguage>English</AuthorLanguage><Author> Madan Kaushik</Author><AuthorLanguage>English</AuthorLanguage><Author> Zeashan Hussain</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Adiantum capillus (AC) Linn (Family: Adiantaceae) commonly known as &#x201C;Hansraj&#x201D; It is used in common cold, cough, pyrexia inflammation, acts as purgative. It improves digestion and renal function. Objective: To investigate the hepato-defensive potential of A. capillus in contradiction of carbon tetrachloride tempted hepatic damage in rats. Methods: The rodents were dosed with 50% ethanolic extract of A. capillus (dose 100, 200, and 300mg/kg. p.o.) against CCl4 induced hepatic damage. Results: CCl4 elevated the level of hepatic markers like SOPT, SGPT, bilirubin and ALP as well as altered the antioxidant enzymes. The level of hepatic biomarkers, as well as antioxidant enzyme, were recovered after the administration of at 100, 200 and 300mg/kg, p.o. among all the doses 300 mg/kg showed the better hepatoprotective potential which was further confirmed by the histopathological. Conclusion: The 50% ethanolic extract of A. capillus (ACE) recover the biochemical as well as antioxidant parameters, which were affected by CCl4. The histopathological analysis supports the outcomes of antioxidants parameters.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adiantum capillus, Hepatoprotective activity, SGOT, Antioxidant, CCl4, Histopathology</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3775</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3775</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study of the Level of Obesity Among Children Aged 6-18 Years in the City of Berat&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>159</FirstPage><LastPage>163</LastPage><AuthorList><Author>Aida Bendo</Author><AuthorLanguage>English</AuthorLanguage><Author> Ferdinand Mara</Author><AuthorLanguage>English</AuthorLanguage><Author> Bashkim Delia</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: One of the greatest problems in the civilized world today is an unhealthy lifestyle, particularly for children and young ones. For this reason, physical education plays a critical role as the first important factor that can educate the new generation. The measurement of anthropometric indicators is an immediate need for the education system, a need that is related to physical education and its impact on children&#x2019;s health. Objective: This study aims to identify the anthropometric indicators in children and young ones of ages 6-18 years old, as the starting point of evaluating their health today, particularly concerning the future. Methods: Children aged 6-18 years old, in total 14138 subjects, from which 6903 girls and 7235 boys were tests through four anthropometric indexes, starting from the main one in evaluating the development of body constituents and the level of obesity. The measurements had undergone the calculation of BMI indicators, comparing of the age groups and genders to observe possible differences and through the statistical evaluations. Results: The results obtained show that 1% of children aged 6-11 years are overweight. While with the increase in age this index increases by 4.5 % and 8.4 % at later ages. Also, boys over the age of 15 are at a higher percentage of fat than girls. BMI assessment shows that out of the total number of the subjects about 3.71% of them are overweight to obese versus 4.36 % of the subjects, taken in the national range. This value is lower than the respective value for the same level of education Conclusion: The curricular program of physical education 3 hours/week is convenient, enables, and helps in the reduction of obesity and overweight, for children who regularly attend classes of physical education.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Lifestyle, Body mass index, Overweight, Obesity, Curricular program, Anthropometric measurements</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3776</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3776</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Hepatoprotective Activity and Lipid Peroxidation of Boerhavia repens L. against Carbon Tetrachloride-Induced Toxicity&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>164</FirstPage><LastPage>169</LastPage><AuthorList><Author>Amit Kumar Nigam</Author><AuthorLanguage>English</AuthorLanguage><Author> Phool Chandra</Author><AuthorLanguage>English</AuthorLanguage><Author> Zeashan Hussain</Author><AuthorLanguage>English</AuthorLanguage><Author> Neetu Sachan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Hepatoprotective activity, lipid peroxidation, Boerhavia repens, Silymarin, Carbon tetrachloride, SGOT</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3777</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3777</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study of the Influence of Sex Stereotyping on Choices of Postgraduate Medical Students&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>170</FirstPage><LastPage>176</LastPage><AuthorList><Author>Anna Elizabeth Mathew</Author><AuthorLanguage>English</AuthorLanguage><Author> Crystal David John</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Sex-based occupational segregation and sex stereotyping have been found to exist all over the world including in the medical field. This paper investigated if sex-based occupational segregation exists among post-graduate medical students in the selection of their specialisation in Tamil Nadu (which is a medical tourism hub), analysed sex stereotyping among these students and its effect on perceived earning capacity. Objective: To investigate if sex-based occupational segregation exists in different medical specialisations based on speciality choices of postgraduate students. To study if sex stereotyping exists among medical students. To study how this bias influences the expected earning capacity of young medical professionals. Methods Secondary data regarding student enrollment was collected from two out of the three government medical colleges in Tamil Nadu and the chi-square test was performed to study if there was any significant association between sex and speciality choice. Questionnaires were distributed to the students and the different specialities were divided into three categories &#x2013; Surgical Speciality Clinical (MSC), Medical Speciality Clinical (MDC) and Medical Speciality Non-Clinical (MDNC). Interviews were also conducted. This was done to investigate if sex stereotyping exists. Results: It was found that there existed significantly greater participation of men in the first category (P=0.0001) and significantly greater participation of women in the third category (P=0.001). Respondents believed that men were better suited for specialisations such as orthopaedics for reasons such as better perceived skill while women were better suited for dermatology and gynaecology due to patient preference. Participants also believed that higher incomes should be a greater determining factor in the choice of specialisations for men than for women. Conclusion: The researcher thus concludes that occupational segregation based on sex exists among postgraduate medical students in Tamil Nadu and that sex stereotyping plays an important role in this.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Education, Gender, Gender Roles, Medical Education, Sexism, Sex Stereotyping</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3778</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3778</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Correlation between Vitamin D, Some Circulating Micro RNA with CRP and Faecal Calprotectin in Patients with Crohn&#x2019;s Disease&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>177</FirstPage><LastPage>183</LastPage><AuthorList><Author>Antonia Atanassova</Author><AuthorLanguage>English</AuthorLanguage><Author> Avgustina Georgieva</Author><AuthorLanguage>English</AuthorLanguage><Author> Trifon Chervenkov</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The mal-absorption and the inflammation participate in the pathogenesis of Crohn&#x2019;s disease (CD) and influence the vitamin D levels. Serum microRNAs (miRNAs) are secreted during the inflammation in the gastrointestinal tract and therefore could affect the regulatory functions of vitamin D and its signal pathways via negative feedback. Objective: This study aims to assess the relationship between the Vitamin D serum levels and the expression of several circulating miRNAs in patients with CD and to correlate their levels with the activity of the disease. Methods: 15 miRNAs expression was assessed using reverse transcriptase quantitive real-time PCR in 27 consecutive CD patients and then correlated with the serum level of 25(OH)D, C-reactive protein (CRP), faecal calprotectin (FCP) and clinical Crohn&#x2019;s disease assessment index (CDAI). Results: Activity of CD is a risk factor for a decrease in the 25(OH)D serum levels (OR=7.5 (1, 09-51, 52; p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Crohn&#x2019;s disease, Micro-RNA, Vitamin D, CRP, Fecal calprotectin</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3779</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3779</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Morphological Anatomy of Round Window for Electrode Insertion through Facial Recess Approach: A Soft Surgical Technique&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>184</FirstPage><LastPage>187</LastPage><AuthorList><Author>Kalambe S</Author><AuthorLanguage>English</AuthorLanguage><Author> Jain S</Author><AuthorLanguage>English</AuthorLanguage><Author> Gaurkar S</Author><AuthorLanguage>English</AuthorLanguage><Author> Saini A</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhalerao P</Author><AuthorLanguage>English</AuthorLanguage><Author> Chaudhary G</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Cochlear implantation is one of the most commonly used surgically techniques used in today&#x2019;s world for adults and children having sensorineural hearing loss. During cochlear implantation, there are surgical key steps that are influenced by the anatomical variation of each individual. Objective: The aim was to study the anatomical characteristics of human RW and its importance for electrode insertion for the preservation of residual hearing in the process of cochlear implantation (CI) surgery. Methods: Five human cadaveric temporal bones were obtained. Microdissection was done through facial recess approach and after dissection of the bone in the area of round and oval window (OW), height and width of the RW were noted, the distance between OW-RW was measured. Results: The average height and width of the RW were 0.76 + 0.065mm and 0.81 + 0.29 mm, respectively. The distance between OW-RW was 2.52 + 0.53 mm Conclusions: Electrode insertion could be challenging in cases where the height and width of RW are &lt; 1mm. This will help to select slimmer and less traumatic electrodes for cochlear implantation to avoid injury to neurovascular structures and preserve residual hearing.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Round window, Cochleostomy, Facial recess, Cochlear implantation</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3780</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3780</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Correlation of HBA1C with UACR and Serum Creatinine Level in Type 2 Diabetes Mellitus&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>188</FirstPage><LastPage>192</LastPage><AuthorList><Author>Hawale D</Author><AuthorLanguage>English</AuthorLanguage><Author> Ambad R</Author><AuthorLanguage>English</AuthorLanguage><Author> Hadke S</Author><AuthorLanguage>English</AuthorLanguage><Author> Anjankar A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Diabetes mellitus (DM) is a major emerging clinical health problem in this world. It is a clinical syndrome characterized by hyperglycaemia due to absolute or relative deficiency of insulin. Type 2 DM comprises about 90% of the diabetic population of any country. Diabetic nephropathy is a chronic microvascular complication of poorly controlled diabetes mellitus (DM), leading to end-stage renal disease (ESRD). Diabetic nephropathy is estimated to turn into the most frequent cause of ESRD in the developing world. About 20% to 30% of people with either type 1 or type 2 diabetes develop nephropathy, whose incidence increases with the duration of diabetes. Objective: To check the association of HbA1c (a marker for glycemic control) &amp; two early markers of renal functional impairments: ACR (reflection of MA) serum creatinine in Type 2DM. Methods: This study was a case-control study, conducted in the Medicine Department at DMMC &amp; SMHRC, Nagpur in collaboration with ABVRH, Sawangi (Meghe) from September 2020 to November 2020. In the present study, the total number of subjects included was 100 having an age group between 41-70. The subjects were grouped into two types Group 1: 50 (control) Healthy Individuals Group 2: 50 (study) Type 2 diabetes mellitus Results: In the present study mean levels of HbA1c, microalbumin, serum creatinine and UACR were significantly increased in the study group as compared to the control group and also find a correlation of glycosylated Haemoglobin with UACR and serum creatinine levels in type 2 diabetes mellitus patient. Conclusions: Raised HbA1c is associated with urinary ACR. Urinary ACR should be estimated in monitoring risk assessment of Type 2DM in patients with raised HbA1c.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> HbA1c, U. ACR (Albumin: Creatinine Ratio), serum creatinine, Type 2 DM</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3781</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3781</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Cross-Sectional Study on Knowledge, Attitude and Practice on Cervical Malignancy and its Screening among Adult Women&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>193</FirstPage><LastPage>198</LastPage><AuthorList><Author>Deshmukh S</Author><AuthorLanguage>English</AuthorLanguage><Author> Inamdar S</Author><AuthorLanguage>English</AuthorLanguage><Author> Shrivastava D</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhagat A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Even though a preventable disease, cervical malignancy remains one of the common cancers among women in India. Lack of knowledge, undesirable attitudes and poor practices are culprits for the late detection of cervical cancer. Early screening and adequate knowledge about the disease remains the important safeguards against this disease. Objective: This study determines the level of knowledge, attitude and practice on cervical cancer, screening and vaccination. Methods: This was a cross-sectional study carried out on women aged 18 -65 years of age in the rural population. Participants were interviewed with the predesigned questionnaire. Results: A total of 502 women participated in the study. Maximum were in the age group of 20-40 years i.e 59.56%. 60.75% had heard about cervical cancer, 31.47% had heard about screening for cancer cervix and only 15.1% knew that cervical cancer is preventable. 79.87% agreed in favour of high importance for cervical screening. 96.81% strongly agreed with the plan of free government screening camps. Despite favourable attitude, only 10.35 % were screened for cervical cancer and 0.79% were vaccinated. Conclusion: The study highlights that knowledge was inadequate and screening and vaccination rates were very low in the participants. This highlights the need to educate the community regarding cervical cancer prevention and to make these services readily available at affordable costs to achieve the ultimate goal of elimination of cervical cancer.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Annual age-standardized incidence rate, Cervical malignancy, Cervical cancer</Keywords><Fulltext>Introduction&#xD;
&#xD;
Japanese encephalitis (JE) is a mosquito-borne encephalitis caused by Group B arbovirus (Flavivirus). It is a zoonotic disease i.e., infecting mainly animals and accidentally man. The vast majority of cases occur among children less than 15 years of age. Nearly 10% cases among those above 60 years perhaps reflecting waning protective immunity.1 The high fatality rate and frequent residual neuropsychiatric sequelae in survivors make JE a considerable health problem.2&#xD;
&#xD;
According to World Health Organization (WHO) report, in Southeast Asia and Western Pacific region approximately 3 billion people are living in countries, which are at risk of JE.3 In India also JE is a serious pediatric problem. its epidemic has been reported from many places of the country since 1952. However it was first detected in 1952 through sero-epidemiological surveys in Nagpur district of Maharashtra and Chingleput district of Tamil Nadu.4 Till 2001, there was no problem of JE in Maharashtra State. But during 2002 &amp; 2003 JE infection was introduced in eastern districts such as Bhandara, Gondiya, &amp; Nagpur. After that in 2004, three focal outbreaks of JE occurred in districts of Gadchiroli, Parbhani&amp;Wardha.In the year of 2005 there were 6 focal outbreaks of JE in districts of Amravati, Yeotmal&amp; Nagpur .5&#xD;
&#xD;
Social, cultural, agricultural and occupational practices, health-seeking behavior, gender roles, and human interaction with animals are all important factors that have failed to grab the attention of researchers and program managers and hence not suitably informed the intervention strategies for prevention and control of JE. Furthermore, the vast diversity of these ecological and social factors has led to different patterns of epidemiologic risks associated with JE incidence in different states and districts. Thus, JE is not merely a zoonotic disease, but a greater developmental issue with multiple linkages to several social and cultural drivers.6&#xD;
&#xD;
The healthcare professionals are important members of the society to combat the disease outbreaks like JE. Additionally, they are important source of information to the general public to provide counselling, education and prevention measures for disease. Therefore, the knowledge and perception of JE among Health professionals needed to be uniformly standardized as it will be critical in educating and protecting communities. In view of this, and due to the paucity of published data in the study area, we conducted this study to assess the knowledge and perception about JE among Health care professionals in a tertiary care centre of Pune city, Maharashtra.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Material and methods&#xD;
&#xD;
&#xD;
A cross-sectional study was carried out in tertiary care hospital at Pimpri, Pune, Maharashtra from April 2018 to October 2018. Study participants were physicians working in various departments above the rank of first year junior residents in the same hospital. From previous study it was found that 40.4% participants exhibited good knowledge of JE7considering same proportion calculated Sample size using formula for proportionate sample size with 10% allowable error at 95% confidence interval was 93(Open epi software). A total of 103 study participants were included. A convenience sampling, method was applied, and participants were approached on a continuous basis until the required sample size achieved. Intern doctors, visiting doctors, and doctors not willing to participate were excluded from the study. &#xD;
&#xD;
Knowledge and perception about JE were assessed with the help of preformed self-assessment questionnaire from existing literature.7 Knowledge assessment: there were total 17 questions to assess knowledge of study participants. Each correct response were given 1 score and wrong response zero score.&#xA0; Knowledge scores ranged from 0&#x2013;17 and cut off level of 0.05) [Table 4].&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Discussion&#xD;
&#xD;
To the best of our knowledge, this is the first study that has evaluated the knowledge and perceptions of medical practitioners about JE in Maharashtra and India.The results of the study found that the overall knowledge and perception of participants in this study was good, but their knowledge about incubation period, role of antiviral in treating JE and role of antibiotics in treating JE, risk of JE for health worker were not satisfactory. Their knowledge was relatively better for disease transmission, symptoms of JE and vaccines. Similar findings were found when knowledge about JE was evaluated among health caregivers in a study at Shaanxi Province, China and One Indian study.7,8 Though Present study includes only medical practioner many were uncertain about disease epidemiology as they use to handle very few JE cases in the study area.&#xD;
&#xD;
Regarding JE case management-in spite of fact that JE is a viral disease and there is no role of antibiotics; also, there is no specific antiviral medication available in the treatment of JE9 participants showed unsatisfactory knowledge about pharmacotherapy, as one fourth of participants (25.2%) felt that antibiotics are the first line of treatment. These findings indicate the need to take essential measures to bridge this knowledge gap by implementing effective interventions such as intensifying educational programs in the form of continuous medical education activities and webinars, etc., as JE is a life-threatening disease. In educational Programme, there should be a focus on the case management aspect. These strategies were also supported by previous researchers in their report on the knowledge of Ebola virus disease (EVD) among HCWS in 2014.10&#xD;
&#xD;
One fifth of participants (19.4%) in this study wrongly answered that JE is not seasonal in its occurrence. This possibly conclude that there was lack of literature reading habit or participation in workshops or symposia by health care professionals.11 Such health care professionals will mislead diagnosis of Acute encephalitic syndrome (AES) and that will be life-threatening to patients and reduced notification of disease burden. Efforts should be made to address this issue by encouraging health professionals to attend and participate in continuous medical education Programme. Impact of continuous medical education Programme results were helpful to improve case management when a research was carried out at the time of swine flu epidemic in Saudi Arabia.12&#xD;
&#xD;
It is noteworthy to mention that experienced senior doctors (faculty) were more knowledgeable as compared to junior ones. The results are in line with another study.14The possible reason for these findings could be due to administrative positions held by faculty, which allow them to participate in different educational forums, conferences, and discussion panels which may increase the overall knowledge of workers about healthcare issues associated with current epidemics. Our study findings are similar to a report which suggested that experienced workers are more effective in dealing with patients in healthcare settings.15 Our study suggests that junior doctors should also focus while conducting training and other educational programs to increase their knowledge about JE. There was no difference in relation to gender, pre and paraclinical department and years of experience for perception towards JE. Even perceptions of the resident doctors and faculty didn&#x2019;t show much difference towards JE. Study in north India found that the perceptions of the physicians were more positive as compared to nurses, while older participants also showed positive perceptions towards JE.7&#xD;
&#xD;
In the present study perception concerning management part of disease like serious illness, its risk of transmission among health care workers, intensive and emergency treatment suggests a wide gap between theory and practical knowledge of managing JE. This gap in practice could be due to no disease burden and management experience by health care professional in the study area. Also, literature showed that the there is no occurrence or outbreak of JE or acute encephalitis syndrome since more than a decade in the study area.5 As of current training pattern of health care professionals in India, they are graduated differently in different parts of the country about managing various health problems depending on local health needs and resources availability so perception about Japanese encephalitis as a serious problem may not be uniform among them all over country.&#xD;
&#xD;
Perception towards acknowledgingthemselves with the information about disease, interventions like mosquito breeding place reduction, community participation, vaccination, and universal standard precaution while handling JE cases was also not satisfactory. These findings suggest that healthcare professionals being pillars of the society should equip uniformly throughout the country to combat future outbreaks of JE, which may be an important public health problem due to lack of intervention or manmade activities.6 Healthcare professionals are also important source of information to general public to provide counselling, education and prevention measures for diseases so it is need of time to strengthen preventive and curative knowledge of post graduate doctors irrespective of disease burden they are handing in particular geographical area during their training. This finding suggests that there is a need to in cult habit of conducting uniform training of health care professionals through seminar/webinar during disease outbreak in different geographical area. Also, there is a need to promote health research uniformly in India as it may provide important information about disease trends, risk factors, and required public health interventions. Arranging research seminars on outbreak of diseases and other health issues on a regular basis may aid in improving perception. Literature found that participation in research activities may change perception of healthcare workers regarding different disease conditions.13&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Health care professionals have optimized knowledge but not up to the mark. Today&#x2019;s resident doctors are future health care manager, so they should uniformly empower through medical education Programmes like conferences, seminar, and workshop on Japanese encephalitis, epidemiology, management and epidemiological shift in disease patterns. The study has explored an area where much research needs to be done. Additionally, study findings will help the stakeholders in India to design customized interventions to optimize the knowledge and perceptions of Health care professionals towards JE. The present study has some limitations like small sample size, convenience sampling approach and single-center study, which may not be generalizable to the whole state or country. Our findings address one of the major healthcare problems that may confront India in future. Further studies large size multicentric studies are required to establish these results by including other major referrals hospitals of the affected states of India. Our findings could be a basis for further development of educational campaigns by targeting less knowledgeable areas as highlighted in this study.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Conflict of Interest: No&#xD;
&#xD;
Source of Funding: Indian Council of Medical Research (ICMR)&#xD;
&#xD;
&#xD;
Author&#x2019;s contribution:&#xD;
&#xD;
Dipendra Singh: Conception, data collection and drafting the article&#xD;
&#xD;
Dr. Jyoti Landge: Data analysis and interpretation, critical revision of article, final approval of the version to be published&#xD;
&#xD;
&#xD;
Acknowledgement: 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;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3782</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3782</Fulltext></URLs><References>1. Park K. Epidemiology of communicable disease. Park&#x2019;s textbook of preventive and social medicine. 24th edition Bhanot publication, Jabalpur. 2017;302. &#xD;
&#xD;
2. Srivastava P, Singh A, Srivastava AK, Singh AP, Prakash D. Role of Education and Counseling for the Prevention of Japanese Encephalitis in the Eastern U.P, India. Epidemiology 2014;4:161. &#xD;
&#xD;
3. Halstead SB, Jacobson J. Japanese encephalitis. Adv Virus Res. 2003;61:103&#x2013;138. &#xD;
&#xD;
4. Dhillon GP, Raina VK. Epidemiology of Japanese encephalitis in context with Indian scenario. J Indian Med Assoc. 2008;106(10):660-3. &#xD;
&#xD;
5. National Japanese Encephalitis Control Programme. Accessed from: http://www.aarogya.com/health-resources/health-programs/national-japanese-encephalitis-control-programme.html dated 23/01/2018&#xD;
&#xD;
6.&#xA0; Chaturvedi S, Sharma N, Kakkar M. Perceptions, practices and health-seeking behaviour constrain JE/AES interventions in high endemic district of North India. BMC Public Health .2017; 17:645. &#xD;
&#xD;
7. Ahmad A, Khan MU, Gogoi LJ, Kalita M, Sikdar AP, Pandey S, et al. Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers&#x2019; Perception to Improve Health Care. PLoS ONE 2015;10(8):e0135767. &#xD;
&#xD;
8. Zhang S, Yin Z, Suraratdecha C, Liu X, Li Y, Hills S, et al. Knowledge, perceptions and practices of caregivers regarding Japanese encephalitis in Shaanxi Province, China, Public Health. 2011; 125:79&#x2013;83.&#xD;
&#xD;
9. Guidelines for surveillance of acute Encephalitis syndrome (with special reference to Japanese Encephalitis), Directorate of National Vector Borne Diseases Control Programme, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India 2006.&#xD;
&#xD;
10. Kilmarx PH, Clarke KR, Dietz PM, Hamel MJ, Husain F. Ebola Virus Disease in Health Care Workers- Sierra Leone, MMWR Morb Mortal Wkly Rep. 2014;63:1168&#x2013;1171. &#xD;
&#xD;
11. Ho TS, Huang MC, Wang SM, Hsu HC, Liu CC. Knowledge, perception, and practice of dengue disease among healthcare professionals in southern Taiwan, J Formos Med Assoc. 2013; 112: 18&#x2013;23. &#xD;
&#xD;
12. Rahman A, Al Mulehim ARS, Almuhaidib NS, Almuhaidib NS, Al Humam A. Knowledge and risk perception among health care workers regarding infection control measures during swine flu epidemic in Al Ahsa Governorate in Eastern Province, KSA. Asian J Med Res. 2013;2:10&#x2013;14.&#xD;
&#xD;
13. Dulce B. The importance of clinical research in improving health care practice. Acta Paul Enferm. 2010;23: 8&#xD;
&#xD;
14. Suchitra JB. Impact of education on knowledge, perceptions and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol. 2007; 25:181&#x2013;187. &#xD;
&#xD;
15. Munnell A, Sass S, Soto M. Employer Perceptions Towards Older Workers: Survey Results. Work Opportunities for Older Americans, 2006 Available: http://crr.bc.edu/images/stories/Briefs/wob_3.pdf.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Molecular Assessment of Genetic Diversity Among Male, Female and Hermaphrodite Simarouba species Using Random Amplified Polymorphic Deoxyribose Nucleic Acid Markers&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>199</FirstPage><LastPage>205</LastPage><AuthorList><Author>Vaidya Gayatri</Author><AuthorLanguage>English</AuthorLanguage><Author> Naik GR</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Crop improvement, Genetic diversity, Polymorphism, RAPD</Keywords><Fulltext>Introduction&#xD;
&#xD;
Simarouba glauca belongs to the family Simaroubaceae. It is a fast-growing, very important seed oil yielding multipurpose tree that grows even on marginal lands under water stress conditions.1 it also improves soil health. It is indigenous to the Amazon rainforest and other tropical areas in Mexico, Cuba, Haiti, Jamaica, and Central America; it was brought to India from Latin America in 1960. Simarouba species aid to control soil erosion and play a promising role in the conservation of soil and watersheds. The root system of the Simarouba species is well developed, which checks soil erosion, thus assisting soil microbial life and improving groundwater position. Plantation of these species facilitates wasteland reclamation, reduce greenhouse effect.2 These species break the wind.3 The oil cake being rich in nitrogen (8%), phosphorus (1.1%) and potash (1.2%) is good organic manure.2 The use of Simarouba press cake as a fertilizer has given good results on coffee, sugarcane, cotton and corn.4 The fruit pulp may be used in the production of vermicompost which is of excellent quality. Leaf litter makes good manure.5 Leaf litter (about 20kg/tree/yr.) makes good manure, improving soil fertility.6 Each well-grown tree yields 15-30 kg nutlets equivalent to 2.5 to 5.0 kg oil and about the same quantity of oil cake.5,7 The annual returns in kg/ha from a moderately well managed 10-year-old plantation of Simarouba is as follows. Oil:-1000-2000, Oil cake: - 1000-2000, Fruit pulp: - 8000-10000, Leaf litter:-10000-15000, Shell: - 4500-9000.6 The tree has high medicinal value used in pharmaceuticals, cosmetics and wood is used for furniture.8 Harnessing the full potential of non-traditional tree-borne oilseeds like Simarouba through systematic block plantations with elite material can carve out a niche that is noncompeting with current needs and support horizontal expansion of oilseeds, increase the green cover, reduce erosion, and generate employment in underdeveloped areas. The establishment of plantations of tree-borne oilseeds can solve the problems of conserving degraded lands, decrease the burden of shortages of fossil fuels and high energy import costs, and maintain a clean environment by reducing greenhouse gas emissions. This would require systematic efforts towards tree improvement program. An assessment of genetic variability in Simarouba germplasm is essential for the exploitation of genetic resource for plant improvement programs.&#xD;
&#xD;
Morphological features, biochemical and cytological studies have not solved the problem of germplasm characterization determination in the economically important dioecious crops. Different attempts to find molecular differences between male and female plants such as immune chemistry, differences in protein and enzyme, mRNA and tRNA polymorphism or RNA hybridization kinetics have been made in several diocious species9 these studies deal with gene expression and could just show the differential expression of shared genes between male and female plants. This has led to the advancement of strategies. Plant biotechnology is enriched with multidisciplinary approaches of DNA/RNA fingerprinting techniques. In recent years, this approach has been applied to develop gender-specific DNA and RNA markers with greater reliability and accuracy and proved useful for marker-assisted selection of male and female and hermaphrodite plants. The stage of plant growth and the environment, in which the plant grows, do not influence the differences in DNA sequence. Therefore, molecular markers are currently being used to study of genetic diversity and identity of crop genotypes.10&#xD;
&#xD;
Random amplified polymorphic DNA (RAPD) which is a polymerase chain reaction-based DNA fingerprinting technique.11,12 Differential PCR amplification of random genomic fragments using random decamer oligonucleotide primers are the basis of RAPD. DNA polymorphisms detected result from rearrangements or deletion at or between oligonucleotide primer binding sites in the genome. RAPD technique does not require sequence information of the genome that is being analyzed so it can be applied across species as universal primers.13 It has numerous applications such as identification of different cultivars genotypes, phylogenetics studies, diversity studies, selection of specific trait of interest, linkage mapping, etc.13-17 No prior knowledge of sequence information, cost efficiency, simple assaying procedure, less sophisticated equipment&#xA0; and&#xA0; no need for cloning and radioactive probes have made RAPD technique a valuable tool. In the present study, RAPD markers were used for molecular characterization and genetic variability of female, male, and hermaphrodite Simarouba plants.&#xD;
&#xD;
Materials and methods&#xD;
&#xD;
Morphological identification of sex of Simarouba plant by flower study&#xD;
&#xD;
Immature leaf samples of both female (P1and P2) and hermaphrodite (P3 ad P4) plants were collected from University of Agricultural Science, Gandhi Krishi Vignan Kendra Bangalore. India. Male (P5) plant sample was collected from the plantation of Simarouba from University of Agricultural Sciences, Dharwad. India, the samples were stored at -80oC. Leaf sample was picked from male, female, and hermaphrodite plants after complete observation of flower types that were used for DNA extraction. The androecium of male and bisexual flowers have ten stamens in two whorls, where as in female flowers, the androecium is represented by ten staminodes which are sterile stamens with poorly developed anthers not producing pollen grains.&#xD;
&#xD;
RAPD study&#xD;
&#xD;
Isolation of genomic DNA from Simarouba species&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Total genomic DNA was isolated from leaf tissues with the minor modifications in the CTAB method.18 About 0.3 g of leaf tissue was ground to a fine powder in liquid nitrogen and mixed with 700 &#xB5;l of CTAB (cetyltrimethylammonium bromide) extraction buffer (100 mM Tris&#x2013;HCl pH 8, 1.4 M NaCl, 20 mM EDTA pH 8, 2% CTAB, 1% b-mercaptoethanol, 1% PVP). This mixture was first incubated at 650C for 30 min, and then an equal volume of a phenol: chloroform: isoamyl alcohol (25:24:1) mixture was added, followed by centrifugation at 4,000 rpm for 30 minutes at 40C. The aqueous phase was decanted and transferred to a new microtube to reduce impurity between the two phases. The extraction steps were repeated using the same phenol: chloroform: isoamyl alcohol (25:24:1) mixture. The last aqueous phase was mixed with two-thirds volume of isopropanol and stored at -200C for at least 2 hours to precipitate the DNA, then centrifuged at 4,000 rpm for 15 minutes. The nucleic acid precipitate was washed with 70% ethanol, air-dried, and suspended in 50 &#xB5;l of TE buffer. &#xD;
&#xD;
Purification of DNA &#xD;
&#xD;
The extracted DNA was treated with RNase (1mg/ml) (Qiagen, USA) incubated at 37oC for 1 hour. This was followed by Proteinase K (20mg/ml) treatment incubated at 37 oC for 30 minutes and sodium chloride to remove RNA, proteins, polysaccharides, and phenols, respectively.&#xD;
&#xD;
Quantification of extracted DNA&#xD;
&#xD;
The purity and quantity of the isolated DNA was determined by NanoDrop Spectrophotometer (ND 1000; Thermo Scientific, Wilmington, DE). The spectral ratio (A260 nm /A280 nm) was measured. The absorbance 1.0 at 260nm and 280nm determines the concentration of the nucleic acid (DNA) of 50 &#xB5;g/ml in the sample. The ratio between the readings at 260 nm and 280 nm provides an estimate of the purity of nucleic acid. DNA preparation is pure when OD260/OD280 value is 1.8. If there is contamination with protein or phenol the OD260/OD280 will be slightly less than 1.8 and if more than 1.8 then it is contaminated with RNA&#xD;
&#xD;
Total quantity of the DNA (&#xB5;g/ml) = OD260 x 50 x dilution factor / 1000&#xD;
&#xD;
Agarose gel electrophoresis&#xD;
&#xD;
Agarose gel electrophoresis performed to check the quality of the extracted DNA samples from the plant samples. Agarose 0.8% (w/v) was prepared in 1x TAE buffer pH-8.0 (for 50x TAE, 242g Tris base, 37.2g ETDA, pH is adjusted with glacial acetic acid).The mixture is heated till agarose is completely dissolved and forms a clear solution. The molten agarose is poured in the gel mould which was set with the comb when cooled down at about 55oC. The set up was left for an hour at room temperature for solidification. The gel slab is placed in an electrophoresis unit, 1 x TAE buffer was poured to immerse the gel. DNA samples were prepared by mixing with 10&#xB5;l of tracking dye Bromophenol Blue (50% Glycerol, 1Mm ETDA-pH-8.0, xylene cyanol and distilled water) and the samples were loaded with uncut &#x3BB; DNA (Bangalore Genei, Bangalore, India) of known concentration in to the wells. Agarose gel was run for about two to three hours at a constant voltage of 5V/cm2 in electrophoresis tank. The gel was visualized under Gel Documentation System. The high intensity bands were considered as good quality DNA samples and smear were of poor quality.&#xD;
&#xD;
Selection of RAPD Primers&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Fifty RAPD primers were obtained from Eurofins MWG Biotech, Bangalore India. These primers were screened with extracted DNA of male, female and andromonecious Simarouba plants. RAPD data analysis was done using only the amplifying primers.&#xD;
&#xD;
PCR amplification&#xD;
&#xD;
Fifty 10-base primers (Eurofins MWG Biotech, Bangalore India) were used for polymerase chain reaction (PCR) to screen known sex to ascertain their potential of clear amplification in polymorphism and the reproducibility. The RAPD-PCR reactions were performed in 30 &#x3BC;l volumes in 100 &#x3BC;l PCR tubes (Tarson Pvt Ltd, India) (Table 1). The reaction mixture contained 30 ng of template DNA, 1 &#xD7; amplification buffer (10 mM of Tris-HCl- pH 8, 50 mM of KCl, 1.8 mM of MgCl2 and 0.01 mg/ml gelatine), 2.5mM each of dCTP, dGTP, dATP, and dTTP, 5pM primers and 1U Taq DNA polymerase (Bangalore Genei, Pvt. Ltd., India). The RAPD-PCR analysis was performed in a 30 &#xB5;l volume in gradient Thermo Cycler. The reactions were performed in a Master Cycler Gradient 5331 (Eppendorf version 2.30. 31-09, Germany). The reaction had an initial denaturation step at 940C for 5 min, followed by 35 cycles of 94 oC for 1 min, 37oC for 1 min, 72oC for 2 min. The final extension step was at 72 oC for 10 min. The reactions were cooled and held at 4oC (Table 2).&#xD;
&#xD;
The RAPD-PCR products were separated on 1.5% (w/v) agarose (Sigma-Aldrich, USA) gel at 5 V/cm in 1 &#xD7; TBE (89 mM Tris-HCl, 89 mM boric acid and 2 mM EDTA, pH 8.0) buffer. The agarose gels were stained with 0.5 &#x3BC;g/ml ethidium bromide, visualized under UV light and photographed on a digital gel-documentation system (SYNGENE). The molecular weights of the RAPD amplicons were estimated with a 100 bp DNA ladder.&#xD;
&#xD;
Data Analysis&#xD;
&#xD;
Scoring of RAPD banding profile&#xD;
&#xD;
The RAPD allele size was determined based on the location of bands with respect to the ladder. The total no of allele was recorded for each RAPD marker in all the accessions by giving allelic number 1, 2, 3, 4, 5, etc.&#xA0; Distinct visible and reproducible bands&#xA0; were scored as 1 for the presence and 0 for absence in DNA profile photographs. Differings band intensities were not considered to avoid errors introduced by competition among priming sites during the initial rounds of RAPD-PCR analysis.19&#xD;
&#xD;
Genetic similarity and cluster analysis&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The binary data obtained from the RAPD&#xA0; banding profile were analysed using Wards Squared Euclidean distance, and was used to construct dendogram through UPGMA (Unweighted Pair Group Method with Arithmetic average statestica). Jaccard similarity coefficient was constructed using NTSYS (Numerical Taxonomy System, PC version 2.02e programme to determine genetic relation among Simaroba individuals.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;Where Na is the number of fragments present in the pattern a but not b.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Nb is the number of fragments present in the pattern b but not a.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Nab is the number of fragments commen for pattern a and b.&#xD;
&#xD;
Results&#xD;
&#xD;
Morphological study of flowers of Simarouba to identify the gender&#xD;
&#xD;
Simarouba is a polygamodioecious with three types of plants, pistillate, staminate and andromonoecious. The inflorescence is compound panicle with main axis showing racemose pattern and ultimate branches having dichasial / monochasial cymes. The time taken from bud initiation to anthesis is about 15 to 20 days. The male inflorescence has longer peduncle than the female. The length of panicle is 12-40 cm in pistillate whereas 45-55 cm in andromonoecious and staminate inflorescences. The bisexual flowers are the largest with 10-15 mm in diameter, followed by male inflorescence with 8&#x2014;12 mm diameter, and the female flowers are the smallest with 5-7 mm diameter.&#xA0; Female flowers were characterized by sterile stamens and anthers, which did not showed pollen grains whereas male and bisexual flowers showed active stemens with pollen grains production.&#xD;
&#xD;
Isolation of Genomic DNA&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Genomic DNA was isolated by the CTAB method, purified by using RNase and proteinase treatment. it was analysed by agarose gel electrophoresis. The &#x3BB;DNA EcoRI digest (Merk, Bangalore) marker was used to determine the amplified DNA&amp;#39;s molecular weight. The high quality DNA suitable for RAPD analysis was observed,&#xA0; intact discrete bands of high molecular weight were seen in the agarose gel ( Figure 1).&#xD;
&#xD;
&#xD;
&#xD;
Quantification of Isolated Genomic DNA &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The quantification of DNA was determined by Nanodrop spectrophotometer. The spectral ratio (A260/A280)of the DNA isolated from Simarouba individuals was found to be in the range of 1.8 to 2.1,&#xA0; which is an indication of low polysaccharides and high quality (Figures 2-6).&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
RAPD-PCR&#xA0; Analysis of Simarouba species.&#xD;
&#xD;
RAPD-PCR has widely been used for population genetic studies as well for various amplification in the several plants. Attempts are made to screen for the primer, which would produce reproducible banding patterns for the genetic analysis of female, male, and hermaphrodite Simarouba plants. A set of 50 decamer primers were used to amplify the genomic DNA of male, female, and hermaphrodite individuals, of which 38 primers showed reproducible results. &#xD;
&#xD;
Statistical Analysis&#xD;
&#xD;
Total of 50 primers were screened to amplify the genomic DNA of Simarouba plants. The total number of bands amplified from polymorphic primers were 223, the percentage of total polymorphic bands is 78.92% and a number of amplified bands per primer are 4 (Table 3).The binary data of&#xA0; RAPD-PCR amplification&#xA0; was analysed using Wards squared Euclidean distance. Dendrogram analysis was done using gel documentation system. Phylogenetic variation was determined by converting&#xA0; RAPD data into Jaccard&amp;#39;s Similarity Coefficient and analyzed by unweighted pair method with arithmetic mean (UPGMA) cluster analysis to produce phylogenetic tree. The similarity matrix (Table 4) reveals that the cultivars fall in the range of 0.63 to 0.81. Among the various combinations, maximum similarity of 81% was observed between P2 and P4 (Female and Andromonecious) cultivars, while maximum dissimilarity of 63% was found between P1(Female) and P5 (Male) cultivars.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Dendrogram generated (Fig.7) based on RAPD data, divided&#xA0; Simarouba cultivars into two distinct clusters. Cluster I comprises of four plants, namely P1, P2, P3 and P4. Cluster II comprises of one plant namly P5. Cluster I is subdivided in to three sub-clusters (I, II, III),&#xA0; sub cluster I comprises of single cultivar that is P1, sub-cluster II comprises of two closely related cultivars those&#xA0; are&#xA0; P2 and P4 and sub-cluster III consist of single cultivar that is P3. The position of P1(female) and P5(male) are at extreme end on dendrogram&#xA0; indicating them as most divergent species. Cluster analyses based on Wards squared Euclidean distance shows combining results from fifty primers. On the linkage distance skill, it is evident that female and andrimoniceous plants are closely linked whereas&#xA0; male and female are divergent.&#xD;
&#xD;
&#xD;
&#xD;
Discussion&#xA0; &#xD;
&#xD;
In the present study, Random amplified polymorphic DNA primers were tested on diecious and hermaphrodite plants of Simarouba glauca. The Jaccard&amp;#39;s similarity co-efficient constructed by binary data of the RAPD-PCR amplification was ranged between 0.63 to 0.81 among Simarouba individuals. The lowest coefficient (0.63 ) was found between male&#xA0; and female&#xA0; plant and the highest similarity coefficient (0.81) was found between female and andromonoecious plants. This reveals the least similarity between male and female plants. Dendrogram was constructed to determine the genetic relationship among the Simarouba individuals. Cluster analysis based on Squared Euclidean distance is represented by the results obtained from oligo primers. On linkage distant scale, it is evident that female and andromonoecious are closely linked. Male is distinctly linked to both female and andromonoecious. The individual of each sex does not form separate cluster; instead, they are mixed, indicating that they are evolution. The most extreme type of gender determination system is found where highly specialized gender chromosomes are found, which usually promotes dioecy in plants.20 The evolution of dioecy from the hermaphrodite species is considered unlikely, since the occurrence and establishment of two independent mutants, one for female and other for male sterility must occur simultaneously, and the mutant genes or multiple loci must be tightly linked so that generation of the hermaphrodites does not occur by recombination.21 As dioecism has raised in different families and genera of plants22 the development of molecular strategies of dioecious taxa has been a priority in breeding programmes for their greater economic potentials Marker-based differences in the genetic relationships between Simarouba genotypes showed that cluster tree analysis has grouped of male and female plants genotypes in separate groups&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The use of molecular markers to distinguish the genders has been employed when the genetic mechanism of gender determination is not available. Molecular marker-based technology has proved a reliable strategy for detecting gender-associated markers in dioecious and bisexual plants. The RAPD marker technique is the cheapest, user friendly and reliable tool used for efficient fingerprinting of many plants. The oligo primers used in the present study were found consistent and reproducible. RAPD marker technique proved to be useful in the present investigation. Studies on marker technology regarding dioecy have rendered a better understanding of dimorphism&amp;#39;s development and evolutionary process.&#xA0; &#xD;
&#xD;
Acknowledgments: Author gratefully acknowledges Department of Biotechnology Gulbarga University Gulbarga for providing the work felicity and Dr Shyam Sundar Joshi retired professor from Department of Botany University of Agricultural sciences. Bangalore. India to provide relative information and Professor S. J. Patil from Department of farm forestry University of Agricultural sciences. Dharwar. India to help for procuring the study materials.&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Conflict of interest: Authors declares that there is no conflict of interest.&#xD;
&#xD;
Source of funding: There is no any source of funding or the present study&#xD;
&#xD;
Authors contribution: Prof G R Naik have framed the study and cross checked the findings, and Dr Gayatri Vaidya has performed the experiments and analyzed the data, and prepared the manuscript. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3783</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3783</Fulltext></URLs><References>1. Rout GR. Das P. In vitro micropropagation of mature S. glauca LINN. an oil yielding tree. Bangladesh J Bot. 1995;24:137-14. &#xD;
&#xD;
2. Patil MS, Gaikwad DK. A Critical Review on Medicinally Important Oil Yielding Plant &#xD;
&#xD;
Laxmitaru (Simarouba glauca DC.). J Pharm Sci Res. 2011;3(4):1195-1213.&#xD;
&#xD;
3. Raina SN, Rani V, Kojima T, Ogihara Y, Singh KP, Devarumath RM. RM RAPD and ISSR fingerprints as useful genetic markers for analysis of genetic diversity, varietal identification, and phylogenetic relationships in peanut (Arachis hypogaea) cultivars and wild species. Genome 2001;44:763&#x2013;772. &#xD;
&#xD;
4. de Sola F. Notes on the aceituno tree (Simarouba glauca&#xA0;DC.) and its adaptation as a vegetable oil crop. Ceiba. 1956;4:351&#x2013;358.&#xD;
&#xD;
5. Govindaraju K, Darukeshwara J, Srivastava AK. Studies on protein characteristics and toxic constituents of Simarouba glauca oil seed meal. Food Chem Toxicol. 2009;47:1327-1332.&#xD;
&#xD;
6. Joshi S, Joshi S.&#xA0; OIL TREE- Laxmitaru glauca. University of Agricultural Sciences, Bangalore and Indian Council of Agricultural Research, New Delhi, India. 2002:86.&#xD;
&#xD;
7. Kaul S. Biodiesel: a clean and sustainable fuel for future. In: All India seminars on national policy on &#x2013; non-edible oils as biofuels. IISC Bangalore. 2003.&#xD;
&#xD;
8. Gilman EF, Watson DG. Simarouba glauca Paradise Tree, Institute of food and Agricultural 210 Sciences, University of Florida, Gainesville, FL 32611, Fact Sheet. 1994;211 ST-590. &#xD;
&#xD;
9. Durand R, Durand B. Sexual determination, and sexual differentiation. Crit Rev Plant Sci. 1990;9:67&#x2013;77. &#xD;
&#xD;
10. Smith S, Helentjaris T. In Genome mapping in plants (AH Paterson, Editor), Academic Press, RG Landes Company. Texas. 1996; 95. &#xD;
&#xD;
11. Welsh J, McClelland M. Fingerprinting genomes using PCR with arbitrary primers. Nucleic Acids Res. 1990;18:7213&#x2013;7218. &#xD;
&#xD;
12. Williams JGK, Rubelik AR, Livak KJ, Rafalski A, Tingey SV. DNA polymorphisms amplified by arbitrary primers&#xA0;are useful as&#xA0; genetic&#xA0; markers.&#xA0; Nucleic Acids&#xA0; Res. 1990;18:6531&#x2013;6535. &#xD;
&#xD;
13. Williams MNV, Pande N, Nair S, Mohan M, Bennett J. Restriction&#xA0;&#xA0;&#xA0;&#xA0; fragment&#xA0;&#xA0;&#xA0;&#xA0; polymorphism&#xA0;&#xA0;&#xA0;&#xA0; analysis&#xA0;&#xA0;&#xA0; of polymerase chain reaction product amplified from mapped loci of rice genomic DNA. Theor Appl Genet. 1991; 82:489&#x2013;498. &#xD;
&#xD;
14. Fernandez ME, Figueiras AM, Benito C. The use of ISSR and RAPD markers for detecting DNA polymorphism, genotype identification and genetic diversity among barley cultivars with known origin. Theor Appl Genet. 2002;104:845&#x2013;851. &#xD;
&#xD;
15. Iruela M, Rubio J, Cubero JI, Gil J, Millan T. &#xA0;Phylogenetic analysis in the genus Cicer and cultivated chickpea using RAPD and ISSR markers. Theor Appl Genet. 2002; 104:643&#x2013;645. &#xD;
&#xD;
16. Wong CL, Gan SY, Phang SM. Morphological and molecular characterization, and differentiation of Sargassum baccularia and S. polycystum (Phaeophyta). J Appl Phycol. 2004;16:439&#x2013;445. &#xD;
&#xD;
17. Yang X, Quiros C. Identification, and classification of celery cultivars with RAPD markers. Theor Appl Genet. 1993;86:205&#x2013;212. &#xD;
&#xD;
18. Samantaray S, Geetha KA, Hidayath KP, Maiti S. Identification of RAPD markers linked to sex determination in guggal [Commiphora wightii (Arnott.)] Bhandari. Plant Biotechnol Rep. 2010;4:95&#x2013;99. &#xD;
&#xD;
19. Bachmann K. Nuclear DNA markers in plant biosystematic research. Opera Botanica. 1997;132:137&#x2013;148. &#xD;
&#xD;
20. Ming R, Wang J, Moore PH, Paterson AH. Sex chromosomes in flowering plants. Am J Bot. 2007;94:141&#x2013;156. &#xD;
&#xD;
21. Ainsworth C. Boys and girls come out to play:&#xA0; the molecular biology of dioeciously plants. Ann Bot. 2000; 86:211&#x2013;221. &#xD;
&#xD;
22. Westergaard M. The mechanism of sex determination in dioecious flowering plants. Adv Genet. 1958;9:217&#x2013;281. &#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Muscle Energy Technique versus Positional Release Technique on Upper Trapezius Trigger Points in Subjects with Neck Pain &#x2013; Comparative Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>87</FirstPage><LastPage>91</LastPage><AuthorList><Author>Nipa Patel</Author><AuthorLanguage>English</AuthorLanguage><Author> Sonali Desai</Author><AuthorLanguage>English</AuthorLanguage><Author> Priyanshi Patel</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The neck is the most common site of nontraumatic musculoskeletal pain. Because the trapezius muscle works to move the neck in several directions, its degree of tightness or looseness affects neck flexibility. For people who work with more movements of the neck, or who spend many hours driving, the upper trapezius becomes very painful and sore. MET(Muscle Energy Technique) and PRT (Positional Release Technique) both are effective forms of treatment for upper trapezius trigger points. So this study compares these two techniques. Objective: This study compared the effect of Muscle Energy Technique (MET) and Positional Release Technique (PRT) on upper trapezius trigger points in subjects with neck pain Methods: This study involved 30 (13 males and 17 females) individuals with neck pain (Duration less than 1 month) and trapezius trigger point. They were divided into two groups: Group A- PRT + Conventional treatment and Group B- MET + Conventional treatment. Treatment was given for 1 week. Pre and Post measurements were taken (VAS was used to measure pain and NDI was used to assess neck disability). Data were analysed using unpaired t-test and paired t-test. Results: In within-group analysis, the p value was less than 0.05 (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Muscle Energy Technique (MET), Positional Release Technique (PRT), Trigger points, Neck pain, Upper Trapezius, Neck  Disabilit</Keywords><Fulltext>Introduction&#xD;
&#xD;
The neck is the most common site of nontraumatic musculoskeletal pain.1 The International Association for the Study of Pain defines neck pain as: &#x201C;Pain perceived as arising from anywhere within the region bounded superiorly by superior nuchal line, inferior by an unoriginally transverse line through the tip of the first thoracic spinous process, and laterally by sagittal plane tangential to the lateral border of the neck&#x201D;.2 Population-based surveys have shown lifetime prevalence of neck pain between 67% to 87% .3&#xA0; Upper trapezius is designated as postural muscle.4 Any position which places trapezius in a shortened state for some time without rest may shorten the fibres and lead to dysfunction and restricted movements of the neck.5 A TrP is a hyperirritability spot in skeletal muscle or its fascia, located in palpable taut bands, which can be active or latent.6 Trigger points form in the muscle fibres, close to the motor endplate (neuromuscular junction). Excess acetylcholine (ACH) is released at the synapse, usually associated with overuse or strain, leading to the release of calcium. The resulting ischemia creates an O2 deficit and energy crisis. Symptoms of Active trigger points include resting pain, tenderness on palpation and can also have referred pain pattern. Also, Latent Trips can cause weakness and restrict movement -and pain is not spontaneous.7 MTrPs are considered a major source of pain in 30% of individuals with musculoskeletal dysfunction.8 Clinical signs of MTrPs include taut band, reproducing of pain, referred pain, restricted range of motion and muscle weakness.9 Muscle palpation adjacent to active myofascial trigger points feels tense.10 For deactivation of Trigger Points (TrPs) and decrease spasm Manual approaches like Muscle Energy Techniques (METs) and Positional Release Technique (PRT) is very effective.11 Muscle energy techniques (MET) were originally developed by two osteopathic physicians, Fred Mitchell, Sr. and Fred Mitchell, Jr.12 The approach involves the introduction of an isometric contraction to the affected muscle producing post isometric relaxation through the influence of the Golgi tendon organs (autogenic inhibition).11 MET may be used to decrease pain, stretch tight muscles and fascia, reduce muscle tonus, improve local circulation, strengthen weak musculature and mobilize joint restrictions.11 Positional Release Therapy [PRT] was developed by Lawrence H.13 PRT is a method in which muscles are placed in a position of greatest comfort, and this causes normalization of muscle hypertonicity and fascial tension. Also, it decreases joint hypomobility, increases circulation, followed by a reduction in swelling, decreased pain, and increase muscle strength.14 There are several studies available that compare these two techniques. After comparing MET and PRT for upper trapezius muscle spasm in computer workers and it is found that PRT is a more effective treatment.11 While other reported MET as a more effective form of treatment.7 Therefore this study will add to the growing body of knowledge whether these two techniques yield comparable outcomes or if one technique is superior to the other.&#xD;
&#xD;
Materials and Methods&#xD;
&#xD;
Patients were selected by convenient sampling based on inclusion (subjects having neck pain with unilateral upper trapezius trigger point, Age: 20-40 years, Duration of pain less than 1 month, VAS &gt; 5, NDIQ &gt; 15) and exclusion Criteria (Fracture of the cervical spine, neck pain with radiation into arms or upper extremity, Diagnosed cases of disc prolapsed, Any neurological impairment, Tumor in the cervical region, Any deformity e.g. spasmodic torticollis, Sprengel&amp;#39;s deformity, scoliosis, History of surgery of the cervical spine during the previous 12 months, patients who are taking analgesics). The study was properly explained and informed consent was taken. They were divided into two groups: &#xD;
&#xD;
Group A- PRT + Conventional treatment&#xD;
&#xD;
Group B- MET + Conventional treatment &#xD;
&#xD;
Pre-outcome measurements (VAS and NDI) were taken on 1st day before starting treatment. Conventional treatment (hot pack, Active neck movements, Shoulder bracing exercises, chin tuck exercises and trapezius stretching) was given in both groups along with specialized technique (MET or PRT)&#xD;
&#xD;
Application of PRT&#xD;
&#xD;
&#xD;
	&#xD;
	The subject was supine with the therapist standing on the affected side, tender points were located along the upper fibres of the trapezius.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Then therapist applied Pressure by pinching the muscle between the thumb and fingers. Lateral flexion of subject&#x2019;s head toward the side of a tender point, the therapist grasps the subject&#x2019;s forearm and abducts shoulder to approximately 90&#xB0; and adds slight flexion or extension to fine-tune. &#xD;
	&#xD;
	&#xD;
	The most comfortable position achieved&#xA0; was held for 90 seconds and after that passive return of the body part to an anatomically neutral position was maintained for 5minutes.15&#xD;
	&#xD;
&#xD;
&#xD;
Application of MET: &#xD;
&#xD;
&#xD;
	&#xD;
	The patient lies supine, arm on the side to be treated lying alongside the trunk, head/neck side-bent away from the side being treated to just short of the restriction barrier, while the practitioner stabilizes the shoulder with one hand and cups the Ipsilateral ear/mastoid area, with the other. &#xD;
	&#xD;
	&#xD;
	With the flexed neck fully side-bent, and fully rotated towards the opposite side, the posterior fibres of the upper trapezius are involved in the contraction. This facilitates subsequent stretching of this aspect of the muscle.&#xD;
	&#xD;
	&#xD;
	With the flexed neck fully side-bent and half rotated, the middle fibres are involved in the contraction.&#xD;
	&#xD;
	&#xD;
	With the flexed neck fully side-bent and slightly rotated towards the side being treated, the anterior fibres of the upper trapezius are engaged. &#xD;
	&#xD;
	&#xD;
	The various contractions and subsequent stretches can be performed with the practitioner&amp;#39;s arms crossed, hands stabilizing the mastoid area and shoulder.&#xD;
	&#xD;
	&#xD;
	The patient introduces a light resisted effort (20% of available strength) to take the stabilised shoulder towards the ear (a shrug movement) and the ear towards the shoulder.&#xD;
	&#xD;
	&#xD;
	The opposite effort towards movement is important in order to introduce a contraction of the muscle from both ends simultaneously. &#xD;
	&#xD;
	&#xD;
	The degree of effort should be mild and there should be no pain. &#xD;
	&#xD;
	&#xD;
	This contraction should be maintained for 7-10 seconds and, upon complete relaxation of effort, the practitioner gently eases the head/neck into an increased degree of side-bending and rotation, where it is stabilized, as the shoulder is stretched caudally.&#xD;
	&#xD;
	&#xD;
	As stretching is introduced, the patient can usefully assist in this phase of the treatment by initiating, on instruction, the stretch of the muscle (&amp;#39;as you breathe out please slide your hand towards your feet).&#xA0; &#xD;
	&#xD;
	&#xD;
	Patient participation in the stretch reduces the chances of a stretch reflex being initiated.&#xD;
	&#xD;
	&#xD;
	Once the muscle is in a stretched position, the patient relaxes and the stretch is held for up to 30 seconds.16 &#xD;
	&#xD;
&#xD;
&#xD;
Treatment was given for 1 week. Post-treatment outcome measurements (VAS and NDI) were taken after the last session of treatment. &#xD;
&#xD;
Results&#xD;
&#xD;
The study comprised of total thirty patients (13 males and 17 females). The age of the subject ranged from 22 to 39 years (mean age &#x2013; 36.16 years).&#xA0; Group 1 consists of 15 patients (mean age &#x2013; 34.66 years) and group 2 consists of 15 patients (mean age &#x2013; 37.66 years). Data were analysed using statistical software SPSS version 20. Before applying statistical tests, data were screened for normal distribution. The level of significance was kept at 95 %.&#xD;
&#xD;
Within-group analysis &#xD;
&#xD;
Group A: Paired t-test was used to compare the Pre and Post value of VAS and NDI in group A. And p-value is less than 0.05 (p 0.05) so it suggests no significant difference between the values. So there is no significant difference between the effect of MET and PRT to reduce pain and neck disability in individuals with upper trapezius tender points. (Table 3, Figure 5 and 6)&#xD;
&#xD;
Discussion&#xD;
&#xD;
Our study was aimed to compare the Muscle Energy Technique versus Positional Release Technique on pain and neck disability in individuals with neck pain. The within-group analysis had shown that there was a significant reduction in pain intensity (VAS) and neck disability (NDI) in both groups, which means that both the treatments (MET and PRT) were effective. Whereas Between groups analysis had shown that there was no significant difference between the effects of both treatments. Muscle energy technique has its effects over the stretch receptors called Golgi tendons and spindles which react to overstretch of muscle and inhibit further muscle contraction. When GTO is triggered, afferent nerve impulses enter the spinal cord dorsal root and reach the inhibitory motor neuron which stops impulses discharge from the efferent motor neuron. This prevents muscle contraction causing lengthening and relaxation of agonist. They also react to movements of the body and this may have a relaxing effect on the muscle. When a muscle gets shorten, the discharge through the spindle decreases and it relaxes the muscle. Pain relief could have occurred due to a decrease in the intrafusal and extrafusal fibre disparity and reset of the inappropriate proprioceptive activity. MET may influence pain mechanisms and promote hypoalgesia. The mechanisms are not known but may involve central and peripheral modulatory mechanisms, such as activation of muscle and joint mechanoreceptors may reduce pro-inflammatory cytokines and desensitize peripheral nociceptors. It may be effective due to the production of viscoelastic change and passive extensibility of muscle. Our finding is supported by a study done by Phadke et al.,2 in which they have compared MET with static stretching in a patient with mechanical neck pain and they found better improvement in the MET group as compared to the stretching group. Positional release therapy is an indirect myofascial technique focusing on the neurologic component of the neurovascular myofascial somatic dysfunction and is proposed to increase muscle flexibility. According to the Korr model, placing the muscle in a shortened position may decrease the muscle spindle activity and enables the central nervous system to decrease gamma discharge activity, therefore inhibiting the facilitated segment of the spinal cord. By shortening the extrafusal fibres or placing them in a position of ease, Korr hypothesises that the intrafusal and extrafusal fibre disparity decreases and the gamma discharge are turned down. This enables the muscle to return to its normal resting length as the hyperactive muscle spindles cease to fire. This passive approximation may be referred to as positional release.3 The effect of PRT is also based on local circulation, inflammatory reaction and neurophysiologic regulation of an activity that is influenced by the sympathetic nervous system. PRT removes restricted barriers of movement by decreasing muscle spasm, trigger point, pain and swelling and increasing circulation. Our finding is supported by a study done by Kumaresan et al.4 as they concluded that Positional Release Therapy can be useful in alleviating neck pain and improve functional ability. According to our results, both techniques were effective in reducing pain and functional disability in our patients. This finding is supported by a study done by Yeole,13 in which they have compared MET and PRT on neck pain in computer users and they found both techniques are effective in reducing pain and improving function in computer users with neck pain. Whereas study done by Thaker et al.7 concluded that the Muscle energy technique (MET) is an effective option in the treatment of chronic upper trapezius than the Positional Release Technique (PRT). Also, a study done by Rana et al.11 concluded that PRT was more statistically and clinically superior for decreasing VAS, NDI score and improving ROM and MMT. PRT showed earlier pain relief as compared to MET. Both groups received isometric neck exercises and upper trapezius stretching exercises with moist heat therapy and are known to have effects on pain and spasm and thus can attribute to pain relief and improved tissue extensibility in both groups.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
This study concluded that both Muscle Energy Technique and Positional Release Therapy were significantly effective in reducing pain and neck disability in subjects with neck pain. After comparison, Cit showed that there was no difference between the effects of these two techniques. So we can use both techniques in clinical practice.&#xD;
&#xD;
Acknowledgement: 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;
Conflict of interest: Nil&#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=3784</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3784</Fulltext></URLs><References>&#xD;
	&#xD;
	Mahajan R, Kataria C, Bansal K. Comparative effectiveness of muscle energy technique and static stretching for treatment of subacute mechanical neck pain. Int J Health Rehabil Sci 2012 Jul;1(1):16-21.&#xD;
	&#xD;
	&#xD;
	Phadke A, Bedekar N, Shyam A, Sancheti P. Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial. Hong Kong Physiother J. 2016;35:5-11.&#xD;
	&#xD;
	&#xD;
	Alagesan J, Shah US. Effect of positional release therapy and taping on unilateral upper trapezius tender points. Int J Health Pharmac Sci. 2012;1(2):13-7.&#xD;
	&#xD;
	&#xD;
	Kumaresan A, Deepthi G, Anandh V, Prathap S. Effectiveness of positional release therapy in the treatment of trapezius. Int J Pharmac Sci Health Care. 2012;1(2):71-81.&#xD;
	&#xD;
	&#xD;
	Ravish VN, Helen S. To compare the effectiveness of myofascial release technique versus positional release technique with laser in patients with the unilateral trapezius. J Evol Med Dental Sci 2014;3(9):2161-7.&#xD;
	&#xD;
	&#xD;
	Saavedra FJ, Cordeiro MT, Alves JV, Fernandes HM, Reis VM, Mont&amp;#39;Alverne DG. The influence of positional release therapy on the myofascial tension of the upper trapezius muscle. Revista Brasileira de Cineantropometria &amp; Desempenho Humano. 2014;16(2):191-9.&#xD;
	&#xD;
	&#xD;
	Thaker S, Dave Y, Patel S. A study to compare the effect of muscle energy techniques and positional release technique on pain and cervical ROM in patients with the chronic upper trapezius. Int J Sci Res. 2019; 8(6):13-17.&#xD;
	&#xD;
	&#xD;
	Basak T, Pal TK, Sasi M. A Comparative Study on the Efficacy of Ischaemic Compression and Dry Needling with Muscle Energy Technique in Patients with Upper Trapezius Myofascial Trigger Points. Int J Health Sci Res. 2018;8(4):74-81.&#xD;
	&#xD;
	&#xD;
	Shah N, Shah N. Comparison of two treatment techniques: Muscle energy technique and Ischemic compression on upper trapezius trigger point in subjects with non-specific neck pain. Int J Therap Rehabil Res. 2015;4(5):260-264 .&#xD;
	&#xD;
	&#xD;
	Rashad A, Asif M, Chughtai RB, Tanveer E, Uddin S, Amjad B, et al. Efficacy of Positional Release Therapy versus Integrated Neuromuscular Ischemic Technique in the Treatment of Upper Trapezius Trigger Point. J Phy Fit Treatment Sports. 2019;6(4): 555694 .&#xD;
	&#xD;
	&#xD;
	Rana P, Brahmbhatt B. Effect of muscle energy technique versus positional release technique in computer workers with upper trapezius muscle spasm: A comparative study. Int J Multidisc Res Dev. 2017;4(5):29-35 .&#xD;
	&#xD;
	&#xD;
	Thomas E, Cavallaro AR, Mani D, Bianco A, Palma A. The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiroprac Man Ther. 2019;27(1):35.&#xD;
	&#xD;
	&#xD;
	Yeole UL, Diwakar NP, Pawar PP. Effect of Muscle Energy Technique And Positional Release Therapy on Neck Pain In Computer Users-A Randomized Control Trial. Int J Recent Sci Res. 2017;8(12):22490-22493.&#xD;
	&#xD;
	&#xD;
	Rishi P, Singh G.&#xA0; Effect of positional release technique versus ischemic compression on pressure pain threshold. Range of motion, and headache patients among college going , students. A randomized controlled trial. Int J Physiother. 2019;6(4):140-148 .&#xD;
	&#xD;
	&#xD;
	Chaitow L. Positional release techniques. 3rd Ed. Churchill Livingstone Elsevier; 2007&#xD;
	&#xD;
	&#xD;
	Chaitow L, Crenshaw K. Muscle energy techniques.3rd Ed. Elsevier Health Sciences; 2006.&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Cross-sectional Descriptive Study to Understand Knowledge and Attitude of Japanese Encephalitis Among Health Professionals in a Tertiary Care Hospital of Pune&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>206</FirstPage><LastPage>211</LastPage><AuthorList><Author>Dipendra Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Jyoti A. Landge</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Japanese encephalitis distribution all over India is not uniform, and there is diversity about incidence, occurrence and prevention strategy in different state of the country. Health care professionals are graduated differently in different parts of the country about managing health problems depending on local health needs so knowledge and perception towards Japanese encephalitis may not be uniform among them all over the country.&#xD;
Objective: Present study was carried out to assess the knowledge and perception about JE among Health care professionals in a tertiary care centre.&#xD;
Methods: A cross-sectional study carried out involving 103 health professionals working in various departments above the rank of first year junior residents in the same hospital for six months. Study was conducted after taking consent from participants using preformed self-administered questionnaire.&#xD;
Results: There were participants of position from junior resident of 2&amp;3 year (64.1%) to faculty (35.9%) and many (57.3%) were from clinical departments. Overall knowledge (68%) of study participants was good and perception was positive (58.3%). There was no variation in knowledge and perception across gender, clinical and para-clinical department (chi-square P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords/><Fulltext>Introduction&#xD;
&#xD;
Japanese encephalitis (JE) is a mosquito-borne encephalitis caused by Group B arbovirus (Flavivirus). It is a zoonotic disease i.e., infecting mainly animals and accidentally man. The vast majority of cases occur among children less than 15 years of age. Nearly 10% cases among those above 60 years perhaps reflecting waning protective immunity.1 The high fatality rate and frequent residual neuropsychiatric sequelae in survivors make JE a considerable health problem.2&#xD;
&#xD;
According to World Health Organization (WHO) report, in Southeast Asia and Western Pacific region approximately 3 billion people are living in countries, which are at risk of JE.3 In India also JE is a serious pediatric problem. its epidemic has been reported from many places of the country since 1952. However it was first detected in 1952 through sero-epidemiological surveys in Nagpur district of Maharashtra and Chingleput district of Tamil Nadu.4 Till 2001, there was no problem of JE in Maharashtra State. But during 2002 &amp; 2003 JE infection was introduced in eastern districts such as Bhandara, Gondiya, &amp; Nagpur. After that in 2004, three focal outbreaks of JE occurred in districts of Gadchiroli, Parbhani&amp;Wardha.In the year of 2005 there were 6 focal outbreaks of JE in districts of Amravati, Yeotmal&amp; Nagpur .5&#xD;
&#xD;
Social, cultural, agricultural and occupational practices, health-seeking behavior, gender roles, and human interaction with animals are all important factors that have failed to grab the attention of researchers and program managers and hence not suitably informed the intervention strategies for prevention and control of JE. Furthermore, the vast diversity of these ecological and social factors has led to different patterns of epidemiologic risks associated with JE incidence in different states and districts. Thus, JE is not merely a zoonotic disease, but a greater developmental issue with multiple linkages to several social and cultural drivers.6&#xD;
&#xD;
The healthcare professionals are important members of the society to combat the disease outbreaks like JE. Additionally, they are important source of information to the general public to provide counselling, education and prevention measures for disease. Therefore, the knowledge and perception of JE among Health professionals needed to be uniformly standardized as it will be critical in educating and protecting communities. In view of this, and due to the paucity of published data in the study area, we conducted this study to assess the knowledge and perception about JE among Health care professionals in a tertiary care centre of Pune city, Maharashtra.&#xD;
&#xD;
Material and methods&#xD;
&#xD;
&#xD;
A cross-sectional study was carried out in tertiary care hospital at Pimpri, Pune, Maharashtra from April 2018 to October 2018. Study participants were physicians working in various departments above the rank of first year junior residents in the same hospital. From previous study it was found that 40.4% participants exhibited good knowledge of JE7considering same proportion calculated Sample size using formula for proportionate sample size with 10% allowable error at 95% confidence interval was 93(Open epi software). A total of 103 study participants were included. A convenience sampling, method was applied, and participants were approached on a continuous basis until the required sample size achieved. Intern doctors, visiting doctors, and doctors not willing to participate were excluded from the study. &#xD;
&#xD;
Knowledge and perception about JE were assessed with the help of preformed self-assessment questionnaire from existing literature.7 Knowledge assessment: there were total 17 questions to assess knowledge of study participants. Each correct response were given 1 score and wrong response zero score.&#xA0; Knowledge scores ranged from 0&#x2013;17 and cut off level of 0.05) [Table 4].&#xD;
&#xD;
Discussion&#xD;
&#xD;
To the best of our knowledge, this is the first study that has evaluated the knowledge and perceptions of medical practitioners about JE in Maharashtra and India.The results of the study found that the overall knowledge and perception of participants in this study was good, but their knowledge about incubation period, role of antiviral in treating JE and role of antibiotics in treating JE, risk of JE for health worker were not satisfactory. Their knowledge was relatively better for disease transmission, symptoms of JE and vaccines. Similar findings were found when knowledge about JE was evaluated among health caregivers in a study at Shaanxi Province, China and One Indian study.7,8 Though Present study includes only medical practioner many were uncertain about disease epidemiology as they use to handle very few JE cases in the study area.&#xD;
&#xD;
Regarding JE case management-in spite of fact that JE is a viral disease and there is no role of antibiotics; also, there is no specific antiviral medication available in the treatment of JE9 participants showed unsatisfactory knowledge about pharmacotherapy, as one fourth of participants (25.2%) felt that antibiotics are the first line of treatment. These findings indicate the need to take essential measures to bridge this knowledge gap by implementing effective interventions such as intensifying educational programs in the form of continuous medical education activities and webinars, etc., as JE is a life-threatening disease. In educational Programme, there should be a focus on the case management aspect. These strategies were also supported by previous researchers in their report on the knowledge of Ebola virus disease (EVD) among HCWS in 2014.10&#xD;
&#xD;
One fifth of participants (19.4%) in this study wrongly answered that JE is not seasonal in its occurrence. This possibly conclude that there was lack of literature reading habit or participation in workshops or symposia by health care professionals.11 Such health care professionals will mislead diagnosis of Acute encephalitic syndrome (AES) and that will be life-threatening to patients and reduced notification of disease burden. Efforts should be made to address this issue by encouraging health professionals to attend and participate in continuous medical education Programme. Impact of continuous medical education Programme results were helpful to improve case management when a research was carried out at the time of swine flu epidemic in Saudi Arabia.12&#xD;
&#xD;
It is noteworthy to mention that experienced senior doctors (faculty) were more knowledgeable as compared to junior ones. The results are in line with another study.14The possible reason for these findings could be due to administrative positions held by faculty, which allow them to participate in different educational forums, conferences, and discussion panels which may increase the overall knowledge of workers about healthcare issues associated with current epidemics. Our study findings are similar to a report which suggested that experienced workers are more effective in dealing with patients in healthcare settings.15 Our study suggests that junior doctors should also focus while conducting training and other educational programs to increase their knowledge about JE. There was no difference in relation to gender, pre and paraclinical department and years of experience for perception towards JE. Even perceptions of the resident doctors and faculty didn&#x2019;t show much difference towards JE. Study in north India found that the perceptions of the physicians were more positive as compared to nurses, while older participants also showed positive perceptions towards JE.7&#xD;
&#xD;
In the present study perception concerning management part of disease like serious illness, its risk of transmission among health care workers, intensive and emergency treatment suggests a wide gap between theory and practical knowledge of managing JE. This gap in practice could be due to no disease burden and management experience by health care professional in the study area. Also, literature showed that the there is no occurrence or outbreak of JE or acute encephalitis syndrome since more than a decade in the study area.5 As of current training pattern of health care professionals in India, they are graduated differently in different parts of the country about managing various health problems depending on local health needs and resources availability so perception about Japanese encephalitis as a serious problem may not be uniform among them all over country.&#xD;
&#xD;
Perception towards acknowledgingthemselves with the information about disease, interventions like mosquito breeding place reduction, community participation, vaccination, and universal standard precaution while handling JE cases was also not satisfactory. These findings suggest that healthcare professionals being pillars of the society should equip uniformly throughout the country to combat future outbreaks of JE, which may be an important public health problem due to lack of intervention or manmade activities.6 Healthcare professionals are also important source of information to general public to provide counselling, education and prevention measures for diseases so it is need of time to strengthen preventive and curative knowledge of post graduate doctors irrespective of disease burden they are handing in particular geographical area during their training. This finding suggests that there is a need to in cult habit of conducting uniform training of health care professionals through seminar/webinar during disease outbreak in different geographical area. Also, there is a need to promote health research uniformly in India as it may provide important information about disease trends, risk factors, and required public health interventions. Arranging research seminars on outbreak of diseases and other health issues on a regular basis may aid in improving perception. Literature found that participation in research activities may change perception of healthcare workers regarding different disease conditions.13&#xD;
&#xD;
Conclusion&#xD;
&#xD;
Health care professionals have optimized knowledge but not up to the mark. Today&#x2019;s resident doctors are future health care manager, so they should uniformly empower through medical education Programmes like conferences, seminar, and workshop on Japanese encephalitis, epidemiology, management and epidemiological shift in disease patterns. The study has explored an area where much research needs to be done. Additionally, study findings will help the stakeholders in India to design customized interventions to optimize the knowledge and perceptions of Health care professionals towards JE. The present study has some limitations like small sample size, convenience sampling approach and single-center study, which may not be generalizable to the whole state or country. Our findings address one of the major healthcare problems that may confront India in future. Further studies large size multicentric studies are required to establish these results by including other major referrals hospitals of the affected states of India. Our findings could be a basis for further development of educational campaigns by targeting less knowledgeable areas as highlighted in this study.&#xD;
&#xD;
Conflict of Interest: No&#xD;
&#xD;
Source of Funding: Indian Council of Medical Research (ICMR)&#xD;
&#xD;
Author&#x2019;s contribution:&#xD;
&#xD;
Dipendra Singh: Conception, data collection and drafting the article&#xD;
&#xD;
Dr. Jyoti Landge: Data analysis and interpretation, critical revision of article, final approval of the version to be published&#xD;
&#xD;
Acknowledgement: 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;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3785</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3785</Fulltext></URLs><References>1. Park K. Epidemiology of communicable disease. Park&#x2019;s textbook of preventive and social medicine. 24th edition Bhanot publication, Jabalpur. 2017;302. &#xD;
&#xD;
2. Srivastava P, Singh A, Srivastava AK, Singh AP, Prakash D. Role of Education and Counseling for the Prevention of Japanese Encephalitis in the Eastern U.P, India. Epidemiology 2014;4:161. &#xD;
&#xD;
3. Halstead SB, Jacobson J. Japanese encephalitis. Adv Virus Res. 2003;61:103&#x2013;138. &#xD;
&#xD;
4. Dhillon GP, Raina VK. Epidemiology of Japanese encephalitis in context with Indian scenario. J Indian Med Assoc. 2008;106(10):660-3. &#xD;
&#xD;
5. National Japanese Encephalitis Control Programme. Accessed from: http://www.aarogya.com/health-resources/health-programs/national-japanese-encephalitis-control-programme.html dated 23/01/2018&#xD;
&#xD;
6.&#xA0; Chaturvedi S, Sharma N, Kakkar M. Perceptions, practices and health-seeking behaviour constrain JE/AES interventions in high endemic district of North India. BMC Public Health .2017; 17:645. &#xD;
&#xD;
7. Ahmad A, Khan MU, Gogoi LJ, Kalita M, Sikdar AP, Pandey S, et al. Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers&#x2019; Perception to Improve Health Care. PLoS ONE 2015;10(8):e0135767. &#xD;
&#xD;
8. Zhang S, Yin Z, Suraratdecha C, Liu X, Li Y, Hills S, et al. Knowledge, perceptions and practices of caregivers regarding Japanese encephalitis in Shaanxi Province, China, Public Health. 2011; 125:79&#x2013;83.&#xD;
&#xD;
9. Guidelines for surveillance of acute Encephalitis syndrome (with special reference to Japanese Encephalitis), Directorate of National Vector Borne Diseases Control Programme, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India 2006.&#xD;
&#xD;
10. Kilmarx PH, Clarke KR, Dietz PM, Hamel MJ, Husain F. Ebola Virus Disease in Health Care Workers- Sierra Leone, MMWR Morb Mortal Wkly Rep. 2014;63:1168&#x2013;1171. &#xD;
&#xD;
11. Ho TS, Huang MC, Wang SM, Hsu HC, Liu CC. Knowledge, perception, and practice of dengue disease among healthcare professionals in southern Taiwan, J Formos Med Assoc. 2013; 112: 18&#x2013;23. &#xD;
&#xD;
12. Rahman A, Al Mulehim ARS, Almuhaidib NS, Almuhaidib NS, Al Humam A. Knowledge and risk perception among health care workers regarding infection control measures during swine flu epidemic in Al Ahsa Governorate in Eastern Province, KSA. Asian J Med Res. 2013;2:10&#x2013;14.&#xD;
&#xD;
13. Dulce B. The importance of clinical research in improving health care practice. Acta Paul Enferm. 2010;23: 8&#xD;
&#xD;
14. Suchitra JB. Impact of education on knowledge, perceptions and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol. 2007; 25:181&#x2013;187. &#xD;
&#xD;
15. Munnell A, Sass S, Soto M. Employer Perceptions Towards Older Workers: Survey Results. Work Opportunities for Older Americans, 2006 Available: http://crr.bc.edu/images/stories/Briefs/wob_3.pdf&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Three dimensional Bone Models Help in Improving the Performance of Orthopaedic Postgraduates on Fracture Fixation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>212</FirstPage><LastPage>218</LastPage><AuthorList><Author>Appala Raju Sanaboyina</Author><AuthorLanguage>English</AuthorLanguage><Author> Saraswathi AV</Author><AuthorLanguage>English</AuthorLanguage><Author> Vijayalakshmi Payala</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Fracture fixation is the most common procedure performed by Orthopaedician. Objective: The main objective of the study is to train the postgraduates in fracture fixation using a skills lab, to have an idea about the establishment of a skills lab, to weigh the pros and cons of establishing a functional skills lab and also to evaluate scientifically the beneficial effects of both cognitive and psychomotor skills on a quantitative scale. Methods: It is a Quantitative Interventional study in which eight postgraduates of first-year Orthopaedics participated in seven sessions of different modules at Maharajah&#x2019;s Institute of Medical College, Nellimarla, Vizianagaram district, Andhrapradesh. The study uses assessment tools like Multiple Choice Question (MCQs) and Objective structured practical examination (OSPE) questionnaire. Results: From the results, it was found that the scores obtained in the post-workshop either in MCQs pattern or OSPE questionnaire pattern for testing knowledge were higher among all the eight postgraduate students comparatively than the scores obtained during the pre-workshop training programme and the obtained results were highly significant as the p-value was less than 0.05. The results of the current study had proved that the skills of all the eight postgraduate students were very well improved from the pre to post-workshop on various modules. It was concluded that OSPE can supplement the existing pattern of conventional methods of clinical examination. Conclusion: In the present scenario, it may be realistic to expect its inclusion in the formal summative evaluation schedule of medical colleges and in the day-to-day assessment of students to improve their clinical competence. The surgical simulation training program on various cognitive and skills modules gained a step forward in the development of a comprehensive orthopedic surgical skills educational curriculum.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Fracture fixation, Trauma, Skills lab, Postgraduate training, OSPE questionnaire, Surgical skills</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3942</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3942</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Cross-Sectional Study to Correlate the Demographic and Clinical Profile of Multidrug-Resistant Tuberculosis Patients&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>227</FirstPage><LastPage>229</LastPage><AuthorList><Author>Pandor DV</Author><AuthorLanguage>English</AuthorLanguage><Author> Suthar D</Author><AuthorLanguage>English</AuthorLanguage><Author> Thakkar KP</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Pathology, Culture, Tuberculosis, Drug resistance, Disease, Eradication</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4122</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4122</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Iatrogenic Effects of Orthodontic Treatment-A Review&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>219</FirstPage><LastPage>226</LastPage><AuthorList><Author>Anusha S</Author><AuthorLanguage>English</AuthorLanguage><Author> Navaneetha N</Author><AuthorLanguage>English</AuthorLanguage><Author> Piradhiba R</Author><AuthorLanguage>English</AuthorLanguage><Author> Veerasankar S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Orthodontics, Iatrogenic, Resorption, Hypersensitivity, Allergy, Demineralisation</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Orthodontic treatment is being practiced since the 1800s and the benefits gained are voluminous like improvement in dental health, function, appearance, and self?esteem.Although orthodontic treatment has many such recognized benefits, orthodontic appliances can cause unwanted complications if adequate care is not taken during the treatment.1 &#xD;
&#xD;
Iatrogenic&#xA0;is&#xA0;derived&#xA0;from the Greek word &#x201C;iatros&#x201D; meaning physician and &#x201C;gen&#x201D; meaning &#x2018;producing&#x2019;. Identifying the risk factors, causes, and ways to prevention is important for a successful orthodontic treatment and the oral health of the patient. Adequate knowledge on these complications has to be imparted to the patient and necessary counselling on his role in avoiding these have to be given. There is less literature on the consolidated review of all the observed iatrogenic effects and ways to prevent them during orthodontic treatment. This review article aims to discuss various iatrogenic effects of orthodontic treatment and ways to avoid the occurrence of these for a successful orthodontic treatment.2&#xD;
&#xD;
&#xA0;WHITE SPOT LESION&#xD;
&#xD;
The white spot lesion (WSL) has been defined by Fejerskov et al. as the first sign of caries-like lesion on enamel that can be detected with the naked eye.1 Enamel decalcification in the form of white spot lesions is a consequence of improper oral hygiene while undergoing orthodontic treatment ( Fig 1). They appear as small lines along the bracket periphery or as large decalcifications with or without cavitations.2&#xD;
&#xD;
&#xD;
&#xD;
Fig. 1: Facial surface of maxillary anterior teeth.&#xD;
&#xD;
(Photo courtesy: Chapman et al, Risk factors for incidenceand severity of white spot lesions during treatment withfixed orthodontic appliances. , AJODO 2010)&#xD;
&#xD;
A sudden increase in the number of WSLs occurred during the first 6 months of treatment and continued to increase at a slower rate to 12 months, thus maintaining proper oral hygiene is critical in the initial months of the treatment.3 According to Oggard et al.,1988 the occurrence of WSLs in orthodontically treated patients was maximum in lateral incisors followed by canines, first premolars, 2nd premolars, and central incisors. The incidence rate is 45.8% and the prevalence rate is 50%&#x2013;96% in patients undergoing orthodontic treatment, which is quite alarming.4, 5&#xD;
&#xD;
Diagnosis: There are various methods to identify which include visual inspection, photographs, fluorescent methods, and optical modalities such as diagnosed, quantitative light-induced fluorescence, and digital image fibre-optic transillumination. Benson et al., 2003 considers quantitative laser techniques as more sensitive, yielding a higher prevalence rate than the simple visual technique.6, 7&#xD;
&#xD;
Prevention and management&#xD;
&#xD;
a) Maintain Oral Hygiene: Mechanical plaque control by proper tooth brushing, interdental brush, disclosing solutions, floss, water irrigation or powered toothbrush can be used8.&#xD;
&#xD;
b) Fluoride Toothpaste: Fluoride toothpaste contains sodium fluoride, monofluorophosphate or stannous fluoride (1500-5000 ppm) where fluoride ions get incorporated into the surface of enamel forming fluorapatite crystals. Sonesson et al., proves that they reduced the incidence of WSL by 32%.9, 10&#xD;
&#xD;
c) Fluoride Mouth rinse: Fluoridated mouth rinses containing 0.05% sodium fluoride used daily or every other day reduced WSL by 25%. Antibacterial agents like chlorhexidine, triclosan, or zinc have been incorporated into these mouthwashes to improve their cariostaticeffects.10,11, 12.&#xD;
&#xD;
d) Fluoride Varnish: Varnishes adhere to the enamel surface longer than other topical fluoride products and do not require patient compliance. 5% NaF forms a reservoir of calcium fluoride on the tooth surface and prevents demineralization by 30- 50% when applied biannually.13, 14,15 &#xD;
&#xD;
e) Fluoride Releasing Banding Cement&#xD;
&#xD;
Resin Modified Glass Ionomer Cement (RMGIC) pumps fluoride by absorbing from the environment and releasing it in the most susceptible areas.16 Bishara et al. reported a very less initial bond strength of RMGIC with a failure rate of 24.8%.17, 18&#xD;
&#xD;
Bioactive glass (BAG) is a cross-linked matrix of hydrolyzed alkoxides of SiO2 and CaO that releases ions such as calcium, fluoride into the oral environment and prevents demineralization of enamel. Manfred et al. showed that BAG-Bond adhesives have better microhardness than Transbond-XT.19&#xD;
&#xD;
f) Elastomeric ligatures: Tin fluoride (SnF) containing elastomeric ligature ties release a low concentration of fluoride for a long period. Wiltshire et al., 1996 reported an initial burst of fluoride-release (35%) during the first 24 hours followed by a continued release of 63%, 83%, and 88% of the total fluoride in the first week, first month, and second month, respectively.20,21&#xD;
&#xD;
g) Pit and fissure sealants: The application of resin sealants on the enamel surface surrounding the bracket protects the enamel surface from acid attack. Benham et al. reported a decrease in WSL by 3.8 times with sealants.22, 23 Sealant combined with brushing was more effective in protecting enamel than brushing alone.24&#xD;
&#xD;
h) Xylitol: Xylitol is a polyol (a type of carbohydrate) that is not metabolized by S mutants and can be used as a sugar substitute. It is available as chewing gum or lozenges.25 Xylitol lozenges reduce the acidogenicity of dental plaque by increasing the pH value.26&#xD;
&#xD;
i) Laser irradiation: Laser irradiation is a new method for inhibiting demineralization around orthodontic appliances which is regularly combined by fluoride therapy. Meurman et al showed that it is possible to convert hydroxyapatite crystals to fluorapatite crystals instantly in the presence of fluoride using a CO2&#xA0;laser. 27&#xD;
&#xD;
j) Intraoral fluoride-releasing devices: Copolymer Membrane Device, Glass Device Continuing Fluoride, Slow-Fluoride Release Tablets. These devices can significantly increase the salivary fluoride concentration without substantially affecting the urinary fluoride levels.28&#xD;
&#xD;
ROOT RESORPTION&#xD;
&#xD;
External apical&#xA0;root resorption&#xA0;(EARR) is defined as a physiologic or&#xA0;pathological process&#xA0;characterized by the loss of&#xA0;cementum&#xA0;or&#xA0;dentine&#xA0;resulting in the shortening of the root apex29. When heavy orthodontic forces are applied for a long duration (weeks or months), necrosis (hyalinization) of the compressed PDL may occur. The defensive leukocytes that migrate out of PDL capillaries include osteoclast progenitors that promptly coalesce to form multinucleated cells, capable of resorbing mineralized tissues (bone and tooth roots).30&#xD;
&#xD;
Stages of root resorption, as proposed by Levander and Malmgren, which was further modified by Beck and Harris in 1994 ( Fig 2).31&#xD;
&#xD;
&#xD;
&#xD;
Fig. 2: Root resorption index acc. to Malmgrenet al., 1982&#xD;
&#xD;
Root resorption after orthodontic treatment of traumatized teeth. AJO. 1982&#xD;
&#xD;
(Grade 0: Normal root length&#xD;
&#xD;
Grade 1: Irregular root contour&#xD;
&#xD;
Grade 2: Root loss apically, </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4125</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4125</Fulltext></URLs><References>&#xD;
	&#xD;
	Hunt O, Hepper P, Johnston C, Stevenson M, Burden D. Professional perceptions of the benefits of orthodontic treatment. Eur J Orthod. 2001 Jun;23(3):315-23&#xD;
	&#xD;
	&#xD;
	Meeran NA. Iatrogenic possibilities of orthodontic treatment and modalities of prevention. J Orthod Sci. 2013 Jul;2(3):73-86.&#xD;
	&#xD;
	&#xD;
	Chapman JA, Roberts WE, Eckert GJ, Kula KS, Gonz&#xE1;lez-Cabezas C. Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010 Aug;138(2):188-94&#xD;
	&#xD;
	&#xD;
	Ogaard B, R&#xF8;lla G, Arends J. Orthodontic appliances and enamel demineralization. Part 1. Lesion development. Am J Orthod Dentofacial Orthop. 1988 Jul;94(1):68-73&#xD;
	&#xD;
	&#xD;
	Mitchell L. Decalcification during orthodontic treatment with fixed appliances--an overview. Br J Orthod. 1992 Aug;19(3):199-205 &#xD;
	&#xD;
	&#xD;
	Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013 Jul;83(4):641-7&#xD;
	&#xD;
	&#xD;
	Benson PE, Pender N, Higham SM. Quantifying enamel demineralization from teeth with orthodontic brackets--a comparison of two methods. Part 2: validity. Eur J Orthod. 2003 Apr;25(2):159-65&#xD;
	&#xD;
	&#xD;
	Harvey WJ, Powell KR. Care of dental enamel for the orthodontic patient. AustOrthod J. 1981 Dec;7(2):70-6. PMID: 6956324.&#xD;
	&#xD;
	&#xD;
	Zabokova-Bilbilova E, Popovska L, Kapusevska B, Stefanovska E. White spot lesions: prevention and management during the orthodontic treatment. Pril (MakedonAkadNaukUmet Odd Med Nauki). 2014;35(2):161-8&#xD;
	&#xD;
	&#xD;
	Sonesson M, Twetman S, Bondemark L. Effectiveness of high-fluoride toothpaste on enamel demineralization during the orthodontic treatment-a multicenter randomized controlled trial. Eur J Orthod. 2014 Dec;36(6):678-82&#xD;
	&#xD;
	&#xD;
	Geiger AM, Gorelick L, Gwinnett AJ, Benson BJ. Reducing white spot lesions in orthodontic populations with fluoride rinsing. Am J OrthodDentofacialOrthop. 1992 May;101(5):403-7 &#xD;
	&#xD;
	&#xD;
	Chadwick BL, Roy J, Knox J, Treasure ET. The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review. Am J OrthodDentofacialOrthop. 2005 Nov;128(5):601-6; quiz 670.&#xD;
	&#xD;
	&#xD;
	Arends J, Lodding A, Petersson LG. Fluoride uptake in enamel. In vitro comparison of topical agents. Caries Res. 1980;14(6):403-13 &#xD;
	&#xD;
	&#xD;
	Todd MA, Staley RN, Kanellis MJ, Donly KJ, Wefel JS. Effect of a fluoride varnish on demineralization adjacent to orthodontic brackets. Am J OrthodDentofacialOrthop. 1999 Aug;116(2):159-67 &#xD;
	&#xD;
	&#xD;
	Demito CF, Rodrigues GV, Ramos AL, Bowman SJ. Efficacy of a fluoride varnish in preventing white-spot lesions as measured with laser fluorescence. J ClinOrthod. 2011 Jan;45(1):25-9; quiz 40 &#xD;
	&#xD;
	&#xD;
	Wilson RM, Donly KJ. Demineralization around orthodontic brackets bonded with resin-modified glass ionomer cement and fluoride-releasing resin composite. Pediatr Dent. 2001 May-Jun;23(3):255-9&#xD;
	&#xD;
	&#xD;
	Bishara SE, VonWald L, Olsen ME, Laffoon JF. Effect of time on the shear bond strength of glass ionomer and composite orthodontic adhesives. Am J OrthodDentofacialOrthop. 1999 Dec;116(6):616-20. doi: 10.1016/s0889-5406(99)70195-2&#xD;
	&#xD;
	&#xD;
	Gaworski M, Weinstein M, Borislow AJ, Braitman LE. Decalcification and bond failure: A comparison of a glass ionomer and a composite resin bonding system in vivo. Am J OrthodDentofacialOrthop. 1999 Nov;116(5):518-21&#xD;
	&#xD;
	&#xD;
	Manfred L, Covell DA, Crowe JJ, Tufekci E, Mitchell JC. A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets. Angle Orthod. 2013 Jan;83(1):97-103. &#xD;
	&#xD;
	&#xD;
	Viriyakosol, Nuttachai&amp;Dechkunakorn, Surachai&amp;Anuwongnukroh, Niwat&amp;Tua-ngam, Peerapong&amp;Wichai, Wassana. An Investigation of Fluoride Release from Orthodontic Elastomeric Ligatures. Advanced Materials Research. 2014;1025-1026:787-791&#xD;
	&#xD;
	&#xD;
	Wiltshire WA. Determination of fluoride from fluoride-releasing elastomeric ligature ties. Am J OrthodDentofacialOrthop. 1996 Oct;110(4):383-7&#xD;
	&#xD;
	&#xD;
	Silverstone LM. Fissure sealants. Laboratory studies. Caries Res. 1974;8(1):2-26&#xD;
	&#xD;
	&#xD;
	Benham AW, Campbell PM, Buschang PH. Effectiveness of pit and fissure sealants in reducing white spot lesions during orthodontic treatment. A pilot study. Angle Orthod. 2009 Mar;79(2):338-45&#xD;
	&#xD;
	&#xD;
	PithonMatheusMelo, Santos Mariana de Jesus, Souza Camilla Andrade de, Le&#xE3;oFilho Jorge C&#xE9;sar Borges, Braz Ana Karla Souza, Araujo Renato Evangelista de et al . Effectiveness of fluoride sealant in the prevention of carious lesions around orthodontic brackets: an OCT evaluation. Dental Press J. Orthod.&#xA0; [Internet]. 2015&#xA0; Dec; 20( 6 ): 37-42&#xD;
	&#xD;
	&#xD;
	Guzm&#xE1;n-Armstrong S, Chalmers J, Warren JJ. Ask us. White spot lesions: prevention and treatment. Am J OrthodDentofacialOrthop. 2010 Dec;138(6):690-6&#xD;
	&#xD;
	&#xD;
	Sengun A, Sari Z, Ramoglu SI, Malko&#xE7; S, Duran I. Evaluation of the dental plaque pH recovery effect of a xylitol lozenge on patients with fixed orthodontic appliances. Angle Orthod. 2004 Apr;74(2):240-4 &#xD;
	&#xD;
	&#xD;
	Meurman JH, Hemmerl&#xE9; J, Voegel JC, Rauhamaa-M&#xE4;kinen R, Luomanen M. Transformation of hydroxyapatite to fluorapatite by irradiation with high-energy CO2 laser. Caries Res. 1997;31(5):397-400&#xD;
	&#xD;
	&#xD;
	Gambhir&#xA0;RS,&#xA0;Kapoor D,&#xA0;Singh G.&#xA0;Singh J,&#xA0;Kakar H.&#xA0;Intraoral Fluoride-Releasing Devices: A literature review. World J Dent 2012;3(4):350-354&#xD;
	&#xD;
	&#xD;
	Ne RF, Witherspoon DE, Gutmann JL. Tooth resorption. Quintessence Int. 1999 Jan;30(1):9-25. &#xD;
	&#xD;
	&#xD;
	Krishnan V. Root Resorption with Orthodontic Mechanics: Pertinent Areas Revisited. Aust Dent J. 2017 Mar;62 Suppl 1:71-77&#xD;
	&#xD;
	&#xD;
	Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root resorption after orthodontic treatment of traumatized teeth. Am J Orthod. 1982 Dec;82(6):487-91.&#xD;
	&#xD;
	&#xD;
	Brezniak N, Wasserstein A. Root resorption after orthodontic treatment: Part 2. Literature review. Am J OrthodDentofacialOrthop. 1993 Feb;103(2):138-46&#xD;
	&#xD;
	&#xD;
	Linge BO, Linge L. Apical root resorption in upper anterior teeth. Eur J Orthod. 1983 Aug;5(3):173-83. &#xD;
	&#xD;
	&#xD;
	Hill FJ. Iatrogenic root resorption of upper first permanent molars associated with orthodontic treatment. Report of a case. Br J Orthod. 1987 Apr;14(2):109-13.&#xD;
	&#xD;
	&#xD;
	Stenvik A, Mj&#xF6;r IA. Pulp and dentine reactions to experimental tooth intrusion. A histologic study of the initial changes. Am J Orthod. 1970 Apr;57(4):370-85&#xD;
	&#xD;
	&#xD;
	Oppenheim A. Human tissue response to orthodontic intervention of short and long duration, American Journal of Orthodontics and Oral Surgery. 1942 May;28(5):263-301&#xD;
	&#xD;
	&#xD;
	Frost HM. The regional acceleratory phenomenon: a review. Henry Ford Hosp Med J. 1983;31(1):3-9&#xD;
	&#xD;
	&#xD;
	Koretsi V, Chatzigianni A, Sidiropoulou S. Enamel roughness and incidence of caries after interproximal enamel reduction: a systematic review. OrthodCraniofac Res. 2014 Feb;17(1):1-13. &#xD;
	&#xD;
	&#xD;
	Baysal A, Uysal T, Usumez S. Temperature rise in the pulp chamber during different stripping procedures. Angle Orthod. 2007 May;77(3):478-82. &#xD;
	&#xD;
	&#xD;
	Sikorska-Bochi?ska J, Jamroszczyk K, ?agocka R, Lipski M, Nowicka A. Ocenawrazliwo?cizebinyposzlifowaniupionowymszkliwa [Dentinal hypersensivity after vertical stripping of enamel]. Ann Acad Med Stetin. 2009;55(2):65-7. Polish&#xD;
	&#xD;
	&#xD;
	Jadhav S, Vattipelli S, Pavitra M. Interproximal enamel reduction in comprehensive orthodontic treatment: a review. Indian J Stomatol. 2011;2(4):245- 8.&#xD;
	&#xD;
	&#xD;
	Nanda R. Biomechanics and esthetic strategies in clinical orthodontics. St. Louis, Mo.: Elsevier Saunders; 2005&#xD;
	&#xD;
	&#xD;
	Radlanski RJ, J&#xE4;ger A, Schwestka R, Bertzbach F. Plaque accumulations caused by interdental stripping. Am J Orthod Dentofacial Orthop. 1988 Nov 1;94(5):416-20.&#xD;
	&#xD;
	&#xD;
	Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodon. 2000. 2013 Jun;62(1):59-94.&#xD;
	&#xD;
	&#xD;
	Graber TM, Vanarsdall RL. Orthodontics: current principles and techniques. 4th ed. St. Louis: Elsevier Mosby; 2005;p.1161-62.&#xD;
	&#xD;
	&#xD;
	Robert L. Vanarsdall. Periodontal problems associated with orthodontic treatment. Ame Acad Pedodontics. 1981;3, Special Issue&#xD;
	&#xD;
	&#xD;
	Morris JW, Campbell PM, Tadlock LP, Boley J, Buschang PH. Prevalence of gingival recession after orthodontic tooth movements. Am J Orthod Dentofacial Orthop. 2017 May;151(5):851-859. &#xD;
	&#xD;
	&#xD;
	Gorbunkova A, Pagni G, Brizhak A, Farronato G, Rasperini G. Impact of orthodontic treatment on periodontal tissues: a narrative review of multidisciplinary literature. Int J Dent. 2016 Jan 19;2016.&#xD;
	&#xD;
	&#xD;
	Kurth JR, Kokich VG. Open gingival embrasures after orthodontic treatment in adults: prevalence and aetiology. Am J Orth Dentofacial Orthoped. 2001 Aug 1;120(2):116-23.&#xD;
	&#xD;
	&#xD;
	Pugliese F, Hess R, Palomo L. Black triangles: Preventing their occurrence, managing them when prevention is not practical. In Seminars in Orthodontics 2019 Jun; 25(2, pp. 175-186). WB Saunders.&#xD;
	&#xD;
	&#xD;
	Burke S, Burch JG, Tetz JA. Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors. American J Orthod Dentof Orthoped. 1994 May 1;105(5):506-11.&#xD;
	&#xD;
	&#xD;
	Kolte R, Kolte A, Mahajan A. Assessment of gingival thickness with regards to age, gender and arch location. J Ind Society of Periodon. 2014 Jul;18(4):478.&#xD;
	&#xD;
	&#xD;
	Ellis PE, Benson PE. Potential hazards of orthodontic treatment&#x2013;what your patient should know. Dental update. 2002 Dec 2;29(10):492-6.&#xD;
	&#xD;
	&#xD;
	AAO issues a special bulletin on extraoral appliance care, Editorial. Am J Orthodontics, 1975;68:457.&#xD;
	&#xD;
	&#xD;
	Samuels RH, Orth D, Orth M. A review of orthodontic face-bow injuriesand safety equipment. Am J Ortho Dentofacial Orthop. 1996 Sep 1;110(3):269-72.&#xD;
	&#xD;
	&#xD;
	Consolaro A, Romano FL. Reasons for mini-implants failure: choosing installation site should be valued!. Dental press journal of orthodontics. 2014 Apr;19(2):18-24.&#xD;
	&#xD;
	&#xD;
	Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J Orthodont Dentofacia lOrthopedics. 2007 Apr 1;131(4):S43-51.&#xD;
	&#xD;
	&#xD;
	Long H, Pyakurel U, Wang Y, Liao L, Zhou Y, Lai W. Interventions for accelerating orthodontic tooth movement: A systematic review. The Angle Orthodontist. 2013 Jan 1;83(1):164-71.&#xD;
	&#xD;
	&#xD;
	Mathews DP, Kokich VG. Accelerating tooth movement: the case against corticotomy-induced orthodontics. Ame J Orthod Dentofacial Orthoped. 2013 Jul 1;144(1):11.&#xD;
	&#xD;
	&#xD;
	Shenava S, Nayak KU, Bhaskar V, Nayak A. Accelerated orthodontics&#x2013;a review. Int J Sci Study. 2014 Feb;1(5):35-9.&#xD;
	&#xD;
	&#xD;
	Puryer J, McNamara C, Sandy J, Ireland T. An ingested orthodontic wire fragment: a case report. Dentistry J. 2016 Sep;4(3):24.&#xD;
	&#xD;
	&#xD;
	British Orthodontic Society .&#xA0;Advice Sheet&#x2014;Guidelines for the Management of Inhaled or Ingested Foreign Bodies.&#xA0;British Orthodontic Society; London, UK: 2011.&#xD;
	&#xD;
	&#xD;
	Cameron SM, Whitlock WL, Tabor MS. Foreign body aspiration in dentistry: a review. J Am Dent Assoc. 1996 Aug;127(8):1224-9. &#xD;
	&#xD;
	&#xD;
	Al-Wahadni A, Al Hamad KQ, Al-Tarawneh A. Foreign body ingestion and aspiration in dentistry: a review of the literature and reports of three cases. Dental update. 2006 Nov 2;33(9):561-70.&#xD;
	&#xD;
	&#xD;
	Wheeler TT. Orthodontic clear aligner treatment. InSeminars in Orthodontics 2017 Mar 1;23(1):83-89. WB Saunders.&#xD;
	&#xD;
	&#xD;
	Papageorgiou SN, Koletsi D, Iliadi A, Peltomaki T, Eliades T. Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses. Eur J Orthod. 2020 Jun 23;42(3):331-43.&#xD;
	&#xD;
	&#xD;
	Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta?analysis. Orthod Craniof Res. 2017 Aug;20(3):127-33.&#xD;
	&#xD;
	&#xD;
	Allareddy V, Nalliah R, Lee MK, Rampa S, Allareddy V. Adverse clinical events reported during Invisalign treatment: Analysis of the MAUDE database. Am J Orthod Dentofacial Orthoped. 2017 Nov 1;152(5):706-10.&#xD;
	&#xD;
	&#xD;
	Bakula A, Lugovi?-Mihi? L, Situm M, Turcin J, Sinkovi? A. Contact allergy in the mouth: diversity of clinical presentations and diagnosis of common allergens relevant to dental practice. ActaClin Croat. 2011 Dec 14;50(4):553-61.&#xD;
	&#xD;
	&#xD;
	Kim H, Johnson JW. Corrosion of stainless steel, nickel-titanium, coated nickel-titanium, and titanium orthodontic wires. Angle Orthod. 1999 Feb;69(1):39-44&#xD;
	&#xD;
	&#xD;
	Rahilly, G. Current Products and Practice: Nickel allergy and orthodontics. J Orthod. 2003 June; 30(2):171-174&#xD;
	&#xD;
	&#xD;
	Patel A, Burden DJ, Sandler J. Medical disorders and orthodontics. J Orthod. 2009 Dec;36 Suppl:1-21&#xD;
	&#xD;
	&#xD;
	Neiburger EJ. A case of possible latex allergy. J Clin Orthodon : JCO. 1991 Sep;25(9):559-560.&#xD;
	&#xD;
	&#xD;
	Hain MA, Longman LP, Field EA, Harrison JE. Natural rubber latex allergy: implications for the orthodontist. J Orthod. 2007 Mar;34(1):6-11&#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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pitfalls and Complications in The Treatment of Cervical Spinal Fractures in Patients with Ankylosing Spondylitis: A Retrospective Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>238</FirstPage><LastPage>243</LastPage><AuthorList><Author>Abdul Razaque Mari</Author><AuthorLanguage>English</AuthorLanguage><Author> Niaz Hussain Keerio</Author><AuthorLanguage>English</AuthorLanguage><Author> Muhammad Aslam Shaikh</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Aamir Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Muzamil Dilber5</Author><AuthorLanguage>English</AuthorLanguage><Author> Fahmida Arab Mallah</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Shahid Noor</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Ankylosing spondylitis is one of the challenging disorders when it comes to managing with surgical treatment. The modified New York criteria include axial lumber pain greater than 3 months which may be reduced by exercise but not by bed rest. Concerning the spinal involvement ankylosing spondylitis ascending inflammation and calcifies the ligamentous insertion points, facet joints, and the annulus fibrosis.&#xD;
Objectives: To evaluate the patient&#x2019;s characteristics, diagnostic criteria and complications of surgical treatment of spinal injuries in patients with ankylosing spondylitis.&#xD;
Study Design: Retrospective Study&#xD;
Place and Duration: This study was conducted in People&#x2019;s University of Medical and Health Sciences for women Nawabshah, Pakistan from January 2019 to December 2020&#xD;
Methodology: We used the impairment scale of the American Spinal Injury Association (ASIA) for analyzing clinical outcomes. Furthermore, British Medical Research Council (BMRC) grading system was also used to analyze the patient&#x2019;s outcomes. We recorded trauma time, diagnosis time, and surgical intervention for analyzing the results. Patient characteristics and outcomes were also reported. For analyzing the fractures related parameters we performed CT and MRI scanning of all patients before surgery.&#xD;
Results: In this study, we recruited 60 patients diagnosed with fractures of the cervical, thoracic, and lumbar spine. A total of 18.3% patients reported surgical complications whereas surgical revision was required in 13.3% cases. Postoperative pneumonia, pulmonary decompensation, and cardiac decompensation were observed in 38.3%, 25%, and 20% of patients respectively.&#xD;
Conclusion: Our study concluded that ankylosing spondylitis patients having cervical spine fractures required special treatment. These patients are more prone to spinal injury even after trivial trauma. Comorbidities and advanced age increase the complications ratio and even result in death.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cervical spine fractures, Ankylosing spondylitis, CT and MRI findings, Surgical treatment, Postoperative pneumonia, patients</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4313</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4313</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Common Complaints and Prescribed Drugs in the Orthopedic&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>244</FirstPage><LastPage>247</LastPage><AuthorList><Author>Abdul Hamid Kakar</Author><AuthorLanguage>English</AuthorLanguage><Author> Muhammad Hamayun Hameed</Author><AuthorLanguage>English</AuthorLanguage><Author> Sajjad Rasool Chaudhary</Author><AuthorLanguage>English</AuthorLanguage><Author> Fayez M. Bin Omran</Author><AuthorLanguage>English</AuthorLanguage><Author> Niaz Hussain Keerio</Author><AuthorLanguage>English</AuthorLanguage><Author> Imtiaz Ahmed Tago</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Pharmacotherapy is an important part of maintaining one&#x2019;s health. Medications are used to manage symptoms, control disease progression, and prevent new diseases in many situations. Drug usage studies have proved extremely useful in determining the effects of medications and prescribing patterns on healthcare. They are essential for using evidence-based medicine and making healthcare decisions. Aim: To assess the prevalence of patient complaints and drug prescriptions in the orthopedics Study Design: Cross-sectional Study Place and Duration: Bolan Medical complex Hospital Quetta Balochistan, Pakistan from June 2019 to June 2020 Methodology: Patients aged 12 to 80 years old who visited the orthopedic department were included with convenience sampling strategy. Prescriptions of 377 patients were evaluated. Data was collected on a predesigned form downloaded from the WHO website. Pharma Guide was used to assess the generic names of the prescribed drugs. SPSS version 20 was used for descriptive analysis. Results: The results showed a higher number of males, 61.53% (n=232), and in the age group of 61 and above. Lower back pain was reported in 165 (43.76 %) of the patients. Total 95 (25.19%) patients came due to fractures. A total of 377 prescriptions were written, with 1925 medications being prescribed. This equates to an average of 5.10 pills per patient. Analgesics, Gastroprotective medicines and Antibiotics were prescribed in 751 (39.01%), 394 (20.46%) and 371 (19.27%) prescriptions, respectively. Conclusion: Multidrug prescription is very common. Analgesics, stomach acid inhibitors, and antimicrobials are commonly used in orthopedic outpatient department (OPD).&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Drug Prescriptions, Orthopedics, Outpatient department, Medicines, Vital, Medications</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4314</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4314</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Clinical, Radiological Findings and Mortality in Cervical Spine Fractures Associated with Ankylosing Spondylitis: A Cross-Sectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>248</FirstPage><LastPage>251</LastPage><AuthorList><Author>Syed Aamir Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Shabnam Nawaz</Author><AuthorLanguage>English</AuthorLanguage><Author> Niaz Hussain Keerio</Author><AuthorLanguage>English</AuthorLanguage><Author> Obaidullah</Author><AuthorLanguage>English</AuthorLanguage><Author> Wajeeha Siddique</Author><AuthorLanguage>English</AuthorLanguage><Author> Abdul Raheem Gul Mohammad</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Shahid Noor</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Ankylosed spine fractures are widespread due to a patient&#x2019;s gradual lack of mobility and secondary osteoporosis. Difficulties in radiographic evaluation of the spine in patients with AS are due to their osteoporosis that may further obscure the diagnosis. Ossified disc spaces may be poorly defined in certain circumstances Aim: To assess the radiological data, clinical findings, and mortality rates in patients with ankylosing spondylitis aggravated by cervical trauma. Study Design: Cross-sectional study Place and Duration: Pakistan institute of medical sciences Islamabad, Pakistan from August 2019 to August 2020 Methodology: We looked at 18 individuals who had been hospitalized to the Spinal Injury Unit with cervical trauma and ankylosing spondylitis. All of the patients had long-term ankylosing spondylitis, with a standard of 22 years and a range of 11 to 40 years. A total of eight individuals were fractured as a consequence of minor mishaps. Four patients were hurt by falls from great heights, while five more were injured in traffic incidents. Results: All patients were suffering from a long-term disease, and half of them had fractures due to minor incidents. Patients with a fracture line that entered the disc space had a less neurological impairment and had a better prognosis. Although horizontal displacement &amp; angulation were not connected to a better outcome, but distraction at the fracture site had better prognosis. Seven patients died due to falls from a sitting or standing posture, while the eighth was killed due to a strike to the face. Conclusion: According to this study, even minor trauma may cause a cervical fracture with neurological implications in those with ankylosing spondylitis. In patients with ankylosing spondylitis and cervical injury, the location of the fracture in respect to the vertebral bodies &amp; discs seems to be prognostic. All clients with ankylosing spondylitis &amp; cervical injury should have a complete radiographic evaluation performed.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cervical Injury, Ankylosing Spondylitis, Neurological manifestations, Fracture, Cervical injury, Patients</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4315</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4315</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Incidence of Deep Venous Thrombosis Followed by Fracture of Neck of Femur in the Elderly Patients with Prophylaxis of Anticoagulant: A Cross-Sectional Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>252</FirstPage><LastPage>255</LastPage><AuthorList><Author>Syed Muhammad Khalid Karim</Author><AuthorLanguage>English</AuthorLanguage><Author> Niaz Hussain Keerio</Author><AuthorLanguage>English</AuthorLanguage><Author> Sajjad Hussain Bhatti</Author><AuthorLanguage>English</AuthorLanguage><Author> Zahoor Illahi Soomro</Author><AuthorLanguage>English</AuthorLanguage><Author> Jamil Ahmed Khoso</Author><AuthorLanguage>English</AuthorLanguage><Author> Ghazanfar Ali Shah</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Fracture of the neck of the femur is the most common fracture due to osteoporosis in the elderly population. Almost one-third of the patients with such fractures lead to mortality.&#xD;
Aim: To determine the incidence of deep vein thrombosis in elderly patients with a fracture in the head of femur and prophylactic administration of anticoagulants.&#xD;
Methodology: Elderly patients (age above 60 years) with fractures in the head of the femur were included in this study. They should have either extracapsular or extracapsular fracture of the neck of the femur. According to the exclusion criteria, patients who were below 60 years old and have a fracture of the neck of the femur but also had multiple traumas and a previous history of deep vein thrombosis. All patients who were non-compliant to the prophylactic drugs were also categorized in exclusion criteria. The patients were administered prophylactic anticoagulants on admission. All the patients were investigated through Color Doppler Ultrasonography when they were admitted for the confirmation and documenting the diagnosis.&#xD;
Result: Total 60 patients standing the inclusion criteria were selected. All of them were above the age of 60 years. They all were given thromboprophylaxis. Total 12 out of 60 patients presented with deep vein thrombosis.&#xD;
Conclusion: Deep vein thrombosis is quite common in patients with fractures of the head of the femur and they must be given anticoagulation prophylactically. In the present study, all patients received the drug enoxaparin for the prevention of DVT, however, significant number of patients still present with the deep vein thrombosis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Deep vein thrombosis, Anticoagulant, Fracture of head of femur, Thromboprophylaxis, Color Doppler Ultrasonography, diagnosis</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4364</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4364</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparison of Lateral and Posterior Surgical Approach in the Treatment of Type III Supracondylar Humeral Fracture in Children: A Retrospective Analysis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>256</FirstPage><LastPage>259</LastPage><AuthorList><Author>Ghazanfar Ali Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Jamil Ahmed Khoso</Author><AuthorLanguage>English</AuthorLanguage><Author> Zahoor Illahi Soomro</Author><AuthorLanguage>English</AuthorLanguage><Author> Sajjad Hussain Bhatti</Author><AuthorLanguage>English</AuthorLanguage><Author> Niaz Hussain Keerio</Author><AuthorLanguage>English</AuthorLanguage><Author> Syed Muhammad Khalid Karim</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Among the elbow fractures, the most common elbow fracture observed in children are the supracondylar humeral fracture. The advancement of modern surgical techniques has reduced the incidence rate of compartment syndrome and malunion. For the treatment of supracondylar humeral fractures, techniques such as closed reduction, traction, splint closed reduction, open reduction, k-wire fixation, and percutaneous pinning are used. There are different approaches that are applied for open reduction method which include double incision method (lateral and medial), medial, anterior, posterior and lateral approach. Till date among all these approaches, the posterior approach via muscles of triceps has produced very good results. Different studies have been conducted to compare the anterior and posterior approaches of surgical treatment.&#xD;
Aim: To compare the results of posterior and lateral surgical approaches while treating the type III supracondylar humeral fracture in children.&#xD;
Methodology: This study included 82 children, who had undergone the surgical treatment, 52 patients were treated by the posterior approach, and 30 patients were treated by the lateral approach. Both the groups had their follow up till 6 months postoperatively.&#xD;
Results: It was observed that the posterior approach had a very short surgery time as compared to the lateral approach. The results obtained according to the Flynn&#x2019;s criteria were 80.7% in the posterior group and 80% in the lateral group, and no statistical significance was observed between the two groups.&#xD;
Conclusion: The posterior approach had shorter operating time as compared to the lateral approach, however, no statistical significance was determined between the two groups in terms of functional results and complications.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Supracondylar humeral fracture, Lateral approach, Posterior approach, Children, statistical significance, Functional results</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4365</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4365</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>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Efficacy of the ABCDE Bundle to Improve the Outcome of Patients in the Intensive Care Unit&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>260</FirstPage><LastPage>264</LastPage><AuthorList><Author>Ankita Adesh Patkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Vaishali R. Mohite</Author><AuthorLanguage>English</AuthorLanguage><Author> Samir K. Choudhari</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahadeo Shinde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: A multidisciplinary team, cutting-edge technology, and state-of-the-art equipment are all available to severely sick patients in intensive care units. These facilities also provide continuous monitoring of patients who are in critical condition. Aims: To improve a patient&#x2019;s physical and cognitive status. Materials and Method: An observational study that was not experimental was conducted out on patients receiving mechanical ventilation in the intensive care unit. The non-probability convenient sampling method was used to recruit a total of three hundred and fifty samples for the sample. The intensive care unit was the setting for the investigation. Patients who were hospitalised to the ICU and were receiving support from a mechanical ventilator were considered for participation in this study. Result: The findings indicate that out of 350 patients, 48.9% fell within the age range of 51&#x2013;70 years, while 96 patients (27.4%) were older than 70 years. Regarding the question of gender, 56.6% of them were men while 152 of them (43.4% of the total) were females. According to the findings of this study, 1.4% of patients exhibited inadequate performance on the sedation awakening trial (SAT). The SAT scores of 32.9% of patients were considered to be average, while 65.7% of patients had good SAT scores. 2.3% of patients had a low score on the Spontaneous Breathing Trial (SBT), 46.6% of patients had an average score for the SBT, and 51.1% of patients had a high score on the SBT. Conclusion: The process of deploying the ABCDE bundles is producing improved results for the outcomes of patients who are being treated in the intensive care unit.&#xD;
&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4638</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4638</Fulltext></URLs><References></References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>11</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>4</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Comparison of the Efficacy of Magnesium Sulphate and Cold Application for the Treatment of Thrombo Phlebitis in Patients Undergoing Intravenous Therapy at a Tertiary Care Hospital&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
	&#xA0;&#xD;
&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>265</FirstPage><LastPage>274</LastPage><AuthorList><Author>Shivali Vitthal Kumbhar</Author><AuthorLanguage>English</AuthorLanguage><Author> Tukaram B. Zagade</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahadeo B. Shinde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: In hospitals, providing care for patients typically includes the utilization of various intravenous devices. The monitoring of a patient&#x2019;s hemodynamic condition as well as the delivery of fluids, nutrition, medicines, and blood products are all accomplished with the assistance of these instruments. Up to eighty percent of hospitalized patients in contemporary medical practice are given intravenous therapy at some point during their hospitalization. This treatment can be given at any time during the patient&#x2019;s stay. Even though peripheral IVs seldom cause serious difficulties, problems might arise, especially when they are used for an extended period of time. Because of this, different hospitals have developed different sets of rules about the suggested amount of time that a peripheral IV should be in place. Early detection, as well as clear and open communication between the patient and the healthcare provider, is essential in the event that a medical procedure results in a side effect or complication of any kind. Aims: The purpose of this study is to compare the efficacy of magnesium sulphate application and cold application for the treatment of thrombophlebitis in patients who are receiving intravenous therapy in a tertiary care hospital. Objectives to determine whether or not the application of cold can effectively treat thrombophlebitis. To determine whether or not magnesium sulphate is effective in treating thrombophlebitis. In order to evaluate the relative efficacy of magnesium sulphate and cold application in the treatment of thrombophlebitis. Material and Method: Techniques and Components Among the 32 patients who participated in the study, an evaluation was carried out using a method called straightforward random sampling. A total of 16 samples were allotted to the group that was to receive the cold treatment, and the same number of samples were given to the group that was to receive the magnesium sulphate application. The research approach known as the pre-experimental two-group design was utilised for the investigation. The medical and surgical wards of the tertiary care hospital located in Karad were chosen as the location for this particular research project. Patients who have acquired thrombophlebitis and are now being treated in medical and/or surgical wards at tertiary care hospitals make up the population of the current research study. Results: In order to determine whether or not there was an effect of cold treatment on thrombophlebitis in group A, a non-parametric repeated ANOVA was carried out using the Friedman test. It was discovered that, beginning on day 2 and continuing onwards, there was a significant decrease in the readings of score on the thrombophlebitis measuring chart when cold treatment was performed each time in group A (p 0.001). When performing a non-parametric repeated ANOVA, the Friedman test was utilised to determine whether or not there was an effect of magnesium sulphate treatment on thrombophlebitis in group B. It was shown that there was a substantial drop in the readings of score of thrombophlebitis measurement chart, beginning on day 1 and continuing onwards for magnesium sulphate application three times in group B (p less than 0.001) According to the findings of the Mann Whitney U test, there was a statistically significant difference between groups A and B regarding the thrombophlebitis assessment grading scale for the various therapies (p less than 0.05). The fact that the median score for magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that the magnesium sulphate paste application was more effective than the cold application. Conclusion: The findings of the study indicated that there was a significant difference between groups A and B with regard to the thrombophlebitis assessment grading scale for various therapies (p less than 0.05). The fact that the median score in magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that magnesium sulphate application was more effective than the application of cold.&#xD;
&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Thrombophlebitis, Cold application, Magnesium sulphate application, Therapies, Lifestyles, Hospitalisation</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4639</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4639</Fulltext></URLs><References>&#xD;
	1. Hunter ES, Bell E, Staub MA, Coyle G. Relationship of local iv complications and the method of intermittenti. v. access. J Infus Nurs. 1995;18(4):202-6. &#xD;
&#xD;
&#xD;
&#xD;
	2. Saini B, Paul P. The effectiveness of cold application, heparinoid application and magnesium sulphate application on superficial thrombophlebitis among patients. Int. J. Nurs. Stud. 2011 Jan;2(1):4. &#xD;
&#xD;
&#xD;
&#xD;
	3. Varghese AT, Moly K. Effectiveness of magnesium sulfate with glycerine versus cold compress on patients with peripheral intravenous cannula induced phlebitis. Asian J Pharm Clin Res. 2018;11:275-8. &#xD;
&#xD;
&#xD;
&#xD;
	4. Ahlqvist M, Bogren A, Hagman S, Nazar I, Nilsson K, Nordin K, Valfridsson BS, S&#xF6;derlund M, Nordstr&#xF6;m G. Handling of peripheral intravenous cannulae: effects of evidence?based clinical guidelines. J. Clin. Nurs. 2006 Nov;15(11):1354-61. &#xD;
&#xD;
&#xD;
&#xD;
	5. Ascoli GB, Deguzman PB, Rowlands A. Peripheral intravenous catheter complication rates between those indwelling&gt; 96 hours&#xA0;to those indwelling 72-96 hours: a retrospective correlational study. Int J Nurs. 2012;1(2):7-12. &#xD;
&#xD;
&#xD;
&#xD;
	6. Tertuliano AC, Borges JD, Fortunato RA, Oliveira AL, Poveda VB. Phlebitis associated with peripheral intravenous catheter among in-patients of a Hospital in Vale do Para&#xED;ba. Rev Min Enferm. 2014 Jun;18(2):334-9. &#xD;
&#xD;
&#xD;
&#xD;
	7. Mandal A, Raghu K. Study on incidence of phlebitis following the use of peripheral intravenous catheter. Fam. Med. Prim. Care Rev. 2019 Sep;8(9):2827. &#xD;
&#xD;
&#xD;
&#xD;
	8. Saini V, Samra T, Ahuja N, Sethi S. A prospective randomized study to evaluate safety and efficacy of heparin topical solution (1000 IU/ml) compared to heparin topical gel (200 IU/g) in prevention of infusion-associated phlebitis. Indian J. Pharmacol. 2018 Nov;50(6):344. &#xD;
&#xD;
&#xD;
&#xD;
	9. Ravindra HN, Patel KD. A quasi experimental study to evaluate effectiveness of glycerin magnesium sulphate dressing on phlebitis among patients undergoing peripheral intravenous infusion in selected hospital, Vadodara. Int J Med Sci Public Health. 2015;4(3):527-30. &#xD;
&#xD;
&#xD;
&#xD;
	10. Sharon Sumi P. A Quasi Experimental study to Evaluate the Effectiveness of Aloe Vera Extract Application in Reducing Pain among Phlebitis Patients in Selected Hospitals at Kanyakumari District (Doctoral dissertation, Annammal College of Nursing, Kuzhithurai). &#xD;
&#xD;
&#xD;
&#xD;
	11. Rukhsana, Rahman, Tamang, Kochhar, A Quasi-experimental Study to Assess the Effectiveness of Cold Application versus Glycerin Magnesium Sulphate Application in Relieving Phlebitis among Patients, 2016: Vol 5, No. 2.&#xD;
&#xD;
&#xD;
&#xD;
	12. &#xD;
&#xD;
&#xD;
&#xD;
	13. Ravindra HN ; A quasi-experimental study to evaluate effectiveness of glycerin magnesium.&#xD;
&#xD;
&#xD;
&#xD;
	14. Hua G, Ying-jia L, Hui-juan M, Efficacy observation of glycerine magnesium sulphate emulsion on the treatment of peripheral phlebitis, (2007). &#xD;
&#xD;
&#xD;
&#xD;
	15. George SC, Tata ST, Effectiveness of magnesium sulphate crystal fomentation vs glycerine magnesium sulphate paste applicaton for phlebitis among children receiving peripberal infusion in krishna hospital, Karad, (2015)&#xD;
&#xD;
</References></Article></ArticleSet></xml>