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<xml><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of Occupational Background over Fertility Issues among Males in Vidarbha Region: 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=3815</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3815</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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Animation Therapy for Improving Social Interaction in Children with Autism Spectrum Disorder&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>08</LastPage><AuthorList><Author>Senthil V</Author><AuthorLanguage>English</AuthorLanguage><Author> Ancy R</Author><AuthorLanguage>English</AuthorLanguage><Author> Christopher AV</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Animation is about creativity, movement, and imagination. It offers the opportunity to bring an object, drawing or person to life. The creative process of animation has been adapted to provide a clinically effective framework to complement evidence-based therapeutic practice. Using simple techniques, this approach has been designed to facilitate motivation with difficult-to-reach clients. With the flexibility to work with verbal, non-verbal materials animation enables the service user to express thoughts and feelings using visual, tactile, and auditory techniques. Aim: To identify high functioning autism children using the High-Functioning Autism Spectrum Screening Questionnaire (ASSQ). To review the effect of animation therapy for improving social skills, communication, and self-confidence in an experimental group of youngsters with an autism spectrum disorder. Method: The study was done on 40 subjects, 20 in the control group and 20 in the experimental group. The screening for top functioning autism clients was done using the High-Functioning Autism Spectrum Screening Questionnaire (ASSQ). The pre-test and post-test were done using the Gilliam Autism Rating Scale (GARS-2). The scores of both groups were compared to find out the effectiveness. Result: Statistical analysis shows there is a statistically important distinction in the social interaction of youngsters. Conclusion: This study concludes that animation medical care is simpler in up social interaction in kids with syndrome Autism Spectrum Disorder.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Chemical imbalance is a complex formative incapacity that regularly shows during the initial three years of life. This neurological problem influences the typical working of the mind, affecting advancement in zones of social cooperation, correspondence, and conduct. The activity is about inventiveness, development, and creative mind.1 It offers the occasion to bring an article, attracting or individual to live. The capacity of liveliness cycles to speak to change and change which be a unique picture seems, by all accounts, to be significant in the restorative cycle and this is being investigated further effectively and essentially. By doing liveliness - the individual, family or gathering effectively take an interest utilizing an active methodology, with the movement cycle for helpful purposes custom fitted to their novel necessities.2, 3&#xD;
&#xD;
Animation Therapy&#xD;
&#xD;
Animation can be used as a strong yet sensitive tool in a therapeutic context to help people to tell their stories and to express emotions, thoughts, and feelings. It enables people to directly and non -directly explore issues and needs therapeutically in a visual, tactile and auditory way. Techniques can be used that extends beyond words and generates different ways of looking at something relevant in a person&amp;#39;s life or therapeutic process.&#xD;
&#xD;
Activity can be utilized as a solid yet touchy instrument in a remedial setting to help individuals to recount their accounts and to communicate feelings, contemplations, and emotions. It empowers individuals to straightforwardly and non - legitimately investigate issues and needs restoratively in a visual, material, and hear-able way. Procedures can be utilized that reaches out incredible and produces various perspectives that are applicable in an individual&amp;#39;s life or restorative cycle.1&#xD;
&#xD;
Why Occupational Therapy and Animation?&#xD;
&#xD;
Animation in its nature involves complex processes that can be graded to help clients achieve optimum occupational performance levels with the right therapeutic facilitation. If the core of occupational therapy is the therapeutic use of an activity to enable independence, optimum -performance and healing, then the benefits of offering animation as a treatment could be as follows: It crosses generation gaps. Animation can be accessible for the very young children &amp; elderly alike if they consider it to be a purposeful activity.1&#xD;
&#xD;
Animation can be incorporated into skills-based training (for example social skills, anxiety and anger control programs) taught on an individual basis or with groups. Animation is essentially a group process in nature with many different roles uniting to contribute to the end product. The therapist can, however, adopt the techniques for individual sessions according to the person&#x2019;s unique interests. The need to work with other people (either directly or non-directly) makes it useful for exploring relationships. Parent-child attachments can be explored through the animation process, building relationships through child-led exploration. Therapy can also be targeted for specific conditions by breaking the activity down into its parts, increasing self-esteem and self-worth and enable therapeutic risk-taking.1&#xD;
&#xD;
Within an institutional setting, for example, forensic psychiatry; youth offending institutes; children requiring long periods of hospitalization; animation enables the client to project into a world of imagination to offer hope and prepare for change. What appears to be unique about the use of animation as an activity in therapy is the range of creative possibilities and activities that can be explored. This can be subsequently tailored into a program of activity and discovery which is specifically motivating for young people lead by their interests, pitched at their level of function.1&#xD;
&#xD;
Activity in its tendency includes complex cycles that can be evaluated to assist customers with accomplishing ideal word related execution levels with the correct restorative help. If the centre of word related treatment is the remedial utilization of an action to empower autonomy, ideal execution, and mending, at that point the advantages of offering movement as a treatment could be as per the following: It crosses age holes. Movement can be open for little youngsters and older the same on the off chance that they believe it to be an intentional action. Liveliness can be consolidated into abilities-based preparing (for instance social aptitudes, tension, and outrage control programs) educated on an individual premise or with gatherings.1 &#xD;
&#xD;
Literature Review &#xD;
&#xD;
Helen RM did a study on activity with explicit conditions: From her underlying perceptions in clinical work, she found that the accompanying conditions might be helped to utilize movement strategies: Obsessive-enthusiastic turmoil (OCD) - the advisor has used acquainting the youngster with the ideas of OCD as a beast with the aims of externalizing feelings into liveliness.1&#xA0; &#xD;
&#xD;
Ulin work exhibited a steady part of video demonstrating for Autism spectrum disorder (ASD) understudies. By utilizing video displaying using companions, it can significantly build ASD understudies&amp;#39; presentation in social commencements and close shortfalls in peer play. It likewise profited the ordinary training understudies by tolerating ASD understudies in a typical social talk inside the comprehensive setting.2&#xD;
&#xD;
Massaro directed an investigation on improving the jargon of kids with hearing misfortune: The objective of this examination was to test the adequacy of a language PC energized coach, for showing new jargon things to youngsters with a consultation misfortune. Eight understudies with hearing misfortune, between the ages of 6 and 10, were tried and prepared for around 20-30 minutes per day, 2 days every week for around 10 weeks on three classifications of eight words each.3&#xA0; Mayer study shows that activity can improve human learning-particularly when the objective is to advance profound comprehension in five out of five test correlations, understudies performed better on critical thinking move tests when they contemplated liveliness and portrayal without as opposed to with unessential words, video, or sounds.4&#xD;
&#xD;
Sunny did an investigation on setting out to expand information about the clinical introduction, weakness level, related issues, and screening/recognizable proof of young ladies coming to centres with non-determined social as well as consideration deficiencies. An inside and out contextual investigation of six young ladies introducing to clinicians with social deficiencies had demonstrated that they all met measures for mental imbalance. The clinical evaluations were completely performed by the creator.5 Karim propose that more open emergency clinics are needed to receive increasingly more electronic health record&#xA0;(EHR) and EHR functionalities. An occasional appraisal of EHR status should be acted notwithstanding or a piece of an empowering/authorizing approaches that can fundamentally build the pace of appropriation of EHR frameworks.6&#xD;
&#xD;
Marja result shows to assess the legitimacy of the ASSQ. The members of this investigation were drawn from two progressing examines concerning more advanced youngsters with a chemical imbalance.7 Maj study evaluated the dispersion of medically introverted highlights in an all-out populace of kids 7-9 years old and investigated the effect old enough, sex, source, and cooperation inclination on indication report. Instructor and parent types of the Autism Spectrum Screening Questionnaire (ASSQ) were utilized, an all-out populace investigation of 9430 youngsters matured 7-9 years. Finished educator structures were returned for 97% and parent structures for 71% of the kids.8 &#xD;
&#xD;
High scorers were characterized by the Autism Spectrum Screening Questionnaire (ASSQ) approval concentrate by Stephen conveyance of ASSQ scores was discovered to be practically consistent. Of the youngsters with both an educator and a parent structure, 2.1% were characterized as high scorers. Young men scored higher and guardians revealed more manifestations, especially in young ladies.9&#xD;
&#xD;
Yan article shows that the Autism Spectrum Screening Scale (ASSQ) is a 27-thing agenda initially created in Sweden and distributed in English for evaluations of Asperger condition and other advanced ASDs. The utility in Chinese-talking populaces was at this point to be set up.10 &#xD;
&#xD;
The Gilliam Autism Rating Scale (GARS) was created as a generally simple, modest guide in the reconnaissance and finding of chemical imbalance. This examination analyzed the legitimacy of the GARS when utilized with an example of 119 youngsters with severe DSM-IV conclusions of chemical imbalance, learned from both clinical and exploration settings. The GARS reliably thought little of the probability that mentally unbalanced youngsters in this example would be delegated having a chemical imbalance.11 The Autism Spectrum Screening Questionnaire (ASSQ) has recently been appeared to have great screening properties in clinical settings. This investigation utilized the ASSQ to screen a complete populace of 7-9-year-olds (N = 9430) for ASD in the Bergen Child Study.12&#xD;
&#xD;
The reason for this investigation was to investigate the legitimacy and dependability of the Turkish Version of the Gilliam Autism Rating Scale-2 (TV-GARS-2). Members included 436 youngsters determined to have a chemical imbalance (331 male and 105 females. Information was likewise gathered from people determined to have a scholarly handicap, with hearing debilitation, and from regularly creating kids to analyze segregation legitimacy of the TV-GARS-2.13&#xD;
&#xD;
Qualitative contrasts in social communication style exist inside the chemical imbalance range. In this investigation, we inspected whether these distinctions are related to (1) the seriousness of medically introverted indications and comorbid problematic conduct issues, (2) the kid&amp;#39;s psycho-social wellbeing, and (3) chief working and point of view taking aptitudes. The social association style of 156 youngsters and youths (6-19 years) with advanced chemical imbalance range problem (HFASD) was resolved.14 This examination investigation the real relational working existing with recognizable accomplices in regular daily existence.15&#xD;
&#xD;
The mental strengthening of medical attendants can upgrade their consistency and support in security measures. This paper adds to the current security writing and nursing researcher by exhibiting the impact of mental strengthening on wellbeing execution. Seen the executive&#x2019;s duty to security as an arbiter gives bits of knowledge to pioneers. Wellbeing policymakers and security directors (i.e., disease control officials) should keep their medical caretakers engaged mentally and know about their genuine promise to wellbeing to upgrade work environment wellbeing of attendants.16&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
Participants and procedures &#xD;
&#xD;
The investigation was led in KMCH College at the Department of word related treatment, Coimbatore for about a month and a half during December 2018. An example size of (n=40) youngsters with ASD were taken, who were separated into 2 gatherings exploratory (n=20) and control (n=20) gathering. Advantageous the arbitrary inspecting procedure was utilized to choose the investigation subjects. Inclusion criteria: Children who are diagnosed with ASD by a psychiatrist or a paediatrician, Children of age group 6-18 years, Children of both sexes, Exclusion criteria: Children with Attention-deficit/hyperactivity disorder (ADHD), Children with visual or hearing impairments, children with apraxia.&#xD;
&#xD;
Tools Used:&#xD;
&#xD;
The High-Functioning Autism Spectrum Screening Questionnaire (ASSQ), A screening poll for Asperger condition and other advanced mental imbalance range issues in young kids. The 27 things were appraised on a 3-point scale (0, 1, and 2), 0-ordinariness, 1-some irregularity, and 2-unequivocal anomaly. Eleven things tap subjects with respect to the social association, 6 cover correspondence issues, and 5 allude to confined and dull conduct. The leftover five things grasp engine ungainliness and other related manifestations including engine and vocal spasms. Absolute scores range from 0 to 54.9&#xD;
&#xD;
Gilliam Autism Rating Scale-2nd Edition&#xD;
&#xD;
The Gilliam Autism Rating Scale&#x2013;Second Edition (GARS-2) tt is a standard referred to as an instrument that mirrors the conceptualizations of chemical imbalance per the Diagnostic and Statistical Manual of Mental Disorders by Gilliam. The GARS-2 uses a normalized score alluded to as the Autism Index. Conduct Checklist with 3 sub-scales comprising of Stereotyped Behaviors, Communication, Social Interaction. The scoring design is 0-Never noticed, 1-rarely noticed, 2-in some cases noticed, and 3-habitually noticed, Concurrent legitimacy was investigated by associating GARS-2 scores with the Autism.17&#xD;
&#xD;
Reliability:&#xD;
&#xD;
The inside consistency of each subscale just as the GARS-2 test was resolved using Cronbach&amp;#39;s coefficient alpha. Coefficients uncover that each subtest, just as the complete Autism Index, is profoundly reliable and subsequently adequate for adding to the determination of mental imbalance. To decide scale soundness, 40 people with mental imbalance were tried twice with the GARS-2 over a 1-week time frame. Test-retest coefficients for each subscale and the all-out score are all past the .01 noteworthiness level, and age-rectified coefficients range from .70 to .90. Connection coefficients were revised for the limitation in range. The outcomes show a high relationship for the Autism Index.&#xD;
&#xD;
Data Collection Procedure:&#xD;
&#xD;
Assent was taken from the top of the organizations and guardians to lead the investigation. The reason for the examination was disclosed to the guardians before the initiation of the investigation. The youngsters were similarly gathered into two as test and control gathering (20 in each gathering). Pretest was accomplished for the 40 kids utilizing the GARS-2 scale to know the seriousness of mental imbalance. The Autism Spectrum Screening Questionnaire (ASSQ) is utilized to screen out advanced mental imbalance customers. &#xD;
&#xD;
An acquaintance was given with the customers about liveliness treatment and an affinity building meeting was directed. To begin with, they were shown movement procedures for the initial 15 minutes and afterwards for 30 minutes they needed to make models utilizing dirt, polished papers, garments and so forth At that point, a set is made utilizing these models and different materials like diagram papers and crepe papers. Pictures of models are caught and placed into the PC and saw. They are educated to make flipbooks utilizing papers and paints, These meetings were was proceeded for 1and off months, Posttest was finished utilizing GARS-2 scale following one and off a long time for both test and control gathering, Using factual examination the adequacy of activity treatment was finished.&#xD;
&#xD;
SESSION 1: An introduction was given to the clients about animation therapy and a rapport building session was conducted. SESSION 2: First they were taught animation techniques for the first 15 minutes and then for 30 minutes they had to make models using clay, glossy papers, clothes etc. SESSION 3: Then a set is made using these models and other materials like chart papers and crepe papers. SESSION 4: Images of models are captured and put into the computer and viewed. SESSION 5: They are taught to make flipbooks using papers and paints, (1)These sessions were was continued for 1 month, (2) Post-test was done using GARS 2 scale after one month for both experimental and control group, (3) Using statistical analysis the effectiveness of animation therapy was done&#xD;
&#xD;
DATA ANALYSIS AND RESULTS&#xD;
&#xD;
A test of 40 subjects took an interest in the investigation out of which 20 were in charge gathering and 20 in test gathering. They were analyzed as a "chemical imbalance range problem" utilizing the ASSQ and GARS-2. Information acquired was factually dissected utilizing the Statistical Package of Social Sciences (SPSS) 23rd Edition.&#xD;
&#xD;
Table 1 Shows the ASSQ Scores among the Control group and Experimental group. All participants having High Functioning Autism in this study. Table 2 shows that there is no factually critical distinction between the pretest scores of control and trial bunch among the Stereotype conduct, Communication and Social collaboration. There is no factually critical distinction between the posttest scores of control and test bunch among the Stereotype conduct and Communication. Be that as it may, there is a measurably huge contrast between posttest scores of control and trial bunch among the Social association. Table 3 show that there is a statistically significant difference in the pre and post-test scores for stereotype behaviour, communication, and social interaction in the control and experimental groups. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In this test study, 40 subjects were included out of which 20 subjects were assembled under trial gathering and the other 20 levelled out gathering. Both gatherings bear similar consideration and prohibition standards. At first, all the subjects were analyzed by directing GARS-2, after which the ASSQ was managed for screening out the "advanced mental imbalance" kids. This investigation uncovers that the exploratory gathering who went through movement treatment demonstrated improvement in the GARS-2 scores after treatment (table3). This discovery associate with the investigation done by Helen Rachel Mason, in which test bunch indicated improvement in social abilities, self-articulation, and correspondence.1&#xD;
&#xD;
Every segment of GARS-2 i.e., generalization conduct, correspondence and social collaboration demonstrated changes, in test bunch customers. This discovering corresponds with the examination done by Ravit in movement treatment which detailed enhancements in correspondence.18 This likewise associates to another investigation done by Ann which announced upgrades in social collaboration and self-articulation and a decrease in generalization conduct. The generalization conduct and correspondence segment have decreased by 2-3 scores. The investigation further uncovers that the control bunch additionally indicated improvement in the GARS-2 scores (table-3).19 &#xD;
&#xD;
The test bunch went through movement treatment, recommending that the improvement made by test bunch is for the most part because of activity treatment, which was led for one and off months (5 days of the week) with a span of 45 minutes for each meeting. The pretest scores of exploratory and control bunch were looked at which indicated no distinction among the two and post-test scores of test and control bunch show that there is a distinction in the scores of control and trial gathering, the measurable investigation uncovers that the distinction in scores isn&amp;#39;t at a critical level. In this examination the term of treatment was short and subsequently, further investigations with an all-encompassing span of treatment would be useful. Generally, the examination clarifies that activity treatment is compelling in improving social connection and correspondence in mental imbalanced kids.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The investigation reasoned that movement treatment is powerful in improving social cooperation and correspondence and decreasing generalization conduct in chemical imbalance youngsters. &#xD;
&#xD;
Impediments: The term of study was for a brief period, just a single part of activity treatment was utilized, just a single part of the GARS-2 scale was engaged, and a Limited number of test size was utilized. Proposals: Duration of the investigation should be broadened, the two parts of liveliness treatment can be utilized, All the three segments of GARS-2 scale can be centred around, Therapy can be actualized for different conditions, for example, OCD, Asperger disorder, a Large number of test size can be utilized.&#xD;
&#xD;
Acknowledgement: All professionals do their work by themselves. Although they can be as prolific or as adept in their respective fields, they will still need assistance one way or another. For instance, writing a body of work takes a lot of research. They often depend on their assistants or subordinates to gather information about the subject matter. Aside from the research people, other individuals can also receive credit for their contributions to the writer&#x2019;s work.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
Author Contributions: Mr. Senthil did the Online study and Review of the writing assortment, Ancy did assortment information on the web and cause to dominate sheet for the SPSS information examination design, Dr Christopher Done the measurable investigation utilizing SPSS programming, results, diary configurations and tables, Dr Palanivel did the technique part, Dr Mohsina has done the references and arrangement.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3816</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3816</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Micro-RNA 155 - On the Crosspoint of Inflammation and Carcinogenesis&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xA0;&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>09</FirstPage><LastPage>15</LastPage><AuthorList><Author>Antonia Atanassova</Author><AuthorLanguage>English</AuthorLanguage><Author> Avgustina Georgieva</Author><AuthorLanguage>English</AuthorLanguage><Author> Trifon Chervenkov</Author><AuthorLanguage>English</AuthorLanguage><Author> Assia Konsoulova</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: As miR-155 influences a wide spectrum of inflammatory mediators, the study of this miRNA may suggest a new insight over the cancer development mechanisms. This is why the investigation of the miR-155 expression may reveal a potential relation between inflammation and gastrointestinal cancer. The aim of the current study is to assess the miR-155 expression levels in patients with Crohn&#x2019;s disease (CD) and ulcerative colitis (UC). Materials and Methods: The expression of miR-155 was studied in 70 consecutive patients with a confirmed diagnosis of IBD: 35 with CD and 35 with UC and 30 healthy controls. Disease activity was evaluated by the clinical symptoms, biochemical inflammatory parameters (CRP, FCP) and validated indices for evaluating IBD activity (CDAI for CD, Montreal Classification, and partial Mayo score for UC). 25(OH)D serum concentrations were measured by a commercial paramagnetic particle chemiluminescent immunoassay for the quantitative determination of total 25 - hydroxyvitamin D [25(OH) vitamin D] levels use on Access 2 Immunoassay Systems. Serum expression of miR-155 by reverse transcriptase, a real-time quantitative polymerase chain reaction (RT-qPCR), was tested in all. Results: The analysis of the results showed that the circulating miR-155 was increased in Crohn-colitis (3.51&#xB1;5.22) and extensive UC (2.86&#xB1;5.44). Levels of CDAI above 150 were a risk factor for detection of increased miR-155 expression levels (OR=10, 91 (1.194-99,688); p=0.017). An increased miR-155 expression was detected in patients, treated with corticosteroids (5.20&#xB1;8.91 for UC and 3.39&#xB1;3.10 for CD). There was an inverse proportional moderate correlation with the levels of FCP (r= -0.344 :p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Fecal calprotectin, CRP, Crohn&#x2019;s disease, micro-RNA 155, Ulcerative colitis, Vitamin D</Keywords><Fulltext>&#xD;
Introduction: &#xD;
&#xD;
Micro RNAs (miRNAs) are endogenous non-coding RNAs (ncRNAs), with a length of about 22 nucleotides. The biogenesis of the miRNAs develops in several steps of post-transcriptional modifications in the nucleus and the cytoplasm.1 Over 60% of all genes, that code proteins, are regulated by miRNAs 2,3,4 and one miRNA has on average 200 targets. [5,6,7]&#xD;
&#xD;
miRNAs are important regulators of different cellular processes, including development, differentiation and signalization.8-12 The dysregulation of specific miRNAs may lead to different diseases in humans: metabolic disturbances, cardiovascular or liver diseases as well as immune dysfunction, including the development of neoplasms.13-18&#xD;
&#xD;
The expression of miRNA-155 (miR-155) is related to different cardiovascular diseases, inflammation and cancers. Its multifunctional regulatory role defines the interest towards this particular miRNA, which is considered to be the most extensively studied.&#xD;
&#xD;
Expression of miR-155 was first reported in the human spleen and thymus and subsequently in the liver, lungs and kidneys [19, 10 Later on, it was established that this miRNA has an abnormally increased expression in different activated immune cells [21], which defines the important role of miR-155 in immune response.22,23,24&#xD;
&#xD;
miR-155 responds to many inflammatory stumuli as tumor necrosis factor alfa (TNF- &#x3B1;), interleukin (IL) -1b, interferons, pathogen-associated molecular patterns (PAMP), damage- associated molecular patterns, (DAMP) [25] , alarmins (e.g. IL-1a) [26] , hypoxia [27] , as well as in Toll-like receptor ligans (TLR) in monocytes and macrophages [28] B cells.29&#xD;
&#xD;
The expression of miR-155 is controlled by multiple signal pathways. The regulatory cytokines, including Transforming Growth Factor beta (TGF-&#x3B2;) may induce or inhibit the expression of miR-155 30,31,32 IL-10 decreases its expression via inhibition of the transcription factor Ets2.&#xD;
&#xD;
In IBD, the negative feedback control over the inflammation is disturbed, leading to excessive activation of the inflammatory signal pathways. The suppressor of the cytokine signalization 1 (SOCS1) is a critical negative regulator, blocking the Janus kinases (JAKs), signal transducer and activator of transcription proteins (STATs)- JAK / STAT pathway [33] and suppressing the interleukin-1 receptor-associated kinase 4 (IRAK4) in the Toll-like receptor 4 (TLR4) signal pathway. 34 The rapid increase of miR-155 suppresses the translation of SOCS1 during the endotoxin-induced inflammatory reaction and thus avoiding any suppression of the ongoing inflammatory cascade. 34,35&#xD;
&#xD;
&#xD;
&#xD;
The endogeneous and the synthetic glucocorticoids are highly effective to slow down the process of acute inflammation via suppression of the miR-155 expression in the glucocorticoid receptor and/or via nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB). 36,37 The expression of MiR-155 is regulated by the associated with the immune response transcription factor forkhead box P3 (FOXP3), which regulates the functioning of the T regulatory (Treg) cells. Moreover, miR-155 regulates the special AT-rich sequence-binding protein-1 (SATB1) and Zinc finger E-box-binding homeobox 2 (ZEB2) expression levels in the Treg cells. 38&#xD;
&#xD;
Chen Y, et.al, 2013 (39) identified that the vitamin D receptor signal pathway blocks the activation of NF-kB and thus leads to a decrease in miR-155 levels. As a result of this, the translation of SOCS1 is increased, allowing for an increase in the regulation of the negative feedback over the immune response. 40&#xD;
&#xD;
At least 15-20% of all types of human cancer are related to chronic inflammation: diseases as IBD, colorectal cancer, colitis-associated cancer (in ulcerative colitis), chronic gastritis and H. pylori (gastric cancer, GC).41 As miR-155 influences a wide spectrum of inflammatory mediators, the study of this micro-RNA may suggest a new insight into the cancer development mechanisms. This is why the investigation of the miR-155 expression may reveal a potential relationship between inflammation and gastrointestinal cancer.&#xD;
&#xD;
The current study aims to assess the miR-155 expression levels in patients with Crohn&#x2019;s disease (CD) and ulcerative colitis (UC).&#xD;
&#xD;
Materials and methods: The expression of miR-155 was studied in 70 consecutive patients with a confirmed diagnosis of IBD: 35 with CD and 35 with UC. Patients were treated at the Gastroenterology clinic for a period of one year (April 2019 &#x2013; April 2020). 30 healthy individuals were also tested to define a healthy control study group. All IBD patients were classified according to the Montreal classification. The clinical course and treatment regimens were assessed. Disease activity was evaluated by the clinical symptoms, biochemical inflammatory parameters (C reactive protein - CRP, faecal calprotectin - FCP) and validated indices for evaluating IBD activity (CDAI for CD, Montreal Classification, and partial Mayo score for UC). Biochemical parameters (CRP and FCP) were assessed as either normal or abnormal: FCP was considered as normal if levels were &lt; 50 mg/g; CRP was considered abnormal (elevated) if measured &gt; 5 mg/l. 25(OH)D serum concentrations were measured by a commercial paramagnetic particle chemiluminescent immunoassay for the quantitative determination of total 25-hydroxyvitamin D [25(OH) vitamin D] levels use on Access 2 Immunoassay Systems. Vitamin D deficiency was defined as a serum level of 25OHD lower&#xA0;than 50 nmol/L; serum level above 50 nmol/L but lower than 75 nmol/L were classified as vitamin D insufficiency.&#xD;
&#xD;
&#xD;
&#xD;
Levels of miR-155 were assessed in blood serum. 5 ml of blood was obtained via peripheral venous puncture with closed system BD Vacutainer&#x2122; SST&#x2122; II Advance (Becton Dickinson, USA). After withdrawal, the blood sample was held 30 minutes at room temperature for clothing. Subsequently, it was centrifuged at 500&#xD7;g for 15 minutes at room temperature and the serum was separated and divided into aliquots of 500 &#xB5;l that were immediately stored at&#xA0;&#x2212;80 &#xB0;C until the moment of the analysis.&#xD;
&#xD;
miRNAs were isolated from 200 &#xB5;l serum using a pre-existing commercial miRNeasy Serum/Plasma Kit (50), catalogue ?217184 (QIAGEN, Germany) as per the protocol of the manufacturer. 3,5 &#x3BC;l (1,6&#xD7;108 copies per &#xB5;l) control miRNA C. elegans miR-39: miRNeasy Serum/Plasma Spike-In Control, catalogue ?219610 (QIAGEN, Germany), was added to each sample for normalization control; the samples were afterwards eluted in 14 &#xB5;l RNA-ase free water.&#xD;
&#xD;
Each of the samples was subsequently submitted to reverse transcription via ready-to-use commercial kit miScript II RT Kit (50), catalogue ?218161 (QIAGEN, Germany) as per manufacturer&#x2019;s protocol from 2,5 &#xB5;l eluted miRNA in a final volume of 10 &#xB5;l with HiFlex buffer and it was incubated at 37 &#xB0;C for 60 minutes and the enzyme was inactivated at 95 &#xB0;C for 5 minutes.&#xD;
&#xD;
Each of the samples was then submitted to a quantitative real-time polymerase chain reaction (rt-PCR) via a ready-to-use commercial kit miScript SYBR Green PCR Kit (200), catalogue ? 218073 (QIAGEN, Germany) and prepared primers miScript Primer Assay (100), catalogue ?218300 (QIAGEN, Germany) as per manufacturer&#x2019;s protocol: 1 &#xB5;l complementary DNA (cDNA) in 10 &#xB5;l reactions in 3-times repetitions for 15 target miRNA in 384 well plates. The used miScript Primer Assay primers (100), catalogue ? 218300 (QIAGEN, Germany) were as follows (the reference number is in the brackets): Ce_miR-39_1 (MS00019789), Hs_miR-155_2 (MS00031486), Hs_RNU6-2_11 (MS00033740). The used temperature parameters were as follows: maintenance for 15 minutes at 95 &#xB0;C for enzyme activation; 40 cycles of 15 seconds at 94 &#xB0;C; 30 seconds at 70 &#xB0;C with fluorescent reading; analysis of the melting curve to prove the specificity of the amplification: primary denaturation for 15 seconds at 95 &#xB0;C and cooling to 55 &#xB0;C for 60 seconds with an increase to 95 &#xB0;C with velocity of +0,05 &#xB0;C per second and fluorescent reading. The analysis was done by QuantStudio Dx instrument of Applied Biosystems (USA) company; a threshold cycle (Ct) was assessed for each sample. Receiver Operating Characteristic Curve (ROC) was calculated to detect&#xA0;diagnostic performance of the test, sensitivity, specificity, positive and negative predictive values. The significance of the obtained results was judged at the 5% level.&#xD;
&#xD;
&#xD;
&#xD;
The results were calculated with SPSS, v. 20.0 for Windows. We used variation, correlation, regression analyses as well risk assessment and comparative analyses (c2, t-test, ANOVA). ?</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3817</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3817</Fulltext></URLs><References>1. Denli AM, Tops BB, Plasterk RH, Ketting RF, Hannon GJ. Processing of primary microRNAs by the Microprocessor complex. Nature. 2004 Nov 11;432(7014):231-235. &#xD;
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6. Krek A, Grun D, Poy MN, Wolf R, Rosenberg L, Epstein EJ, et al.&#xA0; Combinatorial microRNA target predictions. Nat Genet. 2005; 37(5):495&#x2013;500.&#xD;
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19. Tam W. Identification and characterization of human BIC, a gene on chromosome 21 that encodes a noncoding RNA. Gene. 2001; 274(1&#x2013;2):157&#x2013;167.&#xD;
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21. Landgraf P, Rusu M, Sheridan R, Sewer A, Iovino N, Aravin A, et al.&#xA0; A mammalian microRNA expression atlas based on small RNA library sequencing. Cell. 2007; 129(7):1401&#x2013;1414.&#xD;
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22. Costinean S, Zanesi N, Pekarsky Y, Tili E, Volinia S, HeeremaN, Croce CM. Pre-B cell proliferation and lymphoblastic leukaemia/high-grade lymphoma in E(mu)-miR155transgenic mice. Proc Natl Acad Sci. U S A 2006; 103(18):7024&#x2013;7029.&#xD;
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28. Mashima R. Physiological roles of miR-155. Immunology. 2015; 145(3):323&#x2013;333.&#xD;
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31. Pottier N, Maurin T, Chevalier B, Puissegur MP, Lebrigand K, Robbe-Sermesant K, et al. Identification of keratinocyte growth factor as a target of microRNA-155 in lung fibroblasts: implication in epithelial-mesenchymal interactions. PLoS One. 2009; 4(8):e6718.&#xD;
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33. Yoshimura A, Naka T, Kubo M. SOCS proteins, cytokine signalling and immune regulation. Nature Revi Immun. 2007; 7, 454-465.&#xD;
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53. Pathak S, Grillo AR, Scarpa M, Brun P, D&#x2019;Inc&#xE0; R, Nai L, et al. MiR-155 modulates the inflammatory phenotype of intestinal myofibroblasts by targeting SOCS1 in ulcerative colitis. Exp Mol Med. 2015; 47: e164. doi: 10.1038/emm.2015.21.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum Stat&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>16</FirstPage><LastPage>22</LastPage><AuthorList><Author>Mona Isam Eldin Osman</Author><AuthorLanguage>English</AuthorLanguage><Author> Elsharif Ahmed Bazie</Author><AuthorLanguage>English</AuthorLanguage><Author> Hayat Osman</Author><AuthorLanguage>English</AuthorLanguage><Author>  Abdalla Abdel Rahman</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aims: This study aims to provide a review that will hopefully facilitate discussion of the children&#x2019;s psychological consequences of sexual abuse. Methods: Cross-sectional, descriptive study. Done in child and family protection centres in Khartoum State from September 2012 to January 2013. All children were interviewed via a questionnaire including socio-demographic characteristics, risk factors and consequences of child sexual abuse were tested using HADS &amp; MINI scales. Results: This study summarizes what is currently known about these potential impacts of child sexual abuse. The various problems and symptoms described in the literature on child sexual abuse are reviewed in a series of broad categories. Children from all backgrounds are vulnerable to CSA but in this study younger children were more vulnerable as they constitute 53.4%. Among them 62.14% were females. Age, family status, number of household and number of rooms and low economic level were found to be associated with CSA. There is a high level of contact sexual abuse 94.17%. There is a low rate of interfamilial sexual abuse 17.48%. There is a high rate of disclosure 56.7%. Result from the high light behavioural consequence of CSA as it shows its association with posttraumatic stress disorder to be 25.2%, anxiety to be 47.57%, and depression to be 35.29%. Conclusion: Research has demonstrated that the extent to which a given individual manifests abuse-related distress is a function of an undetermined number of abuse-specific variables, as well as individual and environmental factors that existed before, or occurred after, the incidents of sexual abuse.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Child, Sexual, Abuse, Khartoum, Sudan</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Child sexual abuse (CSA) defined as the engaging of a child in sexual activities that the child cannot comprehend, for which the child is developmentally unprepared and cannot give informed consent, and violate the social taboos of society .1 &#xD;
&#xD;
Before the 1970s -1980s child, sexual abuse is secretive and socially unspeakable. First studies on child molestation were done in the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. In&#xA0; 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspected child abuse while legal action started in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act&#xA0;in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since that time reported child abuse cases have increased dramatically. In 1979, the&#xA0;National Abuse Coalition&#xA0;was created and they create pressure in Congress to create more sexual abuse laws. Also, feminism&#xA0;waves brought greater awareness of child sexual abuse and&#xA0;violence against women and made them public, political issues. 2,3,4&#xD;
&#xD;
By 1985, more studies that have concentrated specifically on sexually abused children started to publish. Its conceptualization is complex involving several dimensions from the medical, social, psychological, legal, ethical and moral aspect. Increasing recognition came with the women&#x2019;s movement and reports by adult women survivors of CSA. 2,3,4&#xD;
&#xD;
In Europe 10-20% of women and 3-10% of men had experienced sexual abuse before 18 years of age 11. In the United States by 2002 more than 88,000 children were confirmed to have sexual abuse with a woman ranged 15-32% depending upon definitions. 5&#xD;
&#xD;
In a South African study, adolescent girls represented 1/3rd of the total adult rape, sexual coercion and forced sexual abuse. 6&#xD;
&#xD;
Data from the Arab world is scarce. Only two countries (Bahrain &amp;Palestine) have official records maintained by governmental agencies for child maltreatment cases. Hajj Yahia found the rates of sexual abuse among Palestinian students within the range of rates reported in other societies. Research participants indicated that a family member (8.6 %), a relative (36.2%), or a stranger (45.6%), had perpetrated at least one act of sexual abuse against them since early childhood. No significant differences between female and male participants, or among the sociodemographic characteristics of the sample. In addition, significantly higher levels of psychological symptoms were found among victims abused by a family member.7&#xD;
&#xD;
Aetiology of Child Sexual Abuse:&#xD;
&#xD;
Child sexual abuse is a social phenomenon that is linked to general attitudes and practices towards children, and ways in which social relationships are organized and regulated in a particular society 8. The occurrence of sexual abuse is affected by the following 9:&#xD;
&#xD;
&#xD;
	&#xD;
	Motivation, which includes the abuser&#x2019;s sexuality.&#xD;
	&#xD;
	&#xD;
	Absence of internal inhibitors (Moral values of the adult)&#xD;
	&#xD;
	&#xD;
	Absence of external inhibitors (Supervision of the child by others)&#xD;
	&#xD;
	&#xD;
	Child&#x2019;s resistance towards the adult.&#xD;
	&#xD;
&#xD;
&#xD;
The abuser&#x2019;s sexuality and sexual development which includes paedophilia, fear or avoidance of peer sexual relationship, sadism and interpersonal motivators such as the need to overpower more vulnerable persons, arising as a result of one&#x2019;s past abuse and low self-esteem all are acts as motivators. However, the rates of CSA is lower than rates of expressed sexual interest as the inhibiting factors overcome for CSA to occur. Occasions, where the perpetrator&#x2019;s internal inhibitions (e.g. moral values) may be overcome, are the use of alcohol and the presence of stress. Cognitive distortions including rationalization, minimization of the harmful effect of abuse and conceptualization of abuse as &#x2018;love&#x2019; or &#x2018;education&#x2019; may be motivators for abuse. On the other hand, a protective family, secure attachment to the primary caregiver, good monitoring of child&#x2019;s whereabouts and a confiding relationship with the child prevent or decrease the chances of abuse.&#xD;
&#xD;
In &#x2018;Family Systems Theory&#x2019; the basic problem is that of a father-daughter incestuous relationship due to a dysfunctional family arrangement where parents suffer from an &#x2018;emotion-sexual&#x2019; conflict. When the child comes to the parent(s) seeking emotional relief/care and the child gets a sexual response this a CSA. There are two forms of family pathology viz. conflict avoidance and conflict regulation. In the former type, the family is too insecure to cope with acknowledging the abuse and in the latter, though they hide the abuse from the outside world, they openly recognize the abuse, which leads to frequent arguments amongst the members 9.&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Disclosure&#xD;
&#xD;
Most time Child sexual abuse is silent and witness-free that had no physical signs. The delay between the onset&#xA0;of&#xA0;abuse&#xA0;and disclosure is common. Adults usually did not tell anyone about their&#xA0;abuse during childhood. 10&#xD;
&#xD;
Medical Indicators of Child Sexual Abuse&#xD;
&#xD;
Significant development has been in the medical field to diagnose sexual abuse. In the medical diagnosis of CSA, the presence or absence of a hymen was no longer the only indicator of possible sexual abuse and the same progress occurs in genital findings. It is also observed that in the majority of sexually abused children there are no physical findings. These findings, particularly vaginal ones, are most useful with pre-pubertal victims. As children become older, the possibility of consensual sexual activity needs to be considered. Further, changes that occur with puberty render insignificant some symptoms that have great significance in young children. 11&#xD;
&#xD;
Two High-Probability Physical Indicators&#xD;
&#xD;
the highest probability indicators of child sexual abuse are: 11&#xD;
&#xD;
&#xD;
	&#xD;
	Pregnancy in a child and&#xD;
	&#xD;
	&#xD;
	Venereal disease in a child.&#xD;
	&#xD;
&#xD;
&#xD;
DIAGNOSTIC CONSIDERATIONS&#xD;
&#xD;
The diagnosis of child sexual abuse is made on the basis of a child&#x2019;s history and rarely diagnosed based on only physical examination or laboratory findings. Physical findings are often absent even when the perpetrator admits to penetration of the child&#x2019;s genitalia. 12, 13 Most cases of abuse leave no physical evidence, and mucosal injuries often heal rapidly and completely. In a recent study of pregnant adolescents, only 2 of 36 had evidence of penetration. Occasionally, a child presents with clear evidence of anogenital trauma without an adequate history. Abused children may deny the abuse. Findings in child abuse include:12,13&#xD;
&#xD;
&#xD;
	&#xD;
	&#xD;
		&#xD;
		Abrasions or bruising of the genitalia;&#xD;
		&#xD;
		&#xD;
		An acute or healed tear in the posterior aspect of the hymen that extends to or nearly to the base of the hymen;&#xD;
		&#xD;
		&#xD;
		A markedly decreased amount of hymenal tissue or absent hymenal tissue in the posterior aspect;&#xD;
		&#xD;
		&#xD;
		Injury to or scarring of the posterior fourchette, fossa navicularis, or hymen; and&#xD;
		&#xD;
		&#xD;
		Anal bruising or lacerations.&#xD;
		&#xD;
	&#xD;
	&#xD;
&#xD;
&#xD;
Consequences of Child Sexual Abuse&#xD;
&#xD;
The consequences of child sexual abuse are both psychological and physical. Damaged tissue can heal without scarring but psychological consequences persist 14. Pregnancy and sexually transmitted diseases may result in lifelong effects, some of which can be life-threatening. Serious psychological consequences such as suicide attempts and posttraumatic stress occur in most the abused children. Thus all children with suspicion of being sexually abused should be referred for psychological testing and treatment 14,15.&#xD;
&#xD;
METHODOLOGY &#xD;
&#xD;
&#xA0;Study design:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This is a descriptive cross-sectional facility-based study.&#xD;
&#xD;
&#xA0;Study area: &#xD;
&#xD;
The research took place in Khartoum state, in three police centres that belong to the child and family protection unit-Khartoum (Khartoum, Omdurman and Sharg Alneel) with staff working three shifts. Those centres are receiving direct reporting from victims and their families or indirect reporting through hotlines 24 hours a day. Family and Child Protection Unit became operational in Khartoum in January 2007, operating 24 hours. The unit focuses on providing a child and family-friendly environment, which lessens the trauma of child survivors of crimes and reduces secondary victimization. &#xD;
&#xD;
&#xA0;Study period:&#xD;
&#xD;
This study was conducted during the period from September 2012 to January 2013&#xD;
&#xD;
RESULT&#xD;
&#xD;
A total of&#xA0; 103 children who had been sexually abused were studied from the three police centres that are serving family and child protection unit in Khartoum during the study period.&#xD;
&#xD;
Age&#xA0; of&#xA0; the&#xA0; patients&#xA0; ranged&#xA0; between&#xA0; 7 years&#xA0; and&#xA0; 18 years, with&#xA0; a mean&#xA0; of 10.58 &#xB1;&#xA0; 3.1 years&#xA0; (95%&#xA0; confidence interval, CI = 9.97 to 11.19). The age group 7-10 years of age represent 53.4% (n=55) of the sample, 31.07% (n=32) were between 11-14years and 15.53% (n=16) were between 15-</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3818</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3818</Fulltext></URLs><References>&#xD;
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	Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psych Bull. 1993 Jan;113(1):164.&#xD;
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	Hall RC, Hall RC. A profile of paedophilia: definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues. In Mayo Clinic Proc. 2007 Apr; 82(4):457-471. Elsevier.&#xD;
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	Behrman RE, Vaughan III VC. Nelson textbook of paediatrics. WB Saunders Company; 1983.&#xD;
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	Rhind N, Leung T, Choi F. Child sexual abuse in Hong Kong: Double victimization?. Child abuse Neglect. 1999;23(5):511-7.&#xD;
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	Vogeltanz ND, Wilsnack SC, Harris TR, Wilsnack RW, Wonderlich SA, Kristjanson AF. Prevalence and risk factors for childhood sexual abuse in women: National survey findings. Child abus neglect. 1999 Jun 1;23(6):579-92.&#xD;
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	Jewkes R, Abrahams N. The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med. 2002 Oct 1;55(7):1231-44.&#xD;
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	Haj-Yahia MM, Tamish S. The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students. Child abus neglect. 2001 Oct 1;25(10):1303-27.&#xD;
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	Glaser D, Wiseman M. Child sexual abuse. Principles of Medical Biology. 2000 Jan 1;14:357-78.&#xD;
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	Svedin CG, Back C, S&#xF6;derback SB. Family relations, family climate and sexual abuse. Nordic J Psych. 2002 Jan 1;56(5):355-62.&#xD;
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	Fluke J, Harden BJ, Jenkins M, Ruehrdanz A. Research synthesis on child welfare: Disproportionality and disparities. Disparities and disproportionality in child welfare: Analy the Res. 2011 Dec;1.&#xD;
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	Kerns DL, Ritter ML. Medical findings in child sexual abuse cases with perpetrator confessions. Am J Dis Child. 1992;146:494.&#xD;
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	Heger A, Ticson L, Velasquez O, Bernier R. Children referred for possible sexual abuse: medical findings in 2384 children. Child Ab Neglect. 2002 Jun 1;26(6-7):645-59.&#xD;
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	Glaser D. Child abuse and neglect and the brain&#x2014;a review. J child Psychol Psychiatry. 2000 Jan;41(1):97-116.&#xD;
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	Malhotra S, Biswas P. Behavioral and psychological assessment of child sexual abuse in clinical practice. Int J Behav Consul Ther. 2006;2(1):17.&#xD;
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	Putnam FW. Ten-year research update review: Child sexual abuse. Journal of the American Acad Child&#xA0; Adolescent Psych. 2003 Mar 1;42(3):269-78.&#xD;
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	Walsh T, Douglas H. Legal responses to child protection, poverty and homelessness. J Soc Wel Family Law. 2009 Jun 1;31(2):133-46.&#xD;
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	&#xD;
	Mossige S, Jensen TK, Gulbrandsen W, Reichelt S, Tjersland OA. Children&amp;#39;s narratives of sexual abuse: What characterizes them and how do they contribute to meaning-making. Narrat Inq. 2005 Jan 1;15(2):377-404.&#xD;
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	Tabachnick J, Klein A. A reasoned approach: Reshaping sex offender policy to prevent child sexual abuse. Beaverton. Ass Treat Sexual Abus. 2011 Apr.&#xD;
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	Arreola SG, Neilands TB, Diaz R. Childhood sexual abuse and the socio-cultural context of sexual risk among adult Latino gay and bisexual men. Am J public health. 2009 Oct;99(S2): S432-8.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Macrophage Colony-Stimulating Factor (MCSF) and Receptor Activator of NF?B Ligand (RANKL) in Osteoclastogenesis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>23</FirstPage><LastPage>26</LastPage><AuthorList><Author>Prisca Pakan</Author><AuthorLanguage>English</AuthorLanguage><Author> Abeer Farhan Alanazi</Author><AuthorLanguage>English</AuthorLanguage><Author> Nicholas Andronicos</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Osteoclasts are defined as bone-resorbing cells which have an important function in skeletal development as well as in bone remodelling in the adult stage. Two significant cytokines stimulate the differentiation of osteoclasts from cells of the monocyte/macrophage; the monocyte/macrophage colony-stimulating factor (M-CSF) and receptor activation of NF-&#x3BA;B ligand (RANKL). For osteoclast precursors to proliferate, MCSF needs to bind to its receptor c-Fms which activates the signalling pathway required. Furthermore, RANKL which is the elementary differentiation factor of osteoclast stimulates the process through the gene expression control by activating its receptor. Aims: This study aims to demonstrate osteoclastogenesis using RAW264.7 line cell in vitro and identify the alterations in gene expression of the progenitor cells that typify osteoclast cells. Methodology: The study was conducted using hematopoietic precursor cells to examine the cellular differentiation into osteoclast under the control of RANKL. Furthermore, microarrays were used to accurately analyze the expression of the genes of interest by exhibiting the gene expressions changes and expected regulations of osteoclasts marker genes such as Glyceraldehyde 3-phosphate dehydrogenase (GAPDH), Tartrate-resistant acid phosphate (TRAP) and c-FMS. Results: We have identified that the upregulation of TRAP mRNA expression indicated the differentiation of osteoclast cells in the progenitor cells were induced by RANKL. Conclusion: The presence of Macrophage Colony-Stimulating Factor (MCSF) stimulates the differentiation of osteoclast progenitors into osteoclasts in the presence of RANKL.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Macrophage Colony-Stimulating Factor, Osteoclast, Receptor Activator of NF?B Ligand, RANKL</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Macrophages change their physiology in response to environmental changes that may give incremental changes in the cell population. The established pathway of macrophages activation is through the pathway of Interferon-&#xA5;-dependent activation by T helper 1. Macrophages function as human&#x2019;s immune system that eradicates infectious agents, cancer cells and maintaining tissue homeostasis.1 Macrophage colony-stimulating factor (MSCF) is one of the primary cytokines in osteoclast genesis for the proliferation and differentiation of osteoclast precursors.2 MCSF is differentiated into TRAP, which indicated positive osteoclast.3&#xD;
&#xD;
The osteoclast is defined as cells that developed from macrophages hematopoietic lineage; conforms to the bone matrix and degrade acid as well as lytic enzymes into the extracellular compartment.4,5 Furthermore, osteoclast is an important factor in bone remodelling to regulate and function normally throughout human life. The disproportion of bone remodelling may cause several skeletal muscle diseases such as osteoporosis, periodontal disease, rheumatoid arthritis, myeloma and metastatic cancers.6,7,8 The knowledge of the stimulation and activation of osteoclast cell is required to unfold the process in bone metabolism and remodelling to formulate therapeutic agents for these diseases.7 In addition, Lorenzo (2017) stated that physiological and pathophysiological effects of TNF related cytokines, such as RANKL on bone mass and how it initiates osteoclast genesis, are also important to appreciate. &#xD;
&#xD;
RANKL and polypeptide growth factor CSF-1 (MCSF) are required to induce the expression of osteoclast; including Tartrate-resistant Acid Phosphate (TRAP), Cathepsin K (CATK), Calcitonin receptor.8 When activated by RANKL, the progenitor cells are subject to make structural alterations to reabsorb bone.9 Lytic enzymes TRAP and pro CATK are then exported into the reabsorption region.10 This process deteriorates the underlying bone and the degraded products are subsequently processed within the osteoclast and discharged into the circulation system.11&#xD;
&#xD;
In the present study, we propose a method to investigate cell differentiation of macrophages into osteoclasts by inducing RANKL and MCSF and subsequently analyze the gene expression patterns during in vitro differentiation of RAW264.7 cell line. The results will determine whether RANKL and MSCF as primary cytokines can upregulate the genes expression of the encoding receptor of osteoclast such as TRAP. &#xD;
&#xD;
Materials and METHODs&#xD;
&#xD;
Harvesting the RAW264.7 cells.&#xA0; To culture the mouse myeloid/macrophage tumour cell line, RAW264.7, a 5 ml of the culture medium in the dish of RAW264.7 cells were gently squirted over the entire inside bottom of the dish to dislodge the cells. This procedure was repeated several times until the hazy layer of the cells was dislodged and suspended in the medium. The cell suspension was span at 1000 rpm for 5 minutes at room temperature. The supernatant was discarded and another 10 ml of complete medium was added to the cell pellet to suspend the cell again.&#xD;
&#xD;
Cell differentiation was performed by incubation in complete medium with RANKL (R) for 1 and 7 days (R1, R7; respectively) and without RANKL (U) for 1 day and 7 days (U1 and U7; respectively). The culture medium was replaced on day 3 and 6 of treatment. In addition, other cell cultures were prepared for differentiation by incubating cell suspension in the tissue culture incubator (95% air/5% CO2); these cells were harvested on the next day for Ribonucleic acid (RNA) preparation. &#xD;
&#xD;
Meanwhile, the remaining volume in tubes U (without RANKL) and R (with RANKL) was used to set up separate cultures for cell staining on the next two days. &#xD;
&#xD;
Cell fixation, staining and phenotypic analysis. Both the cell cultures prepared were used.&#xA0; Cell fixation was achieved by using cell fixative and must be performed in a fume hood by gently adding 0.5 mL of cell fixative per well and leave in the fume hood for 30 seconds only and proceed with the preparation of diazotized Tartrate-Resistant Acid Phosphatase (TRAP) stain. A light microscope was used to examine the phenotype of the stained cells.&#xD;
&#xD;
Cell lysis and RNA extraction. Using Aurum&#x2122; Total RNA Mini Kit, the procedure was conducted according to the manufacturer&#x2019;s protocol. &#xD;
&#xD;
Digestion of genomic DNA. The purified RNA acquired was treated with RNase-free DNase I to degrade any genomic DNA remaining in the sample.&#xD;
&#xD;
First-strand cDNA synthesis. To reverse transcribe the mRNA in the samples in obtaining the first-strand cDNA was done using an INVITROGEN SuperScript III First-Strand Synthesis SuperMix-for-RT-PCR kit. This included RNase H digestion of the RNA strand in the cDNA/RNA duplex.&#xD;
&#xD;
RT-PCR analysis. This assayed the expression level of three genes: (i) glyceraldehyde 3-phosphate dehydrogenase (GAPDH), (ii) tartrate-resistant acid phosphatase (TRAP), and (iii) Fms.&#xD;
&#xD;
Agarose gel electrophoresis. The electrophoresis was run with 80 voltages for approximately 45 minutes on a 1.5% TAE agarose gel. &#xD;
&#xD;
RESULTS and discussion&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; Cell fixation, staining and phenotypic analysis&#xD;
&#xD;
The cell size and population analysis in the untreated cells with RANKL (U1 and U7) showed relatively below the range of cell incubated with RANKL for 7 days (R7). Although R1 cell was treated with RANKL, the treatment was only for 1 day and therefore, the result is similar to the RANKL untreated cells. TRAP staining positive cells were apparent in the 7 days of RANKL treatment (R7). The multinucleated cells were exhibited by R7, as expected due to the cell sizes of R7 which were larger and hence indicated that it had more nuclei (Fig 1,2,3 and Table 1). &#xD;
&#xD;
&#xD;
&#xD;
Figure 1. The light microscopic images show the cell population and cell morphological difference of which was not induced by RANKL even after incubated for 7 days (U7) &#xD;
&#xD;
&#xD;
&#xD;
*U1 = incubation of cells without RANKL treatment for 1 day&#xD;
&#xD;
*U7= incubation of cells without RANKL treatment for 7 days&#xD;
&#xD;
*R1= incubation of cells with RANKL treatment for 1 day&#xD;
&#xD;
*R7= incubation of cells with RANKL treatment for 7 days&#xD;
&#xD;
&#xD;
&#xD;
Figure 2. Culture cell induced by 20 &#xB5;l of RANKL for 7 days (R7). This also represented the TRAP staining activity and the multinucleated cell. &#xD;
&#xD;
&#xD;
&#xD;
Figure 3. The agarose electrophoresis of the cDNA product&#xD;
&#xD;
Using gene expression changes to monitor macrophage and osteoclast differentiation&#xD;
&#xD;
After extracting RNA, the next step was the RT-PCR procedure to see the gene expression of macrophages and osteoclast cell differentiation induced by RANKL. The RT-PCR assay was used to analyse the expression of Glyceraldehyde 3-phosphate dehydrogenase (GAPDH), Tartrate-resistant acid phosphate (TRAP) and c-FMS, which were prepared into 12 tubes and loaded in a certain order.&#xA0; &#xD;
&#xD;
The result of agarose gel electrophoresis of the PCR products shown in Fig 3 showed relatively precise expected amplifications from the genes. It can be seen that the lanes of control (GAPDH) were evenly and constantly expressed while TRAP and c-FMS lanes were also expressed but in different intensity. This means that RANKL were able to induce the expression of TRAP mRNA.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
MCSF (Macrophage Colony Stimulating Factor) is expressed constitutively in the bone microenvironment in response to the incremental change of PTH and inflammatory molecules such TNF or RANKL.12, In this study, osteoclast cells were differentiated in vitro using murine stem cell bone marrow. Due to the presence of MCSF, macrophages were differentiated and RANKL activated TRAP which is the marker for osteoclast. Consequently, the mononucleosis progenitor cells altered the motif of their gene expression. These occurred by cells migrating and fusing and thus formed cells with multiple nuclear. As cells continue fusing, the cells get larger and become multinucleated. On day 7 of incubation (Fig 2), it had reached sufficient time for the RANKL concentration, the huge circular-shaped cells continue to fused into large cytoplasmic masses, therefore the cells density continue to increase.13&#xD;
&#xD;
GAPDH&#xD;
&#xD;
Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was used as a comparison to gene expressions data due to its constitutively expressed gene or as referred to as a &#x201C;housekeeping&#x201D; gene.14 It is also asserted that although several other &#x201C;housekeeping&#x201D; genes might be expressed differently between body tissues, it is proven that GAPDH can be used as the internal control for the normalisation in gene expression data, particularly during apoptosis. As housekeeping genes, a constant level of expression in the tissue is supposedly preserved. This is depicted in the result in both Fig 3 which in the lane 2, 3, 4, and 5 the stains were amplified in a stabilized manner. Therefore, these amplifications are not related to whether osteoclasts are associated with this effect or not, but GAPDH is used as the internal control.&#xD;
&#xD;
TRAP&#xD;
&#xD;
TRAP is a cytochemical marker of osteoclasts and its biochemical concentration in serum can be used to analyze osteoclast function and levels of bone resorption because TRAP is secreted in large amount by osteoclasts.15 Based on the ground of this, lane 6, 7, 8 and 9 (Fig 3) there were gene expressions on these, however, they are expressed in a different degree. Lane 6 and 7 (Fig 3) were untreated RANKL cells on day 1 and day 7 (U1 and U7), therefore, the gene expression of TRAP was not as much as in lane 8 and 9 (R1 and R7) which were treated with RANKL. The overexpression in lane 8 and 9 are most likely due to the existence of RANKL. &#xD;
&#xD;
C-FMS&#xD;
&#xD;
C-FMS is a precursor for the mature and late stage of osteoclastogenesis.16 As shown in Fig 3, although lane 10 until 13 were expressed, it can be seen that lane 13 which is RANKL induced for 7 days exhibited a more vivid stain, which indicated a greater expression. &#xD;
&#xD;
CONCLUSIONS&#xD;
&#xD;
RANKL were able to activate the expression of TRAP mRNA. TRAP is a cytochemical marker of osteoclasts; therefore, the positive assay in the culture cell of day 7 treatment with RANKL emphasizes the cellular differentiation of osteoclasts cells. Thus, the presence of Macrophage Colony-Stimulating Factor (MCSF) may stimulate the differentiation of osteoclast progenitors into osteoclasts in the presence of RANKL.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
This research was fully supported and funded by the University of New England, Australia. There was no conflict of interest in this research.&#xD;
&#xD;
Authors contribution: Prisca Pakan and Nicholas Andronicos both designed the project and protocols. Prisca carried out the whole experiment, supervised by Nicholas. Prisca performed the data analysis and wrote the manuscript. Nicholas was responsible for the directing and planning of the research.&#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lou Z, Peng Z, Wang B, Li X, Li X, Zhang X. miR-142-5p promotes the osteoclast differentiation of bone marrow-derived macrophages via PTEN/PI3K/AKT/FoxO1 pathway. J Bone Miner Metab [Internet]. 2019 Sep 17 &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rath, K., Mohanty, B., B., Kumar, S., Nayak, P., Sahoo J. Do Statins Have Potential As Anti Osteoporotic Drugs and Can They Be Used for Prevention or Targeting Osteoporosis. Int J Current Res Rev. 2013;05(04):73&#x2013;81. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Darshan, D.D. Saqib H., Anir, K. Vijay, K, C N. Role of Drugs in Orthodontic Tooth Movement. Int J Current Res Rev. 2012;04(04):59&#x2013;62. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Song C, Yang X, Lei Y, Zhang Z, Smith W, Yan J, et al. Evaluation of efficacy on RANKL induced osteoclast from RAW264.7 cells. J Cell Physiol [Internet]. 2019 Jul 1 [cited 2020 Oct 6];234(7):11969&#x2013;75. Available from: https://pubmed.ncbi.nlm.nih.gov/30515780/&#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Xu F, Teitelbaum SL. Osteoclasts: New Insights [Internet]. Vol. 1, Bone Research. Sichuan University; 2013 [cited 2020 Oct 12]. p. 11&#x2013;26. Available from: /pmc/articles/PMC4472093/?report=abstract&#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Ono T, Nakashima T. Recent advances in osteoclast biology [Internet]. Vol. 149, Histochemistry and Cell Biology. Springer Verlag; 2018 [cited 2020 Oct 6]. p. 325&#x2013;41. Available from: https://pubmed.ncbi.nlm.nih.gov/29392395/&#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Kimura K, Kitaura H, Ishida M, Hakami Z, Saeed J, Sugisawa H, et al. Effect of macrophage colony-stimulating factor receptor c-Fms antibody on lipopolysaccharide-induced pathological osteoclastogenesis and bone resorption. In: Interface Oral Health Science 2014: Innovative Research on Biosis-Abiosis Intelligent Interface [Internet]. Springer Japan; 2015 [cited 2020 Oct 12]. p. 259&#x2013;67. Available from: https://link.springer.com/chapter/10.1007/978-4-431-55192-8_22&#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Lorenzo J. The many ways of osteoclast activation [Internet]. Vol. 127, Journal of Clinical Investigation. American Society for Clinical Investigation; 2017 [cited 2020 Oct 6]. p. 2530&#x2013;2. Available from: https://pubmed.ncbi.nlm.nih.gov/28530641/&#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Qu X, Mei J, Yu Z, Zhai Z, Qiao H, Dai K. Lenalidomide regulates osteocytes fate and related osteoclastogenesis via IL-1&#x3B2;/NF-&#x3BA;B/RANKL signaling. Biochem Biophys Res Commun. 2018 Jun 22;501(2):547&#x2013;55. &#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0; Thummuri D, Jeengar MK, Shrivastava S, Nemani H, Ramavat RN, Chaudhari P, et al. Thymoquinone prevents RANKL-induced osteoclastogenesis activation and osteolysis in an in vivo model of inflammation by suppressing NF-KB and MAPK Signalling. Pharmacol Res. 2015 Jun 11;99:63&#x2013;73. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Zhou C, Liu W, He W, Wang H, Chen Q, Song H. Saikosaponin a inhibits RANKL-induced osteoclastogenesis by suppressing NF-&#x3BA;B and MAPK pathways. Int Immunopharmacol. 2015 Mar 1;25(1):49&#x2013;54. &#xD;
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17. &#xA0;&#xA0;&#xA0;&#xA0; Nishimura K, Shindo S, Movila A, Kayal R, Abdullah A, Savitri IJ, et al. TRAP-positive osteoclast precursors mediate ROS/NO-dependent bactericidal activity via TLR4. Free Radic Biol Med. 2016 Aug 1;97:330&#x2013;41. &#xD;
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18. &#xA0;&#xA0;&#xA0;&#xA0; Yeo CE, Kang WY, Seong SJ, Cho S, Lee HW, Yoon YR, et al. Neuromedin B and its receptor silencing suppresses osteoclast generation by modulating precursor proliferation via M-CSF/c-Fms/D-type cyclins. Exp Cell Res. 2017 Oct 1;359(1):112&#x2013;9. &#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study of Leucorrhoea in Reproductive Age Group in Patients Attending OPDs in Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>27</FirstPage><LastPage>33</LastPage><AuthorList><Author>Swati</Author><AuthorLanguage>English</AuthorLanguage><Author> Sarandeep Singh Puri</Author><AuthorLanguage>English</AuthorLanguage><Author> Seema Goel</Author><AuthorLanguage>English</AuthorLanguage><Author> Parul Singhal</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Leucorrhoea, Menstrual hygiene, Reproductive age</Keywords><Fulltext>INTRODUCTION-&#xD;
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&#x2018;Leucorrhoea&#x2019;, a fairly common gynaecological issue, is an irregular vaginal secretion frequently connected with irritation and is non?hemorrhagic. White, yellow or greenish discharges might be an indication of underlying pelvic pathology. It relates to more than an estimated 1/4th of patients&#x2019; visits to the gynaecologist.1&#xD;
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This may be physiological or pathological. An augment to the normal vaginal discharge develops physiologically at puberty, during pregnancy, at ovulation, sexual arousal and the premenstrual phase of the menstrual cycle. Pathological secretions may be communicable or non-infectious. Infectious secretions may be due to explicit contagion such as Gonorrhoea, Trichomoniasis, Chlamydiasis, which are sexually passed on, and commotions in the normal vaginal flora cause Moniliasis and Bacterial vaginosis.&#xD;
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It is measured that transformation in the vaginal epithelium; changes in the usual bacterial flora and pH of the vaginal discharge dispose to leucorrhoea. But when it turns into a pathological situation it creates connected troubles like low backache, itching and burning sensation of the vulva, poor appetite, uneasiness, common weakness, pain in both legs etc.&#xD;
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As there are very few similar studies in this region, and none in the Hapur area of Uttar Pradesh, this study was undertaken to investigate the various causes of leucorrhea among reproductive-age women attending OPD of a tertiary hospital (Saraswathi Institute of Medical Sciences) in Hapur, Uttar Pradesh&#xD;
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The study aims to investigate the causes of Leucorrhea in reproductive age group women among patients visiting the OPD of a tertiary care hospital (Saraswathi Institute of Medical Sciences) in Hapur, Uttar Pradesh. The objectives of the study are:&#xD;
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	To study the PAP smear findings in the patients presenting with leucorrhoea to establish the profile of the causative organism such as bacterial, fungal, trichomonal or neoplastic.&#xD;
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	To study the presence of various micro-organisms in patients resenting with leucorrhoea, identification done by wet mount, Gram staining and KOH mount.&#xD;
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	To isolate and identify the bacterial and fungal pathogens of the indicated cases by culture identification.&#xD;
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MATERIAL AND METHODS&#xD;
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Study Design&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The present study is an Observational, Cross-sectional, and the inferential study conducted in Saraswathi Institute of Medical Sciences, Hapur (Uttar Pradesh).&#xD;
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Study Area:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study was conducted among OPD patients of SIMS Hapur (UP), India.&#xD;
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Study Period:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The study was conducted from October 2018 to December 2019.&#xD;
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SELECTION OF CASES&#xD;
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Inclusion Criteria:&#xD;
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	Adult female patients of the reproductive age group (aged 18 years to 45 years).&#xD;
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Exclusion Criteria:&#xD;
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	All patients below 18 years and above 45 years.&#xD;
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Clinical History and Examination regarding Leucorrhoea:&#xD;
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				Gynaecological history of the patient, including parity, age at first childbirth, mass per-vaginum, history of any STD.&#xD;
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				Amount, duration, colour and odour of discharge.&#xD;
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Visualization of Cervix: to rule out erosion, hypertrophy, suspicious growth&#xD;
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							Wet Smear preparation: After a thorough vaginal examination a sample of the discharge was taken. A wet smear was prepared. For wet smear preparation, a drop of normal saline is put on a slide and mix a drop of the vaginal discharge. Placed a cover slip on the drop.&#xD;
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							&#xA0;Then the smear was examined immediately first under low power, and later under high power for various micro-organisms like T.vaginalis (motile and flagellated), Candida (budding yeasts) along polymorphonuclear leukocytes, bacteria may be identified in wet film preparations. For further identification of various organisms, tests like the Germ Tube test were put along with various biochemicals and cultures were incubated and confirmed in the Department of Microbiology.&#xD;
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							Simultaneously, the discharge was spread over another few slides for PAP staining (Papanicolau stain). Smears were immediately fixed in absolute alcohol and stained according to the PAP staining method. The cytopathological changes observed in the cervical squamous were graded according to the Bethesda system for reporting cervical cytology&#xD;
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							C/S: The PAP smear showing various neutrophils or pus cells were segregated. Discharge of the cases was processed for culture/sensitivity.&#xD;
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Statistical Analysis:&#xD;
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Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) for Windows (version 24.0). &#xD;
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RESULTS&#xD;
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The age-wise distribution of the study participants (all females) showed that the majority of them was in the age group of 26-30 years shown in Table 1,2,3.&#xD;
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The type of discharge, majority of women have a thin mucoid type discharge from the vagina (72.8%), followed by less commonly reported thick curdy discharge (16.8%).&#xD;
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The majority of women had a &#x2018;moderate&#x2019; amount of discharge (61.6%), followed by a less commonly &#x2018;minimal&#x2019; amount of discharge (23.2%).&#xD;
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Colour of discharge, majority of women reported a greyish colour (52.8%), followed by less commonly white coloured discharge (39.2%).&#xD;
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More than three-fourth (76.4%) of women reported having a smell in discharge, while the rest 23.6% did not report any smell in their vaginal discharge ( Table 4,5,6).&#xD;
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Duration of leucorrhea, majority of women have been experiencing it since 2-4 months(54.8%), a less common reporting was of 1-2 months (33.6%) Table 6.&#xD;
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Pruritis was &#x2018;absent in most of the females (64.8%) and was &#x2018;present&#x2019; only in 35.2% of females. &#xD;
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Dysuria was &#x2018;absent in 70% of the females and was &#x2018;present&#x2019; only in 30%&#xD;
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Dyspareunia, where it was &#x2018;absent in 80% of the females and was &#x2018;present&#x2019; only in 20%.&#xD;
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The majority of females (88.8%) reported having no relationship of leucorrhoea occurrence with oral contraceptives (OCPs), while 11.2% said that there is a possible association between taking OCPs and occurrence of leucorrhoea.&#xD;
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More than half of the females were reported to have the relationship of leucorrhoea with intra-uterine devices (IUDs) (51.2%), while 48.8% of females did not have the relationship of leucorrhoea with IUDs&#xD;
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Only 25.2% of females face the problem of leucorrhoea who had undergone tubectomy procedures, whereas 74.8% did not have any such problem with tubectomy procedures.&#xA0; (Table 7)&#xD;
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A majority of subjects were Negative for intraepithelial lesion or malignancy (NILM) (88%), followed by 6.8% subjects having atypical squamous cells of undetermined significance (ASCUS), and low-grade squamous intraepithelial lesion (LSIL) (2.8% subjects). A minor proportion of subjects (0.8%) had a high-grade squamous intraepithelial lesion (HSIL), Atypical squamous cells-cannot exclude HSIL (ASC-H) (0.8%), and squamous cell carcinoma (0.8%) ( Table 8).&#xD;
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The outcome of Wet Mount for diagnosis of T. vaginalis among study participants, only 13.2% of study subjects were positive for T. vaginalis, and 78% of subjects were negative.&#xD;
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The outcome of Potassium Hydroxide (KOH) Mount for Fungal diagnosis among study participants, only 33.6% of study subjects were positive for fungal infection, and 57.6% of subjects were negative.&#xD;
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The outcome of Gram staining for Bacteria (prevalence of gram-positive/negative bacteria) among study participants, nearly 39.6% of study subjects had gram-positive cocci, and 35.6% had gram-negative bacilli, and 16% of subjects had a negative outcome. ( Table 13,14,15)&#xD;
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The majority of females (34%) were seen to have S. aureus as observed on the bacterial culture of leucorrhoea secretions; followed by E. coli, which was the second-highest (28.8%) observation among study participants.&#xD;
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A minor proportion of study subjects also presented with Enterococcus (5.6%), K. oxytoca (4.4%), and P. aeruginosa (2.4%). Around 16% of subjects had a negative outcome.&#xD;
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The majority of females (27.2%) were seen to have the presence of C. albicans on the culture of leucorrhoeal secretions; followed by C. glabrata (3.2%), C. parapsilosis (2%), C. krusei (1.2%). Around 57.6% of subjects had no outcome (Table 16,17)&#xD;
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DISCUSSION&#xD;
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The present study revealed that Leucorrhea is prevalent throughout life i.e. 18-45 years, but was highly prevalent in the 26-30 years age group. The findings are similar to study by Tabassum et al. in 2014 and Rudri et al. in 2017, among women 15-55 years old in Bangalore.2,3&#xD;
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The findings also correlate with the study by Devi U in 2013 in Nellore in which 50% of the women reporting leucorrhea belonged to the age group of 21-30 years.4&#xD;
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Culture for isolation of candida is a superior method in detecting vaginal candidal vaginosis. The incidence of candidiasis and TV reported in the current study were comparable to studies reported elsewhere4,5,6 Overall prevalence of TV varies from place to place, study to study and ranges from 6-14.9%.5&#xD;
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&#xA0;The chief presenting complaint in the present study was white discharge which is characteristic of leucorrhea.2 The consistency of discharge in the present study varied from thin mucoid (72.8%) to thick curdy (16.8%) and frothy (10.4%) in the current study. This is consistent with studies conducted in Banglore3, Nellore4 and Goa.7&#xD;
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The secretions due to noninfectious causes are non-purulent and non-offensive, nonirritant and never cause itching. Pruritis, dysuria and dyspareunia were present in 35.2%, 30% and 20% of the study participants in the present study. Itching is a common symptom in candidiasis, non-specific vaginitis and trichomoniasis. The findings correlate with the study done elsewhere.4&#xD;
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The mean duration of leucorrhoea in the present study was 2.89&#xAD;+1.32 days (Range: 1-6 days). This is in contrast to the findings reported elsewhere. In a study by Ilankoon et al in 2017 in women living in Colombo District, Sri Lanka, sought treatment at the end because the condition got worse or fear of serious disease consequences.8&#xD;
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Many women are not interested to discuss the symptom with their medical practitioner until matters reach such a stage that, despite their efforts at treatment, the persistence of discharge compels them to seek advice. This delay, coupled with the fact that many women regard quite a considerable amount of vaginal discharge as normal, has often the effect of making the complaint one of long duration when advice is first sought.9&#xD;
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Evidence indicates the minimal effect of OCP use on the vaginal epithelium and vaginal and cervical discharge, and a small effect on vaginal flora.10 The findings of our study corroborated this evidence.&#xD;
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The prevalence of leucorrhoea among IUD users and tubectomized women was 51.2% and 25.2% respectively in the present study. This was much higher than reported by Devi in 2013 and Kulkarni et al in 2005 in Nagpur.4,11&#xD;
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The findings corroborated with the study done by Nwankwo et al in 2010 among women of the reproductive age group in Nigeria.12 The IUCD has been reported to produce inflammation and changes in cervical cytopathology.&#xD;
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In the study done by Ocak et al in 2007 among women in Turkey, 20.7% of UD users were reported to have leucorrhoea as against 8.8% OCP users.13 Leucorrhea among IUD users is most strongly related to the insertion process and the background risk of STI.14&#xD;
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The PAP smear findings among patients in our study were similar to those reported by Sujatha et al in 2016, Yogita et al in 2014 and Karuna et al in 2003.15-17 Thin mucoid discharge was associated with most PAP smear changes in the present study. This is consistent with findings by Parate et al in 2017.18 Atypical squamous cells of undetermined significance (ASCUS) was associated with greyish discharge. The findings corroborated with studies done elsewhere.15-19&#xD;
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Patients diagnosed with TV infection reported varied colour discharge (greenish-yellow to white). Usually, TV infection among women results in a clear, white, greenish, yellow discharge with an unusual fishy smell.20 In the current study too, one-third of the patients reported foul-smelling discharge.&#xD;
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CONCLUSION&#xD;
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The present study revealed that Leucorrhea is prevalent throughout life i.e. 18-45 years, but was highly prevalent in the 26-30 years age group. Married females are at a greater risk for leucorrhoea as they are exposed to sexual activity and frequent childbearing which may lead to vaginal infections, cervicitis, cervical erosion, pelvic inflammatory disease etc. that could lead to leucorrhoea in these women.&#xD;
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Infection of vaginal mucosa by Trichomonas vaginalis and Candida is the most common cause of leucorrhoea. The most common causes of Leucorrhea in our study were: Gram-positive cocci (39.6%), Gram-negative bacilli (35.6%), Fungal/candidiasis (33.6%) and Trichomonas vaginalis (TV) (13.2%).&#xD;
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The chief presenting complaint in the present study was white discharge which is characteristic of leucorrhea.1 The consistency of discharge in the present study varied from thin mucoid (72.8%) to thick curdy (16.8%) and frothy (10.4%) in the current study.&#xD;
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Pruritis, dysuria and dyspareunia were present in 35.2%, 30% and 20% of the study participants in the present study. Itching is a common symptom in candidiasis, non-specific vaginitis and trichomoniasis. The mean duration of leucorrhoea in the present study was 2.89&#xAD;+1.32 days (Range: 1-6 days). The prevalence of leucorrhoea among IUD users and tubectomised women was 51.2% and 25.2% respectively in the present study.&#xD;
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Patients diagnosed with TV infection reported varied colour discharge (greenish-yellow to white). Usually, TV infection among women results in a clear, white, greenish, yellow discharge with an unusual fishy smell.19 In the current study too, one-third of the patients reported foul-smelling discharge. Patients with fungal infection in the present study reported white and grey discharge. The foul smell was present in 17.9% of the patients with a candida infection.&#xD;
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A significant association of leucorrhoea with socio-demographic factors, clinical features, PAP smear, bacterial as well as fungal culture in the present study emphasizes the need for health education and preventive practices related to personal &amp; menstrual hygiene &amp; family planning practices in females.&#xD;
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Acknowledgement: Nil&#xD;
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Conflict of interest: Nil&#xD;
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Source of funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3820</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3820</Fulltext></URLs><References>1. Sabaratnum, Drukumaran, Sivanesa VR, Alokananda C. Textbook of Adolescent gynaecology, a sexually active adolescent. 1999; 46(2):733.&#xD;
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3.Rudri Bai IM, Deepthi M, Dharmavijaya MN. Analysis of leucorrhoea in tertiary care hospital in rural Bangalore. Int J Clin Obstet Gynec. 2018;2(4)76-9.&#xD;
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19. Nair RV, Seetha PM, Sowbharnika CP. A study on cervical Pap smears among women with leucorrhoea in a tertiary care centre. Int J Clin Obst Gyn. 2019;3(2):135-37.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Colloid Preloading Vs Co-loading During Tourniquet Deflation: An Assessment of Haemodynamic Stability in Total Knee Replacement&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>34</FirstPage><LastPage>38</LastPage><AuthorList><Author>Akhya Kumar Kar</Author><AuthorLanguage>English</AuthorLanguage><Author> Abinash Patro</Author><AuthorLanguage>English</AuthorLanguage><Author> Monu Yadav</Author><AuthorLanguage>English</AuthorLanguage><Author> Gopinath Ramachandran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Tourniquet is an essential part of orthopaedic limb surgeries to limit blood loss and achieve a bloodless field during surgery. Some case reports of life-threatening events at the time of deflating tourniquet prompted us to study the impact of tourniquet release on haemodynamics during knee arthroplasty surgery. This study intended to determine the effect of preloading with 6% HES (130/0.4) on the haemodynamic parameters during tourniquet deflation. Methods: This prospective randomized clinical investigation was undertaken at a tertiary care centre after obtaining written informed consent from ASA I&amp;II patients scheduled for elective total knee arthroplasty under spinal anaesthesia, belonging to the age group of 18 and 60 years. The participants were randomized to two groups (group-1 and 2) of 30 each. In group-1 HES given at 5 ml/kg over 30 minutes before tourniquet deflation and in group-2 colloid infusion done based on haemodynamics after tourniquet release. Baseline vitals and tourniquet pre-release value(T0) compared with 1 minute (T1) to 11 minutes (T11) of post-release vitals. Results: Post-deflation of the tourniquet, in group-1 there was a significant increase in heart rate for 3 minutes(P=0.023), while in group-2 it was high throughout the observation period up to T11(P=0.004). Incidences of 20% fall in MAP as compared to baseline (P=0.02) and 10% fall compared to T0(P=0.04) was significantly higher in group-2. The average MAP was significantly low at T3 in group-1 while it was significantly low through T1 to T5 in group-2, compared to T0. Conclusions: Tourniquet release induced hypotension need attention. Preloading with colloids reduces overall hypotensive episodes.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Tourniquet deflation, Hypotension, Total knee arthroplasty, Tourniquets, Spinal anaesthesia, Vasopressors</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
A Pneumatic tourniquet is an essential part of orthopaedic limb surgeries; it reduces blood loss and provides a bloodless field during surgery.1 During inflation and deflation of tourniquet, hemodynamic changes occur, which needs attention&#x2014;many case reports of adverse outcomes published during tourniquet deflation.2,3 Most adverse effects during the deflation period are related to a sudden increase in the volume of distribution, bleeding from the surgical site, circulation of toxic products originated due to prolonged limb ischemia, and release of cementing particles in knee arthroplasty, and associated comorbidities. The adverse events leading to cardiac arrest in literature were attributed to reperfusion syndrome,4pulmonary artery embolization,5,6 and coronary artery vasospasm.7Only a few works of literature available where the impact of tourniquet release on haemodynamics is studied,8 where the mean arterial pressure (MAP) is seen to fall to the extent of 20% as compared to baseline. Fluid management is the key to counter the haemodynamic alteration; however, it is mostly individualized during tourniquet release in the absence of much literature guidance. Preloading is used to reduce hemodynamic variation during spinal anaesthesia; however, there are conflicting views regarding its effectiveness.9Analyzing the effect of preloading before tourniquet release can add to the literature the usefulness of such methods. This study contemplated the primary objective of assessing the impact of preloading of 6% HES (starch,130/0.4) on hemodynamic parameters during tourniquet release. The secondary purpose was to study the effect of tourniquet release on immediate hemodynamic stability and compare preloading and co-loading at the time of tourniquet deflation.&#xD;
&#xD;
MATERIAL AND METHODS: &#xD;
&#xD;
This prospective randomized clinical investigation was undertaken at a tertiary care centre from February 2019 to August 2019. This study has the approval of the institutional ethics committee (EC/NIMS/2208/2018) and prospectively registered with the clinical trial registry of India (http://ctri.nic.in/Clinicaltrials, CTRI/2019/01/016838). After obtaining written informed consent, sixty American Society of Anesthesiologist Physical Status ? and ?? (ASAPS-I and II) patients scheduled for elective total knee arthroplasty belonging to both the gender aged between 18 and 60 years were recruited for the study. Patients with hypertension, long-standing diabetes mellitus or on insulin, deranged renal parameters, antiplatelet drugs, altered coagulation profile, and heart rate control drugs like beta-blockers, alpha agonists, calcium channel blockers were excluded from the study. Instances where activation of epidural anaesthesia was required before tourniquet release was also planned to exclude after inclusion.&#xD;
&#xD;
The recruited patients were randomly assigned to two groups (group-1 and group-2) of 30 patients each according to a computer-generated random number sequence and closed envelope method. Spinal anaesthesia is given with an adequate dose of bupivacaine heavy after epidural catheterization. After spinal anaesthesia, 15ml/kg Ringer lactate infused intravenous route (IV) over 30 minutes and 2 ml/kg/per hour as maintenance fluid. Mean arterial pressure (MAP) fall of more than 30% treated with a bolus of Mephenteramine 6mg IV, the total no of doses required were noted. Vitals before tourniquet release, 2, and 5 minutes after tourniquet inflation was recorded in both the groups. A test dosing of 10 ml HES given to exclude any possibility of an allergic reaction. At the end of the surgery, group-1 patients preloading done before tourniquet release and in group-2, co-loaded with 5ml/kg of HES over 30 minutes. Vitals noted before tourniquet release (T0), 1 min post-tourniquet release (T1), and every 2 minutes after that from 3rd minute to 11th minute in both the groups and named as per the minutes after the tourniquet release time as T3, T5, T7, T9, T11 respectively. Recordings with more than 20% fall in MAP compared to the baseline were treated with 1ml/kg of HES as slow intravenous infusion. If the fall in MAP was more than 30% compared to baseline, then mephenteramine 6mg IV was given to maintain the MAP in a safe range. At the end of the study, the patients were shifted to the postoperative ward for observation and further management. For postoperative analgesia, continuous infusion of 0.125% of bupivacaine administered after activation of epidural space.&#xD;
&#xD;
Statistical analysis was done using the Statistical Package for Social Science (SPSS17.0 Evaluation version). Qualitative data were compared with the chi-square test, and quantitative data were compared within the group against baseline values using the paired t-test. The results were expressed as mean &#xB1; standard deviation, P </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3821</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3821</Fulltext></URLs><References>&#xD;
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	Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2011; 44:33-8.&#xD;
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	&#xD;
	Pradeep Govil, P.N. Kakar, Atul Kishore Kapoor, Ankit Sharma, Deepak Govil, Deep Arora. Refractory Hypotension after Tourniquet Deflation in a Patient on Chronic Clomipramine Therapy. Indian J Anaesth. 2008; 52 (4):443-7.&#xD;
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	Kewal Krishan Gupta, Amanjot Singh. Cardiac arrest following tourniquet release: Needs attention. Saudi J Anaesth. 2015 Oct-Dec; 9(4): 489&#x2013;90.&#xD;
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	Houng WR, Lee CL, Chiou HM, Wei YS. Cardiac arrest after tourniquet deflation in tibial plateau fracture surgery in a healthy man &#x2013; a case report. Formosan J Musculoskel Disord. 2012; 3: 34-8.&#xD;
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	Bharti N, Mahajan S. Massive pulmonary embolism leading to cardiac arrest after tourniquet deflation following lower limb surgery. Anaesth Intensive Care. 2009;37(5): 867-8.&#xD;
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	Cohen JD, Keslin JS, Nili M, Yosipovitch Z, Gassner S. Massive pulmonary embolism and tourniquet deflation- a case report. Anesth Analg 1994;79: 583-5.&#xD;
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	Satoh J, Arakawa J, Ohmori H, Takahashi H, Yamakage M, Namiki A. Intraoperative cardiac arrest due to coronary vasospasm after tourniquet release--a case report. Masui. 2006;55(4):460-3.&#xD;
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	Inkyung Song, Dong Yeon Kim, Youn Jin Kim. The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery. Korean J Anesthesiol. 2012; 63(5): 425-30.&#xD;
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	Mueen Ullah Khan, Abdul Saboor Memon, Mohammad Ishaq and Mansoor Aqil. Preload Versus Co-load and Vasopressor Requirement for the Prevention of Spinal Anesthesia Induced Hypotension in Non-Obstetric Patients. J Coll&#xA0;Physicians&#xA0;Surg Pak. 2015; 25(12): 851-5.&#xD;
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	Iwama H, Kaneko T,&#xA0; Ohmizo H, Furuta H,&#xA0; Ohmori S,&#xA0; Watanabe K.Circulatory, respiratory and metabolic changes after thigh tourniquet release in combined epidural-propofol anaesthesia with preservation of spontaneous respiration. Anaesthes. 2002: 57: 584&#x2013;605.&#xD;
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	Karaca Omera, Gogus Nerminb, Ahiskalioglu Ali, Aksoy&#xA0;Mehmet, Dogus&#xA0;Unal, Kumas Solak&#xA0;Sezen et al. Tourniquet-induced ischaemia-reperfusion injury: the comparison of antioxidative effects of small-dose propofol and ketamine. Braz J Anesthesiol. 2017; 67(3):246-50.&#xD;
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	Westphal M, James MF, Kozek-Langenecker S, Stocker R, Guidet B, Van Aken H. Hydroxyethyl starches. Different products &#x2013; different effects. Anesthes. 2009; 111: 187-202.&#xD;
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	James MFM. The role of tetrastarches for volume replacement in the perioperative setting. Curr Opin Anaesthesiol. 2008; 21: 674-8.&#xD;
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	Estebe JP, Davies JM, Richebe P. The pneumatic tourniquet: Mechanical, ischaemia-reperfusion and systemic effects. Eur J Anaesthesiol. 2011;28:404-11.&#xD;
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	Zaman SM, Islam MM, Chowdhury KK et al. Haemodynamic and end tidal CO2 changes state after inflation and deflation of pneumatic tourniquet on extremities. Mymensingh&#xA0;Med J. 2010;19:524-8.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Polypharmacy and Drug Interactions Study on Diabetic Patients of Geriatric Age Group at Rural Tertiary Care Hospital&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>39</FirstPage><LastPage>43</LastPage><AuthorList><Author>Shailesh Nagpure</Author><AuthorLanguage>English</AuthorLanguage><Author> Krishna Kela</Author><AuthorLanguage>English</AuthorLanguage><Author> Akshay C. Dahiwele</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Diabetes, Geriatric, Polypharmacy, Drug interactions, Adverse effects, Complications</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Ageing is a natural and continuous process that is physiological. Due to the increasing population of elderly individuals in our country, it is very essential to develop the knowledge and understanding of appropriate and safe drugs for therapeutic purposes. Geriatric medicine is an upcoming branch of medicine that focuses on various aspects of therapeutics in an elderly population.1&#xD;
&#xD;
The geriatric population often suffer from multiple comorbidities such as diabetes, hypertension, malignancies, heart failure, age-related pharmacokinetic variability due to liver or kidney diseases, lack of adherence (voluntary or involuntary&#x2014;in psychiatric disorders), and others.2 These multiple comorbidities will lead to polypharmacy practices among the elderly. Also, elderly patients are more likely to take over-the-counter medications and herbal supplements, which can further lead to drug interactions.3&#xD;
&#xD;
Polypharmacy is defined as the concurrent use of multiple medications, whether prescription or over-the-counter, by a single patient, to manage health problems such as diabetes, hypertension.4&#xD;
&#xD;
Drug interactions refer to the modification of response to one drug by another when they are administered simultaneously or in sequence. The possibility of drug-drug interactions increases when more than one drug are prescribed in the same prescription. Although, the seriousness of these interactions in most of the cases is unpredictable.2&#xD;
&#xD;
Potential drug-drug interaction after prescribing multiple drugs among the elderly must be carefully assessed.5&#xD;
&#xD;
Polypharmacy practice in elderly patients can cause certain drug-drug interaction, which may affect the treatment provided to the patients, which ultimately increases the burden on health care providers and facilities.6&#xD;
&#xD;
To find such potential hazards of drug interactions associated with polypharmacy in elderly diabetic patients of rural area, this study is planned.&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
A cross-sectional observational study was conducted at rural tertiary care teaching hospital in Central India, Acharya Vinoba Bhave Rural Hospital (AVBRH). The ethical clearance number was DMIMS (DU) / IEC /May &#x2013; 2020/8860&#xA0; dated 30 June 2020. The study was conducted for 2 months, in this duration, a total of 100 patients were studied. The study was supervised based on elderly diabetic community admitted in the medicine ward of AVBRH, a rural tertiary care hospital, above 60 years of age of either sex ready to give consent were involved in this study and the patients of intensive care unit, patients with serious ailments, malignancies and other fatal, lethal, destructive issues were eliminated from the study. The study aimed to assess polypharmacy and various drug-drug interactions among geriatric diabetic patients admitted in the medicine ward at the rural tertiary care hospital.&#xA0; The study was designed to find out the potentially unsuitable drugs being prescribed by applying &#x201C;Beers Criteria.&#x201D; Data collection was done by the assessment of case sheets of the geriatric diabetic patients admitted in the medical ward. Likewise, the case sheets of all the patients were evaluated by the study investigator every day during the study time. The evaluation of case sheets was studied only once for each patient during one single admission. Comparatively to which, if any patient was admitted in the medicine ward more than once during this study time, the case sheet of such patients was considered as a separate case sheet or separate admission. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
The entire study population was categorized into three age groups 60&#x2013;69, 70&#x2013;79, and 80&#x2013;89. The age group 60&#x2013;69 years were the most common geriatric diabetic patients admitted during the study time with 65% of the total study population, followed by 70&#x2013;79years age group with 26% of the total study population. The third group of Geriatric patients of the 80&#x2013;89years age group were admitted in fewer number and represents 7% of the total study population. The maximum age of patient admitted in the medicine ward was 89years and the minimum age of the patient was 60years [Table 1 and Figure 1]. The males were 47 in number and females were 53 in number out of the total population. &#xD;
&#xD;
The mean age of patients was 69.06 &#xB1; 5.85 years [Table 2 and Figure 2]. Whereas, the mean number of drugs prescribed to the study population admitted in the medicine ward was (4.08 &#xB1; 1.20). Out of the total number of drugs prescribed, &#x2264;4 number drugs were prescribed to 78% population, 5-9 number of drugs were prescribed to 20% population, and 10-14 drugs were prescribed to 2% population [Table 3 and Figure 3].&#xD;
&#xD;
Most numbers of drugs were prescribed to 60&#x2013;69 years age group with 251 number drugs in the study population, followed by 70&#x2013;79 years and 80&#x2013;89 years age groups which were prescribed with 122 and 9 number of drug, respectively [Table 4 and Figure 4]. &#xD;
&#xD;
Out of the total of 402 medicines prescribed to the study population, 289 potential drug-drug interactions were observed among elderly diabetic patient [Table 5 and Figure 5]. The most common drug-drug interactions observed in the study population were of moderate grade 198(2.03%), Mild drug-drug interactions were 52(7.73%) whereas severe drug-drug interactions were 39(10.30%)&#xA0; [Table 6 and Figure 6]. Out of 402 drugs prescribed to the study population, the total number of potentially inappropriate medicine was 8 in number [Table 7 and Figure 7]. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Out of the total 402 prescribed drugs, 239 drug-drug interactions were observed.&#xD;
&#xD;
&#xD;
&#xD;
Out of the total drugs administered in 100 patients, mild, moderate and severe type of drug-drug interactions observed were 12.93%, 49.25% and 9.7% respectively.&#xD;
&#xD;
&#xD;
&#xD;
402 medicines were prescribed in 100 patients out of which 8 medication were found to be potential inappropriate medicine.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
According to the study, the maximum number of patients were between the age group 60-69 years admitted in the medical ward and the number of patients admitted declined with age. Similarly, the maximum number of drugs were prescribed to the patients between the age group 60-69 years. The findings of our study are analogous to the study findings by Armugam A.&#xA0; In this study, a large number of drugs were advised to the age group &#x2265;75 years of age. Although, the results of our study were different from the study by David Baumgartner. In this study, there was an increase in the mean number of drugs advised to elderly patients. &#xA0;&#xD;
&#xD;
The mean number of drugs prescribed to geriatric patients admitted in the medicine ward was 402. Among this, 78% of the population were prescribed with &#x2264;4 number drugs, 20% of the population were prescribed with 5-9 number of drugs and 2% of the population were prescribed with 10-14 number of drugs.&#xA0; The findings of our study were similar to Armugam et al. and Schuler et al study findings. In both of the above-mentioned study, the polypharmacy observed in elderly patients was &gt;55%. Corresponding to which the polypharmacy in Kaufman and Zaveri HG study was considered when more than 5 drugs were prescribed to a patient. Since our study findings resulted in higher polypharmacy than that of international reports, it might be due to patients not responding to the medication, so more options of drugs were used by doctors to treat the elderly patient admitted in the medicine ward. Along with this, the study results indicated several drug-drug interactions.&#xA0; Online drugs interaction checker of drugs.com was reported interaction in the extensive majority of patients. In a study conducted by Gosney M,&#xA0; 33% of potential drug-drug interactions in all prescriptions in admitted elderly patients were seen. The 71.89% (289) of drugs caused potential drug-drug interactions out of the 402 drugs prescribed to the geriatric population. According to our study, 49.25% of potential drug interaction were most common in the population of the elderly. When compared to a study conducted by Bj&#xF6;rkman et al. in the year 2002, drug interactions were present in 46% of patients.&#xA0; Moreover, Gosney M&#x2019;s study revealed 33% of potential drug-drug interaction, prescribed to elderly patients admitted in the medical ward.&#xD;
&#xD;
To find out the drug interaction, different computerized drug-drug interaction programs were used in various studies. The studies showing potential drug-drug interaction should be differentiated from those studies determining the actual drug interaction with the adverse patient outcome as a result of a drug interaction. The probability of drug-drug interactions increases exponentially with the number of drugs prescribed as there are an additional couple of drugs to interact.&#xA0; The ubiquity of clinically appropriate drug interactions in patients taking 2-4 medication is about 6%, those taking 5 medication is 50% and those taking 10 medication is around 100%. Accordingly, we noticed potential drug-drug interaction in &gt;50% of patients in our study also. Various studies noticed low levels of sensitivity and specificity while testing the functioning of drug interaction software, however recent studies specified that sensitivity and specificity have been upgraded.&#xD;
&#xD;
For evaluating the appropriateness of prescribing medications in the geriatric population, beer&#x2019;s criteria is a very constant method used. It was recently updated by the American Geriatric Society in 2012 and was developed in 1999. 1.98% potentially inappropriate medicines were prescribed of total prescribed drugs in elderly patients in our study. Similarly, a study showed potentially appropriate medicines in 22.1% of patient at admission conducted in South India by Harugeri which is much higher than our study findings. Our study findings are alike to a study in which she observed 4.33% of patients by Veena et al. in 2012. Although, our study findings are different from the study conducted by Rothberg et al. in 2008 in which he noticed at least 1 potential appropriate medicine in 49% of patients. The reason for the contradiction may be that our study was conducted in a limited population in tertiary care hospital whereas a study done by Harugeri and Rothburg was conducted on a large population. An increased number of medications may benefit to few patients, but it can be dangerous for other patients. Therefore it is necessary to find out about the inappropriate medicines and their possible drug-drug interactions. &#xD;
&#xD;
Hence, polypharmacy in the geriatric population causes many problems like the use of potentially inappropriate medicines and increased probability of drug-drug interactions, but on the other hand, we cannot ignore it as this population suffered from numerous chronic diseases. For ensuring the safety of the geriatric population and curbing irrational prescriptions, awareness should be created by physicians about life-threatening drug-drug interactions and polypharmacy. &#xD;
&#xD;
Conclusion &#xD;
&#xD;
The conclusion from the present study suggests that polypharmacy is a vital risk factor for secondary morbidity in geriatric patients. The use of various drugs to treat various diseases is necessary, but the unnecessary overload of drugs to the patient will increase the safety problems. Polypharmacy leads to potentially inappropriate medicine use and potential drug-drug interactions. Also, it can be avoided by proper planning and treatment goals. Appropriate prescribing is more important than decreasing the number of prescribed drugs to ensure safety in this high-risk population. Small population and restriction to one speciality are the limitations of the study. To perceive this important problem and to make the prescriptions more rational, larger studies including geriatric patients in the different department was mandatory.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
We would like to thank to the staff from the Department of Medicine of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe). &#xD;
&#xD;
FINANCIAL SUPPORT AND SPONSORSHIP&#xD;
&#xD;
None&#xD;
&#xD;
CONFLICTS OF INTEREST&#xD;
&#xD;
There are no conflicts of interest.&#xD;
&#xD;
Authors contribution &#xD;
&#xD;
&#xA0; Dr Shailesh Nagpure &#x2013; Synopsis preparation and conduction of the study &#xD;
&#xD;
&#xA0; Krishna Kela -&#xA0; Data collection &#xD;
&#xD;
Corresponding author:&#xA0; Dr Akshay Dahiwele &#x2013; Manuscript preparation &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3822</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3822</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Physical Activity Levels and Physical Fitness Components in Male Adolescents: Relationship with Overweight and Obesity&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>44</FirstPage><LastPage>48</LastPage><AuthorList><Author>Kavita Sharma</Author><AuthorLanguage>English</AuthorLanguage><Author> Sukhdev Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Harmandeep Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Amandeep Singh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aim: To examine the relationship of physical activity levels and physical fitness components with overweight and obesity in adolescent boys. Method: We recruited 332 school going boys of age 13-18 years as subjects. The subjects filled a validated questionnaire: Physical Activity Questionnaire-A (PAQ-A) to report their physical activity levels. They were further subjected to the testing of their physical fitness components including speed, explosive power, flexibility, agility, endurance, coordination, balance, handgrip strength and reaction time. The relationship between these variables and overweight and obesity were examined by applying the Point-biserial correlation test. Results: The prevalence of overweight and obesity was 5.42% and 1.51% respectively. Significant correlations were found between the Basal metabolic Index (BMI) status of adolescent boys and their physical activity levels and overall physical fitness status. Conclusion: Overweight and obese adolescent boys had inferior levels of physical activity and physical fitness profile than the non-overweight and obese boys.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>PAQ, Body mass index, Speed, Flexibility, Endurance, Agility</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Childhood obesity is a growing health problem globally attaining rampant magnitudes equally in developed and developing nations.1, 2In India, the prevalence of overall overweight and obesity has been significantly increased from 16.3% in 2001-2005 to 19.3% in 2016.3 Moreover, north India (setting of our study) is more affected by childhood obesity compared to South India.3Alarmingly, the main apprehension with childhood obesity is that 80% of overweight/obese adolescents later turn into the overweight/obese adults and those individuals later demonstrate higher mortality rate because of Cardio Vascular Disease (CVD&#x2019;s) and digestive ailments in later age.5Furthermore, overweight/obese adolescents have a higher risk of getting asthma at a small age, moreover, there is a higher likelihood of fractures, mortality due to traumatic hurts as compared to non-obese adolescents and exhibiting a weak cardio-respiratory fitness in earlier age.6, 7&#xD;
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Because of this, various parameters are required to be regularly considered to examine overweight in youngsters including BMI, physical activity levels and physical fitness components. Though body mass index is frequently utilized as a functional parameter of complete adiposity in adolescents,8 it appears that body mass index has various confines in examining the occurrence of adiposity, body composition and fat proportion specific to age and gender.9 Contrarily, physical activity levels and physical fitness levels are considered as the major predictors of core adiposity and CVD risk factors contributing to elevated levels of plasma lipids and lipoprotein in adolescents.9 Considering this, we led this study to examine the relationship of overweight and obesity with physical activity level and physical fitness components of male adolescents. &#xD;
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METHODS&#xD;
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Subjects&#xD;
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The study participants were selected from different schools of District Amritsar of Punjab, India. The study participants were 332 males adolescents of age ranged from 13-18 years. The conventional approach of sampling was followed to locate the participants. &#xD;
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Data collection &#xD;
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Physical Activity levels &#xD;
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A self-administered questionnaire PAQ-A was used to assess the levels of physical activity.10 It is appropriate for administration on 13 to 19-year-olds. It consists of 8 items that provide physical activity data of the last seven days. Each item was scored on a 5-point scale. &#xD;
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Physical Fitness Components &#xD;
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All the physical fitness components along with their purpose and respective tests are mentioned in table 1. &#xD;
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Overweight and Obesity &#xD;
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The body mass index (BMI) was calculated by dividing the weight in kilograms by height meter squared. The following cut-offs were used to estimate the body mass index is given in table 2: &#xD;
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Statistical Analysis&#xD;
&#xD;
The descriptive figures of the parameters Physical Activity Level and Physical Fitness components were presented as mean, standard deviation and minimum and maximum values. Since the dependent variable overweight/obese was categorical, its relationship with the number of independent variables was examined by running Pearson&#x2019;s Point-biserial correlation. The significance level was at 0.05. All the analyses were performed on IBM SPSS version-21.&#xD;
&#xD;
Ethical approval and consent: The study was ethically approved by the Department of Physical&#xD;
&#xD;
Education (T), Guru Nanak Dev University, Amritsar. The informed consent was taken from all&#xD;
&#xD;
the participants before data collection.&#xD;
&#xD;
Ethical approval and consent: The study was ethically approved by the Department of Physical&#xD;
&#xD;
Education (T), Guru Nanak Dev University, Amritsar. The informed consent was taken from all&#xD;
&#xD;
the participants before data collection.&#xD;
&#xD;
Ethical approval and consent: The study was ethically approved by the Department of Physical Education (T), Guru Nanak Dev University, Amritsar. The informed consent was taken from all the participants before data collection.&#xD;
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&#xD;
&#xD;
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Table 3 shows the mean and standard deviations of demographics of male adolescents. The mean and standard deviation of the age was 15.61 and 1.26 years respectively. The mean value of height was 1.66 meters with a standard deviation of 0.08. The mean and standard deviation of weight was 56.81 Kgs and 7.91 respectively. Of the total sample, 2.11% were found underweight, 90.96% possessed normal weight, 5.42% were overweight and 1.51% were found obese as per the BMI cut off values. &#xD;
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&#xD;
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Table 4 demonstrates the descriptive statistics of physical activity level and the variables of physical fitness in males. The mean score and standard deviation of physical activity level were 3.03 and 1.00 respectively with the score range of 1.05 to 4.98. The mean score and standard deviation of Speed were 8.91 and 1.84 seconds respectively with the score range of 6.08 to 18.18. The mean score and standard deviation of Explosive Power were 1.61 and 0.29 meters respectively with the values ranging from 0.71 to 2.66. The mean value and standard deviation of Flexibility were 28.81 and 7.52 centimetres respectively with the score range of 3 to 60. The mean score and standard deviation of Agility were 24.15 and 2.86 seconds respectively with the score range of 18.17 to 33.52. The mean score and standard deviation of Endurance were 151.24 and 35.86 seconds respectively with the score range of 84 to 346. The mean score and standard deviation of Coordination were 16.55 and 4.03 respectively with the score range of 6 to 26. For Balance, the mean value was 31.58 and the standard deviation was 10.38. The score of Balance ranged from 8 to 60. For Handgrip Strength, the mean value was 11.25 with a standard deviation of 2.95. The minimum value of Handgrip Strength was 5.16 and the maximum was 24.19. The mean value of Reaction time was 5.64 with the standard deviation of 1.21 and minimum and maximum values ranged from 2.67 to 7.95 respectively. &#xD;
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Table 5 outlines the relationship of physical activity levels and physical fitness components with overweight and obesity. As shown in table 5, all the variables were significantly correlated with the overweight and obesity. Physical activity level showed a weak negative correlation (r = -0.21, </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3823</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3823</Fulltext></URLs><References>&#xD;
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	Gomes TN, Katzmarzyk PT, Dos Santos FK, Souza M, Pereira S, Maia JA. Overweight and obesity in Portuguese children: prevalence and correlates. Int J Env Res Public Health. 2014 Nov;11(11):11398-417.&#xD;
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	Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. The lancet. 2002 Aug 10;360(9331):473-82. &#xD;
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	Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, Mohan V. Epidemiology of childhood overweight &amp; obesity in India: A systematic review. Ind J Med Res. 2016 Feb;143(2):160.&#xD;
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	Mossberg HO. 40-year follow-up of overweight children. The Lancet. 1989 Aug 26;334(8661):491-3. &#xD;
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	Loid P, Goks&#xF6;r E, Alm B, Pettersson R, M&#xF6;llborg P, Erdos L, et al. A persistently high body mass index increases the risk of atopic asthma at school age. Acta Paediatr. 2015 Jul;104(7):707-12. &#xD;
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	Kim SJ, Ahn J, Kim HK, Kim JH. Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Paediatr. 2016 Oct;105(10):1152-7. &#xD;
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	Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. J Ame Med Asso. 2002 Oct 9;288(14):1728-32.&#xD;
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	Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes (Lond). 2000 Nov;24(11):1453-8. &#xD;
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	Kowalski KC, Crocker PR, Kowalski NP. Convergent validity of the physical activity questionnaire for adolescents. Pediatr Exerc Sci. 1997 Nov 1;9(4):342-52. &#xD;
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	Hong I, Coker-Bolt P, Anderson KR, Lee D, Velozo CA. Relationship between physical activity and overweight and obesity in children: Findings from the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Am J Occup Ther. 2016 Sep 1;70(5):7005180060p1-8. &#xD;
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	Dumith SC, Ramires VV, Souza MA, Moraes DS, Petry FG, Oliveira ES, et al. Overweight/obesity and physical fitness among children and adolescents. J Phys Act Health. 2010 Sep 1;7(5):641-8.&#xD;
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	Deforche B, Lefevre J, De Bourdeaudhuij I, Hills AP, Duquet W, Bouckaert J. Physical fitness and physical activity in obese and nonobese Flemish youth. Obes Res. 2003 Mar;11(3):434-41. &#xD;
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	Bovet P, Auguste R, Burdette H. Strong inverse association between physical fitness and overweight in adolescents: a large school-based survey. Int J Behav Nutr Phys Act. 2007 Dec;4(1):24.&#xD;
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	Fogelholm M, Stigman S, Huisman T, Mets&#xE4;muuronen J. Physical fitness in adolescents with normal weight and overweight. Scand J Med Sci Sports. 2008 Apr;18(2):162-70.&#xD;
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	Tokmakidis SP, Kasambalis A, Christodoulos AD. Fitness levels of Greek primary schoolchildren in relationship to overweight and obesity. Eur J Pediatr. 2006 Dec 1;165(12):867-74.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Pilot Study on Variation of Blood Pressure of Undergraduate Students in Summer and Winter Seasons&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>49</FirstPage><LastPage>53</LastPage><AuthorList><Author>Anurag Singh Gautam</Author><AuthorLanguage>English</AuthorLanguage><Author> Girish Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Ashutosh Kumar Pathak</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The seasonal variation of blood pressure has been demonstrated in various researches but the studies on the variation of blood pressure in students of the northern region of India is very sparse, also the data regarding the prevalence of prehypertension in Undergraduate students of the Varanasi region is lacking. Aims: This study aims to find the mean blood pressure variation of undergraduate students in the summer and winter season and to screen male and female students in the prehypertensive stage. Method: It was a longitudinal pilot study in which blood pressure of undergraduate students of Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University was measured in two different seasons i.e. summer and winter. A total of 50 students 25 (50%) males and 25 (50%) females of age 18 to 25 years were included in the study. Result and Conclusion: Mean of systolic blood pressure as well as diastolic blood pressure were significantly higher in the winter season as compared to the summer season. The mean difference between systolic blood pressure and diastolic blood pressure in the winter and summer season was 6.26 mmHg and 6.54mmHg, respectively. The mean of systolic blood pressure of males was significantly higher as compared to females in both winter and summer season by the difference of 11 mmHg in winter and 10 mmHg in summer which was statistically significant (P</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Blood pressure, Prehypertension, Season, Summer, Winter</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
In today&#x2019;s era, due to lifestyle changes, there is an increase in metabolic diseases like hypertension, diabetes mellitus etc. These diseases are occurring individually as well combined in a manner of the syndrome. Hypertension is one of these and its cases are increasing day by day. Its pattern and associated factors are still being studied ( Table 1). &#xD;
&#xD;
&#xD;
&#xD;
The Seventh Report of the Joint National Committee on the Prevention Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) introduced a hypertension category &#x201C;pre-hypertension&#x201D;, defined as a systolic blood pressure of 120 to 139 mmHg or diastolic blood pressure of 80 to 89 mmHg.1&#xD;
&#xD;
Various conditions affect blood pressure levels in a normal and diseased person. The effect of seasonal variations on blood pressure is a well-established fact. This effect is more pronounced in humid subtropical regions like Varanasi where the temperature (49&#xB0;F to 106&#xB0;F), as well as humidity (2% to 100%) variation, is quite high.&#xD;
&#xD;
Many studies are depicting the variation of blood pressure in different seasons. Studies from the eastern part of the Delhi area shows that there is high blood pressure during the winter season as compared to the summer season and a study from Punjab stated that cardiovascular morbidity and mortality increases during the winter season. In these two studies of the north Indian region. It was found that the mean difference between winter and summer was 9.01 mmHg and 11mmHgfor systolic blood pressure and 5.61mmHg and 6.79 mmHg for diastolic blood pressure respectively.2,3 Two studies in which one is from the Guwahati region in Assam and the other is Iranian study of Tehran on adult population shows that mean the difference among summer and winter systolic blood pressure was 2 mmHg and 3 mmHg and diastolic blood pressure was1 mmHg and 2 mmHg respectively.4,5&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There are studies on student population also as in a study it was found that756 (22.3%) out of 3385 students of Shimla district in Himachal Pradesh were in prehypertensive stage.6 and in other study of Government medical college, Andhara Pradesh 103 (37.45%) students out of 275 were in prehypertensive stage.7 Out of 84 medical students in karnataka 42 (50%) were prehypertensive.8 140 (25.9%) students were in prehypertensive stage out of 540 students of South Ghana in rainy season.9 and in other studies, it was found that 57 (37.1%) out of 155 students of Northeast Malaysia were prehypertensive in south-west monsoon season.10 and81 (12.83%) out of 631 students of Erode district of Tamil Nadu were in the prehypertensive stage.11&#xD;
&#xD;
Lacunae -&#xD;
&#xD;
This pilot study is part of a study on the effect of marma therapy on blood pressure in different seasons on prehypertensive undergraduate students. Due to the lack of data on the variation of blood pressure of undergraduate students of the northern region in a different season as well as the prevalence of prehypertension among undergraduate students of the northern region, need arises to study the effect of different seasons on blood pressure variations among undergraduate students of the northern region. Thus, it was decided to do a pilot study and evaluate findings for further large samples.&#xD;
&#xD;
AIM AND OBJECTIVE&#xD;
&#xD;
This study aims -&#xD;
&#xD;
&#xD;
	&#xD;
	to find the mean blood pressure variation in male and female students in the summer and winter season. &#xD;
	&#xD;
	&#xD;
	to compare blood pressure variation among students in the summer and winter season. &#xD;
	&#xD;
	&#xD;
	to explore the number of male and female students in the prehypertensive stage.&#xD;
	&#xD;
&#xD;
&#xD;
MATERIAL AND METHOD&#xD;
&#xD;
50 students of the BAMS course of Faculty of Ayurveda, IMS, BHU who had given consent to participate in the study were recruited for the study, 25 males and 25 females of age between 18 to 25 years were included. Blood pressure was measured in two different seasons, summer and winter in month of February and May. Blood pressure was measured thrice in left arm and the mean blood pressure was taken. Blood pressure was measured by AccuSureTSBlood pressure Monitor Model No: TMB-1112-A. Approved Mark: IND/09/13/141.This blood pressure data taken in Varanasi area where temperature range between 9 &#xBA; C to 42&#xBA; C.&#xA0; In month of February the mean temperature was 19.35&#xBA; C and in month of May mean temperature was34.2&#xBA; C. When data is taken in May temperature was 37&#xBA; C and humidity was 27% and in month of February temperature was 22&#xBA; C and humidity 18%. &#xD;
&#xD;
Statistical Methods:&#xD;
&#xD;
The data were analyzed by statistical software SPSS version 20. Paired t-test was applied to test whether variation in mean systolic blood pressure, as well as diastolic blood pressure in both summer and winter season, is statistically significant or not. Variables that had p&lt; 0.05 were considered&#xA0;statistically significant.&#xD;
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Ethical Clearance Number:&#xD;
&#xD;
The pilot study is part of the study &#x201C;A study on the effect of talahridaya marma therapy on blood pressure of prehypertensive students in different seasons&#x201D; approved by the ethical committee of Institute of Medical Sciences, Banaras Hindu University with reference no- Dean/2019/EC/1336&#xD;
&#xD;
Inclusion criteria &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; 1. Undergraduate students of Ayurveda (BAMS) course, Faculty of Ayurveda, Institute of&#xA0;Medical Sciences, Banaras Hindu University, Varanasi, India&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; 2. Males and females of the age group of 18 to 25 years.&#xD;
&#xD;
Exclusion criteria&#xD;
&#xD;
&#xD;
	&#xD;
	Students were not willing to participate in the study.&#xD;
	&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3824</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3824</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Investigation O. The Prevalence of Prehypertension and Hypertension Among US Adults &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;According to the New Joint National Committee Guidelines. 2004;164; 2126-2134&#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sinha P, Tanoja D, Singh N, Saha R. Seasonal variation in the prevalence of hypertension: Implications for interpretation. Indian J Public Health. 2010;54(1):7. &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chakrabarty M, Bora B. The measurement of blood pressure in the winter season and its correlation with blood pressure after cold exposure in summer season: a cross-sectional study in Gauhati medical college and hospital, Guwahati, Assam, India. Int J Res Med Sci. 2017;5(7):3111-3113.&#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Askari S, Asghari G, Ghanbarian A, Khazan M, Alamdari S, Azizi F. Seasonal variations of blood pressure in adults: Tehran lipid and glucose study. Arch Iran Med. 2014;17(6):441&#x2013;443. &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Goyal A, Aslam N, Kaur S, Soni RK, Midha V, Chaudhary A, et al. Factors affecting seasonal changes in blood pressure in North India: A population-based four-seasons study. Ind Heart J.2018; 70 (8): 360-367. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;Prehypertension and Hypertension and its Determinants among Adolescent School Children of a Semi-urban /Area in Erode District, Tamil Nadu. Ind Heart J. 2017;4(12):155&#x2013;60. &#xA0;&#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chitrapu RV, Thakkallapalli ZM. Prehypertension among Medical Students and its Association with Cardiovascular Risk Factors. Ind Heart J. 2015;4(1):8&#x2013;12. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Krishndasa SN. Pre-Hypertension in Apparently Healthy Young Adults?: Incidence and Influence of Haemoglobin Level. Int J Res Med Sci. 2015;9(11);10&#x2013;12. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Rafan SNH, Zakaria R, Ismail SB, Muhamad R. Prevalence of prehypertension and its associated factors among adults visiting the outpatient clinic in Northeast Malaysia. J Taibah University Med Sci. 2018;13(5):459&#x2013;64.&#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Anuradha G, Muraleetharan G, Abinaya R, Tamilkodi M, Sachithanantham S. Prevalence &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;pressure. Br Med J. 1982;285(6346):919&#x2013;23. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Ojeda NB, Grigore D, Robertson EB, Alexander BT. Estrogen Protects Against Increased Blood Pressure in Postpubertal Female Growth Restricted Offspring. Br Med J. 2007;50;679&#x2013;85. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Brennan PJ, Greenberg G, Miall WE, Thompson SG. Seasonal variation in arterial blood&#xA0;&#xA0;&#xA0; Mahajan A, Negi P. Hypertension and pre-hypertension among adolescents in Shimla, Northern India-Time to awaken. Niger J Cardiol. 2015;12(2):71-76. &#xD;
&#xD;
13. &#xA0;&#xA0;&#xA0;&#xA0; Keatinge WR, Coleshaw SR, Cotter F, Mattock M, Murphy M, Chelliah R. Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Bri Med J. 2009;289(6456):1405&#x2013;1408. &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Singh Gautam A, Pathak AK. Greentree Group Publishers Effect of Seasonal Variation on Blood Pressure-A Review. Int J Ayu Pharm Chem. 2019;11(2);664-669. &#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0; Gyamfi D, Obirikorang C, Acheampong E, Danquah KO, Asamoah EA, Liman FZ, et al. Prevalence of pre-hypertension and hypertension and its related risk factors among undergraduate students in a Tertiary institution, Ghana. Alexandria J Med. 2018;54(4):475&#x2013;80. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Chandrashekhar R, Basagoudar S. Study of Hypertension and Its Risk Factors Among&#xA0; Women of Reproductive Age Group. Int J Ayu Pharm Chem. 2013;05(22):27&#x2013;32. &#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment and Interrelation of hs-CRP, Nitrosative Stress and Lipid Profile in Type-2 Diabetes Mellitus&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>54</FirstPage><LastPage>61</LastPage><AuthorList><Author>Bithika Ghosh</Author><AuthorLanguage>English</AuthorLanguage><Author> Saumyajit Maiti</Author><AuthorLanguage>English</AuthorLanguage><Author> Kasturi Mukherjee</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The prevalence of type 2 Diabetes Mellitus, one of the major health problems, is increasing day by day, which is one of the important causes for the development of Cardiovascular Disease (CVD). Aim: To determine serum levels of hs-CRP, total nitrite, endogenous nitrite, Nitrate/Nitrite ratio and Lipid Profile as predictors of inflammation, nitrosative stress and dyslipidemia in Type 2 Diabetes Mellitus patients and to evaluate the correlation among the above mentioned biochemical parameters with age-sex matched healthy controls. Materials and Methods: Current study was designed to estimate the level of fasting blood sugar, hs-CRP, parameters of lipid profile and different parameters of nitrosative stress (total nitrite, endogenous nitrite, nitrate and nitrate/nitrite ratio)in the Department of Biochemistry on diabetics screened from Department of Endocrinology and Metabolism, through proper inclusion and exclusion criteria, and compared with that of age-sex matched healthy controls. Result: Level of total nitrite, nitrate, nitrate/nitrite ratio parameters of nitrosative stress, hs-CRP and total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride are significantly high in the group of diabetics and statistically significant as compared with controls. Conclusion: Assessment of hs-CRP, marker of low-grade inflammation and parameters of nitrosative stress is necessary for the diabetics as they are established independent potent risk factors for CVD. A large study population from multiple centres are required for a better result to conclude the study.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>hs-CRP, Nitrosative stress, Nitrate, Nitrite, Lipid Profile, Type-2 Diabetes Mellitus</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
According to WHO reports, in this 21st century, the prevalence of type 2 Diabetes Mellitus (T2DM) has been increased worldwide very rapidly. T2DM, one of the major public health problems, accounts for approximately 85 to 95 percent of all diagnosed cases of diabetes. In India, the scenario is worsening day by day. Epidemiological data in India show the same upward trend and the projected figure for DM affected people is 33 million in 2025.1&#xD;
&#xD;
Inflammation and endothelial dysfunction followed by oxidative stress &#x2013; the sequence which is ultimately responsible for the development and progress of Type 2 Diabetes Mellitus and all sorts of its complications. In Type 2 Diabetes, 65 to 80 percent of deaths occur due to cardiovascular disease (CVD) whose aetiology cannot be explained by chronic hyperglycemia, dyslipidemia and traditional cardiac risk factors.2, 3&#xD;
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CVD is in part an inflammatory process; C - reactive protein (CRP) has been widely investigated in the context of atherosclerosis and subsequent vascular events. Mild elevation of high&#x2013;sensitivity C &#x2013; reactive protein (hs-CRP) associated with future cardiovascular risk. Chronic low-grade systemic inflammation plays a major role in the pathophysiology of both T2DM as well as atherosclerosis.4&#xD;
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Among the number of factors involved in maintaining proper vascular homeostasis, nitric oxide (NO) plays a pivotal role in guaranteeing physiological endothelial function. It is still a matter of controversy whether and in which way imbalance in glucose metabolism might affect NO synthesis and bioavailability.5Type 2 Diabetes Mellitus is a state of increased free radical activity. The roles of surplus Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) in the diabetic complications of multiple organ systems are widely documented.6The endothelial dysfunction associated with Diabetes has been attributed to a lack of bioavailable NO due to oxidative and nitrosative stress.&#xD;
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This study aims to assess serum levels of hs-CRP, total nitrite, endogenous nitrite, Nitrate/Nitrite ratio and Lipid Profile as predictors of inflammation, nitrosative stress and dyslipidemia in Type 2 Diabetes Mellitus patients and find out the correlation among the above mentioned biochemical parameters with age-sex matched healthy controls.&#xD;
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MATERIALS AND METHODS:&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
This hospital-based case-control study was done in the Department of Biochemistry, Calcutta Medical College and Hospital, Kolkata and the patients were selected from the Out-Patient Department of Endocrinology and Metabolism, Calcutta Medical College and Hospital, Kolkata over one year (from January 2014 to January 2015). The problem is defined as chronic inflammatory endothelial damage; nitrosative stress and dyslipidemia are collectively responsible for multi-organ complications and death in patients of Type 2 Diabetes Mellitus. Written informed consent was taken from the patients as per proforma. Detailed demographical data, history and clinical findings and laboratory investigations were recorded in the proforma.&#xD;
&#xD;
The sample size was determined by using the correlation coefficient (Pearson&#x2019;s) in Type 2 DM between hs-CRP and total cholesterol (r=0.72), triglyceride levels (r=0.58) and LDL Cholesterol (r=0.72) with type 1 error of&#xA0; 5%, and power 80%&#xA0; using statistical software Medcalc version 10.2.0.0. Considering correlation coefficient (Pearson&#x2019;s) as 0.72 the minimum required sample size was 12, and considering 0.58 the size was 21. In our study, we took a total sample of 100 (case 50 and control 50).&#xD;
&#xD;
Study Population:&#xD;
&#xD;
&#xD;
	&#xD;
	Type 2 Diabetes Mellitus patients attending the Out Patient Department of Endocrinology and Metabolism, Medical College and Hospital, Kolkata, who fulfil the Inclusion Criteria.&#xD;
	&#xD;
	&#xD;
	Normal healthy age and sex-matched controls.&#xD;
	&#xD;
&#xD;
&#xD;
Inclusion Criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Male and female newly diagnosed Type 2 Diabetes Mellitus patients aged between 30 to 65 years, having fasting blood glucose more than or equal to 126mg/dl.&#xD;
	&#xD;
	&#xD;
	The Control group includes age-matched healthy volunteers with fasting plasma glucose level less than 100mg/dl of both sexes.&#xD;
	&#xD;
	&#xD;
	Patients willing to participate in the study and gave proper consent.&#xD;
	&#xD;
&#xD;
&#xD;
Exclusion Criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Patients who have- &#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Diabetes was other than Type 2 Diabetes Mellitus.&#xD;
	&#xD;
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	History of insulin and or oral hypoglycaemic drugs.&#xD;
	&#xD;
	&#xD;
	History of any chronic inflammatory disorder.&#xD;
	&#xD;
	&#xD;
	History of renal or hepatic impairment.&#xD;
	&#xD;
	&#xD;
	History of recent trauma/surgery.&#xD;
	&#xD;
	&#xD;
	History of Infective Disease.&#xD;
	&#xD;
	&#xD;
	H/O Myocardial infarction, Hypertension.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Pregnant and lactating woman.&#xD;
	&#xD;
	&#xD;
	Subjects on any concomitant medication such as antioxidants, herbal treatment may interact with nitrosative stress parameter.&#xD;
	&#xD;
	&#xD;
	Cigarette smokers and alcoholics.&#xD;
	&#xD;
&#xD;
&#xD;
Collection of sample:&#xD;
&#xD;
10 ml of venous blood was collected from newly diagnosed Diabetic patients at 12-hour fasting in the early morning with proper aseptic technique. Then the patients were instructed to take a meal that they take normally in their lunch and come again exactly after two hours. Blood was collected in two containers one having no anticoagulant for serum and the other having citrate-fluoride for plasma. The sample taken in clot activator without anticoagulant were allowed to clot and then all the containers were centrifuged at 1500 rpm speed for 3-5 minutes for separation of serum and plasma. The serum and plasma were separated and kept at 2-8?C until analysis.&#xD;
&#xD;
Laboratory investigations parameters and procedures&#xD;
&#xD;
&#xD;
	&#xD;
	Plasma glucose was estimated by Glucose Oxidase-Peroxidase Method. (Crest Biosystem a division of Coral-clinical systems)&#xD;
	&#xD;
	&#xD;
	Nitrate was assessed by the Cadmium Reduction method; Nitrite was determined by Diazotization of Sulphanilamide by coupling it to N-naphthyl ethylene diamine.&#xD;
	&#xD;
&#xD;
&#xD;
Principle&#xD;
&#xD;
The nitrate was assayed by the Cadmium reduction method. The nitrite was determined by diazotization of Sulphanilamide &amp; coupling it to N-naphthyl ethylene diamine dihydrochloride (NED). Since NO has an extremely short half-life of less than 10 sec, it cannot be measured directly. However as NO is rapidly metabolized to nitrite (NO2) and nitrate (NO3) in the cell, the concentration of these stable anions can be used to measure the amount of NO that was originally present in a sample. NO2 is converted to nitrous acid (HNO2) in an acidic solution. HNO2 is diazotized with the Sulphanilic acid and Sulphanilamide &#x2013;Diazonium complex is formed. This is coupled with the amine of NED and a purpled coloured compound is obtained which can be measured spectrophotometrically at 545 nm.7&#xD;
&#xD;
Calculations:&#xD;
&#xD;
The individual reading was put on the Standard curve and the concentration was derived. The result was multiplied by 30 which is the final dilution factor. To obtain the Nitrate concentration, the concentration of endogenous nitrite is subtracted from total nitrite (endogenous nitrite + nitrate converted to nitrite). Finally, the nitrate nitrite ratio was calculated (serum nitrate/endogenous nitrite).&#xD;
&#xD;
&#xD;
	&#xD;
	hs-CRP estimation by Immuno turbidimetric method. (Erba CRP &#x2013;HS)&#xD;
	&#xD;
	&#xD;
	Estimation of serum total cholesterol by (CHOD/PAP) method. (Coral-clynical system)&#xD;
	&#xD;
	&#xD;
	Estimation of serum Triglyceride by (GPO/PAP) method. (Coral-clynical system)&#xD;
	&#xD;
	&#xD;
	Estimation of serum HDL- cholesterol by Direct Enzymatic method. Polyvinyl Sulfonic acid (PVS) and Polyethylene-glycol-methyl ether (PEGME) coupled classic precipitation method. (Kit used Erba XL system pack)&#xD;
	&#xD;
	&#xD;
	LDL- cholesterol and VLDL cholesterol values in mg/dl were indirectly calculated by using the formulae of Friedwald and Fredrickson (1972).&#xD;
	&#xD;
&#xD;
&#xD;
Statistical analysis:&#xD;
&#xD;
Statistical analysis of the study was done by SPSS (statistical package for social sciences) software (version 21 original) after obtaining the data at the end of the study. P-value less than 0.05 was considered to be statistically significant.&#xD;
&#xD;
This study was cleared by the Institutional Ethics committee as per ref no. MC/Kol/IEC/195/12-2013 Dt 21.12.2013 Proforma.&#xD;
&#xD;
RESULT:&#xD;
&#xD;
In this study, 50 newly diagnosed type 2 diabetes patients in the age group of 31-65 years of both sexes were selected from the outpatient department of Endocrinology considering the inclusion and exclusion criteria and 50 healthy age and sex-matched volunteers were selected as controls between January 2014 to January 2015. &#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Table 1 describes the age-gender distribution of the control and case (diabetics) group. The control group consists of 26 (52%) male and 24 (48%) female volunteers whereas in the case group, amongst 50 cases, 25 (50%) were male and 25 (50%) were female.&#xD;
&#xD;
For both, the group&amp;#39;s different biochemical variables were measured. Among the biochemical parameters FBS, hsCRP, Nitrate and Nitrites (NOx), Total cholesterol, Triglyceride, HDL-Cholesterol, LDL-Cholesterol, and VLDL-Cholesterol were done. All these data are thoroughly described in table 2, table 3 and table 4.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Inferential Statistics:&#xD;
&#xD;
In the case (diabetics) group, different parameters were analyzed and the comparison was done which was in the tabular form below, p-value  0.8 mg/dl) were associated with a two-fold increase in CV mortality after adjusting for age, sex, and glucose tolerance tests.4, 13, 14 Inflammation and endothelial dysfunction followed by oxidative stress &#x2013; the sequence which is ultimately responsible for the development and progress of Type 2 Diabetes Mellitus and all sorts of its complications. &#xD;
&#xD;
In lipid metabolism, several steps are influenced by insulin; so dyslipidemia (increased level of serum total cholesterol, LDL cholesterol and triglycerides and significantly reduced level of serum HDL cholesterol) is the most common features of diabetes.15&#xD;
&#xD;
In this present study, the control group, 26 (52%) were male and 24 (48%) were female, whereas in the diabetic groups 25 (50%) were male and 25 (50%) were female (Table 1). The study subjects were age-sex matched. In this study, 8 (16%) diabetics are of intermediate risk and 42 (84%) are of high risk for CVD (Table 3). Comparison of serum hsCRP level by independent t-test in control (mean&#xB1;SE; 0.80&#xB1;0.10 mg/L) and diabetic (mean&#xB1;SE; 4.32&#xB1;0.20 mg/L) which is statistically significant, p-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3825</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3825</Fulltext></URLs><References>&#xD;
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	Ross HM. The Dangers of High Cholesterol and Diabetes. Updated July 22, 2011.&#xD;
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	Cortas NK,&#xA0;Wakid NW. Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method. Clin Chem. 1990 Aug; 36 (8 Pt 1):1440-3.&#xD;
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	Dejam A, Hunter CJ, Pelletier MM, Hsu LL, Macado RF et al. Erythrocytes are major intravascular storage sites of nitrite in human blood. Blood. 2005 Jul 15;106(2):734-9&#xD;
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	Tsai DC, Chiou SH, Lee FL, Chou CK, Chen SJ, Peng CH, et al. Possible Involvement of Nitric Oxide in the Progression of Diabetic Retinop Ophthalm. 2003; 217: 342&#x2013;6.&#xD;
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	Chiriboga DE, Ma Y, Li W, Stanek EJ, Hebert JR, Merriam PA et al. Seasonal and sex variation of the high sensitivity C-reactive protein in healthy adults: A longitudinal study. Clinical Chemistry Clin Chem. 2009 Feb; 55(2): 313&#x2013;321.&#xD;
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	Jager A, Van Hinsberg VW, Kostense PJ. CRP and five-year mortality in diabetic subjects: The Hoorn study. Arteioscl Throm Vasc Biol.1999; 12: 3071-80.&#xD;
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	Yoshimasa ASO, Wakabayashi S, Yamamoto R, Matsutomo R, Kohzo, Takebayashi, Inukai T. Metabolic syndrome accompanied by hypercholesterolemia is strongly associated with proinflammatory state and impairment of fibrinolysis in patients with type 2 diabetes. Diabetes Care. 2005;28:(9) 2211-6.&#xD;
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	Doi Y, Kiyohara Y, Kubo MK, Ninomiya T, Wakugawa Y, Yonemoto Ket al., (2005). Elevated c-reactive protein, is a predictor of the development of diabetes in a normal Japanese population. Diabetes Care. 2005 Oct; 28(10): 2497-2500.&#xD;
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	Liu S, Tinker L, Song Y, Rifai N, Bonds DE, Cook NR, et al. A prospective study of inflammatory cytokines and diabetes mellitus in multiethnic cohort of postmenopausal women. Arch Int Med. 2007 Aug 13-27;167(15):1676-85.&#xD;
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	Mohan V, Deepa R, Velmurugan K, G. Premalatha. Association of C - reactive protein with body fat, diabetes and coronary artery disease in Asian Indian&#x2019;s. The Chennai Urban Rural Epidemiology Study (CURES-6). Diab Med. 2005 July; 22(7):863-870.&#xD;
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	Rhee EJ, Kim YC, Lee WY, Jung CH, Sung KC, Ryu SH, et al. Comparison of insulin resistance and serum high-sensitivity C-reactive protein levels according to the fasting blood glucose subgroups divided by the newly recommended criteria for fasting hyperglycemia in 10059 healthy Koreans. Metabol. 2006 Feb;55(2):183-7.&#xD;
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	Gupt A, Kumar D, Rajvanshi S, Kumar A, TVS Arya. To study the association of high sensitivity c-reactive protein with newly diagnosed DM type 2. J Int Ame Med; 2015:16(1):12-15.&#xD;
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	Bugiardini R, Manfrini O, Pizzi C, Fontana F, Morgagni G. Endothelial function predicts future development of coronary artery disease: A study of women with chest pain and normal coronary angiograms. Circulation. 2004 Jun 1;109(21):2518-23.&#xD;
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	Konukoglu D, Serin O, Turhan MS. Plasma total homocysteine concentrations in obese and non-obese female patients with type 2 diabetes mellitus; its relations with plasma oxidative stress and nitric oxide levels. Clin Hemorheol Microcirc. 2005; 33(1):41&#x2013;6.&#xD;
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	M Cassone Faldetta, O Laurenti, G Desideri, M C Bravi, O De Luca, M C Marinucci, G De Mattia, C Ferri. L-arginine infusion decrease plasma total homocysteine concentration through increased nitric oxide production and decreased oxidative status in Type II diabetic patients. Diabetol. 2002 Aug;45(8):1120-7.&#xD;
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	Yugar-Toledo JC, Tanus-Santos JE, Sabha M, Sousa MG, Cittadino M, T&#xE1;cito LHB, Moreno H Jr. Uncontrolled hypertention, uncompensated type 2 diabetics and smoking have different pattern of vascular dysfunction.Chest.2004 Mar;125(3):823-30.&#xD;
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	Ghosh A, Sherpa ML, Bhutia Y, Pal R, and Dahal S. Serum nitric oxide status in patients with type 2 diabetes mellitus in Sikkim. Int J Appl Basic Med Res. 2011 Jan-Jun; 1(1): 31&#x2013;35.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Role of MRI in Assessment of Hip Joint Avascular Necrosis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>62</FirstPage><LastPage>64</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: A new chapter in the clinical approach to avascular necrosis has begun with the development of cross-sectional imaging techniques, particularly magnetic resonance imaging (MRI). MRI is currently useful in the diagnosis of multiple symptomatic and asymptomatic cases of hip joint avascular necrosis. Aims &amp; Objectives: To study the role of magnetic resonance imaging in the assessment of hip joint avascular necrosis. Methods: It was cross-sectional, hospital-based research carried out over one year in a tertiary care centre. A total of 68 hip pathology cases with OPD complaining of hip joint pain were subjected to MRI scans and all those participants consented. Results: Avascular necrosis was shown to demonstrate 94 percent sensitivity. MRI diagnosis was correctly matched with provisional diagnosis in 64 out of 68 cases, providing 94 percent of sensitivity and the remaining 4 patients were normal. Conclusion: MRI is the modality of choice in the diagnosis of hip joint avascular necrosis. In determining the degree of osseous &amp; chondral involvement, MRI is helpful. MRI sensitivity in diagnosing avascular necrosis is 94 percent in the current study and is very effective in the staging of avascular necrosis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Avascular necrosis, Hip joint, pathology, Magnetic resonance imaging, OPD</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The hip joint is a large synovial joint that has to bear a lot of weight and its rigid ball and socket or nut form, as well as the solid ligaments and muscles around it, provide its stability. 1,2 The acetabular-cartilage is horse-shoe-shaped with a central portion that does not articulate with the femoral head without cartilage coverage (fossa acetabuli). Fatty tissue and ligamentum-teres are imaged on MRI inside the fossa. Except for the insertion of the ligamentum-teres, the femoral head is fully coated with hyaline cartilage. 3,4 Compared to other joints, the hip joint cartilage is thin with a maximum thickness ventro-cranially at the acetabulum and ventro-laterally at the femoral head. In adults and kids, hip pain has distinct etiologies. 5,6 Hip pain in adults may be caused by intra-articular disorders such as avascular necrosis, arthritis, loose bodies, labral tears, peri-articular pathology such as tendinitis and bursitis, or by extra-articular conditions such as lumbar spine pain, Sacro-illiac articulations, and syndromes of nerve capture. In the general population, the incidence of hip pain is 10 per cent and increases with age. 7,8 Pain is generally characterized by long-standing symptoms in the hip and groin area that often do not heal within 6-12 months. Hip and groin pain has been reported to occur regularly in athletes and adults. With its excellent soft tissue contrast and resolution, with no operator reliance and no ionizing radiation, magnetic resonance imaging (MRI) is the imaging tool of choice for assessing hip joint anomalies. 9&#xA0; MRI provides useful data such as stress-fractures, avascular-necrosis of hip joint on occult bony and cartilage injury. The femoral head is the most prevalent site for avascular necrosis and can affect young and old patients. The present research was therefore conducted to study the role of MRI in the assessment of hip joint pathologies. 10,11&#xD;
&#xD;
AIMS &amp; OBJECTIVES: To study the role of magnetic resonance imaging in assessment of hip joint avascular necrosis.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
The present research was a cross-sectional, hospital-based study to estimate the role of MRI in the early evaluation of hip joint avascular necrosis in tertiary health centres. The current period of research has been one year. For both indoor and outdoor patients with hip joint pain, the research population was referred to the Department of Radiology. The research population comprised a total sample size of 68 hip joint pain patients referred to the Department of Radiology at the hospital. Ethical committee clearance no DMIMS (DU) / IEC I 2020-21/9023.&#xD;
&#xD;
OBSERVATIONS AND RESULTS&#xD;
&#xD;
&#xD;
&#xD;
Table 1 demonstrates the distribution of patients by age. It was found that the majority of patients were aged 31-40 years and 41-50 years, respectively. It was found that sore hip joints accompanied by low back pain were present in most patients. The other clinical presentation involves hip joint swelling with minimal movements and constitutional signs of hip pain. The majority of patients (64) had abnormal MRI findings in our sample, while 4 patients were normal.&#xD;
&#xD;
&#xD;
&#xD;
Table 2 shows the distribution of patients according to the group concerned. It was noted that most of the bilateral side of the patient was affected (40), followed by the left side (16) and right side (8).&#xD;
&#xD;
&#xD;
&#xD;
MRI results for avascular necrosis are shown in the table above. Most patients displayed focal sub-chondral signal abnormality (100 per cent) followed by double-line sign abnormality (100 per cent) (75 per cent). Marrow oedema (44 per cent) and joint effusion are the other findings (38 per cent) shown in table 3.&#xD;
&#xD;
&#xD;
&#xD;
By Michelle&amp;#39;s classification, the above table 4 indicates MRI results in avascular necrosis. The majority of patients were found to have Stage C AVN (38 per cent), followed by Stage B (25 per cent).&#xD;
&#xD;
&#xD;
&#xD;
Table 5 above shows MRI findings by Ficat and Arlet classification5 in avascular necrosis. The majority of patients were found to have Stage III AVN (44 per cent), followed by Stage II (30 per cent)&#xD;
&#xD;
&#xD;
&#xD;
Above table 6 illustrates MRI sensitivity in the diagnosis of hip joint avascular necrosis. In the current study, 64 out of 68 cases correctly matched MRI diagnosis with provisional diagnosis, 94 per cent sensitivity, and 4 patients were normal.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In being radiation-free, non-invasive, excellent soft-tissue contrast, multiplanar imaging capability, and high sensitivity in the detection of femoral head osteonecrosis, MRI has a distinct advantage over other modalities. We diagnosed a significant number of early AVN patients with radiographs. In patients with advanced-stage, AVN on the contralateral hip was normal and also observed. Therefore, MRI is the method of choice for AVN staging, which helps to treat patients early and reliably. In the current study, 64 out of 68 cases correctly matched MRI diagnosis with provisional diagnosis, 94 per cent sensitivity, and 4 patients were normal. In a study conducted by Hayam Abd et al 2,5, avascular necrosis MRI sensitivity was 88 per cent. In the current analysis, it was found that the bilateral side of the patient was mainly affected (40), followed by the left side (16) and right side (8). Khaladkar S et al conducted a study to determine the diagnostic role of MRI in avascular necrosis patients and found that 44 (61%) and 14 patients had bilateral side effects (61%) and unilateral side effects (39 per cent). The avascular necrosis MRI findings among patients showed that most patients had focal subchondral signal abnormality (100%), accompanied by double-line sign abnormality (100%) (75 %). 12,13. Marrow oedema (44 per cent) and joint effusion are the other findings (38 per cent). These results are well associated with the Hayam Abd et al2 and Kalekar et al 8, Chaudhari N et al 11. studies. Avascular necrosis MRI results among patients classified by Mitchelles4 showed that the majority of patients had Stage C AVN (38%) followed by Stage B (25%) while by Ficat and Arlet classification5, the majority of patients had Stage III AVN (44%) followed by Stage II (30%).&#xD;
&#xD;
CONCLUSION: &#xD;
&#xD;
MRI is the modality of choice in the diagnosis of hip joint avascular necrosis. MRI is useful in determining the level of involvement of osseous, chondral and soft tissue. MR imaging reliably reveals joint effusions, synovial proliferation, defects of the articular cartilage, subchondral bone, ligaments, muscles, and soft tissue juxta-articulars. In the current study, MRI sensitivity in the diagnosis of avascular necrosis is 94%. MRI is very useful for avascular-necrosis staging. In depicting bone and soft tissue oedema, MRI is the sensitive modality.&#xD;
&#xD;
&#xA0;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=3826</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3826</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Rest-induced Reduction in Walking Speed Helps Differentiate Degenerative Compression Myelopathies from Lumbar Spinal Stenosis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>74</FirstPage><LastPage>81</LastPage><AuthorList><Author>Enoki H</Author><AuthorLanguage>English</AuthorLanguage><Author> Tani T</Author><AuthorLanguage>English</AuthorLanguage><Author> Ishida K</Author><AuthorLanguage>English</AuthorLanguage><Author> Wang S</Author><AuthorLanguage>English</AuthorLanguage><Author> Kimura J</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Patients with degenerative compression myelopathy (DCM) most commonly complain of gait-onset difficulty typically prominent after periods of inactivity. This feature stands in contrast with the post-exerciseneurogenic claudication characteristic of lumbar spinal stenosis (LSS). Aims: To test if DCM patients indeed have a greater difficulty at the beginning of gait than in steady-state conditions as compared with age-, gender-, and height-matched healthy subjects and LSS patients. Methodology: We studied 49 consecutive, ambulatory DCM patients, 11 controls, and 10 LSS patients. After sitting in a chair for 10-min, immobilizing the lower-limb muscles, the subject walked 15 m one way and returned the same distance with one turn at the maximum comfortable speed. A 2.64-m long ground reaction force plate allowed measurement of the step lengths, cadences, and speeds for the initial and terminal 2.64-m walks. Results: Unlike the controls or LSS, the DCM had a smaller (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Gait initiation, Degenerative compression myelopathy, Spasticity, Rest-induced hyperexcitability, Anterior horn cell</Keywords><Fulltext>&#xD;
INTRODUCTION&#xD;
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Degenerative compression myelopathies (DCM), the commonest non-traumatic spinal cord disorders in Japan, gives rise to a variable combination of gait disturbance such as stiffness, clumsiness and unsteadiness.1 These features reflect spastic limb paresis characterized, in part, by functionally impaired fast movements2 especially in rapid repetition,3 which retard voluntary execution out of proportion to the degree of weakness.4 Thus, 30-m walking5 and 10-sec foot-tapping speed 6,7 have proven useful as quantifiable measures for gait impairment in DCM patients with spastic paraparesis. Spastic gait results from inappropriate activation of rapidly lengthened muscle at a certain point during the gait cycle, altering its mechanical properties with increased stiffness.8&#xD;
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Although not as well-recognized as slowness of movements, DCM patients tend to show the most noticeable clumsiness of gait after periods of inactivity such as on rising in the morning and after extended sitting.1 This feature of rest-induced gait difficulty seen in upper motor neuron disorders stands in contrast with post-exerciseneurogenic claudication characteristic of lumbar spinal stenosis (LSS). The opposing presentations of the two very common entities serve as an important clue in identifying the primary site of involvement when cervical and lumbar lesions coexist. Despite the clinically important implication, few previous studies dealt with further confirmation of this point. The present study attempts to verify rest-induced gait disturbances in DCM as compared to healthy controls and LSS.&#xD;
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Materials and METHODS&#xD;
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Subjects&#xD;
&#xD;
We analyzed 49 ambulatory DCM patients (26 men), 62 &#xB1; 14 (mean &#xB1; SD) years in age and 160 &#xB1; 9 cm in height, with spastic paraparesis either by cervical (45) or thoracic myelopathy (4), 11 volunteers (7 men), 70 &#xB1; 7 years in age and 158 &#xB1; 8 cm in height, with no history of peripheral or central nervous system disease or orthopedic diseases impairing the gait, and 10 LSS patients (6 men), 67 &#xB1; 17 years in age and 160 &#xB1; 10 cm in height, with neurogenic claudication. Both DCM and LSS patients were selected out of those who had been consecutively referred to a university hospital for surgical treatment between October 2016 and March 2017. They all underwent a gait performance test using a ground reaction force plate, and the DCM patients also had a 10-sec foot-tapping test6,7 to study the correlations between the two test results. &#xD;
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The three groups showed no statistical difference (p&gt;0.05) in age, gender ratio or height. All subjects agreed in writing to participate in the study after reading and signing an informed consent form approved by the ethics committee of Kochi Medical School with the approval number of 23-84 on 1 November 2011.&#xD;
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Functional scale&#xD;
&#xD;
The functional scale developed by the Japanese Orthopedic Association (JOA) for DCM9 scores motor function from 0 to 4 points for lower limbs (Table 1). Three patients walked normally despite signs of spinal cord compromise (4 points); 4 could walk fast unaided but with some difficulty (3 points); 3 needed supports when going downstairs (2.5 points); 24 had supported when going up and down the stairs (2 points); 13 walked unaided but with difficulty (1.5 points); and 2 required walking aids (1 point). Stretch reflexes were generally hyperactive although responses were diminished for the quadriceps in 4 patients and the gastrocnemius in 11. A positive Babinski sign was found in 24 patients. We excluded the patients who were able to stand up but unable to walk (0.5 points), and chair-bound or bedridden patients (0 points). &#xD;
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Gait performance test&#xD;
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A gait analysis system (Gait scan 4000; Nitta Corp, Tokyo Japan) consisted of a rectangular-shaped ground reaction force plate 2.64 m long and 0.54 m wide, an analogue to digital (A-to-D) converter, and an amplifier capable of driving an analogue monitor display. The force plate contained a thin sensor sheet with a resolution of 5 mm for detection of foot pressure greater than 0.5 kg. The subject sat on a chair quietly for 10 min and then stood up on bare feet in response to the verbal signal. The test did not include a measurement of the time taken to rise from sitting, excluding the influence of lower limb strength and balance deficits. When the subject was ready, he/she started to walk over a smooth, flat surface in a corridor for a measured distance of 30 m (going 15 m one way and returning the same distance with one turn). We instructed subjects to walk at the maximum comfortable speed from the beginning, using personal walking aids, and to go through the finish line without reducing the speed. All the participants understood these instructions. The 2.64-m ground reaction force plate covered each end of the 30-m walkway (Figure 1). &#xD;
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First, the subject quietly sat on a chair for 10 min, and then, stood up to his/her bare feet and started walking for a measured 30 m distance (15 m there and back with one turn) at the maximum comfortable speed. We instructed the subject to walk through the finish line without reducing the walking speed. The ground reaction force plate 2.64 m in length recorded the movement trajectories of the centre of foot pressure from heel strike to toe-off as a function of time for the initial and final 2.64-m walks.&#xD;
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The gait analysis system allowed recording of the sequential changes of the ground reaction force from heel strike to toe-off as a function of time during the stance phase of walking (Figure 2). Based on the raw data recorded, this automated device digitally displayed the measured temporal and distance values for initial and final 2.64-m walks, including (1) step length, defined as the average distance from one heel strike to the other for a few strides, which was converted into a percentage of the height, (2) step frequency (cadence), the number of steps per unit of time reported as steps per minute, and (3) walking speed, defined as the average horizontal speed of the body over the 2.64-m distance.8 To assess the degree of slowing at the beginning of gait relative to the steady-state gait, we calculated the measured values for the initial 2.64-m walk in the percentage of those for the final 2.64-m walk (initial/final).&#xD;
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During the initial 2.64-m walk (top) and the final 2.64-m walk (bottom) in a 78-year-old man with cervical spondylotic myelopathy. Abscissa, time in seconds after heel-strike of the first swing leg. Ordinate, foot pressure in the percentage of the maximal value of each recording. The measurement showed the step length of 0.35 m and the walking speed of 0.71 m/s for the initial 2.64-m walk and 0.40 m and 0.96 m/s, respectively, for the final 2.64-m walk. &#xD;
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10-sec foot-tapping test (FTT)&#xD;
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&#xA0; We used a previously described method for a 10-sec foot-tapping test,7 an objective, easy-to-use means of quantifying the slowness of voluntary leg movements resulting from spasticity. In short, the subject sat on a chair with its height adjusted to have both soles flat on the floor and the hip and knee joints flexed at approximately 90&#xB0;. We instructed the subjects to keep both heels firmly placed on the ground and repeatedly tap the floor quickly and vigorously for 10 sec unilaterally. Following a few practice trials, the subjects carried out two test trials once on each side. The examiner counted the number of taps for each trial and obtained the average of the two as the score.&#xD;
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Statistics&#xD;
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Statistical measures, setting the significance level at p &lt; 0.05, included: (1) the Chi-square test for comparing categorical data, (2) Paired t-test for evaluating paired continuous data, (3) the one-way ANOVA followed by Tukey post hoc test (for homoscedasticity data) or Games-Howell test (for heteroscedasticity data) for comparing unpaired continuous data between groups, and (4) the Spearman&#x2019;s rank correlation coefficients for interrelation analyses. We used SPSS software, version 21.0 (SPSS Inc., Japan) for these statistical analyses.&#xD;
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We used G*Power version 3.1.9.2 software (Heinrich-Heine-Universit&#xE4;t D&#xFC;sseldorf, Germany) for power analyses to estimate the statistical power of the results obtained with the current sample sizes.&#xD;
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RESULTS&#xA0; &#xD;
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Step length in gait performance test&#xD;
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Table 2 summarizes the results (mean &#xB1; SD)of the quantitative assessment of the gait performance test. Comparison of the step length (expressed in percentage of the height) within each group demonstrated a significantly smaller value for the initial than final 2.64-m walk in the DCM (34.2&#xB1;6.5 % vs. 36.1&#xB1;6.3 %; p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3827</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3827</Fulltext></URLs><References>1. Allen CD. Neurology of cervical spondylotic myelopathy. In: Saunders RL, Bernini PM, editors. Cervical spondylotic myelopathy. Boston: Blackwell Scientific Publications; 1992: 29-47.&#xD;
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8. Shumway-Cook A, Woollacott MH. Motor control: Translating research into clinical practice. 5th ed. Philadelphia: Wolters Kluwer; 2017. Chapter 15, Spasticity; 381-385.&#xD;
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9. Japanese Orthopaedic Association. Scoring system (17-2) for cervical myelopathy. Nippon Seikeigeka Gakkai Zasshi 1994; 68: 498.&#xD;
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15. Stackhouse C, Shewokis PA, Pierce SR, Smith B, McCarthy J, Tucker C. Gait initiation in children with cerebral palsy. Gait Posture 2007; 26: 301-8.&#xD;
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16. Elble RJ, Cousins R, Leffler K, Hughes L. Gait initiation by patients with lower-half parkinsonism. Brain. 1996; 119: 1705-16.&#xD;
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18. Rosin R, Topka H, Dichgans J. Gait initiation in Parkinson&#x2019;s disease. Mov Disord. 1997; 12: 682-90.&#xD;
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19. Jacobs JV, Nutt JG, Carlson-Kuhta P, Stephens M, Horak FB. Knee trembling freezing of gait represents multiple anticipatory postural adjustments. Exp Neurol. 2009; 215: 334-41.&#xD;
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20. Mancini M, Zampieri C, Carlson-Kuhta P, Chiari L, Horak FB. Anticipatory postural adjustments before step initiation are hypermetric in untreated Parkinson&#x2019;s disease: an accelerometer-based approach. Eur J Neurology. 2009; 16: 1028-34.&#xD;
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21. Delval A, Tard C, Defebvre L. Why we should study gait initiation in Parkinson&#x2019;s disease. Neurophysiol Clin. 2014; 44: 69-76.&#xD;
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22. Breni&#xE8;re Y, Do MC, Sanchez J. A biomechanical study of the gait initiation process. J Biophys Med Nucl. 1981; 5: 197-205.&#xD;
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23. Crenna P, Frigo C. A motor programme for the initiation of forward-oriented movements in humans. J Physiol. 1991; 437: 635-53.&#xD;
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24. Nakamura R, Sajiki N. Motor reaction time as a measure of functional impairment in paraparesis. In: Delwaide PJ, Young RR, editors. Clinical neurophysiology in spasticity. Amsterdam: Elsevier Science Publishers; 1985:125-30.&#xD;
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25. Chang HA, Chuang TY, Lee SJ, Liao SF, Lee HC, Shih YH, et al. Temporal differences in the relative phasing of gait initiation and first step length in patients with cervical and lumbosacral spinal cord injuries. Spinal Cord. 2004; 42: 281-9.&#xD;
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26. Maezawa Y, Uchida K, Baba H. Gait analysis of spastic walking in patients with cervical compressive myelopathy. J Orthop Sci. 2001; 6: 378-84.&#xD;
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27. Kim CR, Yoo JY, Lee SH, Lee DH, Rhim SC. Gait analysis for evaluating the relationship between increased signal intensity on T2-weighted magnetic resonance imaging and gait function in cervical spondylotic myelopathy. Arch Phys Med Rehabil 2010; 91: 1587-92.&#xD;
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28. Malone A, Meldrum D, Gleeson J, Bolger C. Reliability of surface electromyography timing parameters in gait in cervical spondylotic myelopathy. J Electromyogr Kinesiol 2011; 21: 1004-10.&#xD;
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29. McDermott A, Bolger C, Keating L, McEvoy L. Meldrum D. Reliability of three-dimensional gait analysis in cervical spondylotic myelopathy. Gait Posture 2010; 32: 552-8.&#xD;
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33. Nakamura R, Taniguchi R. Reaction time in patients with cerebral hemiparesis. Neuropsychologia. 1977; 15: 845-8.&#xD;
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35. Taniguchi S, Kimura J, Yanagisawa T, Okada F, Yamada T, Taniguchi S, et al. Rest-induced suppression of anterior horn cell excitability as measured by F waves: comparison between volitionally inactivated and control muscles. Muscle Nerve. 2008; 37: 343-9. &#xD;
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36. Taniguchi S, Kimura J, Yamada T, Ichikawa H, Hara M, Fujisawa R, et al. Effect of motion imagery to counter rest-induced suppression of F-wave as a measure of anterior horn cell excitability. Clin Neurophysiol. 2008; 119: 1346-52. &#xD;
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37. Hara M, Kimura J, Walker DD, Taniguchi S, Ichikawa H, Fujisawa R, et al. Effect of motor imagery and voluntary muscle contraction on the F wave. Muscle Nerve. 2010; 42: 208-12.&#xD;
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38. Fujisawa R, Kimura J, Taniguchi S, Ichikawa H, Hara M, Shimizu H, et al. Effect of volitional relaxation and motor imagery on F wave and MEP: Do these tasks affect the excitability of the spinal or cortical motor neurons? Clin Neurophysiol. 2011; 122: 1405-10. &#xD;
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39. Yanagisawa T, Kimura J, Azuma Y, Ogushi M, Taniguchi S. Excitability of the anterior horn cells after volitional inactivity of soleus muscle: H reflex study. Jpn J Clin Neurophysiol. 2006; 34: 89-96. Japanese.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Looking Ahead to Reviewing Some Pharmacologically Active Phytoconstituents Present in Broussonetia papyrifera (L.) Hert. ex Vent.&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>88</FirstPage><LastPage>93</LastPage><AuthorList><Author>Madhukar Vitthalrao Shende</Author><AuthorLanguage>English</AuthorLanguage><Author> Debarshi Kar Mahapatra</Author><AuthorLanguage>English</AuthorLanguage><Author>  Atul Arjun Baravkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Nilesh Ashokrao Nalawade</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Plants have long been used to cure diverse ailments and disorders as a source of conventional medicines. Many of these medicinal plants are also fantastic phytochemical sources, many of which have strong therapeutic practices. Broussonetia papyrifera, also known as paper mulberry, is a well-known traditional natural resource that has been in application for decades and the renowned advances must be presented to researchers for further betterment, product innovation, exploring novel applications, and uncover miscellaneous ideas. Aim: Reviewing some pharmacologically active phytoconstituents present in B. papyrifera Linn. Methodology: The systematic literature compilation about the basic aspects, distribution, plant profile, pharmacological advances, key plant parts, ethnopharmacology, and other crucial information about B. papyrifera was performed through freely available scientific databases / natural products databases such as ScienceDirect, Google Scholar, PubMed, etc. Results: This current fascinating article expansively emphasized the general aspects, plant profile (Kingdom, Sub-Kingdom, Infra-Kingdom, Division, Sub-Division, Super-Division Class, Order, Super-Order, Family, Genus, and Species), traditional uses, distribution, major phytoconstituents, significant pharmacotherapeutic attributes (anti-viral, anti-cancer, anti-oxidant, cytotoxic potentials, anti-inflammatory, anti-diabetic, anti-microbial, anti-nociceptive, anti-gout, and anti-proliferative) mediated by diverse parts (seed, root, leaf, stem, and fruit). Conclusion: This information will be reasonably functional for the passionate contemporary investigators of several areas (natural products, pharmacognosy, medicine, chemistry, botany, pharmacy, etc.) in developing miscellaneous essential formulations for treating numerous disorders such as inflammation, cancer, high blood sugar, pain, infection, along with exhibiting cellular protective effects. This study will pave a new way for modern nature-pharmacotherapeutics for human applications&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Broussonetia papyrifera, Paper mulberry, Phytoconstituents, Ethnopharmacology, Therapeutics, Traditiona</Keywords><Fulltext>INTRODUCTION&#xD;
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Plants have long been used to cure diverse ailments and disorders as a source of conventional medicines. Many of these medicinal plants are also fantastic phytochemical sources, many of which have strong therapeutic practices. The genus Broussonetia was named after P.N.V. Broussonet, a French naturalist, who took a male tree of B. papyrifera from a garden in Scotland, and introduced it to Paris, France, where a female tree was growing, thus enabling fruit to be described.1 The genus contains 8 species, of which 7 are native to Asia and one to Madagascar. There are 16 or 17 recognized varieties of the East Asian species, including 5 wild varieties. The specific name papyrifera means paper-bearing. The paper made from wild varieties is inferior to that from non-wild varieties.2&#xD;
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B. papyrifera (L.) L&amp;#39;Her. ex Vent. (Paper mulberry) is a fast-growing shade tree belonging to the Moraceae family that is widely distributed throughout East Asia.3 It is cultivated within its natural range for its bark. It is native to China, Taiwan, Korea, and Japan and possibly native to the Pacific islands of Hawaii and Samoa. From India and Pakistan to Thailand, Malaysia, and the Pacific Islands, and even in North America, it has been naturalized in Asia. It is now widely found from sea level to 1000 m altitude in several locations in India and Pakistan.4&#xD;
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TAXONOMY&#xD;
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	Kingdom: Plantae&#xD;
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	Sub-Kingdom: Virdiplantae&#xD;
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	Infra-Kingdom: Streptophyta&#xD;
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	Super-Division: Embryophyta&#xD;
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	Division: Tracheophyta&#xD;
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	Sub-Division: Spermatophytina&#xD;
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	Class: Magnoliopsida&#xD;
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	Super-Order: Rosanae&#xD;
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	Order: Rosales&#xD;
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	Family: Moraceae&#xD;
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	Genus: Broussonetia&#xD;
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	Species: papyrifera&#xD;
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TRADITIONAL USES / ETHNOPHARMACOLOGY&#xD;
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B. papyrifera (Moraceae), also known as paper mulberry, grows naturally in Asia and Pacific countries. Its dried fruits have been used as a traditional Chinese medicine for the treatment of ophthalmic disorders and impotency.5 The leaves, twig roots, and barks of this plant are widely used to treat gynecological bleeding, dropsy, dysentery diseases as a folk medicine in China.6 The dried branches, leaves, and roots of this plant are used as a Korean traditional medicine for various therapeutic purposes, such as a diuretic, tonic, and suppressor of oedema.7,8 In particular, isolated metabolites from the roots have multiple biological characteristics including anti-inflammatory,9 anti-asthmatic,10 anti-oxidant,11 anti-cancer,12 anti-nociceptive,13 anti-microbial,14 PTP-1B inhibition,15 and aromatase enzyme inhibition.16 The extracts of this plant have also been described by the Korea Food and Drug Administration (KFDA) as a medicinal ingredient of Korean traditional medicine, and its effectiveness has been supported by the recent identification of bioactive metabolites, including chalcones, flavonoids, and flavonols with potential therapeutic activities like anti-cancer,12 &#x3B1;-glucosidase,7 anti-cholinesterase,17 xanthine oxidase,11 and anti-platelet activities.18 &#xD;
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PHYTOCHEMISTRY&#xD;
&#xD;
Phytochemicals reported in B. papyrifera are: broussonin A; broussonin B; (+)-marmesin; kazinol F; broussochalcone A; 1-(2,4-dihydroxyphenyl)-3-(4-hydroxyphenyl)-propane; 1-(4-hydroxy-2-methoxyphenyl)-3-(4-hydroxy-3-prenylphenyl)-propane; 3&#x2019;-&#x3B3;-hydroxymethyl-(E)- &#x3B3;-methylallyl-2,4,2&#x2019;,4&#x2019;-tetrahydroxychalcone-11&#x2019;-O-coumarate; (2S)-2&#x2019;,4&#x2019;-dihydroxy-2&#x201D;-(1-hydroxy-1-methylethyl)dihydrofuro-2,3-h flavanone; isolicoflavonol; (2S)-abyssinone II; (2S)-5,7,2&#x2019;,4&#x2019;-tetrahydroxyflavanone; (2S)-euchrenone a7; broussoflavonol F; (2S)-naringenin (Syn. Naringetol); albanol A (Syn. Mulberrofuran G); moracin N; isogemichalcone C; chushizisin H; broussoflavonol E; broussoflavonol G; broussoflavonol C; broussoflavonol D; chushizisin I; 5,7,3&#x2019;,4&#x2019;-tetrahydroxy-3-methoxy-6-geranylflavone; broussoflavonol B; broussoflavonol A; 5,7,3&#x2019;,4&#x2019;-tetrahydroxy-6-geranylflavonol; 4&#x2019;-O-methyldavidioside; broussoflavan A; (2R,3R)-lespedezaflavanone C; broussoflavonol F; 5,7,2&#x2019;,4&#x2019;-tetrahydroxy-3-geranylflavone; kazinol A; kazinol B; gancaonin P; uralenol; (2S)-2&#x2019;,4&#x2019;-dihydroxy-2&#x201D;-(1-hydroxy-1-methylethyl)dihydrofuro-2,3-h flavanone; isolicoflavonol; chushizisin C; chushizisin D; chushizisin E; chushizisin B; chushizisin A; chushizisin F; (2S)-euchrenone a7; broussochalcone A; broussoaurone A; chushizisin G; broussinol; isobavachalcone; broussochalcone B; (2S)-abyssinone II; bavachin; moracin I; broussonin C; (2S)-7,4&#x2019;-dihydroxy-3&#x2019;prenylflavan; moracin N; demethylmoracin I; moracin D; broussonin F; broussin; 7,4&#x2019;-dihydroxyflavan; pinocembrin; resveratrol; isoliquiritigenin; isoliquiritigenin 2&#x2019;-methy ether; 2,4,2&#x2019;,4&#x2019;-tetrahydroxychalcone; (+)-dihydrokaempferol (Syn. (+)-aromadendrin); norartocarpanone (Syn. Steppogenin); dimethoxy isogemichalcone C; moracin M; (2S)-7,4&#x2019;-dihydroxyflavan; broussonin E; 1,2,4-dihydroxy-3-(3-methylbut-2-en-1-yl)phenyl-3-(2,4-dihydroxyphenyl)-propan-1-one; 2-{5,7-dihydroxy-2-(4-hydroxyphenyl)-4-oxo-3,4-dihydro-2Hchromen-8-ylamino}pentanedioic acid; papyriflavonol A (Syn. Broussonol E); (2R,3R,5R,6S,9R)-3-hydroxy-5,6-epoxy-&#x3B2;-ionol-2-O-&#x3B2;-D-glucopyra-noside; (2R,3R,5R,6S,9R)-3-hydroxyl-5,6-epoxy-acety-&#x3B2;-ionol-2-O-&#x3B2;-D-glucopyranoside; quercetin (Syn. 3,3&#x2019;,4&#x2019;,5,7-pentahydroxyflavone); 5,7,3&#x2019;,5&#x2019;-tetrahydroxyflavanone; luteolin; 5,7,3&#x2019;,4&#x2019;-tetrahydroxy-3-methoxyflavone; squalene; octacosan-1-ol; lignoceric acid; 4&#x2019;-hydroxy-cis-cinnamic acid octacosyl ester; (&#x2013;)-marmesin; 8-(1,1-dimethylallyl)-5&#x2019;-(3-methylbut-2-enyl)-3&#x2019;,4&#x2019;,5,7-tetrahydroxyflanvonol; 3&#x2019;-(3-methylbut-2-enyl)-3&#x2019;,4&#x2019;,7-trihydroxyflavane; kazinol E; sesquineolignan; 2-(4-hydroxyphenyl)propane-1,3-diol-1-O-&#x3B2;-D-glucopyranoside; 4-hydroxybenzal-dehyde; protocatechuic acid; broussonpapyrine; nitidine; oxyavicine; liriodenine; cosmosiin; (+)-pinoresinol-4&#x2019;-O-&#x3B2;-D-glucopyranosyl-4&#x201D;-O-&#x3B2;-D-apiofuranoside; luteolin-7-O-&#x3B2;-D-glucopyranoside; liriodendrin; 3,5,4&#x2019;-trihydroxy-bibenzyl-3-O-&#x3B2;-D-glucoside; apigenin-6-C-&#x3B2;-Dglycopyranside; 8,11-octadecadienic acid;, broussoside A; broussoside B; broussoside C; broussoside D; broussoside E; syringaresinol-4&#x2019;-O-&#x3B2;-D-glucoside; p-coumaric acid; apigenin; poliothyrsoside; pinoresinol-4&#x2019;-O-&#x3B2;-D-glucopyranoside; flacourtin; dihydrosyringin; apigenin-7-O-&#x3B2;-D-glucoside; chrysoriol-7-O-&#x3B2;-D-glucoside; isovitexin; luteoloside; orientin; vitexin; isoorientin; 3,4-dihydroxyisolonchocarpin; 4-hydroxyisolonchocarpin; 3&#x2019;-(3-methylbut-2-enyl)-3&#x2019;,4&#x2019;,7-trihydroxyflavane; 8-(1,1-dimethylallyl)-5&#x2019;-(3-methylbut-2-enyl)-3&#x2019;,4&#x2019;,5,7-tetra-hydroxyflanvonol; broussofluorenone A; brusso fluorenone B; threo-1-(4-hydroxy-3-methoxyphenyl)-2-{4-(E)-3-hydroxy-1-propenyl-2-methoxyphenoxy}-1,3-propanediol; arbutine; dihydro-coniferyl alcohol; coniferyl alcohol; ferulic acid; p-coumaraldehyde; cis-syringin; cis-coniferin; erythro-1-(4-hydroxyphenyl)glycerol; threo-1-(4-hydroxyphenyl)glycerol; curculigoside I, curculigoside C, (2S)-2&#x2019;,4&#x2019;-dihydroxy-2&#x201D;-(1-hydroxy-1-methylethyl)-dihydrofurano-2,3-h-flavanone; erythro-1-(4-hydroxy-3-methoxyphenyl)-2-{4-(E)-3-hydroxy-1-propenyl-2-methoxy-phenoxy}-1,3-propanediol; 3-2-(4-hydroxyphenyl)-3-hydroxymethyl-2,3-dihydro-1-benzofuran-5-ylpropan-1-ol; 5,7,3&#x2019;,4&#x2019;-tetrahydroxy-3-methoxy-8-geranylflavone; 5,7,3&#x2019;,4&#x2019;-tetrahydroxy-3-methoxy-8,5&#x2019;-diprenylflavone; chelerythrine; isoterihanine; &#x3B2;-sitosterol; fucosterol; ergosterol peroxide; D-galacitol; sulfuretin; and graveolone.19&#xD;
&#xD;
PHARMACOTHERAPEUTIC &#xA0;EFFECTS&#xD;
&#xD;
Anti-inflammatory activity&#xD;
&#xD;
Bioactivity-guided fractionation and metabolite study from the methanolic extracts of root bark of Broussonetia papyrifera (L.) L. Her. ex Vent. led to the isolation of twenty compounds; six 1,3 diphenylpropanes, flavanone, two chalcones, five flavans, dihydroflavonol, and five flavonols, including five new compounds. From the screening for inhibition of nitric oxide (NO) and pro-inflammatory cytokines (TNF-&#x3B1; and IL-6) in LPS-stimulated RAW264.7 cells, few compounds exhibited potent anti-inflammatory effects by reducing NO production through downregulating iNOS, COX-2, TNF-&#x3B1; expression, and iNOS protein expression. This study, therefore, reveals that B. papyrifera is a valuable source of phytoconstituents for pharmaceuticals and functional foods for anti-inflammatory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and atopy.20&#xD;
&#xD;
Anti-SARS CoV-2 activity&#xD;
&#xD;
A group of polyphenolic compounds was isolated from this medicinal plant of which a chalconoid derivative showed the best inhibitory potential against both Mpro and PLpro (IC50 of 27.9 &#x3BC;M and 112.9 &#x3BC;M, respectively).21&#xD;
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The inhibitory potential of ten polyphenols derived from B. papyrifera roots, i.e. broussochalcone A, broussochalcone B, 4-hydroxyisolonchocarpin, papyriflavonol A, 3&amp;#39;-(3-methylbut-2-enyl)-3&#x2019;,4,7-trihydroxyflavane, kazinol A, kazinol B, broussoflavan A, kazinol F, and kazinol J were tested against the two SARS CoV proteases with a more potent inhibition recorded against PLpro than that of 3CLpro. The most potent PLpro inhibition was exhibited by the prenylated flavone derivative viz. papyriflavonol A with an IC50 value of 3.7 &#x3BC;M, exceeding the inhibitory potential of non-prenylated flavone derivatives viz. quercetin and kaempferol (IC50 of 8.6 &#x3BC;M and 16.3 &#x3BC;M, respectively). This signified the crucial role of the prenyl group in forming stronger hydrophobic interactions with the enzyme as well as the increase in the hydroxylation in the flavone backbone.22,23&#xD;
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Anti-cancer Activity&#xD;
&#xD;
The active compounds from B. papyrifera were found to be used for the treatment of human bladder cancer including drug-resistant forms and to establish a potential rationale for their clinical application. The cytotoxic effects of the compound were tested by analyzing cell proliferation, apoptosis, and autophagy where the results suggest that phytoconstituents induces cytotoxic effects in human bladder cancer cells, including the cisplatin-resistant T24R2. The compound may be a candidate for the development of effective anti-cancer drugs on human urinary bladder cancer.24&#xD;
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Anti-nociceptive activity&#xD;
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Various parts of B. papyrifera were studied for its anti-nociceptive and anti-inflammatory activity by chemical-induced pain and inflammation in the rodent model.25 All the parts of B.papyrifera viz., radix, leaf, and fruits effectively inhibit both writhing response induced by 1% acetic acid and late phase licking response caused by 1% formalin. It was observed that radix and fruits reduce the edema induced by 1% carrageenan at 1-2 hrs, also radix reduced the abdominal Evan&#x2019;s blue extravasations caused by inflammatory mediators including serotonin and sodium nitroprusside. This effect has been attributed due to the presence of one active ingredient, betulinic acid, which inhibited the paw edema caused by serotonin and carrageenan.26 &#xD;
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Anti-oxidant activity&#xD;
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Broussochalcone A (BCA), a prenylated chalcone was originally isolated from the cortex of B. papyrifera Vent and the cortex of this plant has been used as traditional medicine for decades.27 BCA is a powerful natural antioxidant that may be primarily attributed due to its free radical-scavenging activity. Moreover, BCA was also found to suppress LPS-induced iNOS protein expression by preventing IkB&#x3B1; degradation in RAW 264.7 macrophages. The free radical-scavenging activity of BCA and its inhibition of iNOS protein expression may have therapeutic potential because excessive free radicals and NO production have been associated with various inflammatory diseases.28&#xD;
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Anti-bacterial Activity&#xD;
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Sohn et al. reported that a prenylated flavonol compound, Papyriflavonol A (Pap A) was isolated from the mulberry roots and evaluated its antimicrobial activity. The results revealed that the minimum inhibitory concentration (MIC) of Pap A against Candida albicans and Saccharomyces cerevisiae were between 10 &#x3BC;g/mL and 25 &#x3BC;g/mL, and its anti-fungal activity was mediated by its ability to disrupt cell membrane integrity. In addition, Pap A had a lower toxic effect than amphotericin B. For the tested strains, the hemolysis ratio of human erythrocytes was less than 5%.29 Geng et al. reported that flavonols in B. papyrifera showed significant in vitro anti-oral microbial activity.30&#xD;
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Anti-proliferative Activity&#xD;
&#xD;
Guo et al. isolated and purified few active compounds (papyriflavonol A, broussochalcone A, uralenol, broussoflavonol B, and 5,7,3&amp;#39;,4&amp;#39;-tetrahydroxy-3-methoxy-8,5&amp;#39;&#x2013;diprenylflavone) from EtOAc extract of mulberry bark where all of them showed significant anti-proliferative effects on ER-positive breast cancer MCF-7 cells in vitro. The phytocompounds; broussoflavonol B with IC50 = 4.19 &#x3BC;M and 5,7,3&amp;#39;,4&amp;#39;-tetrahydroxy-3-methoxy-8,5&amp;#39;-diprenylflavone with IC50 = 4.41 &#x3BC;M were the most effective components than the positive control, icaritin. In an established human breast cancer BCAP-37 xenograft BALB/c nude mice model, broussochalcone A and broussoflavonol B were found to significantly reduce the tumor growth significantly at a concentration of 1 &#x3BC;M by reducing ERK phosphorylation. Western blot indicated that the compounds strongly downregulated the expression of estrogen receptor-&#x3B1; (ER-&#x3B1;).31&#xD;
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Anti-diabetic Activity&#xD;
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Ryu et al. isolated 12 polyphenols from the chloroform extract of the roots of B. papyrifera. Among them, papyriflavonol A (IC50 = 2.1 &#x3BC;M), deoxynojirimycin (IC50 = 3.5 &#x3BC;M), brossoflurenone A (IC50 = 27.6 &#x3BC;M), and brossoflurenone B (IC50 = 33.3 &#x3BC;M) have been identified as potential &#x3B1;-glucosidase inhibitors in comparison to the standard voglibose (IC50 = 23.4 &#x3BC;M). The activity was similar to sugar-derived &#x3B1;-glucosidase inhibitors.32&#xD;
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Lou et al. reported broupapyrin A, a new isoprenylated flavonol isolated from the branches of B. papyrifera in exhibiting a significant inhibitory effect on the well-known anti-diabetic target enzyme PTP-1B with an IC50 value of 0.83&#xB1;0.30 &#x3BC;M.33&#xD;
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Anti-gout Activity&#xD;
&#xD;
Researchers found that broussochalcone A (IC50 = 5.8 &#x3BC;M) and 3,4-dihydroxyisolonchocarpin (IC50 = 7.7 &#x3BC;M) were the major contributors to the inhibition of xanthine oxidase. The compound broussochalcone A was identified as the most effective candidate.34 &#xD;
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Cytotoxic activity&#xD;
&#xD;
Ran et al. reported the cytotoxic potentials (against HepG2 cell line) of the compounds (liriodendrin, (+)-pinoresinol-4&amp;#39;-O-&#x3B2;-D-glucopyranosyl-4&#x2033;-O-&#x3B2;-D-apiofuranoside, and apigenin-6-C-&#x3B2;-D-glycopyranside) that were isolated from the leaves with the IC50 values of 14.56 &#x3BC;g/mL, 19.53 &#x3BC;g/mL, and 17.19 &#x3BC;g/mL, respectively.35&#xD;
&#xD;
Zhang et al. isolated and reported a new compound altertoxin-IV together with nine known compounds from the ethyl acetate extract (through bioassay-guided fractionation) of a culture of the endophytic fungus Alternaria species G7 present in B. papyrifera. The compounds presented impressive cytotoxic activities against three cancer cell lines (MG-63, A549, and SMMC-7721), of which 3,4&amp;#39;,5&amp;#39;-trihydroxy-5-methoxy-6H-benzo[c]chromen-6-one demonstrated noteworthy cytotoxic activity with IC50 values of 2.11 &#x3BC;g/mL, 1.47 &#x3BC;g/mL, and 7.34 &#x3BC;g/mL, respectively. The compound altersolanol A also presented a considerable cytotoxic activity against two cell lines; SMMC-7721 (IC50 = 2.92 &#x3BC;g/mL) and MG-63 (IC50 = 0.53 &#x3BC;g/mL).36&#xD;
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CONCLUSION&#xD;
&#xD;
This current fascinating article expansively emphasized the general aspects, plant profile (Kingdom, Sub-Kingdom, Infra-Kingdom, Division, Sub-Division, Super-Division Class, Order, Super-Order, Family, Genus, and Species), traditional uses, distribution, major phytoconstituents, significant pharmacotherapeutic attributes (anti-viral, anti-cancer, anti-oxidant, cytotoxic potentials, anti-inflammatory, anti-diabetic, anti-microbial, anti-nociceptive, anti-gout, and anti-proliferative) mediated by diverse parts (seed, root, leaf, stem, and fruit). This information will be reasonably functional for the passionate contemporary investigators of several areas (natural products, pharmacognosy, medicine, chemistry, botany, pharmacy, etc.) in developing miscellaneous essential formulations for treating numerous disorders. This study will pave a new way for modern nature-pharmacotherapeutics for human applications.&#xD;
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ACKNOWLEDGEMENT&#xD;
&#xD;
None declared.&#xD;
&#xD;
CONFLICT OF INTEREST&#xD;
&#xD;
The authors declare no Conflict of Interest regarding the publication of the article.&#xD;
&#xD;
FUNDING INFORMATION&#xD;
&#xD;
No funding agency is acknowledged.&#xD;
&#xD;
AUTHORS CONTRIBUTION&#xD;
&#xD;
Madhukar Vitthalrao Shende: Physically wrote the full manuscript.&#xD;
&#xD;
Debarshi Kar Mahapatra: Performed the literature review, set references uniformly, drawn graphical abstract, and prepared the structured abstract.&#xD;
&#xD;
Atul Arjun Baravkar: Proofread, did necessary changes/corrections, and provided suggestions.&#xD;
&#xD;
Nilesh Ashokrao Nalawade: Removed plagiarized contents, corrected grammar, and attended all the revisions.&#xD;
&#xD;
&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Machine Learning Implementation and Challenges: A Study of Lifestyle Behaviors Pattern and Hba1c Status&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>94</FirstPage><LastPage>98</LastPage><AuthorList><Author>Christie Natashia Archie</Author><AuthorLanguage>English</AuthorLanguage><Author> Debashish Das</Author><AuthorLanguage>English</AuthorLanguage><Author> Fatemeh Meskaran</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Diabetes is a chronic metabolic disease that has a long-term impact on the individual&#x2019;s well-being and one of the causes of adulthood death. Objective: This research paper represents an attempt to find the correlation between lifestyle behaviour patterns and diabetes by leveraging machine learning in the form to facilitate patients with risk stratification in a population. Results: The major findings that emerged were as follows: an unhealthy lifestyle and dietary pattern lead to Non-communicable Disease (NCD) including diabetes. In the form to identify diabetes, Glycated Hemoglobin (HbA1c) will be used to diagnose diabetes considering its efficiency and convenience to the patient. Furthermore, contrary to what has been assumed of the superiority of machine learning has been provided in many aspects, few challenges should be taken into consideration when it comes to the implementation of Machine Learning in the healthcare field, racial bias, for instance. Conclusion: In the Asia Pacific region, there is a range of cut-off point of HbA1c values due to HbA1c is subject to external factors such as race and ethnicity. Therefore, narrowing down the population scope in healthcare is considered in this paper as the best practice to facilitate better accuracy and assurance&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Diabetes, Glycated Hemoglobin, HbA1c, Lifestyle Behavior, Machine Learning, Noncommunicable diseases</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
The global efficiency improvement in the human living condition gives an abundance transformation to lifestyle behaviour and food consumption pattern which might lead to various states of illness including&#xA0;cancer, cardiovascular, respiratory disease, hepatic illness, and diabetes.1 According to the International Diabetes Federation (IDF), one of the causes of adulthood death is diabetes.2&#xD;
&#xD;
Diabetes is a chronic metabolic disease that has a long-term impact on the individual&#x2019;s well-being.3 In 2019, IDF has reported that 463 million people are diagnosed with diabetes in 2019, which is 9.3% of the world population and it has been predicted that diabetes might increase to 578 million by 2030.2 Additionally, several studies have been proven that unhealthy lifestyle behaviours during early adolescence can lead to obesity due to unhealthy diet, lack of physical exercise, high blood pressure which are the early symptoms of chronic diseases including diabetes1,3.&#xD;
&#xD;
American Diabetes Association has revealed that unlike Fasting &#xD;
&#xD;
Plasma Glucose (FPG) and Oral Glucose Tolerance Test (OGTT) diagnostic method, Glycated Hemoglobin or also known as HbA1c is generally used as a measurement for diabetes that provides convenience where the patient does not require to fast, unaffected with daily stress and disease disruption and better preanalytical stability.4 HbA1c test is a standardized accurate measurement with international reference principles where 6.5% of HbA1c is suggested as the cut-off point for diabetes diagnostics.5,6&#xD;
&#xD;
Additionally, it is true that over the past decade, almost every aspect of modern life is somehow changed by the advancement of the machine to make predictions7. By leveraging Machine learning in healthcare, this research is focusing on identifying the correlation between lifestyle behaviour and dietary pattern and probability of diabetes by using Glycated Hemoglobin (HbA1c) as a diabetes measurement.&#xD;
&#xD;
THE LIFESTYLE BEHAVIOR PATTERN&#xD;
&#xD;
Noncommunicable diseases (NCDs) including respiratory disease, chronic cancer, cardiovascular, and diabetes can be prevented by living in healthy lifestyle behaviour patterns.8There are four lifestyle behaviour factors such as lack of dietary ingredients intake, physical inactivity, smoking habit, and alcohol consumption can lead to a range of health issues such as obesity and high blood pressure at the early age, which can give the rise of NCDs possibility in adulthood.9 &#xD;
&#xD;
Based on these premises, minimizing the risk for Noncommunicable diseases especially at an early age increase the opportunity for a better individual&#x2019;s well-being. A lifestyle and food consumption study on university students has been conducted by El-Kassas and Ziade revealed that overall population dietary consumption behaviour falls below the average of recommended levels and it is estimated that 41.2% among 369 students having low physical activity level due to significant living condition changes in the university environment. Regression analysis by this study showed that food cravings, increased appetite, comfort eating, parental obesity, and stressful eating have a high level of relationship with the probability of NCD disease including diabetes. Over the past decade, westernized food consumption which rich in fat, salt, sugar, and alcohol is becoming the substitute for healthy food that consists of dietary ingredients including fruit, vegetables, and fibre.1 &#xD;
&#xD;
Furthermore, an investigation has been conducted by Al-Nakeeb et al. that there are few main factors of dietary options mostly derived from the individual itself. Dietary knowledge, food preferences and personal state of mind for instance. These become the most factor of how individual dietary practice. His studies believe that lifestyle and nutritional habits planning strategy in early adulthood should be taken into action in the form of lower the risk of a range of chronic illnesses. For instance, Obesity Intervention in Teenagers leveraging several disciplinary Intervention Mapping policies to introduce health awareness program for young adult10 considering that obesity is one of the common symptoms that lead to diabetes.11 This concept can be applied by universities to increase the awareness of a healthy lifestyle and dietary programs for university students.12 &#xD;
&#xD;
DIABETES MEASUREMENT&#xD;
&#xD;
Numerous health associations around the world have suggested some diabetes diagnosis tests which are: (1) Oral Glucose Tolerance Test (OGTT), (2) Fasting Plasma Glucose (FPG), and (3) Glycated Hemoglobin.13,14 FPG is used to measure a patient blood sugar level which requires at least 8 hours of fasting. While OGTT is a glucose medical test that requires blood samples to assess the capability of blood to extract glucose in the body. A test of diabetes is done on a two-hour test with 75-gram oral tolerance glucose (OGTT) to be taken by the patient.15 Lastly, Glycated haemoglobin is also known as Hemoglobin A1c (HbA1c) which is a body glycosylated protein that represents an average blood glucose level which has 100 to 120 erythrocyte (two or three months) lifespan.16 &#xD;
&#xD;
Diagnosis cut off point for diabetes diagnostic criteria recommended by the American Diabetes Association15 and the World Health Organization6 is listed in Table 1:&#xD;
&#xD;
&#xD;
&#xD;
HbA1c Level for Diabetes Measurement&#xD;
&#xD;
Although there are some diabetes measurement has been suggested by international references, HbA1c level can be the best alternative to assess the potentials of diabetes.16 Not only that, it is used for tracking glucose level for long-term treatment for the patient who has been diagnosed with diabetes as well.16 The benefit of using HbA1c for diabetes diagnosis has been highlighted by Sacks and the American Diabetes Association which is the capability of the test to be completed at any time of the day and no fasting is required to be done. Although HbA1c introduces the robust stability result, this measurement has not been worldwide adopted.17 Because HbA1c is subject to well-known factors outside the control of healthcare providers and should be taken into consideration to prevent arbitrary comparisons such as race, ethnicity, age, diabetes length and type, patient adherence, and comorbidity.18 &#xD;
&#xD;
As the result, HbA1c is adopted differently, in the Asia-Pacific region, Region like Malaysia and Singapore which is multi-racial country are advised to concern with racial differences Malaysia use HbA1c with a cut-off of 6.30%, while Singapore uses a cut-off between 6.10%-6.20%. On the other hand, New Zealand uses a cut-off of 6.70%, Thailand does not use HbA1c to diagnose diabetes. Finally, in Japan, a 6.00% cut-off was suggested for the Japanese population to be used for first stage screening with the sensitivity of 0.837 to 0.876 with other glucose-based validation like Fasting Plasma Glucose (FPG) and oral glucose tolerance test (OGTT).17&#xD;
&#xD;
Due to the efficiency and convenience that HbA1c provided as a diabetes measurement, HbA1c will be used as the target variable to predict patient who has potentially diagnose with diabetes. With that being said, appropriate sample data selection in a population has to be narrow down into racial scale which in this paper will be the focus on the Japanese population.&#xD;
&#xD;
MACHINE LEARNING IMPLEMENTATION IN HEALTHCARE&#xD;
&#xD;
With adequate data, machine learning leveraging mathematical concepts and statistical models to learn the pattern of the given dataset without explicit rules or instruction to perform prediction or classification tasks.19 The fundamental transformation of conventional biostatistics leads to the implementation of machine learning in clinical analysis.20 Machine learning implementation requires huge amount of clinical data to be carefully labelled and organized. Medical data can be derived from clinical images, log data from medical devices, laboratory reports, or the form of doctor&#x2019;s notes.21 &#xD;
&#xD;
Guidance on a medical device issued by Food and Drug Administration (FDA) also suggested that the AI and Machine Learning instruments are required for clinical analytical, health validation and risk stratification.22 One of the machine learning techniques such as incremental learning has been widely used in healthcare as its capability to be iteratively enhanced the prediction accuracy.23 This process leveraging the data feedback loop to improve the accuracy of the prediction of the system through continuously training as shown in figure 1.&#xD;
&#xD;
&#xD;
&#xD;
There is a range of incremental learning models which are often used in the healthcare sector to make a prediction which is: (a) Random Tree Forest (b) Multi-Layer Perceptron (MPL) (c) Support Vector Machine (SVM) (d) Neural Network that supports incremental learning.23&#xD;
&#xD;
Char et al. revealed that leveraging machine learning in complicated clinical practices is a constant issue, since the correct diagnosis and best practice may be problematic in a given case. The study believes that early incorporation in an algorithm of a specific diagnosis or procedure can indicate a legitimacy not supported by data.24 The delivery of machine learning in the medical can vary by age, ethnicity, or race. Some of the problems might not draw a clear boundary of external non-genetic factor, and it is not protected from such concerns that algorithm may reflect human biases in making decisions. Several non-genetic studies in certain populations resulted in an algorithm designed to predict biased prediction25. For instance, attempts to use the Framingham Heart Study dataset for cardiovascular risk prediction in non-white populations have provided limited results, both with overestimation of risk and underestimation of risk.24 Therefore, it is important to narrowing the scope of prediction to prevent any external factor bias during model development.&#xD;
&#xD;
Human to Machine Decision Making in Healthcare&#xD;
&#xD;
Unlike Finance and Sales, the placement of the machine spectrum not always indicate superiority since healthcare cases and problem background require a different level of human guidance and involvement. Furthermore, every medical data has various complexity and variety. Contrary to what has been assumed of the superiority of machine learning has been provided in many aspects, few challenges should be taken into consideration when it comes to implementing Machine Learning in the healthcare. &#xD;
&#xD;
Healthcare algorithm refinement requires continuous training to gain accurate outcome, not only that human involvement which is in the fourth phase of incremental learning as shown in Figure 1 play a huge role to develop a reliable prediction21. Furthermore, the different algorithm used in healthcare has a different level of human involvement and machine to decide as shown in figure 2.7 The algorithm selection of each healthcare case is varying depending on the problem that needs to be addressed. For instance, Atrial Fibrillation stroke prediction uses a regression algorithm.25,26 that requires a high level of human effort to make decision making. While Random forest is used to predict Cardiovascular risk 27 which that require moderate human guidance. Finally, the application of Neural Network requires less human decision making to predict diabetic retinopathy using the image recognition concept.28&#xD;
&#xD;
&#xD;
&#xD;
RELATED WORKS ON HBA1C STATUS PREDICTION&#xD;
&#xD;
Recent work by Karpati et al. proposed K-mean clustering to identify the clusters of patients and facilitate the characteristic of each patient cluster for better treatment. The outcome resulted in three clusters of HbA1c level which are: (a) stable, (b) low, (c) high with 99.8 % accuracy.28,29 On the other hand, the work by Parigi et al. proposed an analysis of HbA1c statue to targeting Haemoglobin A1c below 7% for diabetes patients. Random Forest model is used for model development to analyze the diabetes treatment response and patient lifestyle.30 Finally, Nagaraj et al. proposed three supervised learning models which are: (a) Support Vector Machine (b) Random Forest (c) Generalized Linear to develop predictive model in the form to determine Haemoglobin A1c response after insulin treatment and make comparison to determine the best machine learning approach. HbA1c measurement test result is used as the benchmark. The outcome of their work resulted that Linear regression has better performance compared to other models.31&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Through domain research, previous researchers revealed that there is a correlation between lifestyle and dietary behavior with Noncommunicable Disease (NCD), including diabetes12. Machine learning implementation can be used to predict HbA1c status from an individual&#x2019;s lifestyle behaviours pattern, it will help to gain an awareness of living a healthy lifestyle. A small change in lifestyle habits, especially smoking habit, involved in physical activities, and consume dietary fibers, could reduce the prevalence of diabetes.&#xD;
&#xD;
However, the appropriate application of Machine Learning in the healthcare sector has to be carefully planned considering that clinical cases require different levels of human guidance and involvement to make medical decisions. Algorithm selection is also a crucial task, as each healthcare case is varying depending on the problem that needs to be addressed.&#xD;
&#xD;
As the adoption of HbA1c to diagnose diabetes has not widely used especially in the multi-racial population in the Asia Pacific region due to the various range of cut-off values of HbA1c. Glycated Haemoglobin (HbA1c) can still be an alternative in the form to diagnose diabetes considering its convenience and effectiveness compare to Fasting Plasma Glucose (FPG) and oral glucose tolerance test (OGTT). &#xD;
&#xD;
The fact that HbA1c is subject to non-genetic factors outside the control of healthcare providers should be taken into consideration to prevent arbitrary comparisons such as race, ethnicity, age, diabetes length and type, patient adherence, and comorbidity. This consideration helps to prevent prediction that reflects race/ethnicity biases in making clinical decisions. With that being said, appropriate data sample selection in a population has to be narrowed down into a racial scale. To deliver high predictive power and promise to transform patient risk stratification without any biases, the selected population should be a single-racial population country like Japan.&#xD;
&#xD;
ACKNOWLEDGMENTS&#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=3829</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3829</Fulltext></URLs><References>&#xD;
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	Bleich SN, Vercammen KA, Zatz LY, Frelier JM, Ebbeling CB, Peeters A. Interventions to prevent global childhood overweight and obesity: a systematic review. Lancet Diab&#xA0; Endoc. 2018 Apr 1;6(4):332-346. &#xD;
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	Lim WY, Ma S, Heng D, Tai ES, Khoo CM, Loh TP. Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Sci Repor. 2018 Aug 20;8(1):1-9. &#xD;
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	Bergenstal RM, Gal RL, Connor CG, Gubitosi-Klug R, Kruger D. Racial differences in the relationship of glucose concentrations and haemoglobin A1c levels. Ann Int Med. 2017 Jul 18;167(2):95-102. &#xD;
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	Arcadu F, Benmansour F, Maunz A, Willis J, Haskovo Z, Prunotto M. Deep-learning algorithm predicts diabetic retinopathy progression in individual patients. J Dig Med. 2019 Sep 20;2(1):1-9.&#xD;
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	Del Parigi A, Tang W, Liu D, Lee C, Pratley R. Machine Learning to Identify Predictors of Glycemic Control in Type 2 Diabetes: An Analysis of Target HbA1c Reduction Using Empagliflozin/Linagliptin Data. Pharm&#xA0; Med. 2019;33(3):209-217.&#xD;
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	Grigory Sidorenkov MD, van Boven PharmD JF. Predicting short-and long-term glycated haemoglobin response after insulin initiation in patients with type 2 diabetes mellitus using machine-learning algorithms. Pharm&#xA0; Med.2018; 24(7):412-417.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Formulation Development and Evaluation of Polyherbal Suspension of Some Medicinal Plants&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>99</FirstPage><LastPage>106</LastPage><AuthorList><Author>Sachin M. Mahajan</Author><AuthorLanguage>English</AuthorLanguage><Author> Dheeraj T. Baviskar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: World Health Organisation promoting the application of traditional medicinal plant in the form of herbal formulation in various countries. Aim: The present investigation was focused on the development and stability study of polyherbal suspension produced from alcoholic extracts of selected medicinal plant. Methodology: Three suspensions Polyherbal formulation-A, Polyherbal formulation-B, Polyherbal formulation-C of different concentration of Sodium Carboxy Methyl Cellulose 0.7%, 1.4%, 2.0% respectively formulated and evaluated to accelerated stability for 3 months. Result: Polyherbal formulation-C exhibited pleasant appearance and texture; there were no changes in sedimentation, flow rate, pH, viscosity and other physiochemical parameters. Quality control parameters like phytochemical and High-Performance Thin Layer Chromatography were also done on the developed polyherbal formulation. It reveals the presence of various phytoconstituents. All the quality control parameters in formulated suspension are stable and acceptable. Conclusion: It is concluded that suspension of ethanolic extracts of Curcuma caesia, Citrullus lanatus, Evolvulus alsinoide, Gymnema sylvestre, Tinospora cordifolia, Caesalpinia bonduc, Withania coagulants formulated in combinational therapy could be effective and safe for use.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Polyherbal formulation, Suspension, Quality Evaluation, Stability testing, Heavy metal test, Microbial limit test, HPTLC  fingerprinting</Keywords><Fulltext>&#xA0;INTRODUCTION:&#xD;
&#xD;
The oral route of drug administration is one of the oldest methods of administrating drugs for systemic effects. In general, the parenteral route is not readily used for the self-administration of Medicines. The majority of medicine used to produce systemic therapeutic effects are probably given by the oral route.1, 2 Polyherbal formulations are the product of nature, they are comparatively cheaper, eco-friendly and readily available than Modern drugs. Their better affordability and greater accessibility account for increasing demand globally, particularly in rural areas and some developing countries, where costly modern treatments are not available. The scientific advancement carries with its developments in Polyherbal formulations through the study of diverse phytoconstituents and the discovery of helpful medicinal herbs combinations that work synergistically to exert a therapeutic effect. Almost, they bring out satisfactory effect and safety making them one of the highly selected drugs of choice.3,4 Ayurvedic herbal formulations were also administered preferentially by oral route.&#xD;
&#xD;
Liquid forms of drugs contain certain limitation, but public demand or expectations are tremendous for such formulations. Moreover, some formulations are more effective in a liquid form and are used commonly by young children&#x2019;s or the adult to overcome difficulty in swallowing solid oral dosage forms. Most of the orally administered herbal formulations belong to the liquid dosage form of drug or drug combination. Designing and developing oral liquid herbal formulations is to date a challenge in modern pharmaceutics.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
Plant Materials&#xD;
&#xD;
The plant material required for the present study the selected plant material was collected from the hills of Satpuda Mountains especially from the hills of Toranmal and from the forest of Boradi. Plant materials which are collected with the help of the traditional healers of Toranmal such as the whole of the plant of Evolvulus alsinoides, seeds of Citrullus lanatus (Thumb) Matsumura, leaves of Gymnema sylvestre (Retz.) R. Br. Ex Roem and Schut, (Asclepidaceae) (Bedki Pal), stems of Tinospora cordifolia (Gulvel), seeds of Caesalpinia bonduc L. Roxb. (Caesalpiniaceae)&#xA0; (Sagargota), fruits of Withania coagulance Dunal (Solanaceae) paneer Ke Phool), rhizomes of Curcuma caesia Roxb (Zingiberaceae) purchased from the local market. After collection of the plant material was sent to Prof. Dr. D.A. Patil, Department of Botany, S.S.V.P. Sanstha&amp;#39;s Dr. P.R. Ghogere Science College, Dhule and properly authenticated. After collection and authentication of the plant material was subjected to shade drying and pulverization. All the chemicals required for the present study were analytical grade.&#xD;
&#xD;
Preparation of extracts&#xD;
&#xD;
Air-dried coarsely powdered plant materials of were defatted petroleum ether; extracted with ethanol using soxhlet apparatus. All the ethanolic extracts were concentrated, dried and lyophilized.5&#xD;
&#xD;
Formulations&#xD;
&#xD;
The dried lyophilised ethanolic extracts of Curcuma caesia, Citrullus lanatus, Evolvulus alsinoide, Gymnema sylvestre, Tinospora cordifolia, Caesalpinia bonduc, Withania coagulance were taken for the preparation of 100 ml of Suspension. (Table 1).&#xD;
&#xD;
Preparation of Polyherbal Suspension Dosage Form&#xD;
&#xD;
The formulae for preparing 100 ml of a suspension of extracts of Curcuma caesia, Citrullus lanatus, Evolvulus alsinoide, Gymnema Sylvestre, Tinospora cordifolia, Caesalpinia bonduc, Withania coagulance was as shown in Table 1.They were taken in the ratio of 1:1:1.6,7 Suspension was prepared by using various bioactive extracts of selected plant materials trituration method in mortar and pestle by using the suitable suspending agent of Tween 80 and Sodium carboxy methyl cellulose (CMC) along with other excipients. The dried extracts were mix in water and the additives likeTween-80, Sodium CMC. The suspending agent, sodium CMC in the aqueous medium containing selected preservatives was added in mortar and pestle along with ethanolic extracts of selected plant material with continuous triturating. Three possible formulations of Suspension viz. Polyherbal formulation-A, Polyherbal formulation-B and Polyherbal formulation-C were prepared by using 0.7%, 1.4%, 2.0% aqueous Sodium C.M.C solution respectively. Finally, by addition of purified water by continuous trituration in suspension brought up to the final volume to get the uniform product. All three possible forms of suspension of extracts of Curcuma caesia, Citrullus lanatus, Evolvulus alsinoide, Gymnema Sylvestre, Tinospora cordifolia, Caesalpinia bonduc, Withania coagulance were then subjected to evaluation as per standards (Table 2).&#xD;
&#xD;
Phytochemical investigation of the polyherbal formulation.8&#xD;
&#xD;
Phytochemical analysis of polyherbal formulation was carried out and it reveals the presence of alkaloids, Steroids, terpenoides, glycosides, flavonoids, phenolic compounds etc. (Table 3).&#xD;
&#xD;
QUALITY PARAMETERS OF POLYHERBAL SUSPENSION.9.10,11&#xD;
&#xD;
The organoleptic characters of the Polyherbal Suspension were evaluated by using the following parameters colour, odour, taste and texture etc. (Table no.4).&#xD;
&#xD;
Accelerated stability studies&#xD;
&#xD;
The accelerated stability studies were carried out for polyherbal formulations (Polyherbal formulation-A, Polyherbal formulation-B and Polyherbal formulation-C) of bioactive constituents at 8&#xB0;C, room temperature and 45&#xB0;C&#xB1;2 at 75%&#xB1;5 humidity. The stability of polyherbal suspension was studied for three months. The different parameters such as pH, sedimentation volume, re-dispersibility were studied for all the formulation at 1st, 2nd and 3rd months. &#xD;
&#xD;
&#xD;
	&#xD;
	Sedimentation volume:&#xD;
	&#xD;
&#xD;
&#xD;
The sedimentation volume is the ratio of the ultimate height of the sediment to the initial height of the total suspension as the suspension settles in a cylinder under appropriate standard conditions. It was evaluated by keeping a measured volume of suspension in a graduated cylinder in an undisturbed state for a certain period and note that the volume of the sediment is expressed as ultimate height.&#xD;
&#xD;
&#xD;
	&#xD;
	Redispersibility&#xD;
	&#xD;
&#xD;
&#xD;
The suspension was allowed to settle in a measuring cylinder. The mouth of the cylinder was closed and was inverted through 180&#xBA; and the number of inversions necessary to restore a homogeneous suspension was determined.&#xD;
&#xD;
&#xD;
	&#xD;
	Rheology &#xD;
	&#xD;
&#xD;
&#xD;
The time required for each suspension sample to flow through a 10 ml pipette was determined by the apparent viscosity by using the equation.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	pH&#xD;
	&#xD;
&#xD;
&#xD;
The pH of the suspension was determined by using a pH meter (Eutech).&#xD;
&#xD;
&#xD;
	&#xD;
	Particles size analysis:&#xD;
	&#xD;
&#xD;
&#xD;
The distribution of particle size in suspension is an important aspect of its stability. Particle size distribution was carried out by using optical microscopy in dilute suspensions.&#xD;
&#xD;
Determination of Microbial limit test:&#xD;
&#xD;
A microbial limit test was performed as per I.P 2014. 12&#xD;
&#xD;
Determination of Heavy metal&#xD;
&#xD;
Heavy metals such as lead, cadmium and arsenic were estimated for Polyherbal formulation C at Nutralytica research centre as per the protocol of inductively coupled plasma mass spectrometry ICP-MS (Agilent 7700e) with an autosampler (ASX-500).&#xD;
&#xD;
High-Performance Thin Layer Chromatography (HPTLC) of polyherbal formulation C &#xD;
&#xD;
Preparation of Sample for HPTLC determination. 13, 14, 15&#xD;
&#xD;
10.0 g of polyherbal formulation (suspension) C was weighed accurately in a 100 ml conical flask; 30 mL of water was added and mixed thoroughly. The solution was transferred carefully in a 250 mL separating funnel and 50 mL of ethyl acetate was added in the funnel and was shaken carefully for 10 min. After complete separation of layers, the upper ethyl acetate layer was filtered through the Whatman filter paper. Extraction was repeated four times more and ethyl acetate fraction was collected into the same round-bottomed flask. The organic fraction was evaporated under a vacuum. The dry residue obtained from fractionation was dissolved in 5 ml of ethanol and transferred quantitatively into a 10 ml volumetric flask which is further applied for HPTLC determination after making it up to the mark.&#xD;
&#xD;
Procedure&#xD;
&#xD;
Before starting the analysis, HPTLC (CAMAG Linomat 5) plates were cleaned by predevelopment with methanol by ascending method. HPTLC plate was immersed in a CAMAG glass chamber (20 cm &#xD7; 10 cm). Apply 10&#x3BC;l of Test solution on a precoated silica gel GF254 HPTLC plate (E. Merck) which was used as stationary phase, mobile phase Toluene: ethyl acetate: formic acid (7:3:1) and of uniform thickness of 0.2 mm. along with 10&#x3BC;l ethanolic extracts of each plant prepared in a concentration of 1mg/1ml.&#xA0; Develop the plate in the solvent system to a set distance. The plate was visualised under UV 254 nm and photo documentation was done. The plate was scanned at 254 nm wavelength.&#xD;
&#xD;
RESULT AND DISCUSSION&#xD;
&#xD;
It was observed that all these three formulation Polyherbal formulation-A, Polyherbal formulation-B and Polyherbal formulation-C have similar organoleptic characteristics such as liquid in nature, brownish-black slightly yellowish-green shade in colour, slightly bitter taste.&#xD;
&#xD;
In Polyherbal formulation &#x2013;A it was observed that, sedimentation volume ranging from (2.26-2.37), PH slightly alkaline pH (7.52-7.82), viscosity (48.0-52.2) rapid flow rate (25sec-27sec) per 5 ml of formulation and particle size observed around (20.25um-20.10um) (Table:5).&#xD;
&#xD;
In Polyherbal Formulation &#x2013;B it was observed that sedimentation volume reduced to ranging from (1.43- 1.52) as compared to Polyherbal formulation-A due to the increase in the concentration of Sodium C.M.C. it also affects the viscosity (51 centipoise to 56.2 centipoise), alkaline pH (6.68-7.40), increase in viscosity decrease the flow rate of formulation (40sec-44sec) per 5 ml of formulation and particle size observed around (20.25um-20.10um) (Table:6).&#xD;
&#xD;
Polyherbal Formulation-3 formulation appears like brownish-black slightly yellowish-green shade in colour with characteristic odour and texture at room temperature (RT) and 45&#xBA;C. The suspension had a pleasant appearance and texture at different temperature and did not exhibit any change. As shown in the resulting pH of the suspension is 6.34 throughout storage, it does not show any appreciable changes. Viscosity centipoise and flow rate 56, 60 and 62 seconds per 5 ml indicating satisfactory rheological behaviour of formulated suspension. There were no noticeable changes in sedimentation volume as time increases because it is near to 1 which is the acceptable limit (Table no. 7). &#xD;
&#xD;
To assess the standard and shelf life of the herbal formulation total aerobic bacterial count was performed.&#xA0; Unintentional contamination, like fungal contamination throughout the production stage, may cause deterioration in safety and quality as the risk of mycotoxin production, particularly aflatoxin, could arise mutagenic, carcinogenic, teratogenicity, neurotoxic, nephrotoxic, and immunosuppressive activities For the evaluation of microbial contamination, total aerobic count, Total Fungal count, Escherichia coli, Candida albicans and&#xA0;Salmonella&#xA0;spp. the count was determined as per Indian Pharmacopoeia. It was observed that Polyherbal Formulation-C there is presence of TAC (7.4 and 5x102) cfu, TFC (18) cfu, and absence of&#xA0; Escherichia coli, Salmonella&#xA0;and&#xA0;Candida albicans which is within limits of standardization parameters (Table no-8).&#xD;
&#xD;
WHO recommends that raw material obtained from medicinal plants which are used for the finished products may be scrutinized for the presence of heavy metals. World health organization set up the limits 1.0, 0.3, and 10 parts per million (ppm) of toxic metals like Arsenic, Cadmium, and Lead. During growth, development, collection transformation and processing of medicinal plants are mostly contaminated. During the development of dosage form, heavy metals enter into the body through plant material and accumulate in different organs and de channelized the normal functions of the central nervous system, liver, lungs, heart, kidney, brain and produce serious health problems such as damage to the kidneys, symptoms of chronic toxicity,&#xA0; liver damage and renal failure.&#xD;
&#xD;
Heavy metals such as lead, cadmium and arsenic were estimated for Polyherbal formulation C at Nutralytica research centre and it was found to be below the level of quantification as per standardization parameters (Table no.9).&#xD;
&#xD;
Investigation of the ethanolic extracts of the polyherbal formulation revealed the presence of phenols, flavonoids, tannins, terpenoids, steroids, glycosides and alkaloids whereas saponin was absent in the formulation as mentioned in alkaloids, etc. Fingerprinting analysis of the phytoconstituents present in Polyherbal formulation-C (Suspension)&#xA0;&#xA0; was carried out by using the HPTLC method. The results of the analysis are concluded in (Table 10) and Fig.(1 2).&#xD;
&#xD;
The scanning done at wavelength 254 nm showed a total of thirteen bioactive compounds with Rf values 0.10,0.18, 0.27,0.36, 0.40, 0.48, 0.50,0.55, 0.61, 0.67, 0.78 with percentage peak area 37.40, 0.80, 1.91,2.73,2.42,14.08, 2.99, 6.74, 5.05, 3.53, 7.24, 8.10, 7.00 respectively. Out of the thirteen compounds, the compounds with Rf values 0.10, 0.48, 0.55, 0.61, 0.78, 0.83, were found to be predominant with peak area percentage in the range of 5.23 to 37.40. The maximum peak area percentage observed was 37.40 for the compound with the Rf value of 0.10. The HPTLC fingerprint analysis confirmed that the formulation possesses many phytoconstituents.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The present investigation revealed the presents of bioactive compounds such as phenolic, flavonoids, terpenoids, steroids, alkaloids and glycoside in the polyherbal formulation. The HPTLC fingerprint analysis confirmed that the polyherbal formulation possesses many phytoconstituents&#xD;
&#xD;
Liquid dosage forms have the upper hand over solid dosage form in children and elder people due to them overcome the problem of swallowing. In Ayurveda, most of the formulations are developed in liquid form and mostly in combination with more than two crude drugs. Pharmaceutical suspension is one of the most trusted and acceptable formulations among another oral dosage form because of flexibility, ease of administration, easy swallowing in the administration of the drug. The polyherbal suspension was prepared by using lyophilized ethanolic extracts of selected plants by trituration method using a suitable suspending agent and other excipients. &#xD;
&#xD;
There are noticeable changes were observed in sedimentation, viscosity and other physicochemical parameters after performing stability studies at variable temperature with different concentration of Sodium CMC. As per the result of accelerated stability studies of Polyherbal suspension A, B, and C it concludes that as we increase the concentration of Sodium C.M.C. gradually there is an increase in viscosity of the formulation, decreases the flow rate of formulation simultaneously. It also affects sedimentation volume and PH of the suspension. There were no noticeable changes in the organoleptic and physicochemical properties of the polyherbal formulation. In Polyherbal Formulation-C all the stability parameters are stable acceptable, and optimum at variable temperature.&#xA0; &#xD;
&#xD;
ABBREVARTION&#xD;
&#xD;
HPTLC: High performance thin layer chromatography;&#xD;
&#xD;
CMC: carboxy methyl cellulose; Rf: retention factor; &#xD;
&#xD;
nm: nanometer; &#xD;
&#xD;
cfu: colony forming units; &#xD;
&#xD;
TAC: Total Arabic count;&#xD;
&#xD;
&#xA0;TFC: Total Fungal count; &#xD;
&#xD;
ICP-MS: inductively coupled plasma mass spectrometry; &#xD;
&#xD;
UV: Ultra Violet; &#xD;
&#xD;
RT: room temperature;&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
CONFLICT OF INTEREST&#xD;
&#xD;
The authors declare that there is no conflict of interest &#xD;
&#xD;
SOURCE OF FUNDING&#xD;
&#xD;
Nil&#xD;
&#xD;
ETHICAL APPROVAL &#xD;
&#xD;
Not Applicable&#xD;
&#xD;
Present work is carried out under the supervision of Dr. Dheeraj T Baviskar and Manuscript preparation was prepared by Mr. S.M. Mahajan along with experimental work. &#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
I am highly grateful to the Nutralytica research centre for performing the heavy metal detection test.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3830</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3830</Fulltext></URLs><References>&#xD;
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	Ansel HC, Allen LV. Pharmaceutical dosage forms and drug delivery systems, 7th edition, Lippincott, 2000; 347-56.&#xD;
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	Aulton ME, Pharmaceutics: The Science of Dosage form. Churchill Livingstone, 1996, 304.&#xD;
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	Subramani P, Gan ST, Sokkalingam A, Dhanaraj. Polyherbal Formulation: Concept of Ayurveda. Pharmac Rev. 2014; 8(16): 73&#x2013;80.&#xD;
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	Shinde JS, Khurde SS, Suchita LS, Chavan SS. Hulmajge SB. Need of polyherbal formulations and its standardization: A Review. World J Pharm Pharmac Scien.2016; 5(11):526-533.&#xD;
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	Mukherjee PK. Quality Control of Herbal Drugs. New Delhi: Syndicate Binders; 2002.&#xD;
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	Dandagi PM, Patil MB, Mastiholimath VS, Gadad AP. Development and evaluation of a hepatoprotective polyherbal formulation containing some indigenous medicinal plants. Ind J Pharm Sci&#xA0;Mar-Apr 2008;70(2):265-8.&#xD;
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	Pandey VN, Rajagopalan. An effective ayurvedic hypoglycemic formulation. J Res Ayur Siddha. 1995; 16:1-14.&#xD;
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	Khandelwal KR. Practical Pharmacognosy Technique and Experiments. Nirali Prakashan, 15th edition, 2006; 25.1-26.6.&#xD;
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	Jain NK, Sharma SN. Textbook of Professional Pharmacy, Vallabh Prakashan, New Delhi, 3rd ed, 1994, 228.&#xD;
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	Stability studies an overview of ICH guidelines for drug products: Natalie McClure, Matrix Pharmaceutical Inc. 1997. &#xD;
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	Mahato RI. Pharmaceutical dosage forms and drug delivery. Boca Raton: CRC Press, Taylor &amp; Francis group. 2007.123-133. &#xD;
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	Microbial contamination in non-sterile products, (2.2.9), Volume I, Indian Pharmacopoeia, 2014; 38-50.&#xD;
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	Stahl E. Thin Layer Chromatography &#x2013; A Laboratory Hand Book. Second Edition. New York: Springer International Student Edition; 1969:311-471 &#xD;
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	Wagner H, Baldt S, Zagainski EM. Plant Drug Analysis. Germany: Springer-Verlag Berlin Heidelberg; 1994:149-355.&#xD;
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	Shanthi A, Radha R. pre-formulation Assessment: the fruit of Cuminum cyminum, Linn. Int J Curr Res Rev.2011;3(6):49-57.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study on Activity Recognition Technology for Elderly Care&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>107</FirstPage><LastPage>111</LastPage><AuthorList><Author>Hemalata Vasudavan</Author><AuthorLanguage>English</AuthorLanguage><Author> Sumathi Balakrishnan</Author><AuthorLanguage>English</AuthorLanguage><Author> Raja Kumar Murugesan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: It is a global challenge to assist the ever-growing elderly populations&#x2019; needs. There are needs related to healthcare, ageing in place, security, social and well-being of the elderly. Activity recognition enables continuous monitoring and prevents a hazardous situation such as falls. Objective: This paper discusses the type of sensors and processes involved to support the elderly to stay in their home independently and continue their routine activities. Although this technology has been around for a long time, it has not been implemented in elderly homes. Conclusion: This multi-level processing system has many benefits if the data is processed to fit the needs of the resident ambient environment. However, the majority of the research detects single user environment almost perfectly. This paper focuses its attention on research on composite activities and multi-users in an ambient intelligent environment. In addition to that, there are also discussions on the benefit of activity recognition to the elderly, healthcare-related Activity Recognition (AR) and the technology supporting AR.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Activity Recognition, Multi-user, Multi-inhabitant, Smart Home technology, Ambient Assisted Living, Elderly</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
According to the United Nations (2017), it is estimated that the 65 and over age group across several different countries will rise to 28% by 2050. Figure 1 shows 2016 statistic in Malaysia, revealing that 6% of the 31.7 million population is elderly and further predicted that by the year 2030, the elderly population will make up to 15% of the total population.1&#xD;
&#xD;
The expectancy age of Ageing for various regions such as African, Eastern Mediterranean, European, Western Pacific, Americas, South East Asia and other parts of the world from 1950 to 2050 all shows a definite increase in the numbers.2&#xD;
&#xD;
Elderly Centered Activity Recognition&#xD;
&#xD;
With the increase in the elderly population, issues such as the quality of life, prolonged independent living, reducing caregivers&#x2019; time and healthcare costs should be tackled carefully. This research discusses activity recognition (AR) environment and Ambient Assisted Living (AAL). Currently, there are many smart technologies developed to enhance the lifestyle of assisted elderly including their safety, security and surveillance, healthcare, social connectedness, social isolation, wealth management services, and many others.&#xA0;&#xA0; In recent research, services for the methods and applications have been classified into five which are Health &#xD;
&#xD;
Monitoring, Safety Monitoring, Nutrition Monitoring, Social Network, Localization, and Navigation (Figure 1).3 All of these elements are important and includes some aspects of outdoor and indoor requirements.4&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
These environments are found to be smartly assisting the elderly and at the same time give great relief for the next of keens and caretakers of the elderly as it can provide support in terms of supervision, alerting in case of emergency, and prevention of potential fatality. The principles of AAL is similar to smart home technologies except that it is skewed to monitoring special conditioned residents such as the disabled and elderly.2 This intelligent environment allows the elderly to Age in Place (AIP). Figure 2 shows an example of multiple sensors sensing the Activity of Daily Living (ADL) in an indoor and outdoor environment. Many research proved that using multiple sensors increases the accuracy of recognizing types of activity. Some of the most common sensors found in smart homes are accelerometer which detects object&#x2019;s motion and movement, gyroscopes, on the other hand, supports to find objects rotations and magnetometers sensors detect the strength of magnetic fields.&#xD;
&#xD;
As AR can help to fix these issues that can help facilitate seamless monitoring services in their own homes which indirectly helps to delay ageing as the elderly are very comfortable in their own space.3,4 &#xA0;Opportunity to recover from illness in their own home leaves positive impacts. This also can be a benefit to their mental wellness. Figure 3 shows a statistic on the living arrangement of ageing in Japan. Such statistic for other regions and other latest report was difficult to trace but Japan is always advanced in this area as their percentage of the ageing population has increased tremendously.5&#xD;
&#xD;
These statistics prove that a significant increase in living with spouse alone, living alone and staying in old folks homes. To be able to receive better and necessary assistance in their own home and home care centres, the current acceptance of the activity recognition model needs to be explored thoroughly.&#xD;
&#xD;
HEALTHCARE-RELATED ACTIVITY RECOGNITION&#xD;
&#xD;
Several authors have recognized the potential of a Human Activity Recognition (HAR) system that specializes in identifying patterns and expert systems.6 This approach would improve the cost of services for healthcare which eventually takes off the burden of the elderly.7&#xA0; Healthcare systems are needed to ensure the life of the elderly remain as smooth as their younger days and minimizing their suffering from old age and ailments such as Alzheimer&#x2019;s.8 Currently, there is a growing range of sensor system which can devise automatic activity recognition that possibly rolls out to other great applications that supports healthcare, comfort, and security.9&#xD;
&#xD;
&#xA0;Other than that behavioural monitoring, location detections, and other vital information that will be essential to assist when the help arrives, thus can optimize the geriatric care services10. Nighttime wandering is one of the symptoms of severe Alzheimer and can be a nightmare for the caretakers. Through a customized ambient support system, Alzheimer patients can benefit as it can help them to stay at home and regain a circadian cycle, Figure 3. 11&#xD;
&#xD;
&#xD;
&#xD;
PROBLEM WITH ACTIVITY RECOGNITION SOLUTION &#xD;
&#xD;
There is not a single solution to solve the problems faced by the AAL actors4. The challenge is to improve activity recognition performance, interpretation and inference. Therefore it raises many questions on the effectiveness of classifiers and sensors, obstruction in the environment, the pervasiveness of gadgets, privacy and security of data, the accuracy of the result, variation in result of similar activity, sensor calibrations, and sensor placements, self-healing of technology, recognition latency and performance of battery life. Most importantly the activity classification for the specific actor in that environment has to be accurate.&#xD;
&#xD;
Although many research works points out that smart home systems do assist greatly in AIP12 but problems still exist in terms of connecting these well-designed robotic systems to other systems. This is due to the lack of a unified platform and integration of the platforms. To stress the significance of interoperability, emphasized the connectivity, standards and communication protocols plays a vital role in maintaining a home network.13&#xD;
&#xD;
In a multi-user environment, the gathered data have ambiguities in its interpretation and prediction. In another research, they proposed crowdsourced landmarks to support a multi-user environment.14 In any case, this will require numerous data exchange between server and residents to gather the crowdsourced landmark information, which eventually slows down the system.&#xD;
&#xD;
Each of the ADLs consists of simple and complex steps. Activity recognition remains a challenge for simultaneous, interleaved, parallel, sequential activities. The pattern of the simple activities leads to the main activities and these are called the composite activities15. &#xD;
&#xD;
Simple activities are recognized as actions or events.16 These simple activities such as walking and sitting are easy to recognize, activities that have more than one event is difficult to recognize. Thus, more effort is required to recognize these complex activities. Research shows that when there is the presence of multi inhabitant in an intelligent ambient with activity recognition it is deemed to be a detriment as the majority of systems does implicit assumptions based on object detection and their location to the user.17&#xD;
&#xD;
One study has categorized high-level activities into three that is action (single user), interaction (multiple users) and group activity6. &#xD;
&#xD;
The technique used in research determines that the smart relation between correlations and constrain which provides a simpler understanding of the recognition of activity in a complex environment.27 Figure 4 shows a compilation of types of the technique used to measure single and multiple users in AR environment taken from various research papers.&#xD;
&#xD;
To recognize activities effectively there are three stages involved that are activity sensing, activity modelling, and finally the inference of the type of activity. This is also believed to support a multi-user environment.28 &#xD;
&#xD;
As mentioned accuracy improvement depends on multiple sensors and continuous data sensing15, however, this will result in a high number of data to be processed. Many methods such a data fusion, or sensor fusion are taken to classify the activity and also eliminate the redundancy. Deep Learning and Machine learning support in extracting appropriate data to recognize desired activities. Among its steps feature selection and feature extraction algorithms supports extracting relevant data that accurately produce the type of activity. Additionally, temporal reasoning refines the correctness of the algorithms23. &#xA0;Findings show that although there are many methods to do sensor fusion, most of the research does not specify any reasons for their usage.30 The same research also compared heterogeneous sensors to homogenous sensors which showed that the former gives better performance. From that finding, it is suggested that to get better performance in recognizing activities consider research on the optimal sensor combination that may give a better result.&#xD;
&#xD;
TECHNOLOGY SUPPORT AND SOLUTION&#xD;
&#xD;
&#xA0;There are four approaches to activity recognition, which is some using wearable devices, video-based device, devices in an ambient environment and Smartphone-based pervasive devices 5 and also robotics. Ubiquitously networked robotics has also become part of the activity recognition approach. It is used in the new applications in which robotics systems will render various assistive services. The contextual information that is collected will be assisting the robot to automatically provide services.21 Computerized approaches focusing on continuous, objective, and quantitative assessment.23 Since the accuracy of the recognition of the activity is a challenge for real-world situations, implementation of temporal reasoning improves the accuracy of their algorithms. To identify (activities in real-time, using online sensor streaming and also a set of different statistical spatiotemporal features through the proposed windowing technique is used.1 Recognizing multi-user is using data location too determines the position of the user indoors by using an indoor positioning module (IP) that is based on Bluetooth technology. Another more efficient method is to analyze the data from inertial and acceleration sensors embedded on the user&#x2019;s wearable device or smartphone to track his or her movement. Additionally, this can also be achieved in using vision-based techniques for human activity recognition.31,32&#xD;
&#xD;
These days the smartphone makes it possible for ubiquitous healthcare service for anyone because the smartphones have become a necessity in everyone&#x2019;s life.12 These smart devices itself gets more sophisticated with sensing capabilities, better algorithm computing capabilities and intensive algorithms on the mobile devices.5&#xD;
&#xD;
&#xD;
&#xD;
Most smartphones are equipped with motion and location sensors such as accelerometer, light sensors, magnetometer and GPS. They can be integrated with the AAL system that works together with other environmental sensors through collecting information that determines environmental conditions such as CO2 level, temperature and humidity 18 and Smartphones rapid improvement on its memory, a fast processor(s) and the powerful battery provides a new opportunity for HAR researches as no additional devices are needed (Figure 4). The most interesting improvement to smartphones is their capability to do high-level programming with various visualizations. 24 &#xD;
&#xD;
Although the battle in improving the performance and accuracy of recognizing activities in a multi-user environment continues the future work must cater to this large variability of activities. Especially as human started to multi-task even more than before. Therefore it is essential to continuously monitor the living condition through fusing data acquired from various wearable and mobile sensors, video, infrared camera, image or object detections with other technologies such as IoT, Machine Learning, Human Activity Recognition, deep learning and Cognitive IOT. 17, 23&#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
Activity recognition safeguards the elderly&#x2019;s safety in emergencies and identifies changes in their body by continuous unobtrusive monitoring and accurate activity, lifestyle and behavioural profiling stress the importance of monitoring activities of daily living (ADLs) to continuously determine their safety as they age. Activity recognition in a multi-user activity home has to be improved to enhance the living standard of the elderly. This is essentially where AR&#x2019;s effectiveness is revolutionizing. Through powerful data processing capability from the ambient intelligent environment.&#xA0; AAL comes into the picture because its main aim is to aid the elderly and the disabled to care for themselves independently in their own homes.&#xD;
&#xD;
ACKNOWLEDGMENTS&#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=3831</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3831</Fulltext></URLs><References>[1]&#xA0;&#xA0; Al Machot F, Mayr HC. Improving human activity recognition by smart windowing and Spatio-temporal feature analysis. InProceedings of the 9th ACM International Conference on PErvasive Technologies Related to Assistive Environments 2016;29: 1-7. &#xD;
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[2] Al-Sharqi R, Mourshed M, Rezgui Y. Progress in ambient assisted systems for independent living by the elderly. Springer Plus. 2016 Dec 1;5(1):624.&#xD;
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[3]&#xA0;&#xA0;&#xA0;&#xA0; Avgerinakis K, Briassouli A, Kompatsiaris I. Activity detection and recognition of daily living events. InHealth Monitoring and Personalized Feedback using Multimedia Data. Springer, Cham. 2015; 15:139-160..&#xD;
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[4]&#xA0;&#xA0;&#xA0;&#xA0; Calvaresi D, Cesarini D, Sernani P, Marinoni M, Dragoni AF, Sturm A. Exploring the ambient assisted living domain: a systematic review. J Amb Intellig Hum Comp. 2017 Apr 1;8(2):239-257.&#xD;
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[18]&#xA0;&#xA0; Pereira JD, da Silva e Silva FJ, Coutinho LR, de T&#xE1;cio Pereira Gomes B, Endler M. A movement activity recognition pervasive system for patient monitoring in ambient assisted living. InProceedings of the 31st Annual ACM Symposium on Applied Computing 2016;4:155-161.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Novel Method Development and Validation for UV-Visible Spectrophotometric Analysis of Methscopolamine Bromide&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>112</FirstPage><LastPage>117</LastPage><AuthorList><Author>Maninder Pal Singh</Author><AuthorLanguage>English</AuthorLanguage><Author> Manish Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Kashish Wilson</Author><AuthorLanguage>English</AuthorLanguage><Author> Prerna</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aims and Objectives: The research work presented here aims to develop a novel approach towards a precise and effective analytical method for qualitative estimation of methscopolamine bromide, a drug of choice to treat peptic ulcer. Methods: The absorbance of methscopolamine bromide was low even at a higher concentration as obtained from the Ultraviolet visible (U.V.) spectroscopical method. Therefore it was required to enhance absorbance value to precisely perform qualitative analysis by different approaches. In this process, novel attempts were made to develop a new method for estimation such as the addition of chromophores and the use of colourimetric techniques but all of the attempts did not produce satisfactory results. Results: At last encouraging results including enhanced absorbance were obtained by using sodium picrate at &#x3BB;max of 440 nm and linearity was observed within the range of 1-5 &#x3BC;g/ml with a regression coefficient of 0.984. The method was then validated to ensure reproducibility as per ICH (International Conference on Harmonization) guidelines. Conclusion: The method was successfully employed for the determination of methscopolamine bromide with good linearity, precision, robustness and specificity. The proposed method can be used for quality control during the routine quality assessment of bulk drug and does not involve the use of residual solvents which ensures that the method is novel and economic which may be used by pharmaceutical industries for commercial utilization.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Methscopolamine bromide, UV-spectrophotometry, Validation, Novel, Analytical method, Quantitative estimation </Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Methscopolamine bromide (Mb) is an anticholinergic drug. It reduces the secretions of certain organs in the body such as stomach. It is used to control the peptic ulcers by blocking the muscarinic receptor.1,2 The melting point of methscopolamine bromide is 220-2300C.3 Chemically it is (1S, 5S, 7R)-7-{[(2S)-3-hydroxyphenylpropanoyl] oxy} 9, 9-dimethyl-3-oxa-9azatricyclo [3.3.1.0{2,4}] nonanium bromide.3 Molecular Formula of methscopolamine bromide is C18H24BrNO4. The molecular weight of Mb is 398.30. It is a white crystalline powder. It is freely soluble in water, slightly soluble in ethanol (95%v/v).&#xD;
&#xD;
The mechanism of action of bromide methscopolamine interferes with the delivery of acetylcholine nerve impulses in the parasympathetic nervous system. (specifically the vomiting centre).4 It does so by acting as a muscarinic antagonist. It is used as adjunctive therapy for the treatment of peptic ulcer.5 Pharmacodynamic of methscopolamine bromide is poorly and unreliably absorbed (10% to 25%)6. Elimination of Mb primarily in urine and bile as well as an unabsorbed drug in the faeces. The onset of the time of methscopolamine bromide is 1 hour and the duration is 4 to 6 hours.7 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; An important component in the formulation development of any drug molecule is an analysis. A validated and suitable method has to be available for the analysis of drug(s) in the bulk, in drug delivery systems, in biological samples and from release dissolution studies. If a suitable method, for a specific need, is not available then it becomes essential to develop a simple, sensitive, accurate, precise, reproducible method for the estimation of drug samples. The estimation of methscopolamine bromide by, high-performance liquid chromatography [HPLC], high-performance thin-layer chromatography [HPTLC] and sensitivity of UV is very less reported in the literature.8 Thus the present study was undertaken to develop and validate a simple, sensitive, accurate, precise and reproducible U.V method for methscopolamine bromide.&#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
Equipments&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The following equipments were used: double beam UV visible spectrophotometer connected to a computer loaded with Shimadzu UVPC, Electronic balance, BL -220H (Shimadzu Corporation, Japan). &#xD;
&#xD;
Reagents and Chemicals&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Methscopolamine Bromide (assigned purity 99%) was provided as a gift sample by Alkaloids Private Limited, Kolkata (India). Taurine for synthesis (99% pure) and Picric acid were purchased from Loba Chemie Private Limited (India). Sodium Periodate (99% pure) was purchased from Nice Chemicals Private Limited, Cochin (India) and Ninhydrin (99% pure) was obtained from Qualikems Private Limited (India).&#xD;
&#xD;
Method development&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The scanning and U.V spectra of the solution containing methscopolamine were recorded for the concentration ranging from 300-500&#x3BC;g/ml. It was observed that the resulting &#x3BB;max was showing less absorbance even at high concentration. This problem highlighted the requirement and necessity for the development of a new method that can offer detection with enhanced sensitivity. The method was then successfully developed and validated to fulfil the desired needs. Initially different functional groups present in the drug molecule like hydroxyl, quaternary amine and epoxide groups were treated with reagents to form coloured complex, however, the method was developed by complexation with an epoxide group.&#xD;
&#xD;
Addition of chromophore&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The hydroxyl group of methscopolamine bromide was estimated to form complex with sodium periodate and Taurine.9 The chromophore solution (Sodium periodate and Taurine) was added to drug solution with concentration of 10 &#x3BC;g/ml. The solution was then heated at 80-1000c for 15 minutes and was scanned by UV-spectrophotometer. The absorbance was less and it was observed that the method was not efficient in estimation of drug (Fig. 2b).&#xD;
&#xD;
Addition of ninhydrin and silver nitrate&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The structure of methscopolamine bromide is having quaternary ammonium as one of the functional group. The group was targeted to provide complexation with ninhydrin or silver nitrate. The reaction was expected to produce a coloured complex which can be detected by colourimetric technique. 500 &#x3BC;g/ml solution of ninhydrin was added to the drug solution of concentration 100&#x3BC;g/ml. The solution was mixed properly with the reagent and was scanned spectrophotometrically. One drop of silver nitrate was added separately in another 10&#x3BC;g/ml drug solution and was scanned10. In both cases again, the method was not found to be good enough to be used for estimation of the drug as the absorbance was found to be very less as well as the complexes were not found to be stable (Fig. 2c and 2d).&#xD;
&#xD;
Addition of picric acid solution&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The epoxide group of methscopolamine bromide was predicted to form a complex with picric acid.11 One ml of 0.25M picric acid was added to the drug solution with a concentration of 10 &#x3BC;g/ml. The solution was heated at 50-600C for 15 minutes and was scanned by using a spectrophotometer. This method was found to show little improvement but the desired results were not obtained (Fig 2e).&#xD;
&#xD;
Addition of sodium picrate &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The sodium picrate solution was the one which reacted with the epoxide group of methscopolamine bromide and formed stable complex. 0.1 ml of sodium picrate solution was added in drug solutions with concentration ranging from 1&#x3BC;g/ml to 5&#x3BC;g/ml and these solutions were kept undisturbed for some time at room temperature12. The scanning was done and the &#x3BB;max was found to be 440 nm. The standard plot was then prepared for drug solution with concentration ranging from 1-5 &#x3BC;g/ml. Thus, a sensitive method for the estimation of methscopolamine bromide was developed. The method was further validated according to ICH guidelines (Fig 2f).&#xD;
&#xD;
&#xA0;Method validation&#xD;
&#xD;
Method validation was performed following International Conference on Harmonization (ICH)13 specifications, which include linearity, specificity, accuracy, precision, robustness, detection limit and quantitation limits.&#xD;
&#xD;
Linearity&#xD;
&#xD;
Linearity is the ability of the method to elicit the results of test samples that are directly proportional to analyte concentration within a given range. Different aliquots from the stock solution were sufficiently diluted to get the solution in a concentration ranging 1-5 &#x3BC;g/ml in triplicate. Calibration plots were obtained by plotting the graphs between absorbance versus concentration data and linear regression analysis was carried for the same. The values were reported as the mean &#xB1; S.D. of the calibration curves. The data were analyzed at a wavelength of 244 nm.&#xD;
&#xD;
Accuracy&#xD;
&#xD;
Accuracy was determined by performing recovery studies. It was performed by preparing different concentration levels (2, 3 and 4) &#x3BC;g/ml. the study was carried out in triplicate as three sample solutions were prepared for each recovery level. U.V absorbance was analyzed and % mean recovery along with % R.S.D was calculated.&#xD;
&#xD;
Precision&#xD;
&#xD;
The precision of proposed method was determined for three concentrations (2, 3 and 4 &#x3BC;g/ml) covering the entire linearity range by intraday (repeatability) and interday studies (intermediate precision). Intraday precision was determined by analyzing (2, 3 and 4 &#x3BC;g/ml) at three different time points of the same day and interday precision was determined by analyzing the solutions at three different time points on different days.14 For analyzing the precision % R.S.D was calculated for intraday and interday precision studies.&#xD;
&#xD;
Robustness&#xD;
&#xD;
The robustness of the method was determined by analyzing a change of 2 nm in the wavelength of the analysis. Six sample solutions of concentration 3 &#x3BC;g/ml were prepared and the assays were carried out at 440 and 442 nm. The % R.S.D was determined for the solutions to observe the variation and limits of variation in response to the small deliberate change in wavelength. &#xD;
&#xD;
Limit of detection (L.O.D) and limit of quantification (L.O.Q)&#xD;
&#xD;
Estimation of L.O.D and L.O.Q was based on the standard deviation of response and slope of the calibration curve. It was calculated from equation (1) and equation (2)&#xD;
&#xD;
L.O.D = 3.3 &#x3C3; /S&#xA0;&#xA0; (&#x3C3; = Standard deviation of the intercept of linear regression equation)&#xA0;&#xA0;&#xA0; (1)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (S= Slope of the regression equation)&#xD;
&#xD;
L.O.Q = 10 &#x3C3; /S&#xA0;&#xA0;&#xA0; (&#x3C3; = Standard deviation of the intercept of linear regression equation)&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (2)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (S= Slope of the regression equation).&#xD;
&#xD;
RESULTS AND DISCUSSION:&#xD;
&#xD;
Preparation of standard plot&#xD;
&#xD;
Scanning of methscopolamine bromide &#xD;
&#xD;
Scanning of drug was done by using UV spectrophotometer and &#x3BB;max was found to be 257 nm. &#xD;
&#xD;
Standard plot &#xD;
&#xD;
Standard plot of methscopolamine bromide was prepared in 0.1 N hydrochloric acid (pH 1.2) at 257 nm. The range of the concentration was 100-1000 &#xB5;g/ml. The plot of different concentration of the drug and absorbance was found to be linear but showed very less absorbance at higher concentration i.e. 0.506 at 1000 &#xB5;g/ml. The dose of methscopolamine bromide was very less (5 mg) so developed the UV visible analytical method as shown in Table 1(a). &#xD;
&#xD;
Method development using UV visible range&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The absorbance maximum was found to be 440 nm. The calibration plot of methscopolamine bromide was found to be 0.506 at 1000 &#xB5;g/ml. The absorbance was very less at a higher concentration so the method was developed by the complexation method. Sodium picrate solution was used to develop the method. The &#x3BB;max was found out to be 440 nm.&#xD;
&#xD;
Scanning of methscopolamine bromide with 0.1 ml sodium picrate&#xD;
&#xD;
Scanning of the drug was done by adding sodium picrate using a UV spectrophotometer (400-800 nm range) and &#x3BB; max was found to be 440 nm. &#xD;
&#xD;
The standard plot of methscopolamine bromide with 0.1 ml of sodium picrate&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 0.1 ml of sodium picrate solution were added in drug having 1&#x3BC;g/ml to 5&#x3BC;g/ml concentration and kept for 15-30 minutes at room temperature. The absorbance (0.2 to 0.8) was found to be 1&#x3BC;g/ml to 5&#x3BC;g/ml at 440 nm (Table 1 (b)).&#xD;
&#xD;
Method validation&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Method validation was performed in accordance with International Conference on Harmonization (ICH) specifications, which include linearity, specificity, accuracy, precision, robustness, detection limit and quantification limits.15&#xD;
&#xD;
Linearity and Range&#xD;
&#xD;
Table I c shows concentration and absorbance at 440 nm. Linearity was observed in the range of 1&#x2013; 5 &#x3BC;g/ml at 440 nm with a significantly higher value of correlation coefficient, R2 = 0.984 thus, follow Beer Lambert&amp;#39;s law in this range as shown in Table 1 (c).&#xD;
&#xD;
Accuracy&#xD;
&#xD;
Accuracy results showed good reproducibility with an SD value below 2. The method was found to be accurate within the acceptable deviation. These results proved that the method was accurate shown in Table 2 (a).&#xD;
&#xD;
Precision study&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The results of intraday, interday repeatability and reproducibility have been summarized in Table II b and c respectively. The results were found to show good reproducibility with SD below 2. The results were very close to the true value. There was negligible variation in intraday and interday precision.&#xD;
&#xD;
Robustness&#xD;
&#xD;
Robustness results have been summarized in Table 2(d) and showed good results. All the samples in 0.1N HCl (pH 1.2) showed SD below 2. From the observed data, it was found that slight changes in &#x3BB;max do not affect the absorbance.&#xD;
&#xD;
Limit of detection (L.O.D) and limit of quantification (L.O.Q)&#xD;
&#xD;
The L.O.D. and L.O.Q. were found to be 0.042 &#x3BC;g/ml and 0.12 &#x3BC;g/ml respectively. These results demonstrate that the method is sensitive and can detect the drug in the above-mentioned concentration range.&#xD;
&#xD;
&#xA0;&#xA0; UV, UV-VIS and Derivative spectrophotometry are broadly used techniques to quantify drugs4 because they are simple, inexpensive and do not require time-consuming sample preparation compared with others techniques.2 Moreover, UV spectrophotometry produces very low amounts of residues and solvents, which is an important ecological aspect currently discussed in routine laboratory analysis. Because of these reasons and the careful validation of this method, can be recommended for routine laboratory analysis.2&#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
The validated analytical method for the quantitative determination of methscopolamine bromide has the advantages of speed, simplicity, low-cost conditions. All validation parameters were found to be satisfactory, including linearity, accuracy, precision, robustness and adequate detection and quantification limits. The validated method is a good alternative for routine quality control of methscopolamine bromide by the pharmaceutical industry and quality control laboratories. This procedure uses simple reagents, requires minimal sample preparation. Its use is therefore encouraged for routine analysis. We had developed an alternative method to using chromophores by making use of sodium picrate to enhance absorbance and hence greater sensitivity of UV analysis.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
We are thankful to Alkaloid Corporation Pvt. Ltd. Kolkata for providing the gift sample of methscopolamine bromide. We would also like to thank Dr. G.S Kalra Campus Director CT Group of Institutions Jalandhar for providing all the facilities to complete our work successfully.&#xD;
&#xD;
SOURCE OF FUNDING: No Funding&#xD;
&#xD;
CONFLICT OF INTEREST: We have no conflicts of interest. &#xD;
&#xD;
ETHICAL APPROVAL: None&#xD;
&#xD;
AUTHORS&#x2019; CONTRIBUTION: Mr. Maninder Pal Singh had done experimental work.&#xA0; Dr. Manish Kumar and Dr. Narendra Kumar Pandey have written manuscript.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Fig. 2: (a) Scan of Methscopolamine bromide (300, 500&#xB5;g/ml)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (b) Scan of Methscopolamine bromide (10 &#x3BC;g/ml, 100 &#x3BC;g/ml) with Sodium periodate&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; and Taurine&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (c) Scan of drug 100&#x3BC;g/ml with Ninhydrin solution 500&#x3BC;g/ml&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (d) Scan of drug solution 10&#x3BC;g/ml with silver nitrate.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (e) Scan of 10&#x3BC;g/ml drug solution with 0.25 M picric acid solution.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (f) Scan of methscopolamine bromide (2 &#x3BC;g/ml) solution with sodium picrate&#xD;
&#xD;
&#xD;
&#xD;
Fig. 3: (a) Scanning of methscopolamine bromide (500&#xB5;g/ml).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (b) Standard plot of methscopolamine bromide in 0.1N HCl (pH1.2).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (c) Observed view of 5&#x3BC;g/ml drug solution with 0.1 ml of sodium picrate solution.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (d) Scan of methscopolamine bromide + sodium picrate. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (e) Standard plot of methscopolamine bromide + sodium picrate.&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Fingerprint Authentication for Android-Based Healthcare Appointment Scheduling System&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>118</FirstPage><LastPage>122</LastPage><AuthorList><Author>Abdulmalek Al-Shujaa</Author><AuthorLanguage>English</AuthorLanguage><Author> MS Nabi</Author><AuthorLanguage>English</AuthorLanguage><Author> Qusay Al-Maatouk</Author><AuthorLanguage>English</AuthorLanguage><Author>  Abdulaleem Zaid Al-Othmani</Author><AuthorLanguage>English</AuthorLanguage><Author> NAA Rahman</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Healthcare organizations maintain patient sensitive data that requires to comply with privacy and security laws. At the same time should provide a system with ease of access. Objective: The main purpose of this research is to develop a mobile application that can manage, and control patients flow at the healthcare by allowing the doctor to upload their appointments and then allow clients (patients) to book one of the available slots in an efficient and effective way. Methods: A survey has been conducted on 100 android app users in Malaysia, it has been observed that businesses&#x2019; owners does not trust current mobile appointment applications and prefer to use the traditional methods, which is on first come, first serve bases. Aside from that, current issues that are faced by the users are that most of the mobile appointment applications are unsecured and there is no security control over the account holders for these applications. Results: The developed application also includes extra feature such as secure chatting function that links between the users of the app and let them discuss any type of inquiries related to the booked appointment. AES, SHA-256 and SCRYPTE algorithm has been implemented successfully on the developed application and hence will increase the layer of security and keep user data in a safe manner. AES encryption used to encrypt the users chatting messages while the SHA-256 used to hash the secret key that used to encrypt and decrypt data. Moreover, Conclusion: Biometric fingerprint authentication has integrated with the system in order to solve the existing security flaws of the current appointment applications as well as email verification for avoiding the anonymous user and increase the overall security features.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>AES, Appointment System, Fingerprint Authentication, Healthcare, SCRYPTE, SHA-256</Keywords><Fulltext>&#xD;
INTRODUCTION &#xD;
&#xD;
According to a survey conducted on 100 android app users in Malaysia, it has been observed that most of the businesses&amp;#39; owner does not trust current appointment mobile applications and prefer to use the traditional methodology which is based on &#x201C;first-come, first-serve&#x201D;. The current issues that are faced by the users are that most of the mobile appointment applications are unsecured and there is no security control over the account holders for these applications. 1 For example, a user can create an account and book an appointment anonymously without any sort of verification being conducted by the application. Aside from that, even after an appointment is booked, still patients usually need to queue at the business enterprise for a long time before getting served. This means the currently available appointment scheduling system is cumbersome, time-consuming, constant manual management and fallible. &#xD;
&#xD;
Moreover, the currently available apps do not provide high security to end-users. These applications allow users to create an account and book an appointment without any security measurements such as sending a one-time password for confirming the booking process etc. These issues led security technologies such as biometrics authentication, email verification and cryptography to get involved in apps development and help users and business owners to maintain business flow in an effective, efficient and secure manner. The proposed solution for the issues discussed earlier is to develop a secure mobile appointment scheduling app.2,3 Considering scheduling and managing appointments at the healthcare service provider, the proposed app will manage and control the patient&#x2019;s flow by allowing the clinic assistant to upload their business appointments and then allow clients to book one of the available appointments efficiently and securely. In addition, the expected application will have biometric fingerprint authentication to solve the existing security flaws of the current appointment applications as well as implementing a secure channel that links the application&#x2019;s users and the database. The proposed mobile application will have email verification to avoid the anonymous user and increase the layer of security. The development of any system in the healthcare sector requires extra attention to the privacy of the patient&#x2019;s data. Hence, healthcare-related systems should pay more attention to patient&#x2019;s data privacy from the early stages of the system design.4,5 &#xD;
&#xD;
Literature Review&#xD;
&#xD;
One study has studied the fingerprint-based on recognition method and performance analysis.1 The fingerprint is the common and alterable method that uses intentionally as a legal method to identify a person. Plus, the fingerprint uses in numerous application that uses in the military, law enforcement, medicine, education, civil service, and forensics. The researchers have compared the biometrics technologies based on the EER (Equal Error Rate), FAR (False Acceptance Rate) and FRR (False Rejection Rate). Based on these comparisons, the researchers observed that fingerprint recognition has the strongest biometric authentication amongst the other biometric technologies and agreed that fingerprint recognition is the best biometric technology for explosives security from an analysis of the requirements. A few studies have compared among three types of fingerprint scanners and simplify the process of enrollment, identification and verification.2,3 The fingerprint recognition consists of four stages which are capturing the biometric data, pre-processing stage, extraction stage, and matching stage 4. In the enrollment stage, the biometric data is acquired from the sensor and stored in a database along with the person&#x2019;s identity for the recognition process. The biometric data is captured, and the digital image will be created and then pre-processing applies to the digital image to remove unwanted data as well as apply the post-processing. Lastly, the data will be stored on the database and trigger according to the user needs. In addition, the retrieved data will be compared with the user finger pattern with the template in the database. The biometric data is re-acquired from the sensor during the recognition mode which will be compared to the stored data to determine the user identity.&#xD;
&#xD;
Hashing Algorithms&#xD;
&#xD;
Password hashing is the most common approach for maintaining users&#x2019; password-related information that later use to authenticate the user.5 Therefore, the password of the user will be hashed and store in the database as a hashed value and then when the user logs in the hashed values will be compared and login to the system if the hashed values are matched. Moreover, the authors have reviewed all such algorithm and proved the weakness behind each one.6 There exist several hashing algorithms and each one has its advantages and limitations. For example, when comparing (Secure Hash Algorithm 1) SHA-1 and (Secure Hash Algorithm 1) SHA-2 hashing algorithms both are not time efficient but still not breakable and can be used by the developers. Regarding this, the authors in7, have analyzed and juxtaposed the two most widely used algorithms which are Message Digest (MD5) and SHA and concluded that SHA hashing algorithms are easier to compute but are much harder to reverse and would take around millions of years to compute the authentic or veritable message content while MD5 is the message-digest algorithm that replaces its predecessor MD4.8&#xD;
&#xD;
Secure Hashing Algorithm-256 is a cryptographic hash function that takes an input of the random size and produces an output of a fixed size. 9 SHA-256 was designed by the National Institute of Standards and Technology (NIST). Usually, hashing algorithms are used with other cryptographic algorithm or protocols to protect sensitive data. In our case, the developer has protected the public key using the AES algorithm. In addition, SHA-256 is given a fixed output value regardless of the input that is given in the first place. 3&#xD;
&#xD;
In 2012 the internet engineering task force organization has examined this algorithm to test the power behind it. In addition, the algorithm works base on key derivation which means it derives one or more secrete keys from a secret value such as passwords or a passphrase. Key deviation function proposed for low-memory setting.&#xD;
&#xD;
AES is a symmetric key block cypher encryption algorithm and this algorithm was designed in 1998 by Vincent Rijmen and Joan Daemen and it is based on the Feistel network and supports 128-bit block size and key length 128, 192 and 256 bits. AES perform 10, 12 or 14 round and the number of rounds depends on the key. To illustrate, it performs 10 rounds for 128-bit key length and 12 rounds for 192-bit key length and lastly 14 rounds for 256-bit key length 10. In advance encryption standard (AES) each round performs some steps. Key-expansion, initial rounds and final rounds. In the rounds step, Sub-byte generation, Shift-rows, Mix-columns and Addround_key are performed whereas, in the Final-rounds step, the same functions are performed except Mix-columns function.3, 4&#xD;
&#xD;
DESIGN OF THE PROPOSED APPLICATION &#xD;
&#xD;
The general architecture of the proposed solution along with its components is outlined in this section and depicted in Figure 1. As observed in Figure 1, the user of the application will be able to perform various tasks once he/she runs the application. In addition, the system architecture shows the main three components of the system and each one of these components has a various mechanism work than others. These three main components are as follows:&#xD;
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Front-end service &#xD;
&#xD;
&#xD;
&#xD;
Front-end service is the user interface which will be displayed to the user whenever the user launches the application. Users will be able to interact with each other and forward a request to a remotely located back-end program on another device which in our case is the firebase database. The Figure 1 shows the proposed system front-end service separated down into two sections which are the customer and doctor interface. Each one of these front-end has many functions that user can interact with and perform the desired tasks efficiently.&#xA0; &#xD;
&#xD;
Secure channel &#xD;
&#xD;
The secure channel is the component that takes care of the data transformation which means the developer should protect the users&#x2019; data and prevent information from leaking to third-party hand (Hacker). All data (Sensitive and non-Sensitive) will be passed through the secure channel. In addition, AES encryption and SHA-256 algorithms have been used for this purpose and implemented in the chatting function which will protect the user&#x2019;s messages and make end-to-end messages encryption. Furthermore, the CIA triad (Confidently, Integrity and Availability) including Authentication and authorization have been considered during app development and used wisely to protect the user data and safely keep their data. 5&#xD;
&#xD;
Back-end service &#xD;
&#xD;
Back-end service is responsible for the business logic, performance and database interactions. In this case, the system data like the user&#x2019;s personal data, encrypted data and other data will be store in the database and then retrieve whenever the user interact and perform tasks with the application. &#xD;
&#xD;
The proposed application functionalities will be listed and discussed in the following section: &#xD;
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&#xD;
	&#xD;
	Registration function &#xD;
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&#xD;
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After downloading the application, the user (i.e. Doctor or Patient) will be allowed to sign up and create a new account. The users will have to fill in all the required fields such as username, email, password and phone number. By doing so, a new user will be created, and email verification will be sent to the registered email address. Aside from that, the doctor should upload the clinic license to confirm the registration process and consider his/her clinic as the authorized clinic. &#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;&#xA0;&#xA0;Email verification function &#xD;
	&#xD;
&#xD;
&#xD;
The system will have an email verification function that allows newly registered users to verify their account through their signed-up email address. The main point of this function is to avoid anonymous users from accessing the system and only allow verified and authorized users to access and start performing different tasks.&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	Login and Logout function &#xD;
	&#xD;
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The application will allow users to login into the system by using their previously registered credential such as email address and password. The application will check the validity of the users and only allows verified users to gain access to the system.4,5&#xD;
&#xD;
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	&#xD;
	Reset password function &#xD;
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&#xD;
&#xD;
In term of user accessibility, the reset password function is very important for users who forget their account password or getting into trouble during the login in process. The user will be able to send a request for a password reset by entering the registered email address, accordingly the system will respond with a reset password link sent to the registered email address.&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;&#xA0;&#xA0;Upload appointment function &#xD;
	&#xD;
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The application will allow the user (doctor) to upload his/her available time slot to provide the patient with a choice to select the preferred available time slot and accordingly book the desired time slot easily and smoothly. 6,7 &#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;&#xA0;&#xA0;List appointment function &#xD;
	&#xD;
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This feature will allow the user (proprietor) to list all the uploaded appointments and accordingly check the booked and available appointments. &#xD;
&#xD;
&#xD;
	&#xD;
	Delete, cancel and update appointment function&#xA0; &#xD;
	&#xD;
&#xD;
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Through this feature, the user will be able to manage the appointments by deleting, cancelling or updating the booked appointments. There will be different buttons available for the user for each function i.e. deleting, updating and cancelling.6 &#xD;
&#xD;
&#xD;
	&#xD;
	Online live chat function with AES encryption &#xD;
	&#xD;
&#xD;
&#xD;
The proposed application supports a chatting channel that links between the different systems&#x2019; users. This channel should be secure to keep user messages safely. The system will encrypt using Advanced Encryption Standard (AES) all the users&#x2019; messages and save them in the database. Decryption will be done automatically upon users request for viewing the chat history.&#xA0;&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	Update user&#x2019;s email&#xA0; &#xD;
	&#xD;
&#xD;
&#xD;
Updating user&#x2019;s email is a feature that helps system&#x2019;s users to update their email address whenever they face trouble to reach their email. In addition, the application will allow only authenticated users to update their email address. This means users should authenticate with the system again and then only they will be allowed to update their email address. &#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;&#xA0;&#xA0;Notification&#xD;
	&#xD;
&#xD;
&#xD;
The system will have a notification feature that notifies system users whenever an appointment gets booked or cancelled. Therefore, the system will have two types of notification which are onscreen notification and email-based notification.7&#xD;
&#xD;
&#xD;
	&#xD;
	Book appointment with fingerprint authentication This feature is considered the main function of the system. The mobile application will allow users (patient) to book any of the available appointments by placing their finger on the smartphone sensor to compare between the stored and the placed fingerprint pattern and assign the appointment as a booked appointment in case if the user fingerprint pattern matched, otherwise an error message will be displayed to the user, Figure 2.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
SYSTEM IMPLEMENTATION &#xD;
&#xD;
The system implementation was done in two parts to properly manage and control the flow of information throughout the system and accordingly achieving both efficiency and security.9 The first application which is called controller will manage doctor-side operations and will allow only registered doctors to open and manage their account in the system. In addition, the doctor should upload his/her medical license that proves the eligibility of working in the medical area. On the other hand, the second application which is the main appointment app, will be used by both users of the app i.e. the patient and the healthcare service provider for controlling and managing the appointments at both ends (Figure 3,4). &#xD;
&#xD;
The following section depicts some screenshots that were taken from the developed android application and displays some pages that users can navigate through when using the application. During the development process, screen resolution was also taken under consideration to make the system flexible and user friendly.9,10&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The controller application won&#x2019;t be published to the play store as it is used to activate or disable the account that is registered under the doctor&#x2019;s name or healthcare provider. In addition, the admin will have the ability to check the clinic medical certificate and take proper decisions based on the validity of the certificate (Figure 5, 6).10 &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;CONCLUSION &#xD;
&#xD;
In conclusion, the main idea of the propped system is to automate the process of booking between the patients and doctors in an efficient and secure way. The solution also considered establishing a secure communication channel between the patient and the doctor. A comparison study between different encryption and hashing algorithms on mobile apps have been conducted to discover the weaknesses and strengths of each and then selecting the most suited encryption algorithm in terms of speed and security. The developed application used fingerprint authentication, AES encryption and SHA-256 hashing algorithm to achieve a high level of security with an efficient booking process. SCRYPT password algorithm has been adopted in the system to hash the user&#x2019;s password and save it safely and securely.&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The authors also wish to express gratitude to the management of Asia Pacific University of Technology &amp; Innovation 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=3833</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3833</Fulltext></URLs><References>&#xD;
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	Kiah MM, Nabi MS, Zaidan BB, Zaidan AA. An enhanced security solution for electronic medical records based on AES hybrid technique with SOAP/XML and SHA-1. Journal of medical systems. 2013 Oct;37(5):1-8.&#xD;
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	Hatzivasilis G, Papaefstathiou I, Manifavas C. Password Hashing Competition-Survey and Benchmark. IACR Cryptol. ePrint Arch.. 2015;2015:265.&#xD;
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	Kumar EA, Blandi EN. A graphical password-based authentication based system for mobile devices. International Journal of Computer Science and Mobile Computing. 2014 Apr;3(4):744-54.&#xD;
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	Aggarwal SR. What&amp;#39;s fueling the biotech engine&#x2014;2012 to 2013. Nature biotechnology. 2014 Jan;32(1):32-9.&#xD;
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	Alanazi H, Zaidan BB, Zaidan AA, Jalab HA, Shabbir M, Al-Nabhani Y. New comparative study between DES, 3DES and AES within nine factors. arXiv preprint arXiv:1003.4085. 2010 Mar 22.&#xD;
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	Zhang X, Hu H. Optimization of hash function implementation for bitcoin mining. In3rd International Conference on Mechatronics Engineering and Information Technology (ICMEIT 2019) 2019 Apr (pp. 448-452). Atlantis Press.&#xD;
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	Barfield C, Cornell J, Arbour J, inventors. Secure data storage system and method. United States patent US 8,201,261. 2012 Jun 12.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study of Insulin Resistance and Glucose Tolerance Test in Patients with Essential Hypertension&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>123</FirstPage><LastPage>127</LastPage><AuthorList><Author>Rao B Deepak</Author><AuthorLanguage>English</AuthorLanguage><Author> Chakrapani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The number of hypertensive cases has been slowly rising in the world. Many studies have been pointing out the fact that arterial hypertension is an insulin-resistant condition that has been associated with an increased incidence in diabetes. This study puts in a sincere effort to find if there is any relation. This study is intended to be of great help to the community by throwing up some light on this matter. This study is also intended to be of great help to the practising physicians and also academicians. Aims and Objectives: To study insulin resistance and glucose tolerance test in patients with essential hypertension. Materials and Methods: The present study was conducted over a year, 50 patients of which 30 were cases and 20 controlled who was admitted to KMC Attavarand other hospitals under Kasturba medical college. Results: Insulin resistance was about 16 % in cases, with a mean of 1.33 and std deviation of 1.4. No controls had insulin resistance. Conclusion: There was an increased incidence of impaired fasting glucose among hypertensive which was statistically significant.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Insulin, Resistance, Glucose Tolerance, Essential Hypertension</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The prevalence of hypertension is rising rapidly worldwide and the impact is particularly being felt in developing countries.1 This is due to the epidemiological transition taking place in developing countries leading to alarming increases in non-communicable diseases, especially diabetes and hypertension.2,3 India now has the largest number of diabetic patients in any given country in the world. Hypertension is also likely to follow suit. Risk factors for hypertension may vary between developed and developing nations due to changes in genetic and environmental factors.4,5Thus, studies looking at the relationship between insulin resistance and hypertension in developing countries like India are of great interest. It is still unclear whether hypertension is related to insulin resistance per se or the insulin resistance cluster. Arterial hypertension is an insulin-resistant condition that has been associated with an increased incidence of diabetes. Diabetes mellitus and insulin resistance have been shown to increase future cardiovascular morbidity and mortality. Thus in hypertensive patients, early diagnosis and treatment of abnormal glucose metabolism may be important to reduce cardiovascular mortality.6,7&#xD;
&#xD;
AIM&#xD;
&#xD;
To study insulin resistance and glucose tolerance test in patients with essential hypertension.&#xD;
&#xD;
METHODS AND MATERIALS&#xD;
&#xD;
The present study was conducted over a year, 50 patients of which 30 were cases and 20 controlled who was admitted to KMC Attavarand other hospitals under Kasturba medical college.&#xD;
&#xD;
INCLUSION CRITERIA:&#xD;
&#xD;
&#xD;
	&#xD;
	Patients of over 30 yrs of age of either sex are&#xD;
	&#xD;
	&#xD;
	30 patients with essential hypertension without diabetes are cases, 20 without diabetes or hypertension are controls.&#xD;
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Exclusion criteria:&#xD;
&#xD;
&#xD;
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	Patients who are diagnosed to have diabetes.&#xD;
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	Cases of secondary hypertension.&#xD;
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	&#xD;
	All patients or controls below 30 yrs of age.&#xD;
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	Pregnant, lactating mothers&#xD;
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All cases and controls are subjected to:&#xD;
&#xD;
&#xD;
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	Detailed history and clinical examination. Anthropometric measure - waist circumference was done.&#xD;
	&#xD;
	&#xD;
	Routine investigations including fasting lipid profile, renal function tests.&#xD;
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	&#xD;
	A glucose tolerance test is performed using 75g of glucose, a fasting glucose sample and a 2 hr postprandial sample are obtained.&#xD;
	&#xD;
	&#xD;
	A fasting insulin venous sample is obtained and insulin resistance is calculated as follows : (HOMA )&#xD;
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	Insulin resistance = fasting glucose in mmol x fasting insulin sample in, micro lu /d1 22.5&#xD;
	&#xD;
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	Value IR &gt; 2.5 is defined as insulin resistance.&#xD;
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	A microalbuminuria test is done using the urine dipstick method. A value &gt; 30mg is significant&#xD;
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&#xD;
&#xD;
Results:&#xD;
&#xD;
Graph 1: Age Distribution:&#xD;
&#xD;
&#xD;
&#xD;
Out of 30 cases 40% between 40 to 50 yrs with a mean of 49.4 and&#xD;
&#xD;
standard deviation of 9.2.Out 20 controls 50% were between 40 and 50 yrs with a mean of 39.5 and standard deviation of 7.4. (Graph 1)&#xD;
&#xD;
&#xD;
&#xD;
Out of 30 cases, 56 % were male and 44 % were female, in the control group55 % were male and 45 % were female. (Graph 2)&#xD;
&#xD;
&#xD;
&#xD;
The %of male patients who had a waist circumference of more than90 ems in cases were 76 % while compared to 61 % in the control group with a mean of 96.5 and 83.5, the standard deviation of 12.5 and 3.5, with p value</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3834</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3834</Fulltext></URLs><References>&#xD;
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	Reaven GM, Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med; 1993; 44 (1) :121-131&#xD;
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	Haffner SM, Epidemiology of insulin resistance and its relation to coronary artery disease. Am J Cardiol. 1999; 84 (1) :11-14&#xD;
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	Kannel WB. Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens. 2000; 13 (1): 3S-10S&#xD;
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	Miccoli R, Ceraudo AM, Manfredi SG, Odoguardi L, Navalesi R Atherogenic dyslipidemia, metabolic syndrome andcardiovascular risk. Cardiologia . 1999; 44 (1) :885-899.&#xD;
	&#xD;
	&#xD;
	Chen W, Srinivasan SR, Elkasabany A, Berenson GS Cardiovascular risk factors clustering features of insulin resistance syndrome (Syndrome X) in a biracial (Black-White) population of children, adolescents, and young adults: the Bogalusa Heart Study. Am J Epidemiol. 1990; 150 (1) :667-674&#xD;
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	Ferri C, Bellini C, Desideri G, Valenti M, De Mattia G, Santucci A. Relationship between insulin resistance and non-modulating hypertension. Linkage of metabolic abnormalities and cardiovascular risk. Diabetes. 1999; 48 (1) :1623-1630&#xD;
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	Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, OlegginiM, Graziadei L &#xA0;Insulin resistance in essential hypertension. N Engl J Med. 1987; 317:350-357&#xD;
	&#xD;
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	Lehto S, Ronnemaa T, Pyorala K, Laakso M &#xA0;Cardiovascular risk factors clustering with endogenous hyperinsulinemia predict death from coronary heart disease in patients with type II diabetes. Diabetologia. 2000; 43 (1) :148-155&#xD;
	&#xD;
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	Shanthi Rani CS, Rema M, Deepa R, Premalatha G, Ravikumar R, Anjana Mohan, Sastry NG, Ramu M, SarojaR, Kayalvizhi G, Mohan V. The Chennai Urban Population Study (CUPS). Methodological Details (CUPS Paper No. 1). Int J Diabetes Dev Countries. 1999; 19 :149-157&#xD;
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	Alberti KG; Zimmet I, Shaw J. The metabolic syndrome-a new worldwide definition. Diabetologia. 2005; 24-30;366:1059-62.&#xD;
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	Pollard T, Lithell H, Berne. Insulin resistance is a characteristic feature of primary hypertension independent of obesity. Metabolism. 1990; 39: 167-174.&#xD;
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	&#xD;
	Mogensen, CE, Vestbo, E, Poulsen, PL, et al. Microalbuminuriaand potential confounders. A review and some observations on the variability of urinary albumin excretion. Diabetes Care 1995; 18:572.&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Protocol on Assessment of Maternal and Fetal Outcome by Using Antenatal Mother&#x2019;s Overview List (Anmol) Mobile Application&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>128</FirstPage><LastPage>132</LastPage><AuthorList><Author>Kavita J. Gomase</Author><AuthorLanguage>English</AuthorLanguage><Author> Vaishali Taksande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
One of the great wonders of nature is the growth of a foetus within its mother. The growth and development of the baby are dependent upon the health and nutrition of the mother (not the father) because she is both the seed as well as the soil where the baby is nurtured for nine months. Pregnancy and childbirth are special events in women&#x2019;s lives and indeed, in the lives of their families. This can be a time of great joy and joyful anticipation. It can also be a time of fear, suffering and even death. Even though pregnancy is not a disease; but a normal physiological process, it is associated with certain risks to the health and survival both for women and fetuses.1&#xD;
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Maternal death and disability are the leading causes of healthy life years lost for developing country women of reproductive age, accounting for more than 28 million disability-adjusted life years (DALYS) lost and at least 18% of the problem of disease in these women. Most women survive in childbearing but who was suffering from serious disease, disability or physical damage caused by pregnancy-related complications.2&#xD;
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Maternal mortality is a neglected tragedy and it has been neglected because those who suffer are neglected people with the least power and influence, they are the poor, the rural peasants and above all women.3Globally, levels of maternal mortality have remained stable since 1995. About 510,000 maternal deaths occurred worldwide during the year 2002.4 In addition to maternal mortality, seven million more women suffer serious health problems related to childbearing, and 50 million suffer adverse health effects.5Maternal morbidity and maternal deaths are a significant cause of death in women in the 15-49 years age group, and they make up a larger proportion of all-cause deaths in the rural areas of poorer states, compared to other regions of India.6&#xD;
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Definition:&#xA0;The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.7&#xD;
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Pregnancy and labour are physiological events and should have a joyful culmination with a healthy mother and a healthy baby, however, the potential for dramatic and even catastrophic complications during pregnancy, labour or postpartum are real, either because of aggravation of a pre-existing illness or disorder arising during pregnancy, labour, postpartum. It is estimated that maximum maternal deaths could be prevented or avoided through actions that are proven to be effective and affordable, and none of the interventions is complex or beyond the capacity of a functional health system even in resource-poor countries. The number of deprived is likely to be much higher in India because of its vast population and diversity in the literacy levels and health facilities available. Non-availability of accessible, acceptable, quality health care, including emergency obstetric care during pregnancy and childbirth, compounded by the inability of women to recognize the need and seek health care during pregnancy and childbirth is the cause of high morbidity rates in developing countries. Swanton et al. have reported that diastolic blood pressure was included in all 9 obstetric specific EWS that they reviewed. Goldhill et al. noted the most common abnormalities to be tachypnoea and altered level of consciousness in patients admitted to ICU.8&#xD;
&#xD;
In published literature by Singh et al. 2012, the MEOWS chart in the UK population is 89% sensitive, 79% specific with a positive and negative predictive value of 39% and 98% respectively. Though the results of our study 86.4% sensitive and 85.2% specific are comparable to the study by Singh et al. the few minor differences could be explained by the difference in the prevalence of obstetric morbidity for the Indian subcontinent9.&#xD;
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Baskett et al. have reported that delay in seeking care and transfer is one of the main factors leading to morbidity10.&#xD;
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Baja et al. in Banur, India also found poor transport facility, poor rural health infrastructure, custom and traditions to be contributing factors towards increase morbidity.11&#xD;
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The major complications during labour are severe bleeding, infection, high blood pressure, unsafe abortion. While admitting women in the labour room for safe confinement, she ensures that her delivery should be done safely without any complications. Earlier there is the protocol of making the written formats for her all assessment which is starting from the admission. While assessing the patient there was an inability to focus most of the parameters. As the labour process is the crucial events, the timely decision is very much important.&#xD;
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RATIONALE OF STUDY:&#xD;
&#xD;
Deterioration of maternal health can occur at a very rapid rate, with catastrophic consequences therefore early recognition is essential. ANMOL mobile application is a simple objective useful tool to record and aid in recognition of maternal morbidity at an early stage, ultimately halting the cascade of severe maternal morbidity and mortality.&#xA0; By doing this study we will be able to test the effectiveness of the Antenatal Mother Overview List mobile application to enhance the maternal and fetal outcome time before the patient goes into critical condition.&#xD;
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AIM OF THE STUDY: &#xD;
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The aim of this study to evaluate the effectiveness of the Antenatal Mother&#x2019;s Overview List (ANMOL) Mobile Application in terms of Maternal AndFetal Outcome as compare to contemporary protocol.&#xD;
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METHODOLOGY:&#xD;
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This study will be based on an experimental approach. The study will be conducted in the Labour room of the department of Obstetrics and Gynaecology of AVBRH, Sawangi. &#xD;
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Inclusion Criteria &#xD;
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	Pregnant Women inLabour (&gt;4 Cm Cervical Dilatation). &#xD;
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	Pregnant Women with More Than 34 Weeks Gestation.&#xD;
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&#xA0;Exclusion Criteria&#xD;
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	Pregnant Women With High-Risk Pregnancies (Pregnancy Induced Hypertension, Gestational Diabetes Mellitus, Heart Diseases, Renal Diseases, IUGR)&#xD;
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	Pregnant Women with Preterm Labor.&#xD;
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Sample size:&#xD;
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Sample Size Formula: N =&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; X2 .N .P(1-P)/&#xD;
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C2(N-1) + X2.P(1-P)&#xD;
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Total number of deliveries in last year in AVBRH = 1288&#xD;
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	X2= Chi-square value=3.84&#xD;
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	P=50% proportion = 0.5&#xD;
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	Q = 100 &#x2013; P =50&#xD;
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	C= Confidence interval = 0.05&#xD;
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Sample Size=&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 3.84 x1288 x 0.5 x 0.5&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; (0.05)2 x 1287+ 3.84 x 0.5x0.5&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; = 295.98 = 300&#xD;
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Total number of patients to be surveyed = 300&#xD;
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Randomization &#x2013; All the participants will be assigned simple randomly by the coin toss method. Method of Concealment will used sequentially numbered, sealed, opaque envelopes.&#xD;
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Blinding- Participant Blinded&#xD;
&#xD;
Interventions- ANMOL mobile application the tools used for assessing the physiological parameters in terms of maternal and foetal outcome. For collecting data in ANMOL mobile application, the women admitted in the labour room with &gt;4 cm cervical dilation and with more than&#xA0; 34 weeks gestation will be enrolled for the using ANMOL mobile application. Control group which follows the contemporary protocol for assessing maternal and foetal outcome.&#xD;
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Outcome measures &#xD;
&#xD;
For each pregnancy, the outcome was dichotomized as &amp;#39;good&amp;#39; or &amp;#39;adverse&amp;#39;. The outcome of pregnancy was coded as adverse if there was either an adverse maternal outcome or an adverse foetal outcome. &#xD;
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The outcomes of pregnancy studied are:-&#xD;
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1.Maternal outcomes&#xD;
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&#xA0;- Mortality - Maternal death&#xD;
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&#xA0;- Morbidity - Abnormal type of delivery-i.e., Caesarean section, forceps delivery, vacuum delivery, postpartum haemorrhage, puerperal pyrexia, seizures, shock.&#xD;
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2. Neonatal outcomes &#x2013;&#xD;
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-&#xA0; Mortality Perinatal mortality, stillbirth and neonatal death.&#xD;
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- Morbidity. Birth injuries, neonatal infection, neonatal jaundice, respiratory distress, hypothermia, hypoglycemia,&#xD;
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The time points of evaluation are shown in Table 1&#xD;
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Data management and monitoring:&#xD;
&#xD;
&#xA0;In ANMOL mobile application, Demographic variable includes followings physiological parameters-Patient ID, Name, Age, Hemoglobin, Edema, Hb electrophoresis, RBS, Platelets, Delivery details, Birth status, Type of delivery, Bleeding amount, Gender of baby, Weight of baby, APGAR Score, DOB &amp; TIME, Fetal Heart rate. &#xD;
&#xD;
In ANMOL&#x2013; 1. The patient will be assessed with the following physiological parameters at the interval of one hour till the 24 h after delivery.&#xD;
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It includes respiration rate, saturation, temperature, heart rate, systolic blood pressure, diastolic blood pressure, urine output, proteinuria, amniotic fluid, neuro, pain score, looks,&#xA0; SPO2.&#xD;
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The application is based on the principle that abnormalities in physiological parameters precede a critical illness.&#xA0; The &amp;#39;track and trigger&amp;#39; of physiological parameters on this chart can aid in the recognition of maternal morbidity at an early stage, ultimately halting the cascade of severe maternal morbidity and mortality.&#xA0;A trigger is defined as a single markedly abnormal observation (red trigger) or the combination of two simultaneously mildly abnormal observation (two yellow triggers). The second group will be the control group which follows the contemporary protocol for the maternal and fetal outcome of labouring women. Step 3 -For collecting data, women admitted in the labour room with &gt;4 cm cervical dilation and with more than 34 weeks gestation will be enrolled for the study in the control group. A schematic diagram of the Study methodology is shown in Figure no. 1.&#xD;
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Statistical analysis- &#xD;
&#xD;
Statistical analyses will be performed using SPSS software version 22. Paired t-test (Wilcoxon sign rank) and unpaired t-test (Wilcoxon Rank-sum) will be applied to analyze the data.&#xD;
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Ethics and dissemination: &#xD;
&#xD;
This study is approved by the Institutional Ethics Committee of DMIMS (DMIMS (DU)/IEC/2018-19/7131). All participants will be asked to read and sign the informed consent. The study results will be disseminated to study participants and published in peer-reviewed publications. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
Once the ANMOL mobile application utilization is validated, these can be introduced in other remote area or low economic resources with a lack of trained manpower and facilities. This mobile application can be utilized without an internet facility. The findings of this study will have implications on obstetrics unit to recognize deviation from normal monitoring of labouring women and enhance the labour outcome by ANMOL mobile application.&#xA0; &#xD;
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CONCLUSION:&#xD;
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A conclusion will be drawn from the statistical analysis.&#xD;
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CONFLICTS OF INTEREST: Nil &#xD;
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FINANCIAL SUPPORT:&#xA0; Self&#xD;
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ACKNOWLEDGEMENT: &#xD;
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I would like to express my sincere thanks to all faculties of Smt. Radhikabai nursing College, Sawangi (Meghe) Wardha, India for smooth completion of my research work. We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We would like to thank the authors whose works have cited and included in this study such as Singh S, McGlennan A, England A, Simons R T.Baskett et al, Bajwa et al.We are also grateful to the authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3835</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3835</Fulltext></URLs><References>&#xD;
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			Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL, Bishop GF, Simmons G. et al. Duration of life-threatening antecedents before intensive care admission. Int Care Med. 2002 Nov;28(11):1629-34.&#xD;
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			Bowyer L. The confidential enquiry into maternal and Child health (CEMACH). Saving mothers&#x2019; lives: reviewing maternal deaths to make motherhood safer 2003&#x2013;2005. The seventh report of the confidential enquiries into maternal deaths in the UK.&#xD;
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			Program NH. Report of the national high blood pressure education program working group on high blood pressure in pregnancy. Am J Obst Gynec. 2000 Jul 1;183(1):s1-22.&#xD;
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			Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications. Maternal near-miss&#x2014;towards a standard tool for monitoring the quality of maternal health care. Clin Obstet Gynaecol. 2009;23(3):287&#x2013;96.&#xD;
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			Morgan RJ, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care. 1997;8(2):100.&#xD;
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			Friedman AM. Maternal early warning systems. Obstet Gynecol Clin North Ame. 2015;42(June (2)):289&#x2013;98.&#xD;
			&#xD;
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			Mhyre JM, D&amp;#39;Oria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, Jones RL, King JC, D&amp;#39;Alton ME. The maternal early warning criteria: a proposal from the national partnership for maternal safety. J Obst, Gynec Neon Nur. 2014 Nov 1;43(6):771-9&#xD;
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			Quinn AC, Meek T, Waldmann C. Obstetric early warning systems to prevent a bad outcome. Curr Opin Anesth. 2016 Jun 1;29(3):268-72.&#xD;
			&#xD;
			&#xD;
			Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anae 2012;67(1):12.8&#xD;
			&#xD;
			&#xD;
			Baskett T, Connell M. Maternal critical care in obstetrics. J Obstet Gynaec. 2009;31:218&#x2013;21.&#xD;
			&#xD;
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			Bajwa SK, Bajwa SJ, Kaur J, Singh K, Kaur J. Is intensive care the only answer for high-risk pregnancies in developing nations? J Emerg Trauma Shock. 2010;3:331&#x2013;6.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Prevalence, Risk Factors and Quality of Floaters Among Medical Students, A Questionnaire-Based Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>133</FirstPage><LastPage>138</LastPage><AuthorList><Author>Nivetha U</Author><AuthorLanguage>English</AuthorLanguage><Author> M Dheepak Sundar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Objective: To assess the prevalence, risk factors and quality of floaters among medical students and to evaluate the association of floaters with related variables. Methodology: A cross-sectional descriptive study was carried out among 331 students belonging to the medical stream. A semi-structured google form questionnaire was used as the study tool. It was designed to assess the factors associated with the prevalence of floaters. The obtained responses were inspected using appropriate statistical tests. Results: Among 331 medical students, 37.76%(n=125) reported visualizing floaters. The presence of floaters was significantly associated with frequent rubbing of eyes (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Floaters, Myopia, Rubbing of eyes, Flashes, Emmetropia</Keywords><Fulltext>Introduction:&#xD;
&#xD;
Floaters or Muscae volitantes are mobile and scattered structures that float in the visual field. 1,2 They are mostly idiopathic or age-related, commonly associated with synchysis and syneresis.1 Though the presence of floaters is a common complaint among the elderly age group, it is nowadays found to be equally prevalent in the younger age group also.3 4 Floaters are frequently associated with refractive errors especially high myopia and they might be an important clue in early detection of Posterior Vitreous Detachment (PVD)especially with a positive history. 5, 6 Floaters do not need any treatment on a large scale. However, when they hinder the quality of the vision, surgical interventions like Nd: YAG Vitreolysis and Pars plana Vitrectomy might be required.10&#xD;
&#xD;
The study was conducted to assess the prevalence, risk factors and quality of floaters in the student population as hardly a few similar prototype studies have been conducted in the past. &#xD;
&#xD;
Methodology:&#xD;
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A questionnaire-based cross-sectional study was conducted among the medical students studying in Saveetha Medical College And Hospital, Thandalam, Tamil Nadu in South India. Based on the study conducted by Webb et al. 14, the sample size was calculated as 331 with the formula 4pq/d2. Institutional Ethics Committee approval was obtained and the study was conducted according to the tenets of the declaration of Helsinki.&#xD;
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A semi-structured google form was designed to assess the prevalence of floaters and the risk factors that increase its prevalence among the study population. The questionnaire was designed to assess the possible risk factors of floaters like refractive error, rubbing of eyes, gym and sports activity. The quality of the floaters was assessed by the duration, number, frequency, severity and progression.7-10The association between the floaters and the various parameters were analyzed using Chi-square test and odds ratio. A P-value less than 0.05 was considered significant.&#xD;
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Result:&#xD;
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About 331 medical students studying at Saveetha Medical College And Hospital were&#xA0; provided with the questionnaire of study. &#xD;
&#xD;
Demographic details: &#xD;
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The majority of the students 66.46%(n=220) were in the age group o&#xA0;20-22 years and most of them were females 69.48%(n=230). About 5.13%(n=17) of &#xD;
&#xD;
students had a positive history of diabetes. 41.69%(n=138) of the study population had myopia, 6.04%(n=20) had hypermetropia and 52.26%(n=173) had normal vision ( Table 1). &#xD;
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Prevalence of the floaters in the study population:&#xD;
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Table No:2 represents the prevalence of floaters and its relative variables among the study population. Overall,37.76%(n=125) of the students reported experiencing floaters. About 40.59%(n=41) among the males responded positively to the floaters and about 36.52%(n=84) among the females reported seeing floaters. 46.37 %(n=64) among the myopes, 50%(n=10) among the hyperopes 29.47%(n=115) among the students with normal vision reported visualizing floaters.&#xD;
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&#xA0;It was also found that about 52.94%(n=9) among the diabetics reported floaters. About 68%(n=24) of the students who rub eyes frequently reported an increase in the number of floaters. 37.5%(n=72) of the study population who played sports and 22.72%(n=5) of the students who went to the gym reported visualizing floaters (Table 3).&#xD;
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Association between floaters and related variables among the study population:&#xD;
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Table No:4 represents the probable risk factors that affect the prevalence of floaters. &#xD;
&#xD;
Factors like age[p=0.231098], gender[p=0.481615], family history[p=0.532694], playing sports[p=0.907182], going to gym[p=0.697266] or diabetes[p=1.92] didn&#x2019;t affect the prevalence of floaters. Whereas a statistical significance was established between refractive error [p=0.004793] and prevalence of floaters. There was also a significant increase in the prevalence of floaters among the population who rubbed their eyes frequently [p=0.00001].&#xD;
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The odds ratio for the significant risk factors:&#xD;
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Table No:5 represents the odds ratio for the significant factors. It was found that there was about a 1.87 times increase in the risk of developing floaters in the myopic population. Whereas frequent rubbing of eyes increased the risk of developing floaters by 5.23 times. The emmetropic population were 0.47 times likely in developing floaters. &#xD;
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Assessment of the quality of floaters:&#xD;
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Table no :3 represents the quality of floaters such as frequency, progression, severity, time of visualizing floaters and willingness to get treated for the same as reported by the study population. About 68%(n=85) among the students who reported visualizing floaters graded the severity in visual disturbance as mild and 9.6%(n=12) graded it as moderate and 0.8%(n=1) graded it as severe. 80%(n=100) of the students reported seeing floaters during the daytime. 5.6%(n=7) reported visualizing floaters during the night time and the same percentage (5.6%) of students reported visualizing it both times. When asked about the progression of the floaters. 44%(n=55) of the study population reported no change in progression whereas 22.4% reported it getting better and 2.4% reported it as worsening. When asked about the frequency of visualizing floaters, 15.2%(n=19) reported it seeing occasionally and 3.2%(n=4) reported visualizing persistently. About 8%(n=10) of the study population were willing to be treated for floaters whereas 83.2%(n=104) were not interested in getting treated. &#xD;
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Discussion: &#xD;
&#xD;
Floaters are lines or dark dots that are visualized clearly against a bright background. They are mostly age-related and idiopathic. However, there is an increased reporting of floaters even among the young population.11-14 Our study was primarily conducted to&#xA0; evaluate the various parameters affecting the prevalence of floaters in the youngpopulation. In our study sample, the prevalence of floaters was about 37.76% whereas , in the study conducted by Blake F. Webb et al, 76% reported seeing floaters.15,16 The increased prevalence in the previous study might be due to the various age groups (18 and above) that was included. While our study was primarily conducted in the younger (17-27) age group. This signifies the fact that the prevalence of floaters tends to rise with increasing age. with the increase in age, vitreous liquefication also increases which is the most important cause of floaters. 17 Floaters are also reported commonly in retinal detachment.18,19&#xD;
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The vitreous body is a homogenous transparent gel composed of collagen and fibrils. Usually, the gel liquefies with age which results in posterior vitreous detachment. However, in the young population, early vitreous liquefaction and anomalous PVD occurs in myopia as a result of myopic vitreopathy. 19,20,21 Thus, myopes tend to have an increase in the number of floaters due to visualization of the shadows caused by clumped degenerated vitreous fibrils or the Weiss ring associated with PVD. Various studies show that most of the clinical population approaching help for floaters included a high proportion of myopes. 15, 21 Similarly, our study revealed a significant association between myopia and floaters. &#xD;
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&#xA0;Almost 50% of the hyperopes also complained of floaters, but the total number of hyperopes (20) in our study was too minimal to elucidate a cause-effect relationship, There was also a statistical significance established between the prevalence of floaters and emmetropia in our study. The significance might be probably due to the unchecked low degree refractive errors which appear to be more common. 20&#xD;
&#xD;
Our study revealed that frequent rubbing of eyes likely resulted from a 5.23 times increase in the prevalence of floaters. This seems to be a novel finding from our study. Constant and hard rubbing can result in disturbances in the vitreous causing posterior vitreous detachment or vitreous degenerations and thus leading to floaters.&#xA0; 21,22 &#xD;
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Full-body workouts and heavy weight lifting may be accompanied b floaters and flashes as PVD is common during their exertion.10. However, our study revealed no significance between workouts and the prevalence of floaters. Only, 5.13% of our total study population were diabetic out of which 52.94% of the students reported visualizing floaters. The number of diabetics in our study were too less to establish a statistical association between diabetes and prevalence floaters.&#xD;
&#xD;
In our study, only 3.2% of the population reported persistent floaters and 0.8% of the population reported it to be severe. Previous studies suggest that severe and persistent floaters can affect the quality of life. 20 Surgical interventions might be required in such cases of floaters. 3 However, to determine the severity of floaters to support the patient&#x2019;s complaints objective clinical measures like quantitative ultrasonography and CS and Straylight measures might be carried out. 20,21,22&#xD;
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&#xA0;CONCLUSION:&#xD;
&#xD;
Our study has many limitations. Restricted age group and a relatively smaller study population were the major ones. The study found that there is an about a 5-fold increase in the prevalence of floaters in the population with frequent rubbing of eyes. Myopia and emmetropia were also the major risk factors. To determine the significance of diabetes on the prevalence of floaters, studies should be directed exclusively in youth with a positive history. Thus, more studies should be conducted in a relatively young population to analyze all major risk factors and treat the cause before it becomes an ocular emergency.&#xD;
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ACKNOWLEDGEMENT: We hereby acknowledge our heartfelt respect and gratitude to all the scholars cited in our article.&#xD;
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SOURCE OF FUNDING: None&#xD;
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CONFLICT OF INTEREST: None &#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3836</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3836</Fulltext></URLs><References>&#xD;
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3.National Eye Institute. Floaters. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/floaters [ Accessed 09 August 2020]&#xD;
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4.Laibovitz RA. The vitreous and vitreous floaters: Understanding a common visual complaint. Postgrad Med. 1984 Apr 1;75(5):64-7.&#xD;
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5.Akiba J. Prevalence of posterior vitreous detachment in high myopia. Ophthalmol. 1993 Sep 1;100(9):1384-8.&#xD;
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6.Wilkes SR, Beard CM, Kurland LT, Robertson DM, O&amp;#39;Fallon WM. The incidence of retinal detachment in Rochester, Minnesota, 1970&#x2014;1978. Ame J Ophthalm. 1982 Nov 1;94(5):670-3.&#xD;
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7.American Academy Of Ophthalmology. Flashes of Light. https://www.aao.org/eye-health/symptoms/flashes-of-light [ Accessed on 09 August 2020]&#xD;
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8.Sowka JW, Kabat AG. How to Make Sense of Flashes and Floaters. Rev Optomet. 2000 Jun 15;137(6):67-.&#xD;
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9.Maggiano J, Yu MC, Chen S, You T, Rathod R. Retinal tear formation after whole-body vibration training exercise. BMC ophthalm. 2020 Dec 1;20(1):37&#xD;
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10.Delaney YM, Oyinloye A, Benjamin L. Nd: YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye. 2002 Jan;16(1):21-6.&#xD;
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11.Webb BF, Webb JR, Schroeder MC, North CS. Prevalence of vitreous floaters in a community sample of smartphone users. Int J Ophthal. 2013;6(3):402.&#xD;
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12.&#xA0;Hidayah FK, Dewi NA, Refa S. Profile of Patients with Floaters in Saiful Anwar Hospital Malang. Inter J Ret. 2018 Aug 24;1(2).&#xD;
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13.&#xA0;Wagle AM, Lim WY, Yap TP, Neelam K, Long KG. Utility values associated with vitreous floaters. Am J Ophth. 2011 Jul 1;152(1):60-5.&#xD;
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14.The University of Illinois College of Medicine. Floaters and flashes. https://chicago.medicine.uic.edu/departments/academic-departments/ophthalmology-visual-sciences/our-department/media-center/eye-facts/floaters/ [Accessed on 09 August 2020]&#xA0;&#xA0; &#xD;
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15. Sebag J. Floaters and the quality of life. Am J Ophth. 2011 Jul 1;152(1):3-4?&#xD;
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16.Jobke S, Kasten E, Vorwerk C. The prevalence rates of refractive errors among children, adolescents, and adults in Germany. Clin Ophth. (Auckland, NZ). 2008 Sep;2(3):601. &#xD;
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17.Milston R, Madigan MC, Sebag J. Vitreous floaters: aetiology, diagnostics, and management. Surv Ophthalmic. 2016 Mar 1;61(2):211-27.&#xD;
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18.Yonemoto J, Ideta H, Sasaki K, Tanaka S, Hirose A, Oka C. The age of onset of posterior vitreous detachment. Clin Exp Ophth. 1994 Feb 1;232(2):67-70.&#xD;
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19.Shiferaw Alemu D, Desalegn Gudeta A, Tsega Ferede A, Worataw Alemu H. Prevalence and degrees of myopia and hyperopia at Gondar University Hospital Tertiary Eye Care and Training Center, Northwest Ethiopia. 2016 Nov;2016(8):85-91.&#xD;
&#xD;
20.Ben-Eli H, Ernest N, Solomon A. Pathogenesis and complications of chronic eye rubbing in ocular allergy. Surv Ophthalm. 2019;19(5):526-534.&#xD;
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21.Rodge HY, Lokhande S. Refractive Error in Children. Int J Cur Res Rev. 2020; 2(20) Dec;12(23):185.&#xD;
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22.Narayanan NN, Kumar A, Sukumaran K. An Ayurvedic Protocol to Manage Rhegmatogenous Retinal Detachment and the Resultant Macular Hole-A Case Report. Int J Cur Res Rev. 2020 Jul;12(14):10.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Obesity-Related Lifestyle Intervention Strategies Among School-Going Adolescents in Selected Schools of Bhubaneswar:&#xA0;A Quasi-Experimental Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>139</FirstPage><LastPage>146</LastPage><AuthorList><Author>Kundu A</Author><AuthorLanguage>English</AuthorLanguage><Author> Patnaik L</Author><AuthorLanguage>English</AuthorLanguage><Author> Sahu T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Obesity has become a major epidemic causing serious public health concern especially in developing countries. The proportion of children and adolescents in the general population who are overweight and obese has doubled over the past two decades in developed and developing countries including India. Interventions in school are an important strategy to prevent obesity among them. Objectives: To find out the changes in anthropometric parameters and practices following lifestyle interventions related to obesity among school-going adolescents. Methods: A quasi-experimental study conducted from June 2016 to August 2018, in two private schools. A total of 173 students, 86 from the control school and 87 from the intervention school were included. Study participants were interviewed using a pre-designed, pretested and semi-structured interview schedule at baseline and after an intervention. Control school students were given printed educational materials in the form of a carefully prepared poster and intervention school students were intervened for one year by interactive sessions with an integrated educational package, personal and parental counselling for overweight/ obese students followed by reinforcement. Results: No significant difference was seen in anthropometric measurements among the control and intervention group at baseline. In the intervention group, a significant decrease was observed in body mass index (BMI) (P=0.000), the proportion of overweight and obese students (P=0.012), students with elevated BP(P=0.008). A significant increase in physical activity was found among the intervention group in doing regular physical exercise (P=0.004). Conclusion: This school-based intervention program on a healthy lifestyle significantly decrease BMI, blood pressure and improve eating habits, physical activity among adolescents.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Overweight, Pediatric obesity, Teens, Body Mass Index, Schoolchildren</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Obesity has become a major epidemic causing serious public health concern and the researchers estimated that elevated body weight contributed to 7 per cent of the deaths from any cause in 2015. The number of overweight or obese infants and young children increased from 32 million globally in 1990 to 41 million in 2016. In developing countries, the vast majority of overweight or obese children live in, where the rate of increase was more than 30% higher than that of developed countries (WHO). The proportion of children in the general population who are overweight and obese has doubled over the past two decades in developed and developing countries including India.1,2&#xD;
&#xD;
Overweight in early childhood has been shown to track to adulthood in one-third to one-half of cases and, where it becomes associated with an increased prevalence of chronic diseases such as type 2 diabetes, cardiovascular disease (CVD), hypertension and polycystic ovarian syndrome (PCOS) later in life.3,4,5 By the year 2035, it is estimated that the prevalence of coronary heart disease will increase by 5% to 16%, with more than one lac excess cases, attributable to increased obesity among today&#x2019;s adolescents. It is predicted that pediatric obesity may shorten life expectancy by 2 to 5 years by mid-century in the United States.6 It is observed that 30% of obesity begins in childhood and out of that 50-80% become obese adults. 7&#xD;
&#xD;
Therefore, effective school-based interventions to reduce overweight and obesity in the adolescent age group is needed. For overweight and obesity, factors like consumption of energy-dense foods, low levels of physical activity, sedentary lifestyle play a major role. So, diet and energy expenditure &#x2013; these two components are the cornerstones of prevention and treatment programs of obesity. Healthy lifestyle approaches to treat younger children with obesity can successfully decrease body mass index (BMI) and implementation of these approaches among adolescents and adults is much effective.8&#xD;
&#xD;
To address the overweight and obesity problems among children and adolescents, interventions in school is an important strategy. There are no school-based intervention studies to address adolescent obesity in this part of India. With this background, an interventional study was planned to find out the effects of lifestyle interventions among school-going adolescents, as such type of study has not been conducted in this region so far. So this study was conducted to find out the changes in anthropometric parameters and to study the changes in practices following lifestyle interventions related to obesity among school-going adolescents&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This study was a quasi-experimental study conducted over two years and four months from June 2016 to August 2018, carried out in two private schools of Bhubaneswar. All students of two randomly selected section, one from class VIII and one from class IX were constituted the study population. A total of 173 students, 86 from the the control school and 87 from the intervention school were included. Due care was taken to include the absentees. &#xD;
&#xD;
Study tool: The study subjects were interviewed using a predesigned, pretested and semi-structured interview schedule. Data regarding socio-demographic profile and information about their lifestyle, family history of obesity, type and duration of physical activity, dietary/eating habit, the habit of watching TV or computer etc. were obtained. Data collection including all anthropometric measurements and blood pressure measurement was done by the investigator himself. &#xD;
&#xD;
Data collection: The prospect of the study for improvement of health and nutrition of students and prevention of complications of obesity was explained to the participants. In 1st phase of the study, baseline data of every student have been recorded. The collection of data was done in a friendly atmosphere after obtaining informed consent from parents and assent from students. &#xD;
&#xD;
Intervention: The schools were allocated to control school and intervention school. Control school students were given printed educational materials in the form of a carefully prepared poster. Intervention school students were intervened by an integrated educational package which included intense lifestyle education using audiovisual presentations, poster and practical demonstration. &#xD;
&#xD;
The package included materials on nutrition and lifestyle modification for obesity management. Before giving intervention to the students, the package was shared with the principal of the school and class teacher of concerned sections. The intervention was done by arranging interactive sessions with students in their respective classes, personal counselling for overweight/obese students regarding healthy lifestyle and counselling of parents of overweight/obese students during the parent-teacher meeting as well as over the telephone.&#xD;
&#xD;
During the interactive sessions, a healthy discussion has been done by power-point presentations, videos. To improve their physical activity, yoga classes in the group were arranged during their physical education period. In the initial two months of the intervention, one interactive audio-visual sessions of 40 minutes each, one per week was conducted for each section in the smart classroom with the help of the respective class teacher. A total of 8 interactive sessions were conducted over two months for both the classes of the intervention school. The sessions were regarding food and nutrients, energy and its role in weight gain, maintenance of ideal body weight through dietary modification and physical activity, stress relaxation including meditation &amp; yoga. They were motivated to do a minimum of 30 minutes of physical activity every day which consisted of Surya-namaskar (5 to 10 repetitions), 10 to 15 minutes of brisk walk or run, 15 to 20 minutes of yoga. They were encouraged to play outdoor games minimum of 30 minutes per day.&#xD;
&#xD;
There was a gap of two months due to the annual examinations of the students. During the summer vacation of the next two months, parents of the overweight/obese students were counselled over the telephone after baseline data analysis.&#xD;
&#xD;
The intervention activities had been reinforced by personal as well as group interactions in the next six months by conducting one session fortnightly. The activity of each student was observed closely during their physical education class and they were motivated to play outdoor games and to do physical exercises every day. Personal counselling of overweight/obese students was done regarding healthy dietary habits and physical activity. Counselling of the parents of overweight/obese students was done during the parent-teacher meeting. Parents were also contacted over the telephone once in two months. Each parent was contacted at least three times during these six months. &#xD;
&#xD;
Post-intervention assessment: On completion of the intervention, data were collected to assess the changes in behaviour towards diet and physical activity. All anthropometric measurements and blood pressure measurement of students were again done by the investigator himself both in the intervention school and control school. &#xD;
&#xD;
Data analysis: The data were entered in a Microsoft Excel spreadsheet and imported to SPSS software version 20 (IBM Corp., Armonk, NY). Descriptive statistics were expressed as proportions, means, median, standard deviations and 95% confidence interval. Independent t-test and paired t-test were performed to compare means of continuous variables. Chi-squared test and McNemer Chi-squared test were used to test the difference of proportions between independent and paired observations respectively. A P-value less than 0.05 considered statistically significant.&#xD;
&#xD;
Methods adopted physical examination: Height was measured by using a stadiometer without shoes, to the nearest 0.1 cm. Weight was measured by an electronic weighing machine with uniform after removal of shoes. BMI was defined as the weight in kilograms divided by the square of the height in meters (kg/m2). BMI of students was classified as per the recommendation of Khadilkar VV et al.9 They were categorized using BMI percentile curves for Indian boys and girls from 5-17 years with 3rd, 10th, 25th, 50th, 85th and 95th percentiles, along with two additional percentiles corresponding to a BMI of 23 and 28 kg/m2 at 18 years. They were classified as: underweight (BMI </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3837</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3837</Fulltext></URLs><References>&#xD;
	Bundred P, Kitchiner D, Buchan I. Prevalence of overweight and obese children between 1989 and 1998: population-based series of cross-sectional studies. Br Med J. 2001;322:326-28.&#xD;
	Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002; 288: 1728-32.&#xD;
	Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53: 1925-1932&#xD;
	World Health Organisation (WHO) 2005. Preventing chronic diseases: A vital investment, WHO Global report.&#xD;
	Singh AS, Mulder C, Twisk JW, Mechelen VW, Chinapaw MJ. Tracking of childhood overweight into adulthood: A systematic review of the literature. Obes Rev.2008; 9:474&#x2013;88. &#xD;
	Ludwig DS. Childhood obesity- the shape of things to come. N Engl J Med 2007;357:2325-27.&#xD;
	Obesity: preventing and managing the global epidemic. Report of a WHO consultation. (WHO Technical Report Series, No.894). Geneva, World Health Organisation 2000.&#xD;
	Caroline M. Apovian. The Obesity Epidemic &#x2014; Understanding the Disease and the Treatment. N Engl J Med [Internet]. 2016; 374 (2):176&#x2013;7. &#xD;
	Khadilkar V, Khadilkar A, Sa C, Borade A, SA C. Body Mass Index Cut-offs for Screening for Childhood Overweight and Obesity in Indian Children. Indian Pediatr. 2012; 49(1):29&#x2013;34.&#xD;
	WHO. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation. Geneva, World Heal Organ. 2008;8&#x2013;11. &#xD;
	Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Paediatrics. 2017;140(3).&#xD;
	Robertson W, Friede T, Blissett J, Rudolf MCJ, Wallis M, Stewart-Brown S. Pilot of &#x201C;families for health&#x201D;: Community-based family intervention for obesity. Arch Dis Child. 2008;93(11):921&#x2013;26. &#xD;
	Savoye M, Shaw M, Dziura J, Tamborlane W V., Rose P, Guandalini C, et al. Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children. J Am Med Assoc. 2007;297(24):2697&#x2013;704. &#xD;
	Gortmaker SL, Peterson K, Wiecha J, Sobol M, Dixit S, Fox MK, et al. Reducing Obesity via a School-Based Intervention Among Youth. Arch Pediatr Adolesc Med. 1999;153(4):409&#x2013;18. &#xD;
	Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, et al. Successful overweight prevention in adolescents by increasing physical activity: A 4-year randomized controlled intervention. Int J Obes. 2008; 32(10):1489&#x2013;98. &#xD;
	Sichieri R, Paula Trotte A, De Souza RA, Veiga G V. School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr. 2009;12 (2):197&#x2013;202. &#xD;
	Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, et al. A Policy-Based School Intervention to Prevent Overweight and Obesity. Paediatrics. 2008;121(4):794&#x2013;802. &#xD;
	Njelekela MA, Muhihi A, Mpembeni RNM, Anaeli A, Chillo O, Kubhoja S, et al. Knowledge and attitudes towards obesity among primary school children in Dar es Salaam, Tanzania. Niger Med J . 2015;56(2):103&#x2013;8&#xD;
	Bayne-Smith M, Fardy PS, Azzollini A, Magel J, Schmitz KH, Agin D. Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: The PATH program. Am J Public Health. 2004;94(9):1538&#x2013;43.&#xD;
	Chen Y, Ma L, Ma Y, Wang H, Luo J, Zhang X, et al. A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China. BMC Public Health. 2015;15:210. &#xD;
	Haerens L, De Bourdeaudhuij I, Maes L, Cardon G, Deforche B. School-Based Randomized Controlled Trial of a Physical Activity Intervention among Adolescents. J Adolesc Heal. 2007;40(3):258&#x2013;65. &#xD;
	Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, et al. prevention of obesity in American Indian schoolchildren. Am J Clin Nutr.2003;78(5):1030&#x2013;8. &#xD;
	Kafatos A, Manios Y, Moschandreas J, Ioanna A, Froso B, Caroline C, et al. Health and nutrition education in primary schools of Crete: Follow-up changes in body mass index and overweight status. Eur J Clin Nutr. 2005;59(9):1090&#x2013;2. &#xD;
	James J, Thomas P, Kerr D. Preventing childhood obesity: Two-year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). Br Med J. 2007;335 (7623):762&#x2013;4.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Application-Based Animation Based Teaching vs Cadaver Dissection Based Teaching. A Cross-Sectional Comparative Study in I - MBBS&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>147</FirstPage><LastPage>149</LastPage><AuthorList><Author>Naik Shishir Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Kaur Harmeet</Author><AuthorLanguage>English</AuthorLanguage><Author> Minakshi</Author><AuthorLanguage>English</AuthorLanguage><Author> Upadhyaya Prerna</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: With the growing number of Medical Colleges in the country, proclaiming cadavers for dissection-based teaching in the Department of Anatomy has been a difficult task in recent years. The students in the first year not only learn Human Anatomy but also learn to empathize, without which being a doctor becomes the hollow experience. But today&#x2019;s generation is computer savvy and they are adjusted to learn online. But is it possible to learn Human Anatomy only by application-based simulation or the traditional cadaver-based teaching is also needed? This study puts in a sincere effort to find the answer. Methods: 150 students were selected in the Department of Anatomy, JNUIMSRC, Jaipur. They were divided into two groups by the lottery method. One group underwent cadaver-based learning for 5 classes each of gross anatomy and surface marking. At the end of the session, the perception of the students was asked in the form of a Likert&#x2019;s scale followed by Multiple choice question (MCQ) based question and Objective structural pattern examination( OSPE) examination. Results: The perception score was better in the application-based Animation based teaching group. The MCQ score was better in the application-based Animation based teaching group. ?&#x2003;The OSPE score was better in the cadaver-based teaching group. After 30 days. The MCQ score was better in the application-based Animation based teaching group. ?&#x2003;The OSPE score was better in the cadaver-based teaching group. Conclusion: Cadaver-based teaching is better for practical understanding and Animation based teaching can be used only as an adjuvant for cadaver-based teaching.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Cadaver, Dissection, Animation</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Our Nation is undergoing a great medical teaching revolution. The new curriculum has been introduced in 2019 by the Medical Council of India and great emphasis has been laid on CBME (competency-based Medical Education). National Medical Commission which replaced the Medical Council of India also emphasized the use of a new curriculum. The growing number of medical colleges in the country and lack of trained faculties adds to the problem of implementing teaching programme. Pre-Clinical subjects are the core subject in Medical Education and the foundation on which the CBME curriculum is supposed to stand. With all these in the background, cadavers are very hard to be proclaimed for Medical Education, a sorry state for a country that boasts of 1.5 billion populations. Lack of trained teachers at one end and lack of cadavers for teaching at the other end of the spectrum adds to the quandary the situation has created.1, 2&#xD;
&#xD;
Some authors in their study have debated over the importance of cadaver based teaching in Medical Education.1-4 Some authors have reported the absolute necessity for the use of human cadavers for the fact that it provides practical superiority by adding tactile and visual superior experiences.5,6 Some on the other end have argued the opposite and questioned the use of cadavers in today&#x2019;s modern age of technological advances.7Western countries have already restricted the use of cadavers in Medical Education.7 Also the cost of maintaining cadavers against economically viable options has to be weighed against.7This study puts in a sincere effort to find the better method of teaching in terms of perception score, Multiple choice question test and also OSPE examination. &#xD;
&#xD;
AIMS AND OBJECTIVES:&#xD;
&#xD;
&#xD;
	&#xD;
	To study the perception score between the two groups.&#xD;
	&#xD;
	&#xD;
	To study the MCQ score between the two groups.&#xD;
	&#xD;
	&#xD;
	To study the OSPE score between the two groups.&#xD;
	&#xD;
	&#xD;
	To understand which method is better for the students to retain the concepts for a longer time. &#xD;
	&#xD;
&#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
This study was done in the Department of Anatomy, JNUIMSRC, Jaipur.&#xD;
&#xD;
This study was conducted from February 1st 2020 to March 15th 2020.&#xD;
&#xD;
All students from the 1st year MBBS were selected. The total sample size was thus 150.&#xD;
&#xD;
The design of the study was Interventional and Cross-over. &#xD;
&#xD;
The students were divided into 2 groups based on the lottery method.&#xD;
&#xD;
Tools: Validated Questionnaire, MCQ and OSPE &#xD;
&#xD;
Inclusion Criteria: &#xD;
&#xD;
1st MBBS students of 2019-2020batch&#xD;
&#xD;
Exclusion Criteria: &#xD;
&#xD;
Students who did not give consent.&#xD;
&#xD;
Data Collection: Likert&#x2019;s scale analysis and OSPE score.&#xD;
&#xD;
Procedure:&#xD;
&#xD;
Group 1 was made to undergo 5 classes of gross anatomy and surface marking in cadaver based teaching.&#xD;
&#xD;
Group 2 was made to undergo 5 classes of gross anatomy and surface marking in animation application-based teaching.&#xD;
&#xD;
The application was used as a window based complete Anatomy Application. &#xD;
&#xD;
At the end of the session, the perception score was taken. The Likert&#x2019;s scale questionnaire was prepared and validated. Then after the sessions, the MCQ questionnaire was immediately distributed and the answers were taken. After this immediately the students were taken into the dissection hall for the OSPE examination. &#xD;
&#xD;
All of this was repeated after 30 days to find which method to be the superior tool for retaining the subjects which were taught. &#xD;
&#xD;
Statistical Analysis:&#xD;
&#xD;
&#xD;
	&#xD;
	The perception score was analysed using an unpaired t-test. &#xD;
	&#xD;
	&#xD;
	Unpaired t-test to compare the difference in the two methods of teaching in terms of Multiple Choice Questions score and OSPE score.&#xD;
	&#xD;
	&#xD;
	Paired t-test was used to analyse the OSPE scores and MCQ scores between the scores obtained after the lecture session and the scores obtained after 30 days. &#xD;
	&#xD;
&#xD;
&#xD;
At the end of this session, the student groups underwent cross over and the same thing was repeated. No exams were conducted and it was done only for ethical reasons. &#xD;
&#xD;
RESULTS:&#xD;
&#xD;
We found out that the new generation of medical students was more interested in animations and their perception scores reflect on the same. Even the MCQ exams result reflected that it would be a better idea (Table 1). But when it came to OSPE examination the old trusted cadaver based teaching was the clear winner. Practising Medicine is always dynamic and there are many domains under which the students need to be trained. Of course, the knowledge domain can be touched by using these new gizmos but the psychomotor is much more complex to be trained and the old trusted cadaver based teaching answers this question. Even the retaining of knowledge was better in each of the groups (Table 2). &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
If we check our past, men have been studying Human Anatomy on cadavers for a very long time. We are now in the 21st century and we have been constantly trying to reach and try new methods to replace the old. A very little amount of time has been spent and little is known on how to learn using these new technologies against the time tested methods. 5,6&#xD;
&#xD;
Teaching and learning anatomy is not defined to or just limited to learning whatever the books printed. Of course, learning and completing the syllabus is one of the dimensions. But at the same time at a much deeper level Anatomy teaches the basic ethical values and empathy to the students. This cannot be merely replaced by today&#x2019;s fancy technology.7,8&#xD;
&#xD;
The actual transfer of the knowledge from the animation to the cadaver also was not taking place and this was proven by the gap in the OSPE scores between the two methods of teaching. This was also suggested by another two studies conducted by Hisley et al.8and Nasr et al.9 We are in full agreement with those two studies. &#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
Cadaver based teaching is better for practical understanding and Animation based teaching can be used only as an adjuvant for cadaver based teaching. Animation can be used when cadavers are very scarce. But if cadavers are not available for dissection purpose there should be at least prosection (demonstration of already dissected bodies) which can be combined with animation based teaching. It is highly recommended to make the students accustomed to the cadavers so that sufficient time is given to the students so that they can make the adjustments both physically and mentally. They should learn to empathize and at the same time also learn to be mentally fit and qualified to handle human tissues. &#xD;
&#xD;
The animation based is a great adjuvant but cannot be used to create moral and ethical grounds for the students. &#xD;
&#xD;
CONFLICT OF INTEREST: Nil.&#xD;
&#xD;
SOURCE OF FUNDING: Self-funded.&#xD;
&#xD;
AUTHOR CONTRIBUTION:&#xD;
&#xD;
&#xD;
	&#xD;
	Naik C Shishir Kumar: Principal investigator, Research methodology.&#xD;
	&#xD;
	&#xD;
	Dr Kaur Harmeet: Principal Investigator&#xD;
	&#xD;
	&#xD;
	Dr Minakshi: Principal Investigator and research methodology&#xD;
	&#xD;
	&#xD;
	Dr Upadhyaya Prerna: Principal investigator, statistics. &#xD;
	&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3838</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3838</Fulltext></URLs><References>&#xD;
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	McLachlan JC, Bligh J, Bradley P, Searle J. Teaching anatomy without cadavers. Med Educ 2004; 38:418&#x2013;424.&#xD;
	&#xD;
	&#xD;
	Mitchell BS, Stephens CR. Teaching anatomy as a multimedia experience. Med Educ. 2004; 38:911&#x2013;91&#xD;
	&#xD;
	&#xD;
	Pereira JA, Pleguezuelos E, Mer&#xED; A, Molina-Ros A, Molina-Tom&#xE1;s MC, Masdeu C. Effectiveness of using blended learning strategies for teaching and learning human anatomy. Med Educ. 2007; 41:189&#x2013;195.&#xD;
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	Ramsey-Stewart G, Burgess AW, Hill DA. Back to the future: Teaching anatomy by whole-body dissection. Med J Austr. 2010; 193:668&#x2013;671.&#xD;
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	Dyer GS, Thorndike ME. The evolving purpose of human dissection in medical education. Acad Med. 2000; 75:969&#x2013;979.&#xD;
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	Aziz MA, Mckenzie JC, Wilson JS, Cowie RJ, Ayeni SA, Dunn BK. The human cadaver in the age of biomedical informatics. Anat Rec. 2002; 269:20&#x2013;32.&#xD;
	&#xD;
	&#xD;
	McLachlan JC, Bligh J, Bradley P, Searle J. Teaching anatomy without cadavers. Med Educ. 2004; 38:418&#x2013;424.&#xD;
	&#xD;
	&#xD;
	Hisley KC, Anderson LD, Smith SE, Kavic SM, Tracy JK. Coupled physical and digital cadaver dissection followed by a visual test protocol provides insights into the nature of anatomical knowledge and its evaluation. Anat Sci Edu. 2008; 1:27&#x2013;40.&#xD;
	&#xD;
	&#xD;
	Nasr P. Impact of multimedia technology on academic performance and student perception in the anatomy laboratory. Ohio Assoc Two Year Coll J. 2008; 31:30&#x2013;36.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Efficacy and Safety of Creatine Supplementation on Strength and Muscle Mass in Resistance Trained Individuals:&#xA0;A Prospective Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>150</FirstPage><LastPage>154</LastPage><AuthorList><Author>Priyanka Mirdha</Author><AuthorLanguage>English</AuthorLanguage><Author> Vivek Nalgirkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Anant Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Vijaykumar Gupta</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Creatine is one of the widely researched nutritional supplements which increases intramuscular creatine and helps to improve training adaptations. Creatine supplement with resistance exercise also increases fat-free mass. Literature evaluating the efficacy and safety of creatine in the Indian population is sparse. Aim: To study the efficacy and safety of creatine in improving muscle mass and strength in resistance-trained individuals. Methodology: In this prospective, study, healthy young male (18-25 years) received a regular diet and exercise program (Control group) or creatine monohydrate 20 gm/day for seven days and five gram/day for the next three weeks along with designed exercise program (Creatine group). Parameters for strength, body composition and body circumference measurements were recorded. Results: Thirty participants were included. In the creatine group, the difference in the weight from baseline to day seven was significant (62.19+5.57 vs 63.28+5.49 kg; p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Creatine loading, Efficacy, Exercise, Resistance training, Safety, Strength</Keywords><Fulltext>Introduction:&#xD;
&#xD;
With the increasing number of cases of obesity and associated diseases, the importance of physical fitness is ever-growing.1 Several interventions including diet, exercise and its combination are being tried to reduce weight and improve physical fitness.2 With increased adaptation to automation and changes in lifestyle, physical fitness&#xA0;awareness among the public is becoming very important. Among adults and students, sports and exercise science is gaining popularity over the years. People are becoming interested in knowing how the body responds and adapts to exercise and strategies to improve performance for enjoying a longer and healthier life. &#xD;
&#xD;
Now a day, resistance training for sports and physical activities is gaining popularity. It provides significant functional benefits and improvement in overall health and well-being including increased muscular strength, muscle tone, physical appearance, enhanced endurance and bone density and increased fitness. As resistance training improves the strength of muscle, many sports adopted resistance training as part of their training regimen.&#xA0; Fitness enthusiast and athletes also improve their performance by using various nutritional strategies and diet. Hence, a lot of nutritional supplements are being aggressively marketed in the fitness and sports industry. Nutrition plays a pivotal role in sustaining human health, extending a healthy life span and enhances sports performance. It has been reported that a greater intake of energy with resistance training helps to increase muscle mass.3&#xD;
&#xD;
Several nutritional supplements are readily available in the market for improving muscle mass and exercise performance. Many people practice resistance exercise training with protein supplementation for improving muscle mass. It is important to consider composition and timing of intake of protein for better results.4&#xD;
&#xD;
Creatine is one of the widely researched nutritional supplements. Several forms of creatine are available in the sports nutrition market.5 Creatine supplementation increases intramuscular creatine and helps to improve training adaptations.6,7 Creatine supplement with resistance exercise also increases fat-free mass.8 Creatine monohydrate is popular and one of the most commonly used ergogenic nutritional supplement.7,9,10 Creatine with heavy resistance training improves strength, fat-free mass, and muscle morphology.5 However, its supplementation does not prevent disuse atrophy in people with leg immobilization.11Moreover, the evidence regarding creatine loading to improve muscle creatine is mixed and literature evaluating efficacy and safety of creatine in the Indian population is sparse.10&#xD;
&#xD;
Aim: &#xD;
&#xD;
The objective of this study was to study the efficacy and safety of creatine supplement in improving muscle mass and strength development in resistance-trained healthy individuals. &#xD;
&#xD;
Methodology:&#xD;
&#xD;
In this prospective study, healthy young male in the age group of 18-25 years, having normal body mass index (BMI) (18-23 kg/m2)and resistance training experience of more than one year were enrolled. Participants on any ergogenic aids and those with any acute or chronic disorders were excluded.&#xD;
&#xD;
At baseline, the height, weight and BMI of all study participants was recorded. Standardized diet protocol was given to all participants by a registered dietician. Participants in one group (control group) received a regular diet and exercise program. Participants in another group (creatine group) received a creatine monohydrate supplement (Labrada Nutrition- CreaLean&#x2122; 100% Pure Creatine). Creatine was given as 20 gm/day during the loading phase of seven days and five gram every day was given as a maintenance dose for the next three weeks along with a designed exercise program.&#xD;
&#xD;
Participants in both groups consumed their assigned diet for consecutive seven days under supervision and regular 24 hours diet recall was done by the dietician. Exercise scientist performed exercise recall for all the subjects. All participants completed the supervised exercise sessions on five consecutive days followed by two days of no exercise before the final evaluation. All training sessions started with the warmup targeted at elevating heart rate, mobilizing joints and activating muscles for the training session. The exercise sessions consist of resistance training sessions (upper-body resistance training, lower-body resistance training and full-body resistance training) and aerobic endurance training.&#xD;
&#xD;
The resistance training involved exercises for major muscle groups: quadriceps, hamstrings, calves,&#xA0;chest, back, shoulders, triceps, biceps and&#xA0;abs and involved the use of dumbbells, barbells, machines and cables to perform the exercises. Parameters for strength, body composition and body circumference measurements were recorded. The fat-free mass of all participants was calculated. The comparative assessment was done based on the outcome of parameters.&#xA0;&#xA0; For the assessment of strength, a one-repetition maximum bench press test and one-repetition maximum leg press test were performed whereas muscle mass was measured by circumference with measuring tape at arm, thigh and calf region. &#xD;
&#xD;
Safety was evaluated by reporting adverse events after consumption of creatine monohydrate till the end of the study period. &#xD;
&#xD;
The study was approved by the institutional ethics committee (Approval date: 8th February 2018) and consent was obtained from all study participants.&#xD;
&#xD;
Statistical analysis:&#xD;
&#xD;
Continuous variables are presented as mean and standard deviation whereas categorical variables are presented as frequency and percentages. Paired student t-test was used to compare continuous variables within the group. An unpaired student t-test was used to compare continuous variables between two groups. ANOVA test was applied to compared the difference between three-time points i.e. baseline, after one week and four weeks duration. A p-value of less than 0.05 was considered statistically significant. &#xD;
&#xD;
Results:&#xD;
&#xD;
A total of 60 participants (creatine group n=30; control group n=30) were included in the study. The mean (+SD) age of participants in the creatine group was 19.63 (+1.77) years. The range of age group in both groups was 18 to 24 years.&#xA0; &#xD;
&#xD;
There was no difference in the mean weight between the control and creatine group at the baseline (62.82+ 6.80 vs 62.19+5.57 kg; p=0.6843).&#xA0; In the creatine group, the difference in the weight from baseline to day seven was significant (62.19+5.57 vs 63.28+5.49 kg; p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3839</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3839</Fulltext></URLs><References>&#xD;
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	Srivastava S, Dhar U, Malhotra V. Correlation between physical fitness and body mass index. Int J Cur Res Rev. 2013;5:44-48&#xD;
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	Clark JE. Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18&#x2013;65 years old) who are overfat, or obese; systematic review and meta-analysis. J Diabetes Metab Disord. 2015;14:31 &#xD;
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	Ribeiro AS, Nunes JP, Schoenfeld BJ, Aguiar AF, Cyrino ES. Effects of different dietary energy intake following resistance training on muscle mass and body fat in bodybuilders: A pilot study. J Human Kinet. 2019;17:125-134&#xD;
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	Park Y, Park H-Y, Kim J, Hwang H, Jung Y, Kreider R. Effects of whey protein supplementation before, and following, resistance exercise on body composition and training responses: A randomized double-blind placebo-controlled study. J Exerc Nutrition Biochem. 2019;23:034-044&#xD;
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	Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. J Inter Soc Sports Nutr. 2012, 9:33 &#xD;
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	Powers ME, Arnold BL, Weltman AL, Perrin DH, Mistry D, Khahler DM, et al. Creatine supplementation increases total body water without altering fluid distribution. J Athl Train. 2003;38:44&#x2013;50 &#xD;
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	Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Inter Soc Sports Nutr. 2017; 14:18 &#xD;
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	Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Inter Soc Sports Nutr. 2013, 10:36&#xD;
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	Bird SP. Creatine supplementation and exercise performance: a brief review. J Sports Sci Med. 2003; 2:123-132 &#xD;
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	Helms ER, Aragon AA, Fitschen PJ. Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. J Inter Soc Sports Nutr. 2014, 11:20&#xD;
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	Backx EMP, Hangelbroek R, Snijder T, Verscheijden M-L, Verdijk LB, de Groot LPGM, et al. Creatine loading does not preserve muscle mass or strength during leg immobilization in healthy, young males: a randomized controlled trial. Sports Med. 2017;47:1661&#x2013;1671 &#xD;
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	Koduff LP, Vidakovic P, Cooney G, Twycross-Lewis R, Amuna P, Parker M, et al. Effects of creatine on isometric bench-press performance in resistance-trained humans. Med Sci Sports Exerc. 2002;34:1176-83&#xD;
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	Sakkas GK, Schambelan M, Mulligan K. Can the use of creatine supplementation attenuate muscle loss in cachexia and wasting? Curr Opin Clin Nutr Metab Care. 2009; 12: 623&#x2013;27 &#xD;
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	Volek JS, Duncan ND, Mazzetti SA, Staron RS, Putukian M, Gomez AL, et al. Performance and muscle fibre adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc. 1999;31:1147-56&#xD;
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	Wang C-C, Fang C-C, Lee Y-H, Yang M-T, Chan K-H. Effects of 4-week creatine supplementation combined with complex training on muscle damage and sports performance. Nutrients. 2018;10;1640&#xD;
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	Kutz MR, Gunter MJ. Creatine monohydrate supplementation on body weight and per cent body fat. J Strength Cond Res. 2003;17:817-21&#xD;
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	Deminice R, Rosa FT, Pfrimer K, Ferrioli E, Jordao AA, Freitas E. Creatine supplementation increases total body water in soccer players: a deuterium oxide dilution study. Int J Sports Med. 2016;37:149-53&#xD;
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	Francaux M, Poortmans JR. Effects of training and creatine supplement on muscle strength and body mass. Eur J Appl Physiol Occup Physiol. 1999;80:165-8&#xD;
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	Deldicque L, Louis M, Theisen D, Nielens H, Dehoux M, Thissen J-P, et al. Increased IGF mRNA in human skeletal muscle after creatine supplementation. Med Sci Sports Exerc. 2005;37:731-6 &#xD;
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	Kreider RB, Ferreira M, Wilson M, Grindstaff P, Plisk S, Reinardy J, et al. Effects of creatine supplementation on body composition, strength, and sprint performance. Med Sci Sports Exerc. 1998;30:73-82&#xD;
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	Burke DG, Chilibeck PD, Parise G, Candow DG, Mahoney D, Tarnopolsky M. Effect of creatine and weight training on muscle creatine and performance in vegetarians. Med Sci Sports Exerc. 2003;35:1946-55&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Lipopolysaccharide-Induced Double Hit on Neurobehaviour and Neurochemistry in the Wistar Kyoto Rat, A Model with Endogenous Depressive-Like Profile&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>65</FirstPage><LastPage>73</LastPage><AuthorList><Author>Reshma A. Shetty</Author><AuthorLanguage>English</AuthorLanguage><Author> Monika Sadananda</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Wistar Kyoto rat, Lipopolysaccharide, Depression, Behaviour, Neurochemistry</Keywords><Fulltext>Introduction&#xD;
&#xD;
Investigating links that exist between peripheral infection and inflammation and brain function and dysfunction has become essential because of the currently ongoing pandemic. However, to tease out this circuitry, there is a need to evolve suitable models. The Wistar-Kyoto (WKY) rat, which is an inbred strain of the progenitor Wistar rat arose as a hypotensive control for the spontaneous hypersensitive rat (SHR) model is one such model as it has since been proposed as a putative model of depression. This is because WKYs demonstrated hormonal and physiological measures and depicted behavioural responses similar to those found in symptom-presenting depressive patients. These include, for instance, hyperreactivity to stress, behavioural inhibition, anxiety-like profile, dysregulation of hypothalamic-pituitary-adrenal (HPA) axis, increased adrenocorticotropic hormone (ACTH) and corticosterone (CORT) levels, neurochemical abnormalities in several systems (dopaminergic, serotonergic and noradrenergic) as well as in peripheral hormones such as thyroid-stimulating hormone (TSH) etc.1-6&#xD;
&#xD;
So the WKY strain, which exhibits endogenous depressive-like behaviour is thought to be impaired in adaptive capabilities, making it more susceptible to exogenous stressors as it demonstrates hypersensitivity to stress with a propensity to develop stress-induced anxiety-like characteristics. However, the WKY strain harbours heterogeneity not found in other inbred strains, including greater behavioural and genetic variability, which has led to mixed results being obtained earlier from anxiety and learned helplessness measures with differences emerging between inbred strains of WKY.7&#xD;
&#xD;
Despite this, the WKY rat may be suitable to unravel underlying phenomena that link depression and exogenously-induced stressors or inflammatory states8-11as in the case of a diathesis or double hit model, whether through activation of the HPA system or the immune system that lead to altered physiology. Sickness behaviour is an immunological/inflammatory model of depression or a non-specific reaction to various infectious and pro-inflammatory stimuli, such as LPS administration, which constitutes a well-established experimental approach to study the effects of an acute and transient immune activation on physiology and behaviour.8-12&#xD;
&#xD;
Acting as a stressor,12 LPS activates common physiological responses (brain cytokine expression, HPA axis activation). How a susceptible WKY strain responds to extraneous immune stimulants would provide a window into understanding vulnerability. LPS elicits a strong immune response leading to the secretion of pro-inflammatory cytokines, which can act on the hypothalamus and other areas of the brain through humoral and nervous routes with profound behavioural deficits like prolonged sleepiness, depression, reduced levels of mobility, anxiety, food and water intake, rearing, grooming.13 These complex behavioural changes such as reduced general activity, reduced social motivation and fever response, collectively termed &#x201C;sickness behaviour,&#x201D;14,12include reduced exploration, increased anxiety, cognitive dysfunction, and social withdrawal in rodents.11-16 As WKY demonstrate great heterogeneity, it is essential to carry out baseline tests, assessing anxiety- and depressive-like measures. Towards this, the ideal paradigm is the elevated plus maze (EPM), which introduces a conflict between the animal&#x2019;s inherent urge to explore new environments, vis-&#xE0;-vis it&amp;#39;s fear of open, brightly lit spaces. It is, therefore, best suited to assess anxiety-like behaviour. Anxiety and depression often demonstrate comorbidity. Typical features or subtypes of the depression syndrome are better coping style or increased resilience,17,18 which are ideally tested out in the forced swim test (FST) in rodents that detects coping strategies in response to stress and is a paradigm for behavioural despair. Immobility or passive behaviour is interpreted as behavioural despair, while swimming is coping with the stressor and climbing is more of defensive behaviour.&#xD;
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Neurochemical and behavioural responses are impacted by LPS administration. LPS induces profound cerebral changes in monoamine metabolism. For instance, at 2-4 hrs post LPS administration, monoaminergic transmission is on the rise with the serotonergic system and the HPA axis is activated.19 Brain areas such as the frontal cortex are stressor sensitive, while the hypothalamus is the seat of neuro vegetative symptoms associated with sickness behaviour, so we selected these brain areas for assaying ubiquitous acetylcholinesterase (AChE), monoamine oxidase (MAO) and stress marker neuronal nitric oxide synthase (NOS).&#xD;
&#xD;
Peripherally, LPS induces inflammation by acting via macrophage TLRs. These activated macrophages initiate a cascade of events culminating in reactive oxygen species (ROS) and generation of free radicals, a reaction that leads to lipid peroxidation, as measured here by liver MDA levels wherein the phospholipid bilayer gets increasingly porous, culminating in necrosis. GSH, the primary non-protein sulfhydryl ubiquitous tripeptide catalyzed by glutamyl cysteinyl synthetase is a potent anti-oxidant scavenging molecule is, which donates its electron to ROS, thus lowering their adverse effect, so liver GSH activity was also measured.&#xD;
&#xD;
Here, we first established whether the experimental WKY subjects demonstrate anxiety- and depressive-like profiles and then used them for further testing with LPS with behavioural measures being recorded in EPM 2 hours post-injection and a novel activity box 3 hours post-injection. Oxidative stress was quantified by performing biochemical assays of potent anti-oxidant molecules in the liver such as Glutathione (GSH) and levels of malondialdehyde (MDA) were used to assess lipid peroxidation in the liver. Quantification of ubiquitous central acetylcholine degrading enzyme AChE, monoaminergic modulator MAO and gaseous signalling molecule NOS, was carried out. As the immune system is activated in response to mitogens, such as LPS and stressors by inducing an increase in immune cell populations, especially lymphocytes and neutrophils, total and differential leukocyte count [total leukocyte count (TLC), and differential leukocyte count (DLC)] in blood circulation was carried out to detect leucocyte misdistribution. Thus, we screened for anxiety-related behaviours in adult male WKY vis-a-viz Wistar and observed LPS-induced changes in behaviour and neurochemical profiles in WKY.&#xD;
&#xD;
Materials and Methods&#xD;
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Subjects &#xD;
&#xD;
90-day old, male Wistar (n=8) and WKY (n=8) rats were procured from the ICMR-National Animal Resource Facility for Biomedical Research (NARFBR), Hyderabad, India and housed in the group under standard laboratory conditions with artificial 12h light/dark cycle (lights on at 7:00 h) at an ambient temperature of 22-24&#xB0;C with free access to food and water. Animals were maintained in groups of 3-4, and experiments carried out according to the guidelines laid down by the Committee for Control and Supervision of Experiments on Animals, Government of India, as per the ARRIVE guidelines and were permitted by Institutional Animal Ethics Committee (No. IAEC/106/2011). All experiments were conducted in the light cycle (9:00&#x2013;17:00 h). All behavioural recordings were carried out for 5 minutes under 8-8.5 lux as measured at the base of the arena. Recording done with a CCD camera (WV CP500; Panasonic) and data acquisition and analysis done with Ethovision&#xAE; 9.0 (Noldus, Netherlands).&#xD;
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Baseline behaviour &#xD;
&#xD;
Wistars (n=8) and WKY (n=8) rats were subjected to baseline testing in the elevated plus maze (EPM), habituated to the swim apparatus and 24hrs later tested in the forced swim test (FST).&#xD;
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Elevated Plus Maze (EPM)&#xD;
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The EPM test was carried out as described in detail elsewhere.20,21 Briefly open and closed arm time and entries along with locomotion were automatically quantified. Anxiety index was calculated as open arm time and entries about total time and total entries.22 Non-classical anxiety measures such as nose dips, stretch-attend postures 22,23 were also quantified.&#xD;
&#xD;
Forced Swim Test (FST)&#xD;
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The modified FST protocol was adapted24, 25 and is a well-characterized paradigm to analyze depression-like behaviour in rodents. The FST was carried out as described in detail elsewhere.20,21&#xD;
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Lipopolysaccharide in WKY rats&#xD;
&#xD;
24hrs later, WKY rats were randomly divided into two groups. N=4 were injected with 1mg/kg body weight of LPS (E.coli, serotype, Sigma) dissolved in saline i.p. with volume made up with saline to 1 ml. Controls (n=4) were injected with the same volume of the vehicle. Two hours after the injection, rats were placed into the EPM as described above.&#xD;
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Activity Box&#xD;
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Three hours after the injection, the rats were placed in the centre of an activity box which was an open cube of 44x44x44cms. The box was located 50 cms above the ground, and the animal&#x2019;s behaviour was observed for 5 minutes. The observed parameters were ambulation and rearing. &#xD;
&#xD;
Differential Leucocyte Counting&#xD;
&#xD;
Immediate after exposure to the activity box, all animals were deeply anaesthetized, and blood collected for mono- and poly-morphonuclear leucocyte (PMNL) staining and quantification. Briefly, blood was smeared and stained with Leishman&#x2019;s stain (Himedia) and observed under a Leica DM2500 and quantification were done using Leica Application Suite software. &#xD;
&#xD;
Enzyme Assays&#xD;
&#xD;
Liver and brain tissues of LPS-injected rats (n=4) and control rats (n=4) were taken and deep-frozen until further. Brain areas, frontal cortex and hypothalamus, were dissected out, tissues were homogenized, centrifuged and the supernatant used for spectrophotometric estimations of acetylcholinesterase, nitric oxide synthase, and monoamine oxidase. Liver tissues were homogenized, centrifuged and the supernatant used for spectrophotometric estimations of Glutathione (GSH), Lipid peroxidation by Malondialdehyde. Enzyme activity was expressed as specific activity in nanomoles or micromoles of the enzyme per mg of protein. 26-29&#xD;
&#xD;
Statistical analysis &#xD;
&#xD;
All data are expressed as group mean &#xB1; S.E.M and tested for statistical differences using t-test. Repeated measures t-test was used to detect differences between habituation and test in Wistar and WKY rats. Differences at p values less than 0.05 were considered significant.&#xD;
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Results&#xD;
&#xD;
WKYs demonstrated increased anxiety levels with reduced open arm time in the EPM but did not demonstrate learned helplessness in the FST test. LPS induced a decrease in all parameters, notably distance moved and centre time when compared to saline-injected controls, though anxiety-related measures showed no difference. Risk assessment in the EPM and exploratory behaviour in the activity box was significantly reduced. These behavioural changes were accompanied by increased hypothalamic acetylcholinesterase activity and the concomitant decrease in MAO activity in both the frontal cortex and the hypothalamus. Activated brain substrates underlying this were prefrontal and piriform cortices. &#xD;
&#xD;
EPM&#xD;
&#xD;
As compared to the parent progenitor strain Wistars, WKYs demonstrated reduced open arm time and increased closed-arm time (fig. 1a,b). Though entries into closed and open arms were not significantly different (fig. 1d,e), the cumulative anxiety-related measures translated into increased anxiety levels in WKYs when compared to age-matched Wistars (fig. 1f). WKYs demonstrated significantly (tdf=14 = 4.014; p &lt; 0.0017) reduced ambulation as assessed by distance moved when compared to Wistars. WKYs covered a distance of 9.46 &#xB1; 0.97m while Wistars covered close to double the distance at 17.93 &#xB1; 1.66m. Latency or time taken to enter the open arm was increased in WKYs (0.32 &#xB1; 0.12s) as against Wistars (0.51 &#xB1; 0.20s), though the difference was not significant (tdf=14 = 0.73; p &gt; 0.05). Centre time was significantly reduced in WKY (fig. 1c).&#xD;
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Among the ethological measures, rearing behaviour was comparable between strains (fig. 1g). Risk assessment, as measured in stretch-attend postures wherein the animal while remaining in the confines of the closed arm stretches into the open arm, were significantly increased in WKY (fig. 1i). Head dips, indicative of risk-taking, wherein the animal positioned in the open arm dips its head, were significantly reduced in WKY (fig. 1h). For Mean &#xB1; SE values of anxiety-related and ethological measures, see fig.1. &#xD;
&#xD;
&#xD;
&#xD;
Fig. 1 Anxiety-related and ethological parameters in the EPM of WKYs vs. Wistars. Top panel: Duration spent in the a) open arm (tdf=14=3.35; p=0.0074) was significantly reduced in WKYs with a corresponding increase in b) closed arm time (tdf=14=5.84; p=0.0002), while c) centre time was also significantly reduced in WKYs (tdf=14=3.776; p=0.0026). Middle panel: Entries into the d) open arm (tdf=14=2.412; p=0.05) were significantly reduced in WKYs while those into the e) closed arm were comparable with Wistars (tdf=14=0.7699; p=0.4592). Anxiety index was significantly higher in WKYs than Wistars (tdf=14=2.636; p=0.0249). Lower panel: Ethological parameters: a) Rearing demonstrated a trend (tdf=14=2.073; p=0.0625) while stretch-attend postures (tdf=14=5.302; p=0.0003) were significantly increased in WKY. Head dips from the open arm were significantly reduced (tdf=14=7.571; p 0.05). No differences were observed in latency (time taken) to immobility (Wistar: 43.74 &#xB1; 5.54; WKY 49.80 &#xB1; 7.05; (tdf=14 = 0.6848; p &gt; 0.05).&#xD;
&#xD;
During the test exposure, WKY spent 9.08 &#xB1; 1.75% of the time in the FST immobile while Wistars spent 21.69 &#xB1; 3.92% of the time immobile, the difference being significant (tdf=14 = 2.560; p = 0.0284). WKY demonstrated increased swimming behaviour in the FST with 22.52 &#xB1; 0.89%, when compared to Wistar who spent 20.08 &#xB1; 1.11% time in swimming, though the difference was not significant (tdf=14 = 1.63; p &gt; 0.05). WKY demonstrated increased climbing behaviour at 64.70 &#xB1; 4.10%, when compared to Wistar who spent 51.82 &#xB1; 4.96% time in climbing, the difference not being significant (tdf=14 = 1.957; p = 0.07). No differences were observed in latency to immobility (Wistar: 26.71 &#xB1; 5.78; WKY 31.73 &#xB1; 8.226; (tdf=14 = 0.5105; p &gt; 0.05).&#xD;
&#xD;
Hab vs Test&#xD;
&#xD;
Differences between habituation and test are depicted in fig. 2. WKY took a lesser time to become immobile (fig. 2a), demonstrated significantly reduced immobility (fig. 2b) and increased climbing (fig. 2d) behaviour during the test. Swimming behaviour was comparable between habituation and test. Wistars, on the other hand, also demonstrated significantly reduced immobility (fig. 2b) and increased climbing (fig. 2d) behaviour during the test. Their latency to immobility (fig. 2a) and swimming behaviour (fig. 2c) were comparable between the two exposures. The repeated measures t statistic and p values are depicted in fig. 2.&#xD;
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&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Fig. 2 Forced Swim Test. Differences between habituation and test. a) Latency/time taken to Immobility/become immobile: Wistar - tdf=7=1.231; p=0.273; WKY - tdf=7=2.645; p=0.0457; b) Immobility: Wistar - tdf=7=3.872; p=0.0117; WKY - tdf=7=3.331; p=0.0447; c) Mobility/Swimming behaviour: Wistar - tdf=7=1.291; p=0.2378; WKY - tdf=7=2.282; p=0.0714; d) High mobility/Climbing behaviour - Wistar - tdf=7=2.652; p=0.0380; WKY) - tdf=7=3.940; p=0.0110&#xD;
&#xD;
LPS in WKY - EPM&#xD;
&#xD;
LPS treatment reduced locomotory activity by inducing a significant (tdf=6 = 3.344; p = 0.0086) reduction in distance moved (Veh: 1.14 &#xB1; 0.10m vs. LPS: 0.59 &#xB1; 0.13m). Latency to enter the open arm was comparable, with Vehicle-treated animals taking 40.97 &#xB1; 19.36s while LPS-treated rats took 22.03 &#xB1; 12.87s to enter the open arm (tdf=6 = 0.8144; p &gt; 0.05). Entries into the open arm were very few (Veh: 0.16 &#xB1; 0.02s vs. LPS 0.14 &#xB1; 0.08s; tdf=6 = 0.220; p &gt; 0.05) as also closed arm entries (Veh: 0.86 &#xB1; 0.33s vs. LPS 0.91 &#xB1; 0.06s; tdf=6 = 0.902; p &gt; 0.05). &#xD;
&#xD;
LPS affected center time which was significantly (tdf=6 = 3.59; p = 0.007) reduced in LPS-treated rats (10.17 &#xB1; 2.86s) as compared to controls (34.75 &#xB1; 7.37s). Open arm time was significantly reduced in LPS-treated rats (Veh: 4.20 &#xB1; 1.18; LPS 0.70 &#xB1; 0.47; tdf=6 = 2.305; p = 0.05). Closed arm time was significantly (tdf=6 = 3.752; p = 0.005) higher in LPS-treated rats (287.2 &#xB1; 3.85s vs. Veh: 259.8 &#xB1; 6.98s). For % open arm time, % centre time and % closed arm time see fig. 3a. &#xD;
&#xD;
LPS induced a decrease in the ethological parameters tested such as rearing frequency (Veh: 8.00 &#xB1; 0.55; LPS: 4.60 &#xB1; 1.29) which were significantly reduced (tdf=6 = 2.429, p = 0.041), as also stretch-attend postures from the safety of the closed arm onto the open arm (Veh: 8.60 &#xB1; 1.17; LPS: 3.80&#xA0; &#xB1; 1.16 (tdf=6 = 2.921, p = 0.019). &#xD;
&#xD;
LPS in WKY - Activity box&#xD;
&#xD;
3 hours LPS injection, reduced ambulation was observed, with vehicle-treated WKY demonstrating 8.78 &#xB1; 0.56m while LPS-treated rats demonstrated reduced locomotor activity at 3.59 &#xB1; 0.60m moved; tdf=6 = 6.284; p ? 0.0001). Rearing behaviour was also influenced by LPS: vehicle-treated rats exhibited 7.18 &#xB1; 0.91 rears vs. LPS-treated rats which exhibited 3.20 &#xB1; 1.16 rears, the difference being significant (tdf=6 = 2.735; p = 0.023). There was no significant difference in centre duration with vehicle-treated rats depicting 2.90 &#xB1; 0.98s in the center of the activity box vs. LPS-treated rats which demonstrated 38.30 &#xB1; 30.64s, the difference being not significant (tdf=6 = 1.155; p = 0.2750). Neither was there any difference in time spent in the periphery (Veh: 297.3 &#xB1; 0.98s vs. LPS: 261.9 &#xB1; 30.64s; tdf=6 = 1.155; p &gt; 0.05). For activity box measures of vehicle vs. LPS treated animals three hours following the LPS injection, see fig. 3b.&#xD;
&#xD;
&#xD;
&#xD;
Fig. 3 a): In the EPM at 2 hrs post LPS injection, LPS-induced effects on open arm, centre and closed arm times. There was a significant reduction in centre time of LPS group (tdf=6=3.59; p=0.007), a significant increase in closed arm time (tdf=6=3.752; p=0.005) while open arm time just reached significance (tdf=6=2.305; p=0.05). For time in secs, see text. b) At 3hrs post LPS, distance moved and rearing behavior in the activity box. Distance moved: Veh: 8.783&#xB1;0.5639m; LPS: 3.593&#xB1;0.6035 (tdf=6=6.284; p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3840</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3840</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparison of Colour Stability of Three Types of Provisional Prosthodontic Materials in Coffee and UV Light -&#xA0;an In vitro Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>82</FirstPage><LastPage>87</LastPage><AuthorList><Author>Sejal Narendrakumar Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Govind Lal Meena</Author><AuthorLanguage>English</AuthorLanguage><Author> Tarun Kumar Singh</Author><AuthorLanguage>English</AuthorLanguage><Author>  Manish Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Sankalp Agnani</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Provisional prosthodontic materials provide pulpal protection by covering the prepared tooth structure, providing thermal insulation, and preventing leakage by forming an intimate seal with the prepared tooth during the fabrication of the definitive prosthesis. Aims and Objectives: To compare colour stability of provisional restoration to provide an initial esthetic shade match and then to remain colour-stable during its period of service. Material and Methods: A total of 90 disc-shaped specimens (10 &#xB1; 0.1mm by 1 &#xB1; 0.05mm) will be fabricated with three commercially available provisional prosthodontic materials: Methyl Methacrylate Resin (RR Rapid Repair, Dentsply), Methyl Methacrylate Resin (RR Cold Cure, DPI), Methyl Methacrylate Resin (Acrylic-R, Asian). Ten specimens of each material will be randomly selected and immersed individually in coffee (37&#xB0;C) for 20 days or exposed to UV irradiation for 1 hour time respectively. Colour will be measured with a colourimeter before and after the immersion or UV exposure. Colour change (?E) will be calculated and data will be analysed by 1-way ANOVA and the Tukey multiple comparisons test (&#x3B1; =0.05). Results: In 3 types of provisional restorative material, Asian provisional restorative material shows the highest colour difference and least colour stability. Integrity provisional restorative material sample shows the lowest colour difference and highly colour stable. Comparison of mean of colour change by coffee and UV light shows that coffee caused more colour change than UV light. Discussion and Conclusion: Discolouration of provisional materials in fixed prosthodontics may lead to patient dissatisfaction and additional expense for replacement. The stainability of the various materials is not just related to the chromogens but also to the chemical composition of the materials that are being tested.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Colour stability, Provisional Prosthodontic material, Esthetics, Coffee, UV light</Keywords><Fulltext>INTRODUCTION&#xA0; &#xD;
&#xD;
Achieving optimum esthetics has been one of the goals in Prosthodontics. In this changing world, appearance is important. A provisional restoration is a transitional restoration that provides protection, stabilization and function before the fabrication of a definitive prosthesis. It may also be used to determine the esthetics, functional and therapeutic effectiveness of a treatment plan.1&#xD;
&#xD;
&#xA0;The provisional restoration may be required to be placed in the patient&#x2019;s mouth for a few days to few weeks. A fixed or removable dental prosthesis or maxillofacial prosthesis is designed to enhance esthetics, stabilization and/or function for a limited period, after which it is to be replaced by a definitive dental or maxillofacial prosthesis. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; While the provisional restoration is in use, it is prone to discolouration due to its contact with various pigments present in the food and this does adversely affect the esthetics of the patient. Thus, the colour stability of the material becomes an important criterion for the selection of the provisional restorative material. It is used in the anterior region for esthetics and masticatory function in the posterior region.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Various studies have been done on the effect of various food colourants on colour stability of provisional restorative materials.1-4&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Today, there are several new provisional materials available that differ in their chemical composition and curing methods thus having different physical properties. Thus, there is a need to comparatively analyse the colour stability of these materials.5,&#xD;
&#xD;
AIMS AND OBJECTIVES&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The aims and objectives of the study are:&#xD;
&#xD;
&#xD;
	&#xD;
	To evaluate the effect of selected food colourant (consumed by the Indian population) on the colour stability of the provisional restorative materials.&#xA0; &#xD;
	&#xD;
	&#xD;
	To evaluate the effect of coffee and UV light on the colour stability of the provisional restorative materials.&#xA0; &#xD;
	&#xD;
	&#xD;
	To compare the colour stability of three commercially available provisional restorative materials in coffee and UV light.&#xD;
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&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
The effect of two media coffee and Ultraviolet (UV) light was investigated on the colour of three different types of provisional restorative materials. This prospective, in-vitro study was conducted in the Department of Prosthodontics and Crown and Bridge, Tatyasaheb kore dental college and research centre Kolhapur Maharashtra and Department of Chemical Engineering in Dattajirao Kadam Technical Education Society (DKTE) engineering institute rajwada Maharashtra.&#xD;
&#xD;
The colour stability was measured using a spectrophotometer with the measurements being taken in the International Commission on Illumination (CIELAB) colour system.&#xD;
&#xD;
The methodology will be discussed under the following headings:&#xD;
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	&#xA0;Specimen fabrication&#xD;
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	Staining solution preparation&#xD;
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	Colour measurement&#xD;
	&#xD;
	&#xD;
	Statistical analysis&#xD;
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	&#xD;
	Specimen fabrication:&#xD;
	&#xD;
&#xD;
&#xD;
A total of 90 disc-shaped specimens (10 mm in diameter by 1 mm in thickness) were prepared from each material using similar shade groups using stainless steel die. This size of the specimen allowed ease of manipulation and polishing to approximately 1.0 &#xB1; 0.5 mm, which is generally the thickness of the material at the facial and the occlusal surfaces. &#xD;
&#xD;
The DPI, Asian, and Integrity provisional restorative material were directly added with the monomer polymer ratio given by the manufacturer in the stainless steel die (1:1.3) with petroleum jelly as the separating medium and allowed to cure for 30 min. &#xD;
&#xD;
It is supplied in an automix system. The die was coated with petroleum jelly. The automix system was then used to dispense the material into the die carefully to avoid void formation. The stainless steel slab was placed on the material to allow uniform thickness and the discs were removed after 4 min.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;Once polymerisation is over, the specimens were removed from the die and were polished. Specimens were polished using a 15 sec. application of pumice applied with moist muslin wheel. A single individual polished all the specimens to avoid intra variation. 7,8&#xD;
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The specimens were divided into groups of nine, with ten samples each. The discs were randomly picked and serially-numbered using an acrylic bur. &#xD;
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	Staining solution preparation:&#xD;
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For the evaluation of the colour stability, the specimens were immersed in coffee for 20 days and exposed to ultraviolet (UV) light for 1-2 hours.&#xA0; The coffee was prepared by using a standardized method. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The specimens of each type were divided into nine groups with ten specimens in each group. Ten specimens of each group were immersed in coffee for 20 days. The samples were immersed at 37&#xB0; C in an incubator to simulate the temperature of the oral environment. Ten specimens of each group were exposed to Ultraviolet light (UV) for 1-2 hours. They were evaluated for the colour change before and after the immersion or UV exposure. 9,10&#xD;
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	Colour measurement: &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; For the measurement of colour, the specimens were removed from the staining solution and cleaned using an ultrasonic cleaning device. The specimens were then wiped clean dry using an absorbing tissue paper. Thereafter, the specimens were subjected to spectrophotometric analysis.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The spectrophotometer used was a reflectance spectrophotometer &#x2013; Premier Colour scan. The specimens were placed on a clean surface. The aperture of the spectrophotometer was placed and the reading was taken, which was recorded on the computer.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Values of the colour change were recorded in the CIELAB colour system. The CIELAB colour system is an approximately uniform colour space with coordinates for lightness, namely, white-black (L*), redness &#x2013; greenness (a*) and yellowness &#x2013; blueness (b*). The L, a and b values of each specimen was measured 3 times, and a mean of each was calculated. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0; The colour difference was calculated from the means using the following formula:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; DE = (DL2 + Da2+ Db2)1/2&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Where, DL, Da, Db denotes the values of the samples before and after the immersion or UV exposure, DE is the colour difference between the samples before and after the immersion or UV exposure. Readings were taken of three randomly selected areas of the discs and the mean was calculated. All data recordings were taken by the same investigator to minimise inconsistency of the technique. 11&#xD;
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&#xD;
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	Statistical analysis:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The statistical analysis of the data obtained was done using the Statistical Package for Social Scientists (SPSS) computer software for windows version XP. This program provides the descriptive summary statistics and statistical technique applied in the study. The results were then analysed using ANOVA analysis, paired test for intragroup comparisons. 12&#xD;
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RESULTS&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The purpose of this study was to determine the colour stability of 3 provisional restorative materials before and after immersion in coffee, and exposure to UV light. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table I shows the master table with DE values of 90 Asian provisional restorative material samples. It shows the highest colour difference and the least colour stable.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;Table II shows the master table with DE values of 90 DPI &#x2013; self-cure provisional restorative material samples. It shows the significant colour difference in coffee and UV light.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table III shows the master table with DE values of 90 Integrity provisional restorative material samples. It shows the lowest colour difference and highly colour stable.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table IV and Graph I shows the comparison of the mean of three different materials for before and after immersion in coffee and exposure to UV light. The material I &amp; II shows significant colour change compared to Material III.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table V and Graph II show the comparison of mean colour change by coffee, distilled water and UV light. It shows that coffee caused more colour changes compared to UV light. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table VI shows the intragroup comparison of Asian (Material &#x2013; I) and DPI self-cure (Material &#x2013;II) provisional restorative materials. It shows that material II is better than the material I.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table VII shows the intragroup comparison of Asian (Material &#x2013; I) and Integrity (Material &#x2013;III) provisional restorative materials. It shows that material III is better than the material I.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table VIII shows intra group comparison of DPI self-cure (Material &#x2013;II) and Integrity (Material &#x2013;III) provisional restorative materials. It shows that material III is better than material II.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; DISCUSSION&#xD;
&#xD;
One of the important things to consider is that restoration must not only satisfy function but also the esthetics. In fixed prosthodontics, a provisional restoration is given until the permanent restoration is fabricated. Colour stability can govern the selection of materials when a long period of service is anticipated. The materials should be esthetically acceptable and colour stable. Discolouration of provisional materials in fixed prosthodontics may lead to patient dissatisfaction and additional expense for replacement.13 The degree of color change can be affected by several factors including incomplete polymerization, water sorption, diet and oral hygiene.14 &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The stainability of the various materials is not just related to the chromogens but also to the chemical composition of the materials that are being tested. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The discolouration of resin-based materials can be caused by various factors. According to Hersek et al. 15, one of the factors involves the discolouration of the resin material itself, such as alteration of the resin matrix and the interface of the matrix and fillers. The cause of chemical discolouration has been attributed to the change of oxidation of the amine accelerator, oxidation in the structure of the polymer matrix and oxidation of unreacted pendant methacrylate groups.16&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; However, there is another threshold regarding the stability of the materials. This threshold justifies the clinical acceptability of the stained materials. The upper limit of acceptability in subjective visual evaluations has been confirmed by Um and Ruyter17 who suggested that a perceptible discolouration must be referred to as acceptable up to a Value DE =3.3, while Guler et al18 have stated that a value of 3.7 should be considered as visually perceptible. The colour measurement was done using a reflectance spectrophotometer that incorporates 10 &#x2013; degree observer, 45- degree illumination, with light provided by a pulsed xenon arc lamp.&#xA0; &#xD;
&#xD;
&#xA0;Changes in optical properties within the materials could have been responsible for the colour change. Studies demonstrated lower water sorption for composite materials with high filler content (low resin content) compared with materials with lower filler content. Highly cross-linked resins were also shown to exhibit less water sorption. It is unknown from the manufacturers or the literature whether any differences exist in water sorption or filler content and the amount of cross-linking between the methyl/ethyl methacrylate and the bis-acryl methacrylate-based resins. Additional research is necessary to validate such a hypothesis. 17&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Conversely, DE values for bis-acryl methacrylate were significantly lower than methyl/ethyl methacrylate after immersion in coffee. Mechanisms explaining how UV radiation affects the colour stability of acrylic resins have been proposed. It was suggested that the oxidation of residual unreacted carbon double bonds (C=C) in the polymerized resins may promote the production of yellowing compounds.18,19 &#xD;
&#xD;
In a study conducted by Jyoti et al, it was found that nano-composite denture teeth are highly polished table, stain and impact-resistant material. 20&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
SUMMARY&#xD;
&#xD;
A provisional restoration is required to be worn till the final restoration is fabricated. The provisional restoration should not undergo colour change during the period it is worn. The colour change of the material may occur as a consequence of the consumption of chromogenic food. &#xD;
&#xD;
With the advent of newer materials being introduced at a rapid pace, a need was felt to compare and evaluate the colour stability of the provisional materials in coffee and UV light.&#xD;
&#xD;
Three commercially available provisional restorative materials with different chemistry and curing methods were chosen. &#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Provisional restoration is an important part of fixed prosthodontic treatment. The provisional restoration, while it is in use by the patient, is prone to discolouration with various types of food colourants. Thus colour stability of the materials used in the provisional restoration is an important property. &#xD;
&#xD;
The present investigation aimed at evaluating the colour stability of provisional restorative materials before and after immersion in distilled water, coffee for 20 days &amp; ultraviolet light (UV) for 1-2 hours using spectrophotometric analysis was done to evaluate the colour change.&#xD;
&#xD;
Within the limitations of the study, the following conclusions can be drawn:&#xD;
&#xD;
&#xD;
	&#xD;
	Integrity material showed the least colour change after immersion in distilled water, coffee for 20 days and exposure to ultraviolet light (UV) for 1-2 hours.&#xD;
	&#xD;
	&#xD;
	Asian material showed the maximum colour change after immersion in distilled water, coffee for 20 days &amp; ultraviolet light (UV) for 1-2 hours.&#xD;
	&#xD;
	&#xD;
	DPI Self-Cure material showed significant colour change after immersion in distilled water, coffee for 20 days &amp; ultraviolet light (UV) for 1-2 hours.&#xD;
	&#xD;
	&#xD;
	Coffee caused the maximum discolouration on the first day, while distilled water caused the least discolouration. Ultraviolet light (UV) showed colour change greater than distilled water but less than coffee.&#xD;
	&#xD;
&#xD;
&#xD;
ACKNOWLEDGEMENT: Authors acknowledge the enormous help received from the authors whose articles are cited and included in references to this manuscript. &#xD;
&#xD;
CONFLICT OF INTEREST: NIL&#xD;
&#xD;
ETHICAL CLEARANCE: Not required (In- Vitro Study)&#xD;
&#xD;
PATIENT CONSENT- Not required (In- Vitro Study)&#xD;
&#xD;
FINANCIAL SUPPORT- NIL&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3841</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3841</Fulltext></URLs><References>&#xD;
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	Criptin BJ, Caputo AA. Colour stability of temporary restorative materials. J Prosthet Dent. 1979;42:27-33.&#xD;
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	Koumjian JH, Firtell DN, Nimmo A. Colour stability of provisional materials in vivo. J Prosthet Dent. 1991;65:740-2.&#xD;
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	Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Colour stability of provisional resin restorative materials. J Prosthet Dent. 1998;80:533-9. &#xD;
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	Lang R, Rosentritt M, Leibrock A, Behr M, Handel G. Colour stability of provisional crown and bridge restoration materials. Br Dent J. 1998;185:468-71.&#xD;
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	Ergun G, Mutlu &#x2013; sagesen L, Ozkan Y, Demirel E. In vitro colour stability of provisional crown and bridge restoration materials. Dent. Mater J. 2005;24:342-50.&#xD;
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	Haselton DR, Diaz &#x2013; Arnold AM, Dawson DV. Colour stability of provisional crown and fixed partial denture resins. J Prosthet Dent. 2005; 93:70-5.&#xD;
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	Guler AU, Yilmaz F, Kulunk T, Guler E, Kurt S. Effects of different drinks on stainability of resin composite provisional restorative materials. J Prosthet Dent. 2005; 94:118-24.&#xD;
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	Jyoti K, Kumar R, Seshan S. A study on evaluation of surface roughness and the anti-staining propensity of nano-composite denture teeth.Int J Curr Res Rev. 2014; 06(07): 52-57.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Physiotherapy Treatment in Early Postpartum Period after Lower Segment Caesarean Section (LSCS)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>155</FirstPage><LastPage>159</LastPage><AuthorList><Author>Purvi Patel</Author><AuthorLanguage>English</AuthorLanguage><Author> Mansi Shah</Author><AuthorLanguage>English</AuthorLanguage><Author> Lata Parmar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The immediate postpartum period is more challenging for mothers who have had a caesarean delivery. The pain presented after a caesarean section makes the recovery difficult and delays the mother&#x2019;s mobility. This study aimed to evaluate the effect of Physiotherapy treatment on Pain by VAS, Difference in PEFR and functional mobility by &#x201C;time up and go&#x201D; scale and on cadence. Method: Mothers with lower segment caesarean section (LSCS) eligible to participate in the study were divided into two groups; routine nursing care only as to date was the practice. The experimental exercise group was given fixed physiotherapy protocol from postoperative (POD) 1 up to the day of discharge. The severity of pain was assessed with the visual analogue scale on POD 1 and the day of discharge and functional mobility was to be assessed with the &#x201C;time up and go&#x201D; scale and cadence on the day of discharge. Peak expiratory flow rate was taken op Pod 1 and day of discharge. Result: There was a significant reduction in VAS at rest and movement within the group (P0.05). There was a significant difference in mean PEFR at the day of discharge within and between the group (P0.05). Conclusion: Early Postpartum physiotherapy was found to be beneficial in both the active patient group and also in the group where education and demonstration were given.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords></Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Pregnancy is a long and very special journey for women.1 Term pregnancy has traditionally defined as a duration of 10 lunar months or 9 calendar months and 7 days since the first day of the last menstrual period.2,3 There are two types of delivery for birth: vaginal delivery and caesarean delivery. With an incidence of around 25%, lower segment caesarean section (LSCS) becomes the most common abdominal surgery in the world performed on females.4&#xD;
&#xD;
Births by caesarean sections, many of them unnecessary, have started to increase, globally. India has the highest annual rate for CS among all the East Asian countries which were 7.1% in 1998 and increased up to 16.7% in recent years.5,6&#xD;
&#xD;
A C-section is performed for the safety of the child and mother which might be at the risk of vaginal delivery is performed (emergency CS) or there is the chance of any danger to the baby or mother with vaginal delivery (planned CS).7,8 The most common reasons for a C-section are fetal distress, prolonged labour, breech presentation, multiple gestations, previous section and CS on demand.4-10 The lower abdominal transverse incision is adequate for the vast majority of caesarean operations. It has the advantages of cosmetic approval and minimal risk of postoperative complication.11,12&#xD;
&#xD;
Post-natal care is necessary to ensure that no complications have developed in the woman after childbirth. The immediate postpartum period even more challenging for mothers who have had a caesarean delivery and most often occurs in the hospital setting, where the majority of women remain for approximately 2 days after a vaginal delivery and 3-5 days after caesarean delivery. The pain presented after a caesarean section makes the recovery difficult and delays the mothers&amp;#39; mobility.12,13,14&#xD;
&#xD;
Postpartum physiotherapy assessment can identify postural and structural weaknesses arising from the pregnancy, delivery, or postpartum conditions. Physiotherapy management should be comprised of ergonomics and education as the key components for women after childbirth. Exercise has been proven to be beneficial during pregnancy as well as in the post-partum period for up to 24 weeks. Postpartum exercise improves aerobic fitness, high-density lipoprotein-cholesterol levels, insulin sensitivity, and psychological well-being. Physical activity during postpartum is both a recommended and an essential contributor to maternal health. Physiotherapists instruct women in transverses abdominus, multifidus, and pelvic floor co-activation, which strengthens core stability and is beneficial in the prevention and treatment of back pain.15-18&#xD;
&#xD;
Early ambulation is one of the very important parts of extensive postoperative care. That indicates that along with other exercises, the patient should be mobilised out of bed as soon as possible. A supervised programme within the first 24 hours is best and this should be reinforced every two hours by the team. Effective postoperative pain relief is also important to allow the patient to mobilize early.16,19&#xD;
&#xD;
Several studies evaluated the effects of physiotherapy management in early post-CS patients and found that physiotherapy can improve the well-being of females after childbirth by improving productivity and quality of life in the early stage of post caesarean section.20,21,22 In India however there are several hospitals where such services are yet to be provided. The present study was undertaken to identify the benefits of physiotherapy post LSCS.&#xD;
&#xD;
MATERIAL AND METHODS&#xD;
&#xD;
This interventional study was approved by SVIEC. Every consecutive mother who had undergone LSCS and was willing to participate in the study was recruited with the approval of the Obstetrician. Mothers with cardiac, respiratory, musculoskeletal or neurological problems and who were suffering from major pregnancy complication like severe anaemia, pregnancy-induced hypertension, and postpartum haemorrhage were excluded from the study. Participants were explained about the study and a written informed consent form was taken. Mothers eligible to participate in the study were divided into two groups by even and odd method. One control group and one was the experimental group. A total of 29 patients were recruited in the study. Out of which 14 were in the control group and 15 were in the experiment group. The Control group was verbally educated and demonstrated physiotherapy along with routine nursing care as to date was the practice. The experimental group underwent a structured physiotherapy programme from post-operative (pod) 1 up to the day of discharge in form of Assisted active and active movements of the limbs like ankle toe movements, leg slides, movement around the bed, bottom lift techniques using crook lying, gentle exercises, such as pelvic rock, knee rolls from side to side, abdominal contraction on expiration, gluteal contractions, pelvic tilt exercises and ambulation. Each exercise was performed 5-10 times. Ergonomic training was also given such as comfortable breastfeeding positions, sitting and lying on the bed, walking, elimination of urine, excretion of bowel material, diet, self-care and attention to the newborn.23,24,25&#xD;
&#xD;
The severity of pain was assessed with a visual analogue scale (VAS) on pod 1 and the day of discharge and functional mobility was assessed with the &#x201C;time up and go scale&#x201D;,26 and cadence by pedometer on the day of discharge. Peak expiratory flow rate was taken on pod 1 and the day of discharge.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
To check normality assumption descriptive statistics, normality plot, and Shapiro Wilk test was obtained for all data, it was found that PEFR at baseline in the control group and VAS on movement in the experimental group did not satisfy normality assumptions whereas all other parameters satisfied the normality assumptions. Therefore non-parametric test was carried out for PEFR at baseline in control and VAS on movement in the experimental group. A parametric test was carried for all other variables. The same type of normality check was done for difference (pre to post) of PEFR and VAS between the control and experimental group. It was seen that only VAS on movement difference in the experimental group was not satisfying normality assumptions and this variable was dealt with non-parametric and the rest of all with a parametric test.&#xD;
&#xD;
RESULT&#xD;
&#xD;
All data were entered into a Microsoft Excel sheet. Collected data were analysed using SPSS and STATA software. Descriptive statistics including mean, standard deviation (SD), and confidence interval (CI) were obtained.&#xD;
&#xD;
Table 1 shows VAS at rest in both the groups and VAS on movement in the control group was significantly reduced (P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3842</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3842</Fulltext></URLs><References>&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparing Short Term Effect of Aqua Stretch with Supervised Land-Based Stretching in Chronic Non-Specific Neck Pain Among Young Working Female Physiotherapists: A Randomized Clinical Trial&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>160</FirstPage><LastPage>167</LastPage><AuthorList><Author>Esha Pandya</Author><AuthorLanguage>English</AuthorLanguage><Author> Komal Makhecha</Author><AuthorLanguage>English</AuthorLanguage><Author>Anand Patel</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Although the natural history of neck pain appears to be favourable, rates of recurrence and chronicity are high.As physiotherapists daily deal with all work-related musculoskeletal problems and the job nature of physiotherapists including treating the patients, lifting the body part of the patients and awkward posture to treat the patients leads to neck pain. Aqua stretch is a new form of assisted stretching in the water. It is considered a breakthrough in pain management and preventive medicine. Aqua stretch exercising seems to quickly dissolve/release fascial adhesions by controlling stretch resistance. Aim: To comparing the short term effect of aqua stretch with supervised land-based stretching among young working female physiotherapists having chronic non-specific neck pain. Methodology: 60 female physiotherapists with chronic neck pain age between 22-30 years of age were randomly allocated into 2 groups (aqua stretch and land-based stretching). After signing the consent form, patients were taken for pre-intervention NDI (neck disability index) score, NPRS (numerical pain rating scale) &amp; ROM (range of motion). Then instructions about aqua stretch were given. Treatment sessions will be 3 sessions per week and each session will be of 30 minutes up to 6 weeks. NDI questionnaire will be taken on the 1st meeting and again on weeks 4th and 6th. ROM will be measured weekly till 6 weeks, NPRS will be taken immediately after every session, twice a week, till 6 weeks. Result: Statistical significance (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Key Words: Aquatic Therapy, AquaStretch, Non-specific neck pain, Chronic neck pain in physiotherapists, Musculoskeletal problems  in female physiotherapists, Stretching exercise in chronic pain</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The International Association for the Study of Pain-IASP-defines cervical spinal pain as "pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process"1 Pain is classified as chronic when it has a duration of 12 weeks or more. Chronic neck pain often presents hyperalgesia on palpation and in both passive and active movements in the neck and shoulder area. 1&#xD;
&#xD;
Although the natural history of neck pain appears to be favourable, rates of recurrence and chronicity are high. 30% of patients with neck pain will develop chronic symptoms. With neck pain longer than 6 months in duration affecting 14% of all individuals who experience an episode of neck pain. 37% of individuals who experience neck pain will report persistent problems for at least 12 months. 5% of the adult population with neck pain will be disabled by the pain, representing a serious health concern. 2&#xD;
&#xD;
Occupational health hazards are very common. As physiotherapists daily deal with&#xA0;all work-related musculoskeletal problems and the job nature of physiotherapists including&#xA0;treating the patients, lifting the body part of the patients and awkward posture to treat the&#xA0;patients leads to neck pain. The prevalence of neck pain in physiotherapists is 41% according to one study. One more study shows that the prevalence of neck pain among physiotherapists is 51.7%. Working in OPD &amp; poor posture are major factors that contributed to neck pain. 3,4&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Neck pain is the second most common work-related musculoskeletal disorder. And if we compare the prevalence of male and female physiotherapist having neck pain, female physiotherapists of relatively younger age are at higher cumulative risk of neck pain.5&#xD;
&#xD;
According to one study, commonly affected muscles are upper trapezius with&#xA0;the prevalence of 93.75%, levator scapulae with the prevalence of 82.14%, multifidi with the prevalence of 77.68% and splenius cervicis with the prevalence of 62.5%. Till now so many different techniques are developed which are used to treat chronic neck pain, but the effectiveness of assisted stretching in water is unknown.3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Aqua stretch is a new form of assisted stretching in the water. It is considered a breakthrough in pain management and preventive medicine. Aqua stretch exercising seems&#xA0;to quickly dissolve/release fascial adhesions by controlling stretch resistance, by&#xA0;changing buoyancy, and by accepting the body&#x2019;s intuitive movements that occur when&#xA0;joints are subjected to stretch pressure. In the low environment of water, the body may&#xA0;stretch in positions it cannot while under the influence of normal gravity on land and for&#xA0;much longer periods. Aqua stretch is a myofascial release technique performed in shallow water. Aqua stretch breaks down fascial adhesions using a combination of the&#xA0;facilitator/therapist&amp;#39;s manual pressure and the client/patient&amp;#39;s active movement, quickly&#xA0;restoring flexibility and reducing pain. Aqua stretch promotes relaxation, which helps to&#xA0;improve function, quality of life, sleep, and the overall ability to heal. Upon immersion, physical stress and load on the body, or the weight-bearing on the joints, is going to be extremely reduced. It is a zero-gravity event that the client experiences. The buoyancy, increase in blood flow, increase in flexibility, and reduction in joint compression will allow the participant to have increased movement with reduced restriction. They will be able to get into positions that they would not necessarily be able to get into when on land. That is exciting and a key factor in the effectiveness of this particular modality. 7&#xD;
&#xD;
A previous study was done on comparison of the effect of aqua stretch and land-based&#xA0;stretching in patients with chronic low back pain. Statistical significance (p &lt; 0.05) was&#xA0;observed in the aqua stretch group for reduction in pain with P = 0.006, in kinesiophobia with P = 0.029, and in perceived disability with P = 0.001. Both techniques are suggested to be beneficial for chronic low back pain patients however aqua stretch has key additional benefits including time efficiency and cost effectiveness.8Another study was done comparing the effect of hydrotherapy and land-based exercises in the management of chronic low back pain and they found that the two exercise media were relevant in the management of chronic low back pain, though hydrotherapy seems to be better for spinal flexibility, thus serving as a better alternative in clinical practice.9&#xD;
&#xD;
Till now no studies could be retrieved examining the effect of aqua stretch in patients with chronic neck pain. Moreover, according to the literature, it is concluded that the effect of aqua stretch is immediate and also it persist 3 to 4 times longer than the normal land-based stretches which are used by the therapist in clinical practice.7&#xD;
&#xD;
So, the need of this study was to find out better management for chronic neck pain&#xA0;which will be more effective and could be a better alternative for the management of chronic neck pain in clinical practice.&#xD;
&#xD;
AIM OF THE STUDY&#xD;
&#xD;
The study aimed to compare the short term effect of aqua stretch with&#xA0;supervised land-based stretching among young working female physiotherapists having&#xA0;chronic non-specific neck pain.&#xD;
&#xD;
OBJECTIVES OF THE STUDY&#xD;
&#xD;
&#xD;
	&#xD;
	To measure ROM (Range of Motion) Of cervical spine with a Mobile inclinometer,&#xD;
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	&#xD;
	To evaluate the pain and functional disability level with NDI (Neck Disability Index)&#xD;
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	&#xD;
	To evaluate pain perception with, NPRS (Numerical Pain Rating Scale).&#xD;
	&#xD;
&#xD;
&#xD;
MATERIALS AND METHOD:&#xD;
&#xD;
Study design Randomised clinical trial&#xA0;Study population young working female physiotherapists with chronic non-specific neck pain&#xD;
&#xD;
Study sample (TYPE OF SAMPLING)Purposive sampling&#xD;
&#xD;
Study sampling size 60 subjects with chronic non-specific neck pain&#xD;
&#xD;
Study setting Govt. and private clinics of Mangalore, Karnataka and ASIAN physiotherapy and research centre, Surat, Gujarat.&#xD;
&#xD;
Inclusion criteria: 3,5,10&#xD;
&#xD;
&#xD;
	&#xD;
	Female physiotherapists having neck pain for more than 3 months,&#xD;
	&#xD;
	&#xD;
	Age: 22-30 years,&#xD;
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	&#xD;
	Working in clinical field at least for 4-5 hours per day&#xD;
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Exclusion criteria: 3,13&#xD;
&#xD;
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	Having neck pain before starting work as a physiotherapist,&#xD;
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	Recent injuries around shoulder and neck region(less than 6 months),&#xD;
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	Hydrophobia,&#xD;
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	Any deformities (torticollis),&#xD;
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	&#xD;
	Any skin infections (tinea pedis, ring warms),&#xD;
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	Open wound,&#xD;
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	Pathological neck pain,&#xD;
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	Working in academic field,&#xD;
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	History of uncontrolled seizures during the last year,&#xD;
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Outcome measures&#xD;
&#xD;
&#xD;
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	Neck disability index&#xD;
	&#xD;
	&#xD;
	Numerical pain rating scale&#xD;
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	&#xD;
	Cervical spine range of motion&#xD;
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Method of collection of data&#xD;
&#xD;
Subjects were screened and were selected according to the inclusion criteria. All subjects were asked to sign the written consent form stating the voluntary acceptance to participate in the study. &#xD;
&#xD;
Then the demographic information (i.e. age, gender, height, weight, and other details) was collected from all selected subjects. Then a screening questionnaire was given to the patient to confirm the neck pain and the pain is because of their work. After that subjects were selected according to the inclusion. &#xD;
&#xD;
Subjects were asked not to participate in any form of additional therapy for the duration of the study. They were asked to refrain from taking any pain-relief or anti-inflammatory medication on the data collection and intervention days. The subjects were instructed to continue their normal levels of physical activity throughout the study period without changes. They were specifically instructed to avoid any new form of treatment for chronic neck pain. &#xD;
&#xD;
Then the first set of NDI (Neck disability index) questionnaire, NPRS (Numericalpain rating scale) and ROM (Range of motion) of the cervical spine was completed by the subjects. &#xD;
&#xD;
Randomization and allocation:&#xD;
&#xD;
Subjects were randomly assigned into two groups (aqua stretch and land-based stretching) using a blind chit method to assign participants to each of the two groups, aqua stretch and land stretching (Figure 1).&#xD;
&#xD;
&#xD;
&#xD;
Intervention&#xD;
&#xD;
1) Land stretching group: For all stretches, position of the subjects was supine.Therapist was at the head of the treatment table. Hand placements was according tocomfort and size of the subject&#x2019;s head. All stretches will be repeated 3 times with 30 seconds of hold. 13&#xD;
&#xD;
&#x2022; Stretching of upper trapezius: Position of subject and therapist was as describedabove. For stretching of upper trapezius, therapist&#xA0; stabilized the subject&#x2019;s shoulder of one side (more affected side will be stretched first) with one hand and then took subject&#x2019;s head in lateral flexion to the opposite side. This was be repeated on other side too.13&#xD;
&#xD;
&#x2022; Stretching of levator scapulae: Position of subject and the therapist was as described above. For stretching of levator scapulae, the therapist stabilized the subject&#x2019;s shoulder on the side to be stretched and with the other hand, held the subject&#x2019;s head from occiput. Then therapist took the subject&#x2019;s head in flexion, opposite side lateral flexion and opposite side rotation. This was repeated on another side too (Figure 2).13&#xD;
&#xD;
&#x2022; Stretching of splenius cervicis: The position of therapist and subject was as described above. For stretching of splenius cervicis, the therapist stabilized the subject&#x2019;s shoulder on the side to be stretched and with the other hand, held the subject&#x2019;s head from occiput. Then therapist took the subject&#x2019;s head on opposite side flexion and rotation (Figure 3).13&#xD;
&#xD;
2) Aqua stretch group: For an aqua stretch, muscles to be stretched were the same as land stretching. The position of the subject was supine (buoyancy supported) with ankle and wrist floaters. The position of the therapist was the same as land stretching. All stretches were also the same as land stretching following the four-step procedure of aqua stretch. Just the treatment media was changed to water. The temperature of the pool water was maintained at around 28 degrees.7,13&#xD;
&#xD;
The four strep procedure of aqua stretch is as below:&#xD;
&#xD;
1. Play: Patient is asked to move (play) with their body&#x2019;s movement until they experience pain or restriction.&#xD;
&#xD;
2. Freeze: Patient freezes in the exact position they feel pain or tension&#xD;
&#xD;
3. Pressure: The therapist applies pressure to the area of pain or restriction, while the client maintains&#xD;
&#xD;
a frozen position (Figure 4, 5).&#xD;
&#xD;
4. Move: Patient is asked to move if they feel the need to move&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
EXERCISE DOSAGE: &#xA0;Both the interventions were given 3 sessions per week till 6 weeks.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Statistical analysis was performed using Statistical Package for Social Sciences (SPSS&#xD;
&#xD;
v21.0.0). Results were considered statistically significant at a 95% confidence level (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3843</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3843</Fulltext></URLs><References>&#xD;
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	Misailidou V, Malliou P, Beneka A, Karagiannidis A, Godolias G. Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools. J Chiropr Med. 2010 Jun 1;9(2):49&#x2013;59.&#xD;
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	Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017;47(7): A1&#x2013;83.&#xD;
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	Shah. S, Kachhadiya A., Kachhadia A, Savani P, Shukla V, Patel A, Parmar E, et al. Prevalence of back and neck pain among physiotherapists. Ind J Physiother Occup Ther Int J. 2012;6(4):1-3&#xD;
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	Shah I, Gangwal A, Bedekar N, Shyam A, Sancheti P.Work related musculoskeletal disorders among Indian physiotherapists. Ind J Physic Ther.2016 Jul 3;4(1):20-4.&#xD;
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	Khan U, Fasih M.Prevalence of work related neck pain among physiotherapists and its association with age and gender. Pak J Physiol.2017;13(3):39-42.&#xD;
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	Cerezo T&#xE9;llez E, Torres Lacomba M, Mayoral Del Moral O, S&#xE1;nchez S&#xE1;nchez B, Dommerholt J, Guti&#xE9;rrez-Ortega C. Prevalence of Myofascial Pain Syndrome in Chronic Non-Specific Neck Pain: A Population-Based Cross-Sectional Descriptive Study. Pain Med. 2016;17(12):2369&#x2013;77.&#xD;
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	Sova, R. (2012). Introduction of Aquatic Therapy and Rehab. (Third Edition). Port Washington, WI: DSL, Ltd&#xD;
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	Keane LG. Comparing AquaStretch with supervised land-based stretching for Chronic Lower Back Pain. J Bodyw Mov Ther. 2017 Apr 1;21(2):297-305.&#xD;
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	Bello AI, Kalu NH, Adegoke BOA, Agyepong-Badu S. Hydrotherapy Versus Land-Based Exercises in the Management of Chronic Low Back Pain: a Comparative Study. J Musculoskelet Res. 2010;13(4):159&#x2013;65.&#xD;
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	Glover W. Work-related Strain Injuries in Physiotherapists: Prevalence and prevention of musculoskeletal disorders. Physiother. 2002 Jun 1;88(6):364-72.&#xD;
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	Y., Tousignant-Laflamme, N. Boutin, A.M. Dion C., A. Vallee C.A., Vallee. Reliability and criterion validity of two applications of the iPhone to measure the cervical range of motion in healthy participants. J Neuroeng Rehabil. 2013;10(1):69.&#xD;
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	Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991 Sep;14(7):409-15.&#xD;
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	Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis; 2017 Oct 18.&#xD;
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	H&#xE4;kkinen A, Salo P, Tarvainen U, Wiren K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehab Med. 2007 Sep 5;39(7):575-9.&#xD;
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	Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation vs. Mobilization on pain and range of motion in the cervical spine: A randomized controlled trial. J Manipulative Physiol Ther. 1993;16:279-80. &#xD;
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	Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: a randomized, controlled trial. Ann Internal Med. 2002;136:713-22.&#xD;
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	Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, C&#xF4;t&#xE9; P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009;32:S61-9.&#xD;
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	Ngai SZ. Some conceptual issues in disability and rehabilitation. In: Sussman MB, editor. Sociology and rehabilitation.Washington (DC): Amer Soci Assoc. 1965. P100-13.&#xD;
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	Riaz F, Haider R, Qamar MM, Basharat A, Manzoor A, Rasul A, Ayyoub A, Ahmad W. Effects of static stretching in comparison with Kaltenborn mobilization technique in nonspecific neck pain. J Health Sci. 2018 Jul 1;3(2):85.&#xD;
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	Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Health Sci. &#xA0;2017 Jan 1;30(6):1149-69.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Routein Immunization Coverage and Factors Associated with Non-Compliance of Immunizations by Parents of Children Aged 0-5 Years&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>168</FirstPage><LastPage>173</LastPage><AuthorList><Author>Manisha Praharaj</Author><AuthorLanguage>English</AuthorLanguage><Author> Kshirabdhi Tanaya</Author><AuthorLanguage>English</AuthorLanguage><Author> Saurjya Ranjan Das</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Immunization, Factors, Noncompliance, Parents, Children, Odisha</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Immunization prevents most childhood diseases and it is the most cost-effective way of health intervention. The Government of India implements the vaccination programme by the guidelines set by EPI (Expanded Programme on Immunization). The immunization schedule includes OPV, IPV, BCG, Pentavalent vaccine (Diphtheria, Pertussis, Tetanus, Hib, Hepatitis &#x2013; B), Rotavirus vaccine, MMR vaccine (measles, mumps, rubella) and Japanese encephalitis vaccine. According to the NFHS-3 in India, the percentage of immunization increased from 36.0% in (1992) to 42.0% in (1998) and further to 44.0% in (2005) of the children in age one to two years.&#xA0; But it is still, very less than the desired goal of achieving 85.0% coverage.1,2 These all vaccines are provided free of cost to all children. The EPI has conducted immunization day and campaigns, fixed areas for vaccinations, mobile vaccination teams to reach small villages and unvaccinated areas.3 As per many surveys still there are a lot of children who are not receiving complete recommended vaccines according to their age. &#xD;
&#xD;
The knowledge and belief of parents, proper information regarding vaccines are more important factors for giving vaccines.4 many factors contribute to non-compliance of immunization including difficulties in reaching immunization service centre, lack of awareness, misinformation about vaccines, adverse effect of vaccines, lack of knowledge regarding vaccine-preventable diseases, lack of communication between parents and source of immunization providers, deficiency of knowledge in parents regarding contraindication and adverse effect of vaccines. Many parents believe mild illness is associated with immunization; therefore, mild illness also considered as not giving vaccines to their children etc.5,6 It is important to improve parent&#x2019;s knowledge regarding adverse effects and benefits of vaccines, national immunization schedule and other information. Proper practice of immunization by parents will reduce many infectious diseases and practice can be improved by correct information and proper communication regarding the risks and benefits of vaccines. There should be a strong source of information. Therefore, all health care providers, media, social media play an important role in improving parent&#x2019;s perceptions of the risks and benefits of vaccines.7,8&#xD;
&#xD;
The Global vaccine action plan 2011-2020 approved in 2012 by the World Health Assembly to achieve &#x2265;90% national coverage of all the vaccines in their countries according to their national immunization schedule by 2020.9 According to a report given by H. Pletcher in 2017, in India the population of 0 &#x2013; 14 years of children are about 27.78 percentage.10 A survey by National Family Health in 2016 in India shows the percentage of vaccination coverage of children between 12-23 months of age received all recommended vaccines in Odisha 78.6%, Punjab 89.5%, Goa 88.4%, West Bengal 84.4% and Kerala 82.1%. As per World Health Organization and UNICEF 27 million children and 40 million pregnant women worldwide do not receive routine immunization and around 10 million children under the age of five years die every year and over 27 million infants in the world do not get coverage of full routine immunization. In the developing world, it does not only prevent about 3 million child death per year but also has the potential to avert additional 2 million deaths if immunization programmes are expanded and fully implemented.11 According to Global Immunization coverage in 2017 the percentages of received different vaccines by the children are: Hib vaccine is estimated at 72%, Hepatitis B vaccine taken 84%, Measles vaccine taken 85%, Rotavirus taken 28%, Polio vaccine taken 85%.12&#xD;
&#xD;
MATERIALS &amp; METHODS&#xD;
&#xD;
Research design and setting&#xD;
&#xD;
The research design was a non-experimental descriptive survey. The research approach used for the present study was quantitative. The data was collected directly from study subjects by using a dichotomous (yes/no scale).&#xD;
&#xD;
Sample and Sampling technique&#xD;
&#xD;
The samples for the present study were the parents of children between 0 to 5 years and the samples were collected from different community areas of Bhubneswar, Odisha by using the purposive sampling technique. The sample size was calculated by (z2* p&#x2C6; [1&#x2212;p&#x2C6;]/&#x3B5;2) where z is (1.96), &#x3B5; is margin error (7.4) and p&#x2C6; is population proportion (45.6).&#xA0; thus, the sample size for the present study was 169. &#xD;
&#xD;
Inclusion and exclusion criteria&#xD;
&#xD;
The parents were chosen who has children less than 5 years, who can read and understand the local language because the parents are responsible to vaccinate their child and the study focused on the factor parents could not vaccinate their child. The parents were excluded from the study who did not meet the criteria.&#xD;
&#xD;
Methods of data collection&#xD;
&#xD;
In this cross-sectional study, a self-administered questionnaire was designed to collect data from participants, to know the factors causing non-compliance of immunization, to measure the variables and to test the hypothesis quantitatively. The self-structured questionnaire has two parts. Part A: contains socio-demographic characteristics of parents aged 0 &#x2013; 5 years of children. Part B: consists of 26 questionnaires about perceived barriers for non &#x2013; compliance of immunization by parents of 0 &#x2013; 5 years of children. Each item has yes/no options. Data collection was done during June &#x2013; July 2019 after formal written permission from Anganwadi worker of Bharatpur AWC (Anganwadi centre), Anganwadi worker of Adibasi gaon-2 AWC, Medical officer of Urban PHC (Public Health Centre) IRC village. The self&#x2013;structured questionnaire was given to all the participants followed by an interview and checking the immunization card.&#xD;
&#xD;
Data were analysed by using SPSS (Statistical Package for the social sciences, 20.0) licensed to the institute. Variables are expressed by frequency, percentage, mean and SD (Standard Deviation). Chi-square test was used to find out the association. P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3844</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3844</Fulltext></URLs><References>&#xD;
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	Jheeta M, Newell J. Childhood vaccination in Africa and Asia: the effect of parents&#x2019; knowledge and attitude. Bull World Health Organ 2008; 86:419-420.&#xD;
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	WHO 8.7.2008: the module for mid-level managers: The EPI coverage survey WHO/IVB/08.07.08.Availablefrom:http://www.who.int/immunization/documents/mlm/en/indx.html. (Last accessed on 2016 Jan 15).&#xD;
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	Awosan KJ, M.T.O. Ibrahim, Knowledge, attitude and compliance with full immunization of children against vaccine-preventable diseases among pregnant mothers in Sokoto, /Nigeria. Int J Contemp Med Res. 2018;(5):10-16.&#xD;
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	Mugada V DivyaSai, knowledge towards childhood immunization among mothers &amp; reasons for incomplete immunization. J Appl Pharm Sci. 2017: 7(10):157-161.&#xD;
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	Bello L, Yunusa U, Determinants of parental compliance with routine childhood immunization schedule in Nassarawa State, Nigeria. Int J Nur Care. 2017;(1): 1-7&#xD;
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	Esohe Konwea Patience, Alice D, Determinants of compliance with child immunization among mothers of children under five years of age in Ekiti State, Nigeria. J Health Res. 2018; 3(32). Pp.229-236. &#xD;
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	Choudhary B, Solanki S. Knowledge and Practices of Caretakers About Immunization Among Children Aged 12 - 23 Months of Rural block Gudamalani, District Barmer (Rajasthan). Int J Curr Res Rev. 2017;9(3);28-33.&#xD;
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	Babirye JN, Berwa R, More support for mothers: a qualitative study on factors affecting immunization behaviour in Kampala, Uganda. BMC Public Health. 2011;(11). P.723.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Psychological Impact of the Covid -&#xA0;19 Pandemic on Health Professionals&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>174</FirstPage><LastPage>178</LastPage><AuthorList><Author>Rosa PS</Author><AuthorLanguage>English</AuthorLanguage><Author> Hernan MS</Author><AuthorLanguage>English</AuthorLanguage><Author> Eduardo MS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The coronavirus pandemic nowadays is one of the most important challenges for health professionals, since, during this situation, many of them are under pressure regarding their physical and mental health. Objective: The objective is to determine the psychological impact of the COVID-19 pandemic on health professionals, which it will allow observing what psychological impact exists on health professionals from different Hospitals and Health Centers of Lima - North. It is a descriptive and cross-sectional design, the population is made up of 100 health professionals from different hospitals and health centers in North Lima. Results: The psychological impact on health professionals from different hospitals and health centers in North Lima, of the 100 health professionals participating in the research work, 42.0% of health professionals have a medium psychological impact, 33% have a low psychological impact and 25% have a high psychological impact. Conclusions: It is concluded that the health professional must be adequately trained and oriented for the activities of care for patients who have the disease since programs must be specified in which professionals can access and be able to adapt to the reality that is happening to not perform the attentions of inadequate way.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>COVID &#x2013; 19, Health personnel, Mental health, Pandemic</Keywords><Fulltext>Introduction &#xD;
&#xD;
The consequences of the rapid expansion of the coronavirus (COVID - 19),&#xA0; worldwide, has had an impact on society, generating fear and concern both in the population and in health professionals, for which the World Health Organization (WHO) in terms of public and professional mental health maintains that the psychological impact has generated increased stress and anxiety in health professionals because they are available in first-line care against this disease.1&#xD;
&#xD;
Also, in our country, the COVID-19 disease has potentially exposed the population and health professionals, generating negative effects on them, such as stress, worry, fear that they may be infected, they are factors that predispose the population but that in health personnel alters the quality of care for patients.2&#xD;
&#xD;
The COVID &#x2013; 19 pandemic today is one of the most important challenges for health professionals, since, during this situation, many of them are under pressure regarding their physical and mental health-compromising their physical and mental well-being,3 however, in the health professional is not only altered physical and mental health due to this disease, also the quality of care that health professional performs during its working hours is altered.4,5&#xD;
&#xD;
Also, health professionals are not only under high pressure to work day by day fighting in the first line of care for the (COVID - 19), but they are also highly exposed to being at risk of contagion of the COVID-19, due to inadequate protection, frustration, discrimination, isolation and interacting with patients with negative thoughts about their health, all this has repercussions on the health professional causing physical and mental exhaustion.6,7&#xD;
&#xD;
The psychological impact caused by the virus has generated fear for those who may be the carriers of the virus and therefore, they can transmit it to their family if they continue working, therefore many of the workers have resigned leaving a burden of excessive work to other health workers where there is a probability that they due to the high demand for care, may be carriers of this disease,8since being continuously in contact with COVID-19 patients makes the mental health of health professionals can relapse and can be infected by the decrease in their physical and mental well-being and that can be affected in the medium and long term while the pandemic is still present.9&#xD;
&#xD;
In Spain, after declaring a state of sanitary emergency, a situation of increased stress was seen, a work burden of the health professional, while research was carried out to observe the degree of psychological impact that health professionals had with pictures of depression, anxiety, stress, and insomnia in a population of 421 health professionals where 46.7% of the professionals surveyed presented stress pictures, 37% presented anxiety pictures, 27.4% presented depression pictures and the 28.9% presented insomnia.10&#xD;
&#xD;
In the research work carried out in Saudi Arabia, it was observed that 582 health workers surveyed, the degree of anxiety presented by health workers for Coronavirus disease 19 (COVID-19) is higher than in the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) or seasonal influenza, where 41.1% are more anxious and concerned about COVID-19, 41.4% are anxious and concerned about MERS-CoV and COVID-19, and 17.5% are more anxious, concerned, and stressed about the MERS-CoV outbreak at the hospital, therefore, the health workers were in a degree of anxiety in such a way that they thought that the infection would not only reach them but also their relatives.11&#xD;
&#xD;
In the research work carried out in Singapore, it was mentioned that health workers have a higher prevalence of contracting anxiety, stress, and depression, especially nursing professionals since they are in the first line of care and are in contact with the patient every time because they do not have relevant information about this disease that allows them to know how to act appropriately and also have the necessary protective equipment and infection control measures to counteract it.12&#xD;
&#xD;
The objective of the research work is to determine the psychological impact of the COVID-19 pandemic on health professionals, 2020, which it will allow observing what psychological impact exists on health professionals from different Hospitals and Health Centers of Lima - North. This study is important since it will provide relevant and real data about the mental vulnerability that health professionals have as the first line of action against this disease.&#xD;
&#xD;
In the present research, the depression, anxiety, and stress scale (DASS-21) will be used as the data collection instrument. The data collection was processed through the survey of health professionals from different Hospitals and Health Centers of Lima - North, the data to be entered was carried out in a data matrix that will be designed in the statistical program IBM SPSS Statistics Base 25.0, it proceeded to its corresponding analysis, which will allow to better process data to make statistical tables so that they can be described and interpreted in results and discussions, respectively.&#xD;
&#xD;
This study is important since it will observe in the health professional the mental quality, due to the difficulties present in the global crisis by the coronavirus pandemic, where the health professional has not have been adequately trained or prepared to face this disease.&#xD;
&#xD;
Methodology&#xD;
&#xD;
Research type and Design&#xD;
&#xD;
The present study, due to its characteristics, the way of collecting data and measurement of the variables involved is a quantitative approach. As for the methodological design, it is a non-experimental, descriptive, cross-sectional study.13&#xD;
&#xD;
Population and Sample&#xD;
&#xD;
The population is made up of 100 health professionals from different hospitals and health centers in North Lima - Peru.&#xD;
&#xD;
Inclusion Criteria&#xD;
&#xD;
Health Professionals including doctors, nursing graduates, and nursing technicians who are directly in contact with patients infected with COVID &#x2013; 19.&#xD;
&#xD;
Health Professionals who signed the consent informedACTA N&#xB0;036-2020-CE/UMA UNIVERSIDAD MARIA AUXILIADORA.&#xD;
&#xD;
Exclusion Criteria&#xD;
&#xD;
Those health professionals who are not directly in contact with patients infected with COVID &#x2013; 19 are excluded. &#xD;
&#xD;
Technique and Instrument&#xD;
&#xD;
The technique used was the survey, using the questionnaire or data collection instrument DASS-21, which aims to measure the psychological impact of the COVID-19 pandemic on health professionals.&#xD;
&#xD;
The depression, anxiety, and stress scale (DASS-21), each of the three DASS scales contain 14 elements, divided into subscales of two to five elements with similar content. The 3 scales are the physical, mental and environmental levels of the person. It consists of four response alternatives, 0 "not at all", 1 "sometimes", 2 "much of the time" and 3 "most of the time" that serve to rate the degree to which each state has experienced during the last week. To obtain the final score of the DASS-21, the total score obtained must be multiplied by two (data x2).1.4&#xD;
&#xD;
Place and Application of the Instrument&#xD;
&#xD;
The survey carried out to measure the psychological impact on health professionals was carried out at different Hospitals and Health Centers in North Lima.&#xD;
&#xD;
To start the data collection process, it was coordinated with health professionals such as Doctors, Nursing Graduates, and Nursing Technicians from the Essalud Marino Molina Hospital, Sergio E. Bernales Hospital, Lanfranco la Hoz Hospital, Villa Norte Health Center, and San Martin Confraternidad Health Center to be participants of the research work, although there were limitations to carry out the work because not all health personnel was available to be in the present research work.&#xD;
&#xD;
Results&#xD;
&#xD;
In Table 1, 100 health professionals participating in the research work, 42.0% of health professionals have a medium psychological impact, 33% have a low psychological impact and 25% have a high psychological impact.&#xD;
&#xD;
In Table 2, the psychological impact about the gender of health professionals is related, which was determined with the Pearson chi-square test (X2). The level of significance of the test obtained a value of 6.25 (p&gt; 0.05) (X2 = 12.011; d.f = 2). Therefore, a dissociation hypothesis is not rejected, which is why it verifies that there is no relationship between the psychological impact and the gender of health professionals. Therefore, it can be observed that in the female sex 34 (45.3%) present a medium psychological impact, 23 (30.7%) medium psychological impact, and 18 (24%) low psychological impact, as for the male sex 15 (60%) present a low psychological impact, 8 (32%) medium psychological impact and 2 (8%) high psychological impact.&#xD;
&#xD;
In Table 3, the psychological impact is related according to the type of health professional, which was determined with Pearson&amp;#39;s chi-square test (X2). The level of significance of the test obtained a value of 3.75 (p&gt; 0.05) (X2 = 7.356; d.f = 4). Therefore, an association hypothesis is not rejected, for which there is statistical data that verifies the relationship between the psychological impact and the type of health professionals. It can be seen that 100 health professionals participating in the research work, 43.1% of Nursing Graduates have a medium psychological impact, 31.6% have a low psychological impact and 25.5% have a high psychological impact, in Doctors, 60.0% have a low psychological impact, 33.3% have a medium psychological impact and 6.7% have a high psychological impact, in Nursing Technicians, 44.1% present a medium psychological impact, 33.0% present a low psychological impact and 25.0% present a high psychological impact.&#xD;
&#xD;
Discussions&#xD;
&#xD;
This study raises the issue of psychological impact from the point of view of the promotion of mental health on health professionals, in which it seeks to contribute to programs that benefit the professional with the necessary capacity to face this disease, promoting the ability to adapt and make the right decisions so that they can provide adequate care in patients prone or infected by the coronavirus.&#xD;
&#xD;
These obtained results reflect the crucial role of health professionals during a pandemic, making them more susceptible to presenting symptoms of anxiety, stress, and depression, because health systems are not adequate to be able to provide care effectively, in addition to the fact that the health professionals are afraid of getting this disease and that they may infect their relatives once they are at home. In the same way, M. Temsah et al.,11 maintain that health professionals as the first line of care for COVID-19 are more likely to contract pictures or symptoms of depression, anxiety and stress, as a result of the amount of attending patients.&#xD;
&#xD;
Many of the factors that cause anxiety, depression, and stress are linked to workload, excessive work hours and overtime shifts due to lack of personnel, affect the health professional because they must adapt to the situation and high demand of the population that is having this disease; therefore, health professionals are not in optimal conditions to carry out an effective work that allows care to be carried out correctly. In the same way, Tan B. and collaborators,12 stating that the factors that affect health professionals to contract symptoms of depression, anxiety and stress are the long working hours, the high demand of patients due to COVID - 19, and the excessive workload they present due to lack of personnel.&#xD;
&#xD;
In addition to the conditions where the care is carried out, they do not have the necessary equipment from both the same health establishment and the health professional who cannot acquire the appropriate protective equipment for such care, therefore they are at risk of getting this disease if they do not have adequate protection, which is interpreted by Walton M. et al.3 who argue that the lack of biosafety equipment, inadequate care conditions, and equipment that does not predispose the health facility are the risk that compromises the health professionals to contract COVID - 19.&#xD;
&#xD;
Regarding gender, we can interpret that the female sex is the one that presented a medium psychological impact; therefore, it can be interpreted that as a woman the mental health aspect is more compromised than the men since as being emotional and sentimental, they tend to decrease the capacity mental than in males. Santamar&#xED;a M. and collaborators10, sustain that women are the ones with the highest levels of anxiety and stress during the COVID-19 pandemic because their mental health is unbalanced and they feel fear and concern about being infected at the moment to attend patients with COVID - 19, and thus is a predisposition to increase their levels of anxiety and stress.&#xD;
&#xD;
It is recommended that the headquarters where health professionals work provide adequate training for the management of patients with COVID - 19.&#xD;
&#xD;
It is recommended to look for strategies that allow health professionals to maintain their optimal mental health to provide quality care in COVID-19 positive patients.&#xD;
&#xD;
A psychological intervention strategy planning is recommended for health professionals through telemedicine care.&#xD;
&#xD;
The limitation in the present research work was the access to carry out virtual surveys to health professionals since as professionals in the first line of care against COVID-19, they did not have time to be in the study or be able to develop the survey.&#xD;
&#xD;
This research study will benefit future research on the main topic since in our country there have not been many studies on the psychological impact generated by COVID-19 on health professionals.&#xD;
&#xD;
Conclusions&#xD;
&#xD;
In conclusion, the psychological impact caused by the COVID-19 pandemic has produced a broad and substantial effect that can be long-lasting over time, negatively affecting health professionals, since they must be adequately trained and oriented for the activities of care for patients who get the disease since programs must be specified in which professionals can access and be able to adapt to the reality that is happening if proper care is not performed.&#xD;
&#xD;
It is concluded that there is no hypothesis of an association between the psychological impact of the sex of health professionals.&#xD;
&#xD;
It is concluded that there must be programs that support the mental health of professionals who are on the first line of care for COVID - 19.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
The authors declare no conflict of interest.&#xD;
&#xD;
Funding Source&#xD;
&#xD;
This research work doesn&#x2019;t have Funding Sources&#xD;
&#xD;
Acknowledgment&#xD;
&#xD;
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;
Author&#x2019;s Contributions&#xD;
&#xD;
Rosa PS: Conceived and designed the analysis, wrote the paper, analysis tools, and translation.&#xD;
&#xD;
Hernan MS: Collected the data, Performed the analysis. &#xD;
&#xD;
Eduardo MS: Contact the people for the survey-taking.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3845</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3845</Fulltext></URLs><References>&#xD;
1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Organizaci&#xF3;n Mundial de la Salud. Mental health and COVID-19.. OMS. 2020. &#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Medina R, Jaramillo L. El COVID-19: Cuarentena y su Impacto Psicol&#xF3;gico en la poblaci&#xF3;n. Scielo, n&#xFA;m. 1.Recuperado el 16 de Agosto del 2020. Scielo. 2020;1:1&#x2013;12. &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Walton M, Murray E, Christian M. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Hear J Acute Cardiovasc Care. 2020;9(3):241&#x2013;7. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mu&#xF1;oz C, Rumie H, Torres G, Villarroel K. Impacto en la salud mental de la(del) enfermera(o) que otorga cuidados en situaciones estresantes. Cienc Y Enferm . 2015;21(1):45&#x2013;53. &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Xiao X, Zhu X, Fu S, Hu Y, Li X, Xiao J. Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: a multi-centre cross-sectional survey investigation. J Affect Disord. 2020;274:405&#x2013;10. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lozano A. Impacto de la epidemia del Coronavirus (COVID-19) en la salud mental del personal de salud y en la poblaci&#xF3;n general de China. Rev Neuropsiquiatr. 2020;83(1):51&#x2013;6. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Blake H, Bermingham F, Johnson G, Tabner A. Mitigating the psychological impact of covid-19 on healthcare workers: A digital learning package. Int J Environ Res Public Health [Internet]. 2020;17:2997. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chew N, Lee G, Tan B, Jing M, Goh Y, Ngiam N, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020; 21:113&#x2013;116.&#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Batalla D, Campoverde K, Broncano M. El impacto en la salud mental de los profesionales sanitarios durante la COVID-19. Rev Enfermer&#xED;a y Salud Ment. 2020;16:17&#x2013;25. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Santamar&#xED;a M, Etxebarria N, Rodriguez I, Albondiga J, Gorrochategui M. Impacto psicol&#xF3;gico del COVID-19 en una muestra de profesionales sanitarios espa&#xF1;oles. Rev Psiquiatr Salud Ment. 2020;1&#x2013;13. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Temsah M, Al-Sohime F, Alamro N, Al-Eyadhy A, Al-Hasan K, Jamal A, et al. The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country. J Infect Public Health. 2020; 3(8): 829-832.&#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Tan B, Chew N, Lee G, Jing M, Goh Y, Yeo L, et al. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020;16(4): 542-546. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Fern&#xE1;ndez C, Baptista P. Metodolog&#xED;a de la Investigaci&#xF3;n. 6ta ed. M&#xE9;xico: Mc Graw-Hill/Interamericana.. 2015. 1&#x2013;634 . &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Lovibond A. Depression Anxiety Stress Scale (DASS-21). Psychology Foundation of Australia. Sydney - Australia. 1995&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Endocrown: An Approach Towards Management of Endodontically Treated Teeth -A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>179</FirstPage><LastPage>182</LastPage><AuthorList><Author>Shanvi Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Seema Sathe Kambala</Author><AuthorLanguage>English</AuthorLanguage><Author> Dipak Manohar Shinde</Author><AuthorLanguage>English</AuthorLanguage><Author>  Surekha Godbole Dubey</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Endocrowns are considered a viable option for the restoration of posterior endodontically treated and badly destructed teeth. When compared with conventional post &amp; core crowns, the procedure involving the endocrown fabrication is considered more practical, less complex &amp; easy to perform. Aims: To manage extensively damaged posterior teeth with a PFM based endocrown type of restoration. Methodology: This case report describes the management of extensively damaged endodontically treated posterior teeth, with endocrown-type restorations fabricated with metal ceramic-based prostheses with a 6-month follow-up period. Result: The porcelain-fused-to-metal prosthesis [PFM] based endocrown luted with GIC under proper isolation adheres perfectly with the bio integration concept and also had a success rate. Conclusions: Endocrowns has been considered as a promising treatment alternative for posterior endodontically treated teeth having excessive loss of coronal tooth structure associated with limited interocclusal space based on the patient&#x2019;s affordability and esthetic demands. The endocrown adheres perfectly with the bio integration concept &amp; it should be used in restorative dentistry &amp; should be more widely known.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Endocrown, Porcelain-fused-to-metal prosthesis (PFM), Post-endodontic restoration, Esthetics</Keywords><Fulltext>INTRODUCTION-&#xD;
&#xD;
It remains a challenge to restore an endodontically treated tooth that has been extensively damaged. Their biomechanical deterioration impacts the tooth&#x2019;s long-term prognosis.&#xD;
&#xD;
The most commonly used restoration for these teeth still involves a post-retained foundation restoration and a crown. Increasing the retention of the core structure is the only advantage of post-insertion. Conversely, there is an increased risk of root fracture due to the weakening of the tooth structure because of intracanal retention. This type of restoration, as being invasive, makes the tooth prone to fracture (irreversible) &amp; eliminates the chances for future interventions.1, 2&#xD;
&#xD;
With progress in the advances of adhesive techniques, the emergence of minimally invasive dentistry without a post or crown is challenging the post-and crown concept.1 The monoblock technique, the antecedent of the endocrown was first described by Pissis in 1995.2&#xA0; In 1993, Bindl and Mormann used the term-endocrown for the first.3 They discovered an adhesive restoration made up of monolithic ceramic secured to the pulp chamber, exploiting micromechanical retention properties of the walls of the pulp chamber.&#xD;
&#xD;
CASE REPORT-&#xD;
&#xD;
A female patient, 32 years old, reported to the Department of Prosthodontics and Crown &amp; Bridge from the conservative &amp; endodontics department with restoration in the upper left back tooth region. The patient gave a history of Root Canal Treatment done on the same tooth 5 days back and her medical history was non-contributory.&#xD;
&#xD;
On a complete clinical examination, severe coronal loss of tooth structure was seen (Figure 1) Intra-oral periapical radiograph of 24, 25 shown an acceptable root canal filling without any indication of the periapical lesion and the patient was also asymptomatic.&#xD;
&#xD;
Due to extensive destruction of coronal tooth structure, presence of thin walls, patient&#x2019;s severe economic constraint, conservative post-endodontic management with a metal ceramic-based endocrown (Porcelain Fused to Metal ) was suggested as it has been considered as a practical, conservative,4 less complex &amp; easily performed when compared with that of conventional crowns with post and core &amp; after explaining the treatment options to the patient, informed consent was obtained and treatment is planned for endocrown.&#xD;
&#xD;
Clinical procedure for metal-ceramic endocrown with 24,25&#xD;
&#xD;
The tooth preparation was done according to the Bindl and M&#xF6;rmann technique. At first, the reduction of the occlusal surface of the tooth (1.5-2mm) was carried out using a diamond wheel orienting it parallel to the occlusal surface. Using a flat end diamond bur at high speed, the cervical margins were levelled in shoulder shape maintaining a 1.5 mm thickness uniformly with the remaining coronal tooth structure under a constant cooling system throughout the procedure. (Figure 2)&#xD;
&#xD;
The orientation of the bur was along the long axis of the tooth &amp; a 7 to 10&#xB0; of occlusal convergence was tried to maintain ensuring a constant flow of the prepared coronal pulp chamber &amp; access cavity of depth approximately 3mm.&#xD;
&#xD;
Opening of the root canal was carried out, and removal of GP (gutta-percha) 2 mm below each orifice level was completed, followed by complete sealing of the coronal orifices and the pulp chamber (2 mm thick) with glass ionomer restorative cement-Type II. The shouldered walls and margins were then smoothed with a finishing bur TR21EF (Dia-Burs, Mani).&#xD;
&#xD;
Gingival retraction cord 00 (Ultracord, Dent One Inc, USA) was applied along the gingival crevice and a polyvinyl siloxane impression was made (Aquasil LV, Dentsply DeTrey, Germany) using a single step putty wash impression technique (Figure 3) and for further processing, it was sent to the laboratory. Using tooth moulding temporary self-cure resin material, Temporization was done to maintain the dimensions of the prepared tooth in the inter-appointment period. &#xD;
&#xD;
Also, sandblasting of the fabricated Porcelain Fused to Metal [PFM] endocrown was done to enhance the retention of this conservative single piece restoration (Figure 4 and 5) followed by luting of the final finished PFM based endocrown with GIC under proper isolation (Figure 6 and 7). The patient was then recalled after 6 months.&#xD;
&#xD;
DISCUSSION-&#xD;
&#xD;
In today&#x2019;s era of adhesive dentistry, endocrown may be considered as a viable, feasible &amp; conservative alternative to conventional crowns with post and core restorations. &#x201C;The endocrown is secured to a pulpless posterior tooth, attached with the interior portion of the pulp chamber &amp; cavity margins, obtaining micro-mechanical retention provided by the pulpal walls &amp; micro-retention provided by the adhesive cementation&#x201D;. In addition, it is an easier technique, has better acceptance, and require less clinical time making it a superior alternative amongst the various treatment options.&#xD;
&#xD;
In another 2-year clinical study, according to Bernhart et al5 endocrowns presents a very promising treatment alternative for posterior endodontically treated teeth as well as it is proved to be very simple, feasible and having a success rate.&#xD;
&#xD;
The endocrown adheres perfectly with the bio integration concept &amp; can be a preferred choice for restoration of extensively damaged posterior endodontically treated teeth. Indications of endocrowns are especially in molars with roots that are small dilacerated, fragile, obliterated and severely mutilated tooth and also in situations, with extensive coronal tooth structure loss (i.e., &#x2265;1/2 residual tooth structure) associated with inadequate interocclusal space, covering of ceramic of sufficient thickness on the metal/ceramic substructures is not possible to attain.&#xD;
&#xD;
In this case, a PFM-based endocrown was planned according to the patient&#x2019;s needs. As micro-retention can be affected in this case, the retention of the restoration was increased by incorporating secondary retentive grooves in the axial walls as stated in various studies6 in addition to the sandblasting of the metal surface before cementation thereby reducing the radius of rotation. Grooves limits the path of insertion &amp; provides near parallel-sided walls to the preparation enhancing the retention.&#xD;
&#xD;
Also, the resistance feature is enhanced by the anti-rotational design of the preparation. 7 According to Blair et al, anti-rotational design is chiefly used in metal-ceramic &amp; all metal restorations but is generally unpractical for the all-ceramic crown. 8 Various other secondary retentive factors, such as pins, boxes, slots, can also be considered in such cases in a clinical scenario. &#xD;
&#xD;
In addition, sandblasting was also done in PFM endocrown to enhance the bonding. Additionally, to provide enhanced retention &amp; better bond quality, the cervical margins were levelled in a shoulder shape maintaining a uniform thickness thoroughly. Also, .the interior pulp chamber preparation might have enhanced the mechanical retention &amp; stability of endocrown. &#xD;
&#xD;
The removal of gutta-percha up to 2 mm in the pulp canal was carried out, to obtain the benefit of saddle-like anatomy of the floor of the cavity, &amp; according to a biomimetic concept, placement of GIC in the pulp chamber creates a sufficient preparation geometry by filling of the internal undercuts, thereby contributing to an enhanced marginal seal in these cases. 9&#xD;
&#xD;
However, contraindications of endocrowns are (1) pulp chamber depth - lesser than 3 mm or cervical margin width - lesser than 2 mm, (2) when there is only negligible remaining tooth structure present (3) when adhesion cannot be guaranteed. In addition, the differences in the MOE (modulus of elasticity) amongst the dentin and ceramic might lead to risks of root fracture and debonding. Hence, case selection is very critical &amp; important for the continual success of endocrown-type of restoration.&#xD;
&#xD;
Several factors such as the skill of the operator, correct tooth preparation techniques, suitable ceramic selection &amp; bonding material influences the longevity &amp; success of endocrown. In some circumstances, because of patients&#x2019; economical constraint &amp; the lack of adhesive bonding, endocrown as a treatment option has been rejected. In such cases, PFM based endocrowns with adequate incorporation of retention and resistance features in the tooth preparation can be considered as a promising alternative.&#xD;
&#xD;
In this case study, temporization was done with Luxatemp Automix Plus resin. The metal-ceramic crown, which will reproduce the natural tooth form, to respect the dental anatomy requires an adequate thickness, causing millions of dentinal tubules exposure which may act as a pathway for bacterial diffusion and colonization. Therefore, for the lasting success of the therapy, the prepared tooth surface must be adequately protected during prosthesis fabrication. Provisional restoration fixed with provisional cement offers acceptable retention, restoring form and function, acceptable esthetics as well as prevents tooth fracture and microleakage, to a certain degree maintaining the dimensions of the prepared tooth.&#xD;
&#xD;
From a clinical perspective, if an obturating material in the root canal gets exposed to the saliva for 30 days or more, retreatment might be indicated. 10, In this case, report, the patient came within 15 days after the endodontic treatment for a definitive prosthesis.11&#xD;
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CONCLUSION-&#xD;
&#xD;
Endocrowns has been considered as a promising treatment alternative for posterior endodontically treated teeth having excessive coronal loss of tooth structure associated along with the limited interocclusal space based on the esthetic demands &amp; affordability of the patient. Though, PFM endocrowns might also be considered as a valuable treatment alternative, particularly in patients in whom economical constraint is a limiting factor. All the aforestated clinically significant factors should be analyzed before considering PFM-based endocrown in practical situations, to achieve favourable results. The endocrown adheres perfectly with the bio integration concept &amp; it should be used in restorative dentistry &amp; should be more widely known.&#xD;
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ACKNOWLEDGMENT:&#xD;
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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;
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FUNDING:&#xA0;This research received no external funding.&#xD;
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CONFLICT OF INTEREST: The authors declare that they have no conflict of interest.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3846</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3846</Fulltext></URLs><References>1. Mukherjee P, Patel A, Chandak M, Kashikar R. Minimally Invasive Endodontics a Promising Future Concept: A Review Article. Int J Sci Stud. 2017;5(1):245-251.&#xD;
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2. Vinola SMJ, Balasubramanian S, Mahalaxmi S. &#x201C;ENDOCROWN&#x201D;&#x2014;An Effective Viable Esthetic Option for Expurgated Endodontically treated Teeth: Two Case Reports. J Oper Dent Endod. 2017;2(2):97-102&#xD;
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3. Bindl A, M&#xF6;rmann WH. Clinical evaluation of adhesively placed Cerec endocrowns after 2 years&#x2013;preliminary results. J Adhes Dent. 1999;1:255-65.&#xD;
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4. Oswal N, Chandak M, Oswal R, Saoji M. Management of endodontically treated teeth with endocrown. J Datta Meghe Inst Med Sci Univ. 2018;13:60-2.&#xD;
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5. Bernhart J, Br&#xE4;uning A, Altenburger MJ, Wrbas KT. Cerec3D endocrowns&#x2013;two-year clinical examination of CAD/CAM crowns for restoring endodontically treated molars. Int J Comput Dent. 2009 Dec;13(2):141-154.&#xD;
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6. Casucci A, Osorio E, Osorio R, Monticelli F, Toledano M,&#xA0; Mazzitelli C, Ferrari M. Influence of different surface treatments on surface zirconia frameworks. J Dent. 2009 Nov;37(11): 891-897.&#xD;
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7. Raigrodski AJ. Contemporary materials and technologies for all-ceramic fixed partial dentures: a review of the literature. J Prosthet Dent. 2004 Dec;92(6):557-562.&#xD;
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8. Blair FM, Wassell RW, Steele JG. Crowns and other extracorporeal restorations: preparations for full veneer crowns. Br Dent J. 2002 May;192(10):561-571.&#xD;
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9. Amal S, Nair MG, Sreeja J, Babu A, Ajas A. Endocrown &#x2013; an overlooked alternative. Arch Dent Med Res. 2016;2(1): 34-38.&#xD;
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10. Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001 Jan;34(1):1-10.&#xD;
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11. Ashok: Evaluation of postoperative complaints in fixed partial denture wearers and those with crowns: A questionnaire-based study.Int J Cur Res Rev. 2016;8(16).&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Detection Techniques for Diagnosis of Renal Cell Carcinoma&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>183</FirstPage><LastPage>192</LastPage><AuthorList><Author>Yashaswini C</Author><AuthorLanguage>English</AuthorLanguage><Author> Shilpa Sivashankar</Author><AuthorLanguage>English</AuthorLanguage><Author> Ashalatha</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Renal Cell Carcinoma abbreviated as (RCC) occurs inside the kidney tubular coating in the region inside the renal cortex. RCC is one of the riskiest and most aggressive forms of the tumour as its detection, treatment; rate of recurrence is cumbersome and sophisticated. Many detection techniques are available for kidney cell cancer Diagnosis and Staging Carcinoma. Aims: In this review paper, all such available techniques like Magnetic resonance imaging (MRI), Computerized tomography (CT) and others are discussed and the methods followed in each one of them. Methodology: The findings of these are analysed for the prognosis, staging and further treatment of RCC. Results and Conclusion: The new novel methods enclosing the usage of biomarkers present as tumour markers along with body samples are also enclosed which would be more rapid, specific and constitute novel point-of-care biosensors and are also cost-effective.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Renal Cell Carcinoma, RCC Detection techniques, Kidney Staging, Biomarkers, Point-of-care device, Biosensors</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Kidneys are vital organs that perform the function of excretion of waste matter which is otherwise toxic to the normal functioning of cells in the body. The filtering of blood by these organs helps our body to excrete the toxic matter out of the system. Kidneys are very vulnerable and about 850 million adults are affected and impacted by kidney diseases in many regions all over the world, as per the renal experts.1 It usually takes the form of CKD (Chronic Kidney Disease) and its presence amongst the world&#x2019;s population at large is 14 per cent. &#xD;
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Another dangerous kidney ailment that causes millions of deaths is Kidney Cell Carcinoma. It is a kind of tumour that arises in the renal tissues in kidney tubules and renal cortex. About four to five per cent of newly discovered tumours are malignant kidney tumours in adults.2&#xD;
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Renal Carcinoma:&#xD;
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Renal cell carcinoma (RCC) is considered one of the world&amp;#39;s ten most frequent forms of cancer cases. The heterogeneity related to RCC has been increasing and is very high. Most of it arises either from the kidney tissue epithelium cells or renal cortex cells. For every 1000 people, the number of people who are diagnosed with RCC is about 25 which are quite high. Most of these people have RCC which belongs to the subtypes like clear cell Renal Cell Carcinoma (ccRCC), chromophobe RCC (cRCC) and papillary RCC (pRCC) which is greater than 5%. Other subtypes of RCC occur in very rare circumstances and are included under the category of unclassified RCC (uRCC). The ccRCC presently is responsible for an 80-85% mortality rate and is highly dominant in the American race. In the case of benign clear cell tumours, methods like radical and partial nephrectomy (the process of removal of the kidney); ablation (treatment involving intensive heat or cold shocks) and active surveillance (continuous radiography studies) could be made use for the prognosis, diagnosis and its treatment.3 The type of tumour named Wilms &amp;#39; tumour occurs in Children.4&#xD;
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Epidemiology:&#xD;
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All over the globe, the maximum occurrence of renal carcinoma is usually found to occur at the mean age of 60&#xB1;15 years.5 It is usually found that the incidence of kidney carcinoma in males is double the rate of that of females and on average, it is at the rate of 2/100,000 and 1/100,000 respectively. The highest aspect ratio of its incidence can be witnessed in the regions of the USA, the Czech Republic and Canada amongst all the developed countries. Asian residents who stay in the USA have a very low incidental rate of renal carcinoma.6 The region of Croatia (24.2) has the lowest rate of renal pelvis tumours in comparison to other European regions like Serbia (65.6). The age-standardized rate per 100,000 in Croatia is 24.2, while in Serbia it is around 65.6. The effect due to Balkan nephropathy on renal pelvis tumour is theoretically highly negligible ( Fig 1). Among the USA population, the incidental rate of renal carcinoma differs amongst the race, origin and ethnicity of people all around the world. It is a vital aspect to note that rates are lowest among Pacific Islanders and incident rates in the white Hispanic race are higher in comparison to the Latin American race.7 &#xD;
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Figure1: a) Epidemiology of RCC based on gender b) Epidemiology of RCC based on race c) Epidemiology of RCC based on nationality.8 9&#xD;
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Risk Factors and Causes:&#xD;
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The common notable risk factors that pose a serious threat to the incidence of kidney carcinoma are: &#xD;
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	Smoking- Tobacco increases the rate of occurrence of renal carcinoma two times. About 30% and 25% of kidney tumours in both men, as well as women, are due to smoking respectively.&#xA0; &#xD;
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	Gender - The occurrence rate is two to three times higher in males as compared to females. &#xD;
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	Race- American and African race has a high incidental rate of kidney carcinoma which is 10 % more than the other races in the world. &#xD;
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	Age- The high occurrence of kidney cancer is found between the age group of 50 to 70 years. &#xD;
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	Nutrition and Weight- Obese and malnutrition increase the occurrence of renal carcinoma. &#xD;
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	High blood pressure- Hypertensive patients with Blood pressure (BP) above 140/90 are more prone to RCC. &#xD;
	&#xD;
	&#xD;
	Overuse of Medication- Phenacetin containing medications that are banned in parts of the US and are believed to be one of the causes. Diuretics, analgesic painkillers, ibuprofen are also believed to be associated with renal cancer according to studies by Dutcher et al.9&#xD;
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	Long-term dialysis- A person who has been on the medical procedure of dialysis for quite a long period more than 5 years are prone to develop cancerous tumour or cysts which may spread. &#xD;
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	Family history related to kidney cancer.10&#xD;
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Genetic Alterations in Renal Carcinoma:&#xD;
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The deletion of the shorter arm of chromosome 3(loss of 3p) constitutes the most frequent genetic alteration linked to the origin of ccRCC. This can be witnessed in about 95% of the ccRCC cases. The most usual genes associated with ccRCC&amp;#39;s pathogenesis are - VHL, PBRM-1, SETD2, BAP-1. Other genetic mutations include a slight loss of 14q, 8p deletion, etc. Amongst all the genes Von-Hippel-Lindau gene (VHL) is a suppressor of a tumour kind of gene. Its mechanism and its pathway of action do play a major aspect in the occurrence of ccRCC ( Fig 2). According to the studies done by Nabi et al. The gene called VHL is responsible for coding a protein named pVHL. The formed complex has a major part in the process of breakdown and degradation of proteosome and several intracellular proteins. These intracellular proteins usually bind to the DNA transcripts and create an mRNA to initiate vascular endothelial growth factor abbreviated as (VEGF), which induces the synthesis of high vascular tumors.11&#xD;
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Figure 2: Depicting the pathway of the tumour suppressant VHL gene in tumour suppression 11&#xD;
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DIAGNOSIS:&#xD;
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The 6th and 9th most commonly incidental type of cancer in both men and women is depicted by renal carcinoma amongst all cancers known to date in the world.12 It is highly cumbersome to detect renal carcinoma. This is because of the deep position of the reins in the human body.13 In the last 15 years, incidental identification of renal tumours has increased by 12% and has become more frequent throughout various diagnostic studies.14 Even though ancillary kidney cell carcinomas do possess lower malignancy capacity and low metastasis frequency some cases of small renal carcinomas with related metastasis have been reported.15 Incidence differences in the early first era could be clarified by a simple diagnosis and because of the diffusion and regular use of Diagnostic tools such as Ultrasound Scanning, and not due to a real increase in RCC incidence. It is indeed important to notice that, interestingly, that RCC is identified in 1.5% of autopsies.16&#xD;
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Prognostic methods available to clearly define and provide an explanation about a neural mass include the aforementioned Diagnostic or radiographic assessment studies as follows.&#xD;
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Blood Tests: &#xD;
&#xD;
Laboratory tests cannot show for certain whether an individual is suffering from renal carcinoma, but sometimes they can provide the first indication that some kind of kidney problem can occur. They may also help to show if an individual is stable to undergo surgery.17 Scientists have found that a Blood marker could aid to analyse and study a person&amp;#39;s degree of risk of acquiring renal cancer. It is found that measuring the levels of a protein molecule called KIM-1 in the blood, could suggest whether an individual would be more prone to suffer from RCC for the next decade.18 It cannot be confirmed by any blood tests that the RCC is for the definite presence in an individual. But instead, a test called complete blood count (CBC) along with a blood chemistry check will display signs related to kidney cancer by blood studies.&#xD;
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Complete Blood Count (CBC): &#xD;
&#xD;
The test measures the overall total number and percentage of possible blood cells. The RCC patients usually exhibit symptoms related to anaemia, while in some cases there are chances of more number of various blood cells displayed due to the condition called polycythaemia. This condition occurs because the renal carcinoma cells release a higher amount of hormone known as erythropoietin. The normal threshold level of erythropoietin in the human body can vary from 3.7 to 36 international units per litre (IU/L). But, in the case of RCC, the levels of erythropoietin rise above 45 international units per litre (IU/L). The respective cost of CBC for cancer detection can range widely from $ 50 to $670 based on factors like the type of cancer, parameters and complexity.&#xD;
&#xD;
Blood chemistry tests: &#xD;
&#xD;
Such tests are performed in patients who may have renal carcinoma, as cancer may influence the levels on an average of certain chemicals such as liver enzymes present in the blood, which indicates that cancer might reach or has already reached liver and high optimum levels of calcium ions in the blood indicates that cancer could probably have reached bones.19 20 The average cost of this test varies from $30 to $250. &#xD;
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IMAGINING TECHNIQUES: &#xD;
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CT Scanning:&#xD;
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The computed tomography (CT) has a very prominent role in the initial diagnosis and prognosis of renal carcinoma.21-23 The procedure of specialized renal CT test comprises a narrow-section of about 2.5-5 mm helical visualization angle of the kidneys before the intravenous assay agent administration, followed by visualization for about 60-70 seconds and three to five minutes once the scanning factor assay reagent is studied carefully.24 Previously, enhancement for detection was deemed to be present if the lesion attenuation from baseline was enhanced greater than the level of 10 HU.25 &#xA0;RCCs can appear as is attenuating, hypoattenuating or hyperattenuating.26 27 According to the Bosnian categorization of kidney masses there are four classes: Class I encompasses basic cysts and fibroid masses; Class II includes minimally complex yet predominantly benign, harmless masses with narrow septa, hyper attenuation, and slight septal calcification; Class III comprises of mildly complex masses, dense septa, or uneven or dense benign cysts that often require operational exploration; and Class IV includes noticeably complex and usually malignant masses along with dense and uneven regions of enhancement and distinct solids.28 Nearly all renal tumours with detectable fat areas are angiomyolipomas (AMLs); however, some AMLs will not include excess fat and many times are confused for RCCs. Increased attenuation on no enhanced CT testing scans and the aspect ratio related change was beneficial but less important.29 A false-negative interpretation may arise if the transient response is not properly assessed pre and post administration of diagnostic content 30, to check whether the tumour volumes are not thoroughly investigated for septa and nodularity, or if in case the tumour amplification is omitted (due to drawbacks leading to constrained levels of improvement at the period of scanning), or when the lesions are too low for appropriate characterization at a period of diagnosis.31 32 RCC (particularly the papillary form) is enhanced once the imaging is done quickly post the contrast bolus (throughout the arterial stage) exits.33-36The CT scanning for the complete urinary tract analysis and kidney to detect RCC is approximately $2800 ( Fig 3).37&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0;Figure 3: Renal Carcinoma detected by enhanced type of CT scan for the right kidney.38 39&#xD;
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Magnetic Resonance Imaging:&#xD;
&#xD;
MRI reports are identical to CT results, including masses varying from primary cysts with septa and nodularity to enhanced solids.40 The MRI utilizes radio signals, massive magnets and a device to create accurate body images. The MRI will indicate whether the tumour or cancer has spread to the spine and brain. To undertake and perform the procedure, the person is asked to sleep slowly and lie down on a table during the test as it passes into a tube for the scanning process.41 If a patient cannot tolerate small confined spaces and is claustrophobic,42 then a sedative may be offered before this examination. It takes about 2 to approximately 15 minutes for the scanner to produce an image. There could be a necessity for more than a single set of pictures. On T2-weighted images.43 RCCs are usually highly intense. MRI can be particularly useful in examining the upper or lower side views of kidneys, in either coronal or sagittal visualization, and in assessing venous invasion. The degree of precision of MRI treatment is close to that of CT.44&#xA0; This is because, with CT, RCC&amp;#39;s false-positive results may occur with many other solid-enhancing lesions (metastatic cancer, lymphoma, oncocytoma, non-fat-containing AML, etc.) that are practically indistinguishable from true masses of renal cell carcinoma when preferably they are discrete and the related background is missing (Fig 4).45 The cost for MRI scanning is skyrocketing every day and in present days it costs between $2600 to $10,000.46&#xD;
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Figure 4: Renal Carcinoma Masses detected by MRI scan: (a) Left kidney (b) Right kidney 47&#xD;
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Ultrasonography (Ultrasound): &#xD;
&#xD;
Renal cell cancer on sonogram may be either hyperechoic or isoechoic relative to the rest of the tissue parts within the renal parenchyma. Smaller tumours with much less necrosis appear to always be hyperechoic and could be overanalyzed and mistaken for AMLs.48 Isoechoic lesions are identified only by renal contour distortion, focal enhancement of a part of the tissues in the kidney, or central sinus fat distortion. Studies indicate a requirement for comparison-enhanced Doppler US (CEUS) in mass workup showing poor arterial process CT enhancement.49 A detection rate of 85 per cent was found in lesions greater than a size of 3 cm in a recorded sequence.50 For lesions greater than the size of 2 cm, the rate of detection was less than 60 per cent was seen. Fallacious-positive results are uncommon because the ultrasound is never the primary modality of imaging used before the operation. A significant Bertin column and fetal lobulation can resemble a solid kidney mass and could be solved with just a devoted CT or MRI test.51&#xD;
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False-negative results occur if caution is not taken to completely analyse all the aspects and factors of tissue of the kidney since the ultrasound is extremely operator-dependent.52 It is significant to note that tumours that are generally found by chance are at the preliminary and early point of malignancy (Fig. 5).53 Furthermore, the associative relationship between clinicopathological observations and the complete clinical profile of inevitable RCC has not tried to be elucidated until now.54 The average estimated cost of ultrasound scanning for RCC is comparatively less than CT &amp; MRI scanning and would range between $398 and $568.43&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Figure 5: Renal Carcinoma as imaged in doppler ultrasound: (a) Right kidney (b) Left kidney. 55&#xD;
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Nuclear Imaging: &#xD;
&#xD;
Scintigraphy in nuclear medicine doesn&amp;#39;t get used as the main modality in evaluating the alleged RCC. It can also help in distinguishing the assessment of a false mass of tumours. Nuclear medicine experiments in any individual with a potential renal mass aid to distinguish the malignant mass from such a pseudo mass (e.g., Dromedical hump, Bertin board, fetal lobulation).56 Scintigraphy using technetium dimethyl succinic acids indicates good absorption in the pseudo mass area, whereas a true mass creates a focused photopenic error.57 The precision of the procedure is small because if they are big enough, both forms of masses can induce photopenic defects.58 Late-stage illness diagnosis, which tends to occur more frequently as an un-incidentally diagnosed disorder, is not necessarily meant for recovery, and these patients may generally have reduced life periods.59 The modelling of the risks ratio also shows that. These results confirm the accurate results of many other researchers who suggest that accidentally detected cancers may be linked to higher survival during diagnosis, mostly because a larger proportion of such natured tumours are studied and diagnosed at an earlier level than cancers that are not incidentally detected.60 The cost estimated for nuclear imaging for RCC ranges from $135 to $1138.61&#xD;
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Positron Emission Tomography (PET):&#xD;
&#xD;
For several cancers, fluorodeoxyglucose -F 18 (FDG) positron emission tomography (PET) has become an accepted imaging process. FDG-PET technology makes prominent use of the improved glycolysis intensity correlated with neoplastic tissues. PET has effectively been proved effective in pulmonary imaging 62 head and neck 63 colorectal,64 breasts,65 and also for other cancers. Wahl et al first investigated the enthusiastic adoption of FDG by kidney tumours in 1991.66 Although some research indicates a high accuracy for PET,67 68 others consider high false negative (FN) levels that bring into question the diagnostic usage of the scan.69-71 As a result, the vital function of FDG-PET in the evaluation and treatment of predominant and metastatic kidney cancer (RCC) has still not been thoroughly established. Safaei - et al tested 36 individuals with enhanced RCC and reported that PET was 100% accurate if used in particular for the clinical-stage classification.72 Significantly, PET results were studied found to be 100 per cent responsive to primary lesions, metastasis-related to the retroperitoneal lymph node/kidney zone recurrences, liver and bony tumour metastasis.73 The PET-positive and reliable statistical values of 98.4 per cent and 100.0 per cent for soft tissue for bony tumours suggest the use of PET as a supportive major issue-solving method when traditional scans become sceptical of metastatic Renal carcinoma but contradictory. Although it was not possible to replicate the 100% sensitivity observed by Wu et al, the 100% sensitivity that was observed agrees with their findings, wherein zero among 12 benign types of bone tumours showed positive results for PET ( Fig 6).74 The estimated cost of PET scan along with CT imaging is more than $5000.75&#xD;
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Figure 6: Kidney Cancer as detected by PET scan: (a) Coronal view (b) Axial view. 76&#xD;
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Intravenous Pyelogram - (IVP): &#xD;
&#xD;
Intravenous pyelogram (IVP) is a sequence of kidney X-rays, ureters, including bladder with a fluorescent dye being pumped into another vena. The photographs are often used for identifying cancers, defects, kidney stones, or other obstructions, and for testing the distribution factor of renal blood. These are also used as a diagnostic tool for certain disorders or to test the spread of bladder related cancer to other urinary tract regions.77 An intravenous pyelogram (IVP) is a liver, ureter, and urinary bladder x-ray test using iodinated comparison content inserted gently into the veins. An x-ray (radiograph) is a type of necessary medical examination that is non-invasive and helps doctors accurately diagnose a patient&amp;#39;s medical conditions. The usually utilized equipment for this test comprises a radiographic bench, one or two x-ray tubes, and a TV-like display situated in the examining room. Fluoroscopy, which transforms x-rays to video images, is used widely to track and direct computational development. The video is created by an x-ray system and a detector hanging over a table on which the patient is asked to sit.78 The average estimated price range for the test is between $50 and $100 based on area, cost and availability variables.79&#xD;
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Angiography:&#xD;
&#xD;
Non-invasive cross-sectional visualization (CT, MRI, US) has substituted angiography with known or presumed RCC in the patient workup. Angiography is often used sometimes where the location spot of a tumour is not known (e.g., renal vs. adrenal). In such patients, it might be necessary to inject exclusively the renal as well as adrenal arteries, and external vessels. Renal angiography (also known as arteriography)-a collection of X-rays of the internal renal blood arteries using a contrast dye injected directly into a catheter that is inserted into the blood vessels of the renal to find any symptoms of blockage or anomalies influencing blood flow to the kidneys.80&#xD;
&#xD;
In India, the rate of renal angioplasty begins at around $3000. India&amp;#39;s renal angioplasty rates are among the lowest and economic in the country.81&#xD;
&#xD;
BIOPSY: &#xD;
&#xD;
Once a positive diagnostic study of renal mass is made, effective treatment can be implemented without further examination. For example, if a mass displays characteristic aspects of carcinoma, clinical resection, if necessary, may be performed before pre-operative biopsy since the pre-operative risk of disease will be strong enough; a negative biopsy result will not necessarily change management.82 Similarly, for certain benign masses, reported imaging guidelines to apply, such as clear cysts,83 hyperdense cysts,84 and fat-consisting angiomyolipomas,85 86 which can be treated with a strong degree of trust. Accordingly, the renal tumour mass biopsy was traditionally intended for a small range of indications.87 The biopsy was as well as found to change clinical treatment in 60.5 per cent of patients receiving a biopsy.88 When performing a renal mass biopsy, several technical factors that may highly affect the rates of diagnosis and complications have to be taken into account. The method has its pros and cons.89-92 Usually small (20-gage or thinner) needle samples are histologically studied on the cytological and wide (19-gage or larger) needle samples. It&amp;#39;s difficult to equate the testing efficacy of small and large needles.93 Caoili et al.94 treated 92 per cent of lesions and Neuzillet et al.95 utilizing 18-gage needles alone. The precise size of the solid renal tumour mass is the key criterion for deciding the functioning capacity of biopsy in this evolving sign. Surgical evidence has repeatedly shown that as the scale of a very strong renal mass declines, the probability that it will reflect a benevolent object increases.96-102 Such masses have traditionally undergone needless surgical resection since they really cannot be separated from imaging alone from malignant lesions ( Fig 7).103-107 Kidney biopsy expenses vary from $1,724 to $3,158, respectively. While the national average amounts up to $4915.108&#xD;
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&#xD;
&#xD;
Figure 7:&#xA0; Image depicting percutaneous biopsy through CT scanning.109&#xD;
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Kidney Staging: &#xD;
&#xD;
Staging cancer always is the method of assessing the degree and duration of the early primary tumour&#x2019;s distribution. Staging cancer promotes the exchanging of knowledge between physicians and experts inside and through organizations offering a framework for evaluating cases through areas, ages, and modalities of care ( Table 1). The American Joint Committee on Cancer (AJCC) staging of tumour-node-metastasis (TNM) is the most commonly established and universally accepted form of cancer staging.110 AJCC key staging of tumours for RCC in various contrast of staging with the suggested changes by Shao et al.111&#xD;
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Table 1: Summary of AJCC key staging of tumours for RCC 111&#xD;
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All the above-mentioned techniques of detection are very expensive and are not affordable by all people worldwide due to economic constraints. These methods are also time taking, not so specific and painful. Hence, novel approaches are being developed at a faster pace for the rapid, painless, more specific and low-cost diagnosis, which serves as a platform for the early detection and diagnosis of RCC.&#xD;
&#xD;
RECENT, NOVEL DETECTION TECHNIQUE: &#xD;
&#xD;
Detection through Biomarkers cancer-related biomarker means and refers specifically to a molecule that is released by the tumour cells and the predominant presence of this protein in any body&amp;#39;s biological fluids suggests a probable occurrence of cancer. The best-known cancer biomarkers that have been abruptly used recently to detect early disease of Renal Carcinoma are Aquaporin, Perilipin and ADFP (Adipose differentiation-related protein) in the urine sample.112 The researchers compared the elevated levels of these tumour biomarkers in the patients to the healthy controls, where there was very little concentration of the proteins.113The results suggest that the patients with RCC contained a higher concentration of Aquaporin-1 (Spearman coefficient P =0.78) than the healthy controls (Spearman coefficient P</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3847</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3847</Fulltext></URLs><References>1. Lights V. Kidney Cancer [Internet]. Healthline.com. 2012 [cited 2020 Nov 24]. Available from: https://www.healthline.com/health/kidney-cancer&#xD;
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2. Hu R, Gupta R, Wang Z, Wang C, Sun H, Singamaneni S, et al. Bioplasmonic paper-based assay for perilipin-2 non-invasively detects renal cancer. Kidney Int. 2019;96(6):1417&#x2013;21.&#xD;
&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effectiveness of Fluoroscopy-Guided Genicular Nerve Radiofrequency Ablation in the Management of Chronic Osteoarthritis of Knee: A Prospective Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>193</FirstPage><LastPage>196</LastPage><AuthorList><Author>Sahu SK</Author><AuthorLanguage>English</AuthorLanguage><Author> Pandey A</Author><AuthorLanguage>English</AuthorLanguage><Author> Dash A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Chronic osteoarthritis of the knee is a frequently encountered painful condition in the elderly and requires an astute approach for its treatment. The etiologies of chronic osteoarthritis are multiple:-age, obesity, hereditary, female preponderance, the association of diseases such as thyroid disorder, rheumatoid arthritis increases the risk significantly. Objective: The effectiveness of nonsurgical options in providing pain relief and functional improvement is generally inadequate. Method: Inclusion criteria:- No response to conservative management for a minimum of 3 months. Tibia femoral osteoarthritis (Kellgren-Lawrence) grade 3-4 on radiological evaluation. Exclusion criteria: Acute knee pain, Prior knee surgery, Patients on anticoagulant medications, psychiatric illness, Steroid/ Hyaluronic injections taken in the past 3 months. Result: The pain intensity was much lower post block when compared to baseline pre-procedure values of both the indices throughout 6 months follow up. The patient&#x2019;s painless standing/mobility period also increased significantly after injection as it was before the procedure. Conclusion: Notable heterogeneity (p &lt; 0.001) was noticed and concluded the Funnel Plot. In our result, it was observed that the age group 30-39 had a significantly higher mortality rate.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Chronic osteoarthritis of knee, Genicular nerve, Radiofrequency ablation, Visual analogue score, Oxford knee score</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Chronic osteoarthritis of the knee is a chronic debilitating and troublesome condition in the elderly which results in a significant amount of pain in joints causing limitation of function and day to day activities.1 Many modalities of treatment are available, such as pharmacological and surgical. However, surgical management is the most definitive treatment for chronic osteoarthritis.2 The effectiveness of nonsurgical options in providing pain relief and functional improvement is generally inadequate. Genicular nerve radiofrequency ablation, which was introduced by Choi et al. has given a new dimension for the treatment of chronic osteoarthritis because it is a minimally invasive method being done as a daycare procedure and the patient can be discharged after a brief period of observation for possible post-procedural complications.3-7 The procedure targets chiefly the three nerves supplying the knee joint:-Superomedial genicular nerve(SMGN), Superolateral genicular nerve (SLGN) and Inferomedialgenicular nerve(IMGN). Good relief has been observed with this procedure with significant improvement in the functional well being of the patient for up to 12-15 weeks. If the recent literature is to be followed, studies suggest that GNB (Genicular Nerve Blocks) could be an apt treatment option for patients unwilling to undergo surgery or who are not fit for knee arthroplasty.VAS (visual analogue scale) and OKS (oxford knee score) are commonly used parameters to evaluate the degree of disability and estimate the quality of life of having chronic knee pain.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This is a prospective study done at IMS and SUM Hospital, Bhubaneswar. We have included 30 patients having chronic osteoarthritis of the knee. The duration of this study was 2 years (2018-2020). The patients were of the age group 50-70 years who had pain around the knees, failing conservative management or were not suitable candidates for surgery or were unwilling to undergo knee arthroplasty. IMS-SH/SOA/16089.&#xD;
&#xD;
Inclusion criteria:- &#xD;
&#xD;
1. No response to conservative management for a minimum of 3 months.&#xD;
&#xD;
2. Tibiofemoral osteoarthritis (Kellgren-Lawrence) grade 3-4 on radiological evaluation.&#xD;
&#xD;
Exclusion criteria:- &#xD;
&#xD;
1. Acute knee pain.&#xD;
&#xD;
2. Prior knee surgery.&#xD;
&#xD;
3. Patients on anticoagulant medications, psychiatric illness.&#xD;
&#xD;
4. Steroid/Hyaluronic injections taken in the past 3 months.&#xD;
&#xD;
All patients underwent complete workup with all routine investigations to rule out any co-morbidities, infection and coagulation abnormalities. Analgesics were withdrawn in the post-procedure period. For all patients, an anteroposterior view of the knee (in standing position) and lateral view (in 45 degrees of flexion) was done and the radiological classification done as per the radiographic findings ( Table 1).&#xD;
&#xD;
Procedure:-&#xD;
&#xD;
With the patient lying supine, the knee(s)were prepped and draped in the usual sterile fashion using a sterilized cloth drape[Fig1a]. The skin of the landmark areas was anaesthetized with Xylocard 2%, after confirming under fluoroscopy. A spinal needle (23G) was inserted over the junction of the femoral diaphysis and the medial femoral condyle, another needle was inserted to femoral diaphysis and the lateral femoral condyle junction [Fig1b], 3rd needle to the lateral tibial diaphysis and the medial tibial condyle. Placement of all needles was confirmed on lateral fluoroscopic view and the exact location for the point of injection was confirmed after injecting 0.5ml of Iopamidol(non-ionic contrast solution)in the lateral view to make sure, there is no intravascular extravasation [Fig2]. Asteroid mixture consisting of 2ml of 2% Xylocard, 2ml Triamcinolone acetonide(40 mg), 0.5ml (75 micrograms) of Clonidine hydrochloride and 5 ml of distilling water to make the mixture of 10 ml and was slowly injected at the three designated sites after a negative aspirate. Stryker system was used to ablate the genicular nerve at 50 degree Celsius for 60 seconds, following which the needle was withdrawn about 5mm and a second ablation was done. A sterile dressing was applied at the end of the procedure and the patient was observed for 2 hours post-procedure to make sure, that there were no post-procedure complications. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
In our study, there were a total of 30 patients of which 18 were females and 12 were males with a mean age of individuals 66 years. Mean pain intensity as per visual analogue scale (VAS) in the pre-procedure phase was 6.9 and as per Oxford knee score (OKS), it was 14.3 (Figure 3, 4 and 5). The pain intensity was much lower post block when compared to baseline pre-procedure values of both the indices throughout 6 months follow up. The patient&#x2019;s painless standing/mobility period also increased significantly after injection as it was before the procedure.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
A review of the literature has shown that GNRFA may be an effective alternative for patients with knee osteoarthritis.14-17 The use of fluoroscopy device in performing nerve blocks can greatly increase the efficacy and precision, which in turn can significantly reduce the complications.8,9 Primarily, superolateral, superomedial and in feromedialgenicular nerves transverse along the areas connecting the shaft of the epicondyle, periosteally.10 Secondly, fluoroscopic imaging gives good visualization concerning tissue depth and needle gauge. Thirdly, as we are using contrast fluoroscopy, it can prevent unintentional intravascular injection.11 However, potential complications result after performing every diagnostic procedure. There are some common side effects such as leg muscle weakness, discomfort at the injection site. Other complications include vascular injuries, pseudoaneurysm, AVfistula, hemarthrosis, which are extremely rare but can carry potential morbidity.12 Many authors suggested that the effects of the block were indirect and acted via alterations in nociceptive processing and effect on the neuropathic brain pathway.13 Though genicular nerve radiofrequency ablation targets bony landmarks, it may be difficult to isolate the exact anatomic location of&gt;1 of the genicular nerves18,19. The OKS and VAS scoring system gives us an assessment regarding the quality of life in chronic osteoarthritis patients which are seldom used in other studies. The success of this study is encouraging as evident by the improved pain scores on regular follow up. The patients, after the procedure, are encouraged to undergo physiotherapy sessions in the form of static quadriceps exercises to avoid any recurrences in pain. All the patients were also trained about the mobility process and the areas of work that they should avoid so that the effect of analgesia stays for a considerable amount of time (Table 2). Lifestyle modification is also a very important aspect in the management of chronic osteoarthritis which was judiciously promoted among the patients. However, this study had a limitation in that no control group was assigned for comparison.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
This study demonstrates the long term effects of genicular nerve block under fluoroscopic guidance for patients with chronic osteoarthritis providing them with pain relief. The combination of the genicular nerve block with the addition of other rehabilitative measures extends the pain-free period significantly. In the light of the above study, a longer follows up time is required to assess the efficacy of a single time injection. In addition to the above fact, the frequency of repeat injections and their effectiveness in patients who do not have adequate pain relief demand more studies with larger sample size and a longer study period. For generating high-level evidence, larger studies with randomized control groups can be planned.&#xD;
&#xD;
Acknowledgement: The authors are highly grateful to the Dean IMS &amp; SUM Hospital for providing all the support during the study.&#xD;
&#xD;
Conflict of interest: There is no conflict of interest among the authors.&#xD;
&#xD;
Source of funding: Nil&#xD;
&#xD;
Author&#x2019;s Contribution: Santosh Kumar Sahu conceived, planned, designed and guided the study and drafted the manuscript. Abhishek Pandey collected the data. Aniruddh Dash processed the manuscript for final editing and drafting.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3848</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3848</Fulltext></URLs><References>1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: A review of community burden and current use of primary health care. Ann Rheum Dis. 2001; 60:91-97.&#xD;
&#xD;
2. Yu SP, Hunter DJ. Managing osteoarthritis. Aust Prescr. 2015; 38:115&#x2013;119&#xD;
&#xD;
3. Choi WJ, Hwang SJ, Song JG, Leem JG,Kang YU, Park PH, Shin JW. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain. 2011;152: 481-487.&#xD;
&#xD;
4. Kesikburun S, Yasar E, Uran A, Adiguzel E, Yilmaz B. Ultrasound-guided genicular nerve pulsed radiofrequency treatment for painful knee osteoarthritis: A preliminary report. Pain Physician. 2016;19:E751-E759.&#xD;
&#xD;
5. McCormick ZL, Korn M, Reddy R, Marcolina A, Dayanim D, Mattie R, Cushman D, Bhave M, McCarthy RJ, Khan D, Nagpal G, Walega DR. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: Six-month outcomes. Pain Med. 2017;18:1631-1641.&#xD;
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6. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. Pain Med Res. 2014; 6:373-376.&#xD;
&#xD;
7. Sari S, Aydin ON, Turan Y, Ozlulerden P, Efe U, Kurt Omurlu I. Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: Radiofrequency neurotomy of the genicular nerves or intra-articular injection? Int J Rheum Dis. 2016;doi:10.1111/1756-185X.12925.&#xD;
&#xD;
8. Roos EM, Nk A. Strategies for the prevention of knee osteoarthritis. Nat Rev Rheumatol. 2015;&#xD;
&#xD;
9. Ucuncu F, Capkin E, Karkucak M, OzdenG, Cakirbay H, Tosun M, Guler MA. Comparison of the effectiveness of landmark guided injections and ultrasonography-guided injections for shoulder pain. Clin J Pain. 2009; 25:786-789.&#xD;
&#xD;
10. Hoeber S, Aly AR, Ashworth N, RajasekaranS. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med. 2016; 50:392-396.&#xD;
&#xD;
11. Baker R, Dreyfuss P, Mercer S, BogdukN. Cervical transforaminal injection of corticosteroids into a radicular artery: A possible mechanism for spinal cord injury. Pain 2003; 103:211-215.&#xD;
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12. Kim SY, Le PU, Kosharskyy B, Kaye AD, Shaparin N, Downie SA. Is Genicular Nerve Radiofrequency Ablation Safe? A Literature Review and Anatomical Study. Pain Physician. 2016;&#xD;
&#xD;
13. Afridi SK, Shields KG, Bhola R, GoadsbyPJ. Greater occipital nerve injection in primary headache syndromes&#x2014;prolonged effects from a single injection. Pain.2006; 122:126-129.&#xD;
&#xD;
14.Crawford DC, Miller LE, Block JE.Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev(Pavia).2013.February 22:5(1):e2.&#xD;
&#xD;
15.Kidd VD. Genicular nerve radiofrequency ablation: a novel approach to symptomatic knee osteoarthritis. JBJS JOPA.2018;6(1):e10.&#xD;
&#xD;
16. Choi WJ,Hwang SJ,Song JG,Leem JG, Kang YU. Radiofrequency treatment relieves chronic knee osteoarthritis pain. Orthop Rev. 2011.March:152(3):481-7. &#xD;
&#xD;
17. Iannaccone F, Dixon S, Kaufman A.A review of long term pain relief after genicular nerve radiofrequency ablation in chronic knee osteoarthritis. Pain Physician. 2017.March:20(3): E437-E444.&#xD;
&#xD;
18. Iannaccone F, Le PU, Kim JH, Kim SY. Anatomical basis of genicular nerves: implication for RFA as a treatment for chronic knee pain. Presented as a poster exhibit at the 15th Annual Pain Medicine Meeting. Pain Physician. 2016; 11:17-19:&#xD;
&#xD;
19. Orduna Valls JM, Vallejo R, Lopez Pais, Soto E, Torres Rodriguez D&#xA0; et al. Anatomic and USG evaluation of the knee sensory innervations: a cadaveric study to determine anatomic targets in the treatment of chronic pain. Reg Anesth Pain Med.2017;42(1):90-8.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An Ayurvedic Protocol to Manage Myopia in a 6-Year-Old Child: A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>197</FirstPage><LastPage>201</LastPage><AuthorList><Author>Sreekanth Nelliakkattu Parameswaran</Author><AuthorLanguage>English</AuthorLanguage><Author> Ratna Prava Mishra</Author><AuthorLanguage>English</AuthorLanguage><Author>  Jaya Sankar Mund</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Myopia is a leading cause of visual impairment in children, especially schoolchildren. Prescription of spectacles is the sought-after modality of managing myopia. However, these neither correct nor prevent the progression of the refractive error. The cardinal symptom of myopia, the inability to see distant objects, may be compared with Timira (blurring of vision) in Ayurveda. Case Report: A 6-year-old boy with the blurring of vision that was more in his right eye (OD) and who was previously diagnosed with myopia is presented here. He underwent a specially-tailored Ayurvedic treatment protocol comprising of oral medicines, Netra Kriyakalpa (local ocular therapeutics), and treatments for the head. Results: Visual acuity improved to LogMAR 1.301 in the right eye OD at discharge and was maintained at a subsequent follow-up. Conclusion: The main challenge was maintaining and improving vision. The results indicate the potential of Ayurvedic treatments to both manage myopia and to maintain, and improve in some cases, vision in children&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Alternative methods, Ayurveda, Case Report, Kriyakalpa, Refractive error, Timira</Keywords><Fulltext>Introduction&#xD;
&#xD;
Uncorrected refractive errors are among the top causes of both visual impairment and blindness as per Vision 2020.1 Among these, myopia is the leading cause of visual impairment in children, with a rapid increase in prevalence.2 Myopia presents significant economic and societal impacts on individuals.3 The Consortium for Refractive Error and Myopia (CREAM) study demonstrated that myopia&#x2019;s aetiology is multi-factorial rather than a single mechanism.4 Conventional management options for myopia have either short-term benefits or significant side effects.5 In light of the above, treatment options in contemporary and alternative medicine (CAM), including Ayurveda, may be sought.&#xD;
&#xD;
The case of a 6-year-old male patient diagnosed with myopia and who underwent Ayurvedic treatments is presented in this report. The CARE guidelines were adhered to for ensuring transparency and effectiveness in reporting.6 Written informed consent was obtained from the parents. Institutional ethics committee clearance was not required to prepare this report.&#xD;
&#xD;
Case Report&#xD;
&#xD;
The patient presented with a blurring of vision that was more in his right eye (OD) since birth. He was inclined to watch television very closely and had difficulty in distant vision. He was diagnosed with myopia by an ophthalmologist and was advised of power spectacles, which he did not use. No significant illnesses were reported. His immediate family members do not complain of similar symptoms. The bowel was constipated and appetite, micturition, and sleep were normal. Review of systems and vital signs were within normal limits.&#xD;
&#xD;
Unaided distant visual acuity was LogMAR 1.477 OD and LogMAR 0.301 in his left eye (OS). A -11.00 diopter (D) lens with a -1.50D cylinder and 50&#xB0; axis corrected his vision OD to LogMAR 0.778, and a -1.25D lens with a -1.5D cylinder and 150&#xB0; axis corrected his vision OS to LogMAR 0.176. Near visual acuity was N6 in both eyes (OU). His anterior segment showed a normal sclera and cornea, deep anterior chamber, and normal lens OU. Direct and consensual pupillary reflexes were sluggish OD and normal OS. Posterior segment examination by ophthalmoscopy showed normal media in both eyes (OU), optic disc with normal cup-to-disc ratio and absence of temporal crescent OU, healthy blood vessels with normal calibre OU, normal background with the absence of tessellations and retinal thinning OS, and lattice degeneration OD.&#xD;
&#xD;
The patient was diagnosed with myopia and was prescribed a 13-day course of inpatient Ayurvedic treatment, which comprised oral medicines (Table 1), Netra Kriyakalpa, and treatments for the head (Table 2). Panchakarma(bio-purification) therapies were not attempted on this patient as he was underage. He has advised foods rich in vitamins A, C, and E, coloured fruits, and green leafy vegetables.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Unaided DVA improved to LogMAR 1.301 OD and other readings were maintained. A follow-up consultation demonstrated the same readings in unaided DVA.&#xD;
&#xD;
All medicines were manufactured by SreedhareeyamFarmherbs India, Pvt. Ltd., the hospital&#x2019;s GMP-certified drug manufacturing unit.&#xD;
&#xD;
A timeline of events is provided (Table 3).&#xD;
&#xD;
Discussion&#xD;
&#xD;
The condition of DvitiyaPatalagataDosha (humours invading the second layer of the eye) was explored based on the symptoms of this patient. The Lakshana (feature) of &#x201C;DurantikasthamRupamca(unable to perceive distant objects)&#x201D;7 matched the patient&#x2019;s symptoms. Tamira is named when the Doshasinvade the third Patala as per Susrutaand the second Patalaas per Vagbhata.&#xD;
&#xD;
Medicines employed were not Tikshna (sharp) by nature due to the Saukumaryata (tender and delicate body structure), Alpakayata (under-developed organs), Vividha Anna Anupasevana (unfit GIT to receive all types of food), AparipakvaDhatu (tissues under the progression of transformation), AkleshaSahatva (stress intolerance), and AsampurnaBala (poor immunity).&#xD;
&#xD;
The oral medicines were Cakshushya (good for eyes), Brmhana (nourishing), and Vata Hara (pacify Vata). The external therapies promoted vision and strengthened the eyes and the nerves. Snigdha(unctuous) medicines were for both Pushti(nourishment) as well as relieving Timira, a NanatmajaVikara of Vata according to CarakaSamhita.&#xD;
&#xD;
Wisetone, prepared from Asparagus racemosusLinn.,ZingiberofficinaleRosc., Piper longumLinn., Piper nigrumLinn., HolostemmaadakodienR.Br., and GlycyrrhyzaglabraLinn., enhances the activity of the neurons. KasyapaGhrtaand KasyapaKvathaareprepared from Terminalia chebulaRetz., Terminalia bellericaLinn., EmblicaofficinalisGaertn., AdathodavasicaNees., and BerberisaristataDC, and are indicated in Drishti Rogas. Eye Plus is prepared from Terminalia chebulaRetz.,Terminalia bellerica Linn., EmblicaofficinalisGaertn., and PicorrhizakurroaRoyle ex. Benth, and is Ropanaby nature and indicated for all eye conditions. Sunetra Junior is prepared from NelumbonuciferaGaertn., Ocimum sanctum Linn., Cinnamomumcamphora(L.) Presl., and is indicated in eye conditions of patients under 16 years of age. JatavedhaGhrta is prepared from Terminalia chebulaRetz.,Terminalia bellericaLinn, EmblicaofficinalisGaertn., and HolostemmaadakodienR.Br., and is used for Tarpana in Drishti Rogas. Vinayakanjana is prepared from NelumbonuciferaGaertn., and distilled water, and is indicated in all eye diseases.&#xD;
&#xD;
Netra Dhara, a variety of classical Seka8 practised in Sreedhareeyam, was done to cleanse the eyes and to prevent the increase of Kapha due to the application of Sneha. Anjana, done in the manner of classical Ascyotana9, promoted vision. Drishti Prasadanaand Tarpana was done to strengthen the nerves and to promote vision. The Snehaused for both procedures was Vata Hara. Anna Lepa was done for further pacification of Vata.&#xD;
&#xD;
Conclusion&#xD;
&#xD;
The main challenge, in this case, was an improvement of vision. However, improvement was observed due to healthy Dhatusbeing formed by the treatments, and the ability of the patient&#x2019;s body to acclimatize to the medicines. Usage of medicines that were Brmhana, Samana, Mrdu, and Madhura, as well as external therapies that employed application of Ghrta and Taila facilitated the formation of a healthy physique as well as strengthened the nerves. The results may be validated with large-scale sample trials and studies.&#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The authors acknowledge Sreedhareeyam Ayurvedic Eye Hospital and Research Center, and Sreedhareeyam Farmherbs India Pvt. Ltd., for their help in preparing this case report. 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 the authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed. &#xD;
&#xD;
Conflicts of Interest: None declared&#xD;
&#xD;
Sources of Funding: None declared&#xD;
&#xD;
Abbreviations:&#xD;
&#xD;
DVA: distant visual acuity&#xD;
&#xD;
NVA: near visual acuity&#xD;
&#xD;
LogMAR: logarithm of the minimal angle of resolution&#xD;
&#xD;
OD: oculus dexter&#xD;
&#xD;
OS: oculus sinister&#xD;
&#xD;
OU: oculus uterque&#xD;
&#xD;
AUTHOR&#x2019;S CONTRIBUTIONS&#xD;
&#xD;
&#xD;
	&#xD;
	Dr. Sreekanth N. P. conceptualized the article, collected and interpreted the data, and wrote the article.&#xD;
	&#xD;
	&#xD;
	Dr. RatnaPrava Mishra reviewed the article and interpreted the data.&#xD;
	&#xD;
	&#xD;
	Dr. Jaya Shankar Mundreviewed the article and interpreted the data.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3849</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3849</Fulltext></URLs><References>&#xD;
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	The International Agency for the Prevention of Blindness, Global Vision Impairment Facts, 2020, https://www.iapb.org/vision-2020/who-facts/&#xD;
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	Fricke TR, Jong M, Naidoo KS, et al, Global prevalence of vision impairment associated with myopic macular degeneration and temporal trends from 2000-2050: systematic review, meta-analysis, and modelling, Br J Ophthalmol, 2018; 102(7): 855-862&#xD;
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	Wong HB, Machin D, Tan SB, Wong TY, Saw SM, Visual impairment and its impact on health-related quality of life in adolescents, Am J Ophthalmol, 2009; 147(3): 505-511&#xD;
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	Smith TS, Frick KD, Holden BA, Fricke TR, Naidoo KS, Potential lost productivity resulting from the global burden of uncorrected refractive error, Bull World Health Organ, 2009; 87(6): 431-437&#xD;
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	Gwiazda J, Treatment options for myopia, Optom Vis Sci, 2009; 89(6): 624-628&#xD;
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	Gagnier J, Kienle G, Altman DG, Moher D, Sox H, Riley DS, CARE group, The CARE guidelines: Consensus-based clinical case-reporting guideline development, GlobAdvHealth Med, 2013;2(5): 38-43&#xD;
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	&#xD;
	Murthy KRS, Ashtangahrdaya of Vagbhata: Text, English Translation, Notes, Appendices, and Index, Vol. III: Uttara Sthana, Krishnadas Academy, Varanasi, 2000, 121 pg. &#xD;
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	Murthy PHC, Sarngadhara Samhita: Text with English Translation, Chaukhambha Sanskrit Series Office, Varanasi, 2013, pg. 188&#xD;
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	Murthy KRS, AshtangaHrdaya: Text, English Translation, Notes, Appendices, and Index, Vol. 1: Sutra &amp;SariraSthana, Krishnadas Academy, Varanasi, 121 pg.&#xD;
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&#xD;
</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Histopathological Analysis and Comparison of Synovitis in Rheumatoid Arthritis and Osteoarthritis Patients in a Tertiary Care Centre&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>202</FirstPage><LastPage>209</LastPage><AuthorList><Author>Ujjvala Kalluri</Author><AuthorLanguage>English</AuthorLanguage><Author> Nellaiyappan Balasubramanian</Author><AuthorLanguage>English</AuthorLanguage><Author> Arumugam Vasugi</Author><AuthorLanguage>English</AuthorLanguage><Author>  Divya Dhanabal</Author><AuthorLanguage>English</AuthorLanguage><Author> Leena Dennis Joseph</Author><AuthorLanguage>English</AuthorLanguage><Author> Subalakshmi Balasubramanian</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory disease principally involving the joints, which is autoimmune. However, osteoarthritis is a degenerative disorder commonly affecting large joints. They not only differ clinically but histologically as well. This study entails the comparison and grading of histopathological features of synovial biopsies of patients suffering from these diseases using a pre-established grading system. Aims: To Compare and analyse histopathological features of synovial biopsies of patients suffering from Rheumatoid Arthritis and osteoarthritis. Methodology: 31 synovial biopsy specimens each, of rheumatoid arthritis and osteoarthritis respectively, were reviewed from the institute&#x2019;s case files. The histopathological features were analyzed and a diagnostic criterion was set using a grading system involving seven histological features to differentiate the same. Results: It was observed that all the RA specimens scored a total score of 11 or more. Whereas, out of the 31 OA specimens, all had scored less than 11 points. Conclusion: It was established that a total score of 11 points (maximum 20 points) for RA synovitis biopsies can confirm a histopological diagnosis of RA synovitis. This analysis helped better the understanding of histopathology and compare the histologic variation present in synovial membrane tissue in patients suffering from rheumatoid arthritis and osteoarthritis.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Rheumatoid arthritis, Osteoarthritis, Synovial fluid, Histopathology</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Rheumatoid Arthritis is a chronic inflammatory autoimmune disorder principally involving the joints. It causes a nonsuppurative inflammation of the synovial membrane or synovitis. The inflammation progresses to destroy the articular cartilage and underlying bone resulting in disabling arthritis.&#xD;
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A proper medical history is essential for the diagnosis of rheumatoid arthritis. Blood tests are done to check for antibodies specific for rheumatoid arthritis that include 1) anti-cyclic citrullinated peptide antibodies or anti-CCP antibodies, 2) rheumatoid factor (RF). RF is a sensitive but not a specific antibody for RA as it is also found in other autoimmune disorders. The presence of RF helps to reach a differential diagnosis of RA but it does not confirm it.1 However, the anti-CCP antibody is a strong indicator of RA and has more specificity than RF.2In a large cohort of patients suffering from early stages of RA with a mean symptom duration of 7 months the anti-CCP2 antibody test had helped to differentiate RA patients from those without the disease at a specificity of 91% and sensitivity of 81%.3&#xD;
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&#xA0;A high erythrocyte sedimentation rate and C-reactive protein levels are suggestive of the acute phase response of RA. Radiological imaging studies help to assess the severity of the disease.&#xD;
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One of the investigative methods done to diagnose RA in a patient is the synovial biopsy, where the synovial tissue is biopsied from the involved joint and studied to scrutinise the histopathological features.1A recent study done by performing synovial fluid analyses for 60 patients having joint pathogenesis revealed that rheumatoid arthritis (19%) was the most common aetiology.4 These biopsies have the potential to distinguish RA from other forms of arthritis.5&#xD;
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The synovial membrane contains synoviocytes that are metabolically active cells. They play an excretory role by removing the products of matrix degradation and provide nutrients to the cartilaginous cells through the synovial fluid. During the process of synovitis, they multiply in numbers resulting in hyperplasia.6The synovial membrane also exhibits angiogenesis, infiltration of inflammatory mediators including different types of leukocytes, inhibitors of proteases and cytokines. Tissue oedema and deposition of fibrinogen exudates are then replaced by infiltrates of monocytes and lymphocytes. These cells release metalloproteinases that cause pannus formation and infiltration of cartilage by synoviocytes.7,8&#xD;
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On the other hand, osteoarthritis can be diagnosed clinically but a synovial biopsy would confirm the diagnosis and also rule out other causes of joint pain like RA.9Studies have disproved the orthodox views of osteoarthritis being a degenerative disease of only the cartilage. It is proven that synovial inflammation plays a significant role in the pathogenesis ofosteoarthritis.10,11Despite this synovitis, osteoarthritis is clas&#xAD;sified as a noninflammatory disorder since a certain threshold level of leukocytosis is required for the disease to be classified under inflammatory disorders (2,000 cells per mm3) which is not satisfied by osteoarthritis.6 The histological change that occurs in osteoarthritis include synovial cell hyperplasia as seen as an increase in the number of synovial lining cells which is often accompanied by mononuclear cell infiltration.12This study helped to form a comparison between RA and osteoarthritis based on their inflammatory changes along with other histopathological findings.&#xD;
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MATERIAL AND METHODS:&#xD;
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A retrospective study was done at Sri Ramachandra Institute of Higher Education and Research after obtaining informed consent from the Institutional Ethical Committee of the same institute. The period of study was of three years, spanning from 2015 to 2017. 31 synovial biopsy specimens each, of rheumatoid arthritis and osteoarthritis respectively, were collected from the pathology case files. The tissue specimens were fixed in 10% formalin and embedded in paraffin. Serial tissue sections of each specimen were prepared. Sections were stained with hematoxylin and eosin (HE). They were microscopically reviewed for analyzing histopathological features and a diagnostic criterion was set using a grading system involving seven characteristic histological features. They were given a score of 1&#x2013;3 points each, to evaluate the histological severity of the seven parameters. The total scores were then calculated and compared.&#xD;
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HISTOLOGICAL PARAMETERS&#xD;
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There were seven histopathological features chosen to compare. They included the following:&#xD;
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a) degree of proliferation of synovial cells&#xD;
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b) palisading of synovial cells&#xD;
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c) synovial giant cells&#xD;
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d) inflammatory cell infiltration&#xD;
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e) neo-vascularisation&#xD;
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f) synovial granulation tissue&#xD;
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g) synovial fibrin &#xD;
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h) synovial hemosiderosis.13&#xD;
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a) The degree of synovial hyperplasia was graded based on the number of layers of synovial cells. It was expressed as slight (three to four layers), moderate (five to seven layers) and marked (more than seven layers).&#xD;
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b) The synovial cell proliferation was subsequently classified as typical with the conventional radial arrangement of cylindrical synovial cells, or atypical (Figure 1) with the obscure arrangement of synovial cells.&#xD;
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c) The inflammatory infiltrate was categorised into three subtypes: (i) lymphocytic aggregation (Figure 2), (ii) formation of lymphoid follicle (Figure 3), (iii) formation of germinal centre (Figure 4). &#xD;
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d) The plasma cells (Figure 5) were graded subjectively into slight, moderate and marked depending on their severity. An abundance of up to 25% was marked as slight, between 25-50% as moderate and more than 50% as severe.&#xD;
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e) Granulation tissue (Figure 8) was characterised by newly formed thin-walled capillaries and proliferating fibroblasts. It was graded into slight, moderate or marked and given a score of 1,2 or 3 respectively. An abundance of up to 25% was marked as slight, between 25-50% as moderate and more than 50% as severe.&#xD;
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f) If giant cells were not seen, a score of 0 was given. A score of 1 was allotted for foreign body type giant cells (Figure 6) and a score of 2 for non-foreign body type giant cells (Figure 7).&#xD;
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g) Synovial fibrin (Figure 8) was characterised by polymerised fibrin deposits or fibrinoid necrosis. It was visualised by staining with Masson&#x2019;s trichome stain which was highlighted by red colour. It was graded based on its presence or absence. A score of 2 was given for its presence.&#xD;
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h) Synovial hemosiderosis (Figure 9) was positive for Perls&#x2019; stain. A score of 2 was given for its presence. &#xD;
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RESULTS: &#xD;
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Histopathological features were analysed and moderate to marked synovial hyperplasia was seen in 74.2% of RA synovitis compared to 64.5% of osteoarthritis synovitis (Table II).&#xD;
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In palisading of synovial cells, the typical radial arrangement was seen in 10 of the RA synovitis biopsies and scarcely in 2 of the osteoarthritis specimens. A haphazard synovial arrangement or atypical arrangement was significantly more prevalent in osteoarthritis (93.5%) than RA specimens (Table II).&#xD;
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Giant cells were given points of 1 or 2 depending on whether they were foreign body or non-foreign body type respectively. In particular, foreign body type was observed more in RA synovitis cases than in osteoarthritis cases (Table II). In one of the RA cases that were associated with a clinical diagnosis of tuberculosis and the patient tested positive for acid-fast bacilli staining, a characteristic granuloma containing Langhans giant cells was microscopically noted (Figure 7).&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There were varied differences between the two types of specimens concerning inflammatory cell infiltrate. Most of the osteoarthritis synovitis specimens (27 out of 31) were observed to have aggregates of lymphocytes, i.e, lymphocytic accumulation. Lymphoid follicles were formed in 54.8% of the RA cases whereas germinal centres were present in 22.5% of them. On the other hand, lymphoid follicles were seen in only 4 of the osteoarthritis biopsies and germinal centres were observed in none (Table II).&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; On average, plasma cells were more abundant in RA than osteoarthritis. 90.3% of RA synovitis had moderate to marked plasma cells. Whereas, in a majority of osteoarthritis synovitis (27 out of 31 specimens), a slight degree of plasma cells was noted (Table II).&#xD;
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Granulation tissue was moderate to marked in almost 84% of RA while it was scarce in osteoarthritis. Only 12 out of the 31 osteoarthritis specimens showed moderate granulation tissue formation (Table II). Neovascularisation with frequent periarteriolar fibrosis is generally considered to be the distinct histopathological feature of RA synovitis. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Fibrin deposition was present in 80.6% of RA synovitis specimens and in 16% of osteoarthritis cases (Table II). &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Synovial hemosiderosis was seen in almost half of RA whereas a majority of the osteoarthritis specimens (29 out of 31) lacked the hemosiderin pigment (Table II).&#xD;
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Comparing and calculating the histological features a total score of 11 or more was seen in Rheumatoid arthritis. Whereas, out of the 31 osteoarthritis specimens, all had scored less than 11 points (Table III). &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; All the RA specimens had scores between 11 and 15 and none above 15. Points between 6 and 10 were scored by 77% of the osteoarthritis cases and the rest had scores between 0 and 5. When compared, on average, all RA synovitis had higher scores than the osteoarthritis synovitis (Table III). &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; From the results, it was concluded that in the histological examination of the biopsied synovial tissue of RA, if the total score for synovitis is more than 11 points (maximum 20 points), a histological diagnosis of RA synovitis can be con?rmed (Table III). &#xD;
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DISCUSSION: &#xD;
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The inflammatory response of the synovial membrane is more dependent on local disease activity than on the duration or chronicity of the disease.&#xD;
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There is histopathological evidence that there is an increased maximal synovial cell lining thickness in advanced stages of RA compared to that of early stages of RA, whereas the mean lining thickness of both did not differ.14However, the inflammatory changes and progression of bone destruction are more remarkable in the early stages of RA.15In a study on biopsy specimens of early rheumatoid arthritis patients, it was observed that&#xA0;a proportion of the biopsied synovium showed only angiogenesis without either lining cell proliferation or mononuclear cell infiltration,&#xA0;suggesting that angiogenesis may precede any other features, such as lining cell proliferation and cellular infiltration in early RA.16&#xD;
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The histological changes of osteoarthritis are seen in patients suffering from osteoarthritis of all grades but the most marked changes occur in the advanced stages.17There are no conspicuous differences in the microscopic findings of synovial biopsies taken from large and small joints. Although there is statistical evidence of resemblance in the quantitative abundance of macrophages, T cells, and plasma cells between the knee joint and the small joints.18&#xD;
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In the past few years, medical advances in developing artificial joints have led to an increased number of patients suffering from rheumatoid arthritis undergoing therapy for the replacement of arthritic joints. There has also been an increase in the needle and arthroscopic biopsy samples collected from patients with RA. This has provided pathologists with more opportunities to examine the specimens by molecular and immunohistochemical techniques to gain a better understanding of the pathogenic events in this disease. In addition, synovial biopsies are being used to assess the effects of medical interventions on the production of cytokines, enzymes responsible for joint destruction, adhesion molecules, and other inflammatory mediators.&#xD;
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This scoring system can be used for RA cases with an earlier stage, thus it is considered to be highly useful in diagnosing early-stage RA synovitis as well.13&#xD;
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CONCLUSION: &#xD;
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This analysis helped better the understanding of histopathology and analyze the histologic variation present in the synovial membrane tissue in patients suffering from rheumatoid arthritis and osteoarthritis. &#xD;
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Hence, the usage of a scoring system will be helpful for early diagnosis and better treatment.&#xD;
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ACKNOWLEDGEMENT: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors / editors / publishers of all those articles,journals and books from where the literature for this article has been reviewed and discussed.&#xD;
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CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.&#xD;
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SOURCE OF FUNDING:No funding sources.&#xD;
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AUTHOR&#x2019;S CONTRIBUTION:&#xD;
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Ujjvala Kalluri: Data analysis, specimen retrieval, manuscript preparation&#xD;
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Nellaiyappan Balasubramanian: Clinical and data analysis &#xD;
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ArumugamVasugi: Histopathological analysis&#xD;
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Divya Dhanabal: Histopathological analysis&#xD;
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Leena Dennis Joseph: Data analysis&#xD;
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Subalakshmi Balasubramanian: Histopathological analysis, data analysis, manuscript reviewal &#xD;
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Table I enumerates the histopathological features used to grade the specimens of osteoarthritis and rheumatoid arthritis and the scores given to them according to their severity or abundance.&#xD;
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Table II enumerates the degree of proliferation of synovial cells, differentiates typical and atypical palisading of synovial cells, differentiates based on the type of inflammatory infiltration, enumerates the severity of abundance of plasma cells, differentiates based on the presence and the type of giant cells, enumerates the degree of granulation tissue, differentiates based on the presence or absence of fibrin, differentiates based on the presence or absence of hemosiderosis in the specimens of osteoarthritis and rheumatoid arthritis and scores them accordingly.&#xD;
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Table III enumerates the total number of specimens of osteoarthritis and rheumatoid arthritis with their respective scores&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3850</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3850</Fulltext></URLs><References>1.Heidari B. Rheumatoid Arthritis: Early diagnosis and treatment outcomes. Caspian Journal of internal medicine. 2011;2(1):161.&#xD;
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2. Heidari B, Lotfi Z, Firouzjahi AR, Heidari P. Comparing the diagnostic value of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis.&#xA0;Res med 2010; 33 (3):156&#x2013;61. &#xD;
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3. Quinn MA, Gough AK, Green MJ, Devlin J, Hensor EM, Greenstein A, et al. Anti-CCP antibodies measured at disease onset help identify seronegative rheumatoid arthritis and predict radiological and functional outcome. Rheum. 2006 Apr 1;45(4):478-80.&#xD;
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4. Karthikeyan, M. Sridevi. Synovial fluid analysis - a retrospective study in a tertiary care centre. Int J Curr Res Rev. 2019;11(17):147-149.&#xD;
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5.Gerlag DM, Tak PP. How to perform and analyse synovial biopsies. Best Pract Res Clin Rheum. 2013 Apr 1;27(2):195-207.&#xD;
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6.Dougados M. Synovial fluid cell analysis. Bailli Clin Rheum. 1996 Aug 1;10(3):519-34.&#xD;
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7. Rooney M, Condell D, Quinlan W, Daly L, Whelan A, Feighery C, et al. Analysis of the histologic variation of synovitis in rheumatoid arthritis. Arth Rheum: Off J Amer Coll Rheum. 1988 Aug;31(8):956-63.&#xD;
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8. Dabiri S, Najafipour H, Niazmand S, Tabrizchi H. Histopathological changes of the antigen-induced chronic arthritis in the knee joint of the rabbit. Iranian Journal of Pathology. 2006 Apr 1;1(2):49-54.&#xD;
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9. Manek NJ, Lane NE. Osteoarthritis: current concepts in diagnosis and management. Amer Fam Phys. 2000 Mar 15;61(6):1795-804.&#xD;
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10. Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheum. 2010 Nov;6(11):625.&#xD;
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11. De Lange-Brokaar BJ, Ioan-Facsinay A, Van Osch GJ, Zuurmond AM, Schooners J, Toes RE, Huizinga TW, Kloppenburg M. Synovial inflammation, immune cells and their cytokines in osteoarthritis: a review. Osteoar Cart. 2012 Dec 1;20(12):1484-99.&#xD;
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12. Myers SL, Brandt KD, Ehlich JW, Braunstein EM, Shelbourne KD, Heck DA, et al. Synovial inflammation in patients with early osteoarthritis of the knee. J Rheum. 1990 Dec;17(12):1662.&#xD;
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13. Koizumi F, Matsuno H, Wakaki K, Ishii Y, Kurashige Y, Nakamura H. Synovitis in rheumatoid arthritis: scoring of characteristic histopathological features. Path Intern. 1999 Apr;49(4):298-304.&#xD;
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14. Baeten D, Demetter P, Cuvelier C, Van den Bosch F, Kruithof E, Van Damme N, et al. Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity. Annal Rheum Dis. 2000 Dec 1;59(12):945-53.&#xD;
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15. Tak PP, Smeets TJ, Daha MR, Kluin PM, Meijers KA, Brand R, et al. Analysis of the synovial cell infiltrate in early rheumatoid synovial tissue about local disease activity. Arthritis &amp; Rheumatism: Off J Ame Coll Rheum. 1997 Feb;40(2):217-25.&#xD;
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16.Hirohata S, Sakakibara J. Synovial histopathology in early rheumatoid arthritis. J Arth Res Ther. 1999; 1(S1): S38. &#xD;
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17. Smith MD, Triantafillou S, Parker A, Youssef PP, Coleman M. Synovial membrane inflammation and cytokine production in patients with early osteoarthritis. J Rheum. 1997 Feb;24(2):365-71.&#xD;
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18. Kraan MC, Reece RJ, Smeets TJ, Veale DJ, Emery P, Tak PP. Comparison of synovial tissues from the knee joints and the small joints of rheumatoid arthritis patients: Implications for pathogenesis and evaluation of treatment. Arth Rheum. 2002 Aug;46(8):2034-8.&#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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>3D Densealexnet Model for Brain Tumour Segmentation&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>210</FirstPage><LastPage>214</LastPage><AuthorList><Author>M. Sumithra</Author><AuthorLanguage>English</AuthorLanguage><Author> S. Malathi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The collection of anomalous cells within or around the brain is stated as a brain tumour. Automatic brain tumour segmentation is considered a challenging task due to complexity and gradient diffusion. To improve the segmentation of 3D brain MRI images Deep Neural Network (DNN) is evolved. However, it is subjected to the drawback of training computational power and complexity. Objective: In this paper, proposed a 3D Dense AlexNet model with backpropagation for segmentation of tumour in brain MRI images. The developed architecture consists of Neural Network for processing input 3D images. This paper focused on improving the overall segmentation process with the Alexnet model for 3D brain images for performance improvement. Method: Based on the training and validation test self-constrained 3D Dense ALexNet model is developed. Within the 3D Dense AlexNet backpropagation is adopted for removing complexity in the testing process and accuracy improvement. Based on the training and testing process 3D MRI image sequences are trained and processed for segmentation on the tumour. Result: The analysis of results expressed that the proposed 3D Dense AlexNet exhibits improved segmentation performance. Based on the proposed 3D AlexNet architecture MRI images are segmented with minimal time. The performance of the proposed 3D Dense AlexNet model exhibited the improved accuracy of tumour detection with reduced computational complexity&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>3D Brain MRI, Dense AlexNet, Back Propagation, Segmentation, Deep Neural Network (DNN), Neural Network</Keywords><Fulltext>&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;INTRODUCTION&#xD;
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A tumour is a collection or mass of abnormal cells that occur in various parts of the body. A tumour can result in cancer, which is the main reason for death and accounts for around 13% of every death worldwide. The cancer occurrence rate is rising at an alarming rate in the world. Therefore, tumour detection is significant in previous stages.1 The mast of abnormal cells that grow in or around the brain is called a brain tumour. &#xD;
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It poses a risk to the healthy brain by either destroying or invading normal brain tissue. The tumour in the brain is emerged due to the existence of a glial cell known as GLIOMAS. Those cells are classified and graded from values 1 to 4. In this assigned grade, tumour belongs to grades 3 and 4 are stated as malignant or cancerous cell. The tumour belongs to grade 1 and 2 is stated as benign or non-cancerous cells.2 To identify brain tumour Magnetic Resonance Imaging (MRI) is utilized for the detection of modality to assess tumours in the brain. MRI assists the physician in the investigation of soft tissues in the human brain. MRI offers soft tissues with four different types such as T1-weighted (T1w), T1-weighted with contrast enhancement (T1wc), T2-weighted (T2w), and Fluid Attenuated Inversion Recovery (FLAIR).3 In this, healthy tissue is stated as T1-weighted (T1w).&#xD;
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Corresponding Author: M.Sumithra, Research scholar, Department of computer science and engineering, Sathyabama institute of science and technology, Chennai, India.&#xD;
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Both T2w and T1w are used for the detection of tumours which provides a bright tumour border. The FLAIR is involved in the isolation of the oedema region in the brain from CSF (cerebrospinal fluid). However, the identification of boundaries of the tumour is difficult due to homogeneity with different sequence intensities.4 &#xD;
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Identification of brain tumour from MRI consist of different stages. Segmentation is termed to be a significant but tough step for the classification of medical imaging and its analysis.5 To segment MRI segmentation Convolutional Neural Networks (CNNs) are utilized with multi-modal factors. The CNN model consists of several functions such as extraction and classification of feature with a single model. However, existing CNN is subjected to complexity issues and limited accuracy.6 In recent years, Deep Convolutional Neural Network (DCNN) strategy is adopted for the extraction and classification of features. In, proposed a DCNN model was integrated with convolutional kernels for tumour segmentation in MRI images. In DCNN, a small kernel filter is adopted for cascade connection of convolutional layers with small kernel filters. 7&#xA0; In developed an architecture with a parallel cascade connection of CNN. The cascaded network incorporates training with balanced classes and the second stage involved in the refinement of the last layer with several samples at each class.8&#xD;
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In developed an algorithm based on utilization of fuzzy c-means clustering through the utilization of membership function.9 Based on estimated membership function centres are clustered and simultaneously generated. Recently, in 10 presented a modified FCM algorithm for segmentation of MRI image. We developed a fuzzy segmentation for MRI images. The MRI image segmentation is based on the estimation of IIH with the characterization of Gaussian function. 9 A research conducted developed a multi-objective framework for 3D MRI image segmentation. The proposed approach incorporates a two-stage fuzzy multi-objective framework (2sFMoF). Also, in 13 constructed an FCM algorithm spatial information algorithm for segmentation noisy MRI images. Also, it contains local membership as an objective function for MRI image segmentation. 10,11 In developed a conditional spatial FCM(csFCM) for segmentation of MRI brain image. Similarly, in15 constructed a deep convolutional neural network for MRI image segmentation with the exploitation of convolutional kernels. However, this technique fails to provides an accurate classification of brain tumours. To overcome those limitations this research presented a DenseAlexNet model with a backpropagation classifier. evaluation metrics. 12,13 &#xD;
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This paper developed a Dense AlexNet for tumour segmentation for brain tumour diagnosis. Also, the backpropagation scheme is applied for the classification of tumour regions in MRI images of the brain. 14&#xD;
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3D Dense Alex Net for MRI Segmentation&#xD;
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To achieve segmentation accuracy of 3D brain MRI images this paper uses 3D DenseAlexNet mode. The data for Multimodal Brain Tumour Segmentation is based on MICCAI 2012 conference. The developed Dense AlexNet model performance is based on the estimation of directions in a 3D image. The Dense AlexNet is involved in the extraction of features from brain images with the discriminative representation of MRI images through pooling layers. The next layer of Dense AlexNet generates high-level MRI image features for categorizing features in MRI images. In the next stage, the processed samples are masked for the identification of high-level features of MRI 3D images. With the object localization process in 3D Dense AlexNet, middle features are processed within the network. Through the incorporation of the backpropagation tumour region of the MRI image is segmented. To process input data MRI brain image is considered for pre-processing and segmentation of the tumour part. The feature of MRI brain images is extracted based on GLCM features with selected Region of Interest (ROI) for segmentation of the tumour part. The developed Dense AlexNet based on the adjusted pixel values tumour is segmented concerning position and area. Finally, classification is performed with Backpropagation for obtaining a resultant image with dataset images to identify it is benign or malignant. Initially, the proposed Dense AlexNet perform image pre-processing for removal of noise. To enhance the quality of the image certain features are examined to display image processing. The process involved in MRI pre-processing of MRI brain images is filtering of noise, pseudo-colouring, sharpening, and magnifying. The steps involved in improving image quality are image display, image analysis, and feature extraction. This paper uses median filtering for processing for the elimination of noises in the image. The applied median filter performs a linear operation for the elimination of salt and pepper noise. The process of median filtering is involved in the reduction of noise to preserve image edges. The proposed Dense AlexNet examines the image feature pixel, weight, depth, and colour before classification steps. Image segmentation is involved in the identification of object boundaries and location. Image explicit segmentation in involved in each pixel allocation based on assigned labels with similar label characteristics. Image segmentation outcome covers a complete image or performs image extraction. Every image pixels are based on characteristics of image property, texture, colour, and intensity. The Dense AlexNet performs classification of the image with backpropagation for MRI image training and testing. The proposed Dense AlexNet perform image classification using weighted estimation. The segmented images are trained and tested for image classification. The performance of the proposed Dense AlexNet is compared with image datasets. With image dataset classification tumour region of MRI images are segmented and classified as either normal or abnormal tumour images. &#xD;
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RESULTS&#xD;
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The performance of the proposed Dense AlexNet uses a Backpropagation classifier for segmentation and classification of tumour in MRI images. The proposed Dense AlexNet is implemented using MATLAB 2019 for analysis. To segment tumour in MRI image, Dense AlexNet is designed and obtained results are presented as follows. In figure 1 and 2, the input image considered for segmentation of the MRI brain image and figure 2 provides the pre-processed image for the input 3D MRI image. &#xD;
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In figure 3, the bounding box for the pre-processed image is presented. The Dense AlexNet involved in the processing and quality enhancement of input 3D MRI images. To highlight the tumour within the input image bounding box is adopted. The bounding box estimates the image features and highlights the tumour region. In figure 4 segmented tumour region is presented for input 3D MRI brain image. In figure 5 detected tumour region of the proposed dense AlexNet is presented. &#xD;
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DISCUSSION&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The developed 3D AlexNet model involved in the segmentation of 3D MRI brain images for segmentation. The developed 3D AlexNet model utilizes a backpropagation approach for segmentation of 3D MRI. Based on identified region proposed Dense AlexNet estimate the location of the tumour in the input MRI image and segment tumour part. The proposed Dense AlexNet significantly estimate the 3D view of the input image based on consideration of the input 3D MRI image of the brain for segmentation of tumour in input 3D MRI image. The comparative analysis of results expressed that the proposed 3D AlexNet model exhibits higher accuracy rather than other existing technique. In table 1, time and accuracy of proposed 3D AlexNet with existing Convolutional Neural Network (CNN) and Deep Convolutional Neural Network (DCNN). Table 1 shows the overall comparison.&#xD;
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In figure 8 comparative plot for segmentation time and accuracy is presented&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The simulation analysis expressed that the proposed 3D AlexNet model exhibits a higher accuracy value than the existing CNN and DCNN. Also, the proposed 3D AlexNet significantly reduces segmentation time compared with CNN and DCNN.&#xD;
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CONCLUSION&#xD;
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A brain tumour is caused due to the anomalous growth of tissues within the human brain, this leads to increase mortality. The proper diagnosis is required for reducing mortality rate, hence image processing techniques are evolved for effective diagnosis of brain tumours. Usually, the processing of MRI brain images is a complex task due to the complexity of the human brain structure. To improve the diagnosis process in MRI brain images, this paper proposed a Dense AlexNet for the segmentation of tumours. The proposed Dense AlexNet uses a Backpropagation classifier for tumour detection in the region. The comparative analysis of proposed 3D AlexNet architecture with conventional CNN and DCNN exhibited that improved accuracy with reduced segmentation time. The accuracy of the proposed 3D AlexNet is ~3% improved. Similarly, segmentation time is reduced on average by ~30 sec. &#xA0;In the future, the proposed segmentation scheme is processed with a sophisticated algorithm for detection, segmentation, and classification of brain tumour for medical applications. &#xD;
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ACKNOWLEDGMENT&#xD;
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The authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals, and books from which the literature for this article has been reviewed and discussed. &#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
&#xA0;Source of Funding: Nil&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3851</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3851</Fulltext></URLs><References>&#xD;
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	Bondy M. L, Scheurer M. E, Malmer B, Barnholtz Sloan J. S, Davis F. G, Il&amp;#39;Yasova D and Sadetzki S. Brain tumosur epidemiology: consensus from the Brain Tumour Epidemiology Consortium.&#xA0;Cancer&#xA0;2008;113: 1953-1968.&#xD;
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	Bauer S, Nolte L. P and Reyes M. Fully automatic segmentation of brain tumour images using support vector machine classification in combination with hierarchical conditional random field regularization. International Conference on Medical Image Computing and Computer-Assisted Intervention 2011; 354-361.&#xD;
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	Zhang C, Li P, Sun G, Guan Y, Xiao B and Cong J Optimizing fpga-based accelerator design for deep convolutional neural networks.&#xA0;Proceedings of the ACM/SIGDA international symposium on field-programmable gate arrays, 2015; 161-170. &#xD;
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	Kamnitsas K, Ledig C, Newcombe V. F, Simpson J. P, Kane A. D, Menon D. K and Glocker B Efficient multi-scale 3D CNN with fully connected CRF for accurate brain lesion segmentation.&#xA0;Med Ima Analy. &#xA0;2017;.36: 61-78.&#xD;
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	Pal N. R, Pal K, Keller J. M and Bezdek J. C A possibilistic fuzzy c-means clustering algorithm.&#xA0;IEEE transactions on fuzzy systems. &#xA0;2005;13(4):517-530.&#xD;
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	Mahata N, Kahali S, Adhikari S. K and Sing J. K Local contextual information and Gaussian function induced fuzzy clustering algorithm for brain MR image segmentation and intensity inhomogeneity estimation. &#xA0;Appl Soft Compt.&#xA0;2018; 68:586-596.&#xD;
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	Pereira S, Oliveira A, Alves V and Silva C. A. On hierarchical brain tumour segmentation in MRI using fully convolutional neural networks: a preliminary study. IEEE 5th Portuguese meeting on bioengineering (ENBENG), 2017;1-4.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Utilization of Biodentine in Apexification Combined with Large Periapical lesions in Root Canal Treated Teeth- A Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>215</FirstPage><LastPage>219</LastPage><AuthorList><Author>Suruchi Agrawal</Author><AuthorLanguage>English</AuthorLanguage><Author> Anshul Arora</Author><AuthorLanguage>English</AuthorLanguage><Author> Mandeep S Grewal</Author><AuthorLanguage>English</AuthorLanguage><Author> Ashtha Arya</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The treatment of open apices in non-vital permanent teeth is done with apexification using various materials like MTA, Biodentine and other materials. This study aimed to assess the utilization of Biodentine in apexification and large periapical lesions. Material and Methods: A male patient with the chief complaint of pain and pus discharge in the upper front tooth region. Initially, the patient was asymptomatic but eventually developed periodic swelling. On intraoral examination, it revealed the presence of porcelain fused to the metal crown in the right maxillary central and lateral incisor along with a sinus tract in the periapical region. During percussion of the tooth, it manifests positive tenderness. On radiographic examination, it shows that the root canal was incompletely obturated in both the incisors with incomplete root formation seen in the central incisor. The treatment protocol for tooth 11 and 12 was to perform root canal treatment along with apical plug formation using Biodentine. Therefore, under rubber dam access cavity was prepared and biomechanical preparation was done along with standard disinfection protocol using activation method and given intracanal medicaments. After 2-3 sittings of medicament, the apical plug formation was done in 11 along with filling of rest of the root canal with resin material. Results: In this case report the appreciating healing was seen at 3 months and 1 year follow up. Conclusion: The non-surgical conservative approach used in this case seems to be highly effective and gave astonishing results with complete healing of periapical lesion in central incisors&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Biodentine, ParaCore, Periapical lesions, Open Apices, Retreatment, Triple Antibiotic Paste</Keywords><Fulltext>Introduction &#xD;
&#xD;
Endodontic lesions of teeth with pulpal necrosis and periapical periodontitis is having polymicrobial nature with heightened levels of gram-negative anaerobic endodontic bacteria. These pathogens eventually disseminate from the canal system and exit through root foramen to succeed in the bone surface. The success of endodontic therapy relies on the entire eradication of bacterial infection from in and around the root canal of the teeth.1Interrupted root development, incomplete root formation, results in open apices of the tooth.2&#xD;
&#xD;
Irrigants are preferred for effective reduction of intraarticular microorganisms and also to eliminate the smear layer, particularly during apexification. NaOCl was employed in clinical studies as the most effective irrigant which is followed by 17% EDTA.3&#xD;
&#xD;
The complete biomechanical debridement of the root canal accompanied by the placement of an intracanal medicament to initiate apical healing and the formation of an apical barrier in a root with an open apex is mainly involved in apexification.4 Historically, several materials have been advocated as biologic activators to induce apexification, and calcium hydroxide (CH) has been reported as the material of choice because of its favourable properties.2,5&#xD;
&#xD;
Conversely, a clinician has got to face several challenges when operating the conventional endodontic treatment in open apices teeth, mainly when trying to establish an apical seal in the absence of a complete root apex formation. A fallible apical seal can increase the plausibility of persistent leaky margins and subsequent non-healing or recurrence of periapical lesions. Due to certain disadvantages of using calcium hydroxide as an apical barrier and long duration treatment protocol, new materials were introduced to reduce the treatment time and improve the success of the procedure. It uses nonsurgical condensation of a biocompatible material within the apical third of the canal as an artificial barrier against which root canal filling material can be immediately placed.&#xD;
&#xD;
In past decades, Mineral trioxide aggregate (ProRootMTA; Dentsply Tulsa, Johnson City, TN, USA) has successfully qualified to be a gold standard and also a huge acceptance in apexification procedures.6 Recently, another calcium silicate-based material, Biodentine (Septodont, Saint-Maur-des-Fosses, France), has been introduced with advantages of a shorter setting time; improved mechanical properties like compressive strength, push-out bond strength, and hardness; and easier handling when compared with MTA.7However, only some case reports exist regarding the clinical application of Biodentine.8 Therefore, in this study the assessment of Biodentine in apexification combined with additional nonsurgical measures in root canal treated tooth for managing concomitant open root apices and large periapical/cystic lesions.&#xD;
&#xD;
Material &amp; Methods&#xD;
&#xD;
A 35-year-old male patient presented to the Dept. of Conservative Dentistry and Endodontics of SGT Dental College, SGT University, Gurugram with a chief complaint of pain and pus discharge in the upper front tooth region. He had incurred trauma to the teeth due to a fall from a staircase 10-years ago and underwent endodontic treatment followed by crown 1 year ago as the patient was symptomatic. The patient was asymptomatic for some time but eventually developed periodic swelling and from few months had noticed intermittent pus discharge. &#xD;
&#xD;
Intraoral examination revealed the presence of porcelain fused to the metal crown in the right maxillary central (11) and lateral incisor (12) associated with a sinus tract in the periapical region (Fig1). Tracing of the sinus tract with gutta-percha confirmed the involvement of both the incisor. The tooth was tender on percussion and palpation. The periodontal status was normal with no mobility ruling out any periodontal pathology. On radiographic examination of both incisors, it revealed that the root canal was incompletely obturated with incomplete root formation in 11 also having periapical radiolucency (Fig 2).&#xD;
&#xD;
Electric and thermal tooth vital testing was performed and central and lateral incisors gave a negative response and all the other teeth show a positive response.&#xD;
&#xD;
The tooth was anaesthetized with 2% lidocaine with 1:100000 adrenaline. Under the modified rubber dam technique, the access cavity was prepared through the crown in tooth 11 and 12 (Fig 3). Straw coloured fluid discharge was seen from the canal with a foul smell. Gutta-percha removal was carried out with H-files. Working length was estimated by an apex locator and confirmation was done with an intraoral periapical radiograph (IOPA) (Fig4). Manual instrumentation in 11 was done with K-files(Mani, Japan) 80 no. along with passive irrigation of 5.25% sodium hypochlorite (NaOCl) (Septodont Healthcare India Pvt.Ltd., Mumbai). Irrigation was carried out with side-vented irrigation needles (keeping them 1 mm short of the radiographic apex). Furthermore, irrigants were activated with an Endoactivator(2-3 mm vertical pumping action) keeping the tip 2 mm short of apex without damaging the apical tissue. After a final rinse with 2% chlorhexidine, the canal was dried thoroughly with sterile absorbent paper points. The shaping and cleaning of 12 were completed with rotary NiTi files Hero Shaper up to size 30.04% and 17% EDTA(SybronEndo, CA, USA)was used as a lubricant. The intra-canal medicament of calcium hydroxide was placed for two weeks in 11 and 12. The access cavity was temporarily sealed with Cavit(3M, Espe, Saint Paul, MN, USA).&#xD;
&#xD;
After a 2-week interval, placement of two dressings of Triple antibiotic paste (TAP) (ciprofloxacin 500mg, metronidazole 400mg and minocycline 100mg mixed with normal saline) were also done for 15 days respectively. On the next endodontic visit, the patient was asymptomatic. The removal of intracanal dressing done with copious irrigation of 5.25% hypochlorite followed by EDTA and dried with absorbent paper points. The formation of apical plugin 11Biodentine(Septodont, St. Maur.des.Fosses, France)was manipulated according to the manufacturer&amp;#39;s recommendation and placed in the apical one-third of the root canal with the help of an amalgam carrier. It was condensed into the canal with a plugger to create an apical plug of 5 mm and was left undisturbed for the next 24-48 hour (Fig 5).&#xD;
&#xD;
The correct position of the Biodentine mixture was controlled with a periapical radiograph and the access cavity was closed with a temporary filling material for the setting. The temporary filling was removed after two days and check the hardness of the apical plug with an endodontic plugger. The remaining portion of the root canal was filled with ParaCore (ColteneWhaledent) (Fig 6).12 was obturated using lateral condensation technique with zinc oxide eugenol based sealer and post-operative restoration done with composite (Fig 7-8).&#xD;
&#xD;
Results&#xD;
&#xD;
The clinical follow-up of 3 months and 1 year was taken, revealed no sinus formation and complete healing of periapical radiolucency (Fig 9-10). The formation of the apical third was seen on radiographic examination along with the formation of bone at the periapical region.&#xD;
&#xD;
Discussion &#xD;
&#xD;
Periapical pathology of pulpal origin develops in response to microbial irritants in the root canal system. Irreversible pulpitis and pulpal necrosis usually occur due to constant trauma and injury to the dental pulp.1 Complete eradication of the microbes from the root canal system is the biggest trouble while treating the tooth with non-vital pulp and open apex.9&#xD;
&#xD;
Removal of necrotic pulp tissue remnants and microorganisms from the root canal system and canal disinfection is that the primary factor required for successful apexification. An antibacterial dressing is used to fortify the elimination of bacteria which are impenetrable to instrumentation and irrigation.10&#xD;
&#xD;
Various studies had been reported that when a conservative approach is performed using endodontic therapy alone, the appropriate success rate was to be about 85% and 94.4% in partial or complete healing for the management of periapical lesions.11 The treatment process for non-vital teeth with open apex, it is proposed that the intracanal disinfection protocol has to be highly effective, which involve 5.0% NaOCl as irrigant and CH as an intracanal medicament to reduce the bacterial load, to neutralize acidic environment, activation of phosphate enzyme, for its hygroscopic properties, to repair the damage occur within the root canal and finally to arrest external inflammatory root resorption and promotion of hard tissue deposition; and subsequent placement of TAP dressings were done.12Several studies within the literature have confirmed the antimicrobial efficacy of TAP against endodontic pathogens, especially resistant organisms like Enterococcus faecalis and Candida and biofilms than calcium hydroxide, and also delivered effects within 14 days of duration.13&#xD;
&#xD;
Biodentine is formulated on the theory of &#x2018;&#x2018;active borosilicate technology&#x2019;&#x2019;.It is without any metallic impurities within the mixture accountable for lowering material strength.14Biodentinealso provide various advantages over MTA as expedite setting and ease in manipulation and working. The manufacturer advocates thorough and uniform speculation. The properties of dentine incorporate an initial set of 9 to 12 minutes, therefore further steps like complete root canal obturation, permanent restoration can be performed on the single visit of the apical plug formation. During the setting of the material, precipitation of hydroxyapatite crystallites occurs between the dentinal surface and interface and also provide micromechanical adhesion and adaptability with surrounding dentin. The higher calcium release from Biodentine and prominent uptake of calcium by adjacent root dentin enhances its bioactive effect and periapical healing compared with MTA.15&#xD;
&#xD;
On clinical and radiographic evaluation, the treatment procedure which has been opted shows highly satisfactory results along with the complete resolution of all clinical signs and symptoms along with complete radiographic healing at 3 months and 1 year follow up.&#xD;
&#xD;
Conclusion &#xD;
&#xD;
A conservative approach for treating the periapical lesion and open apices in the non-vital permanent tooth was done by using Biodentine, the outcome of the report was astonishing without surgical intervention. It helps in the protection of anatomic structures and prosthesis against injury and also minimizes the risk and complications of surgery which seems to be beneficial for the patient as well.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Source of Funding: nil&#xD;
&#xD;
Conflict of Interest: nil&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3852</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3852</Fulltext></URLs><References>&#xD;
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	Khan SZ, Karim S, Mirza S. Effect of photodynamic therapy on the morphological changes of periapical inflammation: An experimental study in rats. Photodiagnosis Photodyn Ther. 2020 Sep;31:101839.&#xD;
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	Sharma S, Sharma V, Passi D, Srivastava D, Grover S, Dutta SR. Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series. J Endod. 2018 Jan;44(1):179-185.&#xD;
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	Pace R, Giuliani V, Nieri M, Di Nasso L, Pagavino G. Mineral trioxide aggregate as an apical plugin teeth with necrotic pulp and immature apices: a 10-year case series. J Endod. 2014 Aug;40(8):1250-4.&#xD;
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	KandemirDemirci G, Kaval ME, G&#xFC;neri P, &#xC7;al??kan MK. Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparing MTA with Ca(OH)2. Int Endod J. 2020 Jan;53(1):5-18.&#xD;
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	Rafter M. Apexification: a review.&#xA0;Dent Traumatol. 2005;21(1):1-8.&#xD;
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	Sharma V, Sharma S, Dudeja P, Grover S. Endodontic management of nonvital permanent teeth having immature roots with one step apexification, using mineral trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an internal matrix: Case series. Contemp Clin Dent 2016;7:67-70.&#xD;
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	P&#xE9;rard M, Le Clerc J, Watrin T, Meary F, P&#xE9;rez F, Tricot-Doleux S, Pellen-Mussi P. Spheroid model study comparing the biocompatibility of Biodentine and MTA. J Mater Sci Mater Med. 2013 Jun;24(6):1527-34.&#xD;
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	Villat C, Grosgogeat B, Seux D, Farge P. Conservative approach of the asymptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report. Restore Dent Endod. 2013 Nov;38(4):258-62.&#xD;
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	Yadav S, Nawal RR, Talwar S, Verma M. Low-level laser therapy for the management of large periapical lesions associated with open apex cases. Indian J Dent Res. 2020 Mar-Apr;31(2):334-336.&#xD;
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	Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992 Apr;8(2):45-55.&#xD;
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	Murphy WK, Kaugars GE, Collett WK, Dodds RN. Healing of periapical radiolucencies after nonsurgical endodontic therapy. Oral Surg Oral Med Oral Pathol. 1991 May;71(5):620-4.&#xD;
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	Soares J, Santos S, Silveira F, Nunes E. Nonsurgical treatment of extensive cyst-like periapical lesion of endodontic origin. IntEndod J. 2006 Jul;39(7):566-75.&#xD;
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	Abbaszadegan A, Dadolahi S, Gholami A, Moein MR, Hamedani S, Ghasemi Y, Abbott PV. Antimicrobial and Cytotoxic Activity of Cinnamomumzeylanicum, Calcium Hydroxide, and Triple Antibiotic Paste as Root Canal Dressing Materials. J Contemp Dent Pract. 2016 Feb 1;17(2):105-13.&#xD;
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	Grech L, Mallia B, Camilleri J. Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials. Dent Mater. 2013 Feb;29(2):e20-8.&#xD;
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	Han L, Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials. Int Endod J. 2013 Sep;46(9):808-14.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>To Effectiveness of the Awareness Program on Prevention of Cholelithiasis in General Population&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>220</FirstPage><LastPage>225</LastPage><AuthorList><Author>Morey SG</Author><AuthorLanguage>English</AuthorLanguage><Author> Sharma R</Author><AuthorLanguage>English</AuthorLanguage><Author> Gujar S</Author><AuthorLanguage>English</AuthorLanguage><Author> Sakharkar S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Cholelithiasis is the most common health problem in the western population. In this 80% of gallstones contain cholesterol. The pigment stones and mixed stones are remaining 20%. Every subtype having contained bile acids, calcium salt, and components of bile. The prevalence rate of gallstone is 10% to 20% worldwide. But cholelithiasis is found in a different part of the world. In India, the female prevalence rate is 5.59 % than the males 1.99%. South Indians have a 7 times lower occurrence of cholelithiasis as compared to north Indians. Objective: This study is planned to assess the existing level of awareness on the prevention of cholelithiasis in the general population. To evaluate the effectiveness of awareness program on the prevention of cholelithiasis in the general population. To associate the findings of the awareness program on the prevention of cholelithiasis in the general population with selected demographic variables. Methodology - It is an academic-based study. Research approach &#x2013; Interventional approach use in this study. Research design: One group pre-test post-test design. The study will be conducted in the selected community area of the Wardha district. Sampling technique-probability convenient sampling technique use. Structure questionnaire use. Result: The finding of the study shows that (90.83%) of the general population had an excellent level of awareness score, and (9.17%) had a good level of awareness score. The minimum awareness score in the posttest was 13 and the maximum awareness score in the post-test was 20. The mean awareness score in the post-test was 19.26&#xB1;1.87 and the mean percentage of awareness score in the post-test was 96.33&#xB1;9.36. there was no significant association of awareness score about age education, occupation, Place of residence and diet. Conclusion: The conclusion is drawn on the basic finding of the study, the pre-test finding showed that knowledge of the general population regarding prevention of cholelithiasis inadequate after the planned teaching helped the general population to understand more about prevention of cholelithiasis, most of the general population wear having adequate knowledge after the planned teaching.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Awareness, Cholelithiasis, Effectiveness, General population, Prevention</Keywords><Fulltext>Introduction &#xD;
&#xD;
&#x201C;Diamond snatched by a thief is better than a pebble in the tummy&#x201D;&#xD;
&#xD;
Cholelithiasis is the most common health problem in the western population. In this 80% of gallstones contain cholesterol. The pigment stones and mixed stones are remaining 20%. Every subtype having contained bile acids, calcium salt, and components of bile.1&#xD;
&#xD;
The gall bladder is a small shaped of the pear pouch or sac present below the liver. The gall bladder stored is bile concentrated. But gall stones difference caused in the bile stagnation. In this, there are two types of stone formation. Cholesterol stone and pigment stones. Cholesterol stones are account for 80% of gall stones affect in the world.&#xA0; The majority of the gallstones are caused by age over 40,&#xA0; diet, obesity, and complex interaction of genetic and environmental factors. Women&amp;#39;s rate is higher than men&amp;#39;s. Because of less activity in women as to men. Women tend to have higher body fat. And gall stones are silent form. And its complication is cancer.2&#xD;
&#xD;
Cholelithiasis is a more common reason for abdominal mortality and morbidity in the world.3.But now, Gallbladder&#xA0;disease&#xA0;is&#xA0;a&#xA0;widespread&#xA0;health&#xA0;concern&#xA0;in&#xA0;developing&#xA0;countries&#xA0;and&#xA0;is a&#xA0;major&#xA0;health&#xA0;issue&#xA0;in&#xA0;this&#xA0;regard.4&#xD;
&#xD;
Cholelithiasis is a recurrent and chronic hepatobiliary disease, in this impaired bilirubin, metabolism of cholesterol and bile acids. And this characterized by the formation of gallstones in the gallbladder, common bile duct and hepatic bile duct.5&#xD;
&#xD;
The prevalence rate of gallstone is 10% to 20% worldwide. But cholelithiasis is found in a different part of the world. In India, the female prevalence rate is 5.59 % than the males 1.99%. South Indians have 7 times lower occurrence of cholelithiasis as compared to north Indians. 6&#xD;
&#xD;
While most cholelithiasis is asymptomatic but some peoples experience biliary colic, which is characterized by severe and sudden pain in the upper right abdomen with some time nausea and vomiting and nausea occurring in later times and lasting few hours. Acute or chronic cholelithiasis is also in association with cholecystitis. Complications of cholelithiasis may include gangrene, infection,&#xA0; inflammation and perforation.7&#xD;
&#xD;
Cholecystitis because of cholelithiasis is a big health problem in the prevalence. cholelithiasis occur three times more often in women under 40 years of age and more than; and they also high in frequency with age.8&#xD;
&#xD;
Cholelithiasis&#xA0;is&#xA0;mainly&#xA0;seen&#xA0;in&#xA0;females,&#xA0;most&#xA0;of&#xA0;which&#xA0;have&#xA0;high&#xA0;cholesterol&#xA0;levels.9Gallstones are followed by essential epithelial changes in the gallbladder.10 Cholelithiasis is the type of cholesterol, brown pigment stones, and mixed. In this biliary colic symptom present in most common of the cholelithiasis in this 75 % of people seen the symptomatic cholelithiasis disease. In abdominal pain because of intermitted obstruction of the common bile duct.11 &#xD;
&#xD;
Composition of gall bladder stone is assumed. Heterogeneous, and observed variations within and&#xD;
&#xD;
without people.12,13&#xD;
&#xD;
Abdomen ultrasound is the confine diagnosis evaluation of cholelithiasis and also the identification of the particular disease condition .in this also does the medical and surgical management use for the cholelithiasis. In cholelithiasis medical management given the dissolution of gallstone with the bile. In surgical management do the surgical procedure in this laparoscopic or open cholecystectomy.&#xD;
&#xD;
Cholelithiasis is a more common risk factor in women, multiparty, family history, obesity, hypertension, diabetic Mellitus, birth control pills, vitamin C de?ciency etc.14,15&#xD;
&#xD;
This study aimed to identify the effectiveness of the awareness on the prevention of cholelithiasis among the general population. &#xD;
&#xD;
METHODOLOGY &#xD;
&#xD;
An Interventional research approach and quasi-experimental one group pre-test -post-test design were used in this study. The study was conducted in the selected community area of the Wardha district. the general population with the age group of 18-60. Inclusion criteria wear The both male and female are included study. Who are available at the time of data collection. Participants who are willing to participate in the study. Participants who can read and write Marathi and Hindi. Exclusion criteria wear Those who are participants in a similar type of study. Those who are health professionals. The sampling technique was used as a non-probability convenient sampling technique. The sample size was120. A structured questionnaire was used to collect the data. 16&#xD;
&#xD;
.Organization findings&#xD;
&#xD;
The analysis and interpretation of the observations are given in the following section:&#xD;
&#xD;
&#xD;
	&#xD;
	Section A: Distribution of general population with regards to demographic variables.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Section B: Assessment of level of pre-test and post-test level of awareness on prevention of Cholelithiasis in the general population.&#xD;
	&#xD;
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&#xD;
&#xD;
	&#xD;
	Section C: Assessment of the effectiveness of awareness on prevention of Cholelithiasis in the general population.&#xD;
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	&#xD;
	Section D: Association of the post-test level of awareness on prevention of Cholelithiasis in the general population with their selected demographic variables.&#xD;
	&#xD;
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RESULT :&#xD;
&#xD;
Section A:: Distribution of general population with regards to demographic variables.&#xD;
&#xD;
This table deals with the percentage wise distribution of the general population with regards to their demographic characteristics. A convenient sample of 120 subjects was drawn from the study population, who were from selected areas. The data obtained to describe the sample characteristics including age, education, occupation, place of residence and diet pattern respectively. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table no.1show the distribution of general population according to their age in the year shows that&#xA0; 40% of the general population were in the age group of 18-30 years, 17.50% were in the age group of 31-40 years, 20% were in the age group of 41-50 years and 22.50% of the general population were in the age group of 51-60 years.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Distribution of general population according to their 15.80% of the general population were educated up to primary standard, 40% up to secondary, 32.50% of them up to graduation and 11.70% of the general population were educated up to PG and above occupation. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The distribution of the general population according to their occupation shows that 15.80% of the general population were doing business, 22.50% of them were employees, 34.20% of them were housewife and 27.50% of the general population were doing other types of occupation.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0; The distribution of the general population according to their place of residence shows that 17.50% of the general population were from an urban area and 82.50% of them were from rural area.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The distribution of the general population according to their diet shows that 38.30% of the general population were vegetarian and 61.70% of them were mixed vegetarian.&#xD;
&#xD;
Section B: Assessment of level of awareness on prevention of cholelithiasis in the general&#xA0; population&#xD;
&#xD;
Table no 2 shows that 85% of the general population had a poor level of awareness score and 15%&#xA0; of them had an average level of awareness score. The minimum awareness score in the pretest was 1 and the maximum awareness score in the pretest was 8. The mean awareness score in the pretest was 3.80&#xB1;1.48 and the mean percentage of awareness score in pre-test was 19&#xB1;7.43.&#xD;
&#xD;
Table no. 3 shows that 9.17% of the general population had a good level of awareness score and 90.83% of them had an excellent level of awareness score. The minimum awareness score in the post-test was 13 and the maximum awareness score in the post-test was 20. The mean awareness score in the post-test was 19.26&#xB1;1.87 and the mean percentage of awareness score in the post-test was 96.33&#xB1;9.36.&#xD;
&#xD;
Section C: Evaluation of the effectiveness of awareness on prevention of cholelithiasis in the general population&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table no 4. shows the comparison of pretest and post-test awareness scores of the general population regarding the prevention of cholelithiasis. Mean, standard deviation and mean difference values are compared and student&#x2019;s paired &#x2018;to test is applied at a 5% level of significance. The tabulated value for n=120-1 i.e. 119 degrees of freedom was 1.97. The calculated &#x2018;t&#x2019; value i.e. 70.16 are greater than the tabulated value at a 5% level of significance for the overall awareness score of the general population which is the statistically acceptable level of significance. Hence it is statistically interpreted that the awareness regarding cholelithiasis among the general population was effective. Thus the H1 is accepted.&#xD;
&#xD;
Section D: Association of the level of post-test awareness score regarding prevention of cholelithiasis among the general population about demographic variables.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; There was no significant association of awareness score about age, education, occupation, place of residence and diet.&#xD;
&#xD;
DISCUSSION: &#xD;
&#xD;
Cholelithiasis is a common health problem worldwide. The prevalence rate of gallstone is 10% to 20% worldwide. But cholelithiasis is found in different parts of the world. In India, the female prevalence rate is 5.59 % than the males 1.99%. South Indians have a 7 times lower occurrence of cholelithiasis as compared to north Indians. &#xD;
&#xD;
The findings of the study were discussed regarding the objective stated in chapter 1 and with the finding of the studies in this section. The present study was undertaken &#x2018;To effectiveness of the awareness program on prevention of cholelithiasis in the general population. in the present study that 90.83 of the general population has an excellent level of awareness score. 17&#xD;
&#xD;
So many studies have evaluated the diet role and risk for developing the gallstone in this fatty acids, vitamins, carbohydrates energy intake, cholesterol, fibre alcohol intake and minerals. So many different studies given the association between gallstone and cholesterol intake. Nowadays, discoveries by the role of the orphan nuclear receptor in the regulations of fatty acid and cholesterol metabolism in the hepatic. 18&#xD;
&#xD;
So many studies demonstrated the risk for inflammation, path physiology of the gallbladder disease e.g. of the gallbladder wall, a diameter of the common bile duct. But in ultrasound also help predict the risk of the conversion. That time surgeon has to be decided during the time of the intraoperative open procedure in a short time. 19,20 &#xD;
&#xD;
In cholelithiasis, the prevalence rate is increased in non-vegetarian peoples and females also. all type of risk factors is affected in cholelithiasis especially among the females. Ultrasound also helps to detect and early screening.21&#xD;
&#xD;
So many studies in finding the in cholelithiasis bacterial play a role in the growth and development of cholesterol and pigment stone formation in the gallstone. Infection of the bacterium typos, E. coli,&#xA0; streptococcus. 22 &#xD;
&#xD;
Cholelithiasis is a preventive disease. But in this take the proper treatment. It used the medical, surgical both managed is effective in the treated for the cholelithiasis. In this prevention management in a proper diet, physical activity, lifestyle, proper vitamin C diet or supplement, all this helps to the prevention of cholelithiasis.&#xD;
&#xD;
So many studies found the majority of the study patients are non-vegetarians when compared with vegetarians. A drop in the risk of developing gallstones Holding an optimal body weight and eating the meal same diets recommended for the prevention of some common diseases like Diabetes Mellitus, hypertension, and heart diseases. Some food additives can also be used to help to avoid gallstones without supporting evidence that the option isn&#x2019;t strong. Based on the reality before us, going to suggest 500 to 2000 mg will be fair of additional vitamin C per day for patient&amp;#39;s risk of cholelithiasis developing to reduce their pathogenicity of bile. Iron status should also be measured and weaknesses should be dealt with properly. &#xD;
&#xD;
In this study, 61.7% (74 out of 120 ) population consumed a mixed diet and the rest 38.3% (46 out of 120) population consumed a vegetarians diet. &#xD;
&#xD;
CONCLUSION: &#xD;
&#xD;
This study aimed to identify the effectiveness of the awareness on prevention of cholelithiasis among the general population. Information is given to the general population through planned teaching which includes various aspects like general knowledge regarding causes, sing and symptoms, types, management and prevention of cholelithiasis. The conclusion is drawn on the basic finding of the study, the pre-test finding showed that knowledge of the general population regarding the prevention of cholelithiasis inadequate after the planned teaching helped the general population to understand more about the prevention of cholelithiasis, most of the general population wear having adequate knowledge after the planned teaching. The majority of 90.83 of the general population had an excellent level of awareness score. there was no significant association of awareness score about age education, occupation, Place of residence and diet.&#xD;
&#xD;
ACKNOWLEDGEMENT &#xD;
&#xD;
The author thanks Dr.Seema Singh, Professor cum Principal, Smt.Radhikabai Meghe Memorial College of Nursing. Datta Meghe Institute of Medical Sciences, Sawangi (M) Wardha for her timely support and valuable suggestions.Mrs. Jaya Gawai, Asso. professor cum academic dean.Mrs.Vaishali Taksande, Professor Dept. of OBGY, The author also thanks Mrs. Archana &#xD;
&#xD;
Maurya, Professor, Dept. of Child Health Nursing. Smt.Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Medical Sciences, (Deemed to be University), Sawangi (M) Wardha, for their continuous support and valuable suggestions.&#xA0; The authors are also grateful to authors/editors/publishers of all those articles, journals and books, from where the literature for this article has been reviewed and discussed. The authors are grateful to the IJCRR editorial board members and the IJCRR team of reviewers who have helped to bring quality to this manuscript.&#xD;
&#xD;
ETHICAL APPROVAL&#xD;
&#xD;
&#xA0;Ref.no DMIMS(DU)/IEC/Dec-2019/8646&#xD;
&#xD;
PATIENT INFORM CONSENT&#xD;
&#xD;
Taken.&#xD;
&#xD;
CONFLICT OF INTEREST&#xD;
&#xD;
The author declares that there are no conflicts of interest.&#xD;
&#xD;
FUNDING &#xD;
&#xD;
Not applicable &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3853</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3853</Fulltext></URLs><References>&#xD;
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	Hazrah P, Oahn KT, Tewari M, Pandey AK, Kumar K, Mohapatra TM, Shukla HS. The frequency of live bacteria in gallstones. Int J Res Health Sci.. 2004 Mar 1;6(1):28-32&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An Improved Firefly Algorithm Integrated with Recurrent Neural Network (RNN) for Face Recognition&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>226</FirstPage><LastPage>232</LastPage><AuthorList><Author>Indranil Lahiri</Author><AuthorLanguage>English</AuthorLanguage><Author> Hiranmoy Roy</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Face recognition (FR) is a promising biometric trait widely used for authentication in several applications like finance, military, security, surveillance and so on in daily life. Deep learning involves several processing layers for learning data representations with feature extraction at multiple levels. Hence, deep FR techniques with hierarchical architecture which puts pixels together to represent invariant face has drastically improved the recognition performance and promoted real-time applications successfully. Objective: In this research, an Improved FireFly (IFF) algorithm is developed to recognize face whose performance is estimated by the integration of RNN network. Method: Based on the selected dataset, RNN involved in analysis of facial features with inclusion of improved firefly algorithm (RnnIFF). Result: The results stated that proposed approach provides higher value of accuracy, precision and sensitivity expressing 90%, 90% and 91% respectively. Also, Mean Square Error (MSE) and Peak Signal to Noise ratio (PSNR) is evaluated and comparatively examined with existing techniques. The simulation results illustrated that proposed RnnIFF exhibits significant performance for recognition of faces.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Recurrent Neural Network, Improved Firefly, Facial parts, Facial features, Classification, Peak signal to noise ratio,  Alexnet, Convolutional neural networks</Keywords><Fulltext>&#xD;
INTRODUCTION&#xD;
&#xD;
&#xD;
&#xD;
Face recognition (FR) is extensively used in applications like security and financial sectors, say electronic payments. In the recent decades, FR has attracted the researchers. At the beginning, several classical approaches encountered bottlenecks due to some limitations like computing power and capability of the model designed.1,2 As recurrent neural networks (RNNs) were introduced and due to the increase in hardware capability, several limitations were eliminated rapidly, and thus various FR approaches based on RNNs were developed.3The fundamental concepts of FR are feature extraction and their classification. Feature extraction discovers several discriminative features from the input which helps the classifiers to have a greater impact on recognition rate. &#xD;
&#xD;
In the training set, due to the redundant facial images, the samples are exemplified by the low dimensional features extracted from face.4 By using these extracted features, computational cost is reduced and recognition rate of the classifiers is improved. &#xD;
&#xD;
&#xD;
For real-time applications, changes in illumination, occlusions, facial expressions and varying pose are noted in a probe which makes the extracted features inefficient. An image can be represented effectively by the process of segmentation which retains the informative regions of the image. Neural network based approaches can provide better classification accuracy. But, these methods are in need of numerous training samples. Further, it is believed that few feature extraction techniques namely Principle Component Analysis (PCA),5 Independent Component Analysis (ICA)6 and Linear Discriminate Analysis (LDA),7 contribute less towards classifications, as they are linear representation approaches. Hence, there arises a necessity to develop a classifier for the FR system that uses the more discriminative information of the probe image is varying and corrupted situations.8&#xD;
&#xD;
Generally, the less number of grayscale or color images limits the discriminating ability of FR system. Moreover, with PCA, Gabor filter or Support Vector Machine (SVM), spatial parameters extracted from grayscale or color images, are poor if the image has pose and illumination variations and hence thereby results in low accuracy. Many researchers use hyperspectral imaging facial datasets as they have large volume of images.9 Hyperspectral imaging approach provides better FR results by capturing spectral features from face images which provide additional information for classification. The accuracy of the image is increasedwhich depends on the spatial based approaches; moreover, the facial space distance areminimized by inter-object distance. At this circumstance, hyperspectral imaging approach helps to improve the performance as several features were used.10&#xD;
&#xD;
The traditional deep FR system generally aligns the faces first usingsimple affine transformations which is then fed into convolutional neural networks (CNNs) for extracting identity-preserving features. As this transformation removes only pose variations related to in-plane, still out-plane pose variations exists thereby causes misalignments in faces. Consequently, the accuracy of the FR system is very low when out-plane pose variations are more. To deal with this issue, one of the two following options can be used; aligning images with some additional technology like 3D face alignment11or improving the capability of CNN&#x2019;s to extract pose-invariant features.11&#xD;
&#xD;
LITERATURE REVIEW&#xD;
&#xD;
After investigating the face recollection approaches of image processing, it is found that few methods were successful and those are described here below.12 In the visible light destination approach was introduced for identifying the visual system, least squares were employed for grouping the various poses. The approach was liable to noise. In large-scale face recognizer was suggested which was capable of respondingto the complexity of document asymmetry. For producing, productive universal dataset, a novelapproach was presented image recognition by incorporating fluctuations of data where more effectiveusefulfeatures were extracted.13 &#xD;
&#xD;
In a novel approach to authenticate face was developed which was capable to handle a various pose combinations.14,15 a mutual Bayesian adaptation approach was suggested for modifying GMM to precisely predict the inconsistencies in facial expressions. In a broad space gradient inclusion method which focused on a novel Frenet picture to accept 3-D silhouette-invariant face and posture. Additionally, definedonly one image in the permanent collection to implement a novel approach to detect face with smiling as well as appearance patterns. 16 A 3D Stochastic Facial Emotion Recognition Synthetic Adjustable model was designed and implemented for repeating a 3D method from the original human image using a full 2D anterior imageeitherwith expressions or with no expressions. In the near future, the envisaged FR system can be used inuncontrolledface recognition which is stable to a wide range of patterns related to faces. In an auto encoder was introduced which had the ability to produce a strong-level ethnicity characteristicsfrom posture inconsistencies. Next, empowered personality featuresbydisplacing mechanical auto encoders&#x2019; target principles to generic transmissions. A tri-task CNN was considered for facial recognition in which classification and identification were the major role and other functions were projections of illuminations and poses.18 In changes within the image were examined based onthepixel density, amplification etc.,and revealed a training approach for compensating body transition.17&#xD;
&#xD;
PROPOSED METHODOLOGY&#xD;
&#xD;
An overview of the proposed approach for identification and recognition of facial features is discussed in this section. To enhance the recognition rate, the proposed system incorporates facial parts and features included for facial recognition. Figure 1 illustrates the working of the proposed RnnIFF for facial recognition. &#xD;
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Based on the framed phases, collected facial images to recognize are processed and examined to estimate the performance of the proposed RnnIFF method comparatively with other related methods. The following section explains the proposed approach in detail.&#xD;
&#xD;
Proposed RNN with Improved FireFly (RnnIFF)&#xD;
&#xD;
RnnIFF comprises of three stages namely partness map generation, candidate window ranking using the faceness scores, face proposal refinement to detect face. In the beginning, as demonstrated in Figure2,the five layers of RNNs takes a full image x as input. To reduce the computational time, deep layers are shared by all these RNNs. At the top convolutional layer, by averaging, the weights of all the label maps, every RNN generates a partness map. Every partness maps specifies the position of a particular component in the facial image like eyes, mouth, nose, hair and beard, represented as he, hm, hn, ha and hb respectively. All of the abovepartness maps are combined as a face label map hf which specifies the locations of the face clearly. &#xD;
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In the second stage, windows are ranked based on their faceness scores. These scores were extracted from partness maps relating to the configurations of the various facial parts, as depicted in Figure 2. As an example, considering as in Figure 3, the local region of ha is covered by the candidate window applied in convolution layer 1&#x2013;7whose faceness score is obtained by dividing the upper part values with its lower part values. This is because hair is present at the top region of face. The final faceness score is the average of all the scores of these parts. &#xD;
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In this case, there is a vast possibility to prune numerous false positive windows. Particularly, this proposed approach has the ability to cope with face occlusions, as visualized in Figure 3, where windows &#x2018;A&#x2019; and &#x2018;E&#x2019; are obtained by objectness19 only when several windows are projected, whereas their rank is in top 50 when this method is utilized. Finally, multitask CNN is trained to refine the proposed candidate windows, where both the bounding box regression and classification of face are optimized.&#xD;
&#xD;
Improved FireFly (IFF)&#xD;
&#xD;
Firefly algorithm (FA) is a familiar stochastic approach for optimization which was introduced by Liu20. This algorithm depends on the illumination of firefly where most of them are bright. This illuminations helps in attracting the prey and opposition. Each firefly sends illumination signals to other firefly. Generally, FA is based on attractiveness and brightness21 which are familiar rules of FA. &#xD;
&#xD;
&#xD;
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	As fireflies are unisex, it attracts all other fireflies irrespective of sex. &#xD;
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	The Attraction between two fireflies is directly proportional to Intensity of light or luminance hence brighter ones are more attractive. Firefly having low light intensity moves towards brighter ones. &#xD;
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	Brightness of the firefly is achieved through cost function or fitness function which is used for searching purpose. &#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mathematically, FA is represented as follows. Brighter firefly j attracts firefly i whose movement is obtained by&#xA0; &#xD;
&#xD;
&#xA0; &#xA0; &#xA0; &#xD;
&#xD;
Where, xi&#xA0;&#xA0;and xj&#xA0;represent the position of firefly i and firefly j respectively.&#xA0;&#xA0;is the updated position and &#xA0;is the initial position of firefly. &#x3D2; is considered as attractive force between firefly. &#xA0;is the relative distance between two fireflies.&#xD;
&#xD;
Multilevel thresholding for the grayscale image is a very challenging task. Metaheuristic algorithm can be used to obtain the threshold value with-in range [0, L-1]. Firefly is one of the best metaheuristicalgorithm for maximizing the entropy measure of histogram. FA can be effectively used with levy flight to find optimum threshold value.&#xA0; &#xD;
&#xD;
Step 1: Generate the population&#xA0;&#xA0;randomly within the range. &#xD;
&#xD;
Step 2: Define the Kapoor&#x2019;s Entropy method as Objective function. &#xD;
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Step 3: Initialize Absorption coefficient &#x3D2;, Maximum Attraction &#x3B2;0, Step Size as levy Flight, maximum iteration &#xD;
&#xD;
Step 4: Calculate the fitness value for each firefly using &#xD;
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Step 5: Firefly updates its position towards brighter one using&#xA0; &#xD;
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Step 6: Repeat step 3 to 5 until maximum iteration is reached. &#xD;
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Step 7: Estimate the optimum threshold value with which the facial parts are segmented. &#xD;
&#xD;
Among several segmentation evaluation metrics Peak-signal-to-noise ratio (PSNR) provides significant performance measure. Moreover, computational time and values of objective function are also used as parameters to determine the quality of the image segmented. Usually, PSNR is utilized for approximating the supremacy of the image and the relativity between the original and segmented image.&#xD;
&#xD;
Facial Part Identification&#xD;
&#xD;
A deep network which is trained on common objects, for exampleAlexNet16, is unable to provide precise location of faces. There exists several ways to learn partness maps but the most direct one is using the image as input and its pixelwise segmentation label map as target which is broadly used in image labeling5. Another is classifying faces and non-faces at image-level which is well suited for training images that are well-aligned.&#xA0; &#xD;
&#xD;
However, complex background disorderoccurs as the supervisory information is insufficient for face variations. The feature maps with morenoiseoverwhelm the original position of faces. As an example, an &#x2018;Asian&#x2019; face is differentiated from that of a &#x2018;European&#x2019;. As the attributes of hair are related, they are grouped together. Likewise the other regions too as in Table 1.Various CNNs are involved in modeling different facial regions. Thereby, if one region is occluded, the other regions can be identified by CNNs. &#xD;
&#xD;
&#xD;
&#xD;
Face Detection&#xD;
&#xD;
The windows proposed for this approach achieved by faceness have a greater recall. For further improving it, these windows are refined by face classification and bounding box regression with the help of RNN whose function is similar to AlexNet16. Particularly, AlexNetis fine-tuned using AFLW and PASCAL VOC 2007 face images21. For classification, the window is assigned a positive label and the ground truth bounding box is greater than 0.5; or else negative. For false positive values, RNN produces a vector [&#x2212;1, &#x2212;1, &#x2212;1, &#x2212;1]. &#xD;
&#xD;
EXPERIMENTAL ANALYSIS&#xD;
&#xD;
Training datasets: CelebFaces dataset is used for training attribute-aware networks with 87,628 web-based images. All the images are labelledwith 25 facial attributes which are divided into five categories as in table 1. Around 75, 000 images were randomly selected for training while the rest was reserved for validation. For detecting face, 13,000facial images were chosen from AFLW dataset with pose variations and 5,700 images from the PASCAL VOC 2007 dataset. From LFW dataset, 2,900 images were selected as it manually provides hair as well as beard superpixel labels. With 68 dense facial landmarks, boxes for eye, nose and mouth are labeled manually. &#xD;
&#xD;
Intersection over Union (IoU) was used as a metric for evaluating the algorithm. IoU threshold is fixed to 0.5. Particularly, an object is detected whenIoUis more than 0.5. Detection rate, precision and recall were involved to evaluate the effectiveness of the algorithm.Figure 4 presentsthe overall flow of proposed RnnIFF in face recognition. In figure 5, faces identified from the available dataset are presented. &#xD;
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Figure 4: Face Recognition Process in RnnIFF&#xD;
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&#xA0;&#xA0;&#xA0;&#xD;
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Figure 4, 5 illustrates that this approach significantly outperforms conventional approaches. In table 2, parameters measured for various input images like accuracy, precision and specificity are presented. &#xD;
&#xD;
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The figure 6 shows the accuracy calculated for the entire input image. X- axis gives the image representation and Y-axis gives accuracy measurement. It denotes that accuracy for proposed technique ranges between 85 and 90. This is the optimized accuracy attained by our proposed technique. &#xD;
&#xD;
The figure 7 shows the precision calculated for the input images. X-axis gives the image representation and Y-axis gives precision measurement. It denotes that precision for proposed technique ranges between 85 and 95. This is the optimized precision attained by our proposed technique.&#xD;
&#xD;
&#xD;
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&#xD;
&#xD;
The above figure 8 shows the specificity calculated for the entire input image. X- axis gives the image representation and Y-axis gives specificity measurement. It denotes that specificity for proposed technique ranges between 85 and 90. This is the optimized specificity attained by our proposed technique.&#xD;
&#xD;
Partial occlusion are explicitly handled in this approach by gatheringthe face likeliness via part responses. The speed was achieved by sharing the layers from conv1 to conv5 as part responses of the face were captured only in the layer conv7 as depicted in figure 2.The speed of this approach is comparatively lower than19. Particularly, this method shows that a CNN structure enjoys a 2.5&#xD7; speedup without accuracy loss. This method is also benefited from the latest model compression technique8. In table 3 PSNR measured for different images are presented. &#xD;
&#xD;
&#xD;
&#xD;
In table 2 comparative PSNR values of existing filters and proposed RnnIFF facial recognition method is presented. The observed results demonstrated that proposed RnnIFF approach exhibits higher PSNR value rather than conventional filtering concept. The performance of RnnIFF technique for all 4 images are 20% higher than that of the conventional filtering facial recognition technique.&#xD;
&#xD;
From figure 9, it is observed that the proposed RnnIFF exhibits higher PSNR value than bilateral filter, adaptive filter, granular filter and Gaussian filter. In table 3 MSE measurement of the existing and proposed RnnIFFapproaches are presented. &#xD;
&#xD;
&#xD;
The above table 4 illustrates the MSE performance of existing filtering and the proposed RnnIFF approaches. The RnnIFF approach provides a minimal MSE value of 0.02466 , 0.046656, 0.0058665 and 1.79666 for images 1 to 4 through which it is considered that proposed RnnIFF approach exhibits superior performance rather than existing techniques.In figure 10, comparesthe proposed RnnIFF with the existing bilateral filter, adaptive filter, granular filter and Gaussian filter.&#xD;
&#xD;
&#xD;
&#xD;
From figure 10, it is observed that proposed RnnIFF exhibits superior performance with minimal MSE value compared with existing techniques. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Facial recognition has been utilized in vast range of application due to its security features. In the past, approaches based on neural network were widely applied to locate faces. In this paper, a RNN based approach for facial recognitionis proposed. The proposed approach incorporated RNN with improved firefly algorithm (RnnIFF) for identification of faces. By identification of facial parts, the proposed RnnIFF approach estimated the facial features to perform facial recognition. The evaluation of proposed RnnIFF exhibited that through significant training and testing process facial features were effectively identified. The proposed RnnIFF achieved the accuracy level of 90%, precision value of 90% and specificity value of 91%. The comparative analysis of PSNR and MSE with existing techniques states that the proposed RnnIFF expressed higher PSNR level of approximately 20% and MSE of approximately 10%. The facial features of image expressed that proposed RnnIFF provides improved performance rather than conventional techniques. &#xD;
&#xD;
ACKNOWLEDGMENT&#xD;
&#xD;
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals, and books from which the literature for this article has been reviewed and discussed. &#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xD;
&#xD;
Author&#x2019;s Contribution:&#xD;
&#xD;
I / We both have equally contributed to this article interms of data collections and research methodologies&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3854</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3854</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Mothers&amp;#39; Attitude Towards Self as a Pre-requisite of Social Competence Skills among Children&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>233</FirstPage><LastPage>238</LastPage><AuthorList><Author>Smriti Gandhi</Author><AuthorLanguage>English</AuthorLanguage><Author> Mamata Mahapatra</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: With the advancement in society, women have taken up major responsibilities, not just personally but also professionally. The burden of responsibilities brings a lot of stress, some may manage it, but some may become vulnerable to develop various psychological issues like depression, anxiety, etc. The effect of those vulnerabilities can be seen in their personal lives which can affect their children. Aim: The study focused on assessing the impact of Mothers&#x2019; attitude towards self that suggests cognitive vulnerabilities towards depression, on their child&#x2019;s Social Competence. Methodology: The study was carried out on 200 Mothers (working and homemakers) in the age range of 30-50 years and their children with age range 13-18 years. Mothers&#x2019; attitude was measured using the Attitude Towards Self scale and the child&#x2019;s Social Competence was measured using the Social Competence Scale. Results: There was a significant difference at p&#x2264;.01 in the dimensions of Mothers&#x2019; Attitude towards Self, namely High Standards (t=&#xB1;15.626), Self-Criticism (t=&#xB1;8.369) and Generalization (t=&#xB1;11.203), and Social Competence of their children&#x2019;s between working mothers and homemakers (t=&#xB1;20.442), where the homemakers and their children were higher on every aspect. The Social Competence between boys and girls (t=&#xB1;2.008) was also significant at p&#x2264;.05, where girls showed higher Social Competence as compared to boys which were calculated using an independent t-test. The relationship between Mothers&#x2019; negative attitude towards self and their children&#x2019;s social competence, evaluated using Pearson&#x2019;s r correlation, were moderately significant at p=.01, however was inversely proportional with a significant impact on the child&#x2019;s social competence showing 49% of the variance, analyzed using regression. Conclusion: Therefore, the attitude of working or homemaker mothers significantly affects the child&#x2019;s development.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Mothers, Attitude, Cognitive vulnerabilities, Social Competence, Children</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Parents play an important role in nurturing their children that helps them attain developmental milestones. A child learns from the family and especially parents, where both the parents play an equally important role. Mothers&#x2019; have always been the primary caregivers, as they spend most of the time with the children since the day child opens his/her eyes.1 Mother do have to take up multiple roles simultaneously to keep life going, not only hers but for her whole family. For those who choose to work as well, their responsibilities increase substantially, this, in turn, can increase the stress in life. Stress is a very common factor that every individual experience. However, the intensity may vary which can be due to various factors.&#xD;
&#xD;
Stress can be helpful as it motivates an individual which is also termed as Eustress. It, however, becomes problematic when it starts impacting an individual&#x2019;s life in a negative manner, also known as Distress.2 Distress initiates a negative thinking pattern which gradually increases and starts affecting an individual&#x2019;s life and the attitude and perception towards self. It triggers various cognitions that influences negative thinking patterns, also considered as ruminations that become suggestive of self-regulatory vulnerabilities3 that may lead to developing various psychological issues, depressive and anxiety symptoms being the most common of all.4&#xD;
&#xD;
Mothers, with such heavy responsibilities, are becoming vulnerable to all these psychological issues with other stressors in life.5 Researchers have shown significant differences in the stress level that may develop cognitive vulnerabilities among working and non-working women as they have more stressful lives as compared to non-working women.6, 7, 8 Their mental well-being either positive or negative, impacts the development of their children, that can be seen in their social and emotional behaviour.&#xD;
&#xD;
Researchers have identified that the factors that influence the child&#x2019;s social competence are its environment, the attitude of parents, also the employment status of the mothers, as it may reduce the mother-child interaction time which is very important for the child&#x2019;s development.9, 10 There may be the negative impact of mother&#x2019;s employment on the child, however, they are still able to engage with their children and impart social and emotional abilities in them.11It may become a problem when mothers have their self-regulatory cognitive vulnerabilities towards developing depressive tendencies and may lead to problems in the social competence of their children as compared to non-working mothers. However, there is a dearth of research on the cognitive vulnerabilities towards psychological issues among women that may create an effect on their children&#x2019;s development.12,13 &#xD;
&#xD;
AIM AND OBJECTIVES:&#xD;
&#xD;
To study the impact of mothers&#x2019; attitude towards self on the social competence of their children. &#xD;
&#xD;
The study was carried out with a view of exploring the following objectives:&#xD;
&#xD;
&#xD;
	&#xD;
	To study the difference in the Attitude towards Self between Working Mothers and Homemakers&#xD;
	&#xD;
	&#xD;
	To study the difference in the level of Social Competence of the children of Working Mothers and Homemakers&#xD;
	&#xD;
	&#xD;
	To study the significant difference in the level of Social Competence between boys and girls&#xD;
	&#xD;
	&#xD;
	To examine the relationship between the Mother&#x2019;s Attitude towards Self and their child&#x2019;s Social Competence&#xD;
	&#xD;
	&#xD;
	To study the impact of Mother&#x2019;s attitude towards self on their child&#x2019;s Social Competence&#xA0; &#xD;
	&#xD;
&#xD;
&#xD;
HYPOTHESIS&#xD;
&#xD;
H1: There is a significant difference in the Attitude towards Self between Working Mothers and Homemakers.&#xD;
&#xD;
H2: There is a significant difference in the level of Social Competence of the children of Working Mothers and Homemakers.&#xD;
&#xD;
H3: There is a significant difference in the level of Social Competence between boys and girls.&#xD;
&#xD;
H4: There is a significant relationship between the Mother&#x2019;s Attitude towards Self and their child&#x2019;s Social Competence.&#xD;
&#xD;
H5: There is a significant impact of a Mother&#x2019;s attitude towards self on their child&#x2019;s Social Competence.&#xD;
&#xD;
MATERIAL AND METHOD&#xD;
&#xD;
Participants&#xD;
&#xD;
The questionnaire was distributed among 265 Working Mothers and Homemakers of age range 30-50 years, and their children with age range 13 to 18 years, out which 200 Mothers (n=100 Working Mothers and n=100 Homemakers) and their children (n=100 boys and n=100 girls) were selected for the study. The remaining 65 participants having clinical depression were not included in the study. The study was approved by the ethical committee and the document is attached in Appendix 1.&#xD;
&#xD;
Measures&#xD;
&#xD;
The cognitive vulnerabilities towards Depression in Mothers was measured using the Attitude Towards Self-Revised scale (ATS-R) which was developed and revised by Carver in the year 2013.12 It is a 10 item Likert type scale that evaluates self-regulatory cognitive vulnerabilities towards Depression. It evaluates three core vulnerabilities which are holding overly high standards, being self-critical towards failure and generalizability even from a single failure to a wider sense of self-worth. The reliability coefficient on the dimensions came out to be, for High Standards, Cronbach&#x2019;s Alpha was r= .774, Self-Criticism was r= .759, and for Generalization, the Cronbach&#x2019;s Alpha was r= .674. The reliability coefficient suggested moderate to good reliability.&#xD;
&#xD;
Social Competence in the children was measured by Social Competence Scale developed by Sharma, Shukla &amp; Shukla in 1992.13 It is a 50 item Likert type scale that measures one&#x2019;s social ability and the individual&#x2019;s interpersonal skills, which is evaluated based on 18 dimensions, namely, Social Sensitivity, Social Maturity, Social Skills, Social Relations, Social Commitment, Social Appreciation Ability, Socio-Emotional Integrity, Social Involvement, Social RespectAbility, Social Leadership, Social Cooperation and Compliance, Social Acceptability, Social Tolerance, Social Competition, Social Authority, Adult Resource Exploitability, Social Participation, Pro-Social Attitude and the Composite Score. The reliability of the scale came out to be very high with Cronbach&#x2019;s Alpha r= .936.&#xD;
&#xD;
Procedure&#xD;
&#xD;
Mothers with their children who had come for the Parents Teacher Meeting in a school in Delhi, National Capital Region were considered for the study. The responses from two hundred Mothers including their children out of two hundred and sixty-five responses were included in the study according to the inclusion and exclusion criteria. Mothers&#x2019; attitude towards self was evaluated using a 5-point Likert type scale and their child&#x2019;s social competence was too assessed using another 5-point Likert type scale. The reliability of both the tools was calculated, before the calculation of descriptive and inferential statistics using SPSS v25.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Mothers suggestive of clinical depression were excluded from the study. The low and moderate scores on the Attitude towards self- Revised scale to study the cognitive vulnerabilities towards depression was considered for further analysis due to the nature of the sample being from a non-clinical population. The results were then analysed using the statistical software SPSS v25.&#xD;
&#xD;
Table 1 shows the differences between the means of Working Mothers and Homemakers in the Mothers&#x2019; Attitude towards Self and Social Competence of their children. There was a significant difference in the scores of High Standards of Working Mothers (M=7.99, SD= 1.168) and Homemakers (M=5.44, SD= 1.140); t= &#xB1;15.626, p &#x2264; .01, Self-Criticism of Working Mothers (M=7.50, SD= 1.592) and Homemakers (M=5.63, SD= 1.168); t= &#xB1;8.369, p&#x2264; .01, Generalization of Working Mothers (M=9.65, SD= 1.395) and Homemakers (M= 9.65, SD= 1.395); t= &#xB1;11.203, p &#x2264; .01, and the Social Competence in the children of Working Mothers (M= 166.60, SD= 17.196) and Homemakers (M= 213.31, SD= 15.048); t= &#xB1;20.442, p &#x2264; .01.&#xD;
&#xD;
An independent sample t-test was conducted to compare Social Competence between Boys and Girls. From Table 2, it can be gathered that there was a significant difference observed in the scores of Social Competence of Boys (M= 185.95, SD= 23.259) and Girls (M= 32.414); t= &#xB1;2.008, p &#x2264; .05. The results depicted that girls were high on Social Competence as compared to boys.&#xD;
&#xD;
Based on the results of the study in Table 3, Mother&#x2019;s High Standards, Self- Criticism and Generalization showed a moderate yet negative correlation with the Social Competence of their children. The correlation values came out to be -.590, -.417 and -.606 respectively, which were significant at p= 0.01.&#xD;
&#xD;
Multiple linear regression was calculated to predict Social Competence among children based on their mothers&#x2019; tendency towards High Standards, Self-Criticism, and Generalization. A significant regression equation was found (F (3, 196) = 62.757, p=.000), with an R2 of .490. The results in Table 4 predicted Social Competence is equal to 282.113 &#x2013; 6.027 (High Standards) &#x2013; 1.153 (Self- Criticism) &#x2013; 5.296 (Generalization). Social Competence of children decreased by 6.027 unit of measure for each unit increase in the tendency of High Standards, 1.153 in the tendency to Self-Criticism and 5.296 in the tendency to Generalize among their Mothers. High Standards and Generalization were both statistically significant predictors of Social Competence among their children however, Self- Criticism was not found to be significant.&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The current study focused on exploring the differences in the Attitude towards Self between Working Mothers and Homemakers, Social Competence among their children, the difference in the Social Competence of boys and girls. The study also focused on examining if any relationship existed between the Mothers attitude towards self and the Social Competence of their children, and to assess if Mothers&#x2019; attitude predicted Social Competence in their children. &#xD;
&#xD;
The Mother&#x2019;s cognitive vulnerabilities were evaluated to study if the tendency for high standards, self-criticism and generalization existed in those who are Working or who are Home Makers. The results showed that these tendencies were higher in Working Mothers as compared with Homemakers which was statistically significant at the p &#x2264; .01 level. Researchers in their studies have mentioned that non-working women have good mental health and low depressive symptoms as compared to working women14 which also, in turn, led to decreased satisfaction in life.15 Due to work and family pressure, working women were much vulnerable to mental health issues like depression and anxiety, etc.16 With this pressure, other problems that were associated with working women were financial issues, workplace problems, higher responsibilities along with multitasking, which was the risk factors linked to depression.17 The above factors may have contributed to the mental health of working women which seem to be lower when compared with non-working mothers. These factors may also lead to higher tendencies of Self-criticism in women, which may further play a crucial role in increasing vulnerability towards psychological issues and emotional symptoms.18 Mothers&#x2019; attitude and their mental state affect the development of their children, which was gathered through the data in the present study. The results depicted that working mothers who were vulnerable to depressive tendencies impacted the social competence of their children in a negative way. It was observed that a negative but significant relationship of mothers&#x2019; negative attitude with the social competence of their children. Children of the working mothers showed low social competence as compared to the children of homemaker mothers. Mothers&#x2019; negative attitude affects the development of children in a negative manner.19 and the negative interactions with the child was negatively correlated with the child&#x2019;s Social Competence.20 There also existed gender differences in the Social Competence among children. Girls are generally good in the social skills that they possess as compared with boys, further making them more socially competent than boys. The results of the study also showed that girls are higher on social competence as compared to boys, which was also corroborated in the study done by Mohammed Khalifa in 2017.21 The study had various limitations which stated that the results of the study were applied to the nuclear family structure and middle economic class of Indian Society. Another limitation stated that as children are already vulnerable in the Adolescent age which can be contributed by various factors that may become a challenge for them, consequently affecting their developmental process, especially social and emotional. Those factors have not been taken into consideration for the study purpose. Despite these limitations, the results of the study can contribute to society. Early detection and managing the stress faced by women irrespective of their employment status may prevent serious mental health issues. These also affect their children. It requires efficient management and balancing of the responsibilities which may lower the risk factors related to developmental issues and further preventing their severity. The outlook may turn out to worsen if other mental illnesses are also present. Identification and essential measures in the initial years of growth and development should primarily be considered for healthy children. Children who may display low scores on social competence have greater chances to develop depression or bipolar disorder or become suicidal. Preventive and positive interventions may be developed for such children. The mental healthcare unit may develop the provisional program to use behavioural modification therapy or talk therapy to help teach children to enable and empower them with skills to deal in day to day life with positive emotions and social behaviour.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Stress can cause various issues in one&#x2019;s life that increases with a wider range of responsibilities that an individual may have. With the change in time, societal norms have also undergone a paradigm shift, where earlier few of the women were working, but now most of them go out for work. They have increased responsibility now, where women must look after their family, with their work. This increased responsibility has increased stress in their life which has further made them more vulnerable to developing psychological issues. Children are impacted directly by the mothers&#x2019; attitude, this stress negatively changes the mother&#x2019;s attitude, therefore, having a negative impact on the children. The social competence of the children is affected by mothers&#x2019; attitude towards self and psychological health. Mother being the primary caregiver irrespective of employment or otherwise is the crucial nurturer of holistic development of their children. This will support in creating good human values and healthy communities at large. &#xD;
&#xD;
Acknowledgement&#xD;
&#xD;
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflict of Interest&#xD;
&#xD;
NIL&#xD;
&#xD;
Source of Funding&#xD;
&#xD;
NIL&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
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	Dhingra V, Keswani S. Impact of Working and Non - Working Mothers on Development of their Children in Madhya Pradesh. Int J Res Adv Techn. 2019;7(3):1369-1375.&#xD;
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	Attili G, Vermigli P, Roazzi A. Children&#x2019;s Social Competence, Peer Status, and the Quality of Mother- Child and Father-Child Relationships. Eur Psych. 2010;15(1):23-33.&#xD;
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	Khalifa M. Towards Mental Health with Child Social Competence and Parental Disciplinary Approaches in Egypt. Int J Appl Psych. 2017;7(3):60-69.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>26</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Positive Cognitive Behavior Therapy based Intervention with a Caregiver of a Patient with Mental Illness Amidst the Covid-19 Pandemic:&#xA0;A Case Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>239</FirstPage><LastPage>242</LastPage><AuthorList><Author>Khurana R.</Author><AuthorLanguage>English</AuthorLanguage><Author> Kumar N.</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Caregiver stress, Positive Aspects of Caregiving, Case study, Covid-19 Pandemic, Intervention, Positive CBT</Keywords><Fulltext>Introduction&#xD;
&#xD;
Researchers have indicated that serious dysfunctional behaviour gives rise to a considerable amount of burden for the relatives of the individual suffering from the psychological ailment, particularly those people who opt for a caregiver job.1 It has been reported that individuals who take up the role of caregiving seem to undergo feelings of failure and agony, melancholy, tiredness, mental exhaustion, difficulty in sleeping, nervous breakdown, criticism, feeling liable, loneliness and monetary difficulties, linked with the repercussion of negative views that are connected with psychological ailment.2-5&#xA0; Caregivers reported experiencing an increase in negative feelings like helplessness, burden, distress during the pandemic due to limited support from the healthcare, added responsibilities and abiding by the Covid norms like social distancing.6-10 Nonetheless, members of the family could be a great support in providing additional help to individuals suffering from a psychological ailment in their society, while they are being treated and also are essential in stimulating societal connections. Sadly, appropriate and due attention is not given to caregivers in the psychological health sector all over the world.11-14 A study suggests appropriate availability of treatment is not enough of a remedy, it&#x2019;s equally important to create a system that could offer support to the caregivers. The interventions created to offer support to the caregivers should fulfil the criteria of being attainable, holding social and cultural significance, capable enough to uncover false and questionable beliefs, fitting well to the demands of the individual providing care and include all tiers of the society. 15-18 An interventional research19,20,21 carried out with caregivers showed positive results with a noticeable decrease in caregiver burden22 hardship, depressive and anxious feelings and better quality of life. &#xD;
&#xD;
Case Report&#xD;
&#xD;
R.S, a 55-year-old woman who is a caregiver to her daughter, was diagnosed with Bipolar Disorder. She was administered with assessment tools namely Caregiver Strain Index,1 Beck&#x2019;s Anxiety Inventory,3 Beck&#x2019;s Depression Inventory,2 Satisfaction with life Scale4 and Positive Aspects of caregiving5 to understand the level of Caregiver strain, Anxiety, Depression, Satisfaction with life and positive aspects of caregiving. The caregiver, a Buddhist practitioner, has been rigorously practising chanting. However, surprisingly that did not put her mind to peace due to which she reached out for help. The family members of the caregiver were not in favour of her seeking out professional help so as not to add to the stigma they were already facing because of the daughter&#x2019;s illness. Also, the disheartening side to this case was that despite the understanding that there was an urgent need for admission of her daughter into a psychiatric rehabilitation facility, she chose to not do it as the pandemic guidelines suggested a Covid-19 screening test of the entire family to rule out any possibility of risk. She expressed her concern about how the society she lived in would treat their family like untouchables and make necessities also difficult to get if any one of them tested positive. She reported high levels of stress, mild disturbance in mood, anxiety, compromised life satisfaction and a negative perception of caregiving experience. Post the initial assessment, a five-week Positive CBT based Intervention was carried out with her with proper informed consent procedures. &#xD;
&#xD;
Session 1 &#xD;
&#xD;
The first session began with a brief explanation of concerns by the client and was followed by knowing the best hopes she had from the intervention, wherein she expressed about how she wanted to feel less burdened and to be able to find some quality time for things she loved doing. She was then made to reflect on what difference it would make in her life if she chose to fulfill her desired goal. While she spoke about the obstacles that create a barrier between her and the goal, she was redirected to acknowledge what according to her was already working for her even though the task was a challenging one and also what could be the immediate sign of growth or progress. The client was made to work on a Daily Exceptions Journal and the aim was focused on knowledge of their existing abilities and potential/strengths. She was asked to reflect on when she didn&#x2019;t feel the concern that day, what was better even limitedly, what was she doing distinctively to make things better, what could be done to keep the positive changes persistent and how would her future look if the changes became constant. &#xD;
&#xD;
Feedback: The caregiver felt very motivated and was willing to work towards a positive goal and was grateful to me for sparing time and energy for her. When asked to rate how she felt on a scale of 0-10 (0 being low and 10 being happy), she said 9. &#xD;
&#xD;
Session 2&#xD;
&#xD;
The session was inclined towards helping the client recognize the problem through gratitude. The client was encouraged to pen down a letter to her daughter who she looks after, which would generate positive aspects towards caregiving and also strengthen her relationship with her daughter making the task less strenuous. Through this activity, the aim was to create feelings of gratitude in the client and also make her reflect how being a caregiver made her evolve as an individual. &#xD;
&#xD;
Feedback: The client expressed how the journey of being a caregiver despite being demanding compelled her to recognize her strengths and made her more appreciative. &#xD;
&#xD;
Session 3&#xD;
&#xD;
The objective of the session was to find solutions towards reaching closer to her desired goal. She was asked to recollect an immensely disturbing event and what was her plan of action or go-to technique to evolve out of it. She was encouraged on the aspects that were previously working for her and insisted on practising more of what seems to be already working. The session concluded by helping the client reflect on the insights of how things were working for her even in the worst-case scenarios and what she considers are the three blessings that drive her through the hardships. &#xD;
&#xD;
Feedback: She brought in a spiritual aspect by saying, &#x201C;The blessing that God has sent for me is you in the form of an angel&#x201D;. She also realized that she has the in-built capabilities and strengths to keep going. &#xD;
&#xD;
Session 4 &#xD;
&#xD;
It focused on helping the client recognize her best self. The objective was to make her aware of the strengths and capabilities she possessed and how she can increase the positive emotions by recalling when she was at her best. She was asked to journalize her story by describing her behaviour, emotions, and thoughts in an event that caused her distress and yet she successfully sailed through it. Thereafter, she highlighted and read aloud the phrases or words that stated her strengths and found what benefits that event had for her. Her attention was driven towards how she can bring these strengths into use while dealing with her current issues. &#xD;
&#xD;
Feedback: She speculated that therapy has helped her develop the capabilities to look into oneself about the abilities she already possesses as a caregiver, which has and will further help her deal with challenges. &#xD;
&#xD;
Session 5&#xD;
&#xD;
The last session began by asking the client &#x201C;What&#x2019;s better even a bit?&#x201D; This shifted the mood of the client towards positive and instead of talking about problems she spoke about how things have been better. She was asked to identify what she was doing differently while things seemed to have become better and she expressed about looking at things in a different light and generating benefit out of her miseries. Thereafter, she was made to contemplate how her future would look if these positive changes continued and what she should keep doing differently to keep them going. &#xD;
&#xD;
Feedback: The client expressed that she never saw her problem as a blessing and also was grateful for instilling hope and positivity in her life. She stated that the pandemic had worsened her stress due to difficulty in the availability of psychiatrists and psychotherapists for her daughter and there was an additional burden on her as she had to provide care for 24 hours living under the same roof. A feeling of contentment of providing care to her daughter kept her going. &#xD;
&#xD;
Results:&#xD;
&#xD;
The caregiver reported a remarkable decrease in caregiver strain, depression, anxiety, greater satisfaction with life and high positive aspects of caregiving (As shown in Graph 1). &#xD;
&#xD;
Discussion:&#xD;
&#xD;
The current study revealed that a Positive Cognitive Behavior Therapy Intervention helped lower the levels of caregiver strain, depression, anxiety and the client had an enhancement of satisfaction with life and positive aspects of caregiving. The findings of this study were found to be consistent with two pilot studies which suggest that psychotherapies based on a positive framework reduces depressive symptoms and promotes well-being in people suffering from depression of mild and moderate category. 23 This study strongly recommends that counselling services and efficient interventions should be made available for caregivers. Researchers have amplified the need for adequate guidance, counselling, encouragement and knowledge for caregivers especially those who offer care to individuals suffering from mental illness as they are confronted with higher levels of distress. Caregivers are potentially at threat of developing any illness if their issues are not addressed well in time. 24&#xD;
&#xD;
&#xD;
&#xD;
Conclusion:&#xD;
&#xD;
In the Pandemic, the hospitals and clinics reserved themselves for Covid-19 patients and individuals dealing with psychological illness were restricted to their homes and the duty of caregiving primarily became a job of the family members. While providing care for patients, family members too faced a tremendous amount of burden which was not addressed due to the limitation of doctors and resources. This study recognizes an immediate need for adequate interventions for caregivers as they are the neglected and unsung warriors behind the recovery of an individual suffering from mental illness. It also showed the plight of individuals as they cannot get tested for Covid-19 due to fear of discrimination in society. Positive CBT based Intervention showed promising results in creating hope and resilience in the caregiver while making them aware of their strengths and recognizing that every experience is to be learnt from and grateful for. &#xD;
&#xD;
Declaration of patient consent: It is certified by the authors that proper informed consent through a form has been obtained by the participant. The participant understands that her identity would be kept confidential and the study is purely for research and awareness purposes.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles and journals from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflict of Interest: NIL&#xD;
&#xD;
Funding: The authors of this research received&#xA0;no&#xA0;specific&#xA0;grant/funding&#xA0;from any&#xA0;funding&#xA0;agency in the public, commercial, or not-for-profit sectors.&#xD;
&#xD;
Author Contribution Statement: The authors confirm contribution to the research as follows: The research was conceptualized by both the authors, the data collection was done by Rati Khurana and analysis of results was done by Nimisha Kumar. The manuscript was prepared, reviewed and finalized by both authors collaboratively.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3938</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3938</Fulltext></URLs><References>&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Pelvic Floor Muscle Exercise-Induced Progressive Positioning in Improving Pelvic Floor Muscle Strength&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>243</FirstPage><LastPage>246</LastPage><AuthorList><Author>Jenifer Augustina S</Author><AuthorLanguage>English</AuthorLanguage><Author> Prathap Suganthirababu</Author><AuthorLanguage>English</AuthorLanguage><Author> Vijayaraghavan Rajagopal</Author><AuthorLanguage>English</AuthorLanguage><Author>  Kamalakannan M</Author><AuthorLanguage>English</AuthorLanguage><Author> Kamatchi Kaviraja</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The pelvic floor provides support for the pelvic organs, spine and pelvic girdle, and aid in urination, defecation and sexual function. In particular, these functions require relaxation and coordination of the pelvic floor muscles as well as the urine and anal sphincter muscles. Recent studies for improving Pelvic floor muscle strength contains vaginal cones, bladder training, pelvic floor muscle exercises, biofeedback and the electrical stimulation of pelvic muscles. Kegel exercises had become more popular as it is a non-invasive method of treatment and a perineometer is a quantitative tool used for both assessment and management of pelvic floor strength. Aim: This study had undertaken to intend to improve the pelvic floor muscle strength by improving the progression in different positions such as crook lying, sitting and standing. Methods: A study was conducted on 30 subjects among them 20 are illiterates and 10 are literates using a convenient sampling technique, based on inclusion and exclusion criteria. The brink scale is used as the outcome measure. The strength training program is performed in 3 positions and divided into 3 phases, phase-I is from week one to week three, phase II is from week four to week six and phase -III is from week seven to week nine Result: The statistical analysis of the study revealed that the post-test values of Phase-III had marked improvement due to increased duration and the improved position. The result of the study showed that the pelvic floor muscle strength can be progressed to a maximum of between 8 to 9 weeks. Conclusion: The study concluded that all the positions are equally important in the progression of pelvic floor strength.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Biofeedback, Bladder training, Electrical stimulation, Kegal exercises, Pelvic floor, Perineometer, Vaginal cones</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
The pelvic floor is composed of bone, muscle and connective tissue. Together, these elements provide support for the pelvic organs, spine and pelvic girdle, and aid in urination, defecation and sexual function. In particular, these functions require relaxation and coordination of the pelvic floor muscles as well as the urine and anal sphincter muscles. Therefore, their impaired relaxation or paradoxical contraction can cause various symptoms, such as impaired urination or defecation, pelvic pain and sexual dysfunction. Pelvic Muscle Rehabilitation (PMR) is a multidisciplinary program involving many rehabilitation principles, such as muscle floor retraining, biofeedback, and electrical stimulation of the pelvic floor and functionally related muscle tissue. PMR therapeutic interventions modalities included using one or a combination of six possible therapeutic modalities. Modalities include Muscle Isolation, Discrimination Training, pelvic floor muscle strengthening resistance training down-training, electrical stimulation.1 Urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP) are common conditions in women with a 20% lifetime risk of having a single operation for these floor conditions. A recent cross-section of the health survey mentioned that the symptoms of UI, FI and POP had a prevalence rate of 23.7% in women 20 years of age and older and 49.7% in women aged 80. There will be an increasing need for treatment of pelvic floor disorders (PFDs), according to the United States estimation percentage of women seeking care for these conditions will increase from 28.1 million to 43.8 million by 2050, parallel to demographic ageing. Recent studies for improving Pelvic floor muscle strength contains vaginal cones, bladder training, PFM exercises, biofeedback and the electrical stimulation of pelvic muscles.2,3,4,5,6,7 Kegel exercises had become more popular as it is a non-invasive method of treatment and the perineometer is a quantitative tool used for both assessment and management of pelvic floor strength.8, 9 Numerous studies have been done in past to improve pelvic floor muscle strength, this study aimed to analyse the effect of pelvic floor muscle exercise induce progressive positioning in improving pelvic floor muscle strength in various positions such as cooking sitting and standing. This study had undertaken to intend to improve the pelvic floor muscle strength by improving the progression in different positions such as cooking, sitting and standing. The strength is observed in all the 3phases by using the Brink scale as an outcome measure by documenting the pre and post-intervention values&#xD;
&#xD;
METHODS: A Quasi-Experimental study was conducted on 30 subjects among them 20 are illiterates and 10 are literates using a convenient sampling technique, the inclusion criteria for the study was 25-45-year-old women who had a history of vaginal delivery and the strength of the pelvic floor muscle should score only 3 according to brink scale.1 The exclusion criteria for the study was women who underwent vaginal hysterectomy or pelvic floor repair and who had vaginal infections. Ethical clearance was obtained from HEC (009/09/2019/IEC/SMCH) of SIMATIC. After receiving an informed consent form, the women were explained about the Brink scale for pelvic floor muscle. The strength of the pelvic floor is measured by using the BRINK scale, the scale has 3criteria i.e., pressure, moving the fingers in the horizontal plane and time and each criterion has 4degrees where the minimum score is 3 and the maximum is 12.8 To find the strength of the pelvic floor muscle the subject should be in crook lying position by completely relaxing the perineal area, two fingers are inserted into the vagina and asked to contract her pelvic floor muscles as she holds the urine and should try to pull the finger upward inward, the subject with score -3 are selected for the study.The strength training program is performed in 3 positions and divided into 3 phases, phase-I is from week one to week three, phaseII is from week four to week six and phase -III is from week seven to week nine. In this study, the subjects were taught to perform kegal exercise with a hold of 5seconds and relax of 5sec for 2 minutes in crooklying position per session per day for 6 days in 1st week. Then the pelvic floor strengthening is performed by using a perineometer, subject is taught to contract the transducer of the perineometer for 1minuteproperly during 1st week in the crooklying position. During the 2nd week the kegel exercise is performed for a period of 5minutes and strength training is performed by using a perineometer for a period of 2minutes incrooklying position and in 3rd week the Kegels is performed for 10 minutes and strength training by using perineometer is performed by using 5minutes in crooklying position and sitting position during 4th-week kegals for 15minutes and pelvic floor strengthening by usingperineometer for 10min is performed. During the 5th week in sitting position Kegels is performed for 20minutes and perineometer isused for 15minutes,in the 6th week of progression Kegels is performed for 25minutes and the perineometer is used for 20minutes in the position of sitting.In the week of 7th, the progression is increased by performing Kegels for 30 minutes and perineometer for 25minutes in standing position.During the 8th week of progression in standing position,Kegels is performed for 35 minutes and a perineometer is used for 20minutes to improve the strength. Finally, the progression is done in a standing position by performing Kegels for 40minutes and a perineometer is used for 35 minutes for strength training. The strength is observed in all the 3phases by using the Brink scale as an outcome measure&#xA0; by documenting the pre and post-intervention values ( Table 1).9&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Result: In the total of 30 subjects, the strength of the pelvic floor reached to maximum score by the end of 9weeks.The statistical analyses of phase-I, phase- II and Phase -III revealed that the pre-test means value in phase -I from week 1 to 3 is 3 and the post-test mean value is 4.47, In the phase-II that is from week 4 to 6 the pre-test mean value is 4.47 and the post-test mean value is 6.4. In the finale phase -III from week 7-9 the pre-test mean value is 6.4 and the post-test mean value is 10.7.The post-test mean values of all the 3 phases revealed that the post meansthe value of Phase-III showed a great improvement in pelvic floor muscle strength compared to phase-I and phase-II. So the result of the study showed that the pelvic floor muscle strength can be progressed to a maximum between 8to 9weeks ( Figure 1).&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
Discussion: Pelvic floor muscle strength plays a crucial role in maintaining the quality of life in women. It is very important to strengthen them and the progression of the strength training helps the women to improve their quality of life.10,11,12 In our study we concentrated on the progression of the pelvic floor muscle in different positions. There are many devices to strengthen the pelvic floor muscles like vibrancekegel devices and vaginal cones and biofeedback, there are studies that kegel exercises will help in strength training and also improve sexual life and some studies state that the pelvic floor muscle exercise also helps in reducing low back pain.13 This study focused on knowing the effect of pelvic floor muscle exercise-induced progressive positioning in improving pelvic floor muscle strength.The study showed that there is no significant difference between the groups, we observed an improvement in phase-3 compared to phase-2 and phase -1. Pelvic floor dysfunction is common among women after vaginal delivery and pelvic floor muscle strength plays a crucial role in maintaining the quality of life in women, it is very important to strengthen them and progression of the strength training helps the women to improve their quality of life.14 &#xA0;In this study we observed that three positions have their importance and all the positions help in the good progression of the pelvic floor muscle strengthening as we selected 30 subjects who reached maximum strength after completing 9 weeks of strength training and the statistical analysis of the study revealed that the posttest values of Phase-III had marked improvement due to increased duration and the improved position.15 &#xA0;In our study we focused more on the strength training program as it plays a vital we focused on progression in 3 positions such as cooking, sitting and standing and performed strength training in 3 phases that is phase-I from week 1to3, phase-II from 4 to 6 and phase-III from week 7 to 9 and pre and posttest values are documented by using Brink scale as the outcome measure. Women are not able to participant in all the 3 phases continuously due to the influence of the menstrual cycle.16 In this study both illiterates and literature have participated and our study did not reach the understanding capacity of illiterates here we recommend that future studies should be done to reach the understanding capacity of illiterates without readings or calculations, which provides the pelvic floor strength knowledge. &#xD;
&#xD;
Conclusion: The progression of pelvic floor strengthening can be achieved between 8 to 9 weeks in crook lying, sitting and standing and the study concluded that all the positions are equally important in the progression of the pelvic floor strength. The main issue to be addressed in the study is that as we included the illiterate women in the study they are not able to notice the perineometer readings, so research has to be done in a way to meet the understanding capacity of rural or illiterate women in pelvic floor strength.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Funding: Nil&#xD;
&#xD;
Authors contribution:Study conception and design: S. Jenifer Augustina, Acquisition of data: S. Jenifer augustina, Prathap Suganthirababu, Analysis and interpretation of data: S. Jenifer Augustina, Kamalakannan. M, Drafting of ManusAcript: S. Jenifer Augustina, R.Vijayaraghavan, Kamatchi Kaviraja &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3943</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3943</Fulltext></URLs><References>[1] Kari BO, Sherburn M, Evaluation of Female Pelvic-Floor Muscle Function and Strength, Phys Ther. 2005; 85(3): 269&#x2013;282&#xD;
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[3] Pereira VS, Cofloor Rreia MV, Drissusso P, Individual and group pelvic floor muscle training versus no treatment in female stress urinary incontinence: a randomized controlled pilot study. &#xA0;Eur J Obstet Gynecol Reprod Biol. 2011;159(2):465-471.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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</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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Polycystic Ovary Syndrome (PCOS) and Infertility&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>247</FirstPage><LastPage>254</LastPage><AuthorList><Author>Hitashi Shawani</Author><AuthorLanguage>English</AuthorLanguage><Author> Shruti Singh</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Polycystic ovary syndrome (PCOS) is characterized by a variety of reproductive and metabolic symptoms that affects 4&#x2013;18% of reproductive-age women, depending on the diagnostic criteria used. PCOS is characterized by hormonal deregulation, insulin resistance, and metabolic disorders, all of which raise the risk of infertility, type 2diabetes, and cardiovascular disease (CVD) while also lowering quality of life. Women with PCOS have higher levels of body dissatisfaction and are more likely to develop mood swings, anxiety, and eating disorders. PCOS remains undiagnosed, in part due to the variety of phenotypes exhibited by this disorder, despite its prevalence and consequences for sexual, metabolic, and psychological health. Aims: The aim of the study was to determine the true prevalence rate of PCOS patients in both urban and rural India, as well as to link the disorder&#x2019;s symptoms to lifestyle changes. Methodology: The participants are all exposed to the same climatic conditions, with only man-made shifts distinguishing the urban and rural populations. From the urban and rural populations, a total of 1068 young girls between the ages of 18 and 24 were able to participate in the study. Result: The participants were automatically age matched, and they all shared the same climatic conditions. Conclusion: A larger sample size and a controlled prospective study would be able to shed light on the disease&#x2019;s prevalence as well as other environmental factors that contribute to PCOS manifestation in the Indian population.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Correlated, Characterized, Preponderance, Prevalence, Pathophysiology, Polycystic</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4421</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4421</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>12</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>June</Month><Day>22</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Nerve Conduction Studies in Post-COVID 19 Patients among Egyptian Patients&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>255</FirstPage><LastPage>262</LastPage><AuthorList><Author>Sally A. EL-Leithy</Author><AuthorLanguage>English</AuthorLanguage><Author> Hoda Atiatullah Mohamed</Author><AuthorLanguage>English</AuthorLanguage><Author> Mona Mohamed El-Bably</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Corona viruses are large family of viruses that may cause disease in animals or humans. The most common symptoms are fever, cough, sneezing and shortness of breath. Extra-pulmonary manifestations include thromboembolism, renal, hepatic, gastrointestinal, endocrine, cardiac, dermatological and neurological manifestations. The neurological manifestations include headache, dizziness, encephalopathy, Guillen-barre, myalgia, stroke and insomnia. However, it has not been reported that patients with COVID-19 have any neurological manifestations. Aim: The aim of the study is to demonstrate the presence of neurological manifestations through nerve conduction studies among Egyptian post-COVID patients and its correlation with CRP levels. Methods: A comparative cross-sectional study of 90 post-COVIDmale patients, thirty patients were had mild symptoms during the disease activity, 30 had moderate symptoms and 30 had severe symptoms.In addition, 30 healthy control subjects that had no history of COVID-19 infection were included. Full History taking, Radiological, laboratory and neurological assessments were performed. Nerve conduction studies involve assessment of nerves of both upper and lower limbs. Results: There was a statistically significant difference as regards presence of symptoms and CRP levels in severe group in comparison to the other two groups. There was positive correlation between CRP levels and motor and sensory nerve latency, amplitude, and conduction velocity. No significant difference as regards F waves. Conclusion: COVID-19 may affect nervous system as well as respiratory system. This study offered new clinical information on COVID-19 which would help to raise awareness of involvement of nervous system. Patients who suffered from severe COVID infection have greater chance of neurological involvement. Also, there was positive correlation between CRP and both delayed latencies and conduction velocities in all nerves in severe post-COVID group.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>SARS: severe acute respiratory syndrome, MERS: Middle East respiratory syndrome, COVID-19: Corona virus 2019,  rRT-PCR: reverse transcription polymerase chain reaction, CRP: C reactive protein, CMAP: motor nerve compound muscle action  potential.</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4430</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4430</Fulltext></URLs></Article></ArticleSet></xml>