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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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Job Performance and Occupational Stress among Nurses in a Tertiary Institution in Nigeria: 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=3855</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3855</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Nutrients Removal by Titanium Dioxide-Zeolite (TDZ) Composite&#xD;
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&#xA0;&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>02</FirstPage><LastPage>07</LastPage><AuthorList><Author>Berhanuddin MS</Author><AuthorLanguage>English</AuthorLanguage><Author> Aris A</Author><AuthorLanguage>English</AuthorLanguage><Author> Chelliapan S</Author><AuthorLanguage>English</AuthorLanguage><Author> Abdul Majid Z</Author><AuthorLanguage>English</AuthorLanguage><Author> Hasaan HA</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Nutrients removal, Titanium Dioxide, Zeolite, Composite, Environmental health</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
In recent years, wastewater treatment using zeolite as a low-cost absorbent has been examined by many researchers. Zeolites, either natural or synthetic, can improve the water quality and enhance wastewater treatment by removing substances such as heavy metals, ammonium, phosphorus, dissolved organic matter, cations, and radioactive elements.1,2 Ion exchange based processes, such as using zeolites for the removals of ammonium from the wastewater, could be an attractive additional or potentially complementary treatment option. This is even more essential, especially for the treatment conditions that pose a challenge for biological processes, such as variable loads or low temperatures. Zeolite is a porous material, so both the external and internal (pores and channels) surface area can interact with the solution. By reducing the particle size, the external area increases considerably, but not to the internal area of the zeolite.3 It is considered the cheapest treatment method for removing nutrients from industrial/wastewater effluent.4 The phosphate removals process from aqueous solutions using natural Jordanian zeolitic tuff is a potentially viable and natural adsorbent material.5 Karap?nar also studied the application of natural zeolite for phosphorus and ammonium removals.5 Additionally, zeolite has been used in its modified form during the treatment process. &#xD;
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The application of nano-TiO2 as photocatalytic oxidiser has been well established. The materials&#x2019; semiconducting properties determine the performance of TiO2 for the conversion of solar energy into chemical energy. The conversion process is closely related to the light-induced reactivity between the oxide semiconductors and water, leading to partial water oxidation and, consequently, water disinfection.6 The various sizes of titanium dioxide (TiO2), such as bulk powder and nanoparticles, are used by varying the parameters, such as the pH or ionic strength of samples, to optimise the phosphorus removal from the wastewater. Gong et al. explored the effects of photocatalytic degradation in aqueous solution with a high concentration of ammonia, where immobilised TiO2 on glass beads was employed as the photocatalyst.7 In addition, Nano-TiO2 was also used as the coating for pet bottles used in keeping drinking water and for wastewater treatment. Moreover, it is also applied in stormwater quality improvement. Additionally, Lim et al. observed that TiO2 supported the activated carbon, or TiO2/AC composite, and exhibited bi-functionality of adsorption and photo-catalysis in synergism.8&#xD;
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The composite is defined as combining two or more materials that result in a compound with better application properties than the material produced with only one component. The main advantages of composite materials include their high strength and stiffness and low density compared with bulk materials, thus weight lesser for the finishing products. The removal of contaminants application by using dual-phase composite adsorbent is becoming more popular these days.9&#xA0; The development of different composite types, ranging from nano-composites, activated charcoal composites, polymer composites, oxide-based composites, hybrid composites and biosorbent composites, has been reported.10 These composites are explored to treat or eliminate hazardous substances like heavy metal species, different classes of coloured contaminants (dyes), and several organic and inorganic pollutants from the wastewater.10 The D-optimal mixture design is widely used for the optimisation of the composite mixture. The function of this tool is to suggest the best mix ratio for the Titanium Dioxide-Zeolite (TDZ) components. The experiments are usually carried out according to the run number to minimise all the response values&amp;#39; variability.&#xD;
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This study is significant as it developed the nutrients removals technology from wastewater using inorganic process. The TDZ composite adsorbent developed in this study has satisfying adsorption performances and is economical, comprehensible and environmentally friendly. As the industry is always demanding low cost, lower discharge, environmentally friendly, readily available material usage, and the least space for the effluent treatment plant, most plants use the biological treatment as tertiary treatment. Moreover, biological treatment is vastly feasible and has more advantages than the other adsorption methods that are costly and difficult to be regenerated.&#xD;
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METHODOLOGY&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Materials and chemicals&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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Ammonium nitrate (NH4NO3) and ammonium dihydrogen phosphate ((NH4)H2PO4) were supplied from Merck. Meanwhile, natural zeolite was supplied from NPK-Organo-Zeolite, TiO2 was purchased from Sigma-Aldrich, and the premixed plaster (921) cement was supplied from PYE (M) throughout the whole study. The HACH reagents used for the analysis of ammonia, nitrate and phosphate were purchased from Arachem (M) Sdn Bhd.&#xD;
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Analytical method&#xD;
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The analyses of NH4+, NO3- and PO4+ were carried out using the HACH DR 6000 (or DR3900) spectrophotometer. The surface and elemental composition of TDZ composite were identified using the Field-Emission Scanning Electron Microscopy (FESEM) (Hitachi, S-3400N model), coupled with an energy dispersive X-ray (EDX) analyser. Then, the surface composition and its distribution were determined by the EDX analyser.11 This FESEM model is a versatile analytical ultra-high resolution that extends the imaging and analytical resolutions beyond the previously achievable limits. Moreover, it has a unique variable pressure capability and enables the examination of various non-conducting samples without time-consuming preparation. Hence, the FESEM-EDX was performed to determine the elemental percentages, as well as to confirm the elemental distributions.12&#xD;
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Preparation of synthetic wastewater&#xD;
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The synthetic wastewater was prepared by dissolving 45.0 mg of NH4NO3 and 7.0 mg of (NH4)H2PO4 in 1000 mL distilled water (Systerm). This mixture produced ammonia, nitrate and phosphate concentrations of 10.0, 20.0, and 5.0 mg/L, respectively. These concentrations represented the Standard A of sewage effluent quality, as stipulated in the Environmental Quality Act 1974, published under the Environmental Quality (Sewage and Industrial Effluents) Regulations, 1999.13&#xD;
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Titanium dioxide-zeolite composite&#xD;
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The TDZ composite comprised of three main components, namely zeolite, TiO2 and premix plaster cement. These components were mixed together with water according to the ratio suggested by the Mixture experimental design. Each mixture was placed into a 1 cm3 mould and was cured for up to 7 days. The TDZ composite was then crushed into powder form with sizes of between 800&#xB5;m to 500&#xB5;m before used in the adsorption study. The best composition mixture of TDZ was identified by the adsorption experiment, followed by the analysis and optimisation using the D-optimal design.&#xD;
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Adsorption study &#xD;
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	&#xD;
	Mixture experimental design&#xD;
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The mixture experimental design (D-optimal) was used to determine the optimum mixture ratio of the TDZ composite. The experimental design was developed using the Design Expert software (Version 7). As shown in Table 1, 14 experimental mixtures were tested. The component of zeolite, TiO2 and cement ranged from 25 to 50 g, 1 to 5 g, and 100 to 125 g, respectively. The ratios of TiO2:zeolite:cement was in the range between 5 to 50 to 100 and 1 to 25 to 125. The ratio between the mixture and water was set to 4 to 1. The performance of each TDZ composite mixture was evaluated based on the ability to remove ammonia, nitrate and phosphate.&#xD;
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The adsorption study was conducted in batch mode using a 100 mL conical flask. For each experimental run, a 100 ml aqueous solution with the known concentration of NH4, NO3 and PO4 was placed in the flask containing a 10 g of the TDZ composite adsorbent. These flasks were then shaken on an orbital shaker (Grant-Bio PSU-10i) at a constant shaking rate of 220 rpm to 240 rpm for 24 hours. After the shaking period ended, the supernatants were sampled, filtered with 0.45 &#xB5;m filter and analysed for the contaminants.&#xD;
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RESULTS AND DISCUSSION&#xD;
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Characterisation of TDZ adsorbent&#xD;
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The TDZ composite image captured using the FESEM is shown in Figure 1. The analysis of the captured image revealed that the carrier material is uniform and grain sizes with variable coverage. Once focused, the working distance between the sample surface and the lower lens portion (WD = 10.1mm) of greater than 4 mm was measured. The utilization of magnification (mag = 200x) below 1000x showed significant detector artifacts. Therefore, the useful magnification with respects to the object analysis, line scan or mapping, was limited to 1000x. In addition, the high voltage (HV = 15 keV) of the highest peak, called overvoltage ratio, was determined to be not less than two for all the elements measured in this study.&#xD;
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Figure 2 shows the element compositions and the TDZ composite energies. The X-ray characteristics consist of the narrow emission lines, which are also the characteristic of the chemical elements contained in the sample. The energy of these lines was nearly independent of the chemical bonding state of the affected atoms, as the electron probe microanalysis is element sensitive. The results showed that the TDZ composite is composed of oxygen (O), calcium (Ca), titanium (Ti), silicon (Si), carbon (C), niobium (Nb) and aluminium (Al). These elements are acting as the adsorbents to remove the nutrients during the wastewater treatment.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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TDZ mixture&#x2019;s optimisation results&#xD;
&#xD;
The 14 experimental runs for nutrients removals analysis are as shown in Figure 3. The tests were analysed by using the ANOVA statistic provided in the DX7 software. The removals of ammonia and nitrate ranged from about 22 to 70% and 10 to 18%, respectively. Meanwhile, the removal of phosphate was very high, ranging from about 95 to 99%. The level of significance was considered when P &lt; 0.05. The ANOVA results for the measured responses (Figure 3) and the mixture Cubic Model analyses (Table 2) demonstrated that the model was significant for phosphate but not ammonia and nitrate.Based on Table 2, the significant model terms were shown to have real effects on the responses. The lack of fit reported indicated that the model does not fit the data within the observed replicate variation. The models were proceeded to the diagnostic plots and to optimise the mixtures.&#xD;
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&#xD;
&#xD;
Table 3 and Figure 4 describe the numerical and graphical optimisation, respectively, for the mixture of TDZ composite. There were six solutions recommended by the DX7 software, and the Number 1 mixture was selected as it exhibited the maximum desirability of 0.682. The Analysis of Variance (ANOVA) in DX 7 measured the R-Squared (R2) value. This value is a measure of the variation amount around the mean, as explained by the model. The R2 value for the PO4 adsorption was equal to 0.9933 and was better than the NH4 and NO3 adsorptions that recorded the R2 values of 0.7537 and 0.3478, respectively. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
The desirability is defined as an objective function that ranges from zero to one at the goal. The desirability of 0.682 was selected in this study. The numerical optimisation calculated a point that maximises the desirability function. Based on the Design of Experiment (DoE) principle, the desirability range between 1.0 and 0.80 represents excellent and acceptable quality or performance. Meanwhile, the desirability range of between 0.80 to 0.63 describes the good and acceptable analysis, as well as representing a further improvement over the best commercial quality. The findings on the desirability study described the composite materials used and showed that the composite could contribute to remove three responses.&#xD;
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Water was used as the additional material in bonding the TDZ composite, with the ratio of 0.25 was used. Kovac et al. demonstrated that the changes in water to cement ratio from 0.25 to 0.35 caused only slight differences between the strength characteristics.14 Typically, the lesser water content in concrete mixture leads to the lesser porosity of cement paste. Thus, the desired mechanical properties are provided. In the case of conventional dense concrete, the lower water to cement ratio contributes to the higher or better strength, density and durability of concrete.&#xD;
&#xD;
Figure 5 shows the three-D plot that is demonstrating the desirability of the TDZ adsorbent design. This graphical optimisation displays the feasible response values and areas in the factor space. The regions in the plot were fitted with the optimisation criteria. Furthermore, the performances of nutrients removals using TDZ composite were evaluated by using the adsorption isotherms and kinetic models.&#xA0; &#xD;
&#xD;
CONCLUSIONS&#xD;
&#xD;
The key findings emerged from this study revealed that the composite materials used were not duly significant in all the responses; for example, the nitrate and ammonia (p&gt;0.05) materials showed insignificant results, but the phosphate (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3856</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3856</Fulltext></URLs><References>1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Deng Q. Ammonia removal and recovery from wastewater using natural &#xA0; zeolite: an integrated system for regeneration by air stripping followed &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; ion exchange[dissertation]. University of Waterloo. 2014.&#xD;
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2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kotoulas A, Agathou D, Triantaphyllidou IE, Tatoulis TI, Akratos CS, &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Tekerlekopoulou AG, et al. Zeolite as a potential medium for &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; ammonium recovery and second cheese whey treatment. J Water. 2019; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 11(1):136.&#xD;
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3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Yunnen C, Ye W, Chen L, Lin G, Jinxia N, Rushan R. Continuous fixed-&#xA0;&#xA0; bed column study and adsorption modeling: removal of arsenate and &#xA0;&#xA0; arsenite in aqueous solution by organic modified spent grains. Pol J &#xA0;&#xA0;&#xA0;&#xA0; Environ Stud. 2017;26(4):1847-1854. &#xD;
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4.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Aljbour SH, Al-Harahsheh AM, Aliedeh MA, Al-Zboon K, Al-&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Harahsheh S. Phosphate removal from aqueous solutions by using &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; natural Jordanian zeolitic tuff. Adsorpt Sci &#xA0;&#xA0;&#xA0; Technol. 2017; 35: 284-299.&#xD;
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5.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Karap?nar N. Application of natural zeolite for phosphorus and ammonium &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; removal from aqueous solutions. J Hazard Mater. 2009; 170: 1186-1191.&#xD;
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6.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Wu MJ, Bak T, O&#x2019;Doherty PJ, Moffitt MC, Nowotny J, Bailey TD, et al.&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Photocatalysis of titanium dioxide for water disinfection: Challenges and &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; future perspectives. Int. J Photochem. 2014; 973484. &#xD;
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7.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Gong X, Wang H, Yang C, Li Q, Chen X, Hu J. Photocatalytic degradation &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; of high ammonia concentration wastewater by TiO2. Future Cities &#xA0;&#xA0;&#xA0; Envt. 2015; 1: 12.&#xD;
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8.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Abdollahii S, Faezeh J , Marjan S , Amir MA. Adverse effects of some of the most widely used metal nanoparticles on the reproductive system. J Infert Reprod Bio. 2020, 8: 22-32.&#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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9.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Moideen SNF, Din MFM, Rezania S, Ponraj M, Rahman AA, Pei LW, et al. Dual phase &#xA0; role of composite adsorbents made from cockleshell and &#xA0;&#xA0;&#xA0; natural zeolite in treating river water. J King Saud Univ Sci. 2020; &#xA0;&#xA0;&#xA0;&#xA0; 32: 1-&#xA0; 9&#xD;
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10.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Jaspal D, Malviya A. Composites for wastewater purification: A review. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chemosph. &#xA0;&#xA0;&#xA0;&#xA0; 2020; 246: 125788.&#xD;
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11.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Aziz, MHA, Othman, MHD, Alias, NA, Nakayama, T, Shingaya, Y, &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Hashim, NA, et al. Enhanced omniphobicity of mullite hollow fiber &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; membrane with organosilane-&#xA0; functionalized TiO2 micro-flowers and &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; nanorods layer deposition for desalination using direct contact &#xA0;&#xA0;&#xA0;&#xA0;&#xA0; membrane distillation. J Membr Sci. 2020; 607:118137.&#xD;
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12.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Li N, Jayaraman, S, Tee, SY, Kumar, PS, Lee, CJJ, Liew, SL, Chi, D, et &#xA0;&#xA0;&#xA0; al. Effect of La-Doping on optical bandgap and photo &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; electrochemical performance of hematite &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; nanostructures. JMater. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chem. A 2014; 2:19290.&#xD;
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13.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sabeena AH, Ngadia N, Noor ZZ, Raheema AB, Agouillal F, Mohammed AA, et al. characteristics of the effluent wastewater in sewage &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; treatment plants of malaysian urban areas. Chem Eng Trans. 2018; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; 63:691 &#x2013; 696.&#xD;
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14.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kovac M, Sicakova A. Changes of strength characteristics of pervious &#xA0;&#xA0;&#xA0;&#xA0; concrete due to variations in water to cement ratio. IOP Conf. Earth Environ Sci. 2017; 92: 012029&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Adhesive Capsulitis in Diabetes Mellitus - An Observational Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>08</FirstPage><LastPage>12</LastPage><AuthorList><Author>Neha Mukkamala</Author><AuthorLanguage>English</AuthorLanguage><Author> Jitendra Lakhani</Author><AuthorLanguage>English</AuthorLanguage><Author> Lata Parmar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Adhesive capsulitis, Diabetes mellitus, Frozen shoulder, Periarthritis, Hyperglycemia</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
India, with 65 million cases of diabetes, stands second only to China worldwide in the number of cases with diabetes.1Musculoskeletal complications in diabetes are not very widely known.2&#xD;
&#xD;
The hand and shoulder are the most commonly affected areas due to musculoskeletal complications in diabetes.3,4Shoulder problems are described as the most disabling manifestation of musculoskeletal disorders.5,6Several studies have shown the prevalence of adhesive capsulitis (AC)in diabetes to be around 10-30%, and 2-5% in the general population.5,7-13A meta-analysis by Zreik et al (2016) has shown that patients with diabetes are five times more likely to develop capsulitis compared to non-diabetic controls. In the same study, the mean prevalence of diabetes mellitus in patients with AC was found to be 30%.9&#xD;
&#xD;
Thus the present study aimed to know the prevalence of adhesive capsulitis in diabetes.&#xD;
&#xD;
METHODOLOGY&#xD;
&#xD;
This was a cross-sectional study that was approved by the Institutional Ethics Committee (Ethical clearance letter no: SVIEC/ON/205/15008). After taking a written informed consent, consecutive patients diagnosed with type I and type II diabetes, aged 18 years and above, who complained of shoulder pain (unilateral or bilateral) were approached to take part in the study. Patients with a history of surgery around the shoulder, rotator cuff tear, fractures of the upper limb on the involved side in the past one year, patients having radiating pain from the neck, rheumatoid arthritis, arthritis of glenohumeral joint and neurological deficits were excluded. The patients who gave written consent for inclusion in the study were assessed in detail. &#xD;
&#xD;
Demographic features including age, gender and body mass index (BMI) were taken. Diabetes-related questions like a method of control (diet, oral hypoglycemic drugs or insulin) and duration of diabetes were taken. The dominance of the hand was noted. Adhesive capsulitis was confirmed as shoulder pain along with loss of active and passive range of the shoulder in the absence of a known shoulder disorder. Shoulder ranges were assessed with a goniometer and functional activities like combing the hair, taking the hand behind the back, wearing clothes were assessed.&#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Baseline characteristics are presented as means with standard deviation (SD), medians with range. Normality of the data was seen using the Shapiro Wilk test. As the data was non-parametric, Spearman&#x2019;s correlation coefficient and Mann Whitney U test were performed. Statistical significance was kept at p &lt; 0.05. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
A total of 243 patients with diabetes was enrolled in the study.116 (47.74%) were females, 127(52.26%) were males.&#xD;
&#xD;
Out of 243 patients with diabetes, 22 patients had adhesive capsulitis. The prevalence of adhesive capsulitis was 9.1%. Tables 1 and 2 show the demographic characteristics of patients without and with adhesive capsulitis respectively. Table 3 compares the different variables in patients with diabetes mellitus, with and without Adhesive capsulitis. Figure 1 shows the correlation of adhesive capsulitis with the duration of diabetes.&#xD;
&#xD;
The duration of capsulitis varied from 01 months to 03 years in the present study. The most affected ranges were external rotation (average range-150) and abduction (average range-1000). All patients complained of more pain during overhead activities like combing with the affected side which involves a combination of flexion, abduction and external rotation at the shoulder and wearing clothes with the uninvolved side first. Women complained of more pain in bringing the saree from behind which involves a combination of extension, adduction and internal rotation of the shoulder and men had more pain in removing the wallet from the back pocket which also involves the combination of extension, adduction and internal rotation. &#xD;
&#xD;
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&#xD;
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&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
The present study was undertaken to know the prevalence of adhesive capsulitis in patients with diabetes. The prevalence of adhesive capsulitis was found to be 9.1% in the present study, which is slightly lower than the prevalence in other Indian states: Mathew et al. -16.45%, 14Bhat et al.-13.1%, 15Gupta et al.-29.61%, 16Kumar et al.-45.31%. 17The prevalence of capsulitis in other countries was:Yian et al.- 0.65 %, 18Ramchurn et al.-25%, 19Majjad et al.-12.5%, 20Kidwai et al.-10.9%, 21Hassan et al.-13%, 22Attar S-6.7%. 23Fasika et al. found a 16.6% cumulative prevalence of hand and shoulder disorders, 24and Shah et al. found a 63% prevalence of shoulder pain and/or disability. 25Lower prevalence in our study could be because most of the population (70% in the present study) that comes to our hospital comes from the villages in and around Vadodara as well as rural areas of the neighbouring state of Madhya Pradesh. The prevalence of diabetes is lesser in rural areas compared to urban areas. 6,26&#xD;
&#xD;
The prevalence of capsulitis in diabetes can be attributed to the high glucose levels in patients with diabetes which leads to 1) abnormal collagen deposition in the connective tissues and 2) an increase in advanced glycation end products (AGEs), which causes stiffness of connective tissue. 3,4,27&#xD;
&#xD;
All 22 patients with AC had type 2 diabetes. Capsulitis was present in 08 patients on the left side, 10 patients on the right side and bilaterally in 04 patients. 12,27Sixty four per cent had it on the dominant side and 36% had on the non-dominant side. This shows more involvement on the dominant side which is similar to Gupta et al&#x2019;s study16and contrary to Le et al&#x2019;s study. 10 Also 81.8% had unilateral involvement which is consistent with other studies.6,27&#xD;
&#xD;
A significant correlation was found between AC and duration of diabetes showing that patients with AC had a longer duration of diabetes. The prevalence of AC was 7.4%, 17.1%, 20% and 0% in patients with duration of diabetes of 10 years, 20 years, 30 years and 40 years. This is in agreement with several studies.12,18,22According to Yian et al. (2012) patients whose treatment for diabetes lasted longer than 10 years had an odds ratio of 1.85 to develop AC vs an odds ratio of 1.40 for those with 5-10 years of treatment.18Inayat et al. did not find a correlation with the duration of diabetes. 6 However the number of patients with diabetes and with or without capsulitis in all the groups was not similar.&#xD;
&#xD;
There was no significant correlation seen between AC and age and BMI.6,12Arkkila et al. showed a significant correlation between age and AC but not between BMI and AC. 28&#xD;
&#xD;
Also, no significant correlation was seen between AC and gender, both genders were equally affected. 12According to some studies, females are,1.27 to 2.66 times, more commonly affected than males.6,9,18&#xD;
&#xD;
None of the three patients with type 1 diabetes had capsulitis. This could probably be because all three of them were young (</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3857</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3857</Fulltext></URLs><References>1. Ramachandran A, Snehalatha C, Wan Ma R. Diabetes in South-East Asia: An update. Diab Res Clin Pract. 2014; 103:231-237.&#xD;
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2. Merashli M, Chowdhury TA, Jawad AS. Musculoskeletal manifestations of diabetes mellitus. Quant J Med. 2015; 108 (11): 853&#x2013;857. &#xD;
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3. Smith L, Burnet S, McNeil J. Musculoskeletal manifestations of diabetes mellitus. Br J Sports Med 2003; 37:30&#x2013;35. &#xD;
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4. Kaka B, Maharaja S, Fatoye F. Prevalence of musculoskeletal disorders in patients with diabetes mellitus: A systematic review and meta-analysis. J Back Musculosk Rehab. 2018; 1:1-13.&#xD;
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5. Tighe C, Oakley W. The Prevalence of a Diabetic Condition and Adhesive Capsulitis of the Shoulder. Sout Med J. 2008; 101 (6): 591-595.&#xD;
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6. Inayat F, Ali N, Shahid H, Younus F. Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan. Cureus. 2019; 9(8): e1544.&#xA0; &#xD;
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7. Hsu J, Anakwenze O, Warrenderb W, Abboud J. Current review of adhesive capsulitis. J Shoul Elbow Surg. 2011; 20: 502-514.&#xD;
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8. Whelton C, Peach C.Review of diabetic frozen shoulder. Eur J Orthop Surg. 2018; 28(3):363-371.&#xD;
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9. Zreik N, Malik R, Charalambous C. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, Lig Tend J. 2016;6 (1):26-34. &#xD;
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10. Le H, Lee S, Nazarian A, Rodriguez E. Adhesive capsulitis of the shoulder: a review of pathophysiology and current clinical treatments.Shoul Elbow. 2017; 9(2): 75&#x2013;84.&#xD;
&#xD;
11. Chan J, Ho B, Alvi H, Saltzman M, Marra G. The relationship between the incidence of adhesive capsulitis and haemoglobin A1c. J Shou Elbow Surg. 2017; 26 (10):1834-1837. &#xD;
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12. Doria C, Mosele G, Badessi F, Puddu L, Caggiari G. Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People. Joints 2017;5:143&#x2013;146. &#xD;
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13. Austin D, Gans I, Park M,&#xA0; Carey J, Kelly J. The association of metabolic syndrome markers with adhesive capsulitis. J Shoulder Elbow Surg 2014; 23(7):1043-1051.&#xD;
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14. Mathew A, Nair J, Pillai S. Rheumatic-musculoskeletal manifestations in type 2 diabetes mellitus patients in south India. Int J Rheum Dis. 2011; 14: 55&#x2013;60.&#xD;
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15. Bhat T, Dhar S, Dar T, Naikoo M, Naqqash M, Bhat A, et al. The Musculoskeletal Manifestations of Type 2 Diabetes Mellitus in a Kashmiri Population. Int J Health Sci Qassim Univ. 2016;10 (1): 57-68.&#xD;
&#xD;
16. Gupta S, Raja K, Manikandan N. Impact of adhesive capsulitis on quality of life in elderly subjects with diabetes: A cross sectional study.Int J Diabetes Dev Ctries. 2008; 28(4): 125&#x2013;129.&#xD;
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17. Kumar T, Das A. Rheumatological Manifestations in Diabetes Mellitus: Distribution And Associated Factors (2016).http://iosrjournals.org/iosr-jdms/papers/Vol15-Issue%206/Version-9/K1506095154.pdf. 10.9790/0853-1506095154&#xD;
&#xD;
18. Yian E, Contreras R, Sodl J. Effects of Glycemic Control on Prevalence of Diabetic Frozen Shoulder.J Bone Joint Surg Am. 2012;94:919-23..&#xD;
&#xD;
19. Ramchurn N, Mashamba C, Leitch E, Arutchelvam V, Narayanan K, Weaver J, Hamilton J, Heycock C, Saravanan V, Kelly C. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Int Med. 2009;20: 718&#x2013;721.&#xD;
&#xD;
20. Majjad A, Errahali Y, Toufik H, Djossou J, Ghassem M, Kasouati J, Maghraoui A. Musculoskeletal Disorders in Patients with Diabetes Mellitus: A Cross-Sectional Study. Int J Rheum. 2018;23(19): 1-6. &#xD;
&#xD;
21. Kidwai S, Wahid L, Siddiqi S, Khan R, Ghauri I, Sheikh I. Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan. BMC Res Notes 2013; 6:16. &#xD;
&#xD;
22. Hassan R, Alourfi Z. Shoulder adhesive capsulitis prevalence among patients with type 2 diabetes mellitus in Damascus, Syrian Arab Republic: a case-control study. East Mediterr Health J. 2014;19(3): S19-24. &#xD;
&#xD;
23. Attar S. Musculoskeletal manifestations in diabetic patients at a tertiary centre. Libyan J Med. 2012; 7 (1): 19162. &#xD;
&#xD;
24. Fasika S, Abebe S, Kebede A. The prevalence of shoulder and hand complications and associated factors among diabetic patients at University of Gondar Teaching Referral Hospital in Northwest Ethiopia. J Diab Res Clin Metab.2013; 41(6):2-8. &#xD;
&#xD;
25. Shah K, Clark B, McGill J, Mueller M. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physioth. 2015; 101(2): 147&#x2013;154. &#xD;
&#xD;
26. Mohan V, Bhansali A, Yajnik CS, Dhandhania VK, Joshi S, Joshi P. ICMR INDIA Diabetes (INDIAB) study, Phase I final report (2008-2011). Available at [https://main.icmr.nic.in/sites/default/files/reports/ICMR_INDIAB_PHASE_I_FINAL_REPORT.pdf] Last accessed 23rd August,2020 8 am.&#xD;
&#xD;
27. Moin Uddin M, Khan A, Haig A, Kafil Uddin M. Presentation of frozen shoulder among diabetic and non-diabetic patients. J Clin Orthopaed Traum. 2014; 5(4): 193-198. &#xD;
&#xD;
28. Arkkila PE, Kantola IM, Viikari JS, Ronnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996;55:907-914. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Impact Strength of Silver Nano-Particles Reinforced Heat-Activated Polymethylmethacrylate (Pmma) Resin at Various Proportions&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>13</FirstPage><LastPage>17</LastPage><AuthorList><Author>Suganya S</Author><AuthorLanguage>English</AuthorLanguage><Author> Ahila SC</Author><AuthorLanguage>English</AuthorLanguage><Author> MuthuKumar B</Author><AuthorLanguage>English</AuthorLanguage><Author> Vasantha Kumar M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Impact strength of denture base resin is an important factor for making a durable dental prosthesis. Reinforcement with nanoparticles improves the performance of any kind of medical and dental prosthesis. Purpose: To evaluate and compare the impact strength of heat-activated polymethylmethacrylate resin reinforced with Silver nanoparticles in the ratio of 4:1, 3:1, 2:1 to the weight of denture base resin. Materials and Method: According to the ISO 1570, the die was made with a dimension of 55x10x10 mm with a &#x2018;V&#x2019; shaped notch in the centre. The die was duplicated with putty material and the wax patterns were made in baseplate wax and poured into the mould. Then the synthesis of silver nanoparticles was done by reduction method and incorporated into the heat-activated polymethyl methacrylate (PMMA) resin in the ratio of 0:1 4:1, 3:1, 2:1 (Group A (control), Group B, Group C, and Group D) to the weight of denture base resin. The samples were polymerized at a temperature of 74&#xB0;C for 8 hours. Then the impact strength was calculated with Charpy&#x2019;s tester. Comparison of impact strength within the group was done using one way ANOVA. Results: On comparing the impact strength of conventional heat-activated PMMA resin with PMMA resin reinforced with silver nanoparticles at 4:1,3;1,2;1 showed the significant value P </Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Impact strength; Polymethyl methacrylate resin; Silver nanoparticle</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Removable dental prosthesis is most widely utilized to replace missing teeth in dental applications.1 Polymethyl methacrylate (PMMA) is the commonly used material to fabricate denture base by heat-curing technique since the 1940s.2 Polymethacrylate (PMMA) resins have dominated the denture base market since their introduction in 1937.3 It satisfies most of the requirements of denture base materials in terms of good esthetics, ease of processing and separability, reasonable cost, etc. However, it has relatively poor resistance to impact and flexural forces that may affect denture design and life span.4 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Most dentures fractures are caused by the combination of fatigue and impact failure, whereas for mandibular dentures, 80% of fractures are caused by impact and involves very high repair costs worldwide.5 Ahmed and Ebrahim 6 found that nearly 70% of dentures had broken within the first 3 years of their delivery.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Impact failures usually occur out of the mouth as a result of a sudden blow to the denture or by accidental dropping.7The PMMA has a low modulus of elasticity, low impact strength, and low flexural strength but it has many characteristics,8 made it used as denture base material such as ease in processing, stability in the oral environment, lightweight, excellent aesthetic properties, low cost, low water absorption, and can easily recharge and repaired its shape.9,10 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Recent researches showed that the physical and mechanical properties of denture base materials were improved by the addition of fillers to PMMA resin material fibres like polyethene, aramid, carbon and Kevlar were used for reinforcement of denture base resin. But the carbon and Kevlar fibres gave a black tint to the denture base resin which will affect the esthetics of the denture.8&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; With the advent of nanotechnology, silver nanoparticles have been synthesised and have been shown potent antimicrobial properties. Silver nanoparticles have been shown unique interaction with bacteria, fungi. They are smaller in size hence they possess physical, chemical and biological properties distinction from bulky material. The smaller particle with a larger surface area provides potent antibacterial action at a lower filler level and avoiding negative influence on mechanical properties. Although the literature related to silver nanocomposites reported with antimicrobial application in the medical field,11 very few studies about the addition of silver particles to denture base resins have been published. Hence this study was done to evaluate and compare the impact strength of heat-activated polymethylmethacrylate resin reinforced with Silver (Ag) nanoparticles in the ratio of 4:1, 3:1, 2:1 to the weight of denture base resin. A hypothesis was formulated that the impact strength of silver nanoparticles reinforced heat polymerized&#xA0; PMMA resin would be similar to conventional denture base resin.&#xD;
&#xD;
MATERIALS AND METHOD&#xD;
&#xD;
Preparation of silver nanoparticles&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; For the synthesis of silver nanoparticles chemical reduction method was followed in which the silver nanoparticles were prepared by dissolving 2.52 g of silver nitrate (Merck Specialities Pvt Ltd, India) in 15 mL of deionised water to get a solution of 1 mole. Then 2.23 g of sodium borohydride (Sisco Laboratories Pvt Ltd, India) mixed in 30 mL of deionised with a magnetic stirrer to get a solution of 2 moles in a conical flask. Then the silver nitrate solution is transferred to a burette and then allowed to drop slowly into sodium borohydride solution in a conical flask and mixed with a magnetic stirrer to prevent agglomeration. The temperature around the conical flask was controlled by placing ice cubes. As the stirring process continues, the agglomerates of silver nanoparticles start forming. Then the agglomerates of silver nanoparticles were washed with deionized water, centrifuged, and dried in an incubator at 65&#xB0;C overnight. It is then ground with a mortar and pestle. &#xD;
&#xD;
Sample preparation&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; According to the ISO 1570, a metal die was made with a dimension of 55x10x10mm with a &#x2018;V&#x2019; shaped notch in the centre. The notch is 2mm deep and at an angle of 45&#xB0; to the horizontal plane. Polyvinylsiloxane (Aquasil, Dentsply, India) putty was used as duplicating material to create a mould space for the fabrication of wax patterns. Baseplate wax (Hindustan modelling wax, India) was used for fabricating the wax pattern.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A total number of forty wax patterns (Figure.1) were thus made for the preparation of heat-cured acrylic resin samples with silver nanoparticles for evaluating the impact strength.&#xA0; Heat cure acrylic denture base (Dental Products of India) was chosen as the material for fabricating the samples. The synthetic nanoparticle which was made earlier was mixed with the heat-activated polymer in the ratio of 4:1, 3:1, 2:1 was considered as a control- no nanoparticles (Group A), Group B, Group C, and Group D to the weight of denture base resin with a mortar and pestle. (Table.1)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; For the packing of resin, a compression moulding technique was followed. The hydraulic press (Silfradent, India) was used at 1500 Psi to apply pressure for 3 hours. The curing cycle followed was a long curing cycle and hence the entire flask with the packed material was polymerized at a temperature of 74&#xB0;C for 8 hours (Delta poly bath, India). &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The fabricated samples are then evaluated for impact strength under Charpy tester (Izod digital Charpy impact tester, Blue star India). (Figure.2) Then the samples were analysed under Scanning Electron Microscope (Phenom X, Phenom-World B V, Netherland) for the distribution of silver nanoparticles. (Figure 3, 4 and 5)&#xD;
&#xD;
Statistical analysis used&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The impact strength values were statistically analyzed using SPSS version 22.0 (Armonk, NY: IBM Corp). Power analysis was done to establish the sample size at a 99.9% confidence interval. Comparisons within the group were done using One way ANOVA.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The mean, standard deviation and standard error of impact strength of &#xA0;Group A, Group B, Group C, and Group D. were&#xA0; 0.9910 &#xB1; 0.02424, 1.4590 &#xB1;0.03725, 1.5330 &#xB1;0.01889, 1.9900 &#xB1; 0.01826 J/mm respectively. (Table2) showed the P-value&#xA0; </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3858</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3858</Fulltext></URLs><References>1.Jancar J, Hynstova K, Pavelka V.Toughening of denture base resin with short deformable fibres.Comp Sci Technol.2009;69:457-62. &#xD;
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2.Fernanda CPPS, Heitor P, Vieira A, Garcia LFR, Consani S.Impact and fracture resistance of an experimental acrylic polymer with elastomer in different proportions. Mater Res. 2009;12:415-18.&#xD;
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3.Hargreaves AS.polymethylmethacrylate as a denture base material in service. J Oral Rehabil. 1975;2:97-104.&#xD;
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4.O&#x2019;Brien WJ.Dental materials and their selection. 2nd ed. Chicago (IL).Quintessence Pub.1997; 5:85-86.&#xD;
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5.Hari PA, Kalavathy DS, Mohammed HS. Effect of glass fibre and silane treated glass fibre reinforcement on the impact strength of maxillary complete denture. Ann Essences dent. 2011;3:7-12.&#xD;
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6.Ahmed MA, Ebrahim MI.Effect of zirconium oxide nanofillers addition on the flexural strength, fracture toughness, and hardness of heat-polymerized acrylic resin.World J Nano Sci Eng. 2014;4:50-57.&#xD;
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7.Gupta A, Tewari RK.Evaluation and comparison of transverse and impact strength of different high strength denture base resins.Indian J Dent Res. 2016;27:61-65.&#xD;
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8.Vojdani, M,Khaledi AAR.Transverse strength of reinforced denture base resin with metal wire and E glass fibres. J Dent Teh Univer Med Sci. 2006;3:159-166.&#xD;
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9.Engelmeier RL.The history and development of posterior denture teeth-introduction, part II: Artificial tooth development in America through the nineteenth century.J Prosthodont. 2003;12:288-301.&#xD;
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10.Rama KA, Suresh S, Venkata RA, Kishore G, Nagaraj U. Influence of Fiber Reinforcement on the Properties of Denture Base Resins. J Biomat Nanobiotech. 2012;4:91-7.&#xD;
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11.Correa JM,Morie M,Sanches HL,Da Cruz AD,Poiate E Jr,Poiate IA.Silver nanoparticles in dental biomaterials.Int J Biomater. 2015;1:1-9&#xD;
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&#xA0;12.Furno F et al.Silvernanoparticles and polymeric medical devices: a new approach to prevention of infection. J Antimicrob Chemother. 2004;54:1019-24.&#xD;
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12.Schreiber CK.Polymethylmethacrylate reinforced with carbon fibers.Br Dent J. 1971;130:29-30.&#xD;
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13. Phoenix RD.Denture base materials.Dent Clin North Am. 1996,40;113-120. &#xD;
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14.Dogan OM,Bolayir G,Keskin S, Dogan A, Bek B, Boztug A.The effect of esthetic fibres on the impact resistance of a conventional heat-cured denture base resin.Dent Mat J. 2007;26:232-239.&#xD;
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15.Memon MS,Yunus N,Razak AA.Some mechanical properties of a highly cross-linked, microwave-polymerized, injection-moulded denture base polymer.Int J Prosthodont. 2001;14:214-18.&#xD;
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16.Straioto FG,Ricomini Filho AP, Fernandes Neto AJ,Del Bel Cury AA. Polytetrafluorethylene added to acrylic resins: mechanical properties. Braz Dent J. 2010;21:55-59. &#xD;
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17.Giampaolo ET, Pavarina AC.Effect of reline material and denture base surface treatment on the impact strength of a denture base acrylic resin.Gerodontology. 2010;27:62-69.&#xD;
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18.Begum SS, Ajay R, Devaki V, Divya K, Balu K, Kumar PA. Impact strength and dimensional accuracy of heat-cure denture base resin reinforced with ZrO2 nanoparticles: An in vitro study. J Pharm Biol Sci. 2019;11:S365-70.&#xD;
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&#xA0;19.Abdulkareem MM, HatimNA.Evaluation of the biological effect of adding aluminium oxide, silver nanoparticles into microwave treated PMMA powder.Int J En Res Sc Tech Eng . 2015;4:172-78.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Comparison of Photographic and Visual Method for Tooth Shade Selection Using Two Shade Guides: A Clinical Research to Improve Shade Communication&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>18</FirstPage><LastPage>23</LastPage><AuthorList><Author>Bhandari AN</Author><AuthorLanguage>English</AuthorLanguage><Author> Bulbule NS</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhatt V</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhatlekar T</Author><AuthorLanguage>English</AuthorLanguage><Author> Mondal S</Author><AuthorLanguage>English</AuthorLanguage><Author>Amit K Jagtap</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Aims and Objectives: To evaluate shade of maxillary central incisor visually, digitally by using a smartphone camera and graphic software and calculating the percentage of correct shade matching comparing both the methods using two different shade guides. Materials and Methods: A total of 45 participants were selected from the outpatient department of prosthodontics. The maxillary central incisor chosen had no history of any congenital or acquired deformities, restoration or structural defect. The shade for the same tooth was selected using two shade guides by conventional visual method, digitally by using a smartphone camera and graphic software for computer shade matching and the percentage of correctness between two was calculated. The agreement between both the results was compared and subjected to statistical analysis. Results: The results showed that when both the methods were compared with each shade guide i.e. Vita Classic Shade guide was found to be statically insignificant (p value=0.933) and with Vitapan 3D Master Shade guide was also found to be statistically insignificant (p value=0.825).Though the study showed close clinical relation for shade matching done visually when compared with the digital method the amount of correct shade matching was about 66.66% and 60% for Vita Classic Shade guide and Vitapan 3D Master Shade guide respectively. Conclusion: It was concluded that digital photography when combined with visual shade matching, can prove to be an effective method for shade communication thus improving the final esthetic qualities of restoration.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Shade guide, Visual method, Digital method, Esthetic restoration, Colour science, Shade selection</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
We all know that the success of restorative dentistry which is a combination of art as well as science is based on its functional as well as esthetic results. So, correct shade matching becomes a challenging aspect in esthetic and restorative dentistry.&#xD;
&#xD;
Though colour research has shown that the shade guides have very little representation of colour space of natural dentition but are still used for assessment and communication of colour of teeth in dentistry.1&#xD;
&#xD;
Chairside colour matching with help of shade guides is subjective and tough due to different observer interpretation and environmental factors like the human eye, age, emotions, experience, colour blindness. There has always been a difference in the shade matching done visually by different observers due to all of these factors.2, 3&#xD;
&#xD;
To make a restoration look natural, the selection of shade can be done either visually or by instrumental methods. But, the most common and traditional approach of selection of shade is visually through the use of a prefabricated shade guide. As shade guides are visual support for selecting shades and are defined as the collection of shade tabs, organized by colour (hue, chroma and value) which are used to suit the colour of the natural tooth.4&#xD;
&#xD;
Instruments like computerized colourimeters and spectrophotometers have been developed to describe dental colours digitally. They may yield high stable results but do not have high accuracy.5They evaluate tooth colour by measuring the amount and spectral composition of reflected light on the surface of the tooth .5&#xD;
&#xD;
But these contact type instruments may have several disadvantages like limiting area of measurement on the tooth surface, edge loss of light due to translucency of tooth, measure flat surfaces instead of translucent surfaces on curved teeth.3&#xD;
&#xD;
Digital cameras and imaging systems are substitute for contact-type colour measurement instruments and have been used widely in dentistry. Digital photographs not only help in communication amongst clinicians and technicians but also help in precisely knowing the morphology of teeth, colour distribution as well as intraoral conditions.6&#xD;
&#xD;
As we all know that smartphones have become universal devices and their applications to the clinician have also improved. Photographs from smartphones can be used for referencing colour shade matching for tooth and also help in easy communication between technicians and dentists.6&#xD;
&#xD;
Also to improve the accuracy of shade selection procedures, the use of Vitapan 3D-Master tooth shade guide can be done.1&#xD;
&#xD;
Therefore, this study was designed to compare the shade of maxillary central incisor by two shade guides and by two different techniques-visual method and digital (using smartphone camera graphic software) for computerised shade matching and calculate the measure of correctness between both the methods.&#xD;
&#xD;
MATERIALS AND METHODOLOGY:&#xD;
&#xD;
A sample of size forty-five cases in each group, satisfying the inclusion criteria was chosen. After obtaining the required approval from the Scientific and Ethics Committee of the Institution with ref no. DYPDCH/IEC/123/125/19, forty-five (n=45) patients were randomly selected from the outpatient department of prosthodontics.&#xD;
&#xD;
Inclusion criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Age group:18-60 years&#xD;
	&#xD;
	&#xD;
	Both genders&#xD;
	&#xD;
	&#xD;
	Healthy maxillary central incisor&#xD;
	&#xD;
&#xD;
&#xD;
Exclusion criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Missing maxillary anterior teeth&#xD;
	&#xD;
	&#xD;
	Any congenital or acquired&#xA0; dental deformity, structural defects in anterior teeth&#xD;
	&#xD;
&#xD;
&#xD;
The observer viewed the patient at the eye level so that colour sensitive part of the retina was used for about 10 seconds which reduces the chances of fatigue of the retina. A time interval of 10 minutes between uses of two shade guides was kept .1&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; The clinical area for shade matching was standardized accordingly for shade selection4:&#xD;
&#xD;
&#xD;
	&#xD;
	Remove bright colours from the visual field&#xD;
	&#xD;
	&#xD;
	If participants were found wearing heavy makeup we need to remove it.&#xD;
	&#xD;
	&#xD;
	Shade selection was done in daylight (noon) and near the window.&#xD;
	&#xD;
	&#xD;
	Shade selection was done on the middle third portion of the maxillary central incisor.&#xD;
	&#xD;
&#xD;
&#xD;
The chronological sequence followed in the study:&#xD;
&#xD;
&#xD;
	&#xD;
	The scaling procedure was followed for the participants before shade selection.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Shade selection was done on the tooth using Vitapan classical shade guide which is hue based where chroma increases within the groups (A-D).4&#xA0; (Figure 1)&#xD;
	&#xD;
	&#xD;
	The shade tab was placed at the same relative edge position adjacent to the maxillary central incisor under the lip.4&#xD;
	&#xD;
	&#xD;
	The distance of the operator from the patient was about 25-30 cm.4&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	After each shade selection, relaxation of eyes was done &#xA0;by observing a neutral grey card before the next trial.4&#xD;
	&#xD;
	&#xD;
	Shade selection using VITA tooth guide 3D- Master shade guide was done in a similar procedure by the operator as for the Classic shade guide but since it is value-based; selection of shade was completed by selecting each component of colour i.e., firstly by determining value, secondly by selecting Chroma (vertically) and then the hue of the tooth(horizontally).4&#xA0; (Figure 2)&#xD;
	&#xD;
	&#xD;
	The digital method made use of a smartphone camera to take the image of the teeth which was adjusted at the level of the patient&#x2019;s occlusal plane. The distance between the smartphone camera and teeth will be kept constant about 16-20 cm by use of a measuring scale and tripod stand. The images were taken by smartphone camera by auto features .3&#xD;
	&#xD;
	&#xD;
	The images of both shade guides were captured by using a smartphone camera at the dental clinic against a contrasting background.&#xD;
	&#xD;
	&#xD;
	The images were then transferred to the computer by connecting the phone to the computer in JPEG format.&#xD;
	&#xD;
	&#xD;
	The images were processed by using Adobe Photoshop (7.0) program by moving the shade from their screen position to the incisor position for matching the colour.&#xD;
	&#xD;
	&#xD;
	The magnetic lasso tool was used to delineate the area on the central incisor whose shade has to be decided. The magic wand tool next to it was used to eliminate reflection on the tooth surface.&#xD;
	&#xD;
	&#xD;
	The image of the selected tooth was matched with digital images of both the shade guides (Figure.3 and Figure .4)&#xD;
	&#xD;
	&#xD;
	The selected shade by the operator by using both techniques were assessed and compared.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
RESULTS AND STATISTICAL ANALYSIS:&#xD;
&#xD;
In this study shade matching of maxillary central incisor was done visually with both shade guides. Also, a comparison between visual and digital shade matching by making use of a smartphone camera and two shade guides was done. &#xD;
&#xD;
Testing of data analysis: Data analysis was done with Mann Whitney U test&#xD;
&#xD;
It was found that digital shade matching using smartphone camera was statistically different from conventional visual shade matching with 66.66% correctly matched shade for VITA CLASSIC SHADE GUIDE and 60% correctly matched shade for VITA 3D MASTER SHADE GUIDE (table no-1&#xA0; and Figure no- 5)&#xD;
&#xD;
Comparison between visual and digital shade matching for vita classic shade guide:&#xD;
&#xD;
The mean rank of shade matching done visually (A) was about 45. A 28 and shade matching done digitally (C) was about 45.7A 2 for VITA CLASSIC SHADE GUIDE. Though the clinical significance of relation was seen amongst A and C, the p-value was about 0.933 which considered being statistically insignificant (Table no- 2 and Figure no-6).&#xD;
&#xD;
Comparison between visual and digital shade matching for vita 3 d master shade guide:&#xD;
&#xD;
The mean rank of shade matching done visually (B) was about 44.9A 2 and shade matching done digitally (D) was about 46.08 for VITA 3 D MASTER SHADE GUIDE. Though the clinical significance of relation was seen amongst A and C, the p-value was about 0.825 which considered being statistically insignificant (Table no-3 and Figure no-7). Though statically insignificant, the mean rank values for A and C (45.A 28 and 45.7A 2) were found to be much closer in comparison to B and D (44.9A 2 and 46.08) which suggests a better relation for VITA CLASSIC SHADE GUIDE as compared to VITA 3 D MASTER SHADE GUIDE visually and digitally.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
One of the most common failures of esthetic dentistry is the lack of correct shade matching which maybe because of the clinician&#x2019;s inability to match the shade or miscommunication with the technician or inability of the technician to reproduce it.&#xD;
&#xD;
Due to various combinations in hue, value, chroma in teeth it may be difficult to communicate this to the technician.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the present study, the aim was to check the reliability of shade matching based on digital imaging of tooth and shade tab by using a smartphone camera by comparing it with the conventional visual method of shade matching by making use of two different shade guides by making use of graphic software in colour analysis.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; It was observed that digital shade matching in comparison to the conventional visual shade matching provided a reliability of 66.6% and 60% for VITA CLASSIC and VITAPAN 3D MASTER Shade guide respectively. &#xD;
&#xD;
The mean rank of shade matching done visually was about 45. 28 and shade matching done digitally was about 45.72 for VITA CLASSIC SHADE GUIDE. Though the clinical significance of relation was seen amongst A and C, the p-value was about 0.933 which considered being statistically insignificant.&#xD;
&#xD;
Similarly, the mean rank of shade matching done visually was about 44.92 and shade matching done digitally was about 46.08 for VITA 3 D MASTER SHADE GUIDE. Though the clinical significance of relation was seen amongst A and C, the p-value was about 0.825 which considered being statistically insignificant.&#xD;
&#xD;
In a study conducted by Miyajiwala et al.13, when a comparison of shade matching between the visual and spectrophotometric methods was done, the coefficient of agreement (using Kappa coefficient) was checked. Results revealed a fair agreement between the shades as determined by these two methods with (Kappa coefficient = 0.204).&#xD;
&#xD;
A study conducted by Ihab A. Hammad1which evaluated the effects of 2 shade guides on the interrater repeatability of prosthodontists concerning shade selection stated that interrater repeatability of prosthodontists was significantly higher than that of general practitioners when Vita Lumin Vacuum shade guide was used in comparison to Vita 3 D Master which had higher intrarater repeatability in general practitioners.&#xD;
&#xD;
A study conducted by Amit V Naik et al. 2 compared the interoperator variability in shade matching by visual techniques using two shade guides which stated that Vitapan 3D- Master shade guide was better than the Vitapan Classical shade guide in reducing the interoperator colour differences.&#xD;
&#xD;
A study conducted by Rapti M Dahane et al. 4which studied the comparison between two operators in shade selection by visual techniques using VITA tooth guide 3-D Master and VitapanClassical shade guide stated that there was about 14% interpersonal variability in Vitapan classical shade guide and about 23% in Toothguide 3-D master. This shows that VITA Toothguide&#xA0;&#xA0; 3D - Master showed higher interpersonal variability than Vitapan classical shade guide.&#xD;
&#xD;
None of the studies above could alone prove to be successful in determining the accurate shade of tooth using only one technique.&#xD;
&#xD;
&#xA0;The digital method made sure that both the tooth and shade guide could be viewed on the same screen and shades could be moved around, placed adjacent to or even overlap with the tooth to be matched. It makes use of black background to eliminate the scattering lights in the images.&#xD;
&#xD;
In this study, the use of a smartphone camera for digital shade matching using graphic software provided a new method of colour matching to an operator as well as laboratory technician even in absence of actual shade guides. In cases, where the clinician may find it cumbersome to match a single shade tab to the tooth, a prescription can be made combining several shades from different tabs.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;The different areas on the tooth can be related to these tabs. Making use of digital images will allow the technician to evaluate different tabs of shades about different areas on the tooth. This may help the technician to apply his experience to develop restoration that matches the patient&#x2019;s natural tooth.&#xD;
&#xD;
This method may also improve computer link communication instead of receiving tooth colour as shade number. The digital images can also be sent via the internet to the laboratory and technician who can match tooth colour on the screen.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0; Certain shortcomings were seen because of lack of use of colour corrected lights, environmental illumination, lack of familiarity with the digital photo imaging software and in a clinical setup, the surface texture of tooth, a wide variety of shade tabs available. So there was comparatively less relation between digital and visual shade matching for VITAPAN 3 D Master shade guide in comparison to the VITA CLASSIC Shade guide.&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This study opens up new horizons for the advanced scientific approach to colour matching in dentistry. Furthermore, the colour match of restorations fabricated using shades suggested by the digital photography technique should also be investigated.&#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
Within limitations of this study, we can conclude that,&#xD;
&#xD;
1. The reliability of shade matching by conventional visual shade matching and digital shade matching using a smartphone camera and graphic software were about 66.66% and 60% for VITA CLASSIC and VITAPAN 3 D MASTER Shade guide respectively.&#xD;
&#xD;
2. Digital method of taking photographs using smartphone camera can be used as an aid to visual shade matching using shade tabs to enhance shade communication between technician and dentist&#xD;
&#xD;
3. The use of digital images in shade matching allows technicians to view variations, surface texture and tooth colour and improve shade communication.&#xD;
&#xD;
4. Considering the technological advancement in the current &amp; future world, digital photographs with advanced features will play a significant role in giving a life-like appearance to prosthetic restorations. It will also save the clinical &amp; laboratory time for the operator &amp; technician to visualising the actual shade rather than interpreting the conveyed shade. &#xD;
&#xD;
5. Currently ceramic shades are in conjunction with the shade tabs in the shade guide but with the use of technological advancements, we can expect the introduction of the mobile apps to record the correct shade &amp; do the auto-matching of the same with shades of ceramic. This will help us to produce more lifelike restorations.&#xD;
&#xD;
6. Use of technology for better results is the need of the hour&amp; digital methods of shade selection in form of digital photographs can be an adjunct along with the manual shade guides in recording the correct shade. This technological advantage even though demands financial support but can be an incomparable asset if combined with the conventional method of shade selection with the shade guide &#xD;
&#xD;
AUTHORSHIP STATEMENT: &#xD;
&#xD;
All persons who meet authorship criteria are listed as authors and have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. All authors revised and gave final approval for the version submitted.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#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;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3859</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3859</Fulltext></URLs><References>&#xD;
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	Hammad IA.Intrarater repeatability of shade selections with two shade guides. J Prosthet Dent. 2003;89:50-3.&#xD;
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	Naik AV, Jurel SK, Pai RC.Interopertor variability in shade matching for restoration with two shade guides.Int J Con Den. 2011 Jan;2(1).&#xD;
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	Bayindir F, Kuo S,&#xA0; William M. Johnston,&#xA0; Wee A G. Coverage error of three conceptually different shade guide systems to the vital unrestored dentition. J. Prosthetic Dent. 2007; 98(3):175-84.&#xD;
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	Dahane&#xA0; TM, Gupta R, Godbole SR, Pakhan AJ, Sathe S.Interoperator Variabilty in Shade Selection using two shade guides .Int J Prosthod Restor Dent. 2017;7(4):124-128.&#xD;
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	Paravina R, Stankovi D, Aleskov L, Mladenovic D, Risti K. Problems in standard shade matching and reproduction procedure in dentistry. Uni Dent Con. 1997 May; 4(1);12-16.&#xD;
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	Tam W-K, Lee H-J. Accurate sh. ade image matching by using a smartphone camera. J Prosthodont Res. 2016;71(41): 281.&#xD;
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	Basavanna RS, Gohil C, Shivanna V. Shade selection. Int J Oral Health Sci. 2013; 3:26-31&#xD;
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	Kuzmanovic&#xB4; D, Lyons KM. Tooth shade selection using a colourimetric instrument compared with that using a conventional shade guide. New Zeala Dent J. 2009; 105:131&#x2013;4.&#xD;
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	Alomari M, Chadwick R G. Factors influencing the shade matching performance of dentists and dental technicians when using two different shade guides. Brit Den J. 2011; 1-7.&#xD;
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	Llena C, Lozano E, Amengual J Forner L. Reliability of Two Color Selection Devices in Matching and Measuring Tooth Color. J Contemp Dent Pract. 2011; 12(1):19-23.&#xD;
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	&#xC7;apa N, Malkondu O, Kazazog? LU, &#xC7;al?kkocaog? lu S. Evaluating factors that affect the shade-matching ability of dentists, dental staff members and laypeople. J Ame Dent Ass. 2010; 141(1):71-76.&#xD;
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	Mangal K, Dhamande M, Sathe S, Godbole S, Patel R .: An overview of the implant therapy: The esthetic approach. Int J Cur Res Rev. 2021; 13 (02):106-112.&#xD;
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	Miyajiwala JS, Kheur MG, Patankar AH, Lakha TA. Comparison of photographic and conventional methods for tooth shade selection: A clinical evaluation. J Indian Prosthodont Soc. 2017;17:273-81. https://www.j-ips.org/text.asp?2017/17/3/273/212742.&#xD;
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	Kulkarni&#xA0; P, Bulbule N, Kakade D, Hakepatil N. Radiographic Stents and Surgical Stents in Implant Placements: An Overview. Int J Curr Res Rev. 2019;11(12): 11-15.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Platelet-Rich Plasma in the Treatment of Dorsal Wrist Ganglion&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>24</FirstPage><LastPage>27</LastPage><AuthorList><Author>Prakasam N</Author><AuthorLanguage>English</AuthorLanguage><Author> Vasudevan A</Author><AuthorLanguage>English</AuthorLanguage><Author> Guru Prasad R</Author><AuthorLanguage>English</AuthorLanguage><Author> Prabakar M. S.</Author><AuthorLanguage>English</AuthorLanguage><Author>  Senguttuvan K</Author><AuthorLanguage>English</AuthorLanguage><Author> Palani V</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Ganglions are one of the commonest soft tissue lesions that arise from a joint capsule or tendon sheath. The gold standard treatment for this is excision biopsy. The other options are intra-lesional hyaluronidase injection or triamcinolone injection after aspiration. These techniques have drawbacks. Surgery has a formation of scar which sometimes has a chance of becoming an unsightly hypertrophic scar. Aim: To check the effectiveness of Platelet Rich Plasma (PRP) in dorsal wrist ganglion. Materials and Methods: A case-control study in adherence with the principles of the Declaration of Helsinki was conducted on 60 patients. 20 patients were given intra-lesional hyaluronidase injection after aspiration and 20 patients were given intralesional PRP injection after aspiration and another 20 patients were given triamcinolone injection after aspiration. Results: PRP group had lower recurrence rates compared to the other two groups. The Hyaluronidase group had recurrences and required a repeat injection, it was also noted that the capsule thickened after the treatment in these patients. Triamcinolone group had lower recurrence rates at 1 month follow up but this eventually increased over a 6 monthly follow up, they also required a second injection Conclusion: PRP is easy to obtain, safe and cost-effective in the management of dorsal wrist ganglion. More studies to be conducted in the future in a larger population with a larger observational period to confirm this.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Protein-rich Plasma, Platelet Rich Plasma (PRP), Ganglion, Hyaluronidase, Triamcinolone</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Ganglion cysts are cystic lesions arising from the soft tissues adjacent to joint capsules or tendon sheaths. These are most commonly seen in the wrists, hands and feet, but they do occur within muscles, menisci and tendons also. These are classified based on their site of origin: the tendon sheath, joint, bone or soft tissue. Of these, the most commonly occurring is the one arising from the tendon sheaths followed by the intratendinous ganglion cyst. Most of these arise from the extensor tendons of the wrist and hand.1 &#xD;
&#xD;
The intraneural ganglions are mostly benign and contain the mucinous substance. These are formed within the nerve sheath of the peripheral nerves. The symptoms of these include peripheral neuropathy. Their pathogenesis is unclear. There are different treatments but all of these have been disappointing and the recurrence rates are high.2&#xD;
&#xD;
The aetiology of intratendinous ganglion cysts is controversial. One such aetiology is that recurrent injury to the tendon with subsequent cystic degeneration. And this theory holds good because tenosynovitis or associated tendon tears are present in the area adjacent to the ganglion cyst. 1 There are three possible explanations for these cysts so far. One is that they are formed from a capsular defect of a nearby joint, this allows joint fluid to egress and track along the epineurium of an innervating articular branch. The second is that the fluid follows the path of least resistance; and the third being that the cyst takes form due to pressure changes.2,3,4 &#xD;
&#xD;
Similarly, the aetiology of intraneural ganglion cysts has also been unclear. We have observed this from the very first known report (1809) described by Beauch&#xEA;ne till the newer ones. Although materials from these studies support evidence of an elbow joint connection2.&#xD;
&#xD;
Intraneural recurrences are now becoming commonly recognized. This is probably because of increasing awareness, use of MRI&#x2019;s and better follow-up by patients 5 with increasing imaging technologies, the joint connections are identified initially and/or postoperatively. 6,7 it is also observed that the intraneural recurrences decrease when the diagnosis is made early and treatments target the articular branch connection. 2&#xD;
&#xD;
A surgical approach is still the gold standard and has a significantly lower recurrence rate when compared with aspiration and intra-lesional injections.4,8 Arthroscopic excision has limited data but has so far given good outcomes amongst patients and is not considered superior. 9 It was stated by Crijns et al. in 2019 that patients who have undergone hand surgeries have more tendencies toward depression and chronic pain along with an unsightly hypertrophic scar. 10&#xD;
&#xD;
We wanted a scarless procedure for our patients and we also wanted a low recurrence rate. Hence, the aim of this study was directed to identify the effectiveness of PRP in patients with dorsal wrist ganglion.&#xD;
&#xD;
METHODOLOGY:&#xD;
&#xD;
In adherence to the principles of the Declaration of Helsinki, written informed consent was obtained from participants of this study. Permission from the Institutional Review Board was obtained (ACS-MCH/20/JAN/18/09). This was a case-control study conducted at ACS Medical College from 2018 to 2020. 60 patients were chosen for this study, of which, 20 were given PRP treatment, 20 were given the routine hyaluronidase injections and 20 other patients were given triamcinolone injection. An ultrasound was done before the study for all patients.11&#xD;
&#xD;
Inclusion criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Above 18 years&#xD;
	&#xD;
	&#xD;
	Patients with Dorsal wrist ganglion from all departments&#x2013; single, size up to 2 cms&#xD;
	&#xD;
	&#xD;
	No comorbidities&#xD;
	&#xD;
	&#xD;
	No bone or joint pathologies&#xD;
	&#xD;
	&#xD;
	Consenting for the study&#xD;
	&#xD;
&#xD;
&#xD;
Exclusion Criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Below 18 years of age&#xD;
	&#xD;
	&#xD;
	Multiple ganglia&#xD;
	&#xD;
	&#xD;
	Osteoporosis of the joint&#xD;
	&#xD;
	&#xD;
	Comorbidities like Diabetes mellitus, generalised osteoporosis, blood disorders, bleeding or clotting disorders&#xD;
	&#xD;
	&#xD;
	Patients with HIV, Hepatitis or any other infections&#xD;
	&#xD;
	&#xD;
	Patients on any long-term medications&#xD;
	&#xD;
	&#xD;
	Patients not consenting to the study&#xD;
	&#xD;
&#xD;
&#xD;
Group A patients received Intra lesional PRP injections after aspiration. Review after one week as a routine. Group B patients received intra-lesional hyaluronidase after aspiration. Group C patients were given intra-lesional triamcinolone after aspiration. An 18-gauge needle was used to aspirate the contents. The amount injected into the lesion was always equal to the amount withdrawn from the ganglion.&#xD;
&#xD;
Following this, patients were asked to rest with a compression bandage or a crepe bandage which was removed after a day. &#xD;
&#xD;
These patients were then followed up for one year. All three groups were asked to review at 15 days, then at one month, 3 months than at 6 months and then at one year. There was a total of 5 visits to the hospital including the first visit.&#xD;
&#xD;
Parameters like pain, mobility, size of the swelling were noted during every visit.&#xD;
&#xD;
PRP PREPARATION:12&#xD;
&#xD;
PRP was prepared from the patient&#x2019;s blood. About 5-10 ml of blood was withdrawn from the patient. This was then transferred to a container with an anticoagulant. An initial soft spin of the whole blood (3000 RPM for 5 min at 23&#xB0;C). This separated the blood into two layers. The topmost layer was pipetted out and subjected to a hard spin (4500 RPM for 10 mins) (Figure 1 and 2). The lower one-third portion constitutes the PRP. This was aspirated in a syringe with an 18-Gauge needle and injected as per the above-mentioned protocol.13&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
&#xD;
&#xD;
RESULTS:&#xD;
&#xD;
There were 40 patients, of which 20 were cases and 20 were controls. All the patients were 20-40 years of age. 30 patients were females and 10 were males. 36 of these patients were involved with activities involving fine hand movements. &#xD;
&#xD;
Parameters compared:&#xD;
&#xD;
The pain was slightly higher with the PRP group. The cost involved in the treatment was slightly higher with controls. Patients were able to do their routine activities by the second day in both groups. (Table 1)&#xD;
&#xD;
The following observations were made:&#xD;
&#xD;
&#xD;
	&#xD;
	There was only one recurrence in the PRP group for the entire period of the study. The patient was given a repeat PRP injection and had no complaints in the follow-up.&#xD;
	&#xD;
	&#xD;
	The hyaluronidase group had 5 recurrences at three-month follow-up and three recurrences at 6-month follow-up. &#xD;
	&#xD;
	&#xD;
	The triamcinolone group had 4 recurrences at three-month follow-up and 4 recurrences at six-month follow-up.&#xD;
	&#xD;
	&#xD;
	All the patients with recurrences were administered with a second dose of PRP / Hyaluronidase/triamcinolone injections depending on the group they were in.&#xD;
	&#xD;
	&#xD;
	On follow-up, the hyaluronidase group had a thickening of the capsule and this mimicked a recurrence in some cases. Similarly, the triamcinolone group had slight hypopigmentation of the overlying skin. But this discolouration slowly vanished with time. This discolouration was probably due to the seepage of the injected steroid. &#xD;
	&#xD;
	&#xD;
	A pain score of more than 3 was considered significant. These patients were managed with paracetamol.&#xD;
	&#xD;
	&#xD;
	Long-term patient satisfaction was higher in the PRP group.&#xD;
	&#xD;
&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
Platelet-rich plasma also called PRP promotes physiological and pathological healing. PRP therapy is nowadays used in surgeries. It is also a treatment of choice for osteoarthritis (OA) and tendinopathies. 14&#xD;
&#xD;
PRP therapies are used for disorders that have tissue regeneration. PRP Injections are used to treat tendinopathy and they have shown some clinical benefits with pain management.15 it is also known that PRP can reduce inflammatory and angiogenic status. 14&#xD;
&#xD;
PRP, as we know is biological. Hence it can be used in both physiological and pathological conditions. But to know its importance is a necessity. 16 From chronic tendinopathy to acute traumatic rupture it is observed that multiple cytokines take part.14&#xD;
&#xD;
PRP as the name suggests is known to contain large amounts of platelets. These are activated to form Prostaglandins (PG) and in turn release Platelet Growth Factor (PGF), this is of significant importance in therapy.12&#xD;
&#xD;
As stated by Guo et al. exosomes that are released by PRP may lead to angiogenesis through activation of Erk and Akt signalling pathways. This suggests that PRP-induced re-epithelialization may be triggered by activation of Yes-Activated Protein (YAP). 17&#xD;
&#xD;
The main advantages of PRP are that it is prepared from the patient&#x2019;s blood and it does not need a high-tech lab for this purpose. The more important advantage being, PRP is autologous and hence there are no reactions to this treatment when compared to the commonly used cortico-hyaluronidases. 18,19,20 on the other hand, there are no pieces of evidence to regulate the formulation and composition of PRP and hence make it difficult for us to know the exact dosage that is to be given. 16-20&#xD;
&#xD;
As stated by Prakasam et al. in the year 2018 and 2020, PRP is easy to obtain, can be cost-effective, safe and has a lot of healing properties. This can be used to heal ulcers of any origin. 13,21&#xD;
&#xD;
Although the limitations of this study are its small size and a small follow up period, we conclude by saying that PRP can be used for dorsal wrist ganglion as it is safer, pain-free in the long term and has very minimal recurrences. &#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
PRP is easy to obtain, safe and cost-effective in the management of dorsal wrist ganglion. PRP also fares better in terms of recurrence and pain when compared to the regular Hyalase Injection and Triamcinolone injection. More studies to be conducted in the future in a larger population with a larger observational period to confirm this.&#xD;
&#xD;
ACKNOWLEDGEMENTS:&#xD;
&#xD;
We would like to acknowledge and thank our institute for allowing and encouraging us to conduct and write about this study. We would also like to take this opportunity to thank our staff and other members of our department who have helped us in crossing all the obstacles to make this article a successful one.&#xD;
&#xD;
CONFLICT OF INTEREST:&#xD;
&#xD;
None&#xD;
&#xD;
SOURCE OF FUNDING:&#xD;
&#xD;
None&#xD;
&#xD;
AUTHOR CONTRIBUTIONS:&#xD;
&#xD;
Dr. M. S. Prabakar, Dr. K. Senguttuvan, Dr. V. Palani &#x2013; conceptualisation of the study, overview of the study, review of manuscript and results&#xD;
&#xD;
Dr. Prakasam N, Dr. Vasudevan A, Dr. Guru Prasad R &#x2013; Review of literature, conduction of the study, data analysis, manuscript writing,&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3860</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3860</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kim SK, Park JM. intratendinous ganglion cyst of the semimembranosus tendon. Br J Radiol. 2010;83(April):e79&#x2013;82. &#xD;
&#xD;
2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Desy NM, Frcs C, Wang H, Ahmed M, Elshiekh I, Tanaka S, et al. Intraneural ganglion cysts: a systematic review and reinterpretation of the world&#x2019;s literature. J Neurosurg. 2016;125(9):615&#x2013;630. &#xD;
&#xD;
3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lu H, Chen L, Jiang S, Shen H. A rapidly progressive foot drop caused by the posttraumatic Intraneural ganglion cyst of the deep peroneal nerve. BMC Musculoskelet Disord. 2018;19(298):1&#x2013;5. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Harsch I. Para-Articular Cysts in a 64-Year-Old Man. Dtsch Arztebl Int. 2018;115(249b). &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mathoulin C, Gras M. Arthroscopic Management of Dorsal and Volar Wrist Ganglion Dorsal ganglion Volar ganglion Wrist arthroscopy Treatment. Hand Clin. 2017;33:769&#x2013;777. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kodaira S, Nakajima T, Takahashi R, Moriya S, Nakagawa T. A case of intra-articular ganglion cysts of the knee joint?: correlation between arthroscopic and magnetic resonance imaging. BMC Med Imaging [Internet]. 2016;16(36):8&#x2013;11. Available from: http://dx.doi.org/10.1186/s12880-016-0138-8&#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mao Y, Dong Q, Wang Y. Ganglion cysts of the cruciate ligaments?: a series of 31 cases and review of the literature. BMC Musculoskelet Disord [Internet]. 2012;13(137):1&#x2013;4. Available from: BMC Musculoskeletal Disorders&#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Miralles JR, Cisneros LN, Escol&#xE0; A, Fallone JC, Cots M, Espiga X. Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Orthop Traumatol Surg Res [Internet]. 2016;102(6):791&#x2013;794. Available from: http://dx.doi.org/10.1016/j.otsr.2016.05.014&#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Head L, Gencarelli JR, Allen M, Boyd KU. Wrist Ganglion Treatment: Systematic Review and Meta-Analysis. J Hand Surg Am [Internet]. 2015;40(3):546-553.e8. Available from: http://dx.doi.org/10.1016/j.jhsa.2014.12.014&#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Crijns TJ, Bernstein DN, Ring D, Gonzalez RM, Wilbur DM, Hammert WC. Depression and Pain Interference Correlate With Physical Function in Patients Recovering From Hand Surgery. hand. 2019;14(6):830&#x2013;835. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Ting W, Ke W, Chang V, &#xD6;z&#xE7;akar L. Ultrasound facilitates the diagnosis of tarsal tunnel syndrome?: intraneural ganglion cyst of the tibial nerve. J Ultrasound [Internet]. 2019;22(1):95&#x2013;98. Available from: https://doi.org/10.1007/s40477-018-0314-5&#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Everts PAM, Knape JTA, Weibrich G, Sch&#xF6;nberger JPAM, Hoffmann J, Overdevest EP, et al. Platelet-Rich Plasma and Platelet Gel?: A Review. J Am Soc Extra-Corporeal Technol. 2006;38:174&#x2013;187. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Prakasam N, Prabakar MS, Reshma S, Loganathan K, Senguttuvan K. A clinical study of platelet-rich plasma versus conventional dressing in the management of diabetic foot ulcers. Int Surg J. 2018;5(10):3210&#x2013;3216. &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Andia I, Rubio-azpeitia E. Platelet-rich Plasma Modulates the Secretion of Inflammatory / Angiogenic Proteins by Inflamed Tenocytes. Clin Relat Res. 2015;473:1624&#x2013;1634. &#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0; Lacci KM, Dardik A. Platelet-Rich Plasma?: Support for Its Use in wound healing. YALE J Biol Med. 2010;83:1&#x2013;9. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Everts P, Onishi K, Jayaram P, Mautner K. Platelet-Rich Plasma?: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020;21(7794):1&#x2013;36. &#xD;
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17. &#xA0;&#xA0;&#xA0;&#xA0; Guo S, Tao S, Yin W, Qi X, Yuan T, Zhang C. Exosomes derived from platelet-rich plasma promote the re-epithelization of chronic cutaneous wounds via activation of YAP in a diabetic rat model. Theranostics. 2017;7(1):81&#x2013;96. &#xD;
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18. &#xA0;&#xA0;&#xA0;&#xA0; Ma N. Blood-Derived Products for Tissue Repair / Regeneration. Int J Mol Sci. 2019;20(4581):3&#x2013;5. &#xD;
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19. &#xA0;&#xA0;&#xA0;&#xA0; Mariani E. Platelet Concentrates in Musculoskeletal Medicine. Int J Mol Sci. 2020;21(1328):1&#x2013;43. &#xD;
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20. &#xA0;&#xA0;&#xA0;&#xA0; Noh K, Liu XN, Zhuan Z, Yang C. Leukocyte-Poor Platelet-Rich Plasma-Derived Growth Factors Enhance Human Fibroblast Proliferation In Vitro. Orig Artic Clin Orthop Surg. 2018;10(2):240&#x2013;247. &#xD;
&#xD;
21. &#xA0;&#xA0;&#xA0;&#xA0; Prakasam N, Vasudevan A, Prasad G, Bala V. New Age Treatment For An Age-Old Problem &#x2013; PRP For Post - Surgery Non - Healing Venous Ulcers. Eur J Mol Clin Med ISSN. 2020;07(05):185&#x2013;192. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comparative Analysis of Scoring Systems in Upper Gastrointestinal Bleed to Predict Mortality and Rebleed among Patients from South India&#xD;
&#xD;
&#xA0;&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>28</FirstPage><LastPage>32</LastPage><AuthorList><Author>Aradya H V</Author><AuthorLanguage>English</AuthorLanguage><Author> Deepak Suvarna</Author><AuthorLanguage>English</AuthorLanguage><Author> Anurag Lavekar</Author><AuthorLanguage>English</AuthorLanguage><Author> Nandeesh HP</Author><AuthorLanguage>English</AuthorLanguage><Author>  Vijay Kumar T R</Author><AuthorLanguage>English</AuthorLanguage><Author> Anupama C</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>GI Bleed Scoring, Rebleed, Duodenal Ulcer, Mortality</Keywords><Fulltext>Introduction:&#xD;
&#xD;
One of the major gastroenterological emergencies encountered is Upper Gastrointestinal bleeding. It is considered to be one of the most challenging and life-threatening problems which require immediate hospitalization and surgical intervention for the better outcome of the patient. &#xD;
&#xD;
The overall mortality of upper gastrointestinal bleeding ranges from 10 % to 40% among the patients who are more prone to bleeding disorders and with other comorbid illnesses.1&#xD;
&#xD;
&#xA0;The causes of upper gastrointestinal bleeding range from Mallory Weiss tear to large variceal bleeding. The major factors which influence the bleeding are the age of the patients, Comorbid conditions, Haemoglobin, ulcer size, shock, and need for repeated blood transfusion. The increased mortality rate among patients with upper gastrointestinal bleeding is due to rebleeding.2&#xD;
&#xD;
All the patients suffering from Upper gastrointestinal bleed are hospitalized and subjected to endoscopic examination irrespective of type (variceal or nonvariceal), quantity and severity of the bleeding. The endoscopic examination and the treatment of upper gastrointestinal bleeding within 24 hours can reduce mortality significantly.&#xD;
&#xD;
To assess the risk of mortality and other complications related to upper gastrointestinal bleeding various scoring methods have been developed. Few of the scoring system requires the usage of endoscopy findings to conclude the risk and few of the scoring systems doesn&#x2019;t require an endoscopy to arrive at the risk assessment of upper gastrointestinal bleeding.&#xD;
&#xD;
One of the most common risk assessment scores used is Rockall Score3 and Progetto&#xA0;Nazionale&#xA0;Emorragia&#xA0;Digestiva (PNED) 4 which require the findings of endoscopy before calculating the risk score.&#xA0; There are still many scoring systems that are used to assess the risk score using endoscopy, but they are inferior to the Rockall Score and PNED score. The scoring system using endoscopy can cause a delay in arriving or calculating the risk score due to delay in the performing endoscopy in our health care setting .5&#xD;
&#xD;
Hence other scoring systems were developed which don&#x2019;t require the findings of the endoscopy and determine the risk by the pre-endoscopic scores for upper GI Bleeding were &#x2018;admission&#x2019; Rockall Score, Glasgow Blatchford score, and the AIMS65 score. These scoring systems use clinical, hemodynamic, and quickly available laboratory values for Glasgow Blatchford and AIMS65 Scoring. Few studies suggested that these scores could be used to identify patients at very low risk which can be managed in the outpatients. 6,7&#xD;
&#xD;
In our study, we have tried to compare the different scoring methods used in risk assessment of Upper gastrointestinal bleeding.&#xD;
&#xD;
Objective:&#xD;
&#xD;
&#xA0;To compare the Sensitivity, Specificity of the various scoring system in predicting the outcome of upper gastrointestinal bleeding.&#xD;
&#xD;
Materials and Methods:&#xD;
&#xD;
A Prospective study was conducted at JSS Hospital, Mysore, India inMarch 2018. to September 2018. All the patients who were admitted to the department of medical gastroenterology with a history of hematemesis and melena during the study period were included in the study. Patients in whom Upper Gastroendoscopy was not possible were excluded from the study. A detailed history and clinical examination were done. Complete hemogram, Liver Function Test, Renal Function Test, Upper Gastroendoscopy was done for included patients. Statistical analysis was done using SPS 17. Comparison of different scoring systems (Rockall, Blatchford, AIMS 65, T score, and PNED score) was done using a ROC curve in predicting the risk of rebleed and mortality. A correlation test was used to check the association between Mortality and rebleed with Hemoglobin, creatinine, and Total Leucocyte Count. The Ethical Clearance from the University was obtained.&#xD;
&#xD;
Results:&#xD;
&#xD;
A total of 198 Patients who were included in the study were analyzed. The overall mortality rate was 12.6 % (25/198). The rebleed rate was 16.1 % (32 / 198). The mortality rate in patients with rebleed was 40.6 % (13/32).&#xD;
&#xD;
The most common causes of upper Gastro-Intestinal bleeding were ulcers in the duodenum and oesophagus, 39 each (19.6 %). Oesophagal varices were seen in 16.6% of the cases. Gastric Varices (10.6%), Gastric Ulcer (9.5%), Portal Gastropathy (9%), Mallory Weis Tear (4.5%), GRED (4%) were the other common etiologies responsible for the bleeding in the upper gastrointestinal Bleeding ( Table 1).&#xD;
&#xD;
&#xD;
&#xD;
Rebleed and mortality were correlated with the levels of Hemoglobin, Levels of Creatinine, and Total Leucocyte Count.&#xD;
&#xD;
The Hemoglobin and total Leucocyte count was found to be Positively Correlated with both Rebleeding and Mortality among the cases. The Creatinine level was found to be negatively Correlated with mortality among the cases and positively correlated with Rebleed ( Table 2 and 3). &#xD;
&#xD;
&#xD;
&#xD;
The sensitivity was found to be 100 % for Rockall Score, Blatchford Score, AIMS65 Score and PNED Score. T Scoring technique was found to have a lease sensitivity of 33% when compared to other scoring techniques. The specificity was found to be high for the PNED Scoring technique at 51 %, Followed by AIMS65 Scoring at 48 %. The Blatchford Score had a specificity of only 0.7%. The negative Predictive value was 91% for T Score and 100 % for all the remaining scoring Systems. Positive Predictive value was highest for T Score and least for Blatchford Scores (Graph 1).&#xD;
&#xD;
&#xD;
&#xD;
The area under the curve was more for the PNED Score, followed by Rockall Score. It was least for the T Scoring Technique when compared with Mortality Scoring Pattern with the risk scoring. All the scoring systems were found to be statistically Significant for the Mortality risk factor except for Blatchford Score ( Table 4).&#xD;
&#xD;
&#xD;
&#xD;
The sensitivity was found to be 100 % for Rockall Score, Blatchford Score, AIMS65 Score. It was 92% for PNED Score and 28% for the T Scoring technique. The specificity was found to be high for the PNED Scoring technique at 52 %, Followed by AIMS65 Scoring at 47 %. The Blatchford Score had a specificity of only 0.7%. The negative Predictive value was 98% for T Score and 79 % for the T score. The remaining score had a 100% Negative Predictive Value. Positive Predictive value was highest for PNED Score (13%) and AIMS65 Score (6%) (Graph 2).&#xD;
&#xD;
&#xD;
&#xD;
The different risk scoring for rebleeding was found to better with the PNED Score covering more area followed by AIMS65 Score. T score showed the least covered area under the curve. All the Scoring was found to be statistically insignificant except for the PNED Score which was significant. &#xD;
&#xD;
Discussion:&#xD;
&#xD;
Out of the total 198 cases which were analyzed, the common causes of Upper Gastrointestinal Bleeding seen in our study was similar to various studies .8,9&#xD;
&#xD;
In our study, we tried to evaluate a total of 5 different scoring systems that can predict the outcome of upper gastrointestinal bleeding in terms of mortality and rebleeding among the patients. The scoring techniques like AIMS65, Glasgow Blatchford score, and T Score were the scores that didn&#x2019;t require emergency endoscopy to determine the outcome. Rockall and PNED Risk scoring required the findings of the endoscopy to arrive at any conclusion.&#xD;
&#xD;
Of all these scoring systems it is the AIMS65 Score that can determine the outcomes of the Patients without considering the comorbid conditions which are suffered by the patients. Few of the researcher evaluated the GBS scoring without considering the endoscopic findings or the comorbid conditions and its termed as Clinical Rockall Score .3,4,7,8&#xD;
&#xD;
In our study, we could conclude that the usage of Blatchford Score and AIMS 65 both were equally useful (Sensitivity 100%) in determining the mortality than T Scoring System among those patients in whom it was not able to perform endoscopy within 24 hours. in the studies done by various authors .10,11,12. The limitation of the AIMS65 Scoring was the low Positive Predictive value (10%) which means a significant number of low-risk patients with upper GI Bleeding will be missed.&#xD;
&#xD;
Many of the research studies reported that Rockall Score, Blatchford, AIMS 65 Score, and PNED Score were found similar to the predicting mortality which was comparable to other studies .13,14,15&#xD;
&#xD;
In the study done by Tammaro L et al.16, the T-score was found to use in the triage patients who are likely to have high-risk endoscopic stigmata and therefore need intervention. The conditions like rebleeding, to predict the high-risk endoscopic stigmata and mortality was found to be similar to GBS. The findings of our study were contradictory to our study findings where T score was found to have the least sensitivity among all the scores in predicting mortality.&#xD;
&#xD;
According to Tammaro and collaborators,17 a T-score of &#x2264; 6 was able to predict the presence of high-risk endoscopic stigmata. The Specificity was 96% and the Positive Predictive value was 74.5% in predicting the need for an early endoscopy. He also recommended the use of non-endoscopic scoring Rockall and GBS score in acute GI Bleeding.&#xD;
&#xD;
&#xA0;The major aspect of the risk scoring assessment for the upper gastrointestinal is the timing of the endoscopy. The timing of the endoscopy determines which risk scoring assessment is better in predicting the outcome of mortality or rebleeding among the patients.&#xD;
&#xD;
Bhakurun suggested that endoscopy is always beneficial in reducing mortality and improving the outcome is performed within 24 hours from the admission.&#xA0; Though Endoscopy is not associated with the reduction of mortality or rebleeding it will help increase the efficiency of the care of high-risk patients and reducing the duration of hospital stay. These benefits of performing endoscopy give an added advantage of the risk scores which uses endoscopy when compared to risk score without endoscopy.18&#xD;
&#xD;
Conclusion:&#xD;
&#xD;
Duodenal and oesophageal ulcers are the most common causes of Upper GI bleed in this study. Rockall score, PNED, Blatchford Glasgow score, and AIMS 65 have very good sensitivity, specificity, and negative predictive value for rebleed and mortality. However, their positive predictive value for rebleed and mortality is a limiting factor.&#xD;
&#xD;
Acknowledgment: 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 Intrest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xD;
&#xD;
Authors contribution:&#xD;
&#xD;
Aradia H V: Planning and Data Collection of the study, Analysis of the results, Manuscript Writing and Literature Review &#xD;
&#xD;
&#xA0;Deepak Suvarna: Manuscript Writing and Literature Review &#xD;
&#xD;
&#xA0;Anurag Lavekar: Data Collection of the study&#xD;
&#xD;
&#xA0;Nandeesh HP : Review of the Article and Manuscript Writing&#xD;
&#xD;
&#xA0;Vijay &#x200E;Kumar T R: Analysis of the study, Data Collection of the study&#xD;
&#xD;
&#xA0;Anupama C: Analysis of the study, Literature Review&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3861</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3861</Fulltext></URLs><References>&#xD;
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	Marmo R, Koch M, Cipolletta L, Italian registry on upper gastrointestinal bleeding (Progetto Nazionale Emorragie Digestive-- PNED 2). Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED Score and Prospective Comparison with the Rockall Score. Am J Gastroenterol. 2010; 105(6):1284-91.&#xD;
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	Hyett BH, Abougergi MS, Charpentier JP. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc. 2013; 77(4):551-7. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>The Role of Phytoconstituents in the Development of Newer Drug Compounds&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>33</FirstPage><LastPage>38</LastPage><AuthorList><Author>Gakhar A</Author><AuthorLanguage>English</AuthorLanguage><Author> Singla N</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Natural products have been used in clinical therapeutics since time immemorial. It has been estimated that 56% of the lead compounds for medicines in the British National Formulary are natural products or are derived from natural products. Materials: Despite the achievements of synthetic chemistry and the advances towards rational drugs design, 50 important natural products are described which continue to be essential in providing medicinal compounds and as starting points for the development of synthetic analogues. Result: This article describes the phytoconstituents which are being used as lead compounds for the design, synthesis and development of Novel Drug Compounds. Conclusion: Despite the achievements of synthetic chemistry and the advances towards rational drugs design, natural products will continue to be important in three areas of drug discovery: they can be used as a target for production by biotechnology, as a source of new lead compounds of the novel chemical structure and as active ingredients for useful treatments following the traditional system of medicines. Moreover, along with biologically active primary plant metabolites, secondary compounds also serve additionally as chemical models or templates for the design and total synthesis of new drug entities.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Natural products, Lead compounds, Therapeutics, Medicinal compounds, Phytoconstituents</Keywords><Fulltext>&#xD;
Introduction&#xD;
&#xD;
Naturalproductshavebeenamajorsourceofdrugsforcenturies.1Withmorethan25%of the pharmaceuticals in use today are derived from natural products. Pharmaceutical scientists are experiencing difficulty in identifying new lead structure, templates and scaffold in the finite world of chemical diversity. Although interest in natural products as a source of new biologically active compounds have decreased in the last few decades as synthetic&#xD;
&#xD;
chemistry programs have expanded1. But numbers of synthetic drugs have adverse and unacceptable side effects. Natural Products Still Continue to form a significant proportion of drugs in current use. It has been estimated that 56% of the lead compounds for medicines in the British National Formulary are natural products or are derived from&#xA0;natural products.2 Of the top 20 best-selling pharmaceutical products in 1990, four were derived from natural products (amoxicillin, cefaclor, ceftriaxone, and lovastatin) and two others (captopril and enalapril) resulted from leads provided by a natural product.3 In 1991, 42 new agents were introduced to medical practice; of these, 16 were natural products or were derived from the natural product. Similarly, there were 43 new chemical&#xA0;entities introduced in 1992, and 18 were natural products or their derivatives.4 This article summarizes the natural products that have been used as lead compounds for the design,&#xA0;synthesis and development of Novel Drug Compounds.&#xD;
&#xD;
Natural products in drug discovery&#xD;
&#xD;
Plant products are useful as starting materials for the semi-synthetic preparation of other drugs. The main examples are plant steroids for the manufacture of oral contraceptives&#xA0;and other steroidal hormones. Diosgenin from several species of yams (Dioscorea deltoidea) and echogenic from sisal leaves (Agave sisalana) are the main compounds used.5 There has been an impressive success with botanical medicine, most notably&#xA0;quing-has and artemisinin from Chinese medicine.6 Considerable research in pharmacognosy, chemistry, pharmacology and clinical therapeutics has been carried out on ayurvedic medicinal plants.7 Natural compounds of pharmaceutical importance that&#xA0;were once obtained from higher plant sources, but which are now produced commercially largely by synthesis, include caffeine, theophylline, theobromine, ephedrine, pseudoephedrine, emetine, papaverine, L-&#xA0;dopa, salicylic acid and A-tetrahydrocananbinol.9 Biologically active plant-derived metabolites have found direct medicinal application as drug entities. Bioactive plant compounds have proven useful as &amp;#39;leads&amp;#39; or model compounds for drug synthesis or semisynthesis. For eg. Beta-carotene, a plant primary metabolite that is useful in the prevention and/or treatment of certain cancers is currently produced synthetically on a commercial scale8. Despite that numerous examples of economically synthesizable natural product (Table no. 1), it is frequently forgotten that plant secondary compound can, and often do serve additionally as chemical models or templates for the design and&#xA0;total synthesis of new drug entities.24,25 For example, atropine for tropicamide, quinine for chloroquine,&#xA0; cocaine for procaine and tetracaine, opium alkaloids for codeine and morphine have served as models for the design and synthesis of anticholinergic, antimalarial drugs.2, 8 Similarly, the study of the synthetic analogue of khellin, a Furano chrome derived from the fruits of Ammi visnaga(L.) Lam. is formally marketed in the United States as a bronchodilator and a coronary medication that led to the preparation and development of disodium cromolyn, also known as cromolyn sodium. Cromolyn is now a major drug used as a bronchodilator and for its antiallergenic property. Related synthetic studies based on the benzofur and moiety eventually led to the development of amiodarone, which was originally introduced in Europe as a coronary vasodilator of angina, but which was subsequently found to have a more useful application in the treatment of the specific type of arrhythmias, the wolf-Parkinson syndrome, and for arrhythmias resistant to other drugs.9&#xD;
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In still another example, the guanidine type alkaloids, galegins, the active principle of goat&amp;#39;s rue (Galega officinalis L.), were used clinically for the treatment of diabetics. It had been known for some times previous to this discovery that guanidine itself had anti-diabetic properties, but was too toxic for human use. After hundreds of synthetic compounds were prepared, metformin, a close relative to galegin was developed and&#xA0;marketed as a useful antidiabetic drug.10 Despite the achievements of synthetic chemistry and the advances towards rational drugs design, natural products continue to be essential in providing medicinal compounds and as starting points for the development of synthetic analogues. Plant-derived drug thus represent stable markets upon which both physicians and patients rely. In addition, worldwide markets in plant-derived drugs are difficult to estimate, but undoubtedly amount to many additional billions of dollars.11,12,13&#xD;
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Plants continue to be an Important Source of Drugs, as the recent approval in the United States, of several new plant-derived drugs, and semi-synthetic and synthetic drugs based on plant secondary compounds. For example taxol (paclitaxel), an anticancer taxane diterpenoid derived from the relatively scarce Pacific or western yew tree, Taxus brevifolia Nutt., was approved in the United States for the treatment of refractory ovarian cancer12. Etoposide is a relatively new semisynthetic antineoplastic agent based on podophyllotoxin, a constituent of the mayapple (also known as American mandrake), Podophyllum peltatum.17,18,19 which is useful in the chemotherapeutic treatment of refractory testicular carcinoma, small cell lung carcinoma, non-lymphatic leukaemia, and non-&#xD;
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Hodgkin&amp;#39;s lymphoma.13 Atracurium besylate is a relatively new synthetic relaxant, which is structurally and pharmacologically related to the curare alkaloids. In addition, synthetic A9-tetrahydrocannabinol(originally derived from the marijuana plant, Cannabis sativa L.) and some of its synthetic analogues (e.g., nabilone) has recently been approved in the&#xA0;The U.S.&#xA0;&#xA0; &#xA0;for treatment of nausea associated with cancer chemotherapy.15,16&#xD;
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Cannabinoidsarealsobeingdevelopedfortheuseinglaucomaand in neurological disorders (e.g. epilepsy and dystonia), and as antihypertensives (cardiovascular agents), antiasthmatics(bronchodilator), and potentanalgesics.3, 20-24&#xD;
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Plant-derived drugs which are currently undergoing development and testing include the Chinese drug artemisinin(qinghaosu) and several of its derivatives, which are newly, discovered rapidly acting antimalarial agents derived from Artemisia annua and forskolin, a naturally occurring labdane diterpene with antihypertensive, positive&#xA0;inotropic, and adenylyl cyclase-activating properties. Forskolin is derived from the root&#xA0;of Coleus forskohlii plant used in East Indian folk medicine and cited in ancient Hindu and Ayruvedictexts6,10.Inadditiontothecompoundsmentionedabove, several other bioactive plant secondary metabolites are being investigated for their potential utility. 25,26 For example, the medicinally active organosulphur compounds of garlic and onion are being investigated and evaluated as potentially useful cardiovascular agents and ellagic acid, Beta-carotene, and vitamin (tocopherol) are being tested and evaluated for there possible utility as prototype anti-mutagenic and cancer prevention agents.12,14&#xD;
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Conclusion: &#xD;
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Experimentalagentsfromnaturalproductsareofferingusagreat the opportunity to evaluate new chemical classes of medicinal agents, as well as novel and potentially relevant mechanisms of action. Despite the achievements of synthetic chemistry and the advances towards rational drugs design, natural products will continue to be important in three areas of drug discovery: they can be used as a target for production by biotechnology, as a source of new lead compounds of the novel chemical structure and as active ingredients for useful treatments following the traditional system of medicines. Moreover, along with biologically active primary plant metabolites, secondary compounds also serve additionally as chemical models or templates for the design and total synthesis of new drug entities.&#xD;
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Conflict of Interest : None&#xD;
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Source Of Funding: None&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3862</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3862</Fulltext></URLs><References>&#xD;
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	Farnsworth NR, Akerele O, Bingel AS, Soejarto DD, Guo Z. Medicinal plants in therapy. Bull World Health Organ. 1985, 63:965-981.&#xD;
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	Sumantran VN. Experimental approaches for studying uptake and action of herbal medicines. Phytoth Res. 2007; 21: 210.&#xD;
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	Hobden AN and Harris TJ, The impact of biotechnology and molecular biology on the pharmaceutical industry. Soc Edinburgh Sect B. 1992; 99:37.&#xD;
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	Davis J, New chemical entities disappoint in 1992, Scrip review 1992.PJB publications.1993; 21:20-21.&#xD;
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	Rollinger JM. Strategiesforefficientleadstructurediscovery from natural products, Curr Med Chem. 2006;13: 1491.&#xD;
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	Jan P, Coelmont L, Vliegen I, Hemel JV.Heminpotentiates the anti-hepatitis C virus activity of the antimalarial drug artemisinin, Biochem Biophy Res Comm. 2006;348:139-144.&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0;7 John AP, Healing plant of peninsular India, CABI Publishing, 2001, 217.&#xD;
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	Foye WO, Principles of Medicinal Chemistry, Lea and Febiger: Philadelphia, PA, 3rdEd, 1989,64.&#xD;
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	Dahanukar SA, Kulkarni RA and Rege NN. Pharmacology of medicinal plants and natural products. Ind J Pharmac. 2000;37: 231.&#xD;
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	Sneader W, Drug Discovery: The Evolution of Modern Medicines, John Wiley and Sons: Chichester. 1985;12:165.&#xD;
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	Mukherjee P. Quality control of herbal drugs, Horizons publishers, Istedition, 2002, 35.&#xD;
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	Tabata H. Paclitaxel production by plant cell culture technology, Adv Biochem Engg Biotech. 2004; 87,1-23.&#xD;
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	Ariga T and Seki T, Antithrombotic and anticancer effects of garlic derived sulphur compounds. Biofactors. 2006, 26,93-103.&#xD;
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	Griebenow R, Pittrow DB, Weidinger G and Mutschler E, Antihypertensive efficacy and tolerability of low-dose reserpine/thiazide combination compared anace-&#xA0;inhibitor in first-line treatment. Am J Hypert. 1996; 9: 119.&#xD;
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	Kunio S, Isolation and characterization of angiotensin I-converting enzyme inhibitor dipeptides derived from Allium sativum L (garlic). J &#xA0;Nutrit Biochem. 2017;9: 415-419.&#xD;
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	Lindsay B, Erland E and Richard T, Digitalis structure-activity relationship analysis&#xA0;:Conclusions from indirect binding studies with cardiac (Na+ + K+)-ATPase. Biochem Pharmac.1983; 32: 2767-2774.&#xD;
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	Sumitra M, Manikandan P, Kumar DA, Balakrishnan K, Manohar BM and Puvana Krishnan R, Experimental myocardial Necrosis in Rats &#x2013; Role of ArjunolicAcid on Platelet aggregation, coagulation and Antioxidant status. J Molec Cell Biochem. 2001; 224:135-142.&#xD;
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	GiuffreG,CaputoGandPelusoF,Plateletrichplasmatreatmentandheomatasisinpatients with hemorrhagic risk. Minerva Stomatol. 2006; 55:599-609.&#xD;
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	Duxbury BM and Poller L, The oral anticoagulant saga: past, present, and future, Clin Appl ThrombHemost. 2001; 7,269-75.&#xD;
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	Misso S, The Theobromine class of diuretics. The Lancet. 1907; 169:602-603.&#xD;
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	Lachkar Y and Bouassida W, Drug induced acute angle glaucoma, Curr Opin Ophthalmol. 2007; 18:129-33&#xD;
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	Ishida N, Odani-Kawabata N, Shimazaki A and Hara H, Prostanoids in treatment of glaucoma. Cardiovasc Drug Rev. 2006; 24:1-10.&#xD;
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	&#xA0; Noedl H, Krud Sood S, Laowattana W. In Vitro Antimalarial Activity Of Azithromycin,artesunate, and quinine in combination and correlation with clinical outcome. Antimicrob Agents Chemother. 2007; 51: 651-6.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comparative Study of the Functional Outcome of Patellar Tendon Splitting and Medial Parapatellar Approaches in Intramedullary Interlocking Nailing of Tibia&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>39</FirstPage><LastPage>44</LastPage><AuthorList><Author>Sandesh V</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagakumar JS</Author><AuthorLanguage>English</AuthorLanguage><Author> Sandesh Agarwal</Author><AuthorLanguage>English</AuthorLanguage><Author> B.S. Sheik Nazeer</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Medial parapatellar, Trans patellar, Intramedullary interlocking, Tendon splitting, Nailing of the tibia</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
The tibia is exposed to frequent injury, thereby being the most commonly fractured long bone. Because one-third of the tibial surface is subcutaneous all through its &#x201C;length&#x201D; and it also has a precarious blood supply than other bones, which are enclosed by bulky muscles.1&#xD;
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Tibial shaft fractures are the most common fractures encountered among young aged people.2 Fractures of the tibia are amid the most popular &#x201C;long bone fractures&#x201D; because of their potential for nonunion, malunion and propensity for their open injury.2 For the treatment of diaphyseal tibial fractures, tibial nailing has become the standard care as intramedullary nail acts as an internal splint.1&#xD;
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The intramedullary nail is used to treat diaphyseal fractures of the tibia commonly. The infrapatellar approach is the most commonly used. Hyperflexion of the knee during the procedure may however increase the risk of valgus and procurator deformities in proximal third tibial shaft fractures. To address this problem, a semi- extended technique has been developed,3 of which also a subcutaneous variant exists.4 For the same reasons, the suprapatellar approach has been introduced.5,6 For this approach, an incision is made just proximal to the superior pole of the patella and the nail is inserted through the patellofemoral joint. Few clinical studies have suggested favourable outcomes associated with a suprapatellar approach.5,6,7&#xD;
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The potential damage to the cartilage of the patellofemoral joint remains a significant drawback, although rates of anterior knee pain following this procedure seem lower than seen after the infrapatellar approach.6,7 Infra patellar approaches have gained more importance due to the drawbacks of the suprapatellar approach. Even though all nail insertion techniques have been proven feasible, a contrast of the rates of pain in the anterior part of the knee and functional outcome is lacking. The present study aimed to analyze functional outcome in both the approaches and prevalence of fracture malalignment and study the incidence of anterior knee pain in both approaches, according to Waters and Bentley scoring.&#xD;
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MATERIAL AND METHODS: &#xD;
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This study was a prospective comparative study conducted in the department of orthopaedics at R.L.J. Hospital and research centre, attached to Sri Devaraj Urs Medical College, Tamaka, Kolar. The sample size was estimated based on the functional outcome between the medial parapatellar approach versus the patellar tendon splitting approach. A study by Sadeghpour et al.8 observed a difference of 30% in the functional outcome of excellent, expecting a 40% difference in excellent functional outcome between the methods in the present study with a 95% confidence interval with the power of 80%. The required sample size per group was 30. So, the final sample size was 60. The data collection for the study was done between September 2018 to June 2020. The study population included patients age more than 18 years, closed tibia shaft fracture, Open type I, II tibial diaphyseal fracture, Segmental tibial fractures. Exclusion criteria included Pathological fractures, Tibial shaft fractures with intraarticular extension, previous history of knee surgery, knee osteoarthritis. The study was approved by the institutional human ethics committee. Informed written consent was obtained from all the study participants, and only those participants willing to sign the informed consent were included in our study. &#xD;
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Methodology: &#xD;
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A sample of size 60 was selected using the purposive sampling technique based on inclusion and exclusion criteria. Patients were randomized into two groups with odd and even. Group A was undergoing a medial parapatellar approach (30 patients). Group B was undergoing a patellar tendon splitting approach (30 patients). All patients were evaluated by detailed history about the trauma, mode of injury and detailed clinical examination. Pre-Op Evaluation: The fractures were classified by the method of AO classification and GUSTILO ANDERSON classification for open fractures. Post Op Pain Evaluation: It is based on Waters and Bentley scoring.The clinical anterior knee pain rating system described by Waters and Bentley. The patient is called for periodic follow up on day 1, day 7, 1 month and 6months. Routine Investigations for Surgical Procedure were carried out. The radiological investigation included an X-ray of the leg with knee and ankle &#x2013; AP and lateral view. Blood Investigations: CBC, BT, CT, Blood grouping, Renal function tests, Liver function tests (if required), RBS, FBS/PPBS, HbA1C (If required), HIV, HBsAg, serum electrolytes.&#xD;
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Statistical Methods:&#xD;
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Anterior knee pain and range of movements were assessed on 1st day, one week, one month, six months and was considered as primary outcome variables. Age, gender, mode of injury, etc., were considered as other study relevant variables. Study Group (Sparring v/s Splitting) was considered as an explanatory variable. Shapiro wilk test p-value of &gt;0.05 was considered as a normal distribution. For normally distributed Quantitative parameters, the mean values were compared between study groups using an independent sample t-test (2 groups). Categorical outcomes were compared between study groups using the Chi-square test. Data was also represented using clustered bar charts and error bar chart. P-value &lt; 0.05 was considered statistically significant. IBM SPSS version 22 was used for statistical analysis.9&#xD;
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Results: &#xD;
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A total of 60 participants were included in the final analysis with 30 participants in the sparring and splitting group.&#xD;
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The difference in baseline parameters like age and gender and clinical parameters like mode of injury, side of injury, type of injury and time in the union between the study group was not statistically significant (P Value&gt;0.05). (Table 1)&#xD;
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The difference in the proportion of anterior knee pain at 1st day,&#xA0; one week, one month and six months between the study group were statistically significant (P Value0.05). This is following the study of Vijay Baba et al.19&#xD;
&#xD;
Type of injury: The exposed anatomical location of the tibia makes it vulnerable to direct blow and high energy trauma as a result of motor vehicle accidents thus resulting in comminuted fractures, which are frequently open with significant loss of skin and soft tissues. In contrast to the rest of the&#x201D; appendicular skeleton, tibia has precarious blood supply due to inadequate muscular envelope&#x201D;. When the type of injury was compared between the study group in the sparring group, the majority had open than closed injury, while the reverse was true in the splitting group, though the difference in the proportion of the type of injury between groups was not statistically significant. This is in comparison with the study of Sadeghpour et al17, and Bakshet al.15 In these studies, the closed injuries superseded the open injuries, though not statistically significant. Attention must be paid to the soft tissue. Because the bone is subcutaneous, a closed fracture can easily become an open fracture, as the bone spikes through the skin. In addition, bleeding or swelling in the soft tissues can increase the interstitial pressure and block blood flow, leading to ischemic necrosis of muscle or nerve, i.e., compartment syndrome.&#xD;
&#xD;
Anterior knee pain incidence: In the Tibial fracture treatments, anterior knee pain is the most commonly reported complication with an incidence of about 18%-86%. The cause of this pain is multifactorial like tibial plateau width, fracture type, nail prominence, fracture union, sociodemographic, time after surgery, infrapatellar fat lesion, entry point location and intra articular structure injury, location and size of the scar.11 Iatrogenic injuries to the infrapatellar branch of the saphenous nerve are also believed to be the cause of anterior knee pain.12 The nail designs may also have been implicated in injuring the proximal tibiofibular joint and cause knee pain.20On Comparison of anterior knee pain at different periods between study group the severity of the pain reduced with the time in both the groups. However, the sparring group showed less severity to the pain than the splitting group. This shows a better efficacy of the sparring procedure than the splitting method. The difference in the proportion of anterior knee pain at 1st day, 1st week, one month and six months between the study group was statistically significant (P Value</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3863</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3863</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Toivanen JAK, V&#xE4;ist&#xF6; O, Kannus P, Latvala K, Honkonen SE, J&#xE4;rvinen MJ. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A&#xA0; prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am. 2002 Apr;84(4):580&#x2013;5. &#xD;
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2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Anubhav R, Rajan A. Comparision of transpatellar and medial parapatellar tendon approach in tibial intramedullary nailing for the treatment of fracture shaft of the tibia. Open J Orthop Rheumatol. 2020 Jan 28;5(1):001&#x2013;5. &#xD;
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3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Kubiak EN, Widmer BJ, Horwitz DS. Extra-articular technique for semi extended tibial nailing. J Orthop Trauma. 2010 Nov;24(11):704&#x2013;8. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Leliveld MS, Verhofstad MHJ, Bodegraven E Van, Haaren J Van, Lieshout EMM Van. Anterior knee pain and functional outcome following different surgical techniques for tibial nailing?: a systematic review. Eur J Trauma Emerg Surg. 2020;(0123456789). &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Jones M, Parry M, Whitehouse M, Mitchell S. Radiologic outcome and patient-reported function after intramedullary nailing: a&#xA0; comparison of the retropatellar and infrapatellar approach. J Orthop Trauma. 2014 May;28(5):256&#x2013;62. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended intramedullary nailing of the tibia using a suprapatellar approach:&#xA0; radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma. 2014 May;28(5):245&#x2013;55. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Chan DS, Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, et al. Suprapatellar Versus Infrapatellar Tibial Nail Insertion: A Prospective Randomized&#xA0; Control Pilot Study. J Orthop Trauma. 2016 Mar;30(3):130&#x2013;4. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sadeghpour A, Mansour R, Aghdam HA, Goldust M. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for the treatment of tibial fractures. J Pak Med Assoc. 2011 Jun;61(6):530&#x2013;3. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Gaines RJ, Rockwood J, Garland J, Ellingson C, Demaio M. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopaedics. 2013 Sep;36(9):e1155-8. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Jankovic A, Korac Z, Bozic N-B, Schedule I. Influence of knee flexion and atraumatic mobilisation of the infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing. Injury. 2013 Sep;44 Suppl 3:S33-9. &#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Leliveld MS, Verhofstad MHJ. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012 Jun;43(6):779&#x2013;83. &#xD;
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13. &#xA0;&#xA0;&#xA0;&#xA0; Bong MR, Koval KJ, Egol KA. The history of intramedullary nailing. Bull NYU Hosp Jt Dis. 2006;64(3&#x2013;4):94&#x2013;7. &#xD;
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14. &#xA0;&#xA0;&#xA0;&#xA0; Ahmad S, Ahmed A, Khan L, Javed S, Ahmed N, Aziz A. Comparative Analysis Of Anterior Knee Pain In Transpatellar And Medial Parapatellar&#xA0; Tendon Approaches In Tibial Interlocking Nailing. J Ayub Med Coll Abbottabad. 2016;28(4):694&#x2013;7. &#xD;
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15. &#xA0;&#xA0;&#xA0;&#xA0; Bakhsh WR, Cherney SM, McAndrew CM, Ricci WM, Gardner MJ. Surgical approaches to intramedullary nailing of the tibia: Comparative analysis of knee pain and functional outcomes. Injury. 2016;47(4):958&#x2013;61. &#xD;
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16. &#xA0;&#xA0;&#xA0;&#xA0; Song SY, Chang HG, Byun JC, Kim TY. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthop Trauma. 2012;26(3):172&#x2013;7. &#xD;
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17. &#xA0;&#xA0;&#xA0;&#xA0; Sadeghpour A, Mansour R, Aghdam HA, Goldust M. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for the treatment of tibial fractures. J Pak Med Assoc. 2011;61(6):530&#x2013;3. &#xD;
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18. &#xA0;&#xA0;&#xA0;&#xA0; Shanmuganathan DK, Sounderrajan DD. Evaluation of clinical and functional outcome of internal fixation with intramedullary interlocking nailing with &#x2018;Poller&#x2019; blocking screws in tibial metaphyseal fractures. Int J Orthop Sci. 2020;6(1):573&#x2013;7. &#xD;
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19. &#xA0;&#xA0;&#xA0;&#xA0; N VB, Arumugam B. Interlocked Intramedullary Nailing in the Management of Closed Diaphyseal Fractures of Tibia- A Prospective Analysis. Int J Cont Med Res. 2016;3(7):1987&#x2013;91. &#xD;
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20. &#xA0;&#xA0;&#xA0;&#xA0; Laidlaw MS, Ehmer N, Matityahu A. Proximal tibiofibular joint pain after insertion of a tibial intramedullary nail:&#xA0; two case reports with accompanying computed tomography and cadaveric studies. J Orthop Trauma. 2010 Jun;24(6):e58-64. &#xD;
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21. &#xA0;&#xA0;&#xA0;&#xA0; O&#x2019;Dwyer A, Chakravarty RD ECI nailing technique and its effect on union rates of tibial shaft fracture. Injury. 1994 Sep;25(7):461-4.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Synthesis, Characterization, In-Vitro Antimicrobial Evaluation and Molecular Docking Studies of Aromatic Aldehydes Substituted Thiosemicarbazide Quinoxaline Derivatives&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>45</FirstPage><LastPage>55</LastPage><AuthorList><Author>Bipin Bihari</Author><AuthorLanguage>English</AuthorLanguage><Author> Girendra Kumar Gautam</Author><AuthorLanguage>English</AuthorLanguage><Author> Akash Ved</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: In the present research work a series of novel quinoxaline thiosemicarbazide derivatives were synthesized by substitution of some aromatic aldehydes and their antimicrobial evaluation against various microbial strains with molecular docking studies. Methods: Lead molecule (1E, 4E)-1-(7-chloro-3-isopropyl quinoxaline-2(1H)-ylidene) thiosemicarbazide was synthesized and condensed with various aromatic aldehydes to synthesize derivatives. All derivatives (Va-Vf) were characterized by IR., NMR &amp; Mass spectroscopy. The synthesized derivatives were evaluated in vitro for antibacterial and antifungal activities using the agar dilution method. Molecular docking studies of the derivatives were performed against E.coli DNA gyrase B and topoisomerase IV to find out essential binding sites against target protein PDB: 1AJ6 and 1S14 respectively. Results: Compounds Vb, Vc, Ve&amp;Vf exhibited potent antibacterial and antifungal activity. Compounds, Vb and Vc were found to exhibit more potent activity against Gram &#x2013;Ve, bacterial strains at MIC 0.19 &#xB5;g/ml whereas compound Ve and Vf showed potent activity against Gram +Ve bacterial strains and fungal strains at MIC 0.19 &#xB5;g/ml and 0.78 &#xB5;g/ml respectively. The docking studies revealed that all the compounds exhibit extensive binding to the active pockets of E.coli DNA gyrase B and topoisomerase IV. The compound Vb and Ve exhibit interactive binding energy -8.0 and -8.3 Kcal/mole to the active pocket site of E.coli DNA gyrase and -8.2 and 7.9 Kcal/mole to the active pocket site of topoisomerase IV respectively. Conclusion: In terms of SAR study, it was revealed that the activity profile against microbial strains was altered with electronic effects like electron-withdrawing or donating substitutions in aromatic aldehydes substituted quinoxaline thiosemicarbazide derivatives.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Antimicrobial, Aromatic aldehydes, E.coli DNA gyrase B, E.coli Topoisomerase IV, Quinoxaline, Thiosemicarbazide</Keywords><Fulltext>INTRODUCTION: &#xD;
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Struggling for the development of an antimicrobial drug is a vital global issue due to the rapid development of resistance to currently used antimicrobial drugs, the emergence of new microbial infections and the existence of chronic microbial infections.1Bacteria may obtain resistance through a variety of mechanisms such as by spontaneous mutations or acquisition of genetic material from other resistant organisms or modifying binding sites or production of enzymes that inactivate antimicrobial agents or altering in outer membrane protein channel that the drugs require for cell entry.2&#xD;
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Quinoxaline and its derivatives are important nitrogen-containing benzo-hetero cyclic compounds.3 Substituted quinoxaline derivatives are extensively employed in the building blocks of various pharmacologically active compounds. They exhibit a broad range of pharmacological activities such as antibacterial4,5,6 antifungal7,8, antitubercular9, antimalarial 10,11, antileishmanial12, anticancer13,14 and antidepressant15,16. Also, quinoxaline derivatives reported for antioxidant17, antimycobacterial18, antithrombotic19 and topoisomerase inhibition activity.20&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Over the past few decades, an immense interest of researchers has been focused on thiosemicarbazide pharmacophore due to their wide range of synthetic and analytical applications and pharmacological activities21,22. Thiosemicarbazide derivatives were synthesized and studied for various pharmacological activities such as antiviral23,24, anticancer 25, antitumor26,27, antiamoebic28,29, antiproliferative30, antidiabetic[31], anti-HIV32, anti-tubercular activities33. Recently, many thiosemicarbazide derivatives were synthesized and studied for their antibacterial and antifungal activity.34,35,36,37&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; DNA gyrase and topoisomerase IV are essential enzymes that display crucial roles in biological processes of bacterial growth such as replication, transcription, recombination repair and chromatin remodeling.38,39Nitrogen containing heterocyclic may be potential antibacterial drugs that inhibit bacterial topoisomerases40such as triazoles41, quinolones42, oxazolopyridines, amino pyrazinamides and pyrazole.43In continuation of our search, it was found that certain thiosemicarbazide derivatives evaluated as inhibitors of DNA gyrase and topoisomerase II of S. aureus&#xA0;and&#xA0;E. coli.44,45&#xD;
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Based on the aforementioned facts, we decided to synthesize some novel quinoxaline hybrid thiosemicarbazide derivatives incorporated with different aromatic aldehydes through imine linkage in the thiosemicarbazide nucleus. All the synthesized compounds were screened in vitro for antibacterial and antifungal activities against various strains. In addition, to understand the mechanism of action and binding activity, molecular docking studies were performed against two kinases, E. coli DNA gyrase B and E. coli topoisomerase IV against target protein PDB: 1AJ6 and 1S14 respectively46,47. Computational studies were performed to analyze binding and orientation patterns of the ligands with amino acids against target protein (PDB: 1AJ6 and 1S14)&#xD;
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&#xA0;EXPERIMENTAL&#xD;
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Materials and methods&#xD;
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All the reagents and the solvents used in the research work were of synthetic reagent grade and obtained from Qualigens Ltd. (Fisher Scientific), Ranbaxy, and Fine Chemicals Ltd. India. Muller-Hinton and Sabouraud dextrose agar were obtained from Hi-Media Ltd. India. The bacterial and fungal strains were provided by the Department of Biotechnology of Saroj Institute of Technology &amp; Management, Lucknow, India.&#xD;
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The Progress of reactions and purity of derivatives were monitored by ascending thin layer chromatography on precoated silica gel-G sheets (E. Merck and Co.).Column chromatography was performed over silica gel (60-120 Mesh) obtained from QualigensTM(India). The percentage of yield, Rf values, melting points, and spectral analysis are given for various purified compounds. Yields are presented for crude products. Log P values for synthesized compounds were calculated by using Chem Draw Ultra 10.0.&#xD;
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Melting points were determined by using the Digital Elico melting point apparatus. Infra-red spectra were measured on a Perkin-Elmer FT-IR RXI Spectrophotometer. 1HNMR spectra were reported on a Bruker DPX-300 Spectrometer (300 MHz) using DMSO-D6 as a solvent and tetramethylsilane (TMS) as an internal reference standard. Electron Spinning Ionization Mass spectra (ESI-MS) were obtained on the JEOL SX 102 spectrometer. Elemental analysis was determined on an Elemental Vario EL-III elemental analyzer. The structure of molecules was confirmed based on spectral data.&#xD;
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A series of aromatic aldehydes substituted (1E, 4E)-1-(7-chloro-3-isopropyl quinoxaline-2(1H)-ylidene) thiosemicarbazide derivatives were synthesized according to the respective scheme (Figure 1).&#xD;
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Synthesis of 7-Chloro-3-isopropyl-1H-quinoxaline-2-one(III):&#xD;
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4-Chlorobenzene-1, 2-diamine (I) (21.3 g, 0.15 M) was dissolved in n-butanol (300 ml) and warmed. Ethyl dimethyl pyruvate (II) (21.6 g, 0.15 M) was solubilized separately in n-butanol (150 ml) and added to the former solution with constant stirring. The reaction mixture was refluxed for about 1 hour 30 minutes on the water bath. The reaction mixture was allowed to cool, obtained crystals, which were allowed for filtration, washed and purified by recrystallization from ethanol to obtain the white crystals of 7-chloro-3-isopropyl-1H-quinoxaline-2-one (III). The completion of the reaction and purity of the compound was checked by a single spot TLC.&#xD;
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Yield: 89.5%; m.p.225-228oC; Mol. Formula:C11H11ClN2O; Mol. Wt:222.67; IR (KBr, cm-1): 3465 (NH str.), 3102(C-H sp2 str.), 1659(C=N str.), 1605(C=C aromatic str.), 1372(CH (CH3)2str.). 1042(C-Cl str.), 1690(C=O str.); 1H- NMR(300 MHz, DMSO-d6) &#x3B4;(ppm): 10.15(S, 1H, NH), 8.06(S, 1H, Ar. H), 7.25 -7.28(d, 1H, Ar. H), 6.97-7.05(d, 1H, Ar.&#xA0;H), 2.25-2.43(m, 1H, CH, i-pr.), 1.63(s, 6H, -(CH3)2); ESI-MASS: m/z[M+1]+223.19;Anal. Calculated for (C11H11ClN2O): C, 59.33; H, 4.98; N, 12.58;Found: C, 59.29; H, 5.02; N, 12.52.&#xD;
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Synthesis of (1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene) thiosemicarbazide(IV):&#xD;
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7-Chloro-3-isopropyl-1H-quinoxaline-2-one (III) (22 g, 0.10 M) was dissolved in ethanol (350 ml) and added thiosemicarbazide (9 g, 0.10 M). The reaction mixture was stirred and refluxed for 4 hours. The reaction mixture was allowed to cool at room temperature, obtained crystals. The crystals were collected by filtration, washed and purified by recrystallization from ethanol to yield white crystals of (1E, 4E)-1-(7-chloro-3-isopropyl quinoxaline-2(1H)-ylidene) thiosemicarbazide (IV). The completion of the reaction and purity of the compound was checked by a single spot TLC.&#xD;
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Yield: 85.5 %; m.p. 218--222 oC; Mol. Formula: C12H14ClN5S; Mol. Wt: 295.79; IR (KBr, cm-1): 3442(NH str.), 3066(C-H sp2 str.), 3002(N-H2str.), 1654(C=N str.), 1602(C=C aromatic str.), 1361(CH(CH3)2str.). 1037(C-Clstr.);1H-NMR(300MHz,DMSO-d6)&#x3B4;(ppm):10.02(S,1H,NH),9.62(S,1H,NH),8.09(S,1H,Ar.H),7.26-7.34(d,1H,Ar.H),6.96-6.98(d,1H,Ar.H),4.99(S,2H,NH2),2.18-2.64(m,1H,CH,i-pr.),1.59(d,6H,-(CH3)2);ESI-MASS:m/z[M+1]+296.09;Anal.CalculatedforC12H14ClN5S:C,48.73;H,4.77;N,23.68;S,10.84;Found:C,48.69;H,4.72;N,23.74.&#xD;
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General procedure for the synthesis of a series of different aromatic aldehydes substituted quinoxalinethiosemicarbazide derivatives (Va -Vf):&#xD;
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A typical procedure is described here for the synthesis of a series of different aromatic aldehyde substituted quinoxaline thiosemicarbazide derivatives. In this step N&amp;#39;-(7-chloro-3-isopropyl-1H-quinoxaline-2-ylidine) thiosemicarbazide (IV) (0.01 mmol) was refluxed with different aromatic aldehydes (0.01 mol), in methanol (50 ml) and added glacial acetic acid (6-8 drops) for 4-5 hours. The progress of the reaction was monitored by TLC on silica-gel 60 plates until a distinct spot of the product was obtained. At the end of the reaction, the crude precipitate was filtered and recrystallized with methanol. The final product thus obtained was chromatographed on silica gel (60-120 mesh), using solvent system chloroform: methanol (3:1) as eluent to furnish pure compounds Va-Vf.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-chlorophenyl) methylidene) thiosemicarbazide(Va):&#xD;
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Yield: 67.5 %; m.p.190-192 oC; Mol. Formula:C19H17Cl2N5S;Mol. Wt:418.34; IR (KBr, cm-1): 3215(N-H str.), 2933(C-H sp2 str. aromatic), 2875(C-H sp2 str. alkyl), 1599(C=N str.), 1572(C=C aromatic str.), 1337(CH (CH3)2 str.), 1235(C=S str.), 785(C-Cl str.), 1110,1057,1005( aromatic C-H in plane bending), 668,614,519( aromatic C-H out plane bending); 1H NMR (DMSO-d6): &#x3B4; 10.89(s,1H, N-NH), 10.68(s,1H, NH), 9.15(s, 1H, N=CH), 7.28(s,2H, Ar. H), 7.24-7.27(d, 1H, Ar. H-8), 7.13-7.16(d, 1H, Ar. H-5), 7.01-7.04(d, 1H, ArH-6), 6.95-6.98(s,2H, Ar. H), 2.21-2.24(m, 1H, CH i-pr.), 1.95(s,6H,-(CH3)2); ESI-MASS: m/z [M+1]+ 419.07;Anal. Calculated. for C19H17Cl2N5S:C, 54.55; H, 4.10; N, 16.74; S, 7.66; Found: C, 54.52; H, 4.14; N, 16.73.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-nitrophenyl) methylidene) thiosemicarbazide(Vb):&#xD;
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Yield: 68 %; m.p.197-200 oC; Mol. Formula:C19H17ClN6O2S;Mol. Wt:428.90; IR (KBr, cm-1): 3402(N-H str.), 2939(C-H sp2 str. aromatic), 2864(C-H sp2 str. alkyl), 1607(C=N str.), 1579(C=C aromatic str.), 1398(CH (CH3)2 str.), 1231 (C=S str.), 747 (C-Cl str.), 1147,1105,1054 ( aromatic C-H in plane bending), 850,668,610,560 ( aromatic C-H out plane bending); 1H NMR (DMSO-d6): &#x3B4; 11.02 (s,1H, N-NH), 10.60 (s,1H, NH), 9.31 (s, 1H, N=CH), 7.86-7.89 (d,2H, Ar. H), 7.82-7.85 (d, 1H, Ar. H-8), 7.59-7.62 (d, 1H, Ar. H-5), 7.28-7.34 (d, 1H, Ar. H-6), 6.96-6.98 (d,2H, Ar. H), 2.17-2.23 (m, 1H, CH,i-pr.), 1.30 (s,6H,-(CH3)2); ESI-MASS: m/z [M+2]+ 430.15;Anal. Calculated. for C19H17ClN6O2S: C, 53.21; H, 4.00; N, 19.59; S, 7.46; Found: C, 53.24; H, 4.5; N, 19.56.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-methoxyphenyl) methylidene) thiosemicarbazide(Vc):&#xD;
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Yield: 68.5 %; m.p.202-204oC; Mol. Formula:C20H20ClN5OS;Mol. Wt:413.92; IR (KBr, cm-1): 3380(N-H str.), 3236 (C-H sp2 str. aromatic), 3097 (C-H sp2 str. alkyl), 1611 (C=N str.), 1576 (C=C aromatic str.), 1394 (CH (CH3)2 str.), 1224(C=S str.), 779 (C-Cl str.), 1140,1052,979 ( aromatic C-H in plane bending), 904,668,556 ( aromatic C-H out plane bending); 1H NMR (DMSO-d6): &#x3B4; 10.60 (s,1H, N-NH), 10.51(s,1H, NH), 9.05 (s, 1H, N=CH), 7.71-7.74 (d,2H, Ar. H), 7.50-7.53 (d, 1H, Ar. H-8), 7.28-7.35 (d, 1H, Ar. H-5), 6.94-6.97 (d, 1H, ArH-6), 6.72-6.76 (d,2H, Ar. H), 2.46-2.53 (m, 1H, CH,i-pr.), 1.56 (s, 3H, -OCH3), 1.22 (s,6H,-(CH3)2); ESI-MASS: m/z [M+1]+ 415.02;Anal. Calculated. for C20H20ClN5OS: C, 58.03; H, 4.87; N, 16.92; S, 7.75;Found: C, 58.07; H, 4.92; N, 16.88.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-hydroxyphenyl) methylidene) thiosemicarbazide(Vd):&#xD;
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Yield: 70.5 %; m.p.195-197oC; Mol. Formula:C19H18ClN5OS;Mol. Wt:399.90; IR (KBr, cm-1):3430 (O-H str.), 3395 (N-H str.), 2924 (C-H sp2 str. aromatic), 2839 (C-H sp2 str. alkyl), 1601 (C=N str.), 1569 (C=C aromatic str.), 1372 (CH (CH3)2 str.), 1222 (C=S str.), 738 (C-Cl str.), 1145,1115,1044 ( aromatic C-H in plane bending), 843,657,602,548 ( aromatic C-H out plane bending); 1H NMR (DMSO-d6): &#x3B4; 10.97 (s,1H, N-NH), 10.56 (s,1H, NH), 10.05 (s, 1H, OH), 9.67 (s, 1H, N=CH), 7.83-7.87 (d,2H, Ar. H), 7.71-7.74 (d, 1H, Ar. H-8), 7.49-7.52 (d, 1H, Ar. H-5), 7.25-7.31 (d, 1H, Ar. H-6), 6.91-6.96 (d,2H, Ar. H), 2.19-2.26 (m, 1H, CH,i-pr.), 1.28 (s,6H,-(CH3)2); ESI-MASS: m/z [M+2]+ 402.08;Anal. Calculated. for C19H18ClN5OS: C, 57.07; H, 4.54; N, 17.51; S,7.46; Found: C, 57.04; H, 4.57; N, 17.48.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-methylphenyl) methylidene) thiosemicarbazide(Ve):&#xD;
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Yield: 62.3 %; m.p.188-190oC;Mol. Formula: C20H20ClN5S;Mol. Wt: 397.92;IR (KBr, cm-1): 3354 (N-H str.), 2945 (C-H sp2 str. aromatic), 2840 (C-H sp2 str. alkyl), 1625 (C=N str.), 1529 (C=C aromatic str.), 1343 (CH (CH3)2 str.), 1246 (C=S str.), 756 (C-Cl str.). 1173, 1044, 973 (aromatic C-H in plane bending), 835, 644, 593 (aromatic C-H out plane bending).1H NMR(DMSO-d6): &#x3B4; 11.13 (s,1H, N-NH), 10.70 (s,1H, NH), 9.22 (s, 1H, N=CH), 7.40-7.43 (d,2H, Ar. H), 7.36-7.39 (d, 1H, ArH-8), 6.79-6.81 (d, 1H, ArH-5), 6.58-6.62 (d, 1H, ArH-6), 6.17-6.21 (d,2H, Ar. H), 2.61-2.69 (m, 1H, CH, i-pr.), 1.65 (s, 3H, -CH3), 1.27 (s,6H,-(CH3)2);ESI-MASS: m/z [M+1]+ 399.14;Anal. Calculated. for C20H20ClN5S: C, 60.37; H, 5.07; N, 17.60; S, 8.06;Found:C, 60.41; H, 5.11; N, 17.57.&#xD;
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(1E,4E)-1-(7-chloro-3-isopropylquinoxalin-2(1H)-ylidene)-4-(1-(4-isopropylphenyl) methylidene) thiosemicarbazide(Vf):&#xD;
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Yield: 69.5 %; m.p.210-212oC; Mol. Formula:C22H24ClN5S;Mol. Wt:425.98;IR (KBr, cm-1): 3316(NH str.), 2982 (C-H sp2 aromatic str.), 2808 (C-H sp2 aliphatic str.), 1668 (C=N aromatic str.), 1512 (C=C str.), 1372 (CH (CH3)2 str.), 1342 (C-N str.), 1272 (C=S str.), 789 (C-Cl str.), 1164,1069,978 (aromatic C-H in plane bending), 841,6,98,594 (aromatic C-H in out of plane bending).1H NMR (DMSO-d6):&#x3B4; 11.15 (s,1H, N-NH), 10.35 (s,1H, NH), 8.61 (s, 1H, N=CH), 7.85-7.88 (d,2H, Ar. H), 7.43-7.47 (d, 1H, Ar. H-8), 7.25-7.25 (d, 1H, Ar. H-5), 6.97-7.01 (d, 1H, ArH-6), 6.71-6.75 (d,2H, Ar. H), 2.25-2.40(m, 2H, CH,i-pr.), 1.34 (s, 6H, (CH3)2 ), 1.30 (s,6H,-(CH3)2); ESI-MASS : m/z [M+1]+ 427.12 Anal. Calculated for C22H30ClN5S : C, 62.03; H, 5.68; N, 16.44; S, 7.53; Found: C, 62.06; H, 5.72; N, 16.41.&#xD;
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ANTI-MICROBIAL EVALUATION&#xD;
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MicrobialStrains: All the synthesized compounds (Va-Vf), were evaluated in vitro for their antibacterial and antifungal activity against Gram-negative bacterial strains such as Klebsielapneumonie(ATCC 15380), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27893), Salmonella typhi (MTCC 3216), Helicobacter pylori (ATCC 26695) and Gram-positive bacterial strains such as Bacillus subtilis (ATCC 6633), Bacillus thuringiensis (MTCC 714), Staphylococcus aureus (ATCC 25323), methicillin-resistant Staphylococcus aureus (ATCC 3591). Fungal strains used were Penicillium chrysogenum(ATCC 11709), Aspergillus niger(ATCC 9029), Candida albicans (ATCC 90028).&#xD;
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Antimicrobial Assay Methodology: Antimicrobialevaluation of all the synthesized derivatives (Va-Vf), were assayed by using the agar dilution method to determine the minimum inhibitory concentrations (MICs).48. Ciprofloxacin (CFX) and Fluconazole (FCZ) were used as antibacterial and antifungal reference standards, respectively. The range of concentrations of synthesized agents being tested based on the two-fold dilution series (1 mg/L). The dilutions of the synthesized agents and reference drugs were prepared in Mueller-Hinton (MH) agar for bacteria and in Sabouraud dextrose agar for fungi. Each test derivatives (10 mg) were dissolved in 1mL of dimethyl sulfoxide (DMSO) and the solution was diluted with water (9ml). Two-fold dilutions were made with melted Mueller-Hinton and Sabouraud dextrose agar to obtained the necessary concentrations of 100, 50, 25, 12.5, 6.25, 3.13, 1.56, 0.78, 0.39, 0.19, 0.098, 0.049,.0.025, 0.013 and 0.006 &#xB5;g/ml. The microbial inoculums were prepared by emulsifying overnight colonies from Mueller-Hinton and Sabouraud dextrose agar media in 0.85% saline. The prepared inoculums suspension photometrically adjusted at 600 nm for a cell density comparable to approximately 0.5 McFarland standards (1.5&#xD7;108 CFU/mL). The suspensions of microorganisms were diluted in 0.85% saline to give 107 CFU/mL for bacteria and 105 CFU/mL for fungi. The plate spot was inoculated with microbial suspensions about 1&#xB5;l each and incubated at 35-370C for 18-19 hours for bacteria and 28-300C for 50-72 hours for fungi. The minimum inhibitory concentration was observed and determined.&#xD;
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Antibacterial and AntifungalStudy: The synthesized aromatic aldehydes substituted quinoxaline thiosemicarbazide derivatives (Va-Vf) were evaluated for their antibacterial and antifungal activity. Most of the compounds showed excellent to significant activity towards Gram-negative, Gram-positive bacterial and fungal strains. The minimum inhibitory concentration of more active compounds along with Ciprofloxacin ranges from 0.19 &#x2013; 0.78 &#xB5;g/ mL for bacteria and with Fluconazole ranges 0.78 &#x2013; 3.12 &#xB5;g/ mL for fungal strains. The results of the antibacterial and antifungal activity evaluation are summarized in Table 2.&#xD;
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MOLECULAR DOCKING&#xD;
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Molecular DockingStudies: In today&#x2019;s globalized world, the molecular docking technique is one of the largely acclaimed structure-based drug design approaches, widely used ever since&#xA0;the early 1980s.49To understand the binding interactions of all the synthesized derivatives were docked into the active site of E.coli DNA gyrase B kinase and E. coli Topoisomerase IV. Crystal structure model of the target (PDB: 1AJ6 and 1S14) were downloaded from worldwide protein data bank (http://www.rcsb.org) and molecular docking studies were performed using the Auto Dock Tool 1.5.6 (ADT) 2011 software (Molecular Graphic Laboratory, The Script Research Institute, U. S. A.), To analyze the docking result and execute the protocol, The Discovery Studio&#xAE; v17.2.0.16349 software (Client, U. S. A), was employed.&#xD;
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Protein and ligand preparation: The Crystal structure model of the target E.coli DNA gyrase B (PDB code: 1AJ6) and E. Coli Topoisomerase IV ( PDB code: 1S14), with their native ligand novobiocin were downloaded from Protein Data&#xA0; Bank and prepared by the multistep process through the protein preparation menu of the AutoDock (version 1.5.6). The ChemDraw&#xAE; Ultra 8.0 (Cambridge soft, USA) software was used to draw the various chemical structures of the ligand molecules.&#xD;
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Active Site Prediction: The Sitemap applies theoretical methods and predicts the most accurate binding site. A receptor grid was generated via the selection of the grid box. The binding site was recognized by specifying the atoms of a co-crystallized ligand (novobiocin). The scores were then calculated as the free energy of binding (&#x394;Gb) and the final ten highest-scoring poses (conformations) for each molecule along with their scores and binding energies (&#x394;Gb) were collated into a database. The database file generated from the docking procedure was further analyzed, with the binding mode (interactions) of the highest ten conformations for each docked molecule in the active site visualized and studied with the help of the Discovery studio visualization window&#xD;
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RESULT AND DISCUSSION&#xD;
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Chemistry: A series of various benzaldehydes substituted quinoxaline thiosemicarbazide derivatives (Va-Vf) were synthesized with a good percentage yield as per scheme Figure 1.&#xA0; Structure and physicochemical data of the final compounds represented in Table 1. The chemical structures of the compounds were confirmed by elemental analysis, IR, NMR &amp; Mass spectroscopy.&#xD;
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The IR spectra of the compounds exhibit absorption bands due to OH, N-H, C-H, C=C, C=N, (CH (CH3)2, C=S and C-Cl stretching. The IR of synthesized compounds showed absorption bands near ranges 3215-3395 cm-1, 2932-3236cm-1 and 2839- 3097cm-1 correlated with N-H stretching, C-H sp2 aromatic stretching and C-H sp2 aliphatic stretching respectively.&#xA0; Also, the stretching absorption bands near ranges 1599-1668 cm-1, 1337-1398cm-1 and 1222-1272cm-1 correlated with C=N, -CH(CH3)2, and C=S groups respectively. IR displayed a characteristic broad absorption band at 3430 cm-1 for the OH group in compound Vd. The 1H-NMR at 300 MHz, the solvent used DMSO-d6 of all the derivatives showed a sharp singlet peak near range &#x3B4; 1.27-1.95 ppm indicated isopropyl CH3 (6H) protons and &#x3B4; 8.61-9.67 ppm indicated protons of Schiff bridge (N=CH). Multiple peaks appeared in all compounds ranges between &#x3B4; 2.17-2.64 due to protons of isopropyl C-H. A broad set of singlet and doublet peak ranges &#x3B4; 6.62-7.82 correlated to quinoxaline moiety aromatic hydrogens and sharp singlet peak range between &#x3B4;10.40-11.28 indicated hydrogens of N-H group. A sharp singlet peak in compound Vd at &#x3B4; 10.05 indicated hydroxyl group (OH) proton. The mass spectrum analysis of the compounds displayed characteristic peaks normally with [M+1]+ value and [M+2]+ value in compound Vd. The elemental analysis outcomes of the compounds almost ranged within &#xB1; 0.4% of the calculated values.&#xD;
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antimicrobial activity: The synthesized derivatives exhibited significant activity against Gram-negative and Gram-positive bacteria when compared with standard Ciprofloxacin antibacterial drug (Table 2). The compound Vb showed more potent activity against Gram-negative strains. aeruginosa (0.39 &#xB5;g/ mL) and H. pylori (0.39&#xB5;g / mL) and equipotent activity against K. pneumonia (0.19 &#xB5;g/ mL), E. coli (0.19 &#xB5;g / mL), and less active against S. Typhi (0.19 &#xB5;g/ mL).&#xA0; The compound Vc exhibited good activity against H. pylori (0.39 &#xB5;g / mL) but equipotent activity K. pneumoniae (0.19 &#xB5;g/ mL), E. coli (0.19 &#xB5;g / mL) and P. aeruginosa (0.78 &#xB5;g/ mL). Whereas no compounds showed significant activity against S. typhi. &#xD;
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On the study of Gram-positive strains, a more excellent twofold activity was observed of compound Ve and Vf against B. subtilis (0.39 &#xB5;g / mL), S. aureus (0.19 &#xB5;g / mL)&#xA0; and MRSA (0.78 &#xB5;g / mL) and equipotent activity against B. thuringiensis (0.39 &#xB5;g / mL). The compound Vcalso showed twofold activity against B. subtilis (0.39 &#xB5;g / mL) and equipotent activity against B. thuringiensis (0.39 &#xB5;g / mL) and MRSA (1.56 &#xB5;g / mL). Thus, it was found that compound B exhibited more potent activity against Gram-negative bacterial strains but less active against Gram-positive bacterial strains whereas compound Ve and Vf showed more potent activity against Gram-positive bacterial strains rather than Gram-negative bacterial strains. The study revealed that the compound Vc showed good activity against some Gram-negative strains as well as some Gram-positive strains when compared with reference standard drug ciprofloxacin. &#xD;
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The study of antifungal activity was tested against strains such as P. Chrysogenum, A. niger and C. Albicans using fluconazole as a standard drug (Table 2). Compound Vc and Vf exhibit a twofold amplified activity against A. niger(3.12 &#xB5;g / mL) and C. Albicans (1.56 &#xB5;g / mL), whereas equipotent activity against P. Chrysogenum(0.78 &#xB5;g / mL).The compound Ve exhibit equipotent activity against. Chrysogenum(0.78 &#xB5;g / mL) and A. niger(6.25 &#xB5;g / mL), but less active against C. Albicans (6.25 &#xB5;g / mL). The overall study revealed that compound Vc, Vfand some extent compound Veexplored the best potential activity against fungal strains in comparison with that of the standard compounds.&#xD;
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Molecular docking results: The docking of ligand molecules within the active pocket site of E. coli DNA gyrase B revealed that all the inhibitor compounds were exhibited the bonding with no. of amino acids which are showed in Figure 2. Theoretically, all the synthesized compounds showed very good docking energy ranging from -8.0 to -8.3 kcal/mol for PDB:1AJ6 and -7.6 to -8.2 for PDB:1S14 (Table 3).&#xA0; &#xD;
&#xD;
We concentrated our attention on the more potent compounds Vb, Vc, Ve and Vfembedded nicely within the active pocket of E. coli DNA gyrase B (PDB: 1AJ6) with the binding energy of -8.0, -8.0, -8.3 and -8.1 Kcal/mol respectively. The interactions of the compounds revealed that the methyl groups of isopropyl present on the quinoxaline ring was involved in hydrophobic interaction with ILE94 and VAL20 that may explain the observation that isopropyl substitution on the quinoxaline ring enhances E. Coli DNA gyrase B inhibitory potency. The quinoxaline ring displayed hydrophobic interaction (arene-cation interaction) with ASN46 and THR165. Furthermore, the secondary amine group of the thiosemicarbazide moiety showed hydrogen linkage with GLU50 and thio group linked with THR165 and GLY177. The nitro and methoxy group in compound Vb and Vc showed binding with VAL43, VAL71 and VAL 167 (Figure 2).&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The docking study of the synthesized compounds against E. coli Topoisomerase IV using PDB code: 1S14 reveals that all the compounds exhibited good binding energy ranging from -7.6 to -8.2 kcal/mol (Table 4). The more potent compound Vb showed good docking energy (-8.2 kcal/mol) and docked effectively in the active pocket site of E. coli Topoisomerase IV. The ligand-protein complexes showed that the quinoxaline ring of each compound binds extensively through hydrophobic interactions with GLU1046 and MET1074. The NH of the quinoxaline ring displayed hydrogen bond linkage with GLY1073. The nitrogen of thiosemicarbazide moiety exhibit hydrogen and hydrophobic linkage with ARG1132 and ARG1072(Figure 3).&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In conclusion, the present research reports the successful synthesis of different benzaldehydes substituted (1E, 4E)-1-(7-chloro-3-isopropyl quinoxaline- 2(1H)-ylidene) thiosemicarbazide derivatives and their in-vitro antimicrobial evaluation with molecular docking studies. Most of the evaluated compounds showed slightly more significant antimicrobial activity in comparison to reference compound. The structure-activity relationship study affirmed that the substitution by para-nitro benzaldehyde (Vb) enhance the activity against Gram-negative bacteria whereas substitution by para-methyl benzaldehyde (Ve) and para-isopropyl benzaldehyde (Vf) enhance the spectrum of activity against Gram-positive bacteria as well as fungal strains. Substitution by para-methoxy benzaldehyde as in compound Vc enhances the spectrum of activity against both Gram-negative as well as Gram-positive bacterial strains and also against fungal strains in comparison to reference compound.&#xD;
&#xD;
The electron-withdrawing and donating groups substituted in the para position of benzaldehydes exhibited well binding with amino acids in the active pocket site of DNA gyrase B and E. coli Topoisomerase IV. Thus, following this research, the synthesized molecules could be considered as candidates for more clinically relevant researches in the future to overcome this type of antimicrobial resistance.&#xD;
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ACKNOWLEDGMENTS: The authors are thankful to the authorities, Department of Pharmacy, Bhagwant University Ajmer, Rajasthan, India and Goel institute of pharmacy and Sciences, Lucknow, U.P., India, for providing facilities to perform the research work and also thankful to the Department of Biotechnology of Saroj Institute of Technology &amp; Management, Lucknow, India for providing bacterial and fungal strains.&#xD;
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AUTHORS&#x2019; CONTRIBUTIONS: Girendra Kumar Gautam: provided the concept and design of the study, acquisition of data, analysis and interpretation of data. Akash Ved: provided methodology of study and help in the drafting of the manuscript. Krishna Kumar Varshney: helped in molecular modelling study and interpretation of data. All authors read and approved the final manuscript.&#xD;
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HUMAN AND ANIMAL RIGHTS: No human and animals were used for studies in the present research work.&#xD;
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CONFLICT OF INTEREST: The authors declare no conflict of interest, financial or otherwise.&#xD;
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SOURCE OF FUNDING: TheAuthor received no specific funding for this research work.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3864</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3864</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Rural Healthcare Infrastructure of North-East India and its Challenges&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>56</FirstPage><LastPage>63</LastPage><AuthorList><Author>Manuranjan Gogoi</Author><AuthorLanguage>English</AuthorLanguage><Author> Sarat Hazarika</Author><AuthorLanguage>English</AuthorLanguage><Author> Khirod Kr. Phukan</Author><AuthorLanguage>English</AuthorLanguage><Author> Purabi Gogoi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: There is a vast change in healthcare infrastructure in the twenty-first century in India, but still the nation in general and the North-eastern region, in particular, is deprived of its healthcare infrastructure development. In the sense of health indicators like infant mortality, the life expectancy of birth, mortality rate, NER is still poor compared with the other states of India. Poor conditions of health infrastructure create a lot of problems such as non-availability of free medicines for rural poor, nonavailability of good doctors and lack of a sufficient number of government hospitals in rural areas of the country etc. Objectives: The objectives of the study are to analyze the current status of rural healthcare infrastructure in the North- Eastern Region of India and to identify the challenges faced by the rural healthcare infrastructure of North East India. Methods: The paper based on secondary data only. Data has been collected from different source such as Rural Health Statistics (RHS)- 2018-19 published by the Government of India Ministry of Health and Family Welfare Statistics Division, SRS Bulletin published by Office of The Registrar General, India, India HIV Estimates 2019 Report, published by National aids control organization, ICMR &#x2013; National Institute of Medical Statistics, Ministry of health &amp; family welfare government of India and Database of Government of India (https://data.gov.in). Results: NER of India has a shortfall of an adequate number of SCs, PHCs and CHCs particularly in rural areas as compared to the national average. The study found that the improvement of health care infrastructure in NER of India is unequal and therefore it is unsatisfactory. Conclusion: There is an urgent need to take some policies by the government to establish some new SCs, PHCs in rural parts of the northeastern region of India and also the existing infrastructure needs to be improved through increasing the number of health workers with proper train.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Rural Healthcare, Infrastructure, North-East, India, Challenges, SCs, PHCs, CHCs</Keywords><Fulltext>INTRODUCTION&#xD;
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Health is one of the most important indicators of the human development index after education and standard of living (UNDP). Good health not only provides a hygienic life but also provides better work efficiency in the labour market. The growth of the health care infrastructure is important for the enhancement of the economic development of a nation.&#xA0; According to WHO, 2000 for a very long time, the main objective of most of the developing countries is to develop the health status of their citizens1. In a broad sense, it is a contributor to enhancing the expectancy of life and economic participation that leads to alleviation of poverty of a region.2&#xD;
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For any economic activities, infrastructure is necessary. So, it is defined, Infrastructure as the social capital or basic services of a country that make possible economic and social activities. 3 There is a vast change seen in the twenty-first century in India, but still, the nation is deprived of its infrastructure development as compared to other nations of the world. Mainly the country still poor for its health sector compared with other developing countries of Asia i.e. China, Sri Lanka and Bangladesh. In the sense of health indicators like infant mortality, the life expectancy of birth, mortality under age five, India is still poor compared with the countries mentioned above.3 For the development of the health status of the citizens of the country, there is a need for adequate health care infrastructure. According to Rural Health Statistics (RHS), 2018-19, Govt. of India,&#xA0; the total number of Sub Centres (SCs) are160713(157411 rural + 3302 urban) and they are functioning. Similarly, 30045 Primary Health Centres (PHCs) is functioning in India (24855 rural + 5190 urban) and there are 5685 Community Health Centres (CHCs) (5335 rural + 350 urban) functional in the country. But the current numbers of SCs, PHCs &amp; CHCs are not as per the IPHS norm.4,5&#xA0; &#xD;
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DATA SOURCE&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The paper-based on secondary data only. Data has been collected from a different source such as Rural Health Statistics (RHS)- 2018-19 published by the Government of India Ministry of Health and Family Welfare Statistics Division, SRS Bulletin published by Office of The Registrar General, India, India HIV Estimates 2019 Report, published by National aids control organization, ICMR &#x2013; National Institute of Medical Statistics, Ministry of health &amp; family welfare government of India and Database of Government of India (https://data.gov.in).&#xD;
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PRESENT HEALTH STATUS OF NORTH-EAST INDIA&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The rural health care infrastructure of NER of India is still weaker than the states of the country. But after the implementation of NRHM, in 2005 there is a significant improvement seen in the region for its healthcare infrastructure.11 To analyze the current health status of NER, India the study focused on four indicators like- Birth Rate (BR), the Death rate (DR), Natural Growth Rate (NGR) and Infant Mortality Rate (IMR) of the region.&#xA0; The following Table 1 shows the four indicators that presented separately and categorized each of the indicators like- Total (T), Rural (R) and Urban (U). The total Birth rate of Assam and Meghalaya is more than of the national level (India). The same result happens in the case of rural birth rate also, but the only urban birth rate of all the states of north-east is lower than all India level (16.8). In the case of death rate, the total death rate of Assam (6.5) is higher than all India level (6.3). On the other hand, the rural death rate of all the states of NER is better to position in all India level (6.9) but in the case of urban death rate the states Assam and Manipur are in the same position with all India level (5.3) and the remaining six states are quite better positions than all India level. The natural growth rate of Assam and Meghalaya is greater than the national average also the same condition in the rural sector. But in urban NGR of Sikkim (14.9) is greater than all India average (11.6). In case of IMR the states Assam, Arunachal Pradesh and Meghalaya is shown the higher IMR than all India level(33) but the IMR of the remaining states is quite good than all India average. The state Nagaland is the most favoured states with the lowest IMR (7) among all the states of NER, India. The rural IMR of Assam, Arunachal Pradesh and Meghalaya is also higher than all India average, but in the case of urban IMR the states Arunachal Pradesh, Meghalaya and Tripura are in bad position than all India average. It is also mentionable that, the rural IMR (37) of India is higher than urban IMR (23), resulted from an inadequate health infrastructure of rural India.6,7&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The health status of North-East India cannot be equally treated as shown in Table 1. This is because of the inadequate development of the health infrastructure or its unavailability of adequate manpower in the health sector. Poor conditions of health infrastructure of the country mean, there is a problem of non-availability of free medicines for rural poor, non-availability of good doctors and lack of the sufficient number of government hospitals in rural areas of the country.12&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Another serious health problem not only for North-East India but also the problem of the whole world is Acquired Immune Deficiency Syndrome (AIDS) disease. Still, there are no proper medicines invented for this disease for curing it. Just only a few preventive measures and active awareness among citizens can reduce it to spreading the disease. The present scenario of AIDS mortality of North-Eastern states and other Indian states/UTs represents the Figure 1 below-&#xD;
&#xD;
&#xD;
&#xD;
State-wise AIDS-related mortality per 100,000 population, the three north-eastern states estimated to be in highest position all over India i.e. &#x2013; Manipur (36.86), Mizoram (28.34) and Nagaland (26.2). This means inadequate health awareness of AIDS disease among the citizens of the states. Similarly, Meghalaya (11.08) is also in the fifth position after Andhra Pradesh (21.76) and Pondicherry (15.33). On the other hand, it is reflected in the figure; the states Assam (1.67), Arunachal Pradesh (1.14), Sikkim (0.64) and Tripura (0.46) are somewhere is in a better position and below the level of all India average (4.43). India HIV Estimates report 2019 also mentioned that the HIV-AIDS detected persons are gradually increasing all over the country. So it is a major concern for all human being. In this regards, there is a need for sufficient health infrastructure in the region as well.&#xD;
&#xD;
HEALTHCARE INFRASTRUCTURE OF NORTH-EAST INDIA&#xD;
&#xD;
The healthcare infrastructure in rural areas of India has been developed as a three-tier system i.e. - Sub Centres (SC), Primary Health Centres (PHCs) and Community Health Centres (CHCs). These three are the common health infrastructure of rural society. Mainly SCs and PHCs are the first and foremost choice of health care among rural civilian. Because these centres are situated in village level and they are nearest from the households.8,9 For critical cases, people preferred to go CHCs that are located mainly in semi-urban areas. The following Table 2 shows the rural population and average rural population covered by the health sector in NER.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Table 2 shows the rural population of all the NE states in the year 2011 and 2019. It also shows the average population covered by the health services of those states.&#xA0; In the case of SCs, only Assam is in a better position than the national average. Similarly, the conditions of PHCs of all the NE states are very poor and it was lower than the national average. On the other hand, in the case of CHCs, only Sikkim is in a better position than the national average.&#xD;
&#xD;
CHALLENGES FACED BY THE RURAL HEALTHCARE INFRASTRUCTURE OF NORTH-EAST INDIA&#xD;
&#xD;
Position of SCs, PHCs and CHCs&#xD;
&#xD;
Rural healthcare services of the North-eastern states of India facing many problems for many decades but in some aspects, the states of the region are in a good position than the other states of India. Some of the states of the region do not have an adequate number of SCs, PHCs and CHCs in the rural areas. The following Table 3 is trying to show the present status of rural healthcare centres in the North-eastern states of India.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Table 3 shows the SCs in rural areas of Assam, Manipur and Meghalaya still inadequate with the size of its population and shown a shortfall of rural SCs 1731, 47, 345respectively. But the state Arunachal Pradesh, Mizoram, Nagaland, Sikkim and Tripura have surplus SCs. Similarly, Assam and Meghalaya have a shortfall of rural PHCs 94 and 6 respectively but the other states of NER have in a better position with surplus values. In the case of CHCs, the states Assam, Meghalaya Sikkim and Tripura is facing a problem of unavailability of sufficient community health centres. From this analysis, it is noticeable that the state Assam and Meghalaya have a shortfall of all three types of healthcare infrastructure in the rural areas of those states.&#xA0; In the case of Assam, the health status of the rural areas is poorer than the urban areas1. In the case of all India level, there is also a huge shortfall seen in all three categories. It is implied that the health infrastructure of the country was still inappropriate.10&#xD;
&#xD;
Status of manpower in rural healthcare services&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Healthcare infrastructure will not be sufficient if adequate manpower is not available to provide the services. The states of the North-East are in a good position for its female health workers/ ANMs in rural SCs accept Sikkim and Tripura. There is a shortfall of 24 and 388 of these two states. But the other states of the region are having surplus female workers in SCs of rural areas as per IPHS norms.11 In the case of male health worker in rural SCs, there is a huge deficiency (98063) shown all over the country including NER. Similarly, the availability of doctors, health workers in PHCs is also very important. Because the people of rural areas preferred the PHCs as their first choice if they facing general health-related problems. The following Table 4 shows the present status of rural PHCs of NER in terms of their availability of doctors and other health workers as per IPHS norms.&#xD;
&#xD;
&#xD;
&#xD;
As per IPHS norms, there is one doctor, one female health worker/ANM, one Health Assistant [Female] / LHV, one Health Assistant [Male], one pharmacist, one laboratory technician, one nursing staff is necessary for each PHC. Table 4 shows, surplus doctors are available in rural PHCs of all the states of NER except Arunachal Pradesh. Similarly, two states Mizoram and Tripura have insufficient female health worker/ANM in their rural PHCs but the other states of NER have surplus female health worker/ANM. In the case of health assistant (Male and Female), there is a huge shortfall in every state of the region which means violation of IPHS norms. On the other hand the states Arunachal Pradesh, Mizoram, Nagaland and Sikkim facing a shortage of pharmacists in rural PHCs as per IPHS norms. Similarly, Arunachal Pradesh, Manipur, Nagaland and Tripura are facing the problem of insufficient laboratory technicians in rural PHCs. It is also mentionable that there are surplus nursing pieces of stuff are available in all the states of NER.12 It is a positive sign for rural healthcare service in the region.&#xD;
&#xD;
The role of CHCs is very significant for rural people of the country. During a serious disease or other serious health-related problems, people of the rural areas prefer the CHCs. The present situation of CHCs based on the availability of manpower in NER is shown in the following Table 5. &#xD;
&#xD;
&#xD;
&#xD;
Table 5 shows only Manipur has the surplus AYUSH doctors, Nagaland and Sikkim has also adequate numbers. But the other states of the region have not an adequate number of AYUSH doctors in their CHCs located in the rural areas. Similarly, all the states of the region have a shortfall of total specialist doctors (Surgeons, OB &amp; GY, Physicians and Pediatrician) in rural CHCs. On the other hand, Arunachal Pradesh, Mizoram and Nagaland have an inadequate number of General Duty Medical Officers- Allopathic. In the case of radiographers in rural CHCs, only Manipur and Sikkim has the surplus numbers. There is a shortfall of pharmacists shown in the case of Arunachal Pradesh and Mizoram. In the case of Laboratory technicians, all the states of NER have an adequate number of manpower and it is a positive sign for the health sector of the region. But at the same time, Assam (47) and Mizoram (12) has a shortfall of nursing staffs of rural CHCs.13&#xD;
&#xD;
Status of building positions of the health sector in NER&#xD;
&#xD;
Basic infrastructure facilities are necessary to provide good health services among citizens.&#xA0; In the north-Eastern states, the basic infrastructure facilities of the rural health sector are not very well but comparatively better in some states than other states of the country. One of the basic infrastructures is building facilities. The current status of building facilities in the rural health sector discussed below.&#xD;
&#xD;
Building position of SCs: According to RHS 18-19, Arunachal Pradesh, Mizoram and Sikkim have an adequate number of government buildings. On the other hand, there is a deficiency of government buildings in other states of NER that accept these three states.&#xA0; Assam has the highest deficiency of buildings and required around 594 buildings. This has resulted in Assam; a government package is required to construct new buildings in rural areas mainly for SCs. The following Table 6 shows the current building position of SCs in NER.&#xD;
&#xD;
&#xD;
&#xD;
Notes: Required number of building to be constructed = Total functioning - (Government Buildings + Under construction) (ignoring States having excess.)&#xD;
&#xD;
Source: Rural Health Statistics 2018-19, Govt. of India&#xD;
&#xD;
Building position of PHCs: As per rural health statistics 2018-19, accept Nagaland all the states of northeast India has the sufficient number of building in rural PHCs. There is a shortfall of building only in Nagaland and it was 7 only. Overall the northeastern states are in a better position in the case of buildings of their PHCs.&#xD;
&#xD;
Building position of CHCs: In all the North-Eastern states there is a sufficient number of PHC buildings are available, even there is an additional building is available in Tripura10. It implies that basic infrastructure facilities in the case of buildings in all the states of NER are in a better position.&#xD;
&#xD;
FINDINGS &amp; CONCLUSION&#xD;
&#xD;
The study attempted to examine the current status of rural healthcare infrastructure of the North-Eastern Region of India in terms of birth rate, death rate, natural growth rate and infant mortality rate. Though it is found that the rural death rate of all the states of NER is lower than all India level, in the case of other indicators, it is not good. It also discussed a serious health disease called AIDS and its current status on the NE States through mortality rate and found this is a serious health issue for this region. Similarly, in the case of the healthcare infrastructure of NER, almost all the states of northeast India are lacking better condition of SCs, PHCs as compared to the national average. Some of the states of this region do not have an adequate number of SCs, PHCs and CHCs, particularly in rural areas. It has also a shortfall in terms of availability of doctors, nursing staffs etc. which need to be increased with proper training. The study found that the improvement of health care infrastructure in NER of India is unequal and therefore it is unsatisfactory. There is an urgent need to take some policies by the government to establish some new SCs, PHCs in rural parts of the north eastern region of India and also the existing infrastructure needs to be improved through increasing the number of health workers with proper train.&#xD;
&#xD;
Acknowledgement: Nil &#xD;
&#xD;
Conflict of interest: Nil &#xD;
&#xD;
Funding Source: No Funding sources were granted &#xD;
&#xD;
Authors&#x2019; Contribution: The whole work is a collaborative one and has equal contribution i.e- search the data and analyze the data to get an efficient result.&#xD;
&#xD;
Abbreviations:&#xD;
&#xD;
&#xD;
	&#xD;
	ANM: Auxiliary Nurse Midwife&#xD;
	&#xD;
	&#xD;
	AYUSH: Ayurveda, Yoga &amp; Naturopathy, Unani, Siddha and Homoeopathy&#xD;
	&#xD;
	&#xD;
	CHCs: Community Health Centre&#xD;
	&#xD;
	&#xD;
	GOI: Government of India&#xD;
	&#xD;
	&#xD;
	ICMR: Indian Council of Medical Research&#xD;
	&#xD;
	&#xD;
	IPHS: Indian Public Health Standards&#xD;
	&#xD;
	&#xD;
	LHV: Lady Health Visitor&#xD;
	&#xD;
	&#xD;
	NE: North- East&#xD;
	&#xD;
	&#xD;
	NER: North-Eastern Region&#xD;
	&#xD;
	&#xD;
	NRHM: National Rural Health Mission&#xA0;&#xD;
	&#xD;
	&#xD;
	PHC: Primary Health Centre&#xD;
	&#xD;
	&#xD;
	RHS: Rural Health Statistics&#xD;
	&#xD;
	&#xD;
	SC: Sub Centre&#xD;
	&#xD;
	&#xD;
	UNDP: United Nations Development Programme&#xD;
	&#xD;
	&#xD;
	WHO: World Health Organization&#xD;
	&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3865</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3865</Fulltext></URLs><References>&#xD;
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	Buragohain P.P. Status of rural health infrastructure of Assam. Int J Manag Soc Sci Res Rev. 2015; 1(15): 210-218.&#xD;
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	Das S.&#xA0; Rural Health Status and Health Care in North-Eastern India:&#xA0; A Case Study. J Health Manag. 2012; 14(3): 283&#x2013;296.&#xD;
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	GOI. Report of the National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare. Government of India, 2005.&#xD;
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	India HIV Estimates 2019 Report, National Aids Control Organization&#xA0;&#xA0; |&#xA0;&#xA0; ICMR &#x2013; National Institute of Medical Statistics Ministry of Health &amp; Family Welfare, Government of India. 2019.&#xD;
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	Lyngdoh L M. Inter-State Variations in Rural Healthcare Infrastructure in North-East India. Nehu J. 2015; 13 (2): 31-48.&#xD;
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	Mal S, Bhattacharya P, Ghosh B. Consequence of health infrastructure of northeast India in comparison with India. Radix Int J Res Soc Sci. 2013; 2(7): 1-14.&#xD;
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	National Family Health Survey (NFHS-4) India. Ministry of Health and Family Welfare, Government of India.2016.&#xD;
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	Paul P K, Jana S K, Maiti A. An Analysis of Health Status of the State of Assam, India.Res Rev Int J Multidisc. 2019; 4(9): 1179-1188.&#xD;
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	Rutherford D. Dictionary of Economics. Second Edition. Routledge. London and New York. 2002.&#xD;
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	Rural Health Statistics 2018. Government of India Ministry of Health and Family Welfare Statistics Division.2018.&#xD;
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	Saikia D. Health Care Infrastructure in the Rural Areas of North-East India: Current Status and Future Challenges. J Eco Soc Develop. 2014; 10 (1): 83-99.&#xD;
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	Saikia D. Das KK. Rural Health Infrastructures in the North-East. http://mpra.ub.uni-muenchen.de/41859/ 2012: 1-10.&#xD;
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	The World Health Report.2000. Health Systems: Improving Performance. World Health Organization.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>An Anthropometric Study of Craniofacial Relations in Human Dry Skull&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>64</FirstPage><LastPage>66</LastPage><AuthorList><Author>Shetty Ullasa</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: The craniofacial features of the human have always been one of the main identifying features of the humans. The facial features are remarkable and have always interested not only anthropologists but also anatomists, surgeons and artists. In forensic science, it&#x2019;s an important feature in the identification of the individual in terms of race and culture. The craniofacial features also depend on the different demographical and geographical features. It also depends on the culture. Aims and Objectives: To study the anthropometric data of the Craniofacial features in the dry skull which belonged to the local population. Materials and Methods: This study puts in a sincere effort to find the anthropometric data of the Craniofacial features in the dry skull which belonged to the local population. The mean, standard deviation and range will be calculated for the data. The study was conducted using 100 skulls irrespective of sex in the Department of Forensic Medicine, A.J.Institute of Medical Sciences, Mangalore. Results: The mean FSI was found to be 52.92 and the mean CI was found to be 77.98in our population. Conclusion: The mean values, ratios and indices established for the various vertical and horizontal measurements can be used to determine craniofacial variations.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Facial features, Anthropometry, Forensic, Cranio-facial</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
The majority of the craniofacial features that we use have been derived from anthropometric observations. This set of knowledge have been highly contributed by the Physical Anthropologists.1,2The size and shape of the craniofacial features depends on a lot of factors such as demographic and geographical influences. The hereditary characters also contribute to the individuals.3The bones that contribute to craniofacial features undergo modelling, remodelling and constantly gets adjusted to the environmental influences.4,5The facial features are remarkable and have always interested not only anthropologists but also anatomists, surgeons and artists.6 Some reports have even claimed that the behaviour of the individual can be judged by calculating some specific measurements of the face.7This study puts in a sincere effort to find the anthropometric data of the Craniofacial features in the dry skull which belonged to the local population. The mean, standard deviation and range will be calculated for the data.&#xD;
&#xD;
AIMS AND OBJECTIVES:&#xD;
&#xD;
To study the anthropometric data of the Craniofacial features in the dry skull which belonged to the local population.&#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
The study was conducted using 100 skulls irrespective of sex in the Department of Forensic Medicine, A.J.Institute of Medical Sciences, Mangalore. &#xD;
&#xD;
Exclusion criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	Damaged skulls&#xD;
	&#xD;
	&#xD;
	Foetal skulls&#xD;
	&#xD;
&#xD;
&#xD;
The measurements were done using digital vernier, spreading, sliding and dividing callipers. &#xD;
&#xD;
The following points on the skull were studied. &#xD;
&#xD;
&#xD;
	&#xD;
	gnathion (g): this is the centre point on the lower border of the mandible. &#xD;
	&#xD;
	&#xD;
	nasion (n): the two nasal bones meet each other and the frontal bone at this point.&#xD;
	&#xD;
	&#xD;
	prosthion (p): point between the upper incisor teeth. &#xD;
	&#xD;
	&#xD;
	zygion (z): most lateral point on the zygomatic arch.&#xD;
	&#xD;
	&#xD;
	Ans (Anterior Nasal Spine): most anterior point on anterior nasal spine&#xD;
	&#xD;
	&#xD;
	everyone(e): most lateral point on the cranium.&#xD;
	&#xD;
	&#xD;
	gonion (go): most inferolateral point of the angle of the mandible. &#xD;
	&#xD;
	&#xD;
	ofd (occipitofrontal diameter): distance between glabella and the inion. &#xD;
	&#xD;
	&#xD;
	frontotemporal points (f): coronal suture and temporal bone meet at this point. &#xD;
	&#xD;
&#xD;
&#xD;
Based on the points discussed above, the following measurements will be taken. &#xD;
&#xD;
&#xD;
	&#xD;
	UFH: Upper anterior face height &#x2013; n to ans.&#xA0; &#xD;
	&#xD;
	&#xD;
	LFH: Lower anterior face height &#x2013; ans to g. &#xD;
	&#xD;
	&#xD;
	MFH: middle anterior face height &#x2013;ans to p&#xD;
	&#xD;
	&#xD;
	TFH: total facial height &#x2013; n to g&#xD;
	&#xD;
	&#xD;
	WF: width of the face: z to z&#xD;
	&#xD;
	&#xD;
	WFo: f to f&#xD;
	&#xD;
	&#xD;
	WM : g to g&#xD;
	&#xD;
&#xD;
&#xD;
WC: width of Cranium&#x2013; e to e&#xD;
&#xD;
LC:&#xA0; Length of Cranium: ofd (occipitofrontal diameter): linear distance between the most protuberant points of frontal and occipital bones at mid sagittal plane &#xD;
&#xD;
Based on the obtained results the length-width-height index of the face and cranium was estimated.&#xD;
&#xD;
The facial skeletal index (FSI) was calculated by the following formula:&#xD;
&#xD;
&#xA0;[(Upper facial height (UF) + middle facial height (MFH)] / WF&#xD;
&#xD;
Cranial Index (CI) was calculated by the following formula:&#xD;
&#xD;
width of Cranium (WC)/ Length of Cranium (LC)x 100 &#xD;
&#xD;
RESULTS:&#xD;
&#xD;
Measurements that yield cranial and facial classification, using indices associated with growth patterns, can be taken to assess both the head and the face, making orthopaedic and/or orthodontic diagnosis and treatment planning easier. The skulls in this study were obtained without gender information. The anthropometric study found no influence on sex determination shown in Table 1 and 2. &#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
The majority of previous researchers recommended creating cranial and facial indices for our community to collect local data on classification ranges. Within race, ethnicity, and population groups, there are several variations in cephalic and facial indices. Dissimilarities of this kind are often known to exist between different geographical and ethnic groups. Hormones, nutritional status, cultural distinctions, and environmental factors are only a few of the factors that affect the human skeleton. 8 Anil Kumar discovered that while absolute sex differences are rare, there are some distinct differences observed in the cranial features of male and female crania for a given population.9. We are in absolute agreement with the study that we have compared. &#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
The mean values, ratios and indices established for the various vertical and horizontal measurements can be used to determine craniofacial variations in the South Indian population.&#xD;
&#xD;
CONFLICT OF INTEREST: nil&#xD;
&#xD;
SOURCE OF FUNDING: Self&#xD;
&#xD;
AUTHOR CONTRIBUTION:&#xD;
&#xD;
Dr Shetty Ullasa: Principal investigator. &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3866</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3866</Fulltext></URLs><References>&#xD;
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	Sicher H. Oral anatomy. 6th ed. St Louis: Mosby; 1975.&#xD;
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	Parfitt A. Morphologic basis of bone-mineral measurements-transient and steady-state effects of treatment in osteoporosis. Miner Electrolyte Metab. 1980; 4: 273&#x2013; &#x2013;287. &#xD;
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	Sims NA, Martin TJ. Coupling the activities of bone formation and resorption: a multitude of signals within the basic multicellular unit. Bonekey Rep. 2014; 3: 481. doi: 10.1038/ bone key.2013.215, indexed in Pubmed: 24466412.&#xD;
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	&#xA0;Praveen KD, Janaki CS, Vijayaraghavan J, Raj UD. A study on measurement and correlation of cephalic and facial indices in the male of the south Indian population. Int J Med Res Health Sci. 2013; 2 (3):439&#x2013;446.&#xD;
	&#xD;
	&#xD;
	Carr&#xE9;, J. M., &amp; McCormick, C. M. In your face: Facial metrics predict aggressive behaviour in the laboratory and varsity and professional hockey players. Proceed Roy Soc B. 2008; 275, 2651&#x2013;2656.&#xD;
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	&#xD;
	Felicita AS, Chandrasekar S, Shanthasundari KK. Determination of craniofacial relation among the subethnic Indian population: A modified approach (vertical evaluation). Ind J Dent Res. 2013;24:456-63.&#xD;
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	&#xD;
	Chimmalgi M, Kulkarni Y, Sant SM. Sexing of the skull by new metrical parameters in Western India. J Soc Ind. 2007; 56(1):28-32&#xD;
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	Anil Kumar, Mahindra Nagar : Morphometric estimation of cephalic index in north Indian population: craniometrics study. Int J Sci Res.2015;4 (4) 2319-7064&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Pigmented Basal Cell Carcinoma - A Rare Case Report&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>67</FirstPage><LastPage>69</LastPage><AuthorList><Author>Irri H</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajendran S</Author><AuthorLanguage>English</AuthorLanguage><Author> Narasimhalu CR</Author><AuthorLanguage>English</AuthorLanguage><Author> Sonti S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Basal cell carcinoma is the most common skin cancer. Pigmented basal cell carcinoma is a very rare variant of Basal cell carcinoma with increased pigmentation. Intermittent ultraviolet radiation exposure is the predominant risk factor. Due to its multiple and varied clinicopathological presentations, its diagnosis becomes difficult. A case of multiple pigmented BCC is reported in a 64-year-old manon the right cheek. The diagnosis was established based on histopathology and dermoscopy findings. Result: Dermoscopy showed a maple-leaf like a pattern, blue-grey globules, ulceration and vessels. Histopathological examination showed an island of basaloid cells with peripheral palisading, melanin clumps in the stroma, with retraction artefacts. Conclusion: Dermoscopic analysis of the pigmented basal cell carcinoma eliminated the need for biopsy leading to early diagnosis and prompt intervention. Thus dermoscopy should be used as a routine tool in suspected skin lesions.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Pigmented basal cell carcinoma, Skin cancer, Dermoscopy, Basal cell carcinoma, UV radiation, Basaloid cells</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
&#xA0;Basal cell carcinoma(BCC) is the most common nonmelanoma skin cancer with negligible mortality.1 However they exhibit significant morbidity if diagnosed late or left untreated. Pigmented basal cell carcinoma is a very rare variant accounting for about 6% of total cases of BCC.2Pigmented basal cell carcinoma is commonly seen among black, Hispanic, and Asian individuals.3 They are less frequent in Caucasians. It mostly presents in the elderly with male preponderance attributable to their increased years of exposure to UV radiation. Biopsy of the lesion followed by histopathological examination have been the mainstay in diagnosis. Recently dermoscopy has become an important diagnostic tool aiding in differentiating pigmented BCC from melanoma&#xD;
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CASE REPORT: &#xD;
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A 64-year-old male presented to skin OPD with chief complaints of dark coloured skin lesion over the right cheek of more than 3 years in duration and a similar lesion smaller in size which developed 6 months ago below and behind the right ear. A gradual increase in size was observed in the new lesion with mild itching. There was no appreciable increase in its colour.&#xD;
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On clinical examination, two well-defined plaques with irregular borders, with a central pinkish hue and surrounding hyperpigmentation, size measuring 4.5x3 cm and 1.5x1cm were noted above the right angle of mandile and right infra auricular area respectively (Fig 1). The surface showed irregular pigmentation and was not tender or indurated on palpation. Differential diagnosis of basal cell carcinoma, squamous cell carcinoma and malignant melanoma were considered. Dermoscopic analysis was done which showed the absence of pigment network, focal area of ulceration, arborizing vessels, bluish-grey globules and leaf-like structures on the older plaque (Fig 2). Whereas the new plaque showed the absence of a pigment network with multiple ulcerations and bluish-grey globules (Fig 3). To confirm the diagnosis a punch biopsy was performed and sent for histopathological examination.&#xD;
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Histopathology showed an island of basaloid cells with peripheral palisiding, and melanin clumps in the stroma, with retraction artefacts forming clefted spaces (Fig 4).&#xD;
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DISCUSSION: Basal cell carcinoma is a skin cancer originating from pluripotent cells in the basal layer of the epidermis or follicular structures. Non pigmented basal cell carcinoma is much more common than its pigmented counterpart. Pigmented basal cell carcinoma is a rare variant in which melanin is produced by melanocytes that colonize the tumour and in melanophages located in the surrounding stroma. It is a slow-growing, locally invasive tumour.4 Intermittent, intense exposure to ultraviolet rays from the sun plays a major role along with other risk factors like skin type 1 (never tans, always burns), red or blonde hair, and blue or green eyes in the development of basal cell carcinoma.5 In western literature BCC showed a female preponderance whereas in Indian literature there is a male preponderance.6The risk of basal cell carcinoma is high among males above 60 years, the most common site being the middle third of the face but can occur anywhere on the sun-exposed parts of skin.7Which is in line with our case, where a 65 years old man who was a farmer presented with a lesion on the face. A differential diagnosis of pigmented basal cell carcinoma and melanoma was considered. &#xD;
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Hence a noninvasive diagnostic aid was considered. Dermoscopy helps in the diagnosis of basal cell carcinoma from other pigmented lesions. Menzies&#xA0;et al proposed a simple dermatoscopic method for diagnosing pigmented BCCs. This method has a sensitivity of 97% and a specificity of 92% and 93% for differentiating pigmented basal cell carcinoma from melanoma.8 According to this diagnostic method, pigmented BCC must have a negative feature i.e absence of pigment network and presence of one of the following six criteria: maple leaf-like areas, blue-grey ovoid nests, ulceration, arborizing vessels, spoke wheel areas, multiple blue-grey dots/globules.9,10 This case fits well into the criteria with the absence of pigment network and presence of maple leaves like areas, focal ulceration, blue-grey globules and arborizing vessels.&#xD;
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The clinical and dermoscopic diagnosis was further substantiated with histopathological evidence consistent with pigmented BCC. Plastic surgeons and Oncologist&#x2019;s help were sought for further management and the patient is being followed up.&#xD;
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CONCLUSION: This report describes a pigmented variant of BCC, which is a rare manifestation, diagnosed with classical histopathology and dermoscopy findings. Knowledge of dermoscopic findings in pigmented BCC helps to avoid unnecessary biopsies, aids in early diagnosis and management of the patient. Though a widely used modality it should be incorporated into daily clinical practice to enhance diagnostic accuracy. &#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 &#x2013; Nil&#xD;
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Source of funding&#xA0; - Nil&#xD;
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1, 2,, 4&#xD;
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Author&#x2019;s contribution: &#xD;
&#xD;
Irri H had contributed to the diagnosis and drafted the article. Rajendran S and Sonti S has made a substantial contribution to the diagnosis or design of the article. Narasimhalu CR had revised it critically for important intellectual content and approved the version to be published. &#xD;
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Figure 1: Solitary well defined indurated plaque with black brown pigment at the periphery and irregular border.&#xD;
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Figure 2: Dermoscopy findings: pink arrow &#x2013; maple leaf like structures; yellow diamond &#x2013; ulceration; green star &#x2013; greyish blue globules; blue triangle &#x2013; arborizing vessels.&#xD;
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Figure 3: Dermoscopy findings: Red arrows: multiple ulcerations; Green arrows: bluish grey globules.&#xD;
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Figure 4: HPE shows peripheral palasiding , retraction artefacts with central clumps of pigmentation.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3867</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3867</Fulltext></URLs><References>&#xD;
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	Deepadarshan K, Mallikarjun M, Abdu NN. Pigmented basal cell carcinoma: a clinical variant, report of two cases. J Clin Diagn Res. 2013;7(12):3010&#x2013;3011.&#xD;
	&#xD;
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	Khot K, Deshmukh SB, Alex S. Pigmented basal cell carcinoma: an unusual case report. J Case Report. 2015;4(1):189-92.&#xD;
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	Abudu B, Cohen PR. Pigmented Basal Cell Carcinoma Masquerading as a Melanoma. Cureus. 2019;11(4): e4369.&#xD;
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	Jain M, Madan NK, Agarwal S, Singh S. Pigmented basal cell carcinoma: Cytological diagnosis and differential diagnoses. J Cytol and Acad Cytolog. 2012;29(4):273.&#xD;
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	Wong CS, Strange RC, Lear JT. Basal cell carcinoma.&#xA0;Bri Med J. 2003;327(7418):794-798. &#xD;
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	Nandyal SS, Puranic RB. Study of the demographic profile of skin tumours in a tertiary care hospital. Int J Curr Res Rev. 2014;6(16):24-28.&#xD;
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	Nagi R, Sahu S, Agarwal N. Unusual presentation of pigmented basal cell carcinoma of the face: a surgical challenge. J Curr Drug Res. 2016;10(7): ZJ06-7.&#xD;
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	Lallas A, Apalla Z, Argenziano G, Longo C, Moscarella E, Specchio F, Raucci M, Zalaudek I et al.&#xA0;The dermatoscopic universe of basal cell carcinoma. Dermatol Pract Conc. 2014;4(3):11&#x2013;24.&#xD;
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	Senel E. Dermatoscopy of non-melanocytic skin tumors. Indian J Dermatol Venereol Leprol. 2011;77(1):16.&#xD;
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	&#xD;
	Rambhia KD, Shah VH, Singh RP. Dermoscopy of pigmented basal cell carcinoma. Pigment International. 2018;5(2):123-4.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Application of Machine Learning for Improving Early Cancer Diagnosis&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>70</FirstPage><LastPage>73</LastPage><AuthorList><Author>Jayasri Kotti</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Across the world, cancer becomes a catastrophe for a human being who is suffering from it. Cancer can be diagnosed at a premature stage to overcome the consequences at a later stage and the possibility of endurance considerably, as it can support appropriate medical action to patients. One of the frequently used innovative technologies for the diagnosis and detection of cancer is Machine learning (ML). In recent times ML has been used for the prediction and prognosis of cancer. Machine learning enables the creation of algorithms that can learn and make predictions. Various Machine Learning techniques can build a model to diagnose cancer based on finding accuracy level. It is possible for early detection of cancer through machine learning where we train the machine with previous data. This paper aims to predict cancer type based on symptoms given by the user. Here we adopted a supervised learning algorithm and then use the Logistic Regression based on accuracy and recall score i.e., the algorithm which gives high accuracy level and recall score. The proposed System executes with good performance as it generates accurate results.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Machine Learning (ML), Data sets, Symptoms, Cancer, Logistic Regression, Supervised Learning</Keywords><Fulltext>&#xA0;Introduction&#xD;
&#xD;
Constant growth associated with cancer research has been achieved in the past few decades.&#xA0; For screening in the premature stage to find types of cancer before they cause symptoms different techniques came into existence.&#xA0; Researchers have been providing different innovative techniques and methods for cancer treatment. With the initiation of new techniques and methods in the field of medicine, a huge quantity of cancer disease data have been collected and are available to the medical study community. But the exact prediction of cancer is one of the remarkable and difficult tasks for doctors. For medical researchers, Machine Learning techniques and methods have become more popular. Machine Learning techniques can learn and recognize patterns and relationships between them from compound datasets, while they can successfully forecast future outcomes of a cancer disease. It is possible for early detection of cancer through machine learning where one can train the machine with previous data. &#xD;
&#xD;
Nowadays Machine Learning techniques are being used in an extensive variety of applications ranging from identifying and classifying cancer via x-ray and CRT methods. According to the online statistics many articles have been published on the subject of Machine Learning and cancer disease. Still, the enormous majority of these papers are associated with using Machine Learning techniques to recognize, categorize, identify or discriminate cancer types and other tumours. The primary aim of cancer anticipates and prediction is different from the goals of cancer recognition and identification. Accomplishment in Machine Learning is not constantly assured. As with any technique, a good perceptive of the problem and approval of the restrictions of the data is important. Good quality of data is more important to get accurate results. The success rate in results occurs when we design and implement proper Machine Learning technique.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Machine Learning (ML) techniques repeatedly learn and improve with familiarity. Learning means recognizing and understanding the input data and making intelligent decisions based on the datasets. It is very composite to supply all the decisions based on all possible input dataset. To attempt these types of problems, algorithms are suggested. These algorithms construct information from exact data and past knowledge with the ideology of logic, probability and statistics. There are several ways to execute techniques in Machine Learning, and commonly used methods are supervised and non supervised learning. One of the Machine Learning techniques is classification. It uses known data to determine how the new data should be classified into a set of existing categories. A classification is a form of supervised learning. Figure 1 depicts the classification working process. &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xD;
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Literature Survey&#xD;
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In the world death rates are increased due to various types of cancers. Well, known types are lung cancer, breast cancer, blood cancer etc., and can be curable with early detection and treatment which varies from type to type.1 Scientist has a pack of information such as text, facts and images which are properly separated that can be used by doctors to identify the type of disease.2 Tumors can arise in any part of the body and can be transported to various other parts through blood flow in some cases. Early detection of its beginning stages could save a person&#x2019;s life.3 million women every year are diagnosed with breast cancer, but most of them die due to late detection.4, 10 Various methods are used for detection and prognosis of cancer diseases.5 To discover hidden patterns and relationships advanced data mining techniques can be used.6 For cancer progression Machine Learning techniques are very useful.7 Artificial Intelligence has many branches which also includes Machine Learning that compiles various statistical probabilistic and optimization techniques that allow computers to learn from past datasets of various patterns.8 Early detection of malignant stages reduces the risk of cancer spreading.9 Many ML techniques are used to find the important risk factors. 11, 12 In medical sciences, ML techniques are very useful for solving prognostic and diagnostic problems. It is also useful in the extraction of knowledge from a huge amount of data. 13, 14 &#xD;
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Proposed System&#xD;
&#xD;
Cancer which is one of the deadliest diseases in today&#x2019;s world has an effective way of reduction in its earliest stages. Its cure rate depends upon its time of detection. Many works have been going on worldwide, but each work lacks in many aspects such as intelligent prediction and inefficiency in implementing the Machine Learning based cancer prediction system.&#xA0; The main intent of the paper is to propose a cancer prediction system that can predict the earliest stage by analyzing the minute set of attributes selected from the dataset. &#xD;
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In this paper, the constructed expert system named the cancer prediction system predicts cancer types (liver, thyroid, leukaemia, lymphoma, lung) which helps to predict cancer type also saving cost and time. Here considered the feature set of symptoms that includes lump area, pain region, swelling area, weight loss, appetite change, fever etc., and predict the class label to which the symptoms of an individual belongs to Lung, Liver, Leukaemia, Lymphoma, Thyroid, No cancer as the class labels. In our dataset, we will be filling the missing values by using mean (shown in figure 4), Calculating the non-missing value means in a column and replacing the missing values of each column separately independent from the others shown in figure 5 which can only be used with numeric data.&#xA0; Accuracy can be predicted by the percentage of correctly classified instances.&#xD;
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Accuracy = (tp + tn) / (tp + tn + fp + fn)&#xD;
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where tp, fn, fp and tn represent the number of true positives, false negatives, false positives and true negatives respectively.&#xD;
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Recall&#xA0;is calculated as the ratio of the number of true positives divided by the sum of the true positives and the false negatives.&#xD;
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Recall = True Positive / (True Positive + False Negative)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; = True Positive / Total Actual Positive&#xD;
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The Roc curve or Receiver Operating Characteristic curve is a graphical representation that explains the diagnostic ability of a binary classifier system. Once the user enters the cancer prediction system, they need to provide symptoms. Then the prediction system analyzes the symptoms and displays the cancer type as shown in figure 2.&#xD;
&#xD;
The cancer prediction system predicts the cancer type of the person based on the symptoms entered by the user. The proposed system uses a logistic regression classifier for training a machine learning model, which takes the symptoms from the user. Here we are adopting a logistic regression algorithm it works on the Data set (shown in figure 3) for training the machine learning supervised model which is used to predict the class label. Based on the class label predicted cancer type appear. Firstly consider a cancer dataset and select a classifier that has high accuracy level and recall score. Then we use that classifier for training and testing. The entered symptoms are recorded and according to them predict the cancer type. This Proposed system helps in the detection of a person&#x2019;s tendency of cancer before going for clinical and lab tests which is costly and time-consuming. This proposed System generates accurate results which can be regarded with a good performance. &#xD;
&#xD;
Adopted Logistic Regression statistical model is popular which is used for binary classification (example Yes or No, 0 or 1, etc.,) that is for predictions of the types. This is also used for multiclass classification. The hypothesis of logistic regression tends to limit the cost function between 0 and 1. The recall function is used to calculate the ratio of the number of true positives divided by the sum of the true positives and the false negatives. A true positive is an outcome where the model correctly predicts the positive class. A false negative is an outcome where the model incorrectly predicts the negative class. A ROC (Receiver Operating Characteristic) curve is a graph showing the performance of a classification model at all classification thresholds. This curve plots two parameters True Positive Rate and False Positive Rate shown in figure 6.&#xD;
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Some of the main modules which are involved are&#xD;
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Accuracy-score (y_test,y_pred)&#xD;
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Recall-score (y_test, y_pred)&#xD;
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Roc-auc-score(y_test, y_pred)&#xD;
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Logistic Regression()&#xD;
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predict()&#xD;
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Conclusion&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In this world, Cancer becomes a catastrophe for a human being who is suffering from it. Now a day&#x2019;s cancer is a tedious infection in the world. The most successful way to decrease cancer death is to identify it in the early stage. The premature identity of cancer can help cure the illness. So the latest technologies are used to detect the happening of cancer in the premature stage is growing. The main aim of this paper is to identify cancer type based on symptoms given by the user. Here we adopted a supervised learning algorithm and then used the Logistic Regression based on accuracy and recall score i.e., the algorithm which obtains high accuracy level and recalls score. In future, we are going to extend this work by finding the cancer stage and recommending different hospitals and doctors for the particular type of cancer. The advantages of the proposed system are executed with good performance because it generates accurate results.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed&#xD;
&#xD;
Conflict of Interest:&#xA0; The authors declare that they have no conflict of interest.&#xD;
&#xD;
&#xA0;Source of Funding:&#xA0;&#xA0; Not Applicable&#xD;
&#xD;
Authors&#x2019; Contribution:&#xA0;&#xA0; The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3868</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3868</Fulltext></URLs><References>&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [1] Roseline Jecintha I, Poonguzhali. Study on Data Mining Techniques for Cancer Prediction System. Int J Data Mining Techn Appl. 2018; 07(1): 60-63. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [2] Malarvizhi. K, Rajivsuresh kumar G. An Instant Guidance on Cancer Prediction and Care Using Web Application. Int J Innov Techn Expl Engg. 2019; 8 (6S): 225-228.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [3] Gousbi B, Mohamed Shanavas A R. A Study: Breast Cancer Prediction Using Data Mining Techniques. Asi J Comp Sci Tech. 2019; 8 (S2), 52-56.&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [4] priyanga A, prakasam S. The Role of Data Mining-Based Cancer prediction system (DMBCPS) in Cancer Awareness. Int J Compt Sci Engg Commun. 2013; 1(1): 381. &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [5] Samiksha Zaveri, Kamini Solanki. Data Mining Technique Used For Diagnosis and Prognosis of Cancer Disease. J Emerg Techn Innov Res. 2018; 5(11)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; [6] Eshlaghy,&#xA0;A.T,&#xA0;Poorebrahimi A,&#xA0;&#xA0;Ebrahimi M, Razavi A. R,&#xA0;Ahmad L G. Using three machine learning techniques for predicting breast cancer recurrence. J &#xA0;Heal Med&#xA0; Inform. 2013;&#xA0;4(2):&#xA0;124&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; [7] Konstantina Kourou, Themis P.Exarchos,&#xA0; Konstantinos P.Exarchos, Michalis V.Karamouzis, Dimitrios I.Fotiadis. &#xA0;Machine learning applications in cancer prognosis and prediction. Omputat Str Biotech J. 2015; 13: 8-17&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; [8] Joseph A. Cruz, David S. Wishart. Applications of Machine Learning in Cancer Prediction and Prognosis. Cancer Informatics. 2007; 2: 59-77&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; [9] Nath, A.S pal A, Mukhopadhyay S. A survey on cancer prediction and detection with data analysis. Innov Syst Softw Engg. 2019; 12(5): 185-187 &#xA0;https://doi.org/10.1007/s11334-019-00350-6&#xD;
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&#xA0;&#xA0;&#xA0; [10] Yuanjie Zheng,&#xA0;Brad,M., Keller,&#xA0;Shonket Ray,&#xA0;Yan Wang,&#xA0;Emily F. Conant,&#xA0;James C. Gee, Despina &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;Kontos, Parenchymal. Texture analysis in digital mammography: A fully automated pipeline for breast cancer risk assessment. Med Phys. 2015; https://doi.org/10.1118/s1.4921996&#xD;
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&#xA0;&#xA0;&#xA0; [11] Chih-Jen Tseng, Chi-Jie LU, Chi-chang chang, Gin-Den chen. Application of Machine Learning to predict the recurrence-Proneness for cervical cancer. Neur Comp Appli. 2014; 21(3): 349-352. https://doi.org/10.1007/s00521-013-1359-1&#xD;
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&#xA0;&#xA0;&#xA0; [12] Chi-chang chang, Ssu-Han Chen. Developing a Novel Machine Learning-Based Classification Scheme for Predicting SPCs in Breast Cancer Survivors. Front Gen. 2019; https://doi.org/s10.3389/fgene.2019.00848&#xD;
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&#xA0;&#xA0;&#xA0; [13] Maalel, A., Hattab, M. Literature review: Overview of Cancer Treatment and Prediction Approaches based on Machine Learning: Smart Systems for E-Health. Adv Inf Know Proc Springer. 2019; p. 324&#xD;
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&#xA0;&#xA0;&#xA0; [14] George D. Magoulas., Andriana Prentza. Machine Learning in Medical Applications 2049; &#xA0;Springer LNCS; 2001.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Stages of Psychological Development of Child-An Overview&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>74</FirstPage><LastPage>78</LastPage><AuthorList><Author>Dhanasekhar Kesavelu</Author><AuthorLanguage>English</AuthorLanguage><Author> K. Sheela</Author><AuthorLanguage>English</AuthorLanguage><Author> Ponsekar Abraham</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Child Psychology helps us to understand the changes that occurred from childhood and the way to handle it. They are considered as proposals emanated by great authors who played an important role in every individual&#x2019;s development from birth. Child&#x2019;s behaviour management in medical or dental clinic is an essential requirement to complete the health care of a pediatric patient. Aim: To successfully handle a pediatric patient in a clinical setup, one should have sufficient knowledge of psychological and personality development at different stages of childhood. Anxiety is a common problem that affects people of all ages, most prominently appear in childhood and adolescence. Conclusion: It not only has a distressing effect on the child but also their family which can affect the overall well-being of a child. This article gives an overview of various psychological stages which a human undergo from childhood till death.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Autonomy, Behaviour, Challenge, Ego, Psychosocial, Psychosexual, Relationship, Trust.</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
Child psychology is the science that deals with the study of a child&#x2019;s mind and how it function. It also deals with mental power or an interaction between the conscious and subconscious constituents in a child. A child should not only be studied or treated as embryonic adults, but we should know their talents and we should be efficient to understand their actions and the reason behind them. Children are amazing in every way. Understanding pediatric patients and their psychology is an important part of pediatric dentistry. A child&#x2019;s dental health is very important as poor dental health can affect the overall health of a developing child.1 Parent though they help to care for baby&#x2019;s teeth and gums, regular trips to a pediatric dentist is essential to incorporate proper oral care which further prevents the risk of dental disease. The dentist or a paediatrician fails in their treatment if they couldn&#x2019;t satisfy or fulfil the requirements of the uncooperative or psychologically challenged child. Thus, child psychology is important in all medical fields which always has a special role. 2,3&#xD;
&#xD;
CHILD PSYCHOLOGY&#xD;
&#xD;
Child psychology is important for a dentist to know the pediatric individuals better and understand them psychologically about their behaviour, to render better dental service efficiently, through effective communication and incorporate confidence to the child and their parent, which further can reinforce better working environment for the dental team and the patient. Various theories were introduced in 1907 to understand the stages of child psychology.&#xD;
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They are classified as follows (Elbers., 1906)1&#xD;
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	Psychodynamic Theory:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Psychosexual Concept by Sigmund Freud in 1905&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Psychosocial / Personality development Theory by Erik Erikson in 1963&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Cognitive development theory by Jean Piaget in 1952&#xD;
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	Behavioural Learning Theory&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Classical conditioning Theory by Ivan Pavlov in 1927&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Operant conditioning Theory by Skinner in 1938&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Social learning Concept by Albert Bandura in 1963&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Hierarchy needs theory by Abraham Maslow in 1954&#xD;
&#xD;
There is another theory proposed by Margaret.S.Mahler and it is called separation individualization theory. The two well-known&#xA0;theories of child psychology are the Psychosexual theory&#xA0;introduced by Sigmund Freud and&#xA0;the Psychosocial theory give by Erik Erikson. Erikson in his theory depicted how social relationship and interaction with peer groups played a major role in the development of an individual while Freud&amp;#39;s theory tells various sexual changes which a child undergoes from birth and the influence of those changes in their future life. This article discusses in detail various stages of child development according to Sigmund Freud &amp; Erik Erickson.3,4,5&#xD;
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PSYCHOSOCIAL THEORY:&#xD;
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This theory by Erik Erikson has eight sequential stages of individual development that have an influence on the socio-economical, psychological and biological status of an individual throughout their lifespan.2,3 This multi-centred approach has influenced several fields of study such as pediatric, gerontology, personality and identity formation, and life cycle development.4The stages of child psychological development according to this theory are explained below.&#xD;
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Stage One:&#xD;
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This stage which is considered a fundamental stage of child development ranges between birth and one year of age(infancy). Child&#x2019;s caregivers play a major role in this stage because an infant is completely dependent on them in developing trust in life.5At this point of development, the child is completely dependent on adult(parents/caregivers) for everything they need to survive in life such as food, love, warmth, safety, and nurturing. If they failed to attain these requirements from their dependents, the child will develop mistrust in life. Thus, hope is an important outcome at this stage of a child&amp;#39;s development which is entirely based on trust.&#xD;
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Second Stage:&#xD;
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The second stage of Erikson&amp;#39;s theory of psychosocial development takes place during early childhood(2 to 3 years) and is concentrated on an individual&#x2019;s control and independence. At this stage, children start gaining little independence. They begin to perform on their own and start taking simple decisions about what they want in life. A sense of autonomy is achieved by allowing the children to make choices and gaining control over themselves. Erikson believed that toilet or potty training plays a major role in this stage which motivates the child to develop a sense of autonomy, independence and a feeling of control over themselves. If they fail to achieve these essential controls they develop shame and doubt which affects their future social development. During this stage children&amp;#39;s gain more control over food choices, toy preferences, and clothing selection. Thus &#x201C;will&#x201D; is the only outcome at this stage.4&#xD;
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Third Stage:&#xD;
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During the child&#x2019;s preschool era (3 to 5 years), they begin to explore their power and control over the world through playing and developing social interactions with neighbours and peers. Children who were able to initiate themselves at this stage were successful in their life and are capable of leading others in their life. Those who fail to acquire these qualities and skills are left with a sense of guilt, self-doubt, and lack of initiative. Understanding the &#x201C;Purpose&#x201D; of life is the main outcome of this stage.&#xD;
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Fourth Stage:&#xD;
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The fourth psychosocial stage takes place during the early school years from approximately&#xA0; 6 to 11 years. Events such as social interactions help to adapt the children&amp;#39;s to develop a sense of pride through their participation and abilities. Children need to accompany by these social and academic demands. Such children who were successful in this industry leads to a sense of competence,&#xA0; failure of which results in a feeling of inferiority. Children&amp;#39;s adopt such behaviour in their schools and once they acquire these features, they gain&#xA0; &#x201C;confidence&#x201D; which is the main outcome at this stage of a child&amp;#39;s development. &#xD;
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Fifth Stage:&#xD;
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The fifth psychosocial stage takes place during adolescence(12 to 18 years). This stage plays an important role in developing a sense of personal identity in an individuals life. Teenagers develop a sense of self and personal identity, their ability to stay true to themself, maintaining a social relationship with an identity. Failure to acquire these qualities of life at this stage leads to a weak sense of self, feeling of insecurity, remain&#xA0;unsure of their beliefs, the role of confusion about themselves and their future. Ego identity is defined as the conscious&#xA0;sense of self that is developed through social interaction, which continuously changes due to various experiences and information we acquire in our daily life through interactions with others that helps guide our actions, behaviours and beliefs we age. Due to these new experiences in our day to day life,&#xA0;we also take up many challenges that can help or hide the development of identity. Our identity through developing &#x201C;fidelity&#x201D; (faithfulness to a person) gives each of us an integrated and cohesive sense of self that endures through our lives at this stage.&#xA0;5,6,7&#xD;
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Sixth Stage:&#xD;
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Young adults (19 to 40 years) at this age, develop intimate and loving relationships with other people. If an individual is successful in developing such strong relationships, they can form an enduring and secure relationship at this stage, while failure results in loneliness and isolation. Each step of life build up skills developed in the previous stage. According to Erikson personal identity is very important for developing intimate relationships and many studies have demonstrated that those with a poor sense of &#x2018;self&#x2019; resulted in less committed relationships and are more likely to be affected emotionally due to social isolation,&#xA0;loneliness, and depression. Achievement with the positive qualities of this stage results in the virtue known as love. Thus, this stage is marked by the ability to form lasting, meaningful relationships with other people.&#xD;
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Seventh Stage:&#xD;
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Middle adulthood(40 to 60 years)&#xA0; is the age during which an individual need to generate or nurture things that will outlast them. This is the stage of work, parenthood, career and family. Generativity is accomplished often by having children or creating a positive change that benefits other people such as home and community. Success at this stage leads to feelings of usefulness, and pride moments in life, while failure results in stagnation, shallow involvement in the world. Proud moments at this stage being, watching once children grow into adults, unity with life partners and finally &#x2018;care&#x2019; is the virtue achieved when this stage is handled successfully.6,7 &#xD;
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Eighth Stage:&#xD;
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The final psychosocial stage occurs during old age(65 to death) and is centred and concentrated on &#x2018;reflecting&#x2019; back on life. During this stage of development, people recollect the events of their lives, either accepting that they lead a happy life(sense of fulfilment)&#xA0; in the past or if they regret the things they did or didn&amp;#39;t do. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair. People who feel that they had a sense of peace in a past life will accomplish a sense of integrity. Completing this phase successfully results in looking back on the past with few regrets and more satisfaction. These individuals will attain&#xA0;wisdom (knowledge), even when confronting death. Thus Erikson&amp;#39;s theory involves all ages of man till death. A ninth stage was added by Erik Erikson&#x2019;s wife, Joan Erikson which incorporated new challenges experienced with continued ageing with added experiences of previous eight stages of psychosocial development6.&#xD;
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Many clinical evaluation tools have been used by many researchers and they are considered to be originated from Erikson&amp;#39;s theories on various psychosocial stages of development in pediatric patients. Understanding these theories also paved way for the recovery of mentally ill patients, though it is difficult.7 The Erikson Psychosocial Stage Inventory (EPSI) model was designed and is considered to be a reliable tool used to assess the psychosocial development of the patient.8&#xD;
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Freud&#x2019;s Psychosexual Stages:&#xD;
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Freud identified various stages of child development and emotional pleasures a child experience during their developmental period.9 Freud Psychosexual theory focuses on two elements of human nature such as "sex" and "aggression&#x201D;.A child&amp;#39;s development along with socialization gives way to the formation of a child&amp;#39;s libido. Thus, obtained child&#x2019;s libido can be because of anxiety or neuroses.10In this stage, pleasure-seeking energies of the&#xA0;id&#xA0;become focused on certain erogenous zones. An erogenous zone is described as an area of the body that is particularly sensitive to stimulation. The personality component called the &#x201C;id&#x201D; composed of unconscious psychic energy that operates to satisfy the basic urges, needs, and wishes of a person. The immediate gratification of persons need is obtained through the id which works based on the pleasure principle. Major components of personality named by Freud include&#xA0;id,&#xA0;ego,&#xA0;and superego.8&#xD;
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Freud&#xA0;explained ego&#xA0;as part of the personality that mediates the demands of&#xA0;the id, the superego, and reality. According to Freud id is essentially the basic part of the personality that stimulates people to satisfy their most primal needs. Ego is the part that constitutes things we "know" and how we think about and organize information and conscious experiences. It is rational by nature, whereas the id is irrational.11,12The superego is a part of the personality that forms later in childhood as a result of the upbringing of an individual&amp;#39;s social influences. The most important duty of ego is to strike a balance between id and superego to make sure that fulfilling the needs of the id and superego conforms to the demands of reality. &#xD;
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The psychosexual energy, or&#xA0;libido, was described as the driving force behind one behaviour and is dependent on social, psychological and biological factors. A psychoanalytic theory&#xA0;suggested that personality is accomplished at the age of five. Attaining this earlier may play a major role in personality development and continue to have influenced later in life. If these psychosexual stages are completed successfully, a healthy personality results. If certain issues are not resolved at an appropriate stage,&#xA0;fixations&#xA0;can occur. A fixation is defined as the persistent focus on an earlier psychosexual stage. Unless this conflict is corrected, the individual will remain "stuck" in this stage. A person who is failed (fixed) at the oral stage, for example, maybe over-dependent on others and may seek oral stimulation through&#xA0;certain habits like smoking, drinking, or eating (to gain pleasure). According to Sigmund Freud Psychoanalytic theory, our body has two types of neurons, Phineurons associated with conditions of emotions and&#xA0; Psineurons associated with storage of emotions. Psychoanalysis also suggests that childhood trauma and Oedipal phenomena are necessary for the development of psychoneuroses.8,9&#xD;
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The five psychosexual stages include the oral, anal, phallic, latent, and genital stages and the erogenous zone associated with each stage serves as a source of pleasure. The stages are explained as follows.&#xD;
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The oral Stage:&#xD;
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This stage is from birth to one year. At this stage, the erogenous zone is the mouth. During the oral stage, the primary mode of interaction for an infant occurs through the mouth. The rooting and sucking reflex is especially important for an infant and it occurs through the mouth.&#xA0;The mouth is the main organ for eating, and the infant seeks pleasure from oral stimulation by accomplishing gratifying activities such as tasting and sucking. Infants entirely depend on caretakers (who are responsible for feeding the child), and they develop a sense of trust and comfort through this oral stimulation. The primary conflict at this zone is the process of weaning, the child breaking its dependent relationship with caretakers. Dependency and aggression occur if the fixation on such habits occurs at this stage. Oral fixation can result in problems with drinking, eating, smoking, or nail-biting to accomplish their pleasure through other sources.10&#xD;
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The Anal Stage:&#xD;
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The anal stage is from 1-3 years. Bowel and Bladder control is considered in the erogenous zone during this stage. According to Freud, the primary focus of the&#xA0;libido&#xA0;was on controlling bladder and bowel movements. The major conflict at this stage is toilet training, for the child to learn and establish control of their bodily needs. The child must be successful in accomplishing such activity to meet their body needs. According to Freud, success at this stage depends on the way the parents adapt to toilet training of their child. Parents who encourage the child through praise, rewards bring a positive outcome to children. However, not all parents provide support, motivation and encouragement to the children during this stage. Some improper parental approach such as punishing the child can result in negative outcomes(shame) in the children. Sometimes it may lead to destructive personality (anal expulsive)of individual development. The early beginning of toilet training by some parents leads to an anal-retentive personality&#xA0;where the individual develop stringent, orderly, rigid, and obsessive qualities.11&#xD;
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The Phallic Stage:&#xD;
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This stage ranges from 3 to 6 years. Genitals are considered as an erogenous zone at this stage. Freud suggested that during the phallic stage, the primary focus of the libido is on the genitals. Children&amp;#39;s begin to understand the differences between males and females and the boys begin to view their fathers as a rival for the mother&#x2019;s affections.&#xA0;The Oedipus complex&#xA0;describes the feelings of possessiveness towards the mother and the desire to replace the father. The boy child also fears that he will be punished by the father for these feelings, and fear of anxiousness was termed&#xA0;castration anxiety by Freud. A similar set of feelings experienced by young girls is called Electra complex.12&#xD;
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The latent period:&#xD;
&#xD;
This stage ranges from 6 years to puberty. Though sexual feelings are inactive during this stage, the superego continues to develop while the feelings and energies of the id are suppressed. Young children&amp;#39;s wanted to develop social skills, values and relationships with peers and adults outside of the family. The development of the&#xA0;ego&#xA0;and&#xA0;superego&#xA0;constitute this period. When children enter into school and become more concerned with peer relationships and hobbies, ego and superego develop. This is the period of exploration in which the sexual energy is either inhibited or dormant. This energy may be still present, but it is substituted into other areas such as intellectual conversation and social interactions. It further promotes the development of social communication skills and&#xA0;self-confidence. According to Freud, children may become fixed or "stuck" in this phase which may result in immaturity and an inability to fulfil the relationships as an adult.13&#xD;
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The genital stage:&#xD;
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This stage ranges from puberty to death. The emergence of the puberty stage causes the libido to become active once again. An individual develops a strong sexual interest in the opposite sex during this stage of puberty and lasts throughout the rest of a person&amp;#39;s life. The goal of this stage is to establish a balance between the various life areas such as the welfare of others growth and individual needs. Unlike the earlier stages of development, Freud believed that the ego and superego were fully formed and functions efficiently at this point. Younger children are ruled by the&#xA0;id, which demands immediate satisfaction with their basic needs and wants. Thus the basic features of Freud developmental theory of psychoneuroses includes13, Oedipus complex(an evolutionary-based &#x201C;play behaviour&#x201D; that manifests through competition.)&#xA0; which is a universal experience in children and&#xA0;becomes a conscious desire in children between the age of 3-5 years old. The unconscious ego begins to develop and conflicting feelings are prevented by using a defence mechanism. This leads to neurotic behaviours, perplexes, and disguised dream imagery.14,15&#xD;
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Conscious, unconscious thinking and ego constitutes the structural theories of mind. The id is unconscious thinking and is inaccessible (no interaction with the outside world)which primarily involves gratification. It can be a biological, instinctual drive of an individual. The id contains all the depressed feelings and negative thoughts of an individual. Since it has no relationship with the outside world, the ego enters into it to create interaction between the id and the real world. Irrespective of age, a child&#x2019;s behaviour has an intimate relationship between physical and mental health. They also play an important indirect role in the emotional well being of an individual.16&#xD;
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CONCLUSION:&#xD;
&#xD;
Child psychology is considered to be an important component of a pedodontist&#x2019;s training as it plays a major role in the clinical practice of many pediatric practitioners to handle the behaviour of pediatric patients efficiently. It is also necessary that the medical professionals should also be trained in special needs psychology, sedation and general anaesthesia for children, which are often sensitive issues for both parents and children. The anxiety of children towards dental treatment and doctors can be efficiently managed only by understanding child psychology. Some children may also develop a fear for doctors (white coat syndrome) and dentist because of the pain associated with toothaches and dental procedures. By understanding child psychology and proper child anaesthesia techniques, a pediatric dentist can communicate to meet the needs of his patients, thus better leading to an encouraging experience for your young ones.&#xD;
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ACKNOWLEDGEMENT: NIL&#xD;
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CONFLICT OF INTEREST: No conflict of interest.&#xD;
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FUNDING: No source of funding.&#xD;
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CONTRIBUTION:&#xD;
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Conceptualization &amp; Data Curation- Dr.Dhanasekar Kesavelu, Dr. K.Sheela&#xD;
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Writing Original Article- Dr.K.Sheela&#xD;
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Review &amp; Editing &#x2013; Dr.Dhanasekar Kesavelu&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3869</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3869</Fulltext></URLs><References>1.Elbers E. 11 Children&amp;#39;s Theories and Developmental Theory. Advance Psych. 1986;36:365-403.&#xD;
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2.Kivnick HQ, Wells CK. Untapped richness in Erik H. Erikson&#x2019;s rootstock. Gerontol. 2014 Feb 1;54(1):40-50.&#xD;
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3.Knight ZG. A proposed model of psychodynamic psychotherapy linked to Erik Erikson&amp;#39;s eight stages of psychosocial development. Clin Psych Psychoth. 2017 Sep;24(5):1047-58.&#xD;
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4.Miller PH. Theories of developmental psychology. Macmillan; 2002.&#xD;
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5.Vogel-Scibilia SE, McNulty KC, Baxter B, Miller S, Dine M, Frese FJ. The recovery process utilizing Erikson&#x2019;s stages of human development. Comm Men Hea J. 2009 Dec 1;45(6):405.&#xD;
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6.Orenstein GA, Lewis L. Eriksons Stages of Psychosocial Development. InStatPearls [Internet] 2020 Mar 9. StatPearls Publishing.&#xD;
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7.Darling-Fisher CS. Application of the modified Erikson psychosocial stage inventory: 25 years in review. West J Nursing Res. 2019 Mar;41(3):431-58.&#xD;
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8.Rosenthal DA, Gurney RM, Moore SM. From trust on intimacy: A new inventory for examining Erikson&amp;#39;s stages of psychosocial development. J Youth Adolesc. 1981 Dec 1;10(6):525-37.&#xD;
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9.Sauerteig LD. Loss of innocence: Albert Moll, Sigmund Freud and the invention of childhood sexuality around 1900. Medical Hist. 2012 Apr;56(2):156-83.&#xD;
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10.Lantz SE, Ray S. Freud Developmental Theory. In-State Pearls, May 10, 2020.StatPearls Publishing.&#xD;
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11.Boag S. Ego, drives, and the dynamics of internal objects. Front Psych. 2014 Jul 1;5:666.&#xD;
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12.De Sousa A. Freudian theory and consciousness: A conceptual analysis. Mens Sana Monographs. 2011 Jan;9(1):210.&#xD;
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13.Kupfersmid J. Freud&amp;#39;s clinical theories then and now. Psychody Psych. 2019 Mar;47(1):81-97.&#xD;
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14.Downey JI, Friedman RC. Biology and the Oedipus complex. Psychoanal. Q. 1995;64:234-64&#xD;
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15.?echowski C. Theory of drives and emotions&#x2013;from Sigmund Freud to Jaak Panksepp. Psychiatr Pol. 2017 Dec 30;51(6):1181-9.&#xD;
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16.Durgawale PM, Patil MS, Mohite RV. Social Aspects of&#xA0; Behavioural Problems in Rural School-Age Children. Int J Cur Res Rev. 2020 Oct;12(20):140.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Biogenic Synthesised Nanoparticles and its Role in Solanum Lycopersicum&amp;#39;s Disease Management&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>79</FirstPage><LastPage>84</LastPage><AuthorList><Author>Maheshwari MS</Author><AuthorLanguage>English</AuthorLanguage><Author> Saritha V</Author><AuthorLanguage>English</AuthorLanguage><Author> Gopenath TS</Author><AuthorLanguage>English</AuthorLanguage><Author> Kanthesh BM</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Objective: We evaluated biogenic synthesized nanoparticle (NPs) from plant extracts and their role was studied in Solanum Lycopersicum. Background: Several disease-causing organisms (pathogens) can infect Solanum Lycopersicum(Tomato). The most common diseases that affect tomatoes are caused by various fungi, bacteria, and viruses. The utility of plant extracts for NPs synthesis has various advantages such as accessibility and safety when handling. Methods: We review bacterial diseases of tomatoes, the role of medicinal plants to control diseases. The study also includes the green synthesis of NPs and their application to control phytopathogens in Solanum Lycopersicum. Results: This review critically assesses the role of medicinal extracts synthesized different NPs to control phytopathogens in tomato, application of NPs in tomato plant disease, antimicrobial studies in detail. Conclusion: The need for environmental non-toxic synthetic protocols for NPs synthesis leads to the developing interest in biological approaches that are free from the use of toxic chemicals as by-products. Hence, there is an increasing demand for green nanotechnology. We discussed the role of many medicinal plant extracts to control phytopathogens and their applications in tomatoes.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Solanum Lycopersicum, Nanoparticles, Phytopathogen, Bacteria, Antimicrobial, plant extracts</Keywords><Fulltext>&#xA0;INTRODUCTION&#xD;
&#xD;
Agriculture plays an important role in being the backbone of the economic system of a country, with 60% of the population depending on livelihood. An employment opportunity is provided by agriculture along with food and raw material supply. India has been bestowed with a good climate suitable for growing many kinds of fruits, vegetables, spices, and nuts with an immense nutritional benefit for mankind. Vegetables are important sources of many nutrients, dietary fibre, vitamins, potassium, and naturally low in fats and calories. Most of the vegetables have all these properties and tomato is considered one among them.&#xD;
&#xD;
Tomato (S.lycopersicum) belonging to the Solanaceae family and the genus Solanum is one of the most important vegetable crops after potato. Because of its widespread and health-promoting compounds, it is the model organism for research.1 Tomato cultivation in India is 814000 ha during 2018-19, and the production is 20515000MT (metric tons), by the Indian farmers an average production of tomato is about 25.2 tones/ha. This may vary depending on the season, region, and diseases. Major limiting factors towards the decreased productivity of to matoyield are diseases caused by bacteria, fungi, viruses, nematodes, insect pests, and viroids2. Major bacterial diseases are Bacterial Canker, Bacterial Wilt, Bacterial Spot, and Bacterial Speck. The most common fungal diseases are Anthracnose, Fusarium wilt, Powdery mildew, Late blight, Curly top viral disease, and Root-knot by nematodes.&#xA0; One of the major reasons for the decrease in tomato yield, hence we require a sustainable approach for the management of plant disease. Different chemical methods have been employed to control pathogens that may be hazardous to the environment.2 Even though various biological methods are employed, they have their limitations. Therefore, a sustainable safe strategic environmentally friendly method is required. The use of NPs is one such safe method. The advantage of the opting NPs is that the reagents used in the synthesis are not hazardous and making them eco-friendly and effective.&#xD;
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Nanotechnology is an evolving field of science that involves the manipulation of matter at the nano-scale level to create NPs. NPs can be defined as any solid particle ranging in size from 1-100nm.3 There are various studies carried out that help us understand the importance of physicochemical properties of NPs that aid in designing NPs that control the accumulation and targeted disease treatment. NPs have tremendous applications in various industries including- electronics, chemicals, agriculture, environmental, pharmaceuticals, optical, ceramics, food processing and storage, water treatment, and so on. NPs can be metallic mostly made of the following metals. Silver is the most widely studied and used NPs as it is a very effective anti-microbial agent, also it is used in various other industries.4 Gold NPs are used in immunochemical methods for the detection of various protein interactions. Alloys exhibit different properties compared to their component and these have been exploited to produce NPs with wide applications. Metal oxide NPs have also been synthesized with various strategies and possess wide application in detecting harmful gases, solar cells, electroanalysis for the detection of biomolecules, water treatment as certain metal oxide NPs are excellent adsorbents and so on.5 Awareness received towards the biogenic synthesized NPs is because of the eco-friendly nature of NPs as well as low toxicity and biostability. Instead of using chemicals against pathogens, we can choose a better method to establish an eco-friendly environment.&#xD;
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To build a safe environment free from toxins, a safe approach to &#x2018;Biosynthesis&#x2019; or &#x2018;Green synthesis&#x2019; is required. Green synthesis of the NPs can be achieved by the utilization of bacteria, fungi, algae, and plant extracts. The utility of plant extracts for NPs synthesis has various advantages such as accessibility and safety when handling. These products are known as biogenic NPs.6Various medicinal plant extracts are now used to treat chronic illnesses like diabetes, cancer, and even neurodegenerative disorders like Alzheimer&amp;#39;s. Different medicinal plants were used to synthesize NPs thus incorporating the medicinal property of the plant into the biosynthesized NPs. Plants like Piper longum, Plumeriarubra, Crataevanurvala, Nigella sativa have been utilized to synthesize silver NPs(AgNPs).7The perpetual contribution of people in medicinal plant usage has led to the present-day sophisticated processing and their use as drugs.&#xD;
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BACTERIAL DISEASES IN TOMATO&#xD;
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Tomato is prone to numerous bacterial diseases. Since bacterial pathogens double their population under favourable environmental conditions and colonize in the internal spaces of plants, it is not easy to control bacterial diseases.8 Based on their scientific and economic importance, the ten most important bacterial plant pathogensare&#xA0;Pseudomonas syringaepathovars,&#xA0;Ralstoniasolanacearum, Agrobacteriumtumefaciens, X.oryzae&#xA0;pv.&#xA0;oryzae, X.campestrispathovars, X.axonopodispathovars, Erwiniaamylovora, Xylellafastidiosa, Dickeya (dadantii and solani), and Pectobacteriumcarotovorum.9The most common bacterial diseases are bacterial wilt (Ralstoniasolanacearum), bacterial spot (X.campestrispv.vesicatoria), bacterial canker (Clavibactermichiganensissubsp. Michiganensis (Cmm) and bacterial speck (P.syringaepv. tomato). Cmm which causes the Bacterial canker of tomato is a gram-positive actinomycete. Bacterial canker has been considered as a devasting bacterial disease leading to less production of tomato.10 Contaminated soil, plant debris, and seeds can be the major reason for systemic infections caused by Cmm. At the early stage of infections fruit quality and yield may be affected leading to the death of the plant.11 At a temperature range of 25-30oC with neutral to slightly alkaline pH on nutrient glucose broth medium the causative agent of bacterial canker, Cmmgrows better12.Bacterial canker in tomato caused by Cmma threat that affects productivity. Mechanism of pathogenicity can be studied where transcriptional regulators and virulence factors play a key role and understanding the host bacterial interaction aid in developing new resistant varieties.11 Despite management and breeding efforts, Bacterial canker is the most dangerous bacterial disease with severe outbreaks. Bacteria first spread throughout the plant and then the symptoms are visible which is difficult to control, either by removing the diseased plant or by the chemical treatment.12R.solanacearum, a soil-borne bacteria causative agent of Bacterial Wilt, a serious tomato disease that affects production in major climatic regions of the world.14 The isolation of these bacteria revealed the presence of sucrose and the pathogen dependency on sucrose for its virulence on vegetable crops like tomato and potato. During summer maximum yield loss occurs and the major impact of bacterial wilt on tomato is seen in Karnataka, Madhya Pradesh, West Bengal as well as Maharashtra.R.solanacearum a gram-negative b-proteobacteriumcauses bacterial wilt in food crops like tomato, potato, ginger, and banana along with other plant species. Since the bacteria live in soil and weed hosts for many years it is difficult to control by chemicals.15 Because of its systemic action, R.solanacearum affects the tomato plants at the reproductive as well as vegetative stage causing bacterial wilt that is difficult to control by using chemicals.&#xD;
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Another important disease is bacterial spot caused by four species of Xanthomonas:&#xA0;&#xA0; &#xD;
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&#xA0;X.euvesicatoria, X. vesicatoria, X. perforans, and X. gardneri in tomato, by causing lesions on fruits which decreases the quality of fruit and also resulting in severe yield loss.16 X. euvesicatoria, X. perforans and X. vesicatoria were the important pathogenic species identified by the analysis of phylogenetic and biochemical methods. When pathogenicity was assessed in Australian tomato, chilli, and capsicum plants, they showed at least five Xanthomonas species that cause bacterial leaf spot.17 In Iran, the Bacterial spot in tomato is caused by X. perforans along with &#xA0;&#xA0;X. axonopodisand X. campestri.s18 .X.campestrispv. vesicatoria may not be the only pathogen that causes lesions on tomato leaves, several other pathogens like X. campestrispv.&#xA0;raphani&#xA0;and&#xA0;X.&#xA0;arboricola&#xA0;are also involved. To understand the pathogen and its effect, the mechanism of biological and epidemiological aspects of the pathogen plays the main role. X. perforans that infects the only tomato causing bacterial spot was also seen and identified from pepper plants that showed similar symptoms on leaves and fruits. The bacterial spot spreads through the air, water, symptomatic plant debris, and seeds.19 The bacterial spot in tomato, caused by X.campestrispvvesicatoria was isolated in many countries, this was supported by the cultural, morphological, and biochemical tests.20&#xD;
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P.syringaepv. Tomato, a seed-borne pathogen causes bacterial speck on tomatoes. A relatively low temperature i.e.,12oC &#x2013; 25oC, and high humidity are required for the occurrence of disease. At early stages, on tomato leaves minute dark brown spots surrounded by yellow halo appeared, and at later stages burning of leaf margins, stunted growth appears. Infected seeds and contaminated weeds can be one of the main reasons for the spread of the bacterial pathogen, P.syringaepv tomato that causes bacterial speck in tomato.19 Changes adopted in the cropping system create a suitable environment for pathogens, for example, P.syringae causative agent of bacterial speck, normally known to be found in the open field can also be frequently seen in the protected field.14P. syringae causative agent of bacterial speck encodes a sigma factor AlgU that controls those genes that express alginate biosynthesis. It was found AlgU can be one of the major virulence factors for P.syringaepv tomato DC3000.21Seedling stage infection caused by P.syringaepv. Tomato leads to decreased quality and loss of yield. Bacterial speck causing significant damage to tomato has led to the development of many biological control measures22. Since Chemicals usage releases toxic substances resulting in a hazardous environment and increased demand for safe food has led to the development of an alternative and eco-friendly approach to gain pathogen-free plants. A biological approach is essential for the welfare of mankind.&#xD;
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ROLE OF MEDICINAL EXTRACTS TO CONTROL PHYTOPATHOGENS IN TOMATO&#xD;
&#xD;
Most of the currently available drugs are directly or indirectly derived from a plant source. Sumerian clay slab encryption is one of the oldest written pieces of evidence for using medicinal plants to prepare various drugs which is about 5000 years old. Even Indian Vedas, Chinese literature, Ebers Papyrus mentions treatment using plants and their parts. Over time the importance of medicinal plants decreased but since the early 20th century, the need for natural compounds increased due to adverse side effects from synthetic compounds. The shift from single target to multidrug target approach for complex diseases offers a platform for herbal formulations. Phytochemical studies on various medicinal plants show the presence of various secondary metabolites that possess a wide range of pharmacological activities like anti-inflammatory, anti- cholinesterase, hypolipidemic, antioxidant, anti-microbial, etc. Aqueous and organic extracts prepared from leaves, stems, and fruits of WithaniasomniferaLshowed maximum antifungal activity against the target pathogen Fusariumoxysporum f. sp.radicis- lycopersici (FORL)causal agent of Fusariumcrown and root rot which is one of the devasting diseases in tomato.23 The first report on the in vitro antifungal activity of chloroform, ethyl acetate, and butanol extracts from W. somniferaleaves, stems, and fruits, against FORL. Results showed that W. somniferaextracts exhibited a significant antifungal effect against this pathogen. Bioactive compounds from W. somniferaextracts, involved in the registered antifungal activity, could serve as a potential source of naturally derived fungicides once their efficacy is proved in vivo on FORL-infected tomato plants.23 The potency of aqueous extracts of TageteserectaL. (marigold) in controlling bacterial speck disease in tomato plants. The experimental design consisted of two groups of 50 plants each: group 1&#x2013;sprayed with sterile water (control); and group 2 &#x2013; sprayed with the marigold extract. Spraying was performed under aseptic conditions at the third node from the base of each plant. The observations indicate that marigold extract could be a promising biopesticide24. Trichodermaviridae was most effective in the reduction process of A. solaniand T. harzianum. T. viridaealso showed the highest inhibition in volatile and non-volatile trials. Six plants extract viz., Adhatodavasica(Nees), Azadirachtaindica(A Juss),Ocimujm sanctum (L), Allium sativum (L), Datura metal (Linn), and Zingiberofficinale were selected to evaluate their in-vitro efficacy of 5%, 10% and 20% concentration against the A. solani. A. sativumwas the most effective one against A. solani, followed byA. indica25.All these studies show the wide usage of medicinal extracts and their properties which can be used to build a safe environment.&#xD;
&#xD;
GREEN SYNTHESIS OF NPS&#xD;
&#xD;
NPs can be synthesized using various methods-physical, chemical, biological as well as hybrid techniques. There are two main approaches in the synthesis of NPs the- top-down and bottom-up. The classical top-down approach starts from bulk material and is scaled down to parts and finally to nanoscale details. On the contrary, the bottom-up approach includes the assembly of atoms to form larger nanoscopic structures. This includes physical and chemical methods. Physicalmethods mainly are based on top-down strategy. These methods break down the bulk counterpart by using mechanical pressure, high energy radiations, electrical energy, evaporation, etc to produce fine NPs. These methods are useful as they produce uniform monodisperse NPs but are less economical as they produce ample waste. Chemical methods are under the bottom-up category of NPssynthesis and they are not eco-friendly because of some toxic substances.26 Green syntheses is an alternative and safe approach to synthesize NPs using biological materials like microbes, plant extracts, or by-products of organisms like proteins, lipids by using various biotechnological tools. This bio-assisted method provides low-toxic, cost-effective, environmentally friendly products. NPs synthesized via bioinspired methods offer very interesting applications in biomedicine and related field.27 Plants have been an exemplary source of drugs since ancient times.&#xD;
&#xD;
The utility of plant extracts as reducing agents has various advantages such as Accessibility and safety when handling.NPs can be metallic mostly made of the following metals like gold, silver, etc. Gold NPs are used in immunochemical methods for the detection of various protein interactions. Alloys exhibit different properties compared to their component and these have been exploited to produce NPs with wide applications. Metal oxide NPs have also been synthesized with various strategies and possess wide application in detecting harmful gases, solar cells, electroanalysis for detection of biomolecules, water treatment as certain metal oxide NPs are excellent adsorbents and so on.5 Biosynthesis of metal NPs using medicinal plant extract is a safe, economical method, which protects mankind and helps to maintain a green environment.&#xD;
&#xD;
ROLE OF MEDICINAL EXTRACTS SYNTHESIZED NPS TO CONTROL PHYTOPATHOGENS IN TOMATO&#xD;
&#xD;
A study showed that candidate antibacterial agents made from copper oxide NPs loaded onto the surfaces of graphene oxide sheets to form the series GO&#x2013;Cu NPs. Antibacterial activity results indicated that GO&#x2013;Cu NPs had a 16-times higher antibacterial activity.22 The study on antimicrobial screening of silver NPs (AgNPs) revealed strong inhibition of gram-negative and gram-positive bacteria as well as various fungal species. The effective inhibition of both gram-negative and gram-positive bacteria by AgNPs derived from Moringaoleiferaleaf extracts is of great significance as it demonstrates their broad-spectrum antibacterial activity.3 A sustainably synthesized copper oxide NPs (CuONPs) using papaya leaf extracts was obtained to study the bactericidal activity against Ralstonia solanacearum, where the results showed that CuONPs possessed a strong antibacterial activity, by preventing biofilm formation, showing reduced swarming motility, and also ATP production was altered. Transmission electron microscopy (TEM) results revealed that the interaction of CuONPs on bacteria caused cytomembrane damage.28 This study continued with green Se NPs (selenium NPs) are formed by simple mixing of Withaniasomnifera (W. somnifera) leaves extract and selenious acid (H2SeO3)solution. The synthesized Se NPS by FT-IR spectrum confirms the presence of functional groups which were associated with bioactive molecules. The combination of phytocompounds and NPS serves an efficient role in its multifaceted pharmacological properties29. Cobalt NPs were synthesized by using Drumstick tree leaves. The NPS was also characterized with the help of many different techniques which are Ultraviolet-Visible(UV-VIS) spectroscopy, Fourier transforms infrared (FTIR) spectroscopy and Scanning electron microscopy (SEM). The characteristic UV peak of Co NPs was obtained. Phytochemicals play an important role as capping and reducing agents in nano synthesis. AgNPs obtained from the Clitoriaternateand Solanumnigrumhave very strong inhibitory action against Pseudomonas aeruginosa followed by Staphylococcus aureus, Escherichia coli, and Streptococcus viridans. &#xD;
&#xD;
The AgNPs of Clitoriaternateashowed higher activity than the AgNPs of Solanumnigrumagainst nosocomial pathogens. This study showed a simple, rapid, and economical route to synthesize silver NPs. Gold NPs with an average size of 32.96 &#xB1; 5.25 nm were synthesized using Garciniamangostanacommonly known as mangosteen fruit peel.30 Biosynthesis of copper NPs, gold-iron, and silver iron core-shell NPs using extracts of Punicagranatumwas also reported.31 and characterized using UV-VIS spectroscopy,&#xA0; FTIR, and TEM. The synthesis of NPs was confirmed by UV-VIS spectrophotometer, X-ray diffraction (XRD), and SEM. Their observation through particle size analyzer (PSA) and TEM showed dominant spherical morphology with an average diameter of 5 nm.32The green synthesis shows that the environmentally benign and renewable sources ofMoringaoleifera, Murrayakoingii, and Ocimumsanctumare used as effective reducing agents for the synthesis of AgNPs. This biological reduction of AgNPs would be a boon for the development of a clean, non-toxic, and environmentally acceptable green approach to produce AgNPs, involving organisms even ranging to higher plants. The formed AgNPs are highly stable and have significant activity against diarrhoea bacterial strains (Escherichia coli, Staphylococcus aureus).33 In another work, it was demonstrated that chitosan NPs (CNPs) have significant antifungal activity C. gelosporidies,&#xA0;P. capsici,&#xA0;S. sclerotiorum, F. oxysporum,&#xA0;and&#xA0;G. fujikori, phytopathogens of tomato.34CNPs can be effectively used against plant phytopathogenic fungi ensuring a plethora of positive outcomes ranging from antifungal, antibacterial activities, plant growth promotion, biocidal activities, and reduction in harmful effects to humans and the environment due to chemical fertilizers. The study35shows that biosynthesized NPs can be used as an alternative to conventional fungicides and become helpful in minimizing environmental pollution. Meliaazedarach extract-AgNPs (MLE-AgNPs) is used as an eco-friendly approach to control&#xA0;the Fusarium&#xA0;wilt of tomatoes at various concentrations by suppressing the growth of&#xA0;F. oxysporum. MLE-AgNPs have shown strong potential to restrain the fungal population both in lab and field trials in a dose-dependent manner. The application of NPs on pre-infected roots of tomato plants successfully reduced the wilt by increasing the resistance of the host plant and enhancing the growth parameters of tomato seedlings. The study carried by,36 to investigate the antifungal activity of silver NPs synthesized using Citrus sinensis peel extract against fungal phytopathogens isolated from diseased tomato. The isolated fungal phytopathogensIrenopsis, Diaporthe, and Sphaerosporiumsppobtained the highest antifungal activity with an inhibition rate of 82, 46, and 57% respectively. This research indicated that silver NPs were effective in controlling fungal isolates. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Several species (pathogens) that cause disease can infect S.lycopersicum L (tomato) and cause disease. Various fungi, bacteria, and viruses cause the most common diseases that affect tomatoes. Here, we summarised the bacterial diseases and the green synthesis of NPs in a tomato plant. Under favourable environmental conditions, bacterial pathogens double their population and colonize the internal spaces of tomato plants; bacterial diseases cannot easily be managed. Several studies show that to control plant pathogens including bacteria, fungi, and viruses, biogenic synthesized NPs using microbes and plant extracts without hazardous chemicals are promising. There are various benefits to the usefulness of plant extracts for NPs synthesis, such as accessibility and protection during handling. There is also an increasing demand for green nanotechnology; the need for non-toxic synthetic environmental protocols for NPs synthesis contributes to a growing interest in biological approaches that are free from the use as by-products of toxic chemicals. We also discussed the role of many extracts from medicinal plants in regulating phytopathogens and their tomato applications. Finally, this review critically assesses the function of synthesized medicinal extracts of various NPs in the control of tomato phytopathogens, the application of NPs to tomato plant disease, and extensive antimicrobial studies.&#xD;
&#xD;
DISCLOSURES: The authors declare that there is no conflict of interest in this article&amp;#39;s content.&#xD;
&#xD;
Conflict of Interest: Nil&#xD;
&#xD;
Source of Funding: Nil&#xA0; &#xD;
&#xD;
Author Contributions: Maheshwari MS (MMS) and Kanthesh BM (KBM) conceptualized the study. Maheshwari MS (MMS), Saritha V (SV), and T. S. Gopenath (TSG) drafted the Manuscript. Maheshwari MS (MMS), T. S. Gopenath (TSG), and Kanthesh BM (KBM) helped with the Manuscript and Discussion. &#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
The authors would like to express gratitude towards the institute of JSS Academy of Higher Education &amp; Research and also JSS College for Women, Mysore, for providing the necessary help for the research work. The authors are also grateful to authors/editors/publishers of all those articles, books, and journals from where the literature for this article has been reviewed and discussed.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Assessment of Caregiver&#x2019;s Needs and Burden among Family Caregivers of the Terminally Ill Cancer Patients -&#xA0;A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>85</FirstPage><LastPage>90</LastPage><AuthorList><Author>Pany S</Author><AuthorLanguage>English</AuthorLanguage><Author> Patnaik L</Author><AuthorLanguage>English</AuthorLanguage><Author> Sahu T</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Care within the home usually relies primarily on a family member or friend. Indeed, without the support of a family caregiver, home palliative care would be impossible. Objectives: To assess caregiver&#x2019;s needs and burden among family caregivers of terminally ill cancer patients. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital from July 2015 to September 2017 using a predesigned and pretested schedule. Among family caregivers of terminally ill cancer patients admitted to the hospital, one family member was considered, who was primarily responsible for providing care to the patient. A total of 110 family caregivers were included in the study. The analysis was done using SPSS v. 20.0. Results: Most of the family caregivers were either children (35%) or spouse (23.6%) of terminally ill patients and the average caring time was 4.3 hours per day. 97% of people did not receive any practical help from anyone outside the family. As high as 69% of people were in need of maximum support from physicians or other trained professionals to provide optimum care to their loved ones. About 40% of the people experienced severe burden in the process of caring for their loved ones and they were at high risk of developing psychosomatic symptoms. Conclusion: The family caregivers lack appropriate training and knowledge for providing optimal care to their loved ones in a state of advanced illness. They should be trained about providing better palliative care services and support.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Carers, Care providers, Home palliative care, End of life care, Terminally ill, Caregiver&#x2019;s need</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
"Palliative Care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain and other symptoms, the psychological, social and spiritual needs of the patient are paramount".1,2 The goal of palliative care is the achievement of optimal symptom control, the best possible quality of life, as well as appropriate rehabilitation for the patients, their family. Each year an estimated 40 million people need palliative care, 78% of whom live in low- and middle-income countries.2&#xD;
&#xD;
Palliative care affirms that death should be dignified and the existing is to be fulfilled by a joint committee of the medical fraternity and family members, and appropriate government policy.3,4 There is evidence to support the case that most patients would prefer to die at home.5,6There is a growing trend for people with a terminal illness to remain at home, where practicable. Death may occur in the hospital, but much of the detoriatingphase&#xA0; occurs when the patient is at home. Home palliative care would be impossible for most people without the support of family caregivers. In the United&#xA0; States, in two Gallup Polls, in 1992 and 1996, around 90 per cent of respondents reported that they would prefer home care if they were critically ill for six months.7Despite the input offered by professional palliative care services, care within the home usually relies primarily on a family member or friend. Indeed, without the support of caregivers, home palliative care would be impossible for many people. A study conducted on 18,222 people in Canada shows 88% of people willing to die at the home rather than hospital setting towards the end of their life.7 The trend to die at home is further increasing as a study in Melbourne reports 94.3% inclination to die at home.8&#xD;
&#xD;
A family caregiver&#x201D; is a relative or friend who provides psychosocial and/or physical assistance to a patient who needs palliative care.9 The responsibility of a family carer depends on the physical and psychosocial needs of the patient.9,10,11 Family caregiver&#x2019; responsibilities may include personal care (hygiene, feeding); domestic care (cleaning, meal preparation); auxiliary care (shopping, transportation); social care (informal counselling, emotional support, conversing); nursing care (administering medication, changing catheters); and planning care (establishing and coordinating support for the patient). the diagnosis of a life-threatening illness of a family member is their first major confrontation with death for many families.12&#xD;
&#xD;
The physical, emotional, financial and social impact of providing care for a dying relative may be increased by social burdens such as restrictions on personal time, disturbance of routines and diminished leisure time among family caregivers. Relatives of cancer patients may experience as many psychological problems as per some studies which include anxiety, depression, reduced self-esteem, feelings of isolation, mental fatigue, guilt and grief. Caregiving in the family can have a negative impact on the family&#x2019;s quality of life. Family members of cancer patients may insight many mental issues according to certain studies which incorporate tension, depression, decreased confidence, sensations of disconnection, mental weakness,&#xA0; guilt and sorrow. On contrary, providing care in a family affect the family&amp;#39;s satisfaction.9 Presently home palliative care include a more intricate consideration which incorporates advanced skill, for example, opioid administration and management of symptoms. The physical and psychosocial needs of the patient and the elements of connection among career and patient are significant components for caregiving.9,10,11 Diagnosis of a life-threatening disease of a relative is their first significant encounter with death.12Almost one-third of 106&#xA0;Australian family caregivers reported confronting significant anxiety, and 12% experienced significant depression.13 Being a family caregiver may also predispose a person to health problems, such as physical exhaustion, fatigue, insomnia, burn out and weight loss.&#xD;
&#xD;
Being a family carer may likewise incline an individual to medical issues, like actual weariness, exhaustion, sleep deprivation, burnout and weight reduction. The patient is more comfortable at the home than in the medical clinic. Demise in the home is a more honourable and agreeable experience than death in hospital. Home palliative care is savvier and numerous medical care centers promote home palliative care. &#xA0;One study has shown that demise among 16% of malignancy patients in South Australia was at home12 and a study in Victoria shown that 21% of individuals die at home.14 It was seen in a study that men are more likely&#xA0; to die at home. Elements for the inclination of home demise were satisfactory monetary assets, having malignancy or AIDS, having a full-time career, not living alone, having individual requirements that could be overseen at home.13,9 &#xD;
&#xD;
In Odisha, the paucity of palliative care units has severely affected thousands of cancer patients and their family members. Limited studies are available assessing caregiver&#x2019;s needs and burden among family caregivers of terminally ill cancer patients in Odisha. &#xD;
&#xD;
AIM: To assess caregiver&#x2019;s needs and burden among family caregivers of the terminally ill cancer patients&#xD;
&#xD;
SUBJECTS AND METHODS:&#xD;
&#xD;
Study design: &#xD;
&#xD;
The study was a hospital based Cross-sectional study conducted in Oncology (Medical and Surgical) and Haematology Departments of Institute of Medical Sciences &amp; SUM Hospital, Bhubaneswar, Odisha. The study was conducted over two years and three months, starting from July 2015 to September 2017. The study population comprised of family caregiver of terminally ill patient. The sample size was calculated to be 110 depending upon the prevalence of terminally ill patients among all cancer patients which was 80% taken from a multicentric study by David S et al.15 To assess awareness, perception and practice of palliative care among family caregivers one family member was considered, who was primarily responsible for providing care to the patient. In this way, 110 family caregivers were included in the study. Family caregivers not willing to participate in the study were excluded.&#xD;
&#xD;
Data collection and analysis:&#xD;
&#xD;
Based on the clinical assessment the physicians, terminally ill cases (with survival less than one year) were identified and their caregivers were interviewed. The attendant/s present with them was asked for participation (as family caregivers) and only one was considered for participation (considering that the patient attendant present was more intimately attached in care providing than the other). In this way, a total of 110 family caregivers were interviewed. Data were collected by predesigned and pretested schedule. The subjects were explained in detail about the study and the expected outcome. They were assured of privacy and confidentiality of data. Informed written consent was obtained. The interview was conducted in the local language after establishing a good rapport with subjects and in a very friendly manner. &#xD;
&#xD;
The data collected were entered in a Microsoft Excel spreadsheet. After proper data cleaning data were imported and analysed using IBM SPSS Statistics software version 20 licensed to the institute. Descriptive statistics were expressed as frequencies (percentages), means, standard deviations, standard error of means at 95 confidence intervals.&#xD;
&#xD;
Study tool: The schedule for family caregivers of terminally ill cancer patients consisted of basic information of family caregivers, needs of family caregivers and burden assessment of family caregivers. The questionnaire focused on the primary family caregiver and included three parts. The first Part included questions on the interpersonal relationship between the caregiver and the terminally ill, financial status of the caregiver, additional help received outside the family, etc. The second part of the questionnaire was adapted from &#x201C;The carer support needs assessment tool&#x201D; (CSNAT) which is a comprehensive evidence-based tool. It is used as part of a process of assessment and support that is practitioner facilitated but carer-led. The CSNAT approach provides carers with the opportunity to consider, express and prioritize their support needs.16 The developers of this tool are Gail Ewing and Gunn Grande who work as social workers at tat the University of Cambridge and the University of Manchester respectively. The thipart Burden Scale for Family Caregivers (BSFC) is a scientifically developed instrument designed to measure the perceived burden of family caregivers resulting from home care.17&#xD;
&#xD;
Ethical considerations:&#xD;
&#xD;
Approval for the study was obtained from the Institutional Ethics Committee of the Institute of Medical Sciences &amp; SUM Hospital with reference number IMS/IEC/108/2015. &#xD;
&#xD;
RESULTS&#xD;
&#xD;
A total of 110 family members were interviewed who were present along with the terminally ill patients during the time of the survey.&#xD;
&#xD;
The mean age of the participating family caregivers was 35.69 years with a standard deviation of &#xB1; 9.198 years. The minimum among all the caregivers was 19 years while the maximum age was 56 years. The average hours spent in caregiving ranged from 1 hour to almost 9 hours a day with a mean time of 4.3 hours. The family caregivers that were interviewed did spend an average of 6.58 months with their terminally ill relative and some had a fresh experience of at least a month and some were consistently caring for about one and half years. Most of the family caregivers were male (65.4%). Completion of higher secondary examination was seen in many participants (40%), followed by graduates and postgraduates (21.8). Either of son or daughter (34.5%) in the family was the prime caregiver in the family among most of the study participants; while others included siblings (8.2%), Parents (9.1%), spouse (23.6%), grandchildren (12.4%) and other first-degree family relatives (12.2%). Almost all (97.2%) family caregivers had received no external help outside of the family, neither in terms of finances nor in terms of care providing. The few (2.8%) those who had received some sort of help were from local charitable organisations or personal donations made to the families. (Table 1)&#xD;
&#xD;
The CSNAT is an&#xA0;evidence-based&#xA0;tool that facilitates support for family caregivers of adults with life-limiting conditions. Based on CSNAT scoring the family members were divided into three categories; scores </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3871</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3871</Fulltext></URLs><References>&#xD;
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	Sepulveda C, Marlin A, Yoshida T, Ullrich A. Palliative care: The world health organization&#x2019;s global perspective. J Pain Symptom Manage. 2002;24(2):91&#x2013;6. &#xD;
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	WHO | Palliative Care [Internet]. WHO. World Health Organization; 2016. Available from: http://www.who.int/mediacentre/factsheets/fs402/en/&#xD;
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	Kassa H, Murugan R, Zewdu F, Hailu M, Woldeyohannes D. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC PalliatCare. 2014;13(1):6. &#xD;
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	Gopal KS, Archana PS. Awareness, Knowledge and Attitude about Palliative Care, in General, Population and Health Care Professionals in Tertiary Care Hospital. Int J Sci Stud. 2016;3(10):31-5. &#xD;
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	Townsend J, Frank AO, Fermont D, Dyer S, Karran O, Walgrove A et al. Terminal cancer care and patients&#x2019; preference for place of death: a prospective study. Bri Med J. 1900;301(6749):415&#x2013;7. &#xD;
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	Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J. Rural factors and survival from cancer: analysis of Scottish cancer registrations. Br J Cancer. 2000;82(11):1863&#x2013;6. &#xD;
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	Canadian Medical Association. CMAJ?.1985. Institute of Medicine (US) Committee on Care at the End of Life; FieldMJ, Cassel CK, editors. Approaching Death: Improving Care at the End of Life. Washington (DC): National Academies Press (US); 1997. 2, A Profile of Death and Dyingin America.&#xA0;Available from: https://www.ncbi.nlm.nih.gov/books/NBK233601/&#xD;
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	Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for Alleviating Cancer-Related Dyspnea: A Systematic Review. J Clin Oncol. 2008;26(14):2396&#x2013;404. &#xD;
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	Hudson P. Home-based support for palliative care families: challenges and recommendations. Med J Aust 2003; 179 (6): S35.&#xA0;&#xD;
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	Standards for Providing Quality Palliative Care for all Australians. Palliative Care Australia May 2005. ISBN 0-9752295-4-0.&#xD;
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	Higginson IJ, Bs B, Finlay IG, Goodwin DM, Hood K, Edwards AGK, et al. Is There Evidence That Palliative Care Teams Alter End-of-Life Experiences of Patients and Their Caregivers? J Pain Symptom Manage. 2003;25(2) :150-68. &#xD;
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	Hunt R, Fazekas B, Luke C, Roder D. Where patients with cancer die in South Australia, 1990-1999: a population-based review. Med J Aust. 2001;175:526-29.&#xD;
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	Alexander K, Goldberg J, Korc-Grodzicki B. Palliative Care and Symptom Management in Older Patients with Cancer.&#xA0;Clin Geriatr Med. 2016;32(1):45&#x2013;62. &#xD;
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	Clifford CA, Jolly DJ, Giles GG. Where people die in Victoria. Med J Aust. 1991; 155:446-56.&#xD;
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	David S. Poor palliative care in India.Lancet Oncol. 2008;9(6):515. &#xD;
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	Ewing G, Brundle C, Payne S, Grande G; National Association for Hospice at Home. The Carer Support Needs Assessment Tool (CSNAT) for Use in Palliative and End-of-life Care at Home: A Validation Study. J Pain Symptom Man.2013;46(3):395-405.&#xD;
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	17.New: Burden Scale for Family Caregivers in 20 European languages. Available at: www.virtualhospice.ca&#xA0;&#x203A; Assets &#x203A; BSFC_english_o.&#xD;
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	Vulnerability of family caregivers. Palliative Medicine Grand Round, HKSPM Newsletter 2007;1(2). &#xD;
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	Ewing G, Austin L, Diffin J, Grande G. Developing a person-centred approach to carer assessment and support. Br J Community Nurs. 2015;20(12):580-4.&#xA0;&#xD;
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	Park CH, Shin DW, Choi JY, Kang J, Baek YJ, Mo HN et al. Determinants of the burden and positivity of family caregivers of terminally ill cancer patients in Korea. Psychooncology. 2012;21(3):282&#x2013;90. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Application of Dialectical Behavior Therapy (DBT) for Opioid Dependence: Case Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>91</FirstPage><LastPage>96</LastPage><AuthorList><Author>Komal S</Author><AuthorLanguage>English</AuthorLanguage><Author> Nandha KP</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Opioid dependency is among serious clinical and public health concerns in India. India has had an established pattern of use of an opioid group of drugs. Indeed, a sizable number of people in India use opioid drugs, suffer from opioid dependence and seek treatment for the same. The most common treatment strategy for opioid dependence is opioid substitution therapy (OST). Another regimen used for substance dependents is Dialectical behaviour therapy (DBT). It is said to incorporate concepts and modalities which are designed to promote abstinence and thereafter reduce the length of consumption and also the adverse impact of relapses. Case Presentation: This case study is about AB, a 23-years old male who sought care for opium dependence. His chief complaints were inability to cut down the use of the substance (opium paste), experiencing withdrawal symptoms, low mood, low self-confidence and increased craving for the substance. Psychological Assessment that was done comprised of Severity of dependence scale (SDS), Brief-Cope Questionnaire, Emotional Regulation Questionnaire (ERQ) and Interpersonal Competence Questionnaire-15 (ICQ-15). Subsequently, TAU along with DBT techniques was applied over two months (13 sessions) and showed significant improvement in the patient. The outcome of the intervention showed a decline in independence levels, increased distress tolerance, better emotional regulation and interpersonal relationships. The patient eventually demonstrated decreased drug usage and improved skilful behaviour. Conclusion: Thus, it can be concluded that DBT is effective along with pharmacology therapy to promote and enhance the holistic well-being of the patient with opioid dependence. This gives an example of how trainee treatment can be used not only to decrease opioid dependency level but also to increase distress tolerance, better emotional regulation and interpersonal effectiveness in relationships.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Clinical Psychiatry, Emotional regulation, Inter-personal competence, Opioid dependence.</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The use of psychoactive substances has been part of human civilization for thousands of years. The pattern and dimensions of the use of such psychoactive substances, however, have taken on pathological proportions in modern times.1 in all parts of the world, narcotics have become a scourge, both in villages and towns. Heroin or other synthetic illicit drugs are widely prevalent like distilled opium. &#xD;
&#xD;
If not quantifiable correctly, the complexity of the issue is undeniably vast and troubling. Being one of the largest legal producers of opium, India has had an established pattern of use of an opioid group of drugs. This has resulted in a sizable number of people who are using opioid drugs or are suffering from opioid dependence and seek treatment for the same.2 In the first and the only national survey to date on drug use in India, the prevalence of opioid use was found to be 0.7% of the general population among whom, around 22.3% were found to be opioid dependents.3 &#xD;
&#xD;
Opiate dependence is a chronic relapsing condition with sometimes catastrophic effects for individuals, families and communities. This has been seen as intensified in poor resource settings.4&#xD;
&#xD;
In the last decade, the treatment and care structure of opioid addiction has changed considerably. Eventually, the focus has been put on implementing ambulatory methadone maintenance therapy (MMT) and buprenorphine maintenance (BMT)5. Maintenance therapies are given either through major specialist substitution centres (SSCs) or more recently through primary care doctors who either are entirely eligible to provide MMT / BMT treatment or those who have used it on few patients.5 &#xD;
&#xD;
Opioid substitution therapy (OST) is the most commonly used evidence-based treatment for opioid dependence in pharmacotherapy.6 although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far.&#xA0;It is not a wholesome cure for drug dependence rather it is a therapy for the management of a chronic condition. Some clients may need therapy for years and some for their entire life.6-9&#xA0;&#xD;
&#xD;
Another regimen used for substance abusers is Dialectical behaviour therapy (DBT). It is said to incorporate concepts and modalities which are designed to promote abstinence and thereafter reduce the length of consumption and also the adverse impact of relapses.10 it is a stem of psychotherapy that has been used as an adjunct to pharmacotherapy. It was developed by Marsha Linehan (Ph.D.) in 1980 which focuses on both cognitive and behavioural aspects of psychological treatments. Being an inclusive treatment program helps the patients with their efforts to build a life worth living.11 A successful DBT intervention helps the patient to learn to predict, communicate, pursue and maintain goals that are independent of their history of out-of-control behaviour, including substance abuse and are better able to cope with life&#x2019;s day to day problems.11, 12&#xD;
&#xD;
In the initial controlled trial of Linehan, while treating people with BPD, DBT proved to be efficacious to decrease their behaviour by themselves and their stationary psychiatric days.11 In another clinical study, DBT has demonstrated effective drug de-addiction, opioid use reduction, decrease elderly depression and adaptive coping ability, improved likelihood of completion of treatment and hospitalization among suicidal adolescents.12,13&#xD;
&#xD;
CASE PRESENTATION &#xD;
&#xD;
In the present case report, DBT was given to a male patient (AB) aged 23 to reduce his opioid dependence. AB was a student studying and living in Delhi. He recently presented for treatment at the psychology training clinic because his family was concerned that the use of opioid was interfering with his daily living and has destructed his life.&#xA0; In 2017, due to some family reasons, his family had to move to another city and he lived alone in Delhi to complete his post-graduation. AB&#x2019;s family had 4 members including his parents and one elder sister. As reported by his family, he was never so involved in the family was very shy and hesitant as a child. Also would hardly share his feelings or thoughts with them. After his family left, AB reports that he felt lonely and there was no one around so he started making friends online.&#xD;
&#xD;
&#xA0;He met a person through social media groups and started meeting him on regular basis soon he became his closest friend and AB offered him to live together in his apartment. His friend was a chain smoker and also consumed other substances. At one of the parties organized by both of them his friend insisted AB try &#x201C;black paste&#x201D; (opium paste). AB reports that he wasn&#x2019;t thinking too much and went ahead trying it. He reported that it made him relaxed, feels good about himself, and was comfortable during conversations throughout the party. Also, He reported being drawn towards it and wanted to consume it again. Initially, for few months, he was doing it occasionally (0.3-0.5gms) with his friend (twice or thrice a month). Later he was very overwhelmed by it and escalated to consuming it on weekly basis. He became irregular to college and had low attendance during his 2nd semester. He reported about his increased smoking too (10-13 cigarettes in a day). He would constantly ask for money from his parents for other excuses and would buy opium paste. He then on daily basis started consuming opium paste 3 times (after waking up, afternoon and before going to bed) a day with soft drinks (0.5 grams at a time). He was consuming 1.5 grams a day. He reported no irritability or bodily discomfort due to the consumption of opium paste. This continued for more than a year. His family was completely unaware and due to the work restrictions couldn&#x2019;t visit Delhi often. AB reported that the opium paste would cost him a lot and that he started feeling extremely guilty about his dependence and how dysfunctional he becomes if he tried to cut down the dose. He did repeat attempts to cut down or quit but would fail every time due to horrifying withdrawal symptoms (tremors in the hand, hot and cold flushes, increased heart rate, restlessness, decreased appetite, increased craving, and inability to sleep, irritability and eventually would feel low). In the meantime, he asked his friend to move out so that he could finally be by himself and study for his end semester exams. He scored very low and failed in 3 subjects. It was then that his college communicated with his parents and asked them to meet. His parents immediately came to Delhi and seeing AB in the worst of his health and living conditions asked him what was wrong. He then confronted them about using opium paste for about 2 years and that he was unable to quit and how he felt emotionally and mentally withered. His parents were completely shocked and scared. They immediately approached AB&#x2019;s treatment in Delhi itself.&#xD;
&#xD;
The present case came to a psychiatric centre in West Delhi (September 2019). His chief complaints included inability to cut down the use of the substance (opium paste), increased craving for the substance, experiencing withdrawal symptoms and low mood. He did not feel self-confident because of his academic failure and repeating a year The client reported first consumption of opioid at the age of 21 years. He repeatedly missed college because of withdrawal symptoms (sweating, trouble sleeping, agitation, anxiety). AB stated that his last intake of opioid was 4 days before the day of the appointment &#xD;
&#xD;
Mental Status Examination&#xD;
&#xD;
The patient was kept and tidy, maintained eye contact and was in touch with the surroundings. The attitude was cooperative, attention was aroused and sustained. The speech was relevant, coherent and goal-directed with normal reaction time. Affect was congruent and appropriate. Cognitive functions were intact (memory, attention, orientation, intelligence). No thought or perceptual abnormalities were found. Personal and Social Judgment were partially intact, was at the preparation stage of motivation with insight grade level 4 (awareness of being sick, due to dysfunctional unknown self traits).&#xD;
&#xD;
Behavioural Observation &#xD;
&#xD;
The patient had a positive attitude towards the examiner and the assessment procedure. He was cooperative and showed interest during the assessment. He faced no problem in understanding and responding to the test items. He was comfortable and was curious to know the results.&#xD;
&#xD;
Assessment &#xD;
&#xD;
A preliminary clinical interview by a senior psychiatrist was conducted to confirm the diagnosis of opioid dependence disorder as per ICD-10 (DCR)14 and to evaluate the presence of other psychiatric disorders to support the reliability of assessment procedures and intervention. The present case study was approved by the Institutional Ethical Committee of Shree Guru Gobind Singh Tricentenary University (SGTU/FBSC/ECA/2020/08). Before starting the therapeutic intervention, the baseline assessment was done using valid and reliable tools- the severity of dependence scale (SDS),15 Brief-Cope Questionnaire,16 Emotional Regulation Questionnaire (ERQ)17 and Interpersonal Competence Questionnaire-15 (ICQ-15).18The assessment was done pre and post-intervention to check for effectiveness of DBT for opioid dependence. Mental status examination and behavioural assessment were done by the therapist.&#xD;
&#xD;
RATIONALE OF THERAPY: &#xD;
&#xD;
AB was treated using DBT- According to which the patient required a revised atmosphere in which emotions are controlled, interpersonal disputes are treated, discomfort tolerated and equilibrium is sought. &#xD;
&#xD;
Goals of the therapy: &#xD;
&#xD;
&#xD;
	&#xD;
	To create awareness and understanding about the illness.&#xD;
	&#xD;
	&#xD;
	Reducing the severity of dependence on opioid consumption.&#xD;
	&#xD;
	&#xD;
	Enhancing coping skills, emotion regulation and interpersonal competence/skills.&#xD;
	&#xD;
&#xD;
&#xD;
Detailed Therapy:&#xD;
&#xD;
DBT was planned in the sequence of sessions19 as mentioned in Table 1. The duration of each session held was for 1hr 15mins. The sessions were conducted twice a week by the therapist.&#xD;
&#xD;
&#xD;
	&#xD;
	&#xA0;The TAU (Treatment as Usual) was continued throughout which was:&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Oral opioid substitution therapy consisted of the following medicine list- Tramadol, Tapentadol, Buprenorphine, Benzodiazepine, Clonidine.&#xD;
	&#xD;
	&#xD;
	Intravenous drip (IV) consists of DNS (dextrose and sodium chloride) for electrolyte correction and prevents dehydration caused due to absence of opioids&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
*Termination phase included- the summarization about the previous sessions, reviewing the progress, post-assessment and feedback from the patient. &#xD;
&#xD;
Once the plan for structuring DBT within a training set was determined, the therapist and AB discussed his most prominent concerns to agree for DBT intervention, which included thoughts of substance use and explored how DBT could potentially address these problems. Consistent with DBT, AB was asked to commit to 10 weeks of therapy, as this would allow for sufficient time to work on the complex behaviours and skills deficits often seen with these types of clients. AB also was expected to attend 60- to 90-min individual sessions which were supervised by a clinical psychologist with extensive training and experience in DBT. The sessions were conducted twice in a week (13 individual sessions). AB could contact the therapist in between sessions and informed therapists would respond back as quickly as possible. Other measures were used to assess his general physical health, which he reported was fair and denied any chronic health conditions. The whole package, activities and procedures were chosen from skill repertories of the DBT skill training manual.19 Best efforts were retained to keep AB involved and attain the best of his capabilities. Following the hierarchy of treatment targets consistent with DBT, life-interfering behaviours were targeted first (e.g. reducing episodes of heavy substance use), followed by therapy-interfering behaviours (e.g. not doing homework, missing sessions), and then followed by quality of life-related behaviours (e.g. further reducing emotional impulsivity, initiating new relationships)&#xD;
&#xD;
The mindfulness module was introduced first and the content was reviewed each time AB completed other modules or when he had taken an extended break from therapy. Additionally, he began each session with a brief mindfulness exercise (e.g. spending 10 min observing the sensations of their footsteps during a walk around the clinic or practising a body scan) to calm down, focus on the session and strengthen those skills. &#xD;
&#xD;
The second was the distress tolerance module to provide AB with a set of coping skills via distraction techniques (WISE MIND ACCEPTS) to help him deal with physical and emotional pain caused by the urges to consume the substance. To increase his use of skills, AB frequently relied on skills such as pros and cons lists of using substances versus skills, focusing on the senses and distraction to manage physiological cravings or acutely distressing situations.&#xD;
&#xD;
The third module emotional regulation was introduced to help AB develop effective skills to identify emotions and be mindful of them in different settings. He was asked to practice labelling his emotions in terms of thoughts and physiological responses. The intent was to train him to modify his responses and let go of his emotional vulnerabilities towards unhealthy behavioural patterns.&#xD;
&#xD;
AB was most enthused to learn about the fourth module interpersonal effectiveness because these skills were likely to help him achieve many quality of life-related goals, such as building new relationships and sustaining them. The module focused on the need for effective interpersonal relationships and how to develop the skillset to sustain them. Assertive communication skills (DEAR MAN) were introduced as he would find it extremely hard to say &#x201C;NO&#x201D; to situations or people that can be damaging. One of his chief complaints was that he did not feel self-confident because of his academic failure and repeating a year again. In order to help with specific goal DBT technique (FAST) was used and practised very thoroughly.&#xD;
&#xD;
DISCUSSION- &#xD;
&#xD;
Given the complexity of this case and the fact that the client was treated within a training clinic, there are implications from this case study. Supervision and support from the therapists was a critical component that contributed to the success of this case. The therapist acknowledged feelings of anger and frustration as fluctuations in the clients&#x2019; functioning and substance use. Also was dedicated to being available for consultation during evenings and weekends. The sessions were meticulously planned before achieving the set goals with appropriate techniques.9,10 The different skills were delivered by the therapist using different methods like charts, diagrams, and role play. AB was highly interested in the mindfulness module as it would calm his impulses and frustration; make him more focused inside and out of sessions. At the start of the intervention, AB was smoking 7-9 cigarettes per day; however, toward later in therapy he consciously cut down it to 3-4 in a day. It was difficult for him to learn and be handy with distress tolerance skills but with constant practice, he managed to use them in divergent stress-provoking situations. These skills set improved his tolerance, enhanced his coping (scores improved from 76 to 80 on the brief cope questionnaire) also helped him effectively deal with situations rather than consuming opium and avoiding them. AB showed a significant reduction in opium intake on SDS (severity of dependence scale) from 13 to 10. Similar results have been seen in a Randomized clinical trial.10 Emotion regulation module took a great deal of time for him to understand the dialectics of emotions in everyday life. At times, AB expressed frustration with learning the skills for this module as he felt dumb for not already knowing these skills and these thoughts were complex and questioning to him shown to increase the likelihood that he would use substances rather than skills. In response to this challenge, it was helpful to discuss the dialectic of acceptance versus change. Specifically, it was helpful to explore both acceptance of why and how he did not already have the knowledge and the changes that he was making through treatment (When you&#x2019;ve been able to use skills rather than substances, you tend to feel better in the long term). The viewpoint that substance abusers have difficulties regulating their emotions, and that negative emotional states precipitate substance use, is supported by a large body of empirical evidence.10 As per AB&#x2019;s score on ERQ (emotion regulation questionnaire) the cognitive reappraisal subscale showed improvement of 3 points as AB was now better able to understand and interpret the intense emotion-provoking situation and act accordingly. There was a reduction in the Emotional suppression subscale which shows that AB got more comfortable in expressing and acknowledging his emotions. He realized the importance of maintaining a healthy daily routine for better emotional health. Similar results were shown in study 20 wherein &#x201C;emotion regulation training (DBT) proved more effective than cognitive therapy, increasing distress tolerance and emotional regulation enhancement&#x201D;&#xD;
&#xD;
Relationships can become strained under the weight of addiction. Families, relationships and work often suffer as the person finds taking drugs as a priority above everything else. Interpersonal competence skill training was one of the key reasons for him to seek intervention. Initiating communication had always been a tough aspect of his entire childhood as well as his teenage life due to which he would either be left isolated or drawn towards unhealthy patterns. He learned that respecting oneself is equally important for him to form and sustain healthy relationships with others. He showed significant improvement on all 5 subscales of the interpersonal competence questionnaire (initiation, negative assertion, providing emotional support, disclosure about self and managing conflict). Ongoing assessment and self-monitoring were critical for this case. Throughout therapy, AB completed weekly assessments of overall functioning along with random urine tests. Throughout therapy, he was able to use skills more frequently and in increasingly difficult contexts, also maintained. The process prevented burnout, helped normalize common reactions and facilitated growth in case conceptualization and development of clinical skills for the training therapist as well.&#xD;
&#xD;
This case study depicts the result of an individual patient, thereby restricting the generalization of findings. Further studies are recommended that will include a larger sample size, controlled socio-economic and demographic conditions while assessing different points of follow up. The application of DBT skill training can be also be extended towards the other major factors that significantly affect the frequent relapses in opioid dependence disorder. &#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
In the present case report, there was a significant reduction in opioid dependence level, increasing coping skills, better emotional regulation and interpersonal relationships with the help of DBT. It was evident from the improvement in his pre and post-therapy scores. Thus it can be concluded that DBT offers the structure, strength, and compassion needed to enhance overall functioning and quality of life. It seems that DBT skill training given along with pharmacotherapy increase the effectiveness of treatment concerning substance dependence problem.&#xA0; &#xD;
&#xD;
AUTHOR&#x2019;S CONTRIBUTION &#xD;
&#xD;
&#xA0;Komal Sancheti: Main author of research including planning, intervention and analysis. Dr. Nandha Kumara Pujam: Guidance in design, objectives, analysis and discussion as well as the final presentation. Dr. Nandha Kumara Pujam: &#xA0;is the guarantor for this paper.&#xD;
&#xD;
COMPLIANCE WITH ETHICAL STANDARDS&#xD;
&#xD;
Conflict of Interest- Nil&#xD;
&#xD;
Financial support &#x2013; nil&#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;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3872</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3872</Fulltext></URLs><References>&#xD;
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	Gowing L, Farrell M, Bornemann R, Sullivan LE, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection.&#xA0;Cochrane Database Syst Rev.&#xA0;2008;2: CD004145&#xD;
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	Dimeff LA, Linehan MM. Dialectical behaviour therapy for substance abusers.&#xA0;Addict Sci Clin Pract. 2008;4(2):39-47. &#xD;
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	Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P et al. Dialectical behaviour therapy versus comprehensive validation plus 12-step for the treatment of opioid-dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend. 2002; 67:13-26. &#xD;
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	May JM, Richardi TM, Barth KS. Dialectical behaviour therapy as a treatment for borderline personality disorder.&#xA0;Ment Health Clin. 2016;6(2):62-67. &#xD;
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	Lynch TR, Morse JQ, Mendelson T, Robins CJ. Dialectical behaviour therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry. 2003; 11:33-45.&#xD;
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	World Health Organization. The&#xA0;ICD-10&#xA0;classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization. 1992&#xD;
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	Gossop M, Best D, Marsden J, Strang J. Test-retest reliability of the Severity of Dependence Scale. Addict. 1997;92(3):353. &#xD;
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	Mahmoud JS, Staten R, Hall LA, Lennie TA. The relationship among young adult college students&amp;#39; depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment Health Nurs. 2012;33(3):149-56. &#xD;
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	Gouveia VV, Moura de HM, Oliveira de ICV, Ribeiro MGC, Rezende, AT, Brito de TR. Emotional Regulation Questionnaire (ERQ): Evidence of Construct Validity and Internal Consistency.&#xA0;Psico-USF. 2018;&#xA0;23(3): 461-471.&#xA0;&#xD;
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	Coroiu A, Meyer A, Gomez-Garibello CA, Br&#xE4;hler E, Hessel A,&#xA0; K&#xF6;rner A. Brief form of the Interpersonal Competence Questionnaire (ICQ-15): Development and preliminary validation with a German population sample.&#xA0;Eur J Psychol Assess. 2015; 31(4):272&#x2013;279.&#xD;
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	Linehan MM.&#xA0;Diagnosis and treatment of mental disorders. Skills training manual for treating borderline personality disorder. New York.&#xA0;Guilford Press. 1993&#xD;
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	Azizi A, Borjali A, Golzari M. The effectiveness of emotion regulation training and cognitive therapy on the emotional and addiction problems of substance abusers. Iran J Psych. 2010;5(2):60-5.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Acid-Base Imbalance and Electrolyte Abnormalities in Acute Alcoholic Intoxication&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>97</FirstPage><LastPage>100</LastPage><AuthorList><Author>M Girish</Author><AuthorLanguage>English</AuthorLanguage><Author> B Nivedana Lakshmi</Author><AuthorLanguage>English</AuthorLanguage><Author> Bhat Sonal</Author><AuthorLanguage>English</AuthorLanguage><Author> Hejamady Ismail Mohammed</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Alcohol intoxication contributes to more than 10 million hospital admissions in a year. It is known to cause impairment in cognition and decline in neurological functions as the blood alcohol levels increase. A series of acid base and electrolyte disturbances have been documented in individuals with alcohol use disorder. Alcoholic ketoacidosis is a common manifestation that is known to occur. Aims: This study was done to study the pattern of acid base and electrolyte abnormalities that were seen in acute alcoholic intoxication and to establish an association between the blood alcohol levels and the abnormalities in acid base and electrolytes. Methods: 200 patients in acute alcohol intoxication who satisfy the inclusion criteria were chosen and blood alcohol levels were estimated for them. Blood samples for ABG, Electrolytes were drawn. Results: Of the electrolytes statistically significant negative association with BAC was seen only with serum bicarbonate. A variety of acid base disturbances were seen the most common being compensated respiratory alkalosis &#x2013; 56 patients (28%) followed by metabolic acidosis with partial compensation seen in 46 patients (23%).&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Acid, Base, Imbalance, Electrolyte, Acute, Alcoholic, Intoxication</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Alcoholism is a global issue. 5.9% (3.3 million) of the total deaths globally and 5.1% of the burden of disease(139 million DALYs) are primarily due to alcohol consumption.1&#xD;
&#xD;
Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. Alcohol causes harm in three ways- intoxication, toxicity, and alcohol use disorder. Symptoms correspond to the blood alcohol concentration (BAC). In alcohol nontolerant individuals BAC of more than 300mg/dl is associated with a higher chance of respiratory depression and cardiorespiratory arrest. BAC levels exceeding 500 mg/dl (108.5 mmol/l) may cause death. However, the fatal dose varies with nontolerant and tolerant individuals. In nontolerant individuals death has been known to occur at relatively lower BACs (300mg/dl). In alcohol-dependent patients who have developed tolerance to alcohol owing to repeated exposure, these effects reduce. This is attributed to compensatory changes occurring in the excitatory neurotransmitters like NMDA (N-methyl-D-aspartate) and inhibitory neurotransmitters like GABA (gamma-aminobutyric acid). 1, 2&#xD;
&#xD;
Acute alcohol intoxication is known to produce various metabolic disturbances like hypoglycaemia, lactic acidosis, hypokalaemia, hypomagnesemia, hypoalbuminemia, hypocalcaemia, and hypophosphatemia.2,3 Normal body homeostasis undergoes alterations with alcohol intake both acutely and with chronic alcohol use. Metabolic derangement occurs either as a result of its chemical by-products directly or through alcohol-induced tissue or organ injury.3,4,5&#xD;
&#xD;
There is variation in the pattern of alcohol consumption in India and across the world1. There is a paucity of studies that correlate alcoholic intoxication and metabolic derangements, especially in the Indian setup. Our study thus focuses on the prevalence and pattern of acid-base and electrolyte abnormalities in acute alcohol intoxication.&#xD;
&#xD;
AIMS AND OBJECTIVES&#xD;
&#xD;
Our study aimed to study acid-base imbalance and electrolyte abnormalities in acute alcohol-intoxicated individuals and to investigate the association of blood-alcohol levels to disturbances in acid-base balance and electrolyte levels.&#xD;
&#xD;
METHODS: &#xD;
&#xD;
This was a cross-sectional study conducted in hospitals associated with KMC (Kasturba Medical College), Mangalore. This was a time-bound study conducted from September 2017 to September 2019. The sample size was 200. The study population was selected using convenient sampling.&#xD;
&#xD;
Method of study:&#xD;
&#xD;
After clearance from the institutional ethics committee, KMC Mangalore, the study sample collection was started in September 2017. Informed consent obtained from the patient or patient&#x2019;s relatives. The blood sample was drawn for complete blood counts, renal function tests, liver function tests, ABG, electrolytes after ruling out hypo/ hyperglycemia. A blood sample obtained for estimation of blood alcohol levels. Inclusion criteria being age 18 years or more, Satisfying DSM IV-TR criteria for acute alcoholic intoxication, Blood alcohol concentration 80mg/dl All patients who fit the inclusion criteria were enrolled into the study. Informed consent obtained from the patient or patient&#x2019;s relatives. Exclusion criteria included sugar levels at presentation &lt; 70mg/dl or &gt;200 mg/dl, concomitant acute intoxication with other poisons/ psychoactive substances, patients on treatment with drugs causing electrolyte/ acid-base disturbances, pregnant/ lactating women, known diabetics, recent use of alcohol-containing mouthwash/cologne and patients with a known psychiatric disorder.&#xD;
&#xD;
Blood alcohol levels were estimated using test kits that were based on the enzymatic method with alcohol dehydrogenase. The NADH produced as a result of the action of ADH on alcohol was measured photometrically based on the principle that the rate of change in absorbance is directly proportional to the ethanol concentration&#xD;
&#xD;
Analysis:&#xD;
&#xD;
Collected data were coded and entered into and analyzed using SPSS (statistical package for social sciences &#x2013; version 17)&#xD;
&#xD;
Results expressed in terms of descriptive statistics &#x2013; mean, median and percentages&#xD;
&#xD;
Categorical variables were presented as numerical data statistical comparison was done using ANOVA. the p-value of less than or equal to 0.05 was considered statistically significant.&#xD;
&#xD;
RESULTS:&#xD;
&#xD;
A total of 200 patients were studied. The majority of the patients were </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3873</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3873</Fulltext></URLs><References>1.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Vladimir P, Dag RG, J&#xFC;rgen R, Kevin S, Gretchen S. Status report on alcohol and health 2014. Int J Clin Pract. 2014; 1 (1): 51-52.&#xD;
&#xD;
2.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;Rosato V, Abenavoli L, Federico A, Masarone M, Persico M. Pharmacotherapy of alcoholic liver disease in clinical practice. Int J Clin Pract. 2016;70(2):119&#x2013;31. &#xD;
&#xD;
3.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Heidland A, Horl WH, Schaefer RM, Teschner M, Weipert J, Heidbreder E. Role of alcohol in clinical nephrology. Klin Wochenschr 1985; 63: 948-58&#xD;
&#xD;
4.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Acid-base and electrolyte abnormalities in alcoholic patients. Miner Electrolyte Metab. &#xA0;1994; 20: 274-81.&#xD;
&#xD;
5.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Elisaf M, Kalaitzidis R. Metabolic abnormalities in alcoholic patients: focus on acid-base and electrolyte disorders. J Alcohol Drug Depend. 2015; 3: 185.&#xD;
&#xD;
6.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Mathai PJ. Serum Electrolytes Levels in Patients with Alcohol Dependence Syndrome. Int J Clin Pract. 2017; 4 (5):992&#x2013;997.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Phytochemical Screening and Evaluation of Cytotoxicity and Acute Toxicity of Ethanolic Leaf Extract of Cayratiaauriculata&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>101</FirstPage><LastPage>107</LastPage><AuthorList><Author>Lalitha Surulichamy</Author><AuthorLanguage>English</AuthorLanguage><Author> Anusha Dakshinamoorthi</Author><AuthorLanguage>English</AuthorLanguage><Author> Yogesh Kumar Murkunde</Author><AuthorLanguage>English</AuthorLanguage><Author>  Viji Devaanand</Author><AuthorLanguage>English</AuthorLanguage><Author> K. Maheshkumar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The Cayratiaauriculata has been used as a folk medicine to treat various pathophysiological conditions. Aim: In the present study, we evaluated the presence of major phytochemicals, cytotoxicity and acute toxicity effect of ethanolic extract of Cayratiaauriculata leaves. Methodology: The phytochemical screening was carried out using chemical methods; gas chromatography-mass spectrometry (GC-MS) analysis was performed to identify the individual phytoconstituents present in it; cytotoxicity assay was performed in A549 cells and acute toxicity test was performed in the zebrafish model. Results: The results of the qualitative analysis revealed the presence of flavonoids, phenols, coumarin, saponins, tannins, terpenoids, steroids and glycosides. C. auriculatawas found to contain a significant amount of total flavonoid and phenol contents in quantitative analysis. Fifteen different phytoconstituents were expressed in GCMS analysis. In the acute toxicity test, the methanolic extract of C.auriculatadid does not cause mortality or any clinical signs of toxicity in zebrafish to the maximum concentration of 100 mg/L.Therefore the LC50 value of extract was found to be ?100 mg/L. Hence it can be considered safe. Conclusion: This paper will help in considering C. auriculate or further pharmacological studies in future.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Herbal extract, Cayratia, phytochemicals, Cytotoxicity, Acute toxicity, Zebrafish</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Medicinal plants and their derivatives have a long history of treating human diseases. Day by day, these medicinal plants draw the attention of worldwide researchers because of their lesser side effects and good compatibility with the human body .1The active compounds present in plants containing medicinal properties are considered herbal drugs. These active compounds are phytochemicals and also called secondary metabolites. Some of the common secondary metabolites found in plants include alkaloids, flavonoids, terpenoids, glycosides and phenolics.2&#xA0; Isolated bioactive molecules from plant serve as starting materials for drug development. 3 However, these secondary metabolites are found to be in meagre quantity in plant material. Due to this constraint, the extraction, purification and characterization of secondary metabolites become very crucial in the process of the plant-based drug discovery process. 4 Extraction is a preliminary and critical step in the process of discovery and isolation of bioactive material. Phytochemical analysis of raw plant materials is very significant to detect and quantify the phytoconstituents present in it. 5&#xD;
&#xD;
Cayratiaauriculata(C. auriculata) belongs to the Vitaceae family, class Magnoliopsida and phylum Tracheophyta. It is commonly called Jangliangoor and Amarchotioo. 6 Synonyms ofCayratiaauriculataare Cyphostemmaauriculatum (Roxb.), CissusauriculataRoxb., Vitisauriculata (Rob.), and Cayratiaauriculata (Roxb.) Gamble. It has been reported to be distributed in Bangladesh, Bhutan, India, Myanmar, Thailand and Sri Lanka. C. auriculata is a climber with spongy stems, 5-foliate leaves, tetramerous flower and cherry-sized red fruits (Figure 1). Cayratiaauriculata has 2n= 24 chromosomes. Cayratia species has a significant role in the preparations of Ayurvedic medicines, homemade remedies, and natural pesticides as it has a good source of Phytochemicals. 6,7C. auriculatahas following significant medical application. It has been used to treat ulcers, cough, cold, intestinal worm, rheumatism, hydrocele, ulcer, diarrhoea and abscess. Its leaf decoction was used as a remedy for uterine disorder and fever. 7 The bark of C. auriculata is used to treat burns, boils, wounds and snakebite. 9-12 Apart from this, the shoot and leaves of C. auriculata were also used as vegetables. 7Despite the widely reported therapeutic applications of&#xA0;C.auriculata,&#xA0;there is no research finding reporting its toxicity profile.&#xA0; Moreover, there was no literature available on the phytochemical processing of this plant species. To address these lacunae, in the present study ethanolic extract of C.auriculataleaveswas examined for the qualitative and quantitative phytochemical profile, identification of phytoconstituents through GCMS, cytotoxicity effect and acute toxicity effect in the zebrafish model. &#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
Collection and Extraction of Plant Material:&#xD;
&#xD;
The C. auriculata plant was collected in forest areas of Visakhapatnam district, Andhra Pradesh. The plant was authenticated by DrPadal, Associate Professor, Department of Botany, Andhra University, and Visakhapatnam- 530003. The leaves were washed thrice thoroughly with distilled water to remove the dirt and debris and then dried under shadow till it gets completely dried. The dried leaves were coarsely ground powdered and extracted using a soxhlet apparatus as follows. Briefly, about 20 g of dry leaf powder of C.auriculatawas extracted with 500 ml of ethanol (Finar Ltd.) solvent. The filtered crude plant extract was concentrated using a rotary evaporator (Buchi, Switzerland). The thick extract was obtained and stored under -20&#xB0;C for further analysis.&#xA0;&#xA0; &#xD;
&#xD;
Qualitative preliminary phytochemical analysis&#xD;
&#xD;
The preliminary phytochemical qualitative screening was carried out using an ethanolic extract of C.auriculatasuch as follows&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Saponins:&#xD;
	&#xD;
&#xD;
&#xD;
About 5 ml of extract was shaken vigorously with 5 ml of warm distilled water in a test tube. The formation of stable foam was taken as an indication of the presence of saponins.13&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Glycoside:&#xD;
	&#xD;
&#xD;
&#xD;
About 2 ml of extract was added to 2 ml of acetic and then cooled well in ice. Then Con. H2SO4 was added carefully. A colour change from violet to blue to green indicates the presence of a steroidal nucleus (which is the aglycone portion of glycoside.13&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Coumarin:&#xD;
	&#xD;
&#xD;
&#xD;
To 2 ml of extract 2 ml of 10% sodium hydroxide was added. The appearance of yellow colour indicates the presence of coumarin. 15&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Alkaloids: &#xD;
	&#xD;
&#xD;
&#xD;
To 2 ml of extract, 2 ml of the con. HCL was added. Then few drops of Mayer&#x2019;s reagent were added. The presence of green colour or white precipitate indicates the presence of alkaloids. 13&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Flavonoids&#xD;
	&#xD;
&#xD;
&#xD;
To 5 ml of extract, 3 ml of lead ethanoate solution was added. The formation of buff-coloured precipitate was taken as an indication of the presence of flavonoids. 14&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Tannins: &#xD;
	&#xD;
&#xD;
&#xD;
To 1 ml of extract, 2 ml of 5% ferric chloride was added. The formation of green, blue-black, or blue-green indicates the presence of tannins. 15&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Phenols: &#xD;
	&#xD;
&#xD;
&#xD;
To 1 ml of extract,2 ml of distilled water followed by a few drops of 10% ferric chloride was added. The formation of blue or green colour indicates the presence of phenols. 15&#xD;
&#xD;
&#xD;
	&#xD;
	Test for Terpenoids:&#xD;
	&#xD;
&#xD;
&#xD;
About 2 ml of extract was dissolved in 2ml of chloroform and evaporated to dryness. 2ml of concentrated sulphuric acid was then added and heated for about 2min. Development of a greyish colour indicates the presence of terpenoids.16&#xD;
&#xD;
&#xD;
	&#xD;
	Tests for steroids&#xD;
	&#xD;
&#xD;
&#xD;
About 2 ml of extract was dissolved in 2ml of chloroform and 2ml concentrated sulphuric acid.&#xA0; A red colour produced in the lower chloroform layer indicates the presence of steroids. 16&#xD;
&#xD;
&#xD;
	&#xD;
	Tests for anthraquinones: &#xD;
	&#xD;
&#xD;
&#xD;
About 2 ml of extract was shaken with 10 ml of benzene and then filtered. And 5 ml of the 10% ammonia solution was then added to the filtrate and thereafter shaken vigorously. The appearance of a pink, red or violet colour in the lower ammonia layer was taken as the presence of free anthraquinones.13&#xD;
&#xD;
Phytochemical Quantitative Analysis:&#xD;
&#xD;
The phytochemical quantitative screening was carried out using ethanolic extract of C.auriculatato to estimate the number of total phenolics and flavonoids by the method of. 17&#xD;
&#xD;
2.3.1.Totalphenolics content&#xD;
&#xD;
&#xA0;&#xA0; The total phenolics content of ethanolic extract of C.auriculatawas estimated using Folin-Ciocalteau reagent. About 20 &#xB5;g of the extract was taken and made up to 1 mL with distilled water. Then 500 &#xB5;L of diluted Folin&#x2019;s reagent and 2.5 mL of 20% sodium carbonate solution were added. The mixture was shaken well and incubated in dark for 40 min and read spectrophotometrically at 725 nm. A calibration curve of gallic acid was constructed.&#xA0; The results were compared with the gallic acid calibration curve and the total phenolic content of the sample was expressed as mg of gallic acid equivalent (mg GAE/g extract) by using the standard curve. &#xD;
&#xD;
Total flavonoids content&#xD;
&#xD;
About 1 mL of extract was diluted with 200 &#xB5;L of distilled water followed by the addition of 150 &#xB5;L of 5 % sodium nitrite solution. This mixture was incubated for 5 min and then 150 &#xB5;L of 10% aluminium chloride solution was added and allowed to stand for 6 min. Then 2 mL of 4% sodium hydroxide solution was added and made up to 5 mL with distilled water. The mixture was shaken well and left it for 15 min at room temperature. The absorbance was read at 510 nm. The total flavonoids content was expressed as rutin equivalent mg RE/g extract using the standard curve.&#xD;
&#xD;
&#xA0;GCMS Analysis:&#xD;
&#xD;
Gas chromatography-Mass Spectroscopy analysis was performed to identify the phytoconstituents present ethanolic extract of C.auriculataleaves. It is an effective chemical analysis and also a common confirmation test.18 A Shimadzu GC-2010 Plus gas chromatograph was used for analysis. The sample was introduced by split injection of ratio 10:1. The oven temperature was programmed to increase as follow, 35&#xB0;C for 2 minutes, then rise by 20&#xB0;C per minute to reach 450&#xB0;C and remain at 450&#xB0;Cfor 5 minutes. The helium is used as carrier gas at a flow rate of 2 ml/minute. The software GCMS solution ver. 2.6 was used for analyses. Identification of the components present in the extract was determined by comparing the name, molecular weight, and structure of the spectrum of known components stored in the library of National Institute Standard and Technology (NIST) library V which was provided by the instrument software. &#xD;
&#xD;
Acute toxicity study in zebrafish:&#xD;
&#xD;
60 adult zebrafish of both male &amp; female with a mean body length and weight of 3&#xB1;0.5 cm and 0.334&#xB1;0.05 g respectively were procured from Whizbang Bioresearch, Chennai. The acute toxicity study was performed as per OECD 203. After acclimatization, the fish were randomly divided into six groups of 10 fishes each. The test solution was prepared by dissolving the required quantity of the test item in the aquarium habitat water of known quantity. The fishes in Group I, II, III, IV and V was treated with extract at different concentrations during the test period of 96 hours, that is, 100, 50, 25, 12.5, and 6.25 mg/L respectively. The fishes in Group VI were normal control. The exposure solutions were maintained at optimum pH, temperature and dissolved oxygen concentration throughout the study as same as in the acclimation procedure. The test fishes were observed and recorded at 24, 48, 72 and 96 hours for mortality and morbidity. Observations were done at 0, 3, 6, 24, 48, 72 and 96 hours for clinical signs of toxicity. At the end of the test period, fishes were euthanizedinTricaine (MS-222) and subjected to necropsy. &#xD;
&#xD;
&#xA0;Histology of zebrafish:&#xD;
&#xD;
For the histopathology analysis, the fish was fixed in 10% neutral buffered for 48 h. Then the fish were processed in graded concentrations of alcohol, xylene and impregnate in paraffin. Processed tissues were embedded in paraffin block and whole body sagittal sections were prepared at 5- micron thickness mounted on slides and stained with Haematoxylin and Eosin stain. The analysis of slides was performed under a light microscope [Optoscope] and photographed with the camera (digital). Slides were scored as per the method described based on the severity of histological changes &#xA0;19&#xD;
&#xD;
RESULTS &amp; DISCUSSION:&#xD;
&#xD;
In the present study, we established the phytochemical and toxicity profile of the ethanolic extract of C. auriculata leaves for the first time. No studies were carried out in this species before. Therefore, the further comparison was made on the same plant genus. As C. auriculata has been used as a crude extract in folk medicine, we have used the crude ethanolic extract of C. auriculate or all our experiments. Moreover, the crude extract will contain a mixture of bioactive compounds. Though the plant-based medications are often considered to be safe and have no side effects, 20 it is essential to derive the safety profile of the particular plant extract to determine the dose level for the examination of the therapeutic index of drugs through subsequent pharmacological studies.Hence we scrutinized the cytotoxic potential and acute toxic potential of C. auriculata in a zebrafish model.&#xD;
&#xD;
Phytochemical preliminary Qualitative Analysis:&#xD;
&#xD;
The preliminary phytochemical screening using chemical methodsconducted on the ethanolic extract revealed the presence of various phytochemicals like flavonoids, phenols, coumarin, saponins, tannins, terpenoids, steroids and glycosides. The qualitative analysis for the C.auriculata extract is shown in Table 1. In another study, phytochemical screening of Cayratiapedata(Lam.) Gagnep. var. glabraGamble has been reported to contain carbohydrates, proteins, amino acids, alkaloids, anthraquinones, flavonoids, glycosides, phenols and tannins, steroids and sterols, triterpenoids and volatile oil. 21 Cayratiatrifoliawas found to contain kaempferol, myricetin, quercetin, triterpenes and epifriedelanol, steroids, terpenoids, flavonoids, tannins, hydrocyanic acid and delphinidin. 22 The leaf and stem of Cayratiagracilisshowed the presence of carbohydrates, tannins, saponins, flavonoids, balsams, resins, terpenes, alkaloids and sterols. 23Ethanol extract of galing stem (C. trifoliaDomin.) shows the presence of alkaloids, saponins, terpenoids, tannins, and flavonoids. 24 These results show that all Cayratia plants consist of the following common phytochemicals, flavonoids, glycosides, phenols, tannins, steroids, terpenoids, saponins, and alkaloids. These phytochemicals have certain pharmacological properties. For example, phenolics compound act as a reducing agent, hydrogen donor, metal chelator25 and has anticancer and cardioprotective activity . 21 Flavonoids act as an antioxidant .23, 24, 25 Tannins have astringent and anti-diarrhoea activity. Saponins are known to have activity against gastro-intestinal infections and cardiovascular diseases . 23&#xD;
&#xD;
3.2. Phytochemical Quantitative Analysis:&#xD;
&#xD;
The phytochemicals present in the extracts was quantitatively determined by standard procedure. The total phenolic and flavonoid content in the ethanolic extract of C. auriculata was estimated to be 111.36 mg GAE/g and 26.32 mg RE/g extract. In another study, the stem ethanolic extract of C.trifoliawas estimated to contain total phenol, tannin, alkaloid, flavonoid and saponin contents as 34.97 &#xB1; 0.4, 54.52 &#xB1; 0.3,&#xA0; 33.74 &#xB1; 0.68,&#xA0; 26.07 &#xB1; 0.40,&#xA0; and 39.52 &#xB1; 0.50 mg/g respectively.25 The ethanol extract of C. pedatavar. glabrawas found to contain 131.7 &#xB1; 3.6 and 52.8 &#xB1; 12.9 mg TAE/g extract of Total phenolics and Tannin respectively.21 C. pedateandC.auriculatacontain a large amount of phenolic content.&#xD;
&#xD;
GCMS Analysis:&#xD;
&#xD;
GC-MS chromatogram analysis of the ethanolic extract of C. auriculata indicating the presence of fifteen different phytochemical constituents by comparing their retention times, molecular formula and molecular weight (MW) and mass spectra [Figure 2]. GC-MS analysis for biomolecules in plant extract provides deep insight into the medicinal properties of the plant. 18 The various compounds detected by GC-MS analysis in C. auriculatais shown in (Table 2).&#xA0; In which, the carbonic acid was identified to have an essential role in nitrogen base protonation in blood serum. 26 Further study on predicted biomolecules will help identify the pharmacological activity of each compound.&#xD;
&#xD;
GC-MS analysis on ethanolic extract of C. trifoliastem exhibited 20phytoconstituents. In which the following compounds are found to present in higher concentration, hexadecanoic acid, ethyl ester, phytol, tetratriacontane, stigmasterol, nonacosane and octadecane.27&#xD;
&#xD;
Acute toxicity study of the extract in zebrafish:&#xD;
&#xD;
Zebrafish has around 70% of homologous genes to that of humans. It has become an efficient model vertebrate in toxicity and pharmacology studies .32-34 Hence, we presumed to evaluate the acute toxic potential of C. auriculatain in the zebrafish model. The test conducted to determine the LC50 value of extract in 96 hrs. of exposure. The results show that there were no morbidity, mortality or clinical signs of toxicity were observed in all the experimental groups throughout the study. 28-31All the test fish were found to be normal when compared to the control. There were no treatment-related gross pathological changes were visualized across different test groups in comparison with the control group. These data show that the LC50 of ethanolic extract of C. auriculatawas found to be greater than 100 mg/L under the tested experimental conditions in the present study. As per Organization for Economic Co-operation and Development (OECD) and European Chemicals Bureau (ECB), the pollutants are categorized as harmful to zebrafish if., 10 mg / L &lt; LC 50 &lt; 100 mg / L. 35&#xD;
&#xD;
Based on this categorization, ethanolic extract of C. auriculatawas considered to be safe. An acute toxicity study of ethyl acetate extract of C. trifolia was performed as per OECD guideline No. 420 in female Wistar rats. The result reveals that C. trifoliawas found to be safe up to the dose of 2000 mg/kg .36This result is in line with our study that Cayratiaspecies shows no toxicity. &#xD;
&#xD;
Histopathology of zebrafish:&#xD;
&#xD;
Histopathological investigations were carried out to find out any changes in the cellular morphology and architecture in test fish when compared with control fish. Acute toxicity studies on different doses of C. auriculata leaf extracts showed no discrete histopathological changes in the gills, kidney, liver, and intestine, heart, and muscle tissue of the test fishes in comparison with control group fishes (Figure 4). There was normal cellular architecture observed in all the experimental groups. &#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
To conclude based on the above results, it was found that the ethanolic extract of C. auriculata holds more phytochemicals and contains various phytoconstituents which was detected through GCMS. Future studies on these phytoconstituents may be useful in identifying their pharmacological efficacy. The extract shows a cytotoxic effect against A549 cells in comparison with control. Acute toxicity test results show that the extract is safe in testing with zebrafish. Thus C.auriculatacanbe further studied for its pharmacological activity in future. &#xD;
&#xD;
Acknowledgement: &#xD;
&#xD;
The authors would like to acknowledge the unstinted support by the management of Sri Ramachandra Medical College and Research Institute, SRIHER (DU), Chennai. &#xD;
&#xD;
Conflict of interest: &#xD;
&#xD;
Nil &#xD;
&#xD;
Source of Funding &#xD;
&#xD;
Nil &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3874</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3874</Fulltext></URLs><References>&#xA0;&#xD;
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6. &#xA0;&#xA0;&#xA0; Trias-Blasi A, Chayamarit K, Parnell JAN. Cyphostemmaauriculatum (Roxb.) P. Singh &amp; B. V. Shetty (Vitaceae): typification and a new generic record confirmed for Thailand. Kew Bull.2015;70(2):20. &#xD;
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18. &#xA0; Rukshana. Phytochemical Screening and GC-MS Analysis of Leaf Extract of Pergulariadaemia (Forssk) Chiov. 2017;7. &#xD;
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19. &#xA0; Zodrow JM, Stegeman JJ, Tanguay RL. Histological analysis of acute toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in zebrafish. AquatToxicol. 2004;66(1):25&#x2013;38. &#xD;
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20. &#xA0; Kasthuri O R, Ramesh B. Toxicity Studies on Leaf Extracts of Alternantherabrasiliana (L.) Kuntze and Alternantherabettzickiana (Regel) Voss. J Appl Pharm Sci. 2018;8(10):82&#x2013;9. &#xD;
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21. &#xA0; Sharmila S, Kalaichelvi K, Dhivya SM. Pharmacognostical and phytochemical analysis of Cayratiapedata var. glabra&#x2014;A vitaceae member. Int J Pharm Sci Res. 2018;9:218-26. &#xD;
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22. &#xA0; Kumar D, Gupta J, Gupta A, Kumar S, Arya R. A review on chemical and biological properties of Cayratiatrifolia Linn. (Vitaceae).Pharmacogn Rev. 2011;5(10):184. &#xD;
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23. &#xA0; Henry E, Jemilat I, Kudirat M, Uche E, Samuel O. Phytochemical, Pharmacognostic and Elemental Analysis of Cayratiagracilis (Guill. and Perr.) Suesseng. J Appl Pharm Sci. 2015;048&#x2013;52. &#xD;
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24. &#xA0; Yusuf MI, Wahyuni W W, Sri Susanty S, Ruslan R R, Fawwaz M. Antioxidant and Antidiabetic Potential of Galing Stem Extract (CayratiatrifoliaDomin). Pharmacogn J. 2018 ;10(4):686&#x2013;90. &#xD;
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25. &#xA0; Sowmya S, Perumal Pc, Anusooriya P, Vidya B, Pratibha P, GopalakrishnanVk. Quantitative Analysis And In Vitro Free Radical Scavenging Activity Of CayratiaTrifolia. World J Pharm Res.2019; 3(6):16. &#xD;
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26. &#xA0; https://en.wikipedia.org/wiki/Carbonic_acid#cite_note-8.&#xD;
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28. &#xA0; He Y, Zhu Q, Chen M, Huang Q, Wang W, Li Q, Huang Y, Di W. The changing 50% inhibitory concentration (IC50) of cisplatin: A pilot study on the artefacts of the MTT assay and the precise measurement of density-dependent chemoresistance in ovarian cancer. Oncotarget. 2016;7(43):70803.&#xD;
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29. &#xA0; J. AnbuJebaSunilson, G. Rejitha, K. Anandarajagopal, Amitava Das MM and PP. Cytotoxic Effect of CayratiacarnosaLeaves on Human Breast Cancer Cell Lines. Int J Cancer Res. 2009;5(3):115&#x2013;22.&#xD;
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30. &#xA0; DS, Keo S, Cheng SK, Oh H, Kim YC. Protective effects of Cambodian medicinal plants on tert?butyl hydroperoxide?induced hepatotoxicity via Nrf2?mediated heme oxygenase. Mol Med Rep. 2017;15(1):451-9. &#xD;
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31. &#xA0; Perumal PC, Sowmya S, Velmurugan D, Sivaraman T, Gopalakrishnan VK. Assessment of dual inhibitory activity of epifriedelanol isolated from Cayratiatrifolia against ovarian cancer. Bangladesh J Pharm. 2016;11(2):545. &#xD;
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32. &#xA0; Zakaria F, Ibrahim WN, Ismail IS, Ahmad H, Manshoor N, Ismail N, Zainal Z, Shaari K. LCMS/MS Metabolite Profiling and Analysis of Acute Toxicity Effect of the Ethanolic Extract of Centellaasiatica on Zebrafish Model. Pert J Sci Techn. 2019;27(2): 971 - 989. &#xD;
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34. &#xA0; Wibowo I, Permadi K, Hartati R, Damayanti S. Ethanolic extract of pomegranate (Punicagranatum L) peel: acute toxicity tests on zebrafish (Daniorerio) embryos and its toxicity prediction by in silico. J Appl Pharm Sci. 2018; 8(06):082-6.&#xD;
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35. &#xA0; Batra S, Batra N, Nagori BP. Preliminary phytochemical studies and evaluation of the antidiabetic activity of roots of Cayratiatrifolia (L.) Domin in alloxan-induced diabetic albino rats. J Applied Pharm Sci. 2013;3(3):97.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Collagen Based vs Conventional Dressing in the Treatment of Diabetic Foot Ulcer-A Comparative Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>108</FirstPage><LastPage>113</LastPage><AuthorList><Author>Mishra T</Author><AuthorLanguage>English</AuthorLanguage><Author> Mishra J</Author><AuthorLanguage>English</AuthorLanguage><Author> Panigrahy R</Author><AuthorLanguage>English</AuthorLanguage><Author> Baral P</Author><AuthorLanguage>English</AuthorLanguage><Author> Patra GT</Author><AuthorLanguage>English</AuthorLanguage><Author> Murmu D</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Diabetic Mellitus (DM) currently affects approximately 8.3 percent of the population in the United States and more than 79 million individuals are pre-diabetic. Of the many complications of DM, Diabetic foot ulcers (DFUs) remain a serious and challenging one to deal with. Many treatment modalities have been tried since time immemorial. As the technology and research have advanced, the treatment of DFUs has also seen many changes and the use of collagen dressings in DFUs remains one of them. Aims: Comparison between conventional dressings and collagen dressings in DFUs, to know the effectiveness of collagen dressing, its safety and effectiveness in controlling wound infection. Methodology: A prospective study was undertaken with 100 diabetic foot ulcer patients who presented to surgery OPD between 2018 and 2020. Out of the 100 patients, 50 patients were subjected to collagen dressings and 50 patients to conventional dressing. Results: Complete wound healing was seen in 42 (84%) out of 50 patients treated with collagen dressings while only 31 patients (62%) achieved complete wound healing when treated with conventional dressing. This reduced the need for skin grafting in patients treated with collagen dressings as compared to conventional dressings (16% vs 38%). Conclusion: Collagen dressing accelerates wound healing in patients with DFUs thereby reducing the duration of hospital stay and also decreases the need for split-thickness skin grafting. Through our research, we conclude that conventional dressings are better when compared to conventional dressings.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Diabetes mellitus, Diabetic foot ulcer, Collagen dressings, Chronic wounds, Matrix metalloproteinases (MMPs)</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
A serious and frequent complication of diabetes mellitus (DM) is diabetic foot ulcer (DFU), which raises treatment costs significantly DM currently affects approximately 8.3 per cent of the population in the United States and more than 79 million individuals are pre-diabetic.1,2 And among people with diabetes (PWD), 12%-25% have a lifetime chance of developing a foot ulcer.3,4,5&#xA0; The human foot is a remarkable mirror of the systemic diseases it harbours.&#xD;
&#xD;
In recent years, several new treatment methods, such as growth factors, extracellular matrix materials, bioengineered human skin, hyperbaric oxygen and collagen dressing, have been developed to promote wound healing in DFU. Biological dressings such as collagen, provide a suitable physiological interface between the ulcer and the environment and it also prevents the ulcer&#x2019;s bacterial contamination. In the successful completion of adult wound healing, collagen, the body&amp;#39;s most abundant protein, plays a vital role. Collagen is identified as an endogenous material that forms an essential structural element in connective tissue and is of special significance to the skin. The significance of collagen in wound healing has been known for several years for the basic explanation that during wound healing, the scar formed is made of collagen fibers.6During the body&amp;#39;s protein scaffolding, collagen creates molecular diversity.7&#xD;
&#xD;
The present study contrasts the effectiveness of collagen dressing with commonly used dressing materials such as normal saline and liquid povidone-iodine moistened gauze dressings in DFU management.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
STUDY DESIGN - Prospective study.&#xD;
&#xD;
METHOD OF COLLECTION OF DATA&#xD;
&#xD;
&#xD;
	&#xD;
	Source of data &#x2013; This study is conducted in the Department of General Surgery at the Institute of Medical Sciences and SUM Hospital, Kalinga Nagar, Bhubaneshwar, over 2 years.&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Sample size &#x2013; Sample size of 100 patients fulfilling the inclusion criteria will be a part of this study, &#xD;
	&#xD;
	&#xD;
	The clinical study will be through questionnaires and investigation reports.&#xD;
	&#xD;
	&#xD;
	Ethical Clearance No &#x2013; DMR/IMS.SH/180102&#xD;
	&#xD;
&#xD;
&#xD;
INCLUSION CRITERIA:&#xD;
&#xD;
&#xD;
	&#xD;
	All patients aged 18 and above, with a diabetic foot ulcer which were debrided of necrotic tissue and are admitted to surgery wards in IMS and SUM Hospital.&#xD;
	&#xD;
&#xD;
&#xD;
EXCLUSION CRITERIA:&#xD;
&#xD;
&#xD;
	&#xD;
	Patients with other foot ulcers without diabetes.&#xD;
	&#xD;
	&#xD;
	Patients with known hypersensitivity to any of the dressing components.&#xD;
	&#xD;
	&#xD;
	Patients with conditions that may interfere with wound healing (e.g.- chronic liver or renal disease, connective tissue disorder, immune system disorder, major nutritional deprivation, uncontrolled diabetes mellitus)&#xD;
	&#xD;
	&#xD;
	Patients who are not willing to participate in the study.&#xD;
	&#xD;
&#xD;
&#xD;
METHOD&#xD;
&#xD;
A total of 100 patients admitted in surgery wards of IMS and SUM Hospital between June 2018 and June 2020, with the clinical picture showing Diabetic Foot Ulcer were selected for the study. After explaining the procedure of the study, written informed consent was taken before enrolment into the study.&#xD;
&#xD;
For analysis, the patients were divided into two groups i.e., Group A (Collagen Dressing group) and Group B (Conventional Dressing group). The patients were numbered serially from one to a hundred in the study group. The patients bearing odd study group serial numbers were subjected to Collagen dressing with collagen granules (BioFil) and the patients bearing even study group serial numbers were subjected to Conventional dressing (Normal saline &amp; betadine).&#xD;
&#xD;
In both the groups data regarding characteristics of ulcers such as size, edge, floor characteristics, slough, granulation tissue, pathogenic organisms and wound swab or pus culture sensitivity results were noted and analysed. Wound swabs were taken, first at the time of admission, at the end of the 2nd and 4th week of treatment and also when specifically required. Fasting blood sugar and 2hr PPBS were done every three days interval and result noted. Before applying the dressing, the affected area was thoroughly cleaned for removal of external contamination and infected wounds were debrided properly. Both groups were subjected to antibiotic treatment based on pus culture sensitivity reports. &#xD;
&#xD;
In Group A i.e., "Collagen dressing group" collagen granules were sprinkled over the diabetic foot ulcer after appropriate debridement of slough and necrosed tissue. The wound was then covered with a moist dressing. Initially, the dressing was changed on alternate days or earlier if there is soakage of the dressing, subsequently, the dressings were spaced every three or four days, depending upon the wound condition. Before sprinkling the collagen granules, the wound bed was thoroughly cleaned and the collagen sprinkled over the raw area of the ulcer. Dressing with collagen was continued till the wound heals or for 6 weeks. If by the end of 6 weeks, the DFU had not healed then the patient was considered for split-thickness skin grafting (SSG).&#xD;
&#xD;
In Group B i.e., "Conventional dressing group" isotonic sodium chloride and liquid povidone iodine moistened gauze were applied over wound area and covered with gauze bandage and tapes. The conventional dressings were changed every alternate day or earlier if the dressing was soaked till the wound heals or for 6 weeks. If by the end of 6 weeks, the DFU had not healed then the patient was considered for split-thickness skin grafting (SSG).&#xD;
&#xD;
The patients in both groups were studied for six weeks. After the completion of six weeks, those patients who had not achieved complete wound healing were subjected to split-thickness skin grafting (SSG).&#xD;
&#xD;
Results of this study were noted in terms of the number of dressings required, achieving a sterile wound, time is taken for healthy granulation, complete wound healing and needs for SSG. Both groups were followed till discharge and its results noted. The patients were followed up for three months after discharge and any morbidity or mortality factors recorded.&#xD;
&#xD;
RESULT&#xD;
&#xD;
Out of the 100 patients in the study, 72 were male and 28 were female. (Table &#x2013; 1)&#xD;
&#xD;
In the above study, most of the patients (56%) were found to be in the age group of 51 &#x2013; 65 years. The mean age of patients in the collagen and the conventional group were 61.26 &#xB1; 12.22 and 59.60 &#xB1; 10.31 respectively. (Table &#x2013; 1)&#xD;
&#xD;
The size of the ulcers ranged from 2 cm2 to 18 cm2 in both the study groups. Most of the patients (56%) were having ulcer size between 1 cm2 to 6 cm2. (Table 2)&#xD;
&#xD;
The average size of ulcer in collagen and the conventional groups were 6.46 cm2 and 7.24 cm2 respectively. (Table 2)&#xD;
&#xD;
Most of the patients with DFUs presented in the 2nd week (8-14 days) of them developing the ulcer. It was also observed that larger ulcers were comparatively of longer duration in onset in both the study groups. (Table 3)&#xD;
&#xD;
In the collagen dressing group significantly a greater number of ulcers (P=0.027) became sterile (66%) as compared to the conventional dressing (44%) group at the end of two weeks of the study period as shown by their swab culture reports. (Table 4)&#xD;
&#xD;
*Fisher&#x2019;s exact test is applied as one cell has a value less than 5.&#xD;
&#xD;
Of the DFUs treated with collagen, 94% had sterile wound swab culture at the end of 4 weeks while only 76% of the DFUs wounds were sterile in the patients treated with conventional dressing at the end of 4 weeks. (Table 4)&#xD;
&#xD;
Of the DFUs treated with collagen, 42 patients (84%) had sterile wound swab culture at the end of 6 weeks (P =0.013) while only 31 patients (62%) of the DFUs wounds were sterile in the patients treated with conventional dressing at the end of 6 weeks. (Table 4)&#xD;
&#xD;
Of the DFUs treated with collagen, 16% required SSG while 38% of the DFUs wounds required SSG in the patients treated with conventional dressing. (Table 4)&#xD;
&#xD;
In the collagen group, most of the patients required 5 or fewer no of dressings whereas in the conventional group most of the patients required 6 to 10 numbers of dressings. (Figure 1)&#xD;
&#xD;
Most of the DFUs in the collagen group developed healthy granulation tissue within 10 days of starting of dressing (72%) while the development of healthy granulation tissue in the conventional group was significantly delayed (P &lt; 0.001). (Figure 2)&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Collagen is an important component of wound healing. Wounds tend to stall in the inflammatory phase due to a number of factors such as local tissue ischemia, bioburden, necrotic debris, recurrent trauma etc. increasing their chronicity. Matrix metalloproteinases (MMPs) is one of the key components found to be elevated in chronic wounds. Not only do increase MMPs degrade non-viable collagen, but also viable collagen. In addition, fibroblasts in chronic wounds may not secrete tissue inhibitors of MMPs (TIMPs) at the levels needed to regulate the function of MMPs. This prevents the stage necessary for cell migration from forming and further prevents extracellular matrix (ECM) and granulation tissue from forming. By acting as a &amp;#39;sacrificial substrate&amp;#39; at the wound site, collagen-based wound dressings help solve the issue of increased levels of MMPs. The breakdown products of collagen are chemotactic agents for different cells necessary for the formation of granulation tissue. Dressings based on collagen are also capable of removing wound exudates and preserving a moist wound environment.&#xD;
&#xD;
Collagen is a biological material that facilitates wound healing through the deposition and arrangement of freshly formed fibres and granulation tissue in the wound bed, providing a suitable wound healing environment.8When sprinkled over a wound, collagen granules facilitate angiogenesis and also strengthen the healing processes of the body.9,10 This serves as a mechanical help, reducing oedema and loss of fluid from the ulcer site, promoting the movement of fibroblasts into the ulcer and increasing the granulation tissue metabolic activity.11 Collagen dressings can be applied to wound easily and has the added benefit of preventing bleeding.&#xD;
&#xD;
In a wound-healing analysis performed by Veves et al.&#xA0; 276&#xA0; DFU patients were divided into two comparable groups of the patients, of which the ones treated with Promogran- collagen/oxidized regenerated cellulose dressing- 51 (37.0%) had full wound closure compared to 39 (28.3%) control (moistened gauze) patients after 12 weeks of care, but this disparity was not statistically significant (p value= 0.12).12 This study demonstrated collagen dressings having a significant advantage over conventional dressings in terms of wound healing rates. Compared to conventional dressing groups, we also observed a significant difference in the number of wounds that reached full closure at the end of six weeks in the collagen dressing group (p-value = 0.013). Also, a significantly lesser number of DFUs treated with collagen dressing required SSG as compared to conventional dressing (p-value = 0.013). The need for SSG in a DFU can thus be avoided by collagen dressing.&#xD;
&#xD;
In a similar study done by Onkar et al. on 120 patients, 60 patients suffering from wounds of varied aetiology were given collagen dressing and the other 60 patients were subjected to conventional dressing methods.13 Significant difference was found in sterile wound swab culture status (p value= 0.03), at 2 weeks and 4 weeks (p value= 0.04), average healthy granulation tissue time taken (p value= 0.03) and in the number of patients required to undergo split-thickness skin grafting (p value= 0.04) in between the two study groups. (Table 5)&#xD;
&#xD;
For 8 weeks, the Onkar et al. study was performed and 87% of the wounds treated with collagen dressing had more than 75% wound closure compared to 80% with conventional dressing (p-value = 0.21). This study also shows that the number of patients in the collagen dressing group who need SSG is significantly lower than in the conventional dressing group (p-value = 0.04).&#xD;
&#xD;
Harish Rao et al. compared collagen and conventional dressings in 100 patients with foot ulcers of chronic variety due to diabetes or burn injuries.14 Out of the 100 patients, 75 patients were treated with collagen dressing while the remaining were subjected to conventional dressing. Compared to moistened gauze, the study showed a substantially higher rate of wound healing with collagen dressing. The patients with collagen dressing required a healing time of 4.63&#xB1;1.18 weeks which was significantly lower than the patients receiving conventional dressing (7.79&#xB1;1.61 weeks). SSG was needed only in 64.47% of the patients undergoing collagen dressing as opposed to 100% in the patients treated with conventional dressing, which is significant. No adverse events were reported in either of the groups. The study concluded that collagen dressing is reliable and effective for the treatment of chronic foot ulcers, decreasing healing time, SSG demand and follow-up time significantly.&#xD;
&#xD;
The role of collagen is well known in promoting wound healing in chronic wounds, but there are only a few studies on the use of collagen as a dressing material for DFUs. Therefore, the findings of the present study are promising by showing that the use of collagen dressing has a major advantage in DFU healing compared to conventional dressing. However, the DFUs should be debrided and cleaned before the use of collagen dressing. Suitable antibiotics should be administered based on the wound swab culture reports if there is evidence of local wound infection.&#xD;
&#xD;
Limitations of the Present Study&#xD;
&#xD;
&#xD;
	&#xD;
	Each patient was under treatment for only 6 weeks.&#xD;
	&#xD;
	&#xD;
	The wound was studied in only 2 dimensions, the depth of the wound was not taken into consideration.&#xD;
	&#xD;
	&#xD;
	The researcher and the patient have not been blinded, thereby raising the likelihood of bias.&#xD;
	&#xD;
	&#xD;
	This study didn&#x2019;t include an important issue of the cost of collagen dressing and whether collagen dressing is economically better than conventional dressing.&#xD;
	&#xD;
	&#xD;
	While SSG was required for the significantly smaller number of subjects in the &#x201C;collagen group&#x201D; (8 compared to 19 in the &#x201C;conventional group&#x201D;), this was based on the results of a small sample size.&#xD;
	&#xD;
&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Collagen dressing, when compared to Conventional dressing with betadine, normal saline, gauze pad &amp; bandage -&#xD;
&#xD;
&#xD;
	&#xD;
	Accelerates wound healing and thereby reduces the hospital stay.&#xD;
	&#xD;
	&#xD;
	Gives a better sterile cover to the ulcer.&#xD;
	&#xD;
	&#xD;
	Decreases the need for skin grafting.&#xD;
	&#xD;
	&#xD;
	Reduces the morbidity suffered by the patients.&#xD;
	&#xD;
	&#xD;
	When collagen was put over the DFU, there were no adverse effects or reactions seen.&#xD;
	&#xD;
&#xD;
&#xD;
In terms of the completeness of chronic ulcer recovery, collagen dressing offers substantially better outcomes than traditional dressings. &#xD;
&#xD;
Through our research, we were able to demonstrate that collagen dressing is better compared to conventional dressings, taking into account the early development of granulation tissue, early sterile wound swab culture and the decreased need for split-thickness skin grafting. &#xD;
&#xD;
Thus, we recommend the use of collagen as a routine in Diabetic foot ulcers of small and medium size. Therefore, it is important to acknowledge the findings of the present research that, collagen-based dressings can prevent the need for future skin grafting in a significant number of cases of DFUs, but at the same time it is prudent to appreciate that more randomised controlled trials including a larger number of patients are needed to firmly establish this form of therapy as a suitable option in the treatment of DFUs.&#xD;
&#xD;
&#xA0;Acknowledgement- We are grateful to Siksha &amp;#39;O&amp;#39; Anusandhan (Deemed to be University) for their constant support and encouragement. &#xD;
&#xD;
Conflicts of Interest- Nil.&#xD;
&#xD;
Source of funding- Nil.&#xD;
&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3875</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3875</Fulltext></URLs><References>1. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev. 2004;20(SUPPL. 1):68&#x2013;77. &#xD;
&#xD;
2. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA, USA: Department of Health and Human Services, Centers for Disease Control and Prevention. 2011.201(1):2568-25689&#xD;
&#xD;
3. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Huang Y, Cao Y, Zou M, Luo X, Jiang Y, Xue Y, Gao F. A comparison of tissue versus swab culturing of infected diabetic foot wounds. Intl J Endocrinol. 2016 Jan 1;2016. &#xD;
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4. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; May K. Preventing foot ulcers. Aust Prescr. 2008; 31:94&#x2013;96. &#xD;
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5. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Andersen CA, Roukis TS. The Diabetic Foot. Surg Clin North Am. 2007;87(5):1149&#x2013;1177. &#xD;
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6. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sai KP, Babu M. Collagen based dressings - A review. Burns. 2000;26(1):54&#x2013;62. &#xD;
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7. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Botham KM, Murray RK. The extracellular matrix. Harper&#x2019;s Illustrated Biochemistry. 27th edition. 2006; 545-548. &#xD;
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8. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Nataraj C, Ritter G, Dumas S, Helfer FD, Brunelle J, Sander TW. Extracellular wound matrices: Novel stabilization and sterilization method for collagen-based biologic wound dressings. Wounds. 2007;19(6):148&#x2013;156. &#xD;
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9. &#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Park SN, Lee HJ, Lee KH, Suh H. Biological characterization of EDC-crosslinked collagen-hyaluronic acid matrix in dermal tissue restoration. Biomaterials. 2003;24(9):1631&#x2013;1641. &#xD;
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10. &#xA0;&#xA0;&#xA0;&#xA0; Lazovic G, Colic M, Grubor M, Jovanovic M. The application of collagen sheet in open wound healing. Ann Burns Fire Disasters. 2005;18(3):151&#x2013;156. &#xD;
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11. &#xA0;&#xA0;&#xA0;&#xA0; Motta G, Ratto GB, De Barbieri A, Can heterologous collagen enhance the granulation tissue growth? An experimental study. Ital J Surg Sci. 1983;13(2):101-108.&#xD;
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12. &#xA0;&#xA0;&#xA0;&#xA0; Veves A, Sheehan P, Pham HT. A randomized, controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. Arch Surg. 2002;137(7):822&#x2013;827. &#xD;
&#xD;
13. &#xA0;&#xA0;&#xA0;&#xA0; Singh O, Gupta S, Soni M, Moses S, Shukla S, Mathur R. Collagen dressing versus conventional dressings in burn and chronic wounds: A retrospective study. J Cutan Aesthet Surg. 2011;4(1):12. &#xD;
&#xD;
14. &#xA0;&#xA0;&#xA0;&#xA0; Harish Rao A. A comparative study between collagen dressings and conventional dressings in wound healing. Int J Collab Res Intern Med Public Heal. 2012;4(5):611&#x2013;623. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Systolic Blood Pressure and Heart Rate Responses of Individuals with Neck Versus Abdominal Obesity in Response to -&#xA0;Incentive Spirometry Based 10 Sustained Maximal Inspirations (A Possible Clinical Tool)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>114</FirstPage><LastPage>117</LastPage><AuthorList><Author>Mayank Shukla</Author><AuthorLanguage>English</AuthorLanguage><Author> Ankita Samuel</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Hypertension, Tachycardia, Cardiovascular screening, Obesity, Sustained maximal inspirations</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Excessive deposition of fat topographically on specific body segments is known as regional obesity. It may cause cardiovascular presentations.1&#xA0; Neck obesity is considered an index of upper body obesity. It may cause different responses of blood pressure from those seen for abdominal obesity.2&#xA0; Incentive spirometry (IS) induces sustained maximal inspirations (SMI). They produce changes in the cardiovascular features. Cardiopulmonary is a single functional unit that gives rise to two different body systems of cardiovascular and pulmonary.3,4&#xD;
&#xD;
OBJECTIVE&#xD;
&#xD;
The objective was to compare responses of systolic and diastolic blood pressure, heart rate and peripheral arterial saturation of neck obese and abdominal obese individuals to 10 breaths in 1minute using IS.&#xD;
&#xD;
PROPOSED RATIONALE AND IMPLICATIONS&#xD;
&#xD;
The rationale is seen in Fig.&#xA0;1. Changes in the neck can lead to changes in CVS responses to IS based SMI. Interconnecting structures are carotid and aortic bodies via the autonomic nervous system. How fat deposition changes these features is to be found. Framingham heart study in their landmark findings have reported upon the localization of fat deposition and related health risk.17&#xD;
&#xD;
&#xD;
&#xD;
RESULT AND DISCUSSION&#xD;
&#xD;
Institutional Ethical clearance and informed consent: The study protocol was reviewed and cleared by the Institutional NTCC committee of Amity Institute of Physiotherapy, Amity University Uttar Pradesh. NTCC/AIPT/MPT AY 2014-15-A1102713009.Weekly review and internal and external presentations were done for the progress. Written informed consent was obtained from all participants.&#xD;
&#xD;
N=30 Individual with obesity (15 necks obese and 15 abdominal obese) was taken as per the inclusion and exclusion criteria. Both males and females participated in the study as seen in Table -1.&#xD;
&#xD;
Their resting blood pressure, heart rate, and peripheral oxygen saturation (SpO2) were recorded twice, and an average was taken, following which they were asked to breathe in and out of a flow-based incentive spirometer (IS) 10 breaths in a minute. During these patients were instructed to take inspirations and to raise the ball maximally, hold it for 5 seconds and repeat it after a brief pause.&#xA0; Incentive spirometry induces biofeedback &amp; self-controlled sustained maximal inspirations (SMI). After IS the parameters were measured again immediately. 5, 6, 7&#xD;
&#xD;
&#xD;
&#xD;
Written informed consent was taken from all participants. Ethical approval for this research was granted by the institutional NTCC committee of AIPT, AUUP. &#xD;
&#xD;
&#xD;
&#xD;
Systolic blood pressure is a marker of cardiac contractility, which usually is required to overcome the afterload. Significant changes in this are interpreted as increased contractility of the myocardium. Increased systolic blood pressure is responsible for various adverse effects. In Fig 2 it is seen that there are a significant increase in SBP for neck obese (Grp-1) individuals in response to IS based 10 SMIs in 1 minute. Neck circumference is reported to have higher odds of hypertension.18There are recent reports of cut-off points of NC for children for cardiometabolic risk.19A systematic review has also confirmed NC as a new measure for hypertension. We have shown hyperresponsive SBP to IS based SMIs, it may be taken up in future studies how this measure affects clinical outcomes in different population like individuals with metabolic syndrome or survivors of an acute cardiac event. 8,9 Also, routine use of hypertensive response to IS based 10 SMI instead of resting BP, or in addition to it is a new paradigm of this research report.&#xD;
&#xD;
&#xD;
&#xD;
Diastolic blood pressure (DBP) usually does not change in response to respiratory interaction in asymptomatic individuals, therefore changes are not witnessed by us in DBP with SMI as seen in Fig-3. It is dependent upon the cardiac preload; it may vary in the clinical populations and may be checked by future studies carried out for the IS based SMI responses. 10,11&#xD;
&#xD;
&#xD;
&#xD;
Heart rate is seen as changing significantly in the study as seen in Fig 4. This is important because increased heart rate is a response that may form the very basis of all adverse effects as well. It has obvious clinical implication for symptomatology during activities of daily living, occupational or leisure time for different populations with regional obesity.12&#xD;
&#xD;
The neck is the connecting body segment between the cranium and trunk. It houses the cervical spine, brain stem, cervical plexus, carotid arteries, baroreceptors, carotid bodies, trachea, oesophagus and thyroid gland. The distribution of fat varies among individuals with obesity irrespective of gender where there may be more deposition on the trunk or the neck in certain individuals leading to specific physiological changes.2 Deposition of fat on the neck is an independent prognostic marker for cardiovascular diseases and may reflect in the general assessment of obese individuals.3,4 In clinical practices, the BMI is usually considered as an obesity marker and abdominal obesity is also considered. Neck obesity is not considered generally.5 It can be easily checked by checking neck circumference. 13,14,15&#xD;
&#xD;
Incentive spirometry involves the use of sustained maximal inspirations. These bellowing movements of the lungs and sustained maximal inspiration/ Valsalva manoeuvre are known to stimulate the nervous system.6 Cardiopulmonary system is one unit and changes in each usually reflect in the other.7 Thus incentive spirometry was used. It is commonly used in hospitals and clinics.&#xD;
&#xD;
&#xA0;The cardiovascular responses were exaggerated among the individuals with neck obesity and it may have a sympathetic wing activation response in the autonomic nervous system.1,8,9There are many reports which have demonstrated the different clinical implications of obesity and neck obesity has become a cause to fight for.,14,15.&#xD;
&#xD;
It has been seen in the present study that cardiovascular responses are exaggerated to incentive spirometry induced sustained maximal inspirations significantly among neck obese. This forms an important simple clinical test that may be used for the global neck obese population&#x2019; CVS.17&#xD;
&#xD;
During the screening of COVID-19 cases after they have recovered and for checking the cardiac status this test (IS based CVS screening) is making a case as well.18, 19,20&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Neck Obesity is an independent cardiovascular clinical marker that needs to be checked for preventive and treatment effects. Testing CVS responses to 10 sustained maximal breaths in a minute using incentive spirometry, can be used in initial and follow-up screening of susceptible populations.&#xD;
&#xD;
Conflict of interest: Authors declare no conflict of interest.&#xD;
&#xD;
Financial support: Nil.&#xD;
&#xD;
Acknowledgement: Authors would like to acknowledge all participants for their time and participation. 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. The authors also acknowledge the valuable comments of the reviewers and editors.&#xD;
&#xD;
Authors&#x2019; Contribution: Ankita Samuel contributed to conceptualization, data collection, analysis, report writing for the research. Mayank Shukla contributed to conceptualization, data analysis, report writing and journal communication for the paper.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3876</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3876</Fulltext></URLs><References>1.Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010 May;33(5):386-93. &#xD;
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2.Zen V, Fuchs FD, Wainstein MV, Gon&#xE7;alves SC, Biavatti K, Riedner CE, Fuchs FC, Wainstein RV, Rhoden EL, Ribeiro JP, Fuchs SC. Neck circumference and central obesity are independent predictors of coronary artery disease in patients undergoing coronary angiography. Am J Cardiovasc Dis. 2012;2(4):323-30.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0;&#xA0;&#xD;
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3.Joshipura K, Mu&#xF1;oz-Torres F, Vergara J, Palacios C, P&#xE9;rez CM. Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures. J Diabetes Res. 2016; 2016:6058916.&#xD;
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4.Wang Y, Chen HJ, Shaikh S, Mathur P. Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time. Obes Rev. 2009 Jul;10(4):456-74.&#xD;
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5.Borel AL, Coumes S, Reche F, Ruckly S, P&#xE9;pin JL, Tamisier R, Wion N, Arvieux C. Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort. PLoS One. 2018 Nov 8;13(11): e0206617.&#xD;
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6.Yakinci C, Mungen B, Karabiber H, Tayfun M, Evereklioglu C. Autonomic nervous system functions in obese children. Brain Dev. 2000 May;22(3):151-3.&#xD;
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7.Tonhajzerova I, Javorka M, Trunkvalterova Z, Chroma O, Javorkova J, Lazarova Z, Ciljakova M, Javorka K. Cardio-respiratory interaction and autonomic dysfunction in obesity. J Physiol Pharmacol. 2008 Dec 1;59(Suppl 6):709-18.&#xD;
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8.Malden D, Lacey B, Emberson J, Karpe F, Allen N, Bennett D, Lewington S. Body Fat Distribution and Systolic Blood Pressure in 10,000 Adults with Whole-Body Imaging: UK Biobank and Oxford BioBank. Obesity (Silver Spring). 2019 Jul;27(7):1200-1206.&#xD;
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9.Balasubramanian P, Hall D, Subramanian M. Sympathetic nervous system as a target for aging and obesity-related cardiovascular diseases. Gerosci. 2019 Feb 15;41(1):13-24.&#xD;
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10.Sparrow D, Borkan GA, Gerzof SG, Wisniewski C, Silbert CK. Relationship of fat distribution to glucose tolerance: results of computed tomography in male participants of the Normative Aging Study. Diab. 1986 Apr 1;35(4):411-5.&#xD;
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11.Cornier MA, Despres JP, Davis N, Grossniklaus DA, Klein S, Lamarche B et al. Assessing adiposity: a scientific statement from the American Heart Association. Circul. 2011 Nov 1;124(18):1996-2019.&#xD;
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12.Bastien M, Poirier P, Lemieux I, Despr&#xE9;s JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Progress in cardiovascular diseases. 2014 Jan 1;56(4):369-81.&#xD;
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13.Ortega FB, Sui X, Lavie CJ, Blair SN. Body mass index, the most widely used but also widely criticized index: would a criterion standard measure of total body fat be a better predictor of cardiovascular disease mortality? In Mayo Clinic Proceed. 2016 Apr 91; (4):443-455.&#xD;
&#xD;
14.Pich&#xE9; ME, Poirier P, Lemieux I, Despr&#xE9;s JP. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update. Progr Cardiov Dise. 2018 Jul 1;61(2):103-13.&#xD;
&#xD;
15.Henriksson H, Henriksson P, Tynelius P, Ekstedt M, Berglind D, Labayen I, et al. Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men. Eur Heart J. 2020 Apr 14;41(15):1503-1510.&#xD;
&#xD;
16. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, Schwartz A. COVID-19 and cardiovascular disease. Circul. 2020 May 19;141(20):1648-55.&#xD;
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17-Kannel WB, Cupples LA, Ramaswami R, Stokes III J, Kreger BE, Higgins M. Regional obesity and risk of cardiovascular disease; the Framingham Study. J Cli Epidem. 1991 Jan 1;44(2):183-90.&#xD;
&#xD;
18- Nafiu OO, Zepeda A, Curcio C, Prasad Y. Association of neck circumference and obesity status with elevated blood pressure in children. J Hum Hypert. 2014 Apr;28(4):263-8.&#xD;
&#xD;
19- de Santis Filgueiras M, de Albuquerque FM, Castro AP, Rocha NP, Milagres LC, de Novaes JF. Neck circumference cutoff points to identify excess android fat. J de pediatria. 2020 May 1;96(3):356-63.&#xD;
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20- Moradi S, Mohammadi H, Javaheri A, Ghavami A, Rouhani MH. Association between neck circumference and blood pressure: a systematic review and meta-analysis of observational studies. Horm Metab Res. 2019 Aug 1;51(8):495-502.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Right Ventricular Infarction -&#xA0;A Clinical Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>118</FirstPage><LastPage>121</LastPage><AuthorList><Author>Arunkumar S</Author><AuthorLanguage>English</AuthorLanguage><Author> Sakthivel V</Author><AuthorLanguage>English</AuthorLanguage><Author> Babu RP</Author><AuthorLanguage>English</AuthorLanguage><Author> Jha SJ</Author><AuthorLanguage>English</AuthorLanguage><Author> Nagarajan P.</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Early detection of Right ventricular myocardial infarction is important because the time of onset of its hemodynamic effects is uncertain and the administration of intravenous fluid load can prevent these conditions from occurring. Aim: To study the occurrence, clinical profile and complication of right ventricular infarction in patients with acute inferior wall myocardial infarction. Methods: This study included 50 consecutive patients admitted to the Coronary Care Unit or General Medical Unit, Vinayaka Mission Medical College &amp; Hospital, Karaikal with a proven diagnosis of acute inferior wall infarction. Results: In 50 patients,49 patients had chest pain, 43 patients had sweated, 26 patients had vomiting, 8 patients had palpitation, 7 patients had syncope and 4 patients had breathlessness. Based on risk factors, 40 patients had smoking, 21 patients had alcoholism, 19 patients had hypertension, 12 patients had diabetes and 15 patients had dyslipidemia. Dependent on the clinical sign, 9 patients had pallor, 16 had bradycardia, 6 had tachycardia, 16 had hypotension, 16 had elevated JVP, 10 patients had S 3 on the right, and 2 had tender hepatomegaly. Conclusion: To conclude, the frequency of MI was higher with a prominent symptom in men and age 40 years older and a major risk factor in smoking and a higher mortality in right ventricular infarction patients.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Myocardial Infarction, Right ventricular infarction, ECG, Smoking</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
The term myocardial infarction is used with ischemia to necrosize the myocardium. It may be subendocardial or transmural. Inferior-wall infarction is associated with some special features, particularly second degree atrioventricular (AV) block and sinus bradycardia, such as the connexion with the right ventricular infarction and bradyarrhythmia.&#xD;
&#xD;
Right ventricular infarction is different from that of the left ventricle in the acute presentation, therapy and long term prognosis. The early detection of right myocardial ventricular infarction is important as it is unstable at the outset, and can be prevented by intravenous fluid load administration.1&#xD;
&#xD;
Right myocardial ventricular infarction has appeared more than 60 years ago. But it was considered unimportant until Cohn and co-worker in 1974 published their classic report on Right ventricular myocardial infarction as a distinct clinical entity.2&#xD;
&#xD;
The reporting frequency of myocardial infarction is about 25-50 per cent of the lower wall.3 The involvement of RV in the right coronary artery involves significant atherosclerotic occlusion and is linked to the involvement of the posteroinferior wall and the posterior portion of the septum. Clinically correct ventricular myocardial infarction can also be accused of having higher JVP, positive Kussmaul, sign, third or fourth right-side heart rhythms, tender hepatomegaly, oliguria, unusual TR, simple chest in a patient with lower wall myocardial infarction.4&#xD;
&#xD;
Electrocardiogram was considered to be uninformative in the diagnosis of Right ventricular myocardial infarction before Erhardt and co-workers explained the significance of Right Precordial Lead in patients with autopsy reported Right Ventricular Myocardial infarction. The 1mm ST elevation of this lead is 70 per cent adaptive and 100 per cent specific. A shift is temporary. In one series, 48 per cent of patients had ECG resolution improvements within 10 hours of initiation of symptoms.2&#xD;
&#xD;
Bradycardia is the most prevalent arrhythmias during the early stage of acute myocardial infarctions and is more common in patients with both lower and postoperative infarctions, inferior myocardial wall myocardial violation can cause all forms of AV conduction disruptions and intraventricular blocks more frequently than AWMI. In both, the 2nd degree AV block Mobitz Type 1 arises normally in the lower wall inferior to the anterior wall infarction myocardial. Usually, this is reversible and will not last longer than 72 hours after infarction.5&#xD;
&#xD;
AIM&#xD;
&#xD;
To study the occurrence, clinical profile and complication of right ventricular infarction in patients with acute inferior wall myocardial infarction.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
A total of 50 patients were included in this study, with an existing diagnosis of acute inferior wall myocardial infarction from 2008 to 2009, in the Coronary Care Unit or General Medical Unit Vinayaka Medical College and the Karaikal. Institutional ethical committee approval was obtained. (ECR No: ECR/1147/INST/PY/2018)&#xD;
&#xD;
Inclusion criteria: Patients admitted or diagnosed with acute inferior wall myocardial infarction were included.&#xD;
&#xD;
Exclusion criteria: Patients with a known history of Chronic Lung Disease, Previous MI, Rheumatic Heart Disease and Pericardial Disease or LBBB were excluded. Patients, presented after 24 hrs of the onset of chest pain were excluded as the ST changes in right ventricular infarction may be transient.&#xD;
&#xD;
Patients underwent 12 leads ECG and were examined at the time of admission, second&#xA0;day and up to the day of discharge. Only those cases with hyperacute inferior wall infarction were included in the study. Patients with slope elevation of ST-segment in leads II, III and aVF&#xA0;were taken as having hyperacute inferior wall infarction.&#xD;
&#xD;
All patients were assessed clinically and electrocardiographically with special emphasis on presenting complaints, risk factors, vital signs, arrhythmias and mortality. Data were collected using proforma and presented as frequency and percentage.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
41 patients were male and 9 were female out of 50 patients. Owing to the high prevalence of the age group, two classes have been identified. The first group is 42 years old and the second group is 62 years old. The youngest age was 33, the oldest age 80 ( Table 1).&#xD;
&#xD;
&#xD;
&#xD;
Out of 50 patients, 49 patients had chest pain, 43 patients had sweated, 26 patients had vomiting, 8 patients had palpitation, 7 patients had syncope, 4 patients had breathlessness ( Table 2).&#xD;
&#xD;
&#xD;
&#xD;
Out of 50 patients, 40 patients had smoking, 21 patients had alcoholism, 19 patients had hypertension, 12 patients had diabetes, 15 patients had dyslipidemia. Radiation to the left upper limb was noticed in 19 ( 38%) of patients, 3 (6%) patients had radiation to the right upper limb. Another 3 patients (6%) had radiation to the epigastrium (Table 3).&#xD;
&#xD;
&#xD;
&#xD;
Out of 50 patients, 9 patients had pallor, 16 had bradycardia, 6 had tachycardia, 16 had hypotension, 16 had elevated JVP, 10 patients had S 3 in the right side and 2 had tender hepatomegaly ( Table 4).&#xD;
&#xD;
&#xD;
&#xD;
ECG and clinical criteria for right ventricular infarction were present in 20(40%) patients. True posterior wall infarction as evidence by R/S ratio&gt;1 in V1 with upright T wave was observed in 9 (18%) patients. In all these patients the typical change was evident only after 24 hours.&#xD;
&#xD;
First degree AV block was observed in 5 ( 10%) patients. Second degree &#x2013; mobitz type I block was seen in 3 (6%) patients. Second degree &#x2013; mobitz type II block was present in 1 (2%) patient.&#xD;
&#xD;
Complete heart block was noted in 6 (12%) patients. Transient complete right bundle branch block (RBBB) was noted in 14 cases (28%) Left anterior hemiblock was present in 2 cases (4%). Atrial fibrillation was present in 7 (14%) patients and it developed within the first 24 hours. Sinus bradycardia was present in 5 (10%) patients and ventricular premature complexes were present in 5 (10%) patients. Papillary muscle dysfunction and mitral regurgitation were noted in 2 (4%) patients. Out of the 7 patients who expired in the hospital, 6 of them passed away within 48 hours of admission. These patients had got right ventricular infarction, profound hypotension, complete heart block and arrhythmias. The remaining one patient developed a cerebrovascular accident ( right-sided hemiplegia) CT scan showing infarct in the left middle cerebral artery territory ( Table 5).&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Twenty proven cases of Acute Inferior Wall Myocardial Infarction were selected in the study to examine risk factors associated and to find out how many cases of Inferior Wall Myocardial Infarction are involved in right ventricular myocardial infarction and to evaluate the complications and outcomes of patients. When it was analysed, the Acute Lower Wall Myocardium Infarction was observed to be more frequent above the age of 40 years. 96% of patients met 40, 83.3% of whom were male. In Right ventricular myocardial infarction after inferior wall myocardial infarction, Chang et al.6 1992 find sex distribution. &#xD;
&#xD;
98 per cent of patients had chest pain. They all had common retrosternal chest pain lasting longer than 30 minutes. When evaluating symptoms other than chest pain, the most common was sweating in 86 per cent of patients. It has also been correlated with cold extremities and pallor.&#xD;
&#xD;
Pallor was noted in 18 per cent of patients on the analysis of clinical features. Bradycardia was reported in 28 per cent of patients. Of these, 60 per cent had a conduction disturbance and the remaining 40 per cent had an associated Right Ventricular Infarction. About the previous study, only 34% of patients had systolic BP less than 100 mm / Hg at the time of presentation. Of these 14 patients (28%) had right ventricular infarction.7&#xD;
&#xD;
Harrison et al. Kussmaul positive sign results range from (10%-90%) in Right Ventricular Myocardial infarction.8&#xD;
&#xD;
Smoking was the most frequent risk factor followed by alcohol, hypertension, dyslipidemia and diabetes when analysing the coronary disease risk factor. Blackwell et al. smoking and type 2 diabetes increased the occurrence of Right Ventricular Myocardial Infarction (74%).9&#xD;
&#xD;
In our sample, RBBB complication accompanied by atrial fibrillation, death, and full heart obstruction, etc. In 1950 Bakos identified RBBB and full heart block are the most prominent conduction anomalies associated with Right Ventricular Myocardial infarction.10 The recorded frequency of atrial fibrillation in Acute Myocardial Infarction is 10-15%, but only 1/3 of those with Inferior was MI relative to Anterior Wall MI.11 Buenoh et al.12 recorded 90 per cent cardiogenic shock interaction in his research of those with Right Ventricular Myocardial infarction. Most death in Right Ventricular Myocardial infarction is attributable to cardiogenic shock and conduction abnormalities.13Chockalingam et al.14 recorded 16% mortality in their study of Right Ventricular Myocardial infarction patients.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
To conclude, the frequency of myocardial infarction was higher with a prominent symptom in men and age 40 years older and a major risk factor in smoking and higher mortality in right ventricular infarction patients. Almost all patients had typical retrosternal chest pain lasting more than 3 minutes associated with sweating. Syncope was a prominent symptom in patients with right ventricular infarction. Mortality is higher in a patient with Right ventricular Myocardial infarction when compared with those without this complication.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Financial support: No&#xD;
&#xD;
Author Contribution:&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3877</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3877</Fulltext></URLs><References>&#xD;
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	Braunwald E, Zipes DP, Libby P, Bonow R. Braunwald&amp;#39;s heart disease: a textbook of cardiovascular medicine, single volume. Saunders, 7 Edition. 2004.&#xD;
	&#xD;
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	Cohn JN. Right ventricular infarction revisited.&#xA0;Am J Cardiol.&#xA0;1979;43:666.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Performance Analysis of Flower Pollination Algorithm for Maximizing the Power Yield from Solar Photo-voltaic Arrays&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>122</FirstPage><LastPage>128</LastPage><AuthorList><Author>Hussain A</Author><AuthorLanguage>English</AuthorLanguage><Author> Khatri M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Flower pollination algorithm, Tracking power peak, Solar PV micro-grid, Three diode solar cell models, Maximum power  generation</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3878</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3878</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Comparative Study on Mastoidectomy Cavity Obliteration with Soft Tissue Graft and Cartilage Graft in Canal Wall Down Mastoidectomy&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>129</FirstPage><LastPage>133</LastPage><AuthorList><Author>Sivasubramanian Thirani</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajkamal Pandian Durairaj</Author><AuthorLanguage>English</AuthorLanguage><Author>  Radhakrishnan Kailasm Ramamoorthy</Author><AuthorLanguage>English</AuthorLanguage><Author> Balasubramanian Covindarasu</Author><AuthorLanguage>English</AuthorLanguage><Author>  Sneka Periasamy</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Chronic suppurative otitis media is a long-standing infection of apart or whole of the middle ear cleft characterised by ear discharge. In conditions of Atticoantral type of pathology and cholesteatoma disease clearance from the middle ear cleft, mastoid antrum is done using modified radical mastoidectomy. Aim: This study aims to compare the mastoidectomy cavity obliteration with soft tissue graft and cartilage graft in canal wall down mastoidectomy. Methods: This prospective comparative study on mastoidectomy cavity obliteration with soft tissue graft in 20 patients (Group A) and cartilage graft in 20 patients (Group B) in canal wall down mastoidectomy surgeries conducted on patients diagnosed with chronic suppurative otitis media of atticoantral pathology. Postoperative outcome was compared between 2 groups. Results: The outcome showed that the patients obliterated with cartilage showed a faster rate of epithelialization and formation of the dry cavity when compared to patients obliterated with soft tissue with a statistically significant difference (Pvalue=0.003). There was a gradual decrease in ear discharge in Group A patients compared to Group B at the end of the third month with a significant statistical difference (Pvalue=0.046); however, there was no statistical difference by the end of the sixth month. There was no statistically significant difference in the postoperative hearing in terms of the Air-bone gap between the groups. Conclusion: From this study, we concluded that obliteration with cartilage provided much better results regarding the cavity&#x2019;s epithelialization, thereby forming dry ear at a faster rate both statistically and clinically, along with good anatomical configuration than soft tissues.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Mastoidectomy, Cholesteatoma, Suppurative, Cartilage, Mastoid cavity, Obliteration</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Chronic suppurative otitis media is a prolonged standing infection of a part or whole of the middle ear cleft, characterised by ear discharge. There are two types of chronic suppurative otitis media: Tubotympanic type/ Mucosal ear and Atticoantral type/ Squamous type. From a historical point of view, Moscher1was the first to introduce this concept in 1911, ever since many obliteration techniques are in practice using different obliteration materials. These include soft tissues (muscle pedicled flaps, muscle, fascia), Cartilages (autogenous conchal, tragal cartilage), hydroxyapatite crystals, glass isomers, ceramides.1 Various material have been used for obliteration, which is divided into two categories as free grafts (biologic and non-biologic); such as cartilage, fat tissue, fascia, hydroxyapatite crystals, and local flaps; such as Palva flap (musculoperiosteal flap), temporoparietal fascia flap, and postauricular myocutaneous flap.2-8Different materials and techniques are in vogue in the present scenario, and the merits and demerits of each of these techniques are still under research.&#xD;
&#xD;
Atticoantral type/ Squamous type involves attic, antrum, mastoid, associated with bone eroding, such as cholesteatoma, granulations, and osteitis. This type is more prone to complications. In cholesteatoma cases, surgical intervention is mandatory wherein we prefer&#xA0;&#xA0; Canal wall down mastoidectomy procedures, otherwise called Modified radical mastoidectomy. This procedure provides complete clearance of the disease, thereby leaving behind a wide, open mastoid cavity. However, the creation of a wide cavity is associated with&#xA0;&#xA0; Chronic discharging problems from the cavity. Collection of debris. In this surgical procedure, the disease is eradicated from the middle ear cleft,&#xA0; followed by conversion of mastoid cavity, middle ear, external auditory canal into a&#xA0;&#xA0;&#xA0; single smooth self-cleansing cavity exteriorised through the external auditory canal, leaving behind healthy tissues for future reconstruction.9 Complication of chronic otitis media includes direct bony erosion, acute mastoiditis, petrositis, facial paralysis, labyrinthitis, meningitis, brain abscess and thromphobhebitis. Our study compares mastoidectomy cavity obliteration with soft tissue graft (temporalis muscle pedicled flap, temporalis muscle fascia, temporalis muscle) and cartilage graft (autogenous conchal and tragal cartilage) and their postoperative outcomes.&#xD;
&#xD;
AIM&#xD;
&#xD;
This study compares the mastoidectomy cavity obliteration with soft tissue graft and cartilage graft in canal wall down mastoidectomy.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
This study comprised 40&#xA0;&#xA0;&#xA0; patients who attended the ENT&#xA0;&#xA0; department, Thanjavur&#xA0;&#xA0;&#xA0; Medical&#xA0;&#xA0; College&#xA0;&#xA0; Hospital, Thanjavur, from November&#xA0;&#xA0;&#xA0; 2018&#xA0;&#xA0; to&#xA0;&#xA0;&#xA0; September&#xA0;&#xA0; 2019. Ethical committee approval was received (EC/approval no.580/2018). Patients were diagnosed to have chronic suppurative otitis media of&#xA0;&#xA0; Atticoantral pathology by clinical history and otoscopic examination. Exclusion criteria include Chronic suppurative otitis media -&#xA0; Tubotympanic type (safe type), Chronic suppurative otitis media -Intracranial complication, age less than five years, pregnant and lactating mothers. Informed and written consent was obtained before proceeding with the surgery. The patients underwent the following evaluation like History taking, General examination, Systemic examination, ENT&#xA0;&#xA0; examination, Specific investigations like Aural swab culture and sensitivity, Tuning fork test, X-ray both mastoids, pure tone audiometry, CT&#xA0; temporal bone and Examination under the microscope, Nonspecific investigations like Complete haemogram, Urine analysis and Blood sugar,&#xA0; urea,&#xA0; serum creatinine and assessment of the patient for general anaesthesia.&#xD;
&#xD;
The&#xA0;&#xA0; 40&#xA0;&#xA0; patients included in our study underwent&#xA0;&#xA0;&#xA0; Canal wall down mastoidectomy procedure after their fitness for surgery was ensured. They were divided into two groups, each containing 20 patients.&#xA0; Cartilage graft was used for&#xA0; 20 patients (Group A), and soft tissue was used for the remaining 20 patients for obliteration (Group B). Autogenous Conchal cartilage and tragal cartilage, temporalis muscle pedicled flap, temporalis muscle fascia were the graft materials used for obliteration.&#xD;
&#xD;
Postoperatively the patients were treated with intravenous antibiotics, analgesics, anti-inflammatory drugs. One week after the procedure, mastoid bandage, postauricular sutures were removed, and ear canal pack and discharged.&#xA0; Advised to review at&#xA0;&#xA0; ENT op at corresponding interval seven days.&#xA0; They were given steroid ear drops for two weeks and vinegar with normal saline (1:4)&#xA0;&#xA0; for the next four weeks to ensure average PH&#xA0;&#xA0; balance and proper epithelialisation. The patients were followed up regularly at the second, third, sixth month, respectively.&#xA0; By the end of the third month, the patients were subjected to&#xA0;&#xA0;&#xA0;&#xA0; Puretone audiometry. The postoperative outcomes were compared between the two groups.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
Out of 40 patients, 20 patients included in Group A and 20 patients included in Group B. In Group A, 9 patients were females, and 11 were males. In Group B, 3 cases were females, and 17 were males. (Table 1)&#xD;
&#xD;
&#xD;
&#xD;
Out of 40 patients, 20 patients included in Group A and 20 patients included in Group B. In Group A 5 were in the age group between 10-20years, 7 patients between 21-30 years, 5 were in age between 31-40 years, 1 patient between 41-50 years and 2 patients between 51-60 years. In Group B 3 were in the age group between 10-20years, 8 patients between 21-30 years, 6 were in age between 31-40 years, 2 patients between 41-50 years and 1 patient between 51-60 years. (Table 2).&#xD;
&#xD;
&#xD;
&#xD;
Out of 40 patients, 20 patients included in Group A and 20 patients included in Group B. In Group A, five patients had attic perforation, 4 patients had attic retraction, 2 patients had cholesteatoma, 3 patients had posterosuperior granulation, and 6 patients had posterosuperior retraction. In Group B, 6 patients had attic perforation, 2 patients had attic retraction, 1 patient had cholesteatoma, 3 patients had posterosuperior granulation, and 8 patients had posterosuperior retraction. (Table 3)&#xD;
&#xD;
&#xD;
&#xD;
Out of 40 patients, 20 patients included in Group A and 20 patients included in Group B. In Group A, 2 patients had a large cavity, 13 patients had a medium cavity, and 5 patients had a small cavity. In Group B 1 patient had a large cavity, 11patients had a medium cavity, and 8 patients had a small cavity. (Table 4)&#xD;
&#xD;
&#xD;
&#xD;
Out of 40 patients, 20 patients included in Group A and 20 patients included in Group B. In Group A, based on the duration of postoperative ear discharge, 12 patients had 2 months, 4 patients had 3 months, 1 patient had 6 months, based on postoperative hearing status improvement seen in 13 patients, 2 patients had deterioration, 5 patients had no changes, 1 patient had persistent ear discharge. In Group B based on the duration of postoperative ear discharge, 16 patients had 2 months, 10 patients had 3 months, 4 patients had 6 months, based on postoperative hearing status improvement seen in 11 patients, 3 patients had deterioration, 5 patients had no changes, 4 patients had persistent ear discharge, and 2 patients had a recurrence. (table 5)&#xD;
&#xD;
&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
There were previous studies where different materials were used for obliteration. A retrospective study was conducted on 30 patients regarding mastoidectomy cavity obliteration using Conchal cartilage from&#xA0;&#xA0; May 2014 to January&#xA0;&#xA0; 2017&#xA0;&#xA0; in Al- Sulaimania city in Iraq. Their patients showed complete epithelialization at the end of the follow-up period.&#xA0; The mean Air-bone gap&#xA0;&#xA0; was 42.2dB +/-10.8, preoperatively&#xA0;&#xA0; that became 27.4dB (+/-12.9) with&#xA0;&#xA0; p-value </Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3879</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3879</Fulltext></URLs><References>&#xD;
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	Mosher HP. A method of filling the excavated mastoid with a flap from the back of the auricle. Laryngoscope&#xA0;. 1911 Dec 21(12):1158-63.&#xD;
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	PalvaT. Cholesteatoma surgery today. Clin. Otolaryngol. 1993 Aug 18(4):245-52.&#xD;
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	Kaur N, Sharma DK, Singh J. Comparative evaluation of mastoid cavity obliteration by vascularised temporalis myofascial flap and deep temporal fascial-periosteal flap in canal wall down mastoidectomy. J Clin Diagn Res J Clin Diagn. 2016 Dec;10(12):MC08.&#xD;
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	Olson KL, Manolidis S. The pedicled superficial temporalis fascial flap: a new method for reconstruction in otologic surgery. Otol Head Neck&#xA0;Surg. 2002 May 1;126(5):538-47.&#xD;
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	Kahramanyol M, &#xD6;z&#xFC;nl&#xFC; A, Pabus&#xE7;u Y. Fascioperiosteal flap and neo-osteogenesis in radical mastoidectomy: long-term results. Ear Nose Throat J. 2000 Jul;79(7):524-6.&#xD;
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	Jo SY, Eom TH, Yang HC, Cho YB, Jang CH. Comparison of obliteration materials used for revision canal wall-down mastoidectomy with mastoid obliteration. &#xA0;J In vivo Laryngoscope. 2014 Nov 1;28(6):1207-12.&#xD;
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	Lee HJ, Chao JR, Yeon YK, Kumar V, Park CH, Kim HJ, Lee JH. Canal reconstruction and mastoid obliteration using floating cartilages and mucoperiosteal flaps. Laryngoscope. 2017 May;127(5):1153-60.&#xD;
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	Al-Tayyar M, Baban M, Khdhayer A, Najeeb R, Othman S. The Efficacy of Mastoid Cavity Obliteration by Conchal Cartilage in Canal Wall Down Mastoidectomy. J Otolaryngol Res 1: 103.&#xD;
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	Maniu A, Cosgarea M. Mastoid obliteration with concha cartilage graft and temporal muscle fascia. ORL J Otorhin Relat Spec. 2012;74(3):141-5.&#xD;
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	Chhapola S, Matta I. Mastoid obliteration versus open cavity: a comparative study. Indian J Otolaryngol Head Neck&#xA0;Surg. 2014 Jan 1;66(1):207-13.&#xD;
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	Walker PC, Mowry SE, Hansen MR, Gantz BJ. Long-term results of canal wall reconstruction tympanomastoidectomy. Otol Neurotol. 2014 Jul 1;35(6):954-60.&#xD;
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	Kronenberg J, Shapira Y, Migirov L. Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta&#xA0;Otolaryngol. 2012 Apr 1;132(4):400-3.&#xD;
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	Harris AT, Mettias B, Lesser TH. Pooled analysis of the evidence for an open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery. J Laryngol Otol. 2016 Mar 1;130(3):235.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Shear Bond Strength of Self Etch and Total-Etch Adhesive System to Caries Affected Dentinal Surface after Chemomechanical Caries Removal: An In Vitro Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>134</FirstPage><LastPage>137</LastPage><AuthorList><Author>Mohit Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Shubhra Malik Juneja</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Shear bond strength, Chemomechanical caries removal, Self etch adhesive, Total-etch adhesive, Carie Care, Papain</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Dental caries brings about the destruction of teeth.1 The conventional method for caries removal which utilizes a high-speed handpiece is quick but there may be undesirable removal of the tooth.2 The main aim should be to conserve tooth structure. A substitute to the conventional method is the chemomechanical caries removal method which utilizes chemical agents that soften carious dentin and aid in its excavation.3 Among the various methods of chemomechanical caries removal, some systems had some disadvantages such as short shelf life, the demand of specific instruments, and were expensive so papacarie, papain enzyme-based product was introduced in Brazil.4 A chemomechanical system similar to it has been created in India i.e.Carie- Care. Latex of leaves and fruits of Carica Papaya tree is used to get papain.5,6 The carious tissues are devoid of antiprotease alpha-1-anti-trypsin, which impedes protein digestion in healthy collagen-based tissues.7 Also there is chlorination of incompletely degraded collagen by the action of chloramines. This disrupts the collagen structure and destroys hydrogen bonds which facilitate tissue removal.5 Following caries removal, morphological alterations in the dentinal surface by the chemical agent used for caries removal may play a role in its binding with resins.8,9 This study was done to assess the shear bond strength of self-etch and total-etch adhesive system to caries affected dentinal surface after chemomechanical caries removal.&#xD;
&#xD;
MATERIALS AND METHOD&#xD;
&#xD;
Forty extracted non-restored human maxillary and mandibular molars having carious lesion on occlusal surfaces extending midway between dentin enamel junction and pulp seen in radiograph were selected. Each tooth was embedded in self-cure resin just below cementoenamel junction in standardized moulds. The enamel and dentin from each tooth were removed by abrading the occlusal surface with 600 grit silicon carbide papers until a flat surface was developed near the excavated carious lesion. Samples were divided into two main groups of 20 teeth each according to the type of caries removal method.&#xD;
&#xD;
Group I: Caries removal by the conventional method&#xD;
&#xD;
Group II: Caries removal by chemomechanical method (using Carie Care)&#xD;
&#xD;
It consists of papaya extract (papain) 100 mg, clove oil 2 mg, coloured gel (blue), chloramines, sodium chloride, and sodium methylparaben.&#xD;
&#xD;
Each group was further subdivided into two subgroups of 10 teeth each according to the type of adhesive used.&#xD;
&#xD;
Subgroup IA: Restored using the total-etch technique&#xD;
&#xD;
Subgroup IB: Restored using self etch technique&#xD;
&#xD;
Subgroup IIA: Restored using the total-etch technique&#xD;
&#xD;
Subgroup IIB: Restored using self etch technique&#xD;
&#xD;
Group I was treated with the conventional method, caries was removed using diamond points in a slow-speed handpiece. &#xD;
&#xD;
In group II chemomechanical caries excavation was done using Carie Care gel. The carie-Care gel was applied to the carious surface and left undisturbed for 1 min. When the gel turned cloudy, it was removed with a spoon excavator and then the fresh gel was applied.&#xD;
&#xD;
This was repeated till the gel turned clear; caries removal was complete when the dentin was hard on probing.&#xD;
&#xD;
Groups IA and Group IIA: Dentin surfaces were etched with 37% phosphoric acid 15 s, rinsed with distilled water, and the excess was removed with absorbent paper.&#xD;
&#xD;
Total etch adhesive was applied to all prepared areas of specimens with applicator tip and light-cured together with the adhesive for 20 seconds. &#xD;
&#xD;
Standardised cylindrical mould was placed on the occlusal surface of each specimen and composite resin was placed in two increments to have a final build-up of 3mm in diameter and 4 mm in height. Each increment was light-cured for 20 seconds using quartz halogen activation light.&#xD;
&#xD;
The teeth with composite build-ups were stored in water in the incubator at 37&#xB0;C for 7 days.&#xD;
&#xD;
Group IB and Group II B: Cavity surfaces were treated with self etch adhesive according to manufacturer&#x2019;s instructions followed by restoration as done in group I. &#xD;
&#xD;
The teeth with composite build-ups were stored in water in the incubator at 37&#xB0;C for 7 days before testing.&#xD;
&#xD;
For shear bond strength testing, the loading was conducted in a universal testing machine at a cross-head speed of 0.5 mm/min until failure. The force was applied at the interface between dentin and adhesive. The force necessary for separating the sample was divided by the cross-sectional bonding area to obtain SBS in MPa.&#xD;
&#xD;
The SBS values were calculated for each specimen using the formula:&#xD;
&#xD;
&#xD;
&#xD;
The values thus obtained were tabulated and subjected to statistical analysis using an unpaired or independent t-test to compare the mean shear bond strength between the groups.&#xD;
&#xD;
Table 1: Intergroup comparison revealed that the chemomechanical group showed slightly higher shear bond strength values than the conventional group in both totals etch and self-etch subgroups, the difference between them was not statistically significant.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
RESULT&#xD;
&#xD;
Table 1: Intergroup comparison revealed that the chemomechanical group showed slightly higher shear bond strength values than the conventional group in both totals etch and self-etch subgroups, the difference between them was not statistically significant.&#xD;
&#xD;
DISCUSSION:&#xD;
&#xD;
Chemomechanical caries removal has been developed as a substitute to the conventional method of removing caries and it works on the principle to chemically modify the carious tooth to soften it; which eases its removal. In Chemo mechanical method, chlorination of slightly deteriorated collagen in carious dentine occurs that disrupts hydrogen bonding which aids in caries removal.10,11&#xD;
&#xD;
Enamel predominantly contains inorganic material thus bonding to enamel is easy as compared to dentin.12 Dentine bonding system provides a retentive phase between the hydrophobic resin restoration and relatively hydrophilic dentine along with enamel. Previous studies have compared the effect of various adhesives on the bond strength of dentin but few studies have evaluated the effect of the chemomechanical method on caries affected dentine. Therefore, the present study was done to evaluate the shear bond strength of adhesive systems (total-etch and self-etch) to caries-affected dentine that is treated with the chemomechanical and conventional method.&#xD;
&#xD;
In the present study, Group I was treated by the conventional method, in which caries was removed using diamond points. In group II chemomechanical caries excavation was done using Carie Care gel. Group I and II were further divided into I A, IB and II A, II B depending upon the type of adhesive used for bonding. In Groups IA and Group IIA total-etch adhesive (Single bond 2), was applied while in Group IB and Group II B cavity surfaces was treated with self etch adhesive (single bond universal) followed by restoration and shear bond strength was calculated which helps to evaluate the adhesion of dental adhesives 13&#xD;
&#xD;
Intergroup comparison revealed that the chemomechanical group showed slightly more shear bond strength values than the conventional group in both totals etch and self etch subgroups, the difference was not statistically significant. This might be since papain based chemomechanical caries removal removes the smear layer because of the proteolytic property thus patent dentinal tubules are left behind.14,15 This enhances bonding by helping in the infiltration of adhesive resin into intertubular dentine and patent dentinal tubules.6 A rough dentine surface having micro-irregularities is generated with the chemomechanical method which improves the adhesion of restorative materials.16,17 &#xD;
&#xD;
Adebayo et al.18 also reported that when the adhesive resin is used with a scrubbing action resin penetration into dentin was improved. This may be the reason for the non-significant difference between the chemomechanical and conventional caries excavated groups in the present study.&#xD;
&#xD;
Bernasconi et al. 19 showed that Papacarie results in superficial destruction of collagen fibrils and hybrid layer formation at the dentin resin interface may be the reason for better bond strength.&#xD;
&#xD;
Schutzbank et al. 20 showed that surface irregularities improved micromechanical interlocking after using the chemomechanical method. However, Zawaideh et al.21 showed that chemomechanical method did not affect the bond strength. Similar results were shown by Cehreli et al.22 and Chittum et al.23 where there was no difference in the mode of caries removal to bond strength.&#xD;
&#xD;
The intragroup comparison showed that the highest shear bond strength value was seen in the total-etch group as compared to self etch in both conventional and chemomechanical method. In total-etch adhesives, when phosphoric acid is applied before the adhesive results in smear layer removal and demineralizes the dentin which causes exposure of collagen fibrils. This collagen might yield reactive groups that would be able to chemically interact with bonding primers. 24- 27 &#xD;
&#xD;
In the total-etch system, complete removal of the chemomechanical agent after acid-etching and water rinsing is expected believed to take place. But in the self-etching system, the absence of the rinsing step results in remnants of the gel on the dentin surface and might interfere with the bonding mechanism.28&#xD;
&#xD;
Our study demonstrates that the caries removal method did not lead to significant differences in the shear bond strength. Total etch adhesive system led to higher bond strength as compared to self etch adhesive system. Further investigations simulating the clinical conditions should be carried out to validate the findings of the present study.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
Within the limitations of this study, the chemomechanical group showed slightly higher shear bond strength values than the conventional group in both total-etch and self etch subgroups, the difference between them was not statistically significant. Also, total-etch adhesive showed better bond strength than self etch adhesives.&#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;
&#xD;
Author&#x2019;s Contribution: Dr Mohit Kumar (Study design, Preparation of manuscript)&#xD;
&#xD;
Dr Shubhra Malik (Sample preparation and Conduct of Study)&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3880</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3880</Fulltext></URLs><References>1. Karaarslan ES, Yildiz E, Cebe MA, Yegin Z, Ozturk B. Evaluation of micro-tensile bond strength of caries-affected dentine after three different caries removal techniques. J Dent. 2012; 40(10):793-801.&#xD;
&#xD;
2. Khattab NMA, Omar OM. Papain-based gel for chemo-mechanical caries removal: influence on microleakage and micro shear bond strength of esthetic restorative materials. J Am Sci. 2012;8(3):391-9&#xD;
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3. Mohammed TI, Salih SA. The effect of chemomechanical caries removal and different bonding systems on shear bond strength of carious dentin (In vitro study). Mustansiria Dent J. 2011;8(2):115-26.&#xD;
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4. Viral PM, Nagarathna C, Shakuntala BS. Chemomechanical caries removal in primary molars: Evaluation of marginal leakage and shear bond strength in bonded restorations-An in vitro study. J Clin Pediatr Dent. 2013;37(3):269-74.&#xD;
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5. Ramamoorthi S, Nivedhitha MS, Vanajassun PP. Effect of two different chemomechanical caries removal agents on dentin microhardness: An in vitro study. J Conserv Dent. 2013;16(5):429-33.&#xD;
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6. Hamama HHH, Yiu CKY, Burrow MF, King NM. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent J. 2013;58(3):283-92.&#xD;
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7. Hamama HHH, Yiu CKY, Burrow MF. Effect of chemomechanical caries removal on the bonding of self-etching adhesives to caries-affected dentin. J Adhes Dent. 2014;16(6):507-16.&#xD;
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8. Dinesh DS. Comparative evaluation of shear bond strength of a self etch adhesive system and total-etch adhesive system to normal human permanent dentin with and without carisolv treatment. Pak Oral Dental J. 2011;31(2):443-6.&#xD;
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9. Aggarwal V, Singla M, Yadav S, Yadav H. The effect of caries excavation methods on the bond strength of etch-and-rinse and self-etch adhesives to caries affected dentine. Aust Dent J. 2013;58(4):454-60.&#xD;
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10. Hamama H, Yiu C, Burrow M. Current update of chemomechanical caries removal methods. Aust Dent J. 2014;59(4):446-56&#xD;
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11. Venkataraghavan K et al. Chemomechanical Caries Removal: A Review &amp; Study of an Indigenously Developed Agent (Carie Care TM Gel) In Children. J Int Oral Health. 2013;5(4):84-90.&#xD;
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12. Santos&#xA0; RA, Lima&#xA0; EA,&#xA0;Pontes&#xA0; MMA, Nascimento ABL,&#xA0;Montes MAJR. Braz R. Bond strength to dentin of total-etch and self-etch adhesive systems. Rev Ga&#xFA;ch Odontol, Porto Alegre.&#xA0; 2014;62(4):365-70.&#xD;
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13. Hgde MN, Bhandary S. An evaluation and comparison of shear bond strength of composite resin to dentin, using newer bonding agents. J Conserv Dent. 2008;11:71&#x2013;5.&#xD;
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14. Amaral FLB, Martao Florio F, Ambrosano GMB, Basting RT. Morphology and micro tensile bond strength of adhesive systems to in situ-formed caries-affected dentin after the use of a papain-based chemomechanical gel method. Am J Dent. 2011;24(1):13-9.&#xD;
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15. Ahmed AA, Godoy FG, Kunzelmann KH. Self-limiting caries therapy with proteolytic agents. Am J Dent. 2008;21:303&#x2013;312.&#xD;
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16. Banerjee A, Kellow S, Mannocci F, Cook RJ, Watson TF. An in vitro evaluation of microtensile bond strengths of two adhesive bonding agents to residual dentine after caries removal using three excavation techniques. J Dent. 2010;38:480&#x2013;489.&#xD;
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17. Hossain M, Nakamura Y, Tamaki Y, Yamada Y, Jayawardena JA, Matsumoto K et al. Dentinal composition and Knoop hardness measurements of cavity floor following carious dentin removal with Carisolv. Oper Dent. 2003;28:346&#x2013;351.&#xD;
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18. Adebayo OA, Burrow MF, Tyas MJ, Palamara J. Effect of tooth surface preparation on the bonding of self-etching primer adhesives. Oper Dent. 2012;37(2):137-49.&#xD;
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19. Bertassoni LE, Marshall GW.&#xA0; Papain-gel Degrades Intact Nonmineralized Type I Collagen Fibrils. J Scan 2009;31(6):253-8.&#xD;
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20. Schutzbank SG, Galaini J, Kronman J, Goldman M, Clark REA. Comparative in vitro study of GK-101 and GK-101E in caries removal. J Dent Res. 1978; 57:861-4.&#xD;
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21. Zawaideh F, Palamara JE, Messer LB. Bonding of resin composite to caries affected dentin after Carisolv&#xA0; treatment. Pediatr Dent. 2011;33(3):213-20.&#xD;
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22. Cehreli ZC, Yazici AR, Akca T, Ozg&#xFC;naltay G. A morphological and micro-tensile bond strength evaluation of a single-bottle adhesive to caries-affected human dentine after four different caries removal techniques. J Dent. 2003;31(6):429-35.&#xD;
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23. Chittem J, Sajjan GS, Varma KM. Comparative evaluation of micro shear bond strength of caries affected dentinal surface treated with conventional method and chemomechanical method. J Conserv Dent. 2015;18(5):369-73.&#xD;
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24. De Goes MF, Pachane GCF, Garcia-Godoy F. Resin bond strength with different methods to remove excess water from the dentin. Am J Dent. 1997;10(6):298-301.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xD;
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25. Nakabayashi N, Sami Y. Bonding to intact dentin. J Dent Res. 1996;75(9):1706-15.&#xD;
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26. Prati C, Chersoni S, Mongiorgi R, Pashley DH. Resin-infiltrated dentin layer formation of new bonding systems. Oper Dent. 1998;23(4):185-94.&#xA0;&#xA0;&#xA0;&#xD;
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27. Inokoshi S, Hosoda H. Interfacial structure between dentin and seven dentin bonding systems revealed using argon ion beam etching. Oper Dent. 1993;18:121&#x2013;5.&#xD;
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28. Piva E, Ogliari FA, de Moraes RR et al. Papain-based gel for biochemical caries removal: influence on microtensile bond strength to dentin. Braz Oral Res. 2008;22(4):364-70.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Cleft Lip/Cleft Palate Infants and Breastfeeding: A Survey&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>138</FirstPage><LastPage>140</LastPage><AuthorList><Author>Chattopadhyay D</Author><AuthorLanguage>English</AuthorLanguage><Author> Deol R</Author><AuthorLanguage>English</AuthorLanguage><Author> Rashim M</Author><AuthorLanguage>English</AuthorLanguage><Author> Vathulya M</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Breastfeeding, Infants, Cleft lip, Cleft palate</Keywords><Fulltext>Introduction:&#xD;
&#xD;
Cleft lip and palate are congenital malformations affecting the lip, palate or both caused by an error in the facial fusion process during the embryonic period due to changes in the normal development of primary and/or secondary palate. Cleft lip/palate causes various issues, feeding being the major concern for parents.1 The rate of incidence of this anomaly varies from 0.28 to 3.74 per 1000 live births.2&#xA0;&#xA0; &#xD;
&#xD;
WHO recommends breastfeeding for 6 months. The cleft population is traditionally thought to be unable to breastfeed due to poor suckling. To deal with issues like inadequate gain in weight of infant due to feeding issues, trying out different feeding strategies and supplementation of calories through formula feeding, infant and mother often require assistance and guidance. &#xA0;Feeding issues due to an infant&#x2019;s condition often result in maternal stress, increased anxiety among mothers and has a negative impact on mother-infant bonding. Breast milk provision is not given much importance as an outcome of the above-mentioned issues.&#xA0;Though the importance of human milk is well known, still breastfeeding is often discouraged for infants with cleft lip and palate. Inability to feed effectively can lead to maternal stress and anxiety as well as poor mother-infant bonding.3, 5&#xD;
&#xD;
So, the researchers felt a need to explore breastfeeding practices among mothers of infants with cleft lip and /or palate. A survey was conducted from a tertiary care centre to assess&#xA0; breastfeeding practices amongst mothers of cleft lip and palate.6,7&#xD;
&#xD;
Materials and methods:&#xD;
&#xD;
Study Design: A retrospective telephone survey design was used to collect information from mothers of children with cleft operated at tertiary care hospital, Uttarakhand.&#xD;
&#xD;
Study Population and Duration: Only mothers of children with cleft were included as the study sample. All the mothers of children with cleft who visited tertiary care centre, Uttarakhand over the past 3 years (April 2017 to March 2020) were included in the study. &#xD;
&#xD;
Exclusion Criteria: Mothers not willing to give informed consent for participation or not understanding either Hindi or English were excluded from the study.&#xD;
&#xD;
Sampling and Sample size: Total Enumerative technique was used to collect information from mothers regarding breastfeeding practices in children with cleft. A total of 167 children were operated in the institute during the past three years. Out of these, a total of 122 mothers responded/gave consent for participation in the study and was interviewed. Mothers were explained about the maintenance of confidentiality.&#xD;
&#xD;
Data collection tools: Primary sources of data included telephonically asking for socio-demographic information of mother and child and structured question related to breastfeeding of the infant with cleft lip/ palate or both. Structured tools were used for data collection.&#xD;
&#xD;
Reliability and validity:&#xA0; Tools were validated and the reliability was checked. Tools were translated into the Hindi language, back-translated, and retranslated, followed by a pilot study on 5 mothers.&#xD;
&#xD;
Ethical considerations: The study was initiated after due permission from the institutional ethics committee. Anonymity and confidentiality of data were maintained. Informed consent was taken from participants.&#xD;
&#xD;
Analysis &amp; Results:&#xD;
&#xD;
The recorded data were analysed using appropriate statistical measures. Table 1 depicts the socio-demographic profile of mothers and their children with cleft. Details of the diagnosis of children are shown in Table 2.&#xA0; Important breastfeeding-related information is depicted in Table 3. &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;&#xD;
&#xD;
Further, none of the mothers continued direct breastfeeding for more than 15 days. Few of them switched over to expressed breast milk feeding. Out of the total,&#xA0; 82 mothers provided exclusively expressed breastmilk for 1 month.&#xA0;&#xA0; Only 15 infants received exclusively expressed breastmilk for 6 months. On average, infants received breastmilk for 2.28 months. &#xD;
&#xD;
Supplementation was done by formula feed/ cow&#x2019;s milk. Poor supply was cited as the most frequent challenge to providing breast milk and caused a cessation in 71.24% of mothers. A total of 36 infants was advised formula feeds due to poor weight gain.&#xD;
&#xD;
As per the use of additional devices, none of the mothers used any additional special devices for feeding. Total 11 mothers, adopted modified football position for feeding their infants. Difficulties reported in feeding by mothers included poor supply, stress, difficulty in suckling, the increased time required.&#xD;
&#xD;
&#xD;
&#xD;
&#xA0;As per family support, only 21 mothers (17%) &#xA0;received encouragement, 66 mothers (54%) &#xA0;received neither support nor discouragement while 35 mothers (29%) were discouraged from breastfeeding by their family members. (Fig 1)&#xD;
&#xD;
Discussion: &#xD;
&#xD;
A pilot survey done by Kaye et al. on breastfeeding practices among children with Cleft Lip/Palate or both reported that 78% of mothers initiated either direct breastfeeding or expressed breast milk for their infants. The mean duration of human milk provision was 4 months. Most mothers (72%) supplemented human milk feeding with formula either because of poor milk supply or was recommended for improved weight gain. The above findings are in lieu with current study findings, but the mother&#x2019;s milk was provided for a much shorter duration may be due to differences in support system.4,5&#xD;
&#xD;
Conclusions and Recommendations: &#xA0;The study yielded quite significant insights into breastfeeding practices in infants with a cleft. These findings can be utilised to support, counsel and encourage breastfeeding children with cleft. Support from a health care professional, particularly lactation specialist and nursing staff is critical. Breastfeeding and the use of human milk should be emphasized and prioritised.5 Further studies can be done on a larger sample size to generalise the findings. &#xD;
&#xD;
Financial Support and Sponsorship: Nil&#xD;
&#xD;
Conflicts of Interest: There are no conflicts of interest.&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3881</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3881</Fulltext></URLs><References>&#xD;
	&#xD;
	Duarte GA, Ramos RB, Cardoso MC. Feeding methods for children with cleft lip and/or palate: A systematic review. Braz J Otorhin. 2016; 82(5):602-609.&#xD;
	&#xD;
	&#xD;
	Kumar MS, Vankayala B, Kumar M, Gudugunta L, Basavarajaiah JM et al. Evaluation of Feeding Practice in Infants with Cleft Lip and Palate at Cleft Centres. Den Sci. 2019;18 (7):1420-1427. &#xD;
	&#xD;
	&#xD;
	Trenouth MJ, Campbell AN. Questionnaire evaluation of feeding methods for cleft lip and palate neonates. Int J of Ped Dent. 1996; 6:241-244.&#xD;
	&#xD;
	&#xD;
	Kaye A, Cattaneo C, Huff M H, Staggs SV. A pilot study on mother&#x2019;s breastfeeding experiences in infants with cleft lip and/or palate. Adv Neo care. 2019; 19 (2):127-137.&#xD;
	&#xD;
	&#xD;
	Burca NDL, Gephart MS, Miller C, Cote C. Promoting breast milk nutrition in infants with cleft lip and/or palate. Adv Neo Care. 2016; 16 (5):337-344.&#xD;
	&#xD;
	&#xD;
	Kaur N, Deol R, Yadav A. Correlation of feeding practices and health profile of children. Nurs J Ind. 2014 May-Jun;105(3):128-130. PMID: 25643566.&#xD;
	&#xD;
	&#xD;
	Shetty MS, Khan MB. Feeding considerations in infants born with cleft lip and palate. APOS Trends Orthod 2016;6:49?53. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Evaluation of Synergistic Antioxidant Efficacy of Phyllanthus niruri Leaves and Sapindus mukorossi Fruits&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>141</FirstPage><LastPage>148</LastPage><AuthorList><Author>Nazia Malik</Author><AuthorLanguage>English</AuthorLanguage><Author> Rakesh Kumar Jat</Author><AuthorLanguage>English</AuthorLanguage><Author> Darna Bhikshapathi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Numerous physiological and biochemical processes in the human body may produce oxygen-centred free radicals and other reactive oxygen species as by-products. Overproduction of such free radicals can cause oxidative damage to biomolecules, eventually leading to many chronic diseases, such as atherosclerosis, cancer, diabetes, ageing, and other degenerative diseases in humans. A traditional medicine prescription habitually contains various herbs or different parts, and these have a synergistic impact in effecting a cure or reducing toxicity. Aims: The present study was aimed to investigate the effect of a combined extract of Phyllanthus niruri leaves and Sapindus mukorossi fruit on antioxidant activity by in vitro and in vivo methods. Methods: In vitro antioxidant activity was performed by employing 2,2&#x2032;-diphenyl-1-picrylhydrazyl (DPPH), Nitric oxide scavenging, reducing power, hydrogen peroxide scavenging, superoxide anion scavenging and &#x3B2;- Carotene linoleate assays. In vivo antioxidant estimation has been performed using CCL4 and acetaminophen treated rats. Methanolic extract of Phyllanthus niruri leaves (MEPNL), aqueous extract of Sapindus mukorossi fruit (AESMF) and combined extract (MEPNL+AESMF) responses on antioxidant enzymes (Catalase, SOD and GSH) and lipid peroxidation were evaluated and compared. Results: Combined extract (MEPNL+AESMF) at 400 mg/kg has exhibited significant antioxidant activity in in vitro methods by enhancing the scavenging of DPPH, NO, superoxide anion, increasing the reducing power and inhibition of bleaching of &#x3B2;-Carotene linoleic acid when compared to individual extracts (MEPNL &amp; AESMF). Lipid peroxidation was significantly decreased with combined extract than individual extracts. Catalase, SOD and Glutathione levels were remarkably elevated with the combination of extracts than individual extracts in CCl4and Paracetamol treated rats. Conclusions: Present study showed that the combined extract of Phyllanthus niruri leaves and Sapindus mukorossi fruit possess significant synergistic antioxidant activity than the individual leaf and fruit extracts demonstrated in vitro and in vivo methods. The synergistic effect of flavonoids, saponins and other antioxidant components in Phyllanthus niruri leaves and Sapindus mukorossi fruits may be responsible for enhanced antioxidant activity.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Phyllanthus niruri, Sapindus mukorossi, Antioxidant, Synergistic, Flavonoids, Saponins</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
These days, consideration is being centred on the investigation of the efficacy of plant in the customary medication since they are modest and have minimal side effects.1&#xA0;Elective therapeutics dependent on nutraceutical treatment and phytotherapy have developed as new recuperating frameworks and rapidly and generally spread.2Today, oxidative pressure has pulled in the consideration of analysts. An imbalance between free radicals and antioxidants prompts oxidative harm of proteins, fat, nucleic acids, and starches.3,4&#xD;
&#xD;
Oxidation prevention agents have shielded the body from the unsafe impact of the free radicals.5&#xA0;Endogenous antioxidant agents guard against the reactive oxygen species that are fortified by natural antioxidants that reinforce them and reestablish the ideal balance by neutralizing the ROS. 6,7&#xA0;Traditional medication has been utilized in various natural products and herbs to treat an assortment of sicknesses including dangerous tumours.8&#xD;
&#xD;
Ongoing proof has exhibited that combination therapy could give more noteworthy helpful advantages to sicknesses, for example, AIDS, malignant growth, atherosclerosis and diabetes, all of which have complex aetiology and pathophysiology and therefore are hard to treat utilizing a single medication target approach.9Various components in a herbal prescription exert a synergistic impact in such manners as following up on various targets or improving the solubility of active compounds, which constitute the pharmaceutical basis of traditional medicines.10&#xD;
&#xD;
The leaves of the Phyllanthus niruri plant is reported to have multiple therapeutic properties such as anti-inflammatory, antipyretic and analgesic, antifungal, antimicrobial, antibacterial and antiparasitic, anti-cancer and Hepatoprotective activity.11&#xA0;The fruit of the Sapindus mukorossi plant is reported to have expectorant, emetic, hepatoprotective and abortifacient effects. 12&#xD;
&#xD;
The active constituents present in both plants are flavonoids, tannins, saponins, alkaloids, Glycosides, phenolics and steroids. Since flavonoids and saponins have potent antioxidant properties. The present study was carried out to evaluate the antioxidant efficacy of combined extract of Phyllanthus niruri leaves and Sapindus mukorossi fruits by in vitro and in vivo methods and to compare the antioxidant potency of the combined extract with individual leaf and fruit extract and finally to establish the synergistic effect of combined extract over individual extracts.&#xD;
&#xD;
MATERIALS AND METHODS&#xD;
&#xD;
&#xA0;&#xA0; Collection and Authentication of Plant Material&#xD;
&#xD;
For the present study, the Phyllanthus niruri leaves and Sapindus mukorossi fruits were collected from the vicinity of the Meerpet, Saroornagar, Hyderabad. Sample specimens of Phyllanthus niruri leaves and Sapindus mukorossi fruits were deposited in a polythene bag. The sample specimens were kept in fresh condition by adding 2% formalin. The scientific name of the plant has been verified with http://www.theplantlist.org on 7th, March 2020. Plant materials were identified and authenticated by Dr. K. Venkata Ratnam, Rayalaseema University, Kurnool, Andhra Pradesh.&#xD;
&#xD;
Extraction&#xD;
&#xD;
The Phyllanthus niruri leaves and Sapindus mukorossi fruits were shade dried separately and mechanically reduced to a coarse powder. The weight of the coarse powders of Phyllanthus leaves and Sapindus fruits were found to be 1450 g and 1368 g. The powders were subjected to hot continuous successive extraction in a Soxhlet apparatus with solvents in the increasing order of polarity using petroleum ether, ethyl acetate, acetone, methanol and water under controlled temperature (50-60 &#xB0;C). The extracts thus obtained were concentrated in a vacuum rotary evaporator and extracts were kept in desiccators for further use.&#xD;
&#xD;
Phytochemical screening&#xD;
&#xD;
Phytochemical qualitative analysis was performed by subjecting the crude extracts for identification tests to detect the presence of flavonoids, glycosides, alkaloids, carbohydrates, fixed oils, tannins, phytosterols, proteins, amino acids, lignins, phenolic compounds, saponins, gums &amp; mucilages.13&#xD;
&#xD;
Methanolic extract of Phyllanthus niruri leaves (MEPNL) and aqueous extract of Sapindus mukorossi fruits (AESMF) were found to possess a significant number of active constituents and are selected for antioxidant activity. The combined extract was prepared by mixing the extracts of Phyllanthus niruri leaves and Sapindus mukorossi fruits in an equal ratio (1:1).&#xD;
&#xD;
Animals&#xD;
&#xD;
Wistar rats (180-200 g) were procured from Sainath agencies, Musheerabad, Hyderabad (282/99/CPCSEA) and housed in the animal facility of the institution. After randomly dividing the animals into different groups, the rats were accustomed for one month before the initiation of the experiment. Animals were caged in polypropylene cages and preserved under standard environmental conditions such as temperature (26 &#xB1; 2&#xBA;C), relative humidity (45-55%) and 12 hr dark/light cycle. The animals were fed with a rat pellet diet (Golden Mohur Lipton India Ltd.) and water ad libitum.&#xD;
&#xD;
CPCSEA / IAEC Approval for Animal Studies&#xD;
&#xD;
The study protocol was approved by the institutional ethical committee with reference no: 1447/PO/Re/S/11/12/A.&#xD;
&#xD;
Experimental methods&#xD;
&#xD;
In vitro antioxidant activity of methanolic extract of Phyllanthus niruri leaves (MEPNL), aqueous extract of Sapindus mukorossi fruits (AESMF) and combined extract (MEPNL+AESMF)&#xD;
&#xD;
&#xD;
	&#xD;
	DPPH assay: To 1 ml of DPPH (0.1 mM solution) in methanol add 3 ml of different concentrations of MEPNL, AESMF &amp; combined extract (MEPNL+AESMF) (20, 40, 60, 80 &amp; 100 &#xB5;g/ml). The reference standard used is ascorbic acid (100&#xB5;g/ml). All the experiments were reproduced threefold. The percentage suppression (inhibition) was evaluated by using a formula&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
&#xD;
	&#xD;
	Nitric oxide scavenging assay 14: Sodium nitroprusside (2 ml) in pH 7.4 phosphate buffer is combined with 0.5 ml of different strengths of MEPNL, AESMF &amp; combined extract (MEPNL+AESMF) ranging from 5-100 &#xB5;g /ml dissolved in methanol. The mixtures are kept for incubator at 250C at room temperature for 150 minutes. Control consists of the same reaction mixture excluding MEPNL and AESMF. Griess reagent (0.5 ml) was added after incubation of individual sample (up to 0.5 ml) and further incubated for 30 minutes. The absorbance of chromophore was recorded at wavelength 546 nm. This experiment was executed threefold and the % inhibition was evaluated with the formula&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Reducing Power assay: The reducing power potency of the MEPNL, AESMF and combined extract (MEPNL+AESMF) was assessed by Oyaizu method15. Distilled water (1 ml) possessing different strengths of MEPNL, AESMF and combined extract (MEPNL+AESMF) (20-100 &#x3BC;g/ml) were combined with phosphate buffer (pH 6.6, 2.5 ml, 0.2 M), 1% K3[Fe(CN)6] (2.5 ml)&#xA0;and incubated at 500C for 20 minutes. After incubation, a part of TCA (2.5 ml) 10% was combined and solutions were centrifuged for 10 minutes (3000 rpm). Supernatant solutions i.e the above layers were combined with distilled water (2.5 ml) and FeCl3 (0.5 ml) (0.1%) and the&#xA0;absorbance has been interpreted at 700 nm. Sodium metabisulphite was considered as the reference standard. The test was conducted in triplicate. Absorbance is directly proportional to the reducing power. A rise in the reaction mixture absorbance suggests enhancement in reducing power. Percentage rise in absorbance was determined by the formula&#xD;
	&#xD;
&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#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;
&#xD;
	&#xD;
	Hydrogen peroxide Scavenging Assay: 16,17&#xA0;Different concentrations of MEPNL, AESMF &amp; combined extract (MEPNL+AESMF) (50-250 &#x3BC;g/ml) was combined with hydrogen peroxide (2 ml of 20 mM) in PBS (pH7.5) and incubated for 10 minutes. The absorbance was recorded at 230 nm against PBS blank. The experiment was carried out in a triplet. Data were represented as % inhibition. For reference standard ascorbic acid was used.&#xD;
	&#xD;
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&#xD;
&#xD;
	&#xD;
	Superoxide Anion scavenging assay: 100&#xB5;l riboflavin (2&#xB5;m), 200&#xB5;l methionine (13 mM), 200&#xB5;l EDTA (100 &#xB5;m), 100 &#xB5;l of 75 &#xB5;m NBT and MEPNL, AESMF &amp; combined extract (MEPNL+AESMF) (100, 200, 300,400 and 500 &#xB5;g/ml) were combined and further dissolved&#xD;
	&#xD;
&#xD;
&#xD;
with sodium phosphate buffer (up to 3 ml). Generation of formazon was accompanied by reading the absorbance under 560 nm after illumination for 10 minutes by using a lamp of fluorescent light. The solution was kept at dark in similar tubes act as blanks. Percentage suppression has been determined by utilizing the formula.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	&#x3B2;-Carotene Linoleate assay:&#xA0;18&#xA0;2 mg of B-Carotene is liquefied in 10 ml CHCl3and the former solution (2 ml) was passed into 100 ml R.B flask. CHCl3was eliminated using vacuum and a further 40 mg of linoleic acid, 400 mg tween 40, followed by 100 ml distilled H2O were added.&#xA0;The above intermixture (4.8 ml) is supplemented to the tubes possessing MEPNL, AESMF and combined extract (MEPNL+AESMF) (100, 200, 300, 400 &amp; 500 &#xB5;g/ml) in 2 ml, the absorbance of the zero period was calculated using 470 nm. The tubes were incubated at 500C for a period of 2 hr and further recorded the absorbance. A &#x3B2;-carotene blank was prepared &amp; recorded its absorbance. The similar technique has been reciprocated using BHT.&#xD;
	&#xD;
&#xD;
&#xD;
Antioxidant potency = (&#x3B2;-carotene amount after 2 hr of assay/ initial &#x3B2;-Carotene content) x100&#xD;
&#xD;
Single-dose oral acute toxicity for one week with gross behavioural study 19, 20&#xD;
&#xD;
The Acute toxicity evaluation of MEPNL and AESMF were performed based on OECD guidelines 423 by using mice and fixed-dose studies were selected where the limit dose is 2000 mg/kg ( Figure 1).&#xD;
&#xD;
&#xD;
&#xD;
In vivo antioxidant studies of MEPNL, AESMF and combined extract (MEPNL+AESMF)&#xD;
&#xD;
1). Carbon tetrachloride (CCl4) intoxicated rats: 21&#xA0;Rats were separated into 8 groups consisting of 6 rats in each group&#xD;
&#xD;
I: Untreated control (1% liquid paraffin 1ml/kg s.c as vehicle) (-ve control)&#xD;
&#xD;
II: Hepatotoxin control (+ve control) (vehicle for only 7 days (s.c) subsequently 1ml/kg b.w CCl4:liq.paraffin (1:1) s.c on day 7)&#xD;
&#xD;
III: Standard group (Silymarin 100 mg/kg) one time daily for 7 days and then CCl4: Liq. paraffin (1:1) 1 ml/kg s.c on 7th day.&#xD;
&#xD;
IV: MEPNL (200 mg/kg) every day for one week orally and then CCl4:liq.paraffin (1:1) s.c on day 7.&#xD;
&#xD;
V: MEPNL (400 mg/kg) every day for one week orally and then 1 ml/kg CCl4:liq.paraffin (1:1)&#xA0;s.c on 7th day.&#xD;
&#xD;
VI: AESMF (200 mg/kg) every day for one week orally and then CCl4:liq.paraffin (1:1) s.c on day 7&#xD;
&#xD;
VII: AESMF (400 mg/kg) every day for one week orally and then 1 ml/kg CCl4:liq.paraffin (1:1)&#xA0; s.c on 7th day.&#xD;
&#xD;
VIII: Combined extract (MEPNL+ AESMF) (400 mg/kg) every day for one week orally and then 1 ml/kg CCl4:liq.paraffin (1:1) s.c on 7th day.&#xD;
&#xD;
2) Paracetamol intoxicated rats: 22&#xA0;Rats were bifurcated in to 8 groups comprising of 6 rats in each group.&#xD;
&#xD;
I: Untreated control (-ve control) (acacia suspension 2% w/v in distilled water)&#xD;
&#xD;
II: Treated toxic control (+ve control) (1 week vehicle + paracetamol 2g/kg orally on 5th day) III: Standard (Silymarin 100 mg/kg every day for 1 week orally + 2g/kg acetaminophen orally on 5thday).&#xD;
&#xD;
IV: MEPNL (200 mg/kg dose every day for 1 week + 2g/kg acetaminophen on 5th day).&#xD;
&#xD;
V: MEPNL (400 mg/kg dose every day for 7 days orally + 2g/kg acetaminophen orally on 5th day).&#xD;
&#xD;
VI: AESMF (200 mg/kg dose every day for 1 week + 2g/kg acetaminophen on 5th day).&#xD;
&#xD;
VII: AESMF (400 mg/kg dose every day for 1 week + 2g/kg acetaminophen on 5th day).&#xD;
&#xD;
VIII: Combined extract (MEPNL+ AESMF) [(400 mg/kg) dose every day for 1 week + 2g/kg acetaminophen on 5th day].&#xD;
&#xD;
Liver Isolation&#xD;
&#xD;
The rats were killed using mild ether anaesthesia on day 8th for liver isolation. The isolated liver was completely cleansed with an ice cold solution of saline. The liver weight was recorded after blotting it in pads of filter paper. A liver homogenate was made which was utilized for further in vivo antioxidant analysis.&#xD;
&#xD;
Statistical analysis: The findings were exhibited as Mean &#xB1; S.E.M by using one way ANOVA subsequently using Tukey-kramer comparison analysis. The results were regarded to be statistically significant when p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3882</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3882</Fulltext></URLs><References>&#xD;
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	Kilicgun H,&#xA0; &#xA0;Altiner D.Correlation between antioxidant effect mechanisms and polyphenol content of&#xA0;Rosa canina. Pharmacog Mag. 2010; 6(23):238-41.&#xD;
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	Khanam S, Shivprasad N, Devi K.Natural Antimutagens. Ind J Pharm Educ. 2004; 38(4): 180- 83&#xD;
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	Setty SR, Swamy AHM, Patil T, Prakash T, Gouda A V.Evaluation of hepatoprotective and in-vitro cytotoxic activity of leaves of&#xA0;Chrozophora plicata&#xA0;Linn. Fitoterapia. 2007; 79:51-54.&#xD;
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	Singh M, Pragzna Y, Dharmadev B. In-vitro Estimation of Free Radical Scavenging Activity of Fruit juices by DPPH assay. Int J Curr Res Rev. 2012;17(4):67-73.&#xD;
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</References></Article></ArticleSet><ArticleSet><Article><Journal><PublisherName>Radiance Research Academy</PublisherName><JournalTitle>International Journal of Current Research and Review</JournalTitle><PISSN>2231-2196</PISSN><EISSN>0975-5241</EISSN><Volume>13</Volume><Issue>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Morphogenesis of Ureter in Human Fetuses: A Histological Study in North India&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>149</FirstPage><LastPage>153</LastPage><AuthorList><Author>Kaur Harmeet</Author><AuthorLanguage>English</AuthorLanguage><Author> Naik Shishir Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Minakshi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: The contribution of anatomist and pathologist into the knowledge of the developmental and maturational changes in the human fetal ureter has been significant and play an essential vital role in the development of features. Ureter The ureters in neonates and infants can be anatomically and functionally so severely compromised as to warrant the various congenital terms That&#x2019;s why Microsectional study of the ureter has been a dynamic stair that can contribute to understanding congenital diseases such as agenesis, hypoplasia and dysplasia etc. Aim: My study has brought to light numerous insight into the fine structure of the ureter, with specific embryological highlights with cytologic and physiologic considerations. Materials and Methods: The study was conducted in the Department of Anatomy, JNUIMSRC, Jaipur. Thirty aborted human fetuses between 8- 38 weeks of gestational age with no obvious congenital anomalies were obtained from the Department of Obstetrics and Gynaecology after taking consent of parents following approval from the Institutional Ethical Committee Result: Before 12 weeks there is only mesenchymal tissue appear after that mature histological appearance increase with gestational age in the craniocaudal direction. Conclusion: We are now able to better explain several microstructure-function relationships of the ureter in health and disease.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Crown-rump length, Fetal ureter, Itravesical, Juxtavesical</Keywords><Fulltext>INTRODUCTION: &#xD;
&#xD;
Developmental road map and maturational changes in the human fetal ureter has been playing an essential vital role in the identification of normal and abnormal development of human features. The groundbreaking work of Satani,1 and Stein and Weinberg 2 clearly showed that the ureter displays morphologic plasticity, physiologic accommodation, and anatomic change under different conditions, e.g., physiological function, stress, obstruction, and ageing.&#xD;
&#xD;
There are three layers in the ureter from outside inwards they are the transitional epithelium, then comes the smooth muscle layer and then it is continued by the adventitia.3&#xD;
&#xD;
All these develops around the fourth week of intrauterine life. The ureteric bud develops and forms the majority of the collecting part of the kidneys.4 &#xD;
&#xD;
The ureteric bud is a primordial structure giving rise to the ureter, renal pelvis, calyces and collecting tubules. The ureteric wall is highly permeable at an early stage (5 mm CRL). Its lumen becomes obliterated later at (13-22mm CRL) which is subsequently recanalized. Both events begin at intermediate levels of the ureter and proceed cranially and caudally. 5 Two fusiform enlargements appear at the lumbar and the pelvic levels of the ureter at the 5th and 9th months of intrauterine life respectively which is responsible for the ureteric constrictions at its upper end and another as it crosses the pelvic brim. A third narrowing is always present at its lower end and is related to the growth of the bladder wall. Felix W has stated that after the 4 and 5 months of fetal life the ureter no longer is a straight tube of uniform calibre but shows two dilatations in the lumbar and pelvic regions respectively. 6,7 The ureteric wall is highly permeable at an early stage (5 mm CRL). Its lumen becomes obliterated later at (13-22mm CRL) which is subsequently recanalized. Both events begin at intermediate levels of ureter and proceed cranially and caudally. Two fusiform enlargements appear at the lumbar and the pelvic levels of the ureter at the 5th and 9th months of intrauterine life respectively which is responsible for the ureteric constrictions at its upper end and another as it crosses the pelvic brim. A third narrowing is always present at its lower end and is related to the growth of the bladder wall. Felix W has stated that after the 4 and 5 months of fetal life the ureter no longer is a straight tube of uniform calibre but shows two dilatations in the lumbar and pelvic regions respectively. The terminal part of the ureter perfectly continues with the intramural part. One should understand that the muscle fibres and the fibroelastic fibres run longitudinally. There is a fine balance in the formation of the ureter and deviation leads to functional problems.7 One of the most common birth defects seen in the foetus is related to the urinary tract.8 &#xD;
&#xD;
MATERIALS AND METHODS:&#xD;
&#xD;
The present study carried out in the Department of Anatomy, JNUIMSRC, Jaipur. It was based on microscopic examination of ureteric tissue of 30 human features. Ureter procured from different gestational ages ranging from 8 to 40 week of fertilization with no obvious abnormalities on macroscopic inspection. After studying its external morphology tissue samples were taken from proximal, middle and distal regions of the ureter then fixed in 10% formalin and later processed in paraffin wax. 5-7&#xB5; sections were prepared and stained with hematoxylin and eosin. &#xD;
&#xD;
&#xD;
&#xD;
Gestational age, sex and crown-rump length were noted. The abdomen was opened by a midline incision extending from the xiphisternum to the pubic symphysis (FIG .1) Tissue samples of 3-5 mm thickness were collected from both ureter in transverse planes from the abdominal, pelvic, juxtavesical and intramural parts and fixed in 10% formalin separately for 24-48 hours. Tissues were processed and paraffin blocks prepared. 5-7&#xB5; thick sections were cut and stained with haematoxylin and eosin. Some slide stained with Masson&#x2019;s trichrome. All studied under the light microscope.&#xA0;&#xD;
&#xD;
RESULT&#xD;
&#xD;
The structures of the different parts of the ureter were observed histologically in 30 human fetuses ranging from 8 weeks to 38 weeks. Special emphasis was given to the developing muscular layer and the epithelium.&#xD;
&#xD;
Group I (6-11 weeks)&#xD;
&#xD;
At 8th and 9th week, the developing ureter depicted no muscular tissue in its wall. Instead, it consisted of mesenchymal tissue only. The upper part of the ureter was dilated to form the pelvis. At 10 weeks multiple narrow spaces were observed in the middle 1/3 of the developing ureter which seemed that the canalization process had been initiated. The lining epithelium was not observed to line these spaces. The periphery of the ureter was covered by a very thin layer of connective tissue arranged regularly.&#xA0; Sections of the ureter at the 11th week depicted a distinct lumen lined by 5-6 layered epithelium whose cells were polygonal in shape and appeared vacuolated. The surface of the epithelium was thickened and 2-3 shallow mucosal folds were observed. The mesenchymal tissue was very thin and arranged spirally around the lining epithelium which in turn was covered by a layer of loose connective tissue. The juxtavesical part of the ureter showed mesenchymal tissue surrounding the epithelium at the 11th week.&#xD;
&#xD;
&#xD;
&#xD;
The epithelium was 2-3 layered thick and transitional. No epithelial folds were observed (FIG 2). The intravesical part opens in the posterior wall of the bladder by an oblique. The intravesical part showed a 3 layered transitional epithelium whose cells were polygonal in shape and depicted no muscular tissue in its wall.&#xD;
&#xD;
Group II (12-14 weeks)&#xD;
&#xD;
Histological sections studied at the 12th week demonstrated that the basal cells of the lining epithelium were smaller than the superficial cells and rested on a thin and extremely undulating basement membrane. The superficial cells appeared dome-shaped with large oval nuclei. Mucosal folds were observed to be more prominent. Deep to the transitional epithelium single tapered cells were evident in 2-3 rows which were characterized by eosinophilic cytoplasm and elongated nuclei. These cells were the precursors of the smooth muscle cells (Fig.3)&#xD;
&#xD;
&#xD;
&#xD;
Such cells were deficient on the peripheral adventitious coat which contained a few blood vessels. The juxtavesical ureter at this stage had a very thin epithelium and a lamina propria containing darkly stained mesenchymal cells. The epithelium was still 3 layered. During the 13th week, the nuclei of the lining transitional epithelium became more conspicuous with well-defined nucleoli in certain places. The smooth muscle cell precursors were arranged circularly in 3-4 rows. These cells appeared more matured with the increase in its length and a deeper stained eosinophilic cytoplasm which were closely apposed to each other. The density of these cells was observed to be increased in the consecutive 14th week. However, sections from the lower 1/3 of the ureter during this period depicted scattered smooth muscle cell precursors which appeared to mature in the deeper layers closer to the lining transitional epithelium. It was also observed that in the juxtavesical ureter the superficial cells of the lining epithelium were polygonal with large oval nuclei. This was surrounded by a thin layer of smooth muscle cell precursors which were arranged circularly in 3-4 rows. The intramural part presented no muscular tissue in its wall. &#xD;
&#xD;
Group III (15-17 weeks)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In this group sections of the ureter taken from the lumbar region showed a well-formed transitional epithelium with deep folds. The muscular coat comprised of 4-5 layers of smooth muscles spirally arranged and closely apposed to each other. Broadband of lamina propria consisting of connective tissue separated the muscular coat from the epithelium. The adventitious coat was also well-formed containing blood vessels. However, sections of the ureter from its lower 1/3 did contain the transitional epithelium but the folds were not well marked till the 16th week. The smooth muscles which were spirally arranged in the muscular coat appeared to come closer to each other at intervals during the 17th week (Fig.4). Observations on the juxtavesical part showed similar features but were delayed in development.&#xD;
&#xD;
&#xD;
&#xD;
Group IV (18-24 weeks)&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Sections of the ureter from the lumbar regions depicted that the individual muscle fibres in the circular muscle coat became gradually closer to each other to form thicker muscle bundles. At 23 weeks the inner longitudinal muscle coat became slightly visible at focal areas in sections. At 24 weeks this layer could be well demonstrated.&#xA0; Sections from the lower 1/3 of the ureter showed a delayed development in comparison to the middle 1/3 (Fig.5). The transitional epithelium further progressed in development by the increase in the number of layers to 7-8 and increase in the number of mucosal folds giving the shape of a typical star-shaped lumen. An increase in thickness of the adventitious coat was also observed with an increase in its vascularity. Sections observed from the intramural parts of the ureter demonstrated that muscle precursors arranged longitudinally were just observed at the 19th week (Fig.6) which became well differentiated at the 21st week. These longitudinal muscle fibres were observed with the superficial trigonal muscle at this stage also.&#xD;
&#xD;
&#xD;
&#xD;
Group V (25-38 weeks)&#xD;
&#xD;
Observations carried out in this group revealed further maturation of the layers of the ureter. The outer longitudinal coat was first observed in the lower 1/3 at the age of 30 weeks in focal areas adjoining the adventitious layer. The various layers of the ureter observed till the age of 38 weeks showed continued but delayed maturation. Sections of the fetal ureter in lumbar regions depicted that the individual muscle fibres in the circular pattern ,coat became gradually closer to each other to form thicker muscle bundles. The longitudinally arranged muscle fibres in the intramural part were seen to become thicker in this group (Fig. 7).&#xA0; &#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Discussion :&#xD;
&#xD;
It is necessary for correlation with its development in increased gestational age and pathological changes for normal functioning of the urinary system in fetal life. In the present study during the 8th week, the epithelium was the only component that could be distinguished histologically in the wall of the ureter. During the 11th week, a distinct lumen lined by a 5-6 layered epithelium whose cells were polygonal in shape and appearing vacuolated was observed. The surface of the epithelium was thickened with the presence of 2-3 shallow mucosal folds. The mesenchymal tissue was very thin and arranged spirally around the lining epithelium which in turn was covered by a layer of loose connective tissue. Throughout the study sections of the ureter taken from the middle 1/3 showed a well-formed transitional epithelium with deep folds although sections from the lower 1/3 and upper 1/3 of the ureter showed delayed development and the folds were not well marked till the 16th week in comparison to the middle 1/3. A broad layer of lamina propria consisting of vascularized connective tissue separated the muscular coat from the epithelium. The epithelium in the juxtavesical and intramural parts of the ureter at this stage was only 2-3 layered thick and transitional. The superficial cells of the lining epithelium were polygonal with large oval nuclei. Tacciuoli M et al also reported in their study that the development of muscle coat and epithelium was observed earlier in the lumbar part of the ureter but developed slightly later in a craniocaudal direction.11,12 &#xD;
&#xD;
&#xA0;Satan&amp;#39;s report1 observations indicated that fewer polynuclear cells are found in the urethral epithelium and that the size of each cell is smaller than that of the bladder. &#xD;
&#xD;
Walker7 found that at around the 16th to 17th day of embryonic life of the mouse both binucleate cells and polyploid nuclei become obvious in the superficial layers of the urinary bladder. these observations point to the early observations of Satani.1 Significant positive linear relationships exist between a gestational week and distal and intravesical ureteral wall thickness of the mesenchymal and smooth muscle growth to the length of the intravesical ureter in fetuses.13,14&#xA0;&#xD;
&#xD;
In the present study, no muscular tissue could be depicted in the wall of the ureter till the 9th week. Precursors of muscle primordium were observed during the 10th and 11th week of gestation in its wall. Deep to the lamina propria spindle-shaped muscle cells were evident in 2-3 rows characterized by eosinophilic cytoplasm and elongated nuclei during the 12th week in the middle part of the ureter. Throughout the entire study, the lower 1/3 of the ureter was observed to possess a delayed development in comparison to the middle 1/3. At 23 weeks the inner longitudinal muscle coat became slightly visible at focal areas in sections stained with Masson&#x2019;s Trichrome. At 24 weeks this layer could be well demonstrated. Tacciuoli M et al reported a similar observation that the ureter in fetuses of 12 -14 weeks demonstrated single tapered cells overlying the loose connective tissue of the lamina propria in the lumbar region.11 The development of these smooth muscles proceeded in a craniocaudal direction.11,12 &#xA0;On the contrary, Matsuno T et al. observed that the differentiation of the ureteral musculature commenced from the renal pelvis and the upper part of the ureter at the 12th week which proceeded distally.13 &#xD;
&#xD;
The primordia of the smooth muscles in the juxtavesical and intravesical parts of the ureter were just recognizable during the 19th week of fetal life. They were arranged longitudinally in the intramural part. These primordial cells became well-differentiated in sections of the 21st week. The longitudinal muscle fibres were observed to blend with the superficial trigonal muscle of the urinary bladder. It consists of a juxta and intravesical segments with the latter having an oblique course through the bladder wall. &#xA0;Matsuno et al. observed that the intramural part of the ureter consisted of purely longitudinal muscle fibres.13 They were found to appear much later during the 17th week in comparison to the appearance of the muscle fibres in the proximal parts of the ureter. In contrast, the orientation of the ureteral musculature in the proximal parts was spiral. The longitudinal muscle fibres of the intravesical part became continuous with the periureteral sheath. On the other hand, Tacciuoli et al. reported that both longitudinal and oblique muscle fibres were present in the intravesical part of the ureter between 22 and 24 weeks.14 Most of these fascicles were present on the medial side of the intramural ureteric wall and some reached the mucous membrane of the bladder to terminate around the ureteric orifice.11 &#xD;
&#xD;
Conclusion: &#xD;
&#xD;
Canalization of the Ureter was first observed to be initiated at the age of 10 weeks. The lining transitional epithelium was 5-6 layered thick with vacuolated and polygonal cells. The mucosa was lined by mesenchymal tissue. Single tapered muscle cells replaced the surrounding mesenchymal tissue at 12 weeks. The number of mucosal folds also increased. It was observed during this time that the lumbar part of the ureter showed the earliest developmental changes which proceeded in a craniocaudal direction. At 23 weeks the inner longitudinal muscle coat was observed in the middle 1/3. The intravesical part of the ureter depicted smooth muscles arranged longitudinally.&#xD;
&#xD;
CONFLICT OF INTEREST: Nil.&#xD;
&#xD;
SOURCE OF FUNDING: Self-funded.&#xD;
&#xD;
AUTHOR CONTRIBUTION:&#xD;
&#xD;
&#xD;
	&#xD;
	Dr Kaur Harmeet: Principal Investigator&#xD;
	&#xD;
	&#xD;
	Naik C Shishir kumar: Principal investigator, Research methodology.&#xD;
	&#xD;
	&#xD;
	Dr Minakshi: Principal Investigator.&#xD;
	&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3883</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3883</Fulltext></URLs><References>&#xA0;1. Satani Y. Histological study of the ureter. J Urol.1919; 3:247.&#xD;
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&#xA0; 2.Stein J, Weinberg SR. A histologic study of the normal and dilated ureter. J Urol. 1962; 87:33-38. &#xD;
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&#xA0; &#xA0;3.Ross MH, Pawlina W . Histology A Text and Atlas, 6th edition. Lippincott Williams &amp; Wilkins, 2010; 280-282 &#xD;
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&#xA0; &#xA0;4.Moore KL, Persaud TV. &#xA0;The Developing Human- Clinically oriented embryology, 5th ed. University of Michigan : Ishiyaku. 1993; 244-246 &#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; 5.Standring S. Urogenital System. Gray&#x2019;s Anatomy: The Anatomical Basis of Clinical Practice. 40thedn. Churchill Livingst. 2008;.1225-1259.&#xD;
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&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; 6.William J. Larsen. Human Embryology. 3rd edn. Philadelphia, Pennsylvania 19106: Chur chill Livingst. 2001; 265-313.&#xD;
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&#xA0; 7. Felix W. The development of the urogenital organs. Man Hum Embry. 2012;3:752&#x2013;979. &#xD;
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&#xA0; &#xA0;8. Woodburne RT. The Ureter Ureterovesical Junction and Vesical Trigone. Anat Rec. 1965; 151: 243-250.&#xD;
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&#xA0; &#xA0; 9.Smith D, Lau L, Khan B, David A, Jerry L Congenital variations in mucomuscular development of the ureter. BJU Int.&#xA0; 2002; 90:130&#x2013;134. &#xD;
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11.Tacciuoli M, Lotti T, de Matteis A, Laurenti C. Development of the smooth muscle of the ureter and vesical trigone: histological investigation in&#xA0; &#xA0; &#xA0; &#xA0; &#xA0;human fetus. Eur Urol. 1975; 1(6): 282-286. &#xD;
&#xD;
10.Walker&#xA0; BE. Polyploidy and differentiation in the transitional epithelium of mouse urinary bladder. Chromo Soma 1957; 9:105: 1958. &#xD;
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12.Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West PH. Larsen&amp;#39;s Human Embryology. Development of urogenital system. Churchil livingst.&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; 2009; 4: 479-497.&#xD;
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&#xA0; 13.Matsuno T, Tokunaka S, Koyanagi T. Muscular development in the urinary tract. J Urol. 1984; 132(1):148-52. &#xD;
&#xD;
&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; 14.Oswald J, Brenner E, Deibl M, Fritsch H, Bartsch G, Radmayr C. Longitudinal and thickness measurement of the normal distal and intravesical&#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0; &#xA0;ureter in human foetuses. J Urol. 2003; 169:1501.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>To Assess Efficacy and Safety of 0.1% Tacrolimus Ophthalmic Ointment in Refractory Cases of VKC&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>154</FirstPage><LastPage>158</LastPage><AuthorList><Author>Agarwal P</Author><AuthorLanguage>English</AuthorLanguage><Author> Tayal SD</Author><AuthorLanguage>English</AuthorLanguage><Author> Gautum A</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Vernal kerato-conjunctivitis (VKC) is a chronic, bilateral allergic inflammation of the conjunctiva and cornea. For refractory cases, oral or subtarsal corticosteroids are indicated, immunotherapeutic agents like cyclosporine are also used. Recently Tacrolimus is used for the treatment of refractory VKC. It is an immunomodulator with more potency than cyclosporine. Aim &amp; Objective: To assess efficacy and safety of 0.1% tacrolimus ophthalmic ointment in refractory cases of VKC Material and Methods: Present study was a prospective study carried out on refractory cases of vernal kerato-conjunctivitis. Patients were divided into two groups. Group A Patients received Tacrolimus 0.1% ophthalmic ointment twice daily and anti-allergic medications and Group B patients received only allergic medication. Patients were followed up for up to 6 months. At every follow-up, symptoms and signs of both groups were compared. Results: Mean age of the patients in group A was 14.5&#xB1;2.4 years and in the group, B was 15.4&#xB1;3.1 years. Males predominated females in both groups. Patients with tacrolimus treatment showed a statistically significant decrease in symptom score and sign score over 6 months. (p</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Tacrolimus, Vernal kerato-conjunctivitis, Refractorycases, Steroid, Cyclosporine</Keywords><Fulltext>Introduction:&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
&#xD;
Vernal kerato-conjunctivitis (VKC) is a chronic, bilateral allergic inflammation of the conjunctiva and cornea. Prevalence of VKC is more in the 3-25 years age group with peak incidence at 11-13 years.1 Patient commonly present with itching, slight drooping of the upper lid, ropy discharge, photophobia and blurry vision.2Signs observed in VKC are cobblestone papillae on the upper tarsal conjunctiva, discrete or confluent papillary hypertrophy on limbal conjunctiva, white chalky appearing concretions, called Horner-Granta&amp;#39;s dots, corneal erosions and shield ulcer.3Histopathologically it is characterized by a dense inflammatory infiltrate consisting of eosinophils, lymphocytes, basophils, dendritic cells and macrophages within microvessel, outside microvessel and in the epithelium. Lymphocytes are aggregated to form follicles. 4&#xD;
&#xD;
Treatment modalities included measures to control inflammation. Various pharmacological agents used are topical steroids, mast cell stabilizers and topical Non-steroidal anti-inflammatory drugs.5Most of these treatments are ineffective in refractory VKC. Refractory VKC is defined as symptoms and signs that are persistent after conventional treatment. For refractory cases, oral or subtarsal corticosteroids are indicated, immunotherapeutic agents like cyclosporine are also used,6&#xA0; but chronic use of topical corticosteroids may increase intraocular pressure (IOP) and susceptibility to opportunistic infections. &#xD;
&#xD;
Novel treatment therapy for severe allergic ocular diseases with potent anti-inflammatory effects as well as sufficient safety is thus needed. Recently Tacrolimus is used for the treatment of refractory VKC. It is an immunomodulator with more potency than cyclosporine. It suppresses T-cell activation, T helper cell-mediated B-cell proliferation, and formation of cytokines, especially interleukin-2.7 In ophthalmology, tacrolimus has mainly been used to suppress immune reactions in corneal and limbal transplantations, uveitis, and allergic eye disease. 8-10&#xD;
&#xD;
The good safety profile of 0.1% tacrolimus ophthalmic suspension based on the low blood concentration of tacrolimus, coupled with demonstrated better efficacy, make it an important tool for treating severe allergic conjunctivitis. Therefore we chose 0.1% tacrolimus ointment in this study.&#xD;
&#xD;
Side effects noted in the use of tacrolimus ointment are burning sensation, activation of herpes simplex dendritic keratitis and development of molluscum contagiosum11,12.&#xD;
&#xD;
Material &amp; methods: Present study was a prospective study carried out to assess the efficacy of 0.1%tacrolimus ophthalmic ointment in refractory cases of VKC at the Department of Ophthalmology at Saraswathi Institute Of Medical Sciences. Patients were enrolled from November 19 to September 2020. The study population was refractory cases of vernal keratoconjunctivitis.&#xD;
&#xD;
Inclusion criteria: 1. Patients with VKC refractory to conventional treatment for 3 weeks 2. Patients willing to participate in the study&#xA0; and followup&#xD;
&#xD;
Exclusion criteria:&#xD;
&#xD;
&#xA0;1. Patients with trachoma 2. Patients with infectious diseases of eye 3. Patients with hypersensitivity to tacrolimus 4. Patients who had less than 6 months follow up 5.Systemic administration of immunosuppressants within 2 weeks before study.6.pregnant or lactating females7.patients with any cardiac, renal or hepatic disease or diabetes.&#xD;
&#xD;
This study was conducted in compliance with the Declaration of Helsinki. The study was approved by the ethical committee of the institute. A valid written consent was taken from patients after explaining the study to them. &#xD;
&#xD;
Total of 66 patients was included in the study. Out of 66 patients, 6 patients lost to follow up so data of 60 patients was included in the study. Patients were divided into two groups randomly. Group A patients received Tacrolimus0.1%( Talimus-Ajanta Pharmaceuticals, India ) twice daily and anti-allergic medications (sodium cromoglycate eye drop, ketotifen fumarate eye drop) and Group B patients received only antiallergic medications (sodium cromoglicate eye drop, ketotifen fumarate eye drop). All participants were followed up for 6 months. &#xD;
&#xD;
&#xA0;At every follow-up, symptoms and signs of vernal keratoconjunctivitis were noted. Five symptoms ( itching, discharge, lacrimation, photophobia, foreign body sensation ) were scored (0 to3) depending on severity. Total score for symptoms(0 to 15)was noted at the initiation of treatment (Baseline),&#xA0; 2wk, at one month,3 month and six months. &#xD;
&#xD;
Slit-lamp examination findings were used to grade (0=none, 1=mild, 2=moderate and 3=severe) each of the eight clinical signs. Score range (0 to 24). (table 1). For each patient, the eye with a higher total score for clinical findings was selected for efficacy assessment. The reduction in total signs and symptoms scores (from baseline) was used as the determinant of efficacy.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
To assess the safety and side effects of the treatment, intraocular pressure, lens opacification, secondary infections, or other possible complications were assessed. Data were entered in an excel sheet and analysed by SPSS version 20. &#xD;
&#xD;
Results:&#xD;
&#xD;
In our study, we studied 60 patients. Group A patients received Tacrolimus 0.1%Ophthalmic ointment twice daily and anti-allergic medications(sodium cromoglycate eye drop, ketotifen fumarate eye drop). Group B patients received anti-allergic medications(sodium cromoglycate eye drop, ketotifen fumarate eye drop) only.&#xD;
&#xD;
&#xA0;In group A there were 18 males and 12 females and in group B there were 20 males and 10 females. Both the groups were comparable concerning age. The mean age of the patients in group A was 14.5&#xB1;2.4 years and in the group, B was 15.4&#xB1;3.1 years. The age of the patient ranged from 1 -27 years. &#xD;
&#xD;
Table 2 shows the comparison score of symptoms in group A and group B. Participants were followed at 2 weeks, 1 month, 3 months and 6 months. Symptom score ranged from 0-15. In the group, A mean score of symptoms at baseline was 10.56&#xB1;1.73. It decreased over follow up and was found to be 5.93&#xB1;0.78 (2 weeks), 4.23&#xB1;0.67 (1 month), 2.86&#xB1;0.68 (3 months) and 1.7&#xB1;0.65 (6 months). Thus in the group, A patients showed a significant decrease in symptom score over the follow-up period&#xD;
&#xD;
In Group B, the mean symptom score at baseline was 10.53&#xB1;1.67. At 2 weeks it was 8.73&#xB1;1.28. The score decreased to 7.93&#xB1;1.04 at 1 month, 7.13&#xB1;0.77 at 3 months and 6.8&#xB1;0.71 at 6 months. We observed decreased symptom score in Group B over follow up to 6 months. &#xD;
&#xD;
In the comparison of both the groups, we found patients in Group A showed a more significant decrease in symptom score as compared to Group B.Resuts were statistically significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3884</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3884</Fulltext></URLs><References>&#xD;
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	Kawashima H, Fujino Y, Mochizuki M. Effects of a new immunosuppressive agent, FK506, on experimental autoimmune uveoretinitis in rats. Invest Ophthalmol Vis Sci. 1988; 29(8): 1265&#x2013;1271.&#xD;
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	Iwamoto H, Yoshida H, Yoshida O, Fukushima A, Ueno H. Inhibitory effects of FK506 on the development of experimental allergic/immune-mediated blepharoconjunctivitis in Lewis rats by systemic but not by topical administration. Graefes Arch Clin Exp Ophth. 1999; 237(5):407&#x2013;414.&#xD;
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	ZribiH, Descamps V, Hoang-Xuan T, Crickx B, Doan S. Dramatic improvement of atopic keratoconjunctivitis after topical treatment with tacrolimus ointment restricted to the eyelids. J Eur Acad Dermatol Venereol. 2009; 23(4): 489&#x2013;490.&#xD;
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	M&#xFC;ller GG,&#xA0; Jos&#xE9; NK, Castro RS. Topical Tacrolimus 0.03% as Sole Therapy in Vernal Keratoconjunctivitis. Eye Contact Lens. 2014;40:79-83.&#xD;
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	Ebihara N. Blood level of tacrolimus in patients with severe allergic conjunctivitis treated by 0.1% tacrolimus ophthalmic suspension doi: 10.2332/allergolint.11-OA-0349.&#xA0;Epub 2012 Feb 25.&#xD;
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	Ohashi Y, Ebihara N, Fujishima H, Fukushima A, Kumagai N, Nakagawa Y et al. A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1% in severe allergic conjunctivitis. J Ocul Pharmacol Ther. 2010;26:165&#x2013;174.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Successful Outcome in a Case of Ruptured Rudimentary Horn Pregnancy&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>159</FirstPage><LastPage>161</LastPage><AuthorList><Author>Anupama Bahadur</Author><AuthorLanguage>English</AuthorLanguage><Author> Rajlaxmi Mundhra</Author><AuthorLanguage>English</AuthorLanguage><Author> Latika Chawla</Author><AuthorLanguage>English</AuthorLanguage><Author> Juhi Mishra</Author><AuthorLanguage>English</AuthorLanguage><Author>  Megha Ajmani</Author><AuthorLanguage>English</AuthorLanguage><Author> Jaya Chaturvedi</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Mullerian anomalies occur owing to developmental defect at various stages. They range from Mullerian agenesis to mild arcuate uterus. Lateral fusion defect results in the formation of the rudimentary horn of the uterus. Incidence of rudimentary horn pregnancy is known to occur in 1/100,000 and 1/140,000 pregnancy. Aims: To evaluate a case of the second trimester ruptured rudimentary horn pregnancy Methodology: A 23-year-old primigravida at 18 weeks 4 days gestation presented in shock with gross hemoperitoneum. Results: Prompt intervention with exploratory laparotomy with excision of the rudimentary horn with massive blood transfusion and ventilatory support was lifesaving. The patient conceived spontaneously 4 months of laparotomy and gave birth to a term male baby by caesarean section. Conclusion: Uterine anomalies though rare must be kept in differential diagnosis for any pregnant women presenting with shock and hemoperitoneum as early diagnosis and management can result in a better outcome.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Mullerian anomaly, Ruptured rudimentary horn pregnancy, Hemoperitoneum, Maternal collapse, Massive blood  transfusion</Keywords><Fulltext>INTRODUCTION &#xD;
&#xD;
Maldevelopment of Mullerian ducts occur at different stages like interruption during differentiation, migration, fusion, canalization of Mullerian ducts, and based on this, there can be a spectrum of anomalies.1 On one end remains Mullerian agenesis characterized by failure of development of ducts and at the other end lies arcuate uterus, which is a mild abnormality of canalization. Bicornuate uterus remains midway between these two extremes and is mainly a unification defect. Most patients remain asymptomatic but at times the rudimentary horn may contain a cavity with functional endometrium with the capacity to sustain a pregnancy. Rudimentary horn pregnancy is seen between 1/100,000 and 1/140,000 pregnancy.2&#xD;
&#xD;
The fate of this atypical pregnancy is mainly rupturing of the pregnant horn during the first or second trimester, resulting in intractable heavy bleeding, with the diagnosis being made intraoperative for maternal rescue.3,4 Literature search has shown that such women have a poor pregnancy outcome in form of abortion, preterm delivery, low birth weight or operative and caesarean delivery.5 The ultrasound diagnosis of a pregnancy in a malformed uterus remains a difficult task. Hysteroscopy and laparoscopy are the gold standard for the diagnosis of uterine anomalies and help differentiate bicornuate from the septate uterus. &#xD;
&#xD;
We herein present a case of a maternal near-miss survivor with a ruptured rudimentary horn pregnancy necessitating surgical management. She subsequently delivered a full-term healthy baby in her subsequent pregnancy.&#xD;
&#xD;
CASE REPORT:&#xD;
&#xD;
A 23-year-old primigravida at 18 weeks 4 days gestation with no previous antenatal check-ups presented with abdominal pain and distension. On general examination, she was severely anaemic (clinically 5-6 gm%), pulse rate of 110/minutes and blood pressure of 100/60 mm Hg. Bedside ultrasound revealed a live pregnancy corresponding to 13 weeks 1 day&#x2019;s gestation with the gross intraabdominal collection. Because of suspicion of hemoperitoneum with declining general condition (blood pressure of 70/40 mmHg and tachycardia of 130/minutes), immediate laparotomy was done with blood at hand. Intraoperatively, a unicornuate uterus with a ruptured right rudimentary horn was seen with the fetus lying in the abdominal cavity (Figure1). Approximately 3.5 litres of hemoperitoneum was drained (ESHRE/ESGE class U4a). Right uterine horn excision was done. Three units packed red cell transfusion and 4 units of fresh frozen plasma were transfused intraoperatively. She was kept in the Intensive care unit postoperatively wherein she required ventilatory support and inotropes on her first postoperative day. She received massive blood transfusion (7 units PRBC&#x2019;s, 4 RDPs and 9 cryoprecipitates) during the recovery period. Postoperatively, she developed lung consolidation with pleural effusion necessitating pleural tapping. She also underwent six serial hemodialyses for acute renal injury. With a multidisciplinary team approach, the patient recovered and was discharged in a stable condition on a post-operative day 30. She received psychological counselling and was advised to delay the next conception. Histopathology report of the specimen confirmed uterine horn within normal histological limits. The patient was lost to follow up. She conceived spontaneously 4 months after laparotomy. She underwent irregular antenatal care at a nearby health care centre. The antenatal period was uneventful. She delivered a healthy male child at 38 weeks gestation by caesarean section. On day 3 of caesarean delivery, she developed shortness of breath and anasarca. She was referred to our hospital in a state of shock and altered sensorium. Arterial blood gas analysis showed severe metabolic acidosis. Immediate intubation was done and started on ionotropic support. She was identified to have acute kidney injury and underwent hemodialysis. SARS CoV 19 test was negative. With serial hemodialysis and broad-spectrum antibiotics, she was finally discharged in stable condition.&#xD;
&#xD;
DISCUSSION: &#xD;
&#xD;
Mullerian anomalies are diagnosed in 6.3% and 3.8% of infertile &amp; fertile women as compared to sterile (2.4%) ones.6&#xD;
&#xD;
Unicornuate uterus accounts for 5&#x2013;13% of Mullerian duct anomalies with the presence of a rudimentary horn in 74&#x2013;90% of cases.7,8&#xD;
&#xD;
&#xA0;Approximately 25% of these horns have a functional endometrium in their cavity and does not communicate with the main cavity of the contralateral Hemi-uterus (ESHRE/ESGE class U4 or ASRM class II b). The rudimentary horn is preferentially situated on right (62%).3&#xD;
&#xD;
The risk of spontaneous rupture of anomalous uteri is seen in the first trimester but the cause remains unexplained. Literature search shows that there is an abnormal vascular network between these 2 Hemi-cavities of bicornuate uteri, at the level of the midline.9 Weakening of the uterine wall, particularly at the level of the fundus may be a possible hypothesis predisposing to spontaneous rupture.&#xD;
&#xD;
Sonographic diagnosis of this malformation is a real challenge owing to the limited field of view as compared to other diagnostic imaging modalities and lateral deviation of the rudimentary horn.10 Many times, the diagnosis is made intraoperatively because of suspected hemoperitoneum in early pregnancy.4&#xD;
&#xD;
Surgery remains the treatment of choice for ruptured rudimentary horn pregnancy. Prompt diagnosis and early surgical intervention is the mainstay of therapy.&#xA0; If fertility has to be preserved, excision of rudimentary horn with ipsilateral salpingectomy remains the recommended surgery. With advancements in minimally invasive surgery, laparoscopy is safe and effective, particularly in early unruptured cases. In the above case, because of a large gravid uterus and significant bleeding, the decision of exploratory laparotomy was made. &#xD;
&#xD;
The subsequent obstetric prognosis seems reassuring. Diagnostic imaging of the reproductive system after this treatment has shown no negative effect of surgery on future fertility with no reported cases of the ruptured uterus during subsequent pregnancy in the remaining unicornuate uterus after rudimentary horn excision.11&#xD;
&#xD;
To date, several studies have evaluated reproductive outcomes in women with congenital Mullerian duct anomalies. However, evidence from well-controlled studies is lacking on the risk of rupture uterus before or during labour after excision of the rudimentary horn. Though this risk is rare, obstetricians should always prognosticate their patients about maternal and fetal complications. It has been reviewed that unicornuate uterus has 2.7% ectopic pregnancy, 24.3% first-trimester abortion, 9.7% second-trimester abortion, 20.1% preterm birth, 3.8 % intrauterine fetal demise and 51.5% live birth.12&#xD;
&#xD;
An association of birth defects in fetuses born to mother with congenital uterine malformations have been reported. These defects may due to reduced uterine volumes, which leads to insufficient space for a&#xA0;developing fetus to undergo proper growth, while mechanical pressure impacts the growing fetal structures. Martinez et al. demonstrated that birth defect(s) were 4&#xA0;times higher among babies born to mothers with uterine defects than in women without such defect. The risk was found to be statistically significant for nasal hypoplasia, omphalocele, limb deficiencies, teratomas, and acardia-anencephaly.13 Zyla et al. in their study found that the most frequent defects were clubfoot and other defects of the limbs.5 No such defect was seen in our case.&#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
Uterine anomalies though rare must always be considered in early pregnant lady presenting with hemoperitoneum. Timely diagnosis and proper management not only save the patient in the current pregnancy but also increases the chance of a successful future pregnancy.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.&#xA0;The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Conflict of interest: No conflict of interest exists for this article.&#xD;
&#xD;
Source of Funding: No funding was required for this article.&#xD;
&#xD;
Author contributions:&#xD;
&#xD;
Anupama Bahadur &amp; Rajlaxmi Mundhra: Main surgeons, Concept, design, analysis, interpretation, literature search and writing&#xD;
&#xD;
Latika Chawla: Check draft, analysis&#xD;
&#xD;
Juhi Mishra. Megha Ajmani: literature search, writing the first draft&#xD;
&#xD;
Jaya Chaturvedi: Draft check and analysis&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3885</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3885</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Identifying Risk Factors for Temporomandibular Disorders (TMD)&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>162</FirstPage><LastPage>167</LastPage><AuthorList><Author>Rohit B Gadda</Author><AuthorLanguage>English</AuthorLanguage><Author> Keerthilatha M Pai</Author><AuthorLanguage>English</AuthorLanguage><Author> Yogesh Chhaparwal</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies Aim: To identify risk factors for painful TMD among the Indian population presenting to the dental outpatient. Methodology: Subjects with Painful TMD were classified into one of the following three groups: Group 1 (n=24): myofascial pain only, Group 2 (n=38): arthralgia only and Group 3 (n=41): myofascial pain and arthralgia. Forty-one subjects were included in the asymptomatic control group. Adjusted odds ratios (OR) were calculated from multiple logistic regression models that included the relevant risk factors. Results: Increased risk of myofascial pain with arthralgia was significantly associated with clenching (OR: 7.9, CI: 2.1-30), trauma (OR: 12.3, CI: 2.1-69.9), third molar extraction (OR: 3.7, CI: 1.1-12.6), and nonspecific physical symptoms (NPS) with pain (OR: 8.1, CI: 1.8-35.4). Increased risk of myofascial pain only was associated with clenching (OR: 5.5, CI: 1.3-23.3), trauma (OR: 13.2, CI: 2.2-77.5), and NPS with pain (OR: 6, CI: 1.3-26.7). Increased risk of arthralgia only was associated with trauma (OR: 9, CI: 1.8-45.4). Conclusion: A high proportion of subjects with painful TMD reported having clenching, trauma, NPS with and without pain, and depression.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>. Key Words: Temporomandibular disorders, Risk factors, Myofascial pain, Arthralgia, Clenching</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
Temporomandibular disorder (TMD) is a collective term embracing several clinical problems that involve the masticatory musculature, the temporomandibular joint and associated structures, or both. Signs and symptoms of TMD have a higher incidence in the general population (20&#x2013;75%) than the proportion of the population who present for treatment (2&#x2013;4%).1&#xD;
&#xD;
Painful TMDs are classified into the Myofascial pain group and Arthralgia group according to Research Diagnostic Criteria for TMD (RDC/TMD).2,3, 4 The aetiology of TMD remains unclear, but it is likely to be multi-factorial. Five major factors associated with TMD are occlusal factors, trauma, emotional stress, deep pain input and parafunctional activities, but these have been the subject of much debate. &#xD;
&#xD;
G J Huang et al.2 investigated risk factors for three diagnostic subgroups of painful TMD in Washington. Their study consisted of 97 subjects with myofascial pain only, 20 with arthralgia only, 157 with both myofascial pain and arthralgia, and 195 controls without painful TMD. Trauma, clenching, third molar removal, somatization, and female gender were identified as risk factors for subjects with myofascial pain as well as for subjects with concurrent myofascial pain and arthralgia. Analysis of various risk factors associated with subgroups of TMD has been carried out in various studies mostly in the western population. Several studies have categorized painful TMD into subgroups like myofascial pain, arthralgia and concurrent myofascial pain and arthralgia.2, 5-8&#xD;
&#xD;
Since TMD is a common complaint of patients attending dental outpatients, knowledge of risk factors is useful in the management of the condition. Thus, this study aimed to investigate risk factors for the diagnostic subgroups of painful TMD among the Indian population presenting to the dental outpatient. The objectives of the study were to determine the prevalence of various subgroups of painful TMD, to describe the demographic characteristics of patients with painful TMD, to describe various risk factors associated with painful TMD, and to identify risk factors that are more frequently associated with painful TMD.&#xD;
&#xD;
SUBJECTS AND METHODS&#xD;
&#xD;
This study was carried out in the department of Oral Medicine and Radiology, of a dental hospital. Approval to carry out this study was obtained from Institutional Ethics Committee (Letter No.: IEC 146/2008). All subjects in this study were recruited from the dental outpatient department and enrolled for the study after obtaining informed consent. A total of 14,287 patients visiting dental outpatient was screened and those reporting pain in the jaw muscles or the joint in front of the ear or inside the ear (other than ear infection) were enrolled as cases (n=103) after satisfying the inclusion and exclusion criteria. Concurrent controls (n=41) were selected from the same outpatient department. They may have come to the dental clinic for a variety of reasons including cavities, periodontal disease or preventive maintenance, but with no pain in the jaw muscles, temporomandibular joint (TMJ), or inside the ear. Inclusion criteria for cases were patients with pain in the jaw muscles, the joint in front of the ear or inside the ear (other than ear infection) and patients who agree to sign informed consent. Exclusion criteria for cases were the presence of polyarthritis or another rheumatic disease, patient with trauma to jaws with clinical suspicion of jaw fracture, patients with a previous history of temporomandibular joint surgery, patients having pain in the jaw muscles or TMJ region attributed to pathology other than TMD. &#xD;
&#xD;
All subjects underwent an interview using a standard history questionnaire form (modified from RDC/TMD) by a trained examiner. Information on risk factors was obtained by asking questions that required dichotomous answers (Yes/No) as follows: History of Parafunctional activity like clenching or grinding of teeth, Facial trauma with no jaw fracture, Recent dental treatment, Third molar removal, Orthodontic treatment, and Unilateral chewing. Patients were asked to report subjectively whether they consider themselves as being stressed all the time, most of the time, sometimes, rarely, or never. The psychosocial assessment was carried out by administering a scale of SCL-90 as described in the RDC/TMD. Depression, nonspecific physical symptoms (NPS) with pain items included and NPS with pain items excluded were measured. &#xD;
&#xD;
EXAMINATION&#xD;
&#xD;
All subjects underwent detailed TMJ &amp; intraoral examination. Examiner calibrated his finger pressure for palpation of joint and muscles using a pressure algometer. The standardized pressure recommended by RDC/TMD was followed. TMJ examination was carried out according to specification by RDC/TMD. Intraoral examination was performed to note details of missing teeth, root remnants and molar relation. The occlusal condition was classified using Eichner&#x2019;s index. &#xD;
&#xD;
Depending on the data collected, cases were classified into three groups of painful TMD, based on the RDC/TMD:&#xA0; Group 1: One with myofascial pain only. (n=24), Group 2: One with arthralgia only (n=38), Group 3: One with both myofascial pain and arthralgia (n=41). Asymptomatic controls were assigned to group 4 (n=41). &#xD;
&#xD;
The second trained examiner carried out the standard TMJ examination for 10 painful TMD cases which were already examined by the first examiner. She classified the cases into three groups without prior knowledge of the first examiner&#x2019;s findings. Inter-observer variation was assessed for these 10 subjects.&#xA0; &#xD;
&#xD;
STATISTICAL METHODS &#xD;
&#xD;
The SPSS statistical package for Windows, version 11.5, was used for the analysis of the data. Variables like NPS with and without pain, depression and stress were dichotomized (Yes/No, &#x2018;Yes&#x2019; is a moderate and severe level of NPS with &amp; without pain, depression, and presence of stress, whereas &#x2018;No&#x2019; is the normal level of NPS with &amp; without pain, depression, and absence of stress). The occlusal condition was dichotomized as &#x2018;Eichner&#x2019;s class A&#x2019; and &#x2018;Eichner&#x2019;s class B &amp; C&#x2019;. One way ANOVA was used to check any difference in age between all groups. The Chi-square test was used to analyze any difference between groups with gender, education, marital status, and various risk factors. The p value of less than 0.05 was considered to be statistically significant. Association between study groups and risk factors was expressed using an unadjusted odds ratio (OR) and a 95% confidence interval (CI). If 95% CI includes one, then the odds ratio is not significant. Adjusted odds ratios (OR) were calculated from multiple logistic regression models that included the relevant risk factors. &#xD;
&#xD;
RESULTS &#xD;
&#xD;
A total of 14,287 subjects reporting to a dental outpatient section of MCODS, Manipal was screened for painful TMD, 103 subjects were diagnosed as having painful TMD. The prevalence of painful TMD among the patients visiting the dental outpatient department during one year was 0.72%.&#xA0; Subjects with Painful TMD were classified into one of the following three groups: Group 1 (n=24, 23.3%): Subjects with myofascial pain only, Group 2 (n=38, 36.9 %): Subjects with arthralgia only and Group 3 (n=41, 39.8%): Subjects with both myofascial pain and arthralgia. Forty-one subjects were included in the asymptomatic control group (group 4). &#xD;
&#xD;
There was no statistically significant difference in the age, gender and marital status of subjects in the four groups (p&gt; 0.05). The high proportion of subjects with painful TMD had education below elementary school (p &lt; 0.05) (Table 1). Table 2 shows the per cent distribution of risk factors in all four groups. A high proportion of subjects with myofascial pain (with or without arthralgia) reported clenching, facial trauma, third molar removal, NPS with and without pain, and depression.&#xD;
&#xD;
Table 3 shows the adjusted odds ratio for relevant risk factors. In multivariate analysis with simultaneous adjustment for the presence of risk factor, increased risk of myofascial pain with arthralgia was associated with clenching, trauma, third molar extraction, and NPS with pain. Increased risk of myofascial pain only was associated with clenching, trauma, and NPS with pain. Increased risk of arthralgia only was associated with trauma. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
TMD-related pain is a less common symptom with prevalence estimates in the region of 10&#x2013;15% worldwide.9 However; pain is the major reason that people seek professional care for TMD. Patients seeking treatment for TMD-related conditions, notably jaw pain and functional disability, represent a small proportion (around 2%) of the general population.10,11,12&#xA0; Hence our study considers only painful TMD. &#xD;
&#xD;
The present study was an attempt to determine the prevalence of various subgroups of painful TMD among the patients visiting dental outpatient; and to investigate various risk factors associated with diagnostic subgroups of painful TMD, distinguishing between muscular (myofascial) pain and joint pain (arthralgia). &#xD;
&#xD;
The prevalence of painful TMD among the patients visiting the dental outpatient department for one year was 0.72%. It was relatively low as compared to previous studies.10-13&#xA0; This could be attributed to only painful TMD being considered in our study. Also, our study was a single centre study and this centre was an oral medicine speciality clinic and not a TMD pain speciality clinic like in other studies.13,14&#xD;
&#xD;
There was a higher prevalence of myofascial pain (63.1%) in our study. The most common type of TMD was muscle disorders and agrees with studies in other Western and Asian patient groups.13,15-17Painful TMD groups and controls were similar concerning gender. Results of European, US studies and Asian study12,18&#xA0;&#xA0; have shown a significant difference between TMD prevalence in male subjects compared with female subjects.&#xD;
&#xD;
In our study, we did not try to differentiate between clenching and grinding, and a self-report of this habit was noted. A high proportion of subjects with painful TMD reported the presence of a clenching habit. There was an increased risk of myofascial pain only and myofascial pain with arthralgia associated with clenching. These findings were seen in studies by Huang GJ et al.2 and Velly AM et al.19 When the muscles are voluntarily contracted for longer periods, the muscle ?bers start to present fatigue. Muscle fatigue is considered to be one of the causes of pain associated with TMD. The hypothesis of the vicious cycle of cyclic muscle pain helps to explain the association between clenching and myofascial pain.&#xD;
&#xD;
In our study, a high proportion of subjects with painful TMD reported a history of trauma. This finding of trauma as a risk factor for painful TMD was consistent with that of a study by Huang GJ et al.2 but they did not find any significant association for the arthralgia only group. Velly AM et al.19 concluded that trauma may contribute to myofascial pain. Pullinger20 found that a history of trauma was reported by more than 50% of subjects with disc displacement, or myalgia only. &#xD;
&#xD;
In our study, third molar extraction caused a significantly increased risk of myofascial pain with arthralgia. This finding was similar to that seen in the study by Huang GJ et al.3 (2002) but they also found third molar removal as risk factors for subjects with myofascial pain only. We did not attempt to assess the temporal relationship between third molar removal and painful TMD. A prospective design would allow for a more definitive assessment of this risk factor. &#xD;
&#xD;
In our study, there was no significant association seen between TMD and orthodontic treatment. Similar findings were observed in previous studies.2,21&#xD;
&#xD;
Literature data on TMD supports the existence of an association with several psychosocial disorders, such as anxiety, depression and somatization disorders.22&#xA0; There is increasing evidence that the complex relationship between psychopathology and TMD could depend upon the presence of painful TMD conditions and not upon the location of the disorder.13&#xA0;&#xA0; In our study, there was an increased risk of myofascial pain only and myofascial pain with arthralgia associated with NPS with pain. These findings of our study were similar to several studies that have categorized TMD into subgroups similar to those in our study. These studies examined psychological differences between subgroups2,5-8 and generally indicated that patients with myogenic diagnoses had more pain and distress than those with joint-related diagnoses. The psychological distress leads to parafunctional activities (tooth clenching and grinding) that results in muscle pain.23&#xD;
&#xD;
In our study, the presence of Eichner&#x2019;s Class B &amp; C occlusal condition caused a significantly increased risk of myofascial pain with arthralgia. This finding was similar to that seen in the study by Takayama Y et al.24&#xA0; We did not find any association of unilateral chewing and TMD, in contrast to observation by Diernberger S et al. 25 &#xD;
&#xD;
Inter-observer variation was assessed for 10 subjects. Diagnosis using RDC/TMD and classification in the case of a group, by both the examiners were correlated perfectly for 9 out of 10 subjects. John MT et al.26 concluded that the RDC/TMD demonstrated sufficiently high reliability for the most common TMD diagnoses, supporting its use in clinical research and decision making.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The prevalence of painful TMD among the patients visiting dental outpatients for one year was 0.72%. There was a higher prevalence of myofascial pain (63.1%) in the study groups. A high proportion of subjects with painful TMD reported having clenching, trauma, NPS with and without pain, and depression. Increased risk of myofascial pain only was associated with clenching, trauma, and NPS with pain. Increased risk of arthralgia only was associated with trauma. Increased risk of myofascial pain with arthralgia was associated with clenching, trauma, third molar extraction, and NPS with pain.&#xD;
&#xD;
Our study had several strengths, including the reliable, criterion-based (RDC/TMD) examination of all subjects; and adjustment for potentially confounding variables. The number of subjects in the study was small and they were from a single centre. Hence, the results of this study cannot be generalized and studies with larger numbers of subjects are needed.&#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 and source of funding: Nil&#xD;
&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3886</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3886</Fulltext></URLs><References>&#xD;
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	Diernberger S, Bernhardt O, Schwahn C &amp; Kordass B. Self-reported chewing side preference and its associations with occlusal, temporomandibular and prosthodontic factors: results from the population-based Study of Health in Pomerania (SHIP-0).&#xA0;&#xA0;&#xA0; J Oral Rehabil. 2008;35:613-20.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effect of Cartoon Animation Movie on Level of Pain During Intravenous Cannulation Among Children&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>175</FirstPage><LastPage>183</LastPage><AuthorList><Author>Thakur P</Author><AuthorLanguage>English</AuthorLanguage><Author> Deol R</Author><AuthorLanguage>English</AuthorLanguage><Author> Kaur N</Author><AuthorLanguage>English</AuthorLanguage><Author> Bains HS</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment. Painful medical procedures such as immunizations and intravenous cannulation done in hospitals comprise a significant portion of the average child&#x2019;s experience with painful events. Inadequate relief from pain during childhood may have long term negative effects on future pain tolerance and pain response. Objective: To assess the effect of cartoon animation movie on the level of pain during intravenous cannulation among hospitalized children. Methodology: An experimental research design was used to assess the effect of cartoon animation movie on the level of pain during IV cannulation in 100 children of 2-7 years of age selected by convenience sampling. Results: The mean pain score during IV cannulation in the experimental group was lower (02.52 &#xB1; 03.37) than the control group (04.9 &#xB1;0 3.03) and this difference was statistically significant (p0.05). At three minutes after the IV cannulation procedure, the mean pain score in the experimental group was 0.00&#xB1;0.00 while in the control group was 02.43 &#xB1; 02.50 (p&gt;0.05). Conclusion: Cartoon animation movie significantly reduces the level of intravenous cannulation procedural pain in children in the experimental group as compared to the control group.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Cartoon animation movie, Level of pain, Intravenous cannulation, Hospitalized children, FLACC scale</Keywords><Fulltext>Introduction&#xD;
&#xD;
The word pain is derived from the Latin word &#x201C;poena&#x201D; which means punishment, which in turn is derived from the Sanskrit word &#x201C;pu&#x201D; meaning purification.1&#xA0; The International Association for Study of Pain defines it as, &#x201C;An unpleasant sensory and emotional experience associated with actual or potential tissue damage&#x201D;.3 Perception of pain among children is complex and entails physiological, psychological, behavioural and developmental factors. It has been seen that children, who experience pain in early life, show long term changes in terms of pain perception and related behaviour.4&#xD;
&#xD;
&#xA0;It has been seen that children as compared to adults are more vulnerable to pain-related complications. They suffer more because of their lower pain threshold, sensitization from repeated pain and immature systems for maintaining homeostasis. Repeated painful procedures among them may affect the long term neurobehavioral outcome.5&#xD;
&#xD;
Intravenous cannulation is one of the most common procedures among hospitalized children that always causes moderate and severe pain among them. It also creates lots of anxiety and fear. The anticipation of pain during intravenous cannulation is generally underestimated and unappreciated. So to reduce the level of pain during cannulation procedures, some institutions have procedures for minimizing it by using certain kind of interventions.6&#xD;
&#xD;
Distraction (such as cartoon animation movie) is one of the most frequently used non-pharmacological intervention to guide children&#x2019;s attention away from painful stimuli and reduce anxiety related to pain. It is most effective when adapted according to the developmental level of the child. Distraction techniques are often provided by nurses in hospitals. Current research has shown that distraction can lead to reducing in procedure times and the number of staff required for the procedure. &#xD;
&#xD;
It had been observed that no intervention was being used in the study setting to alleviate the intravenous cannulation related pain in children. So children show temper tantrum, making excuses to get rid of this painful procedure and cry a lot to avoid or postpone the procedure. This resulted in an increased level of anxiety among both parents and children.&#xD;
&#xD;
Hence, the researchers planned to assess the effect of a cartoon animation movie to alleviate the level of pain during intravenous cannulation. This in turn may provide benefits to the children, their parents and decrease the fear of pain during intravenous cannulation in children.&#xD;
&#xD;
Material and Methods&#xD;
&#xD;
An&#xA0; experimental research design was used to assess the effect of cartoon animation movie on the level of pain during intravenous cannulation among all children (2-7 years) admitted in paediatric wards of DMC &amp; Hospital, Ludhiana Punjab.&#xD;
The independent variable i.e. cartoon animation movie was shown to the experimental group before, during and after intravenous cannulation and withheld in the control group.&#xD;
&#xD;
A total of 100 hospitalized children admitted in selected paediatric units were selected by convenience sampling technique as the study sample. Random assignment of subjects into experimental group and control group was done by lottery method. Out of 100 hospitalized children, 50 children were taken in the experimental group (shown cartoon animation movie 3 minutes before, during and till 3 minutes after intravenous cannulation procedure) and the remaining 50 were taken in the control group (routine intravenous cannulation procedure) as per the slips picked by children. The tool for data collection was divided into the following two parts:&#xD;
&#xD;
Part A (I): Socio demographic profile of child&#xD;
&#xD;
Part A (II): Clinical profile of the child&#xD;
&#xD;
Part B: FLACC- Behavioral Pain Assessment scale (Terri Voepel Lewis)&#xD;
&#xD;
&#xD;
&#xD;
Table 1 shows the criterion measure for the assessment of pain. The reliability of the tool was found to be 0.87. The study was done after appraisal from the ethical committee of Dayanand Medical College &amp; Hospital (DMCH), Ludhiana, Punjab. Written permission was taken from the Principal, College of Nursing and Head of Department of Paediatrics, DMC &amp; Hospital, Ludhiana. Informed written consent was taken from parents of the hospitalized children for participation in a research study during the intravenous cannulation procedure.&#xD;
&#xD;
&#xA0;Analysis of data was done following the objectives of the study. Both descriptive and inferential statistics were used for analysis. Calculations were carried out manually with the calculator and with the help of Microsoft Excel and SPSS (Statistical Package for Social Sciences) version 16 and Smith&#x2019;s Statistical Package.&#xD;
&#xD;
Results&#xD;
&#xD;
Sample demographics&#xD;
&#xD;
A total of 100 samples participated in the study as summarised in Table 2. It depicts that 74% of children from the experimental group and 76% from the control group belonged to 6-7 years of age, 80% from the experimental group and 74% from the control group were males, 72% from the experimental group and 64% from control group belonged to Hindu religion, 44% of informers from the experimental group were fathers and 32% from the control group were mothers and 78% from the experimental group and 68% from the control group were a firstborn child in the family.&#xD;
&#xD;
Table 3 shows the distribution of children as per educational, occupational and socio-economic status of parents.50% of fathers from the experimental group and 56 % from the control group were graduate and above.52% of mothers from the experimental group and 50% from the control group had secondary level of education. The majority of fathers i.e. 98% from the experimental group and 96% from the control group were working,74% of mothers from the experimental group and 82 % from the control group were non-working, 56% of parents from the experimental group and 50% from control group belonged to the upper middle class (II).&#xD;
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Table 4 depicts the distribution of children as per their clinical profile. it depicts that majority of children&#xA0; 98% from the experimental group and 92% from the control group had thalassemia,94% from the experimental group and 90% from the control group were admitted to the thalassemia ward and 98% from the experimental group and 90% from the control group were admitted in the hospital for one day only.&#xD;
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Table 5 depicts the distribution of children as per IV cannulation related data. It depicts that 100% cannulation in the experimental group and 98% from the control group was done by staff nurses, 58% of health personnel from the experimental group and 48% from the control group had 10-13 years of experience,100% of children from the experimental group and 98% from the control group had the previous history of IV cannulation procedure more than three times94%&#xA0; of children from the experimental group and 96% from the control group were cannulated on hand( dorsal and metacarpal vein), 74% children from the experimental group and 80% from control group received cannulation from 24 gauze needle.&#xD;
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Table 6 depicts the level of pain among children in the experimental group. It depicts that 100 % of children experienced no pain before IV cannulation procedure, during IV cannulation procedure, 44% experienced no pain, 28% mild pain, 12 % moderate pain and 16 % experienced severe pain, at one minute after IV cannulation procedure, 94% children experienced no pain and 6% experienced mild pain and at 3 minutes after IV cannulation procedure, all the children i.e. 100% experienced no pain.&#xD;
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Table 7 depicts the level of pain among children in the control group. It depicts that all the children 100% had no pain before IV cannulation procedure, mild pain during IV cannulation were experienced by 40% of children, moderate pain was experienced by 26% and severe pain was experienced by 34% of children, at one minute after IV cannulation mild pain was experienced by 38% children, and severe pain was experienced by 6 % children, no pain was experienced by 56% children, at three minutes after IV cannulation procedure, 10% children experienced mild pain, 2% experienced moderate pain and 4% experienced severe pain, majority of children 84% experienced no pain at three minutes duration.&#xA0;&#xD;
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Figure 1 reveals that during the IV cannulation procedure 44% of children in the experimental group experienced no pain as compared to 0% in the control group. A mild level of pain was experienced by 28% of children in the experimental group and 40% in the control group. Moderate level of pain was experienced by12% of children in the experimental group and 26% in the control group. Severe pain was experienced by only 16% of children in the experimental group as compared to 34% of children in the control group during the IV cannulation procedure.&#xD;
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Figure 2 depicts the comparison of the level of pain among children in the experimental and control group at one minute after the IV cannulation procedure.&#xA0; At one minute after the IV cannulation procedure, no pain was experienced among 94% of children in the experimental and 56% of children in the control group. A mild level of pain was experienced by 38% of children in the control group as compared to only 06% in the experimental group. 06% of children in the control group and none of the children 0% in the experimental group experienced severe pain at one minute after the IV cannulation procedure.&#xD;
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Figure 3 illustrates the comparison of the level of pain among children at three minutes after the IV cannulation procedure in the experimental and control group. It shows that 100% of children in the experimental group and 84% in the control group experienced no pain. Only 10% of children experienced mild pain in the control group. 02% of children in the control group experienced moderate pain and 02% experienced severe pain at three minutes after the IV cannulation procedure. None of the children in the experimental group experienced mild, moderate and severe pain at 3 minutes after the IV cannulation procedure.&#xD;
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Table 8 shows the comparison of the level of pain among children in the experimental and control group. It shows that during the IV cannulation procedure 44% of children from the experimental group experienced no pain as compared to none of the children in the control group. A mild level of pain was experienced by 28% of children in the experimental group as compared to 40% in the control group. A moderate level of pain was experienced by 12% of children from the experimental group as compared to 26% from the control group. A severe level of pain was experienced by 16% of children from the experimental group as compared to 74% from the control group. &#xD;
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Table 9 shows the comparison of mean intravenous cannulation procedure scores among children in the experimental and control group. The mean pain score &amp; mean % during IV cannulation in the experimental group was lower (02.52&#xB1;3.37, 25.2%) than the control group (04.9&#xB1;3.03, 49%) and this difference was statistically significant (p=0.0003).&#xA0; At one minute after the IV cannulation procedure, the mean pain score &amp; mean % in the experimental group was lower (01&#xB1;0.00, 10%) than the control group (02.5&#xB1;2.43, 25%) (p&gt;0.05).&#xA0; At three minutes after IV cannulation procedure, the mean pain score &amp; mean % &#xA0;in experimental group was lower (0&#xB1;0.00, 0%) than control group (02.43&#xB1;2.50, 24.3%) (p&gt;0.05).&#xD;
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Table 10 depicts the association of level of pain among children with selected socio-demographic and clinical variables in the experimental and control group. A statistically significant association was found between age and pain scores (p=0.01) in the experimental group. Children in the younger age group like 2-3 years had higher mean pain scores (10&#xB1;0.00) as compared to older children. (6-7 years had a mean score of 01.54&#xB1;02.19).&#xD;
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Discussion&#xD;
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The present study depicts that the baseline level of pain among all children in the experimental and control group was zero and was assessed three minutes before the IV cannulation procedure by using FLACC behavioural pain assessment scale by Terri Voepel-Lewis in 2010. The study findings are also supported by Downey AVL, Zun SL who conducted a randomized control trial among 82 children in the department of Roosevelt hospital, Chicago. The baseline level of pain among all children was zero and assessed five minutes before the procedure using Poker Chip Tool and Faces Scale in 2009.8&#xD;
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The present study depicts that the mean pain score during IV cannulation in the experimental group was lower (02.52&#xB1;03.37) than the control group (04.09&#xB1;03.03) and this difference was statistically significant (p</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3887</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3887</Fulltext></URLs><References>&#xD;
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	Smeltzer. C. Smeltzer, Brunner&#x2019;s and Suddarth&#x2019;s. Textbook of Medical-Surgical Nursing: definition of pain.10th ed. Philadelphia: Lippincott Williams and Wilkins. 2004; 789-92. &#xD;
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	Henson John. Pain terms with definitions and notes on usage&#x2013; Recommended by the ISAP Sub-committee on Taxonomy. Pain 1989; 17(9):239. &#xD;
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	Hockenberry JM &amp; Wilson D. Wong&#x2019;s Essentials of Pediatric Nursing. 9th ed. Mosby Elsevier; 2009; 159-171.&#xD;
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	Linhares MBM, Doca FNP, Martinez FE, Carlotti APP, Cassiano&#xA0; RGM et al. Pediatric pain: prevalence, assessment and management in a teaching hospital. Braz J Med Biol Res. 2012; 45(12):1287-129&#xD;
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	Potter AP, Perry GA. Fundamental of nursing. 6th ed. Elseiver. 2007; 28-37. &#xD;
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	Sparks L. Taking the "ouch" out of injections for children. Using distraction to decrease pain. Am J Matern Child Nurs. 2001; 26(2):72-78.&#xD;
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	Cerne D, Sannino L, Peter M. A randomized controlled trial examining the effectiveness of cartoons as a distraction technique. Nurs Child Young Peo. 2015; 27(3):28-33.&#xD;
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	Downey AVL, Zun SL. The impact of watching cartoons for distraction during painful procedures in the emergency department. Pediatr Emerg Care. 2012; 28(10):1033-1035.&#xD;
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	Bagnasco A, Pezzi E, Rosa F, Fornoni I &amp; Sasso I. Distraction techniques in children during IV cannulation: an Italian experience The nurses&#x2019; point of view. J Prev Med Hyg. 2012: 3(3):44-53.&#xD;
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	James J, Ghai S, Rao KL, Sharma N. Effectiveness of animated cartoons as a distraction strategy on the behavioral response to pain perception among children undergoing IV cannulation, Chandigarh. Nsg and Mid Res J. 2013; 23(7):198-209. &#xD;
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	Bagnasco A, Pezzi E, Rosa F, Fornoni I &amp; Sasso I. Distraction techniques in children during IV cannulation: an Italian experience The nurses&#x2019; point of view. J Prev Med Hyg. 2012; 3(3):44-53 .&#xD;
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	Talwar R, Yadav A, Deol R, Kaur J. Efficacy of distraction technique in reducing pain among children receiving the vaccination. Int J Cur Res Rev. 2014; 6(19): 42-46.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Cross-Sectional Study on Brain Lesions Diagnosed Through Magnetic Resonance Spectroscopy in Patients from South Kerala&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>184</FirstPage><LastPage>189</LastPage><AuthorList><Author>Smitha H</Author><AuthorLanguage>English</AuthorLanguage><Author> Meena Devi V N</Author><AuthorLanguage>English</AuthorLanguage><Author> Jacob Vinoo</Author><AuthorLanguage>English</AuthorLanguage><Author> Sreekanth K S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: A hospital-based study is conducted to find out the frequency, types, and aetiology and gender differences in brain lesions in patients diagnosed through Magnetic Resonance Spectroscopy (MRS) from South Kerala. Objectives: The study aims to assess the socio-demographic characteristics with the increasing incidence of brain lesions in patients attending a tertiary care hospital in South Kerala. Materials and Methods: In this study, there were 81 patients, both males and females, who underwent MRS for the diagnosis of brain lesions and studied for their socio-demographic characteristics which were recorded and compared. Results: The present study revealed that brain lesions were more common in males (57%) as compared to females (43%) (46:35). The frequency of brain lesions was higher in the middle aged group (52%) when compared to the younger age (6%) and old age group (42%). It is found that out of the 81cases, Meningioma is the most common types of brain lesions and also found that the symptoms are well correlating with clinical conditions as indicators for intervention. Conclusion: The analysis of the study indicates the need for special attention of such patients who come with early symptoms suggestive of brain lesions for the correct diagnosis through MRS and for further treatments.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Age, Gender, Headache, Meningioma, Magnetic resonance spectroscopy, Vomiting</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
There is an increasing prevalence of brain lesions in recent years and the underlying diseases associated with lesions are also drastically increasing. In most cases since there are tissue damages involved it is very difficult to treat, however, an early diagnosis may help to lead a quality life with proper treatment and medication. &#xD;
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&#xA0;&#xA0;&#xA0; In the UK, the annual incidence of brain tumour is approximately 0.06-0.01%. In which 72 % of people with a brain tumour are above the age of 50 years.1The prevalence of the previous history varies depending on location, type of tumour and age of the patient.2 After a head injury at any age, vomiting is another common symptom noticed.3 Another risk factor of brain injury is high and low blood pressure. The incidence of the infarct is higher in patients with high blood pressure.4 &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0; Brain lesions include brain abscess, tuberculoma, neurocysticercosis, tumours and sarcoidosis.5 The studies revealed that per year the incidence of Central Nervous System (CNS) tumours varies from 10-17 per lakh persons for intracranial and 1-2 per lakh persons for intraspinal tumours.6 With the help of newer advanced techniques like Diffusion-weighted&#xA0; Magnetic Resonance imaging, Perfusion weighted&#xA0; Magnetic Resonance, Magnetic Resonance Spectroscopy etc, Neoplastic lesions can be distinguished from non-neoplastic lesions.7 Magnetic Resonance Spectroscopy (MRS) is a specialized in vivo technique that is used to differentiate the lesions by distinct patterns for the specific disease process to offer quality treatments.8, 9 To our knowledge literature is scarce regarding history like headache, vomiting, nausea, dizziness etc in patients with a brain lesion. The current study was undertaken to investigate the incidence of brain lesions in patients with characteristic risk factors involved including headache, vomiting, dizziness etc to assess the diagnostic significance. &#xD;
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MATERIALS AND METHODS&#xD;
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This is a retrospective study, conducted in the Radiology Department of one of the major tertiary health care centres in South Kerala. All the patients suspected of brain lesions and who underwent MRS for the diagnosis were included in the study from January 2018 to December 2018. The study was approved by the Institutional Ethics Committee. Only patients with proven MRS diagnosis for brain lesion were included as study subjects. In addition to the types of brain lesions, patient&#x2019;s demographics including age and gender were also taken for analysis and interpretation. Both males and females were included in the study. Patients with implants, aneurysm clips, pacemakers, heart valves and those who are not willing to participate in the study and patients with age below 20 years were excluded from this study.&#xD;
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&#xA0;The ethical clearance number is SGMC-IEC NO: /383/11/2018(F)&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The patients were categorised according to the age as patients with 20-40 years, patients with 40-60 years and patients with &gt; 60 years. There were 81 patients, both males and females, who underwent MRS for the diagnosis of brain lesions and studied for their age, gender, types of lesions and history and were recorded to get the distribution and pattern of brain lesions.MRI scans of three different planes- Axial, Coronal and Sagittal were performed by using MRI scans of 1.5 T with sequences like FLAIR T2 weighted imaging and diffusion-weighted imaging (DWI). For analysing the spectra, Spectroscopy-2D Brain software was used. &#xA0;MRS requires radiofrequency (RF) coils and a software package. For the spectrum acquisition, different spatial localization techniques like Single-voxel and Multi-voxel imaging were used. The Single-voxel technique records spectra from one region of the brain at a time. 10 Multi-voxel technique simultaneously recorded spectra from multiple regions.11 &#xA0;&#xA0;&#xA0;&#xD;
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RESULTS&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The brain tissue concentrations of metabolites (Figure 1) like N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), lactate (Lac), Myo-Inositol (mI) etc and measured as spectral peaks through MRS. A raised Cho or decreased NAA combined with a rise in Cho/Cr and Cho/NAA ratios indicated a tumour. Additionally, lipid and lactate peaks were observed in infections. &#xA0;The relation between types of lesions and gender are represented in figure 2. From this study it was observed that out of 81 patients analysed for the study, 46 patients (57%) were males and 35 (43%) were females. The present study indicates that brain lesions were more common in males (57%) when compared to females (43%) with a male to female ratio of (46: 35). Figure.3 represents the frequency of brain lesions concerning age. Among these 81 cases, age varied from 20 years to 60 years. It was revealed that the frequency of brain lesions was higher in the middle aged group (52%) when compared to younger age (6%) and old age groups (42%). Patients with age 20-40 years accounted for 5 cases (6%), 40- 60years accounted for 42 cases (52%) and &gt;60&#xA0; years accounted for 34 cases (42%). &#xD;
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The types of lesion detected by Magnetic Resonance Spectroscopy in these patients are represented in figure 4. It was found that out of the 81 cases, meningioma was the most common types of brain lesions affecting the South Kerala population as diagnosed through MRS. Other types of brain lesions observed were glioma, granuloma, seizure, ophthalmoplegia, cranioplasty, oligodendroglioma, cerebral metastasis, tuberculoma, cavernoma, 6th nerve palsy, subarachnoid haemorrhage (SAH), peripheral vertigo, cerebellopontine angle (CPA) tumour, migraines, macroadenoma, amyotrophic lateral sclerosis, cerebral ischemia, fazeka&#x2019;s grade II, glioblastoma multiforme, cerebral atrophy, granulomatous, cystic lesion, meningitis, Fazekas&amp;#39;s grade I, ethmoid sinusitis, Tolosa hunt syndrome, multiple sclerosis, Rathke&amp;#39;s cleft cyst, microadenoma, encephalomalacia, tubercular granuloma, mastoiditis, glomus tympanum. &#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; As per the study, it was observed that out of 34 types of brain lesions, meningioma is the most common type of lesion affecting females as compared to males (figure 5). Figure: 6 show the types of lesions in three different age groups of 20-40 years,40-60 years and&#xA0;&#xA0; &gt; 60 years.&#xA0; It was observed that meningioma is more common in people age &gt;60 years.&#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;The history of other inflammatory diseases and symptoms were represented in figure 7. It was found that out of 81 patients, 39 % had a headache, 30 % had vomiting, 23 % had Type-2 diabetes mellitus and 7% had dizziness. Further, it was observed that in most of the brain lesions the blood pressure was high for the subjects. Based on the clinical examination, the main symptom observed was vomiting in patients with meningioma, glioma, seizure, oligodendroglioma, tuberculoma, CP angle tumour, amyotrophic lateral sclerosis, fazeka&#x2019;s gradeII, meningitis, Tolosa hunt syndrome, Rathke&amp;#39;s cleft cyst, encephalomalacia and tubercular granuloma. Similarly, it was also found that patients suffering from lesions like glioma, seizure, cerebral metastasis, tuberculoma, cavernoma, CP angle tumour, migraines, macroadenoma, cerebral ischemia, fazeka&#x2019;s grade II were also presented with headache. It was noted that the dizziness was there in patients with CP angle tumour, granulomatous and glomus tympanum. It was also observed that there was a history of type -2 Diabetes mellitus for patients affected with meningioma, cerebral metastasis, tuberculoma, nerve palsy, peripheral vertigo, migrainosus, macroadenoma, cysticlesion, tubercular granuloma and mastoiditis. Another history like hemiparesis was found in lesion granuloma.&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; &#xD;
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DISCUSSION &#xD;
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Nowadays clinician takes a keen interest in the management of brain lesions due to their high incidence. In this study, we retrospectively analyzed the data regarding incidence, medical history and the symptoms associated with different types of brain lesions presented in patients who attended a major tertiary health care centre in South Kerala over 12 months. This information may help to predict the need for a specific diagnosis to confirm the lesions as early as possible to get better treatment. &#xD;
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&#xA0;In this study, it was observed that the middle-aged group is more affected with brain lesions unlike in other studies from developed countries. Previous studies indicate that the incidence of brain lesions in developed and developing countries are common in the elderly population.12 In England, about 1.5 % -1.9% of all cancers, Central Nervous System (CNS) tumours are predominant in old age.13 Present study shows that males are more prone to brain lesions as compared to females in South Kerala indicating gender has a major role in disease risk and prognosis. Earlier study it was also found that there is a measurable difference in the prevalence, mortality and progression of cancer in men and women.14&#xA0; Earlier studies show that there is a higher incidence of CNS tumours in females in the United States compared to England.13 But a study conducted in Asia revealed that brain metastases were more common in males as compared to female.12 Another study also revealed that males are more proponent with seizures compared to females, which were supporting our findings.15 &#xD;
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The present study also found that one of the common types of lesions detected is meningioma.&#xA0; Similarly, it was found to be more in females compared to males. A previous study also revealed that meningioma is asymptomatic and was found that it is the more frequent type of lesion observed in people.16 According to World Health Organization (WHO) meningioma are more common in women.17&#xA0; Similarly in one of the studies it was mentioned that females are more prone to meningioma than male, in the ratio 2:1.18&#xA0; It was observed that in developed countries the meningioma is more common in children.13 In another study it was reported that women are more susceptible to develop meningioma than men.18 It was also detected that females are prone to low-grade meningioma while males are more susceptible to malignant type.14 In one of the study conducted in the US it was found that of all primary central nervous system tumours, 37% were of meningioma.&#xA0; Also, the incidence increases with twice as common in females as in males.19 In our present study it was also found that the meningioma is more in old age group (&#x203A;60yrs). Previous&#xA0; studies&#xA0; revealed&#xA0;&#xA0; that there is an increase in the incidence of meningioma with the increase in age.20 &#xD;
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&#xA0; &#xA0;This study shows that the lesions like cerebral metastases were presented with headache. In one of the study, it was also found that headache was the presenting symptom in intracranial metastases.21 Present study also shows that for the brain lesions including tumours like meningioma, glioma, tuberculoma, CP angle tumour and other lesions like seizure and cerebral metastasis there was a symptom of vomiting. In this study, it was found that the lesion like glioma, the main history was vomiting and headache.&#xA0; Earlier studies also confirmed that vomiting is a common symptom after a head injury at any age.3&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the present study, it was observed that lesion like subdural hematoma was presented with intracranial bleed. The previous study shows that acute subdural hematoma was a reason for intracranial haemorrhage.22 Present study revealed that nerve palsy was associated with diplopia.&#xA0; Earlier studies revealed that there is a clinical history of uncrossed diplopia associated with eye pain in nerve palsy lesions.23 &#xA0;In this study it was found out that SAH was presented with a history of bleed from the nose and mouth. Studies also found that SAH is associated with ruptured intracranial aneurysms.24 &#xA0;In this study it was observed that peripheral vertigo was presented with a history of nephropathy and retinopathy.&#xA0; From one of the study, it was concluded that the complications of diabetes like retinopathy and neuropathy may affect the vestibular system .25&#xA0; &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The current study shows that the lesion including tumours like meningioma, tuberculoma, nerve palsy, peripheral vertigo, migraines, macroadenoma, cystic lesion, tubercular granuloma and mastoiditis were diagnosed with type -2 diabetes mellitus (DM). Earlier studies also reported that DM is a significant risk factor for several types of cancer, including cancer of the breast. In the previous study, it was also found that diabetic individuals had a risk of brain tumours.26 In this study, it was found that individuals with other lesions like cerebral metastasis were also diagnosed with DM. In earlier studies also it was confirmed that DM was a significant predictor in patients treated for brain metastasis.27&#xA0; &#xD;
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Conclusion &#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;Meningioma is the most common types of Brain Lesions which are detected through Magnetic Resonance Spectroscopy (MRS) among the old aged group of patients from South Kerala. It is also found that meningioma is predominant in females. This indicates the need for special attention from the clinicians to take care of female patients in the old aged group who comes with early symptoms suggestive of brain lesions and to impart correct diagnosis through Magnetic Resonance Spectroscopy for time management. This may lead to an improved understanding of the mechanisms of advanced diagnostic modalities, better categorization of symptom constructs, and prospective trials for the management of the symptoms in patients with brain lesions.&#xD;
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Acknowledgement&#xD;
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The authors are greatly thankful to the hospital management of&#xA0;&#xA0; Sree Gokulam Medical College &amp; Research Foundation for their help and support in the patient&amp;#39;s study and facility provided. The authors are also thankful to the Department of Physics, Noorul Islam Centre for Higher Education for their technical support for the study.&#xD;
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&#xA0;Conflict of Interest&#xD;
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All authors declared that they have no conflict of interest and no source of funding.&#xD;
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Authors Contribution &#xD;
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Mrs. H Smitha &#x2013; First author&#xD;
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Is the principal investigator involved in the study. Done in the design, data acquisition, data analysis and manuscript preparation, manuscript editing and literature search. &#xD;
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Dr. VN Meena Devi &#x2013; Second author &#xD;
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She is involved in coordinating the work and giving valuable suggestions for modifications as the corresponding author.&#xD;
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Dr. Jacob Vinoo &#xD;
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Provided the patients for the study and helped in the interpretation of the report of MRS. &#xD;
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Dr. K S Sreekanth - Fourth author&#xD;
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Contributed to the preparation of the manuscript. Involved in the data analysis especially for the analysis and interpretation of the biochemical changes in MRS. &#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3888</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3888</Fulltext></URLs><References>1.Kernick D P, Ahmed F, Bahra A, Dowson A, Elrington G, Fontebasso M, et.al. Imaging patients with suspected brain tumour: guidance for primary care. Bri J of Gen Pract. 2008 Dec; 58 (557): 880&#x2013;885. &#xA0;DOI:&#xA0;https://doi.org/10.3399/bjgp08X376203&#xD;
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12.Saha A, Ghosh SK, Roy C, Choudhury KB, Chakrabarty B, Sarkar R. Demographic and clinical profile of patients with brain metastases: A retrospective study. Asian J Neurosurg. 2013 Jul; 8(3):157-61. doi: 10.4103/1793-5482.121688. &#xD;
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13.Arora RS, Alston RD, Eden TO, Estlin EJ, Moran A, Birch JM. Age-incidence patterns of primary CNS tumours in children, adolescents, and adults in England.&#xA0;Neuro Oncol. 2009; 11(4):403-413. doi:10.1215/15228517-2008-097&#xD;
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14. Sun T, Plutynski A, Ward S, Rubin JB. An integrative view on sex differences in brain tumours. Cell Mol Life Sci. 2015 Sep;72(17):3323-42. doi: 10.1007/s00018-015-1930-2. &#xD;
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15.Rudresh K, Krishna M V, Sebastian K J . Clinical and Aetiological Profile of Ring-enhancing Lesions on CT Brain. Journal, Indian Academy of Clinical Medicine journal.2008 April; 9(2):100-102.&#xD;
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&#xA0;16. Shaikh N, Dixit K, Raizer J. Recent advances in managing/understanding meningioma F1000Res. Clin Cancer Res. &#xA0;2018 Apr; 490(7): 1-8. DOI:&#xA0;10.12688/f1000research.13674.1&#xD;
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17.Asgharian B, Chen YJ, Patronas NJ, Peghini PL, Reynolds JC, Vortmeyer A, et. al. Meningiomas may be a component tumour of multiple endocrine neoplasia type 1. Clin Cancer Res. 2004 Feb 1;10(3):869-80. DOI : 10.1158/1078-0432.&#xD;
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18. Shah S, Gonsai R N, Makwana R. Histopathological Study of Meningioma in Civil Hospital, Ahmedabad. Int J Cur Res Rev. 2013 Feb ; 05 (03) 76-82 .&#xD;
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&#xA0;19.Fogh SE, Johnson DR, Barker FG, Brastianos P K, Clarke JL, Kaufmann TJ,et al .&#xA0;Case-BasedReview:meningioma.NeurooncolPract.2016Jun;3(2):120-134.doi: 10.1093/nop/npv063. &#xD;
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20.Wiemels J, Wrensch M, Claus EB. Epidemiology and aetiology of meningioma. J Neurooncol. 2010 Sep; 99(3):307-14. doi: 10.1007/s11060-010-0386-3. &#xA0;&#xD;
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21.Kaul D, Budach V, Graaf L, Gollrad J, Badakhshi H. Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases. Biomed Res Int. 2015 May 2015: 1-6. doi: 10.1155/2015/868401. &#xD;
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22.Christiaans MH, Kelder JC, Arnoldus EP, Tijssen CC. Prediction of intracranial metastases in cancer patients with headache. Cancer. 2002 Apr 1;94(7):2063-8. doi: 10.1002/cncr.10379. &#xD;
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23.Patel PV, FitzMaurice E, Nandigam RN, Auluck P, Viswanathan A, Goldstein JN, et al. Association of subdural hematoma with increased mortality in lobar intracerebral haemorrhage. Arch Neurol. 2009 Jan;66(1):79-84. doi: 10.1001/archneur.66.1.79. &#xD;
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24 Hussaindeen, J. R., Mani, R., Rakshit, A., Ramasubramanian, S., Vittal Praveen, S.&#xA0; Natural history of idiopathic abducens nerve paresis in a young adult.&#xA0;J Opt.&#xA0;2016 Feb: 9(4), 264&#x2013;268. https://doi.org/10.1016/j.optom.2016.02.002&#xD;
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25.Nomani, A. Z., Rajput, H. M., Iqbal, M., Jan, Z., Irshad, M., Badshah, M, et al.&#xA0; Subarachnoid hemorrhage secondary to forceful sneeze.&#xA0;Case Rep Neur Med.&#xA0;2015 Dec; 1-5. https://doi.org/10.1155/2015/896732.&#xD;
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26..D&amp;#39;Silva LJ, Lin J, Staecker H, Whitney SL, Kluding PM. Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Phys Ther. 2016 Mar; 96(3):400-9. https:// doi: 10.2522/ptj.20140604. &#xD;
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27.Tong JJ, Tao H, Hui OT, Jian, C. &#xA0;Diabetes mellitus and risk of brain tumors: A meta-analysis.&#xA0;Expt Therap Med. 2019;&#xA0;4(5), 877&#x2013;882. https://doi.org/10.3892/etm.2012.698&#xD;
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28. LeCompte MC, McTyre ER, Strowd RE, Lanier C, Soike MH, Hughes RT, et al. Impact of diabetes mellitus on outcomes in patients with brain metastasis treated with stereotactic radiosurgery. J Radiosurg SBRT. 2018; 5(4):285-291. PMID: 30538889; PMCID: PMC6255719.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Study of Structural Variation of Plantaris in Western Odisha Population&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>190</FirstPage><LastPage>193</LastPage><AuthorList><Author>Das SR</Author><AuthorLanguage>English</AuthorLanguage><Author> Dehury MK</Author><AuthorLanguage>English</AuthorLanguage><Author> Baisakh P</Author><AuthorLanguage>English</AuthorLanguage><Author> Champatyray S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Plantaris, Vestigial, Tennis Leg, Plastic Surgeons, Tendon Transfer</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
It is a long, slender, thin, muscle present in the superficial group of the posterior compartment of the leg. Plantaris, soleus and gastrocnemius are together known as the calf (sural region) muscle of the leg. It is a vestigial muscle in humans.1 the muscle originates from the lower end of the lateral supracondylar line of the femur and the oblique popliteal ligament above the origin of the lateral head of the gastrocnemius.2 The muscle belly is fusiform in shape present in the posterior part of the knee joint anteromedially and ends as a long slender tendon. The tendon crosses obliquely, in an inferomedial direction, between gastrocnemius and soleus and finally, it is inserted into the posterior surface of calcaneous just medial to the tendo-calcaneous tendon proper.3It can be damaged in an Achilles tendon rupture but&#xA0;it&amp;#39;s been&#xA0;a&#xA0;source&#xA0;of controversy in&#xA0;a few&#xA0;investigations4. It is innervated by the tibial nerve (S1, S2). The main action of plantaris is weak plantar flexion of the foot and flexor of the knee joint. The muscle has several anatomical variations in its origin, insertion, course and relationship with the neurovascular bundle. The muscle belly may be absent, either unilaterally and bilaterally. In animals, it is inserted into the plantar aponeurosis. It becomes a vestigial muscle in human beings when the foot is evolved for walking and running.&#xD;
&#xD;
Functionally it is of less importance as plantar flexor because it is considered a vestigial muscle. The anatomical knowledge of the variation of plantaris muscle is important for clinical diagnosis of the muscle rupture and to interpret the MRI scans. It is called the "freshman nerve" as it is often mistaken for a nerve by new medical students. The plantaris muscle is clinically important in the differential diagnosis of pain in the lower extremity as its rupture is indistinguishable from deep vein occlusion.5&#xD;
&#xD;
Its long tendon can readily be harvested for reconstruction elsewhere with little functional deficit as its motor function is minimum. In the Tennis leg, there is an injury of the plantaris at the myotendinous junction with or without haematoma. It is seen in tennis players when there is a severe injury to the calf muscles.6&#xD;
&#xD;
MATERIALS AND METHOD;&#xD;
&#xD;
The present study was done in a medical college of western Odisha in four years. Total 60 lower limbs fixed in 10% formalin solution were obtained from adult cadavers.30 limbs are on the right side and 30 on the left side. All the cadavers are aged between 40 to 60 years. &#xD;
&#xD;
The ethical clearance for the study was taken from the Institutional Ethical Committee.&#xD;
&#xD;
The dissection of the popliteal fossa and the posterior compartment of the leg was done meticulously following Cunningham&#x2019;s manual of practical anatomy. The plantaris muscle was traced from its origin to its insertion. While dissection out most care was taken not to damage the nearby structures. Digital photographs were taken Morphometric measurements were taken with the help of measuring tape. The frequency of the occurrence of the plantaris muscle was noted.&#xD;
&#xD;
RESULTS&#xD;
&#xD;
The muscle was present in 52 lower limbs (86.67%) and absent bilaterally in 4 limbs (6.67%) and absent unilaterally in 2 limbs (3.33%) (Figure.3) and tendinous origin in 2 limbs (3.33%) (Figure.1). Such a complete tendinous origin of plantaris are a very uncommon observation It was thought that the absence of plantaris muscle indicates that the muscle has become fused with the gastrocnemius or soleus muscle, but no such condition was observed in the present study. The length of muscle belly in those 52 cadavers varied from 5.5cms &#x2013; 8.5cms.&#xD;
&#xD;
The Plantaris Muscle was present in 32 (61.53%) right and 20 (38.47%)left limbs (Figure.2) Differences in occurrence between body sides were not statistically significant (p= 0.67).&#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
In the present study, the plantaris was absent in 11% of specimens which is near to the study done by Savita k et al. in which the plantaris muscle was absent in 12.5%.7 Olewnik A et al also found that PM was found to be absent in 10.8% which is similar to our study.8&#xD;
&#xD;
Harvey as et al.9 observed the absence of the PM in 19% of cases which is higher than our study and Nayak et al.10 in 7.69% which is less than our study. The entire limbs were carefully examined to confirm if the PM had fused with the surrounding muscles.&#xD;
&#xD;
Van Sterkenburg et al.11and Arag&#x2DC;ao et al.12 reported no cases of absence of plantaris muscle in their study. The plantaris muscle is known to have a lot of variations. Some books of anatomy have reported that the muscle may be sometimes totally absent or it may be double.1 The plantaris muscle was attached to the plantar aponeurosis of the foot in quadrupeds but in humans due to its erect posture, it got shifted to a higher position as a normal evolutionary process.13 In many mammals, it inserts directly or indirectly into the plantar aponeurosis. &#xD;
&#xD;
In American bear, the plantaris muscle attached to the plantar aponeurosis.14 Dual origin was noted in 6 specimens and in one specimen it was the double head.15&#xD;
&#xD;
According to Moore and Dalley, the PM is often found to be absent.3 Daseler and Anson found that the muscle was absent in 6.67% of 750 lower extremities that they examined.13&#xD;
&#xD;
Variation in terms of its interdigitation with the lateral head of gastronemius or having a thick fibrous extension to the patella can cause patellofemoral pain syndrome.16 The presence of a double Plantaris muscle has&#xA0;conjointly&#xA0;been&#xA0;noted&#xA0;within the&#xA0;medical literature.17Plantaris has&#xA0;the lowest&#xA0;motor&#xA0;performance&#xA0;and its long&#xA0;tendon&#xA0;can&#xA0;readily&#xA0;be harvested for reconstruction elsewhere&#xA0;within the&#xA0;human body.18 Due to excellent tensile strength, the tendon of plantaris can be used as a graft for reconstruction of the flexor tendon in the hand and anterior talofibular and calcaneofibular ligament of the ankle and a substitute for the fascia lata in hernial repair.19.20&#xD;
&#xD;
The topographic anatomy of plantaris assumes importance for orthopae&#xAD;dic surgery intervention.21A rare variation seen in plantaris is two separate heads of origin of plantaris which was found by Sawant et al. on the left lower limbs of a&#xA0; male cadaver.22 The plantaris muscle maybe double or absent.23 The plantaris tendon may also pass between the tibial nerve and nerve to the soleus, thereby causing entrapment of the tendon. 24-27&#xD;
&#xD;
Das et al. reported a case in which the plantaris tendon took origin from the lateral supracondylar line and the oblique popliteal ligament, and its tendon passed between the tibial nerve and the nerve to the soleus.24 Nayak et al. reported a case in which they found an extra tendon of the plantaris muscle arising from the fascia covering the popliteus, which joined the original tendon of the plantaris to form one tendon and inserted into the calcaneal tendon.25 Saha et al. reported a case, in which they found a plantaris muscle with double bellies and both the bellies then fused to form a common tendon and inserted into the calcaneal tendon.26Biswas as et al. the plantaris tendon passed between the tibial nerve and the nerve to the soleus, thereby causing its entrapment.27 During their passage, the muscle bellies were entrapped between the tibial nerve and the nerve to the soleus&#xD;
&#xD;
The muscle may be absent in 10 % of cases.1 The&#xA0;tendinous&#xA0;origin of plantaris, found in the present study,&#xA0;might&#xA0;confuse surgeons&#xA0;and make&#xA0;hindrances in surgical procedures involving the&#xA0;popliteal&#xA0;fossa&#xD;
&#xD;
An ultrasonographic investigation by Delgado et al. showed that the tennis leg occurred due to the rupture of the plantaris tendon at the middle of the leg in only 1.4% of cases. They found that&#xA0;66.7% of cases of&#xA0;tennis&#xA0;leg occurred&#xA0;because of&#xA0;the rupture of the medial head of the&#xA0;gastrocnemius muscle,&#xA0;without&#xA0;damaging the PM.28&#xD;
&#xD;
The tendinous injury of the plantaris muscle is significant since it is related to oedema and haemorrhage. The burst of the ligament of the plantaris muscle is regularly hard to analyze and a significant finding is the presence of a strained mass between the gastrocnemius and the soleus muscle. The plantaris muscle has been utilized as an amazing graft. Studies have&#xA0;delineated&#xA0;anatomical procedure of&#xA0;employing a&#xA0;free plantaris&#xA0;tendon&#xA0;graft for reconstruction of the anterior talofibular and calcaneofibular ligaments.29&#xA0;within the&#xA0;presence of&#xA0;alternative&#xA0;flexors like&#xA0;skeletal muscle&#xA0;and&#xA0;soleus muscle&#xA0;muscles, the removal of plantaris muscle&#xA0;might not&#xA0;have&#xA0;an impact&#xA0;on&#xA0;the conventional&#xA0;limb&#xA0;function The ligament of the plantaris muscle is considered as an amazingly pliable structure and has been utilized effectively for flexor ligament substitution in hand and atrioventricular valve fix. magnetic resonance&#xA0;imaging and&#xA0;sonography are&#xA0;used&#xA0;as the essential imaging methods for the assessment of patients with the clinical diagnosis of nonspecific&#xA0;posterior lower leg pain. pain in the lower extremity due to rupture of plantaris is indistinguishable from deep vein occlusion,20 ultrasound with a colour Doppler are the first-line choice in diagnosing ruptures and deep vein thrombosis.&#xD;
&#xD;
CONCLUSION: &#xD;
&#xD;
The presence of tendinous origin of plantaris muscle as seen in the present case may be of academic interest as very few text book of anatomy mentions less about this fact. It is of great interest to surgeons and clinicians for diagnosing muscle tears in the leg. The compression of the nerve to soleus by the tendon of the planataris causes compression neuropathy. &#xD;
&#xD;
It may complicate the surgical exploration of the structures of the posterior compartment of the leg in the repair of the muscle tear by the surgeons.&#xD;
&#xD;
This tendon is often used by surgeons as a tendon graft. Its high tensile strength&#xA0; and no functional deficit after removal, help the surgeons for its use in tendon grafting.&#xA0;This variation of plantaris muscle is an interesting finding, which could be important for anatomists, radiologists, anthropologists, physiotherapists, surgeons and orthopaedic surgeons&#xD;
&#xD;
ACKNOWLEDGMENT &#xD;
&#xD;
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;
Source of Funding: Nil&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3889</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3889</Fulltext></URLs><References>&#xD;
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	Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. J Can Chiropr Assoc. 2007; 51: 158&#x2013;165&#xD;
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	Olewnik A , Wysiadecki G , Podg&#xF3;rski M, Polguj M , &#xA0;Topol M The Plantaris Muscle Tendon and Its Relationship with the Achilles Tendinopathy. BioMed Res Int. 2018;17(7): 1-9, &#xD;
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	&#xA0;Arag&#x2DC;ao JA, Reis FP, Guerra DR, Cabral RH. The occurrence of the plantaris muscle and its muscle-tendon relationship in an adult human. Int J Morph. 2010; 28(1):255&#x2013;258, &#xD;
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	Nayak SR, Krishnamurthy A, Prabhu LV, Madhyastha S. Additional tendinous origin and entrapment of the plantaris muscle.Clinics (Sao Paulo). Eur J Anat. 2009;64(1):67-8.&#xD;
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	Saha S, Mahajan A. An unilateral rare variant of plantaris muscle belly and its entrapment: a clinic-anatomical study. Int J Health Sci Res. 2015;5(10):343-6.&#xD;
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	.Biswas: Entrapment of the plantaris tendon - a rare anomaly. Int J Cur Res Rev. July 2018;10(14);1-3&#xD;
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	&#xA0;Pagenstert GI, Valderrabano V, Hintermann B. Lateral ankle ligament reconstruction with free plantaris tendon graft Techniques in Foot &amp; Ankle Surgery. Int J Cur Res Rev. &#xA0;2005, 4:104- 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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Morphometric Study of Nutrient Foramina of Dry Human Clavicles in Goan Population&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>194</FirstPage><LastPage>199</LastPage><AuthorList><Author>Siddhesh Prakash Prabhu</Author><AuthorLanguage>English</AuthorLanguage><Author> Sulekha Mangesh Kolap</Author><AuthorLanguage>English</AuthorLanguage><Author> Uday Narayan Kudalkar</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Clavicle, Nutrient foramen, Foraminal index, Fracture</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3890</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3890</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Rheumatic Manifestations in Human Immunodeficiency Virus/ Autoimmune Deficiency Syndrome Patients in Jammu Region&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>200</FirstPage><LastPage>204</LastPage><AuthorList><Author>Vinod Kumar</Author><AuthorLanguage>English</AuthorLanguage><Author> Ritu Bhagat</Author><AuthorLanguage>English</AuthorLanguage><Author> Ahmar Javid</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Autoimmune deficiency syndrome, Human immunodeficiency virus, Fibromyalgia</Keywords><Fulltext>&#xD;
Introduction:&#xD;
&#xD;
Infection by Human Immunodeficiency Virus (HIV) is characterized by a wide array of clinical manifestations, including flu-like illness in the initial stages to a multitude of clinical complications involving almost every major organ system in the body1. HIV-associated rheumatic manifestations may occur at any time of the clinical spectrum but tend to be more prevalent in later stages including AIDS1. The first reports of HIV-associated rheumatic diseases emerged in the mid-1980s, with the description of polymyositis, vasculitis, reactive arthritis and HIV-associated Sjogren&#x2019;s syndrome i.e. diffuse infiltrative lymphocytosis syndrome (DILS)2,3,4,5. By 1988, it was recognized that a wide spectrum of rheumatic diseases complicated HIV infection6,7,8,9. HIV-associated rheumatic manifestations are 10&#xD;
&#xD;
-arthralgia &#xD;
&#xD;
-painful articular syndrome&#xD;
&#xD;
-seronegative spondyloarthropathy&#xD;
&#xD;
-HIV-associated arthritis&#xD;
&#xD;
-connective tissue like disorders&#xD;
&#xD;
-miscellaneous.&#xD;
&#xD;
Material and Method: The present cross-sectional study was conducted in the Postgraduate Department of Medicine, GMC Jammu which involves finding &#xA0;Rheumatological manifestations in HIV/AIDS patients in the Jammu region during a period of two years from October 2017 to September 2019. 413 subjects included in the study were patients already diagnosed with HIV/AIDS according to WHO criteria. &#xD;
&#xD;
Inclusion criteria:&#xD;
&#xD;
The patients were selected for study from the following:&#xD;
&#xD;
&#xD;
	&#xD;
	Voluntary Counselling and Training Centre, GMC Jammu&#xD;
	&#xD;
	&#xD;
	Patients detected to be HIV+ while being treated in GMC and its associated hospitals, Jammu (outdoor).&#xD;
	&#xD;
	&#xD;
	Patients referred to HIV/AIDS/ART centre GMC, Jammu from various peripheral health institutions.&#xD;
	&#xD;
&#xD;
&#xD;
Exclusion criteria:&#xD;
&#xD;
&#xD;
	&#xD;
	HIV/AIDS + patients with co-morbid conditions like cirrhosis, diabetes mellitus, underlying malignancies.&#xD;
	&#xD;
&#xD;
&#xD;
All individuals were administered a questionnaire based on the World Health Organisation-International League against Rheumatism (WHO-ILAR), Community Oriented Programme for the control of rheumatic disorders (COPCORD) and Core Questionnaire (CQC). The purpose of the questionnaire was to screen persons with rheumatic complaints. Positive respondents were subjected to clinical examination within one week of administrating the questionnaire. In most cases, it was conducted on the same day. The points in the questionnaire were further clarified by taking the pertinent history. Physical examination was conducted with particular stress on the musculoskeletal system. No ethical clearance was required for this study and written consent was obtained from each subject for their participation in the study.&#xD;
&#xD;
Plan of Analysis: The data obtained were analyzed with the help of computer software SPSS 12.ver. for windows and presented as mean and standard deviations. The statistically significant difference among the groups was assessed by the use of the Chi-Square test and the &#x2018;to test. A p-value of  of cases. Rogeaux et al.13 reported Reiter&amp;#39;s syndrome in 1.6% of cases. Munoz et al.8 reported in 0.5%&gt; of cases. Medina et al.14 reported &#xA0;in 8%&#xA0; of cases. Andrew28 reported a prevalence of 0 to 10%. Krishnan et&#xA0; al.19 reported&#xA0; Reiter&#x2019;s syndrome in 7.1% of cases. Blackout et al.25 reported no case of Reiter&amp;#39;s syndrome. Njobvu et al.24 reported Reiter&amp;#39;s syndrome in 2% of cases.&#xA0; Virtanen et al.26 reported a prevalence of 20%. Massabki et al.29 reported in 2% of cases. Stein et al.30 in 37.5% of cases, In the present study no case of Reiter&#x2019;s syndrome was found.&#xD;
&#xD;
Arthralgia was found in 92 cases (35.7%). Out of these 68 (73.9%) were males and 24 (26.0%) were females. Berman et al.6 reported arthralgia in 34.6% of cases. Buskila et al.9 reported arthralgia in 15.2% of cases. Rogeaux et al.13 in 12.4% of cases. Munoz et al.8 reported arthralgia in 4.5% of cases.&#xA0; Medina et al.14 reported in 45% of cases. Krishnan et al.19 reported arthralgia in 21% of cases. Kanokwan et al.31 reported arthralgia in 26% of cases. Monteagudo et al.27 reported arthralgia in 12.2% of cases.&#xA0; Virtanen et al.26 reported arthralgia in 20% of cases.&#xD;
&#xD;
The painful articular syndrome was diagnosed in 15 (5.8%&gt;) patients of whom 13 (86.6%) were males and 2 (13.3%) were females. Berman et al.6 reported Painful articular syndrome in 9.9%&gt; of cases. A painful articular syndrome is not reported by Krishnan et al.19 as well as Achuthan et al.16. Celular et al.10 reported painful articular syndrome in 10%&gt; of cases. Rogeaux et al.13 reported painful articular syndrome in 4.1 % of cases.&#xD;
&#xD;
myalgia was found in 33 (12.8%) cases. Monteagudo et al.27 reported myalgia in 12.2% of cases. Krishnan et al.19 reported myalgia in 14% &#xA0;of cases. Buskila et al.9 found myalgia in 35% of cases. Virtanen et al.26 in 6.6% of cases. Massabki et al.29 reported it in 28% of cases. Low backache was found in 37 subjects (14.3%). Berman et al.6 reported low backache in (14.2%) of cases. Rogeaux et al.13 reported low backache in 36.6%) of cases. Krishnan et al.19 reported no case of low backache. Virtanen et al.26 reported no case of low backache. Kanokwan et al.31 reported no case of low backache.&#xD;
&#xD;
Fibromyalgia was found in 13 subjects (5%) in our study. Out of the 7 (53.8%) were males and 6 (46.1%) were females. Simms et al.12 reported a prevalence of 11% for fibromyalgia in HIV positive patients and 41% of HIV patients with musculoskeletal symptoms. Krishnan et al.19 reported no case of fibromyalgia. Virtanen et al.26 reported no case of fibromyalgia. Kanokwan et al.31 reported no case of fibromyalgia. &#xD;
&#xD;
Zidovudine induced myopathy was reported in one (0.3%) patient in the present study and no case of polymyositis or dermatomyositis was found. Xuan et al.11 reported Zidovudine induced myopathy in 35% of cases. Krishnan et al.19 reported polymyositis in 3.4% of cases. &#xA0;Johnson et al.32 reported biopsy-proven myositis in 20%. &#xA0;Xuan et al.11 reported myositis in 8.16% of cases. Massabki et al.29 reported polymyositis in 1.1 % of cases. Johnson et al.32 reported myositis in 0.22%&gt; of cases. Narayanan et al.15 reported no case of polymyositis.&#xD;
&#xD;
No case of Sjogren&#x2019;s syndrome/ diffuse infiltrative lymphocytosis syndrome has been reported in our study. Buskila et al.9 reported Sjogren&amp;#39;s syndrome in 1.9%&gt; of subjects. Rogeaux et al.13 reported no case of Sjogren syndrome / DILS in their study of 121 subjects. Munoz et al.8 reported no case of DILS/Sjogren&amp;#39;s syndrome in 556 HIV +ve patients. Williams et al.33 found diffuse infiltrative lymphocytosis syndrome in 3%o of subjects. Krishnan et al.19 reported no case of DILS/ Sjogren syndrome in 29 HIV+ve subjects. Johnson et al.32 found concomitant diffuse infiltrative lymphocytosis syndrome in 9.3% of patients who were having myositis. Xuan et al.11 reported 11.2% of cases with Sjogren like syndrome/Diffuse infiltrative lymphocytosis syndrome.&#xD;
&#xD;
No case of vasculitis was found in our study. Berman et al.6 found a prevalence of 0.9%. Simpson et al.34 reported no case of vasculitis Buskila et al.9 reported in 1.9% cases. Rogeaux et al.13 reported vasculitis in 0.8% of cases.&#xA0; Munoz et al.8 reported vasculitis in 0.4%o of cases. Krishnan et al.19 reported no case of vasculitis. Marquez et al.20 reported no case of vasculitis in their 75 patients.&#xA0; Xuan et al.11 reported vasculitis in 20.41% of cases including Bechet like disease, Henoch-Schonlein purpura and digital gangrene. Stein et al.30 reported no case of vasculitis. Otero et al.35 reported vasculitis in 8 patients. Kanokwan et al.31 reported vasculitis in 18%o of subjects. Manteagudo et al.27 reported vasculitis in 0.9% of cases. Massabki et al.29 reported vasculitis in 1% of cases. Narayanan et al.15 reported no case of vasculitis in their 469 HIV positive patients.&#xD;
&#xD;
No case of SLE like disease was found in our study. Berman et al.6 reported no case of SLE like a disease. Buskila et al.9 reported no case of SLE. Elizabeth et al.36 reported that the prevalence of lupus In HIV is very low and from 1988-2002 only 30 cases were reported. Munoz et al.8 reported no case of lupus in 556 HIV positive patients. Krishnan et al.19 reported no case of lupus. Marquez et al.20 reported no case of lupus in their study. Xuan et al.11 reported a lupus-like disease in 10.2% of subjects.&#xD;
&#xD;
&#xA0;A case of gout is found in our study (0.3%). No case of gout was reported by Buskila et al.9.&#xA0; Berman et al.6 reported no case of gout. Krishnan et al.19 reported no case of Gout.&#xA0; Basu et al.37 retrospectively did chart review and reported no case of gout during 1997, 3% of cases during 1998, 2% of cases during 1999, 2% of cases during 2000, 4% of cases during 2001, 3% of cases during 2002, 2% of cases during 2003, 2% of cases during 2004 and 2% of cases during 2005.&#xD;
&#xD;
Conclusion: As rheumatic manifestations are very common in HIV/AIDS patients. The present study is to define the occurrence of various Rheumatic manifestations in HIV/AIDS patients. The present study was conducted on 413 subjects during their visit to Voluntary Training and Counseling Centre in Government Medical College Jammu, J&amp;K. There were 283 males (68.5%) and 130 females (31.4%) of the 413 HIV/AIDS patients. There were 83 (20%) subjects in WHO Stage II, thirty-one (7.5%) in Stage III, whereas 299 (72.3%) in Stage IV. In the present study, the prevalence was 62.2%. Males were affected more than females. Arthralgia was the most common complaint in our study (35.7%). A rare case of gout (0.03%) is found in our study.&#xD;
&#xD;
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.&#xD;
&#xD;
Source of funding: nil &#xD;
</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3891</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3891</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>205</FirstPage><LastPage>209</LastPage><AuthorList><Author>Suvarna Sunder J</Author><AuthorLanguage>English</AuthorLanguage><Author> Seema Abid Hussain</Author><AuthorLanguage>English</AuthorLanguage><Author> Ullah Tareen Sabahat</Author><AuthorLanguage>English</AuthorLanguage><Author> Prabu Mahin Syed Ismail</Author><AuthorLanguage>English</AuthorLanguage><Author> Shetty Akhil</Author><AuthorLanguage>English</AuthorLanguage><Author> Patel Pawan</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Treatment of necrotic tooth requires extensive management due to chances of fracture. Revascularization is the procedure for the management of immature necrotic tooth. Aim: The study was done to assess endodontic revascularization of the necrotic permanent anterior tooth with Platelet Rich Fibrin (PRF), Platelet Rich Plasma(PRP), and blood clot. Materials &amp; Methods: Thirty patients within the age range 15-25 years with the non-vital maxillary anterior tooth with or without periapical pathology and immature apex were selected and subjected to revascularization endodontics PRF, PRP and blood clot. Healing, root lengthening, apical closure and dentinal wall thickness was determined. Results: Group I used PRF, group II used PRP plus collagen and group III used blood clot. Group I had 6 males and 4 females, group II had 5 males and 5 females and group III had 4 males and 6 females. There was excellent healing seen in 80% in group I, 30% in group II and 10% in group III. Mann Whitney U test showed a significant difference (P 0.05) Conclusion: It was concluded from the present study that PRP had superior result in terms of apical closure, root lengthening and dentine wall thickness compared to the blood clot and PRF.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Apical closure, Endodontics, Necrotic teeth, PRP, Revascularization</Keywords><Fulltext>Introduction&#xD;
&#xD;
Treatment of necrotic tooth requires extensive management since chances of fracture through small roots as well as thin dentinal walls is more.1 The most commonly employed procedure for the closure of immature root apex is apexification. Stem cells are totipotent cells that help in the proliferation and production of cells, capable of differentiating into specialized cells.2 &#xD;
&#xD;
Adult stem cells and embryonic stem cells are two types of stem cells that help in pulp revascularization. The common site of their occurrence is pulp, apical papilla and periodontal ligament.3 These clonogenic cells induce dentin-pulp regeneration after they get differentiated into appropriate cells. Development of a complete tooth from a stem cell will be possible in the future. Stem cells after differentiating odontoblasts induce hard tissue apposition.4 &#xD;
&#xD;
Revascularization is the procedure for the immature necrotic tooth. It helps in the completion of root formation of the immature necrotic tooth.5 Most commonly used material for it is mineral trioxide aggregate (MTA) and calcium hydroxide (Ca (OH)2). The results of the treatment lead to the fracturing of teeth in 30% of cases. Hence there is a shift in the management of immature necrotic teeth.6 &#xD;
&#xD;
The formation of a functional pulp-dentin complex is regarded as a substitute method to exchange the conventional apexification method to initiate root formation and dentinal walls thickening in the case of the immature non-vital tooth.7 Recent studies showed blood clot as a material in regenerative endodontics which acts as scaffold leading to enhance the concentration of growth micromolecules.8 Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)&#xA0;both comprise of increased concentration of growth factors and increase the cell proliferation over time when compared to the blood clot.9&#xA0;The present study aimed at assessing endodontic revascularization of necrotic permanent anterior with PRF, PRP and blood clot. &#xD;
&#xD;
Methodology&#xD;
&#xD;
Study design&#xD;
&#xD;
Thirty patients within the age range 15-25 years of either gender were selected among those reporting to the Endodontic department. Inclusion criteria were non-vital maxillary anterior tooth due to either trauma or caries, a tooth with or without periapical pathology and immature apex. Exclusion criteria were patients beyond the age group, a tooth with mature apex. &#xD;
&#xD;
The sample was decided based on significance level: 0.05, power: 80% and the number of immature teeth as 30. The study commenced with approval from higher authorities and written consent from selected patients. &#xD;
&#xD;
Methods&#xD;
&#xD;
In all patients&#x2019; teeth were carefully examined clinically by an Endodontist. All procedures such as pulp vitality test, palpation, percussion test, depth of clinical pocket and occurrence of sinus were performed. Radiographic analysis with digital intra-oral radiographs was performed such as the presence of radiographic bone loss, widening of periapical pathology etc. &#xD;
&#xD;
All strict asepsis was procedures such as isolation of tooth, access cavity formation, working length determination, biomechanical preparation, irrigation with sodium hypochlorite (NaOCl) was performed. Canals were dried using sterile paper points followed by the use of triple antibiotic dressing paste to medicate the canals. &#xD;
&#xD;
Over root canal medicament, the cotton pellet was inserted followed by insertion of temporary filling material, Cavit. Over it, glass ionomer cement (GIC) was placed and patients were recalled after 2 weeks. On recall visit, if the tooth found to be asymptomatic, Cavit was removed. Triple antibiotic dressing paste was removed with the irrigation of 2.5% sodium hypochlorite and saline. Following this, three groups were made based on the material used. In group I, PRF clot as the scaffold was used, in group II, PRP plus collagen as the scaffold was used which was pushed towards the apical area and in group III, a blood clot was used. Bleeding at the apical end was induced with a 20K- file. After seeing frank bleeding in the canal, a tight cotton pellet was introduced in the coronal portion of the canal and pulp chamber for about10 minutes to induce the clot formation in the apical two-thirds of the root canal. Patients were recalled at regular intervals on 6, 12 and 24 months to assess tooth clinically and radiographically. Signs of healing, apical closure, increase in root length and dentinal wall thickness was recorded. &#xD;
&#xD;
Statistical analysis&#xD;
&#xD;
Results of the study were expressed as percentages. Mann Whitney U test was applied for the assessment. The significance of the study was labelled at 0.05, highly significant at 0.01.&#xD;
&#xD;
Results &#xD;
&#xD;
Table 1 shows that group I used PRF, group II used PRP plus collagen and group III used blood clot. Group I had 6 males and 4 females, group II had 5 males and 5 females and group III had 4 males and 6 females. &#xD;
&#xD;
Table 2 indicates, assessment of healing after revascularization. Group II (PRP) had 70% good, 30% excellent healing, whereas Group III (blood clot) group had 60% good, 10% excellent healing. Group, I (PRF) had 80% excellent healing compared to other groups. Table-3 indicates the outcome of root lengthening. Group II had good (80%) root lengthening compared to Group III (29%) and Group I (10%). &#xD;
&#xD;
Apical closure found to be good in 45% and excellent in 20% in group I, good in 60% and excellent in 20% in group II and good in 20% and fair in 80% in group III. Mann Whitney U test showed a significant difference (P 0.05) (Graph 1).&#xD;
&#xD;
Discussion&#xD;
&#xD;
Regenerative Endodontics is a widely used treatment option nowadays. Dentinal wall thickening and root lengthening are extensively seen with it as compared to apexification.10 The occurrence of sufficient occlusal seal is possible with it, helping in inhibition of re- infection.11 Immature non-vital maxillary anterior tooth is not suitable for endodontic therapy due to its thin dentinal walls.12 PRF offers superior results in terms of apical closure and root lengthening. Revascularization of immature, necrotic maxillary anterior teeth proved to be beneficial for the regeneration of apical tissue to initiate apexogenesis.13 A study by Windley et al.,14 assessed the usefulness of antibiotic paste in the disinfection of immature dog teeth with apical periodontitis.&#xA0; It was ascertained that disinfection of canal, insertion of scaffold matrix for permitting tissue growth and effective coronal seal against micro-organism can be the deciding pints in endodontic revascularization of necrotic immature teeth. This is a novel procedure in endodontics.8 In the present study, we attempted to assess endodontic revascularization of necrotic permanent anterior with PRF, PRP and blood clot.&#xD;
&#xD;
In this study, we enrolled 30 teeth which had 18 males and 12 females. age group 15-25 years comprised of 10 males and 7 females and 20-25 years had 8 males and 5 females. Group I used PRF, group II used PRP plus collagen and group III used blood clot. Group I had 6 males and 4 females, group II had 5 males and 5 females and group III had 4 males and 6 females. Rizk et al.,15 conducted a study on 30 patients for determining pulp revascularization process in maxillary necrotic permanent immature central incisors in which group I was treated with PRP and group II with PRF scaffolds. Results showed significant improvement in the increase in bone density and reduction in apical diameter. PRP found to be an alternative to PRF in the revascularization process. &#xD;
&#xD;
We found that excellent healing was seen in 80% in group I, 30% in group II and 10% in group III. This can be explained by the fact that the PRF serves as a matrix onto which vital cells from the peri-apical is seeded to re-establish pulp vascularity.16&#xD;
&#xD;
In this study it was observed that apical closure found to be good in 45% and excellent in 20% in group I, good in 60% and excellent in 20% in group II and good in 20% and fair in 80% in group III. The concept of revascularization has been explained by numerous researchers. It is hypothesized that at the apical end of the root canal, a small amount of vital pulp tissue containing dental pulp stem cells (DPSCs) remains which retain tissue regeneration potential and can multiply into the newly formed blood clot matrix. It tends to differentiate into odontoblasts and deposits tertiary or tubular dentin.17&#xD;
&#xD;
We observed that dentinal wall thickening was fair in 35%, good in 40% and excellent in 60% in group I, 40% in group II and 25% in group III. It was good in 20%, 30% and 40% in group I, II and III. The revascularization procedure is possible due to the presence of stem cells in the apical papilla of incompletely developed teeth.18 The presence of collateral circulation at the apical papilla region promotes survival during the process of pulp necrosis. It also promotes the regeneration of pulpal tissues. In the presence of surviving epithelial cells from Hertwig&#x2019;s roots sheath, it may differentiate into primary odontoblasts to induce root formation completion.19 &#xD;
&#xD;
Narang et al.20 compared regenerative procedure in 20 patients using MTA, blood clot, PRF and PRP in group I, II, III and IV respectively. It was found that 98% of cases in Group III showed excellently, 60% in Group II and 80% in Group IV showed good results in terms of periapical healing. 90% in Group III showed excellently, 40% in groups II and IV showed good results in terms of root lengthening with the non-significant difference between group (P&gt; 0.05). Apical closure found to be good in 66.7%, 40% and 60% in group II, III and IV respectively. Revascularization accompanied with PRP contributed improved results than blood clot group.&#xD;
The constraint of the present research is the smaller sample size. Only PRF and PRP material was included in this study. The inclusion of more materials could have shown better results. &#xD;
&#xD;
Conclusion&#xD;
&#xD;
A successful revascularization procedure in necrotic permanent anterior teeth was observed both clinically as well as radiographically. It was concluded from the present study that PRP had superior result in terms of apical closure, root lengthening and dentine wall thickness compared to the blood clot and PRF.&#xD;
&#xD;
Conflict of interest: Nil&#xD;
&#xD;
Source of funding: Self&#xD;
&#xD;
Acknowledgement: Nil&#xD;
&#xD;
Authors contribution&#xD;
&#xD;
&#xD;
	&#xD;
	Dr. Suvarna Sunder J- review&#xD;
	&#xD;
	&#xD;
	Dr. Seema Abid- editing&#xD;
	&#xD;
	&#xD;
	Dr. Sabahat Ullah Tareen - manuscript writing&#xD;
	&#xD;
	&#xD;
	Dr. Prabhu Mahin S- evaluation&#xD;
	&#xD;
	&#xD;
	Dr. Akhil&#xA0; Shetty- assessment&#xD;
	&#xD;
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	Dr. Pawn Patel- data collection&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3892</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3892</Fulltext></URLs><References>&#xD;
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	Bonte E, Beslot A, Boukpessi T, Lasfargues JJ. MTA versus Ca (OH)2 in apexification of non-vital immature permanent teeth: A randomized clinical trial comparison. Clin Oral Investig. 2015; 19: 1381&#x2013;1388.&#xD;
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	Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod 2009; 35: 745-749. &#xD;
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	Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in the regeneration of necrotic immature permanent teeth: A clinical study. Contemp Clin Dent. 2015;6:63-8.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Effects of Early Ambulation in Post Operative Recovery Among Women with Abdominal Hysterectomy&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>210</FirstPage><LastPage>217</LastPage><AuthorList><Author>Amruta Taksande</Author><AuthorLanguage>English</AuthorLanguage><Author> Manjusha Mahakalkar</Author><AuthorLanguage>English</AuthorLanguage><Author> Vaishali Taksande</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Background: Amazed all hysterectomy, most frequently performed surgical procedures in women is abdominal hysterectomy. If early ambulation is not done post operatively, there is chance of different complications such as eruption, deficient veins, lowers respiratory tract infection, minor bleeding and venous thrombo-embolism, blockage of pulmonary artery, paraplegic ileum and etcetera. Objectives: 1) To assess post operative recovery among the women who have undergone abdominal hysterectomy in control group.2) To assess the effectiveness of early ambulation in post operative among the women who have undergone abdominal hysterectomy in experimental group. 3) To compare post-operative recovery among the women who have undergone abdominal hysterectomy in control and experimental group. Methods and Materials: A quantitative research approach was used in this study with quasi-experimental group study research design and sample size was 100 were selected by a Non-Probability Purposive Sampling Technique. An observational checklist and post-operative related questionnaire was used to collect the data. Results: In experimental group, duration of post operative recovery among women who has undergone abdominal hysterectomy is less as compared to post-operative recovery among women who has undergone abdominal hysterectomy in control group. Also structured questionnaire related to post-operative recovery interpret that early ambulation is effective one in experimental group as compared to in control group. Conclusion: Early ambulation is effective and helps to recover soon.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Early ambulation, Post operative recovery, Abdominal hysterectomy, Abdominal surgery, Gynecological operations</Keywords><Fulltext>INTRODUCTION&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; Typically a gynecologist performs &#xA0;hysterectomy, which is a cut-out or surgical removal of the vagina. Hysterectomy may be complete body removal, known as total hysterectomy or fundus, and cervix uterine; sometimes referred to as partial removal of &#xA0;uterine body known as partial hysterectomy while keeping the cervix intact, known as supra cervical hysterectomy. It is the most frequently performed surgical procedure. More than 600,000 hysterectomies have been conducted in 2003.1,7 In favorable cases, more than 90 % of these procedures are conducted in the US alone. Such high rates in industrialized world have led major controversy that hysterectomies are performed largely for unwarranted and unnecessary reasons.2,3&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; As a last resort to cure such intractable uterine/reproductive system problems, hysterectomy is usually recommended. These disorders may include uterine fibroids, extreme intractable endometriosis, adenomyosis, chronic pelvic pain, frequent obstetric hemorrhage, and various forms of vaginal prolapse, and sometimes serious pre-placenta and placenta accrete.3,4,5&#xD;
&#xD;
MATERIALS AND METHODS &#xD;
&#xD;
The study was based on a quantitative research approach with a quasi-experimental group study research design. A Non-Probability purposive sampling technique was used and 100 samples of women from selected hospitals. Inclusion criteria were women between ages of 20 and 50 years and older and women who want to take part in this study. Exclusion criteria were women who are not available at the time of study and women who are having post abdominal hysterectomy complications. Tools were an observational checklist and post-operative related questionnaire. The data gathering process began from 12th Aug to 31st Aug 2019. The investigator visited the area in advance and obtained the necessary permission from the concerned authorities. The institutional Ethics Committee in its meeting&#xA0; held &#xA0;on 12/12/2018 has approved the study and the Referral number is 7758. Based on the objectives and the hypothesis the data were analyzed by using various statistical tests. In control group, early ambulation is not suggested while in experimental group, early ambulation is suggested and checklist is assessed after 5-6 days of early ambulation.&#xD;
&#xD;
RESULTS &#xD;
&#xD;
Section 1&#xD;
&#xD;
Part I &#x2013; Distribution of participants within the control group according to their demographic variables.&#xD;
&#xD;
Table no 1 Shows that, 6(12%) of 20-29yrs age, 9(18%) 30-39years old, 24(48%) 40-49yrs, 11(22%)50 yrs &amp; above. 37(74%) married, no subjects &#xA0;unmarried, 3(6%) &#xA0;divorced or separated, 10(20%) widow. 3(6%) illiterate, 18(36%) had primary education, 9(18%) had secondary education,&#xA0; 13(26%)higher secondary &amp; 7(14%) graduated &amp; above. 35(70%)&#xA0; housewife, 4(8%) laborer, 6(12%) &#xA0;business women, 1(2%) on government job, 4(8%) on private job.24(48%)&#xA0; knew &amp; 26(52%) didn&#x2019;t &#xA0;know about abdominal hysterectomy, in 8(16%) &#xA0;source of knowledge was family, in 5(10%) it was friends, in 11(22%) source of knowledge was health personnel.&#xD;
&#xD;
Part II &#x2013; Distribution of participants in the experimental group as per their demographic variables.&#xD;
&#xD;
Table no 2: No subjects were of 20-29 year age group, 11(22 %) were of 30-39 yrs, 19(38 %) 40-49 yrs age, 20(40%) were 50 yr-old &amp; above. 36(72%)&#xA0; married, 3(6%) single, none divorced or separated, 11(22%) were widow. 7(14%) were illiterate,14(28%) primary education, 8(16%) secondary education,&#xA0; 13(26%)&#xA0; higher secondary, 8(16%) is graduated &amp; above. 30(60%) housewife, 7(14%) labourer, 5(10%)&#xA0; business women, 3(6%) on government job and 5(10%) on private job.23(46%) subjects knew whereas 27(54%) did not know about abdominal hysterectomy, in 5(10%) source of knowledge was media, in 3(6%) it was family, in 2(4%) it was friends, in 13(26%) source of knowledge was health personnel.&#xD;
&#xD;
Section 2&#xD;
&#xD;
Part I &#x2013; Checklist to assess the post-surgical recovery among women who have suffered abdominal hysterectomy in Control group.&#xD;
&#xD;
Table no. 3 contain 29(58%) On day 4 &amp; 21(42%) women on 5th day rest on &#xA0;bed&amp;#39;s edge.&#xD;
&#xD;
&#xA0;29(58%) on 4th day &amp; 21(42%) were sitting on bed on POD5.&#xD;
&#xD;
29(58%) on the 4th day &amp; 21(42%) moved out of bed on POD5.&#xD;
&#xD;
20(40%) on day 4 , 20(40%)on 5th &amp; 10(20%) &#xA0;were sitting in &#xA0;chair on 6th day.&#xD;
&#xD;
2(4%) on day 4, 28(56%) on POD5, 20(40%) walk in ward on day 6th day.&#xD;
&#xD;
29(58%) on day 5, 21(42%) on POD6 perform walk in ward.&#xD;
&#xD;
&#xA0;1(2%) on POD 4, 28(56%) on day 5 &amp; 21(42%) on POD 6 perform stairs up &amp; down.&#xD;
&#xD;
&#xA0;22(44%) on day 4, 27(54%) on day 5 &amp; 1(2%) felt decreased intensity of pain on POD6.&#xD;
&#xD;
&#xA0;21(42%) on day 4, 28(56%) on POD 5 and 1(2%) on POD6 felt decreased level of discomfort.&#xD;
&#xD;
&#xA0;5(10%) on day 4, 39(78%) on day 5 and 6(12%) on POD6 felt decreased level of dependency in performing daily activities.&#xD;
&#xD;
5(10%) on day 4, 33(66%) on day 5, 12(24%)on POD6 passed flatus.&#xD;
&#xD;
Part II &#x2013; Checklist to assess the efficacy of early ambulation in post-operational recovery among women who have undergone abdominal hysterectomy in Experimental group.&#xD;
&#xD;
Table no. 4 shows the following data&#xD;
&#xD;
26(52%) on POD2 while 24(48%) sat on bed&#x2019;s edge on POD3.&#xD;
&#xD;
22(44%) on POD2, 28(56%) were sitting in bed on POD3.&#xD;
&#xD;
22(44%) on POD2, while 28(56%) women shifted out of bed on day 3.&#xD;
&#xD;
17(34%) on day 2, 30(60%) women on day 3, 3(6%) &#xA0;on day 4 were sitting at chair.&#xD;
&#xD;
25(50%) on day 3, 25(50%) women walk in ward on POD 4.&#xD;
&#xD;
22(44%) on POD 3, 28(56%) on POD4 perform walking in corridor.&#xD;
&#xD;
22(44%) on POD 3, 28(56%) women on day 4 perform stairs up and down.&#xD;
&#xD;
14(28%) on POD2, 32(64%) on POD 3, 4(8%) on day 4 felt decreased intensity of pain.&#xD;
&#xD;
14(28%) on day 2, 32(64%) on day 3, 4(8%) on day 4 felt decreased level of discomfort.&#xD;
&#xD;
19(38%) on day 2, 28(56%) on day 3 and 3(6%) on day 4 felt decreased level of dependency in performing daily activities.&#xD;
&#xD;
9(18%) on day2, 35(70%) on day 3, 5(10%) on day 4 and 1(2%) women on day 5 passed flatus.&#xD;
&#xD;
Section 3&#xD;
&#xD;
Table no. 5 shows a Comparison between the control and experimental group&#xA0; &#xD;
&#xD;
In control group, 29(58%) on 4th day, 21(42%) on 5th day while in experimental group, 26(52%) on 2nd day &amp; 24(48%) women on 3rd day perform a sitting on edge of bed.&#xD;
&#xD;
In control group, 29(58%) on 4th day, 21(42%) on 5th day wherein among experimental group, 22(44%) on 2nd day, 28(56%) subjects on 3rd day perform a sit to stand by bed.&#xD;
&#xD;
29(58%) on 4th day 21(42%) on 5th day, in control group, 22(44%) on 2nd day, 28(56%) women on 3rd day in experimental group moved out of bed.&#xD;
&#xD;
In the control group, 20(40%) on the 4th day, 20(40%) on the 5th day, 10(20%) on the 6th day whereas in the experimental group, 17(34%) on the 2nd day, 30(60%) on the 3rd day 3(6%) subjects on 4th day sat to stand by the chair&#xD;
&#xD;
2(4%) women on 4th day, 28(56%) on 5th day, 20(40%) on 6th day in the control group whereas 25(50%) on 3rd day, 25(50%) women on 4th day in the experimental group performed walking in the ward.&#xD;
&#xD;
In control group, 29(56%) subjects on 5th day, 21(42%) on 6th day while in experimental group, 22(44%) on 3rd day, 28(56%) on 4th day performed walking in corridor.&#xD;
&#xD;
1(2%) on 4th day, 28(56%) on 5th day 21(42%) on 6th day in control group while 22(44%) on 3rd day, 28(56%) on 4th day in experimental group performed stairs up and down. &#xD;
&#xD;
In the control group, 22(44%) on the 4th day, 27(54%) on the 5th day 1(2%) on the 6th day whereas in the experimental group, 14(28%) on the 2nd day, 32(64%) on 3rd day, 4(8%) women on 4th day had decreased intensity of pain.&#xD;
21(42%) on 4th day, 28(56%) on 5th day 1(2%) on 6th day in control group and 14(28%) on 2nd day, 32(64%) on 3rd day, 4(8%) subjects on 4th day felt decreased level of discomfort.&#xD;
&#xD;
In the control group, 5(10%) on the 4th day 39(78%) on the 5th day, 6(12%) on the 6th day wherein in the experimental group, 19(38%) on the 2nd day, 28(56%) on 3rd day, 3(6%) women on 4th day had decreased level of dependency in performing daily activities.&#xD;
&#xD;
&#xA0;5(10%) on 3rd day, 33(66%) on 4th day, 12(24%) on 6th day in the control group whereas 9(18%) on 2nd day, 35(70%) on 3rd day, 5(10%) on 4th day 1(2%) subjects on 5th day in the experimental group passed flatus.&#xD;
&#xD;
Section 4-&#xD;
&#xD;
Structured questionnaire related post-operative recovery in the control and experimental group and comparison between them.&#xD;
&#xD;
Table no. 6(a) having information about control group, duration of catheterization was 19-24hrs in 10 (20%) and 25-30 hrs in 40 (80%). In experimental group, it was 6-12hrs in 24(48%), 13-18hrs in 3(6%), 19-24hrs in 14(28%) and 25-30 hrs in 9(18%) women.&#xD;
&#xD;
Table no.6(b) shows, control group, 8(16%) self void 2hr however, in experimental group, 48(96%) women self void in 450 ml urine output. In experimental group, 5(10%) having 150-300 ml,4(8%) having 301- 450ml and 41(82%) having &gt;450 ml urine output. &#xD;
&#xD;
Table no. 6(c) having the information,In control group, 45(90%) 1-2 analgesic, 5(10%) required 3-4 analgesics &amp; in experimental group, 49(98%) 1-2, 1(2%) required 3-4 analgesics after hysterectomy. &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; In the control group, 6(12%) for 7-8 days, 44(88%) for &gt;8 days while in the experimental group, 28(56%) for 4-5 days, 8(16%) for 6-7 days and 14(28%) women for 7-8 days stays in the hospital. &#xD;
&#xD;
DISCUSSION&#xD;
&#xD;
Similar study was conducted which was eventual adherent study in which amide 50 patients who had undergone abdominal hysterectomy from June 1, 2003 to December 31, 2003. Study aimed to discover early activity&amp;#39;s security and viability. The study concluded that in patients with hysterectomy, the early operation is possible and healthy. After 2 days of ambulation, most of the clients (78%) were able to ambulate 100feet.4,5,6 &#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; This study shows that, in experimental group, duration of post operative recovery among women is less as compared to post-operative recovery among women who has undergone abdominal hysterectomy in control group. Also structured questionnaire related to post-operative recovery interpret that early ambulation is effective one in experimental group as compared to in control group in which only post-operative recovery checked and early ambulation not suggested.7,8,9&#xD;
&#xD;
CONCLUSION &#xD;
&#xD;
Therefore, healthcare providers at all levels need to understand the importance of early ambulation after abdominal hysterectomy, become educated on the protocols and procedures of practice in order to make early ambulation on day zero new standard of care for all postoperative patients. Conflict of interest is nil and the source of funding was self. Early ambulation improved the state and aids in early discharge.&#xD;
&#xD;
ACKNOWLEDGEMENT&#xD;
&#xD;
We would like to thank all the participants and the authorities of the institutions for their cooperation throughout the data collection.&#xD;
&#xD;
Conflict of Interest : None&#xD;
&#xD;
&#xA0;Source of Funding: None&#xD;
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</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3893</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3893</Fulltext></URLs><References>1.Pinar G, Okdem S, Dogan N, Buyukgonenc L, et al. The Effects of hysterectomy on&#xA0;Body Image, self esteem and Martial adjustment in Turkish women with&#xA0;Gynaecologic cancer. Clin J Onc Nur. 2012; 16(3):99-104.&#xD;
&#xD;
2. Elizabeth A Stewart, Wanda K Nicholson, et al. The burden of uterine fibroids for&#xA0;American-American women: results of a national survey. J Wom Hea.&#xD;
&#xD;
2013:22(10); 807-816.&#xD;
&#xD;
3. Daniel Morgan, Across the country, fewer women are getting hysterectomies and&#xA0;those who do are choosing less invasive methods with no hospital stays, saving&#xA0;millions in health care costs. Inst Health Pol Inn. 2018;23 (9): 142-145.&#xD;
&#xD;
4. Earnest VV. Procedure Checklist to Accompany Caroline Bunker Rosdahl&amp;#39;s&#xA0;Textbook of Basic Nursing. Lippincott; 1999; 142-145.&#xD;
&#xD;
5. Priya SP, Roach EJ, Lobo DJ. Effectiveness of pre-operative instruction on&#xA0;knowledge, pain, and selected post-operative behaviours among women undergoing&#xA0;abdominal hysterectomy in selected hospital, Bangalore, Karnataka. Man J Nur Hea Sci. 2017; 3(1):3-9.&#xD;
&#xD;
6. Katz A. Sexuality after hysterectomy. J Obst Gynec Neon&#xA0;Nur. 2002 May; 31(3):256-62.&#xD;
&#xD;
7. Banos Calbo M. Enhanced Recovery Programme in Abdominal Surgery. J Obst Gynec NeonNur.2018:30(4): 875-879.&#xD;
&#xD;
8.&#xA0; Behjati AZ. An Evaluation of the Historical Importance of Fertility and Its&#xA0;Reflection in Ancient Mythology. Avic Res Insti. 2016; 17(1):&#xA0;2-9.&#xD;
&#xD;
9. Chaudhari S. Psychiatric effects of Hysterectomy. J Adv Res. 1995;&#xA0;January; 51(1): 27&#x2013;30.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Virtual Screening and Molecular Docking Study to Identify Novel Inhibitors Against Japanese Encephalitis Virus&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>168</FirstPage><LastPage>174</LastPage><AuthorList><Author>Kamal Soni</Author><AuthorLanguage>English</AuthorLanguage><Author> Ruchi Yadav</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Japanese Encephalitis Virus, Japanese encephalitis, Docking, Ligand detection, Glide dock</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=3894</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=3894</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>7</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Meaning of Life and Emotional Ventilation of Mothers having Children with Autism Spectrum Disorder&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>218</FirstPage><LastPage>221</LastPage><AuthorList><Author>Sagayaraj K</Author><AuthorLanguage>English</AuthorLanguage><Author> Gopal CNR</Author><AuthorLanguage>English</AuthorLanguage><Author> Karthikeyan S</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Autism Spectrum Disorder (ASD) is a range of neurodevelopmental related mental disorder which affects the individual&#x2019;s social interactions, communication and also causing the comorbid condition of repetitive behaviour, self-injurious behaviour, and developmental delays. It has been identified that mothers having children with autism have a higher level of parenting-related stresses and longing for better physical, social and mental health. Meaning of life comprises of &#x201C;Who are we?, Why are we here ?, What is the purpose of our life? and what is the reason we are living for ?&#x201D; in the context of scientific theories, philosophical and theological explanations. Mothers with special children spend most of their life by providing supportive care to their children and fail to realize their meaning of life. Methods: To understand the purpose of life of mothers who are having children with ASD, The Meaning of Life Questionnaire developed by Steger M. F(2006) was administered to 15 mothers who are having children with ASD followed by a semi-structured interview. An overall perceptive was reported in this study. Result: The result indicates that there was no significant difference in presence and search state in the meaning of life of mothers having children with ASD. Conclusion: The participants from this study disclosed that they have not valued the meaning and purpose in life which can be addressed by psychological counselling and intervention.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Autism, Counselling, Disability, Emotion, Meaning of life, Parenting</Keywords><Fulltext>INTRODUCTION:&#xD;
&#xD;
The term "meaning of life" is commonly used in various contexts and has no clear definition. Many authors have described the experience of one&amp;#39;s life as meaningful based on their feeling of integration and relatedness or a feeling of fulfilment and significance.1,2When someone stating that he or she has meaning in their life, It implies that they have committed to the values, believes and positively committed to some core concept which provides a framework or directive goal to view their life in fulfilment as a feeling of integration, relatedness or significance.3,4Parenthood is one of the most difficult jobs in everyone&#x2019;s life because it creates the new chapter in their life story. It invigorates another self in them something that they did not know was there until they had children. It also gives them a new sense of purpose and meaning in life. As a parent, they tend to encounter love and passion for their children that they have never experienced before.5 There is a vast number of studies that confirms that the parents of special need children experience a higher level of stress, anxiety and depression.6,7The recent study indicates that they experience a mixture of joy and sorrow with the presence of a child with a special need. 8,10All human beings are craving for the meaning and true purposes of their life. In the parenting phase, every parent expects to have an average child who does not have any physical and psychological deficiency but when they have the special child they feel helpless, stressed and lose their purposes in life.11 Research shows that the meaning of life can be viewed in two broader dimensions thus, existence and search for meaning.12&#xD;
&#xD;
Emotional ventilation is an art and essentials of our lives. Emotions in general will add importance and structure to our feelings and without these emotional expressions, we would resemble robots. How we feel and express emotions play a major role in physical and mental functioning. Emotional ventilation is the core of the healthy body, mind and soul. It is a sign of good health and strength rather than weakness.13 Mothers having children with special needs find no time and energy for the continuous caretaking of their children which leave them more stressed, helpless and hopeless in life. Hence, to develop a greater understanding of the lives of families with special needs children especially in the condition of ASD in terms of the meaning of life this study was carried out. &#xD;
&#xD;
Aim:&#xD;
&#xD;
The study aims to analyze the meaning of life and emotional expression of mothers having children with an autism spectrum disorder.&#xD;
&#xD;
METHODOLOGY:&#xD;
&#xD;
Hypothesis for the study:&#xD;
&#xD;
There will be no significant difference in the presence and search state on the meaning of life of the mothers having children with an autism spectrum disorder. &#xD;
&#xD;
Research Design: Ex post facto research design was adopted for this study. &#xD;
&#xD;
Sampling: Purposive sampling method was used in this study. Participants who were fulfilling the following inclusion criteria were only selected.&#xA0; The basic demographic details like age, education, family type, religion and socio-economic status were collected. All the participants were from the rural village of Kanchipuram district such as Kanathur, Mutthukadu and Kovalam located in Tamil Nadu, India. &#xD;
&#xD;
Inclusion Criteria: &#xD;
&#xD;
&#xD;
	&#xD;
	Mothers who were having children with ASD between the age of&#xA0; 5 to 10 years were included. &#xD;
	&#xD;
	&#xD;
	Mothers with no psychiatric conditions were only included.&#xA0; &#xD;
	&#xD;
&#xD;
&#xD;
Exclusion Criteria: Mothers with serious physical and psychiatric problems, not being primary caregivers were excluded.&#xD;
&#xD;
Tool Used:&#xD;
&#xD;
The Meaning of life Questionnaire ( MLQ ).Steger, M. F (2006). It assesses two dimensions of meaning in life ( Presence &amp; Search ) using 10 items rated on a seven-point scale from &#x201C;Absolutely True&#x201D; to &#x201C;Absolutely Untrue.&#x201D; (i) Presence subscale scoring is done by adding items 1, 4, 5, 6 and 9. Scores range between 5 to 35. (ii) Search subscale scoring was done by adding items 2, 3, 7, 8 and 10. Scores range between 5 to 35. The internal consistency of the scale was found to be Presence (0.86) and Search (0.87) with good reliability. The scale is found to have good convergent, discriminant validity. 12&#xD;
&#xD;
Scoring Interpretation:&#xD;
&#xD;
The below interpretation is a probabilistic guess about the areas of life based on the MLQ scoring. Numerous studies also confirmed the same but it cannot be considered as a diagnostic tool for labelling their opinion about life. The context meaning of life differs from a different cultural and religious point of view. &#xD;
&#xD;
&#xD;
	&#xD;
	If the score is above 24 on Presence and also above 24 on search then it can be inferred that, &#x201C;They feel that life has value, meaning and purpose. Yet still openly exploring the meaning or purpose. &#xD;
	&#xD;
	&#xD;
	If the score is above 24 on Presence and below 24 on search, they feel their life has valued meaning and purpose, and are not actively exploring that meaning or seeking meaning in their life.&#xD;
	&#xD;
	&#xD;
	If the score is below 24 on Presence and above 24 on search, they probably do not feel their life has a valued meaning and purpose, and they are actively searching for something or someone that will give their life meaning of purpose.&#xD;
	&#xD;
	&#xD;
	If the score is below 24 on Presence and also below 24 on search, they probably do not feel their life has a valued meaning and purpose, and are not actively exploring the meaning or seeking meaning in their life. &#xD;
	&#xD;
&#xD;
&#xD;
Procedure:&#xD;
&#xD;
All the participants were mothers of children with autism spectrum disorder and they were approached individually. Voluntary participation and the right to withdraw from the study was informed. After obtaining consent from the participants the MLQ questionnaire was used followed by the semi-structured interview. Initially, the participants were asked about how they were feeling about their current life situation, where it was meaningful in their point of view and was there any possibility of finding fulfilment in their life despite having a child with ASD. They were also encouraged to ventilate the family problems and emotional distress, issues in parenting the child with ASD. The interview lasted for about 15 to 20 minutes for each parent. After the personal semi-structured interview session they were thanked for their participation. &#xD;
&#xD;
Ethical Consideration:&#xD;
&#xD;
This study was carried out with the approval of the Institutional Human Ethics Committee of Chettinad Academy of Research and Education (216/IHEC/Nov 2020), Kelambakkam, Chennai, Tamil Nadu, India as a part of the doctoral research. &#xD;
&#xD;
Statistical Analysis: The collected data was analyzed by using the SPSS version 20. Descriptive statistics and t-test was incorporated for the data analysis. &#xD;
&#xD;
RESULTS AND DISCUSSION:&#xD;
&#xD;
&#xD;
&#xD;
The results indicate that the t value of 3.00 was found to be non-significant at the 0.05significant level hence hypothesis 1 is accepted. From the scoring procedure, it can be inferred that their presence and search state is below the expected score, which indicates that the selected samples of mothers having children with ASD have not valued meaning and purpose in their life and also not seeking actively the fulfillment of their life.&#xD;
&#xD;
During the semi-structured interview, the mothers had emphasized the physical and emotional distress that they have undergone in parenting their child. Studies show the present state in one&#x2019;s life is associated with better physical and emotional wellbeing which is generally lacking in parents with a special child.15,17&#xA0; The mean score of both presence and search was found to be 22 in the selected samples and as per interpretation, it can be inferred that selected mothers having children with ASD have not valued their meaning in life and also not keenly looking for the same.&#xA0; When asking about their futuristic plan in life they all stressed upon good well-being of their children and some of them even hoping for a complete cure from ASD.&#xA0; Even though they were educated about the child&#x2019;s condition and prolonged comprehensive care, they were just anticipating the miracle of complete cure from ASD as the child is growing older. According to the meaning of the life refers to their child&#x2019;s normalized physical functioning and recovery from the mental illness. They value nothing more important in their life than their child&#x2019;s well-being. &#xD;
&#xD;
For a longer period, they misunderstood autism with mental retardation and was getting the available medical and psycho rehabilitation therapy which has taken their money, time and energy.&#xA0;To&#xA0;get&#xA0;a clear diagnosis of&#xA0;autism&#xA0;itself took nearly about 2 to 3&#xA0;years.&#xA0;The mothers who were interviewed were&#xA0;from low&#xA0;and middle&#xA0;socioeconomic backgrounds, and they revealed their best financial&#xA0;plan&#xA0;was&#xA0;to feed&#xA0;the&#xA0;child&#xA0;three meals a day&#xA0;and no&#xA0;health insurance, savings were planned due to the low income of the family. During the interview session, they had ventilated the burden of having a child with ASD. Their self-confidence and quality of life were severely affected due to the condition of having a child with ASD. 18,19While explaining their problems they also mentioned the love and care that they show to make the child understand the emotional care of the mother. From being conceived with a child to birth, and from identifying the condition of autism to caretaking daily all these mothers played a vital role in the child comprehensive development. &#xD;
&#xD;
CONCLUSION:&#xD;
&#xD;
&#xA0;The present findings of this investigation reveal that mothers of children with ASD do not find value, meaning and purpose in life. From the responses of the participants, we could understand that the mothers of ASD children would feel happy and find meaning in life only when their children get good physical and mental well-being. It is a challenging task for the mental health care professionals like psychologists, psychiatrists to address the parents with special children to find the purposes in their life. It is a need of the hour which supposed to be addressed in the form of counselling, psychotherapy and intervention. &#xD;
&#xD;
Limitations and Future Directions: Meaning of life is more of one&#x2019;s personal opinion based on cultural, religious aspects and differ from environmental, socio-economic status. Considering the small number of participants of mothers having children with ASD, the result cannot be generalized for the larger population. An attempt of measuring the meaning of life with good psychometric properties allows a more nuanced analysis of their lifestyle and expectations. The Theotherwell-being components can be administered and studied in correlating with MLQ for developing better training, intervention for the mothers having children with ASD. &#xD;
&#xD;
Implications: After an effective training program for the parents who are having special children such as autism spectrum disorder, the meaning of life questionnaire can be administered with appropriate counselling techniques to create a positive attitude towards life and valuing the meaning and purpose of it. In addition, the questionnaire could also be used to gather information about their expectations in life and assess successful therapy outcomes for the same &#xD;
&#xD;
Conflict of Interest: None&#xD;
&#xD;
Source of Funding: Chettinad Academy of Research and Education, Junior Research Fellowship (CARE &#x2013; JRF) fund.&#xD;
&#xD;
Acknowledgement: &#xD;
&#xD;
The corresponding author would like to thank and acknowledge Chettinad Academy of Research and Education, Junior Research Fellowship (CARE &#x2013; JRF) for supporting this work.&#xA0; He would also like to express his gratitude to the doctoral committee members Prof. Dr. R.Murugesan, Director - Research, CARE and Prof. Dr. OT. Sabari Sridhar, Head-Department of Psychiatry, CHRIfor their valuable suggestions and support during the work.&#xD;
&#xD;
Author&#x2019;s Contribution:&#xD;
&#xD;
Conceived and designed the study: Gopal CNR, Sagayaraj K&#xD;
&#xD;
Semi-Structured Interview: Karthikeyan S, Sagayaraj K&#xD;
&#xD;
Statistical analysis and writing original draft: Sagayaraj K&#xD;
&#xD;
Writing - Review &amp;Editing: Gopal CNR, Karthikeyan S&#xD;
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	Weisskopf JE. Mental health and intention. J Psychol. 1968;69(1):101-106. &#xD;
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	Steger MF, Fitch MA, Donnelly J, Rickard&#xA0; CM. Meaning in life and health: Proactive health orientation links meaning in life to health variables among American undergraduates. J Happiness Stud. 2015;16 (3), 583&#x2013;597. &#xD;
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	Karthikeyan S, Sivakumar V, Gopal CNR, Sagayaraj K. General Well-being and Self-Concept of Mothers having children with Multiple Disabilities. J Psyc Resea.2019; 63(1), 39-45. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>A Study on Occupational Health Hazards of Sanitation Workers in District Multan, Pakistan&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>222</FirstPage><LastPage>232</LastPage><AuthorList><Author>Muhammad Meesum Hassan</Author><AuthorLanguage>English</AuthorLanguage><Author> Naveed Farah</Author><AuthorLanguage>English</AuthorLanguage><Author> Saima Afzal</Author><AuthorLanguage>English</AuthorLanguage><Author>Abu Safian</Author><AuthorLanguage>English</AuthorLanguage><Author> Sidra Hussain</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract></Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Sanitation workers, Manual scavengers, Sewage workers, Septic tank cleaner, Job of hazards, Social humiliation</Keywords><Fulltext>&#xD;
INTRODUCTION &#xD;
&#xD;
When confronted with dirty toilets, overflowing septic tanks, or sewage-stained roadways, many of us are unaware of the importance of sanitation employees&amp;#39; work. We need a lot more of these employees to meet the ambitious goal of Sustainable Development Goals (SDG). Despite this, sanitation workers are generally unseen, and they labour in settings that expose them to the worst effects of poor sanitation, including severe illnesses, physical injuries, social humiliation, and even death in the course of their work.1 In the literature, sewage-exposed employees are typically referred to by several job names. A difference is made between employees at the sewage treatment facility and those who maintain the duct system, or sewer system. Often, they are referred to as sewer workers or sewage treatment facility personnel, respectively. There is no obvious difference between the varied labour duties performed by sewage employees and those who operate in other areas of the sewage system.2&#xD;
&#xD;
It&#x2019;s unfortunate that within Pakistan, janitorial work is highly stigmatized and reserved for individuals from low-income social classes. These janitors work in highly unhygienic, often life-threatening and working conditions. Every year, thousands of people in Pakistan lose their lives in gutters and manholes, due to exposure to poisonous gases and unhygienic waste materials. They don&#x2019;t have access to safety equipment and supplies. As a result, they are always at risk of contracting illnesses such as hepatitis and TB, as well as smallpox and rabies. In terms of medical or safety support, workers are not compensated in any way.3 In cities, urbanisation has led to many sanitation issues, including a huge amount of waste, unclean streets, and clogged drains, all of which increase the sanitation employees&amp;#39; workload and working hours significantly. Sanitation employees are in charge of keeping the environment clean. As a result of inadequate resources in underdeveloped nations, the majority of the cleaning procedure in metropolitan areas is still done by hand. Garbage of all kinds is dumped on the streets due to poor waste material categorization at the source. Worker exposure to filth, infectious organisms and other dangerous items such as chemicals, animal excrement and sharp objects is a daily occurrence for sanitation personnel Sanitation employees are exposed to rain, snow, sand, cold, and UV radiation due to their outside employment. These variables have a negative impact on the sanitation employees&amp;#39; general health .4&#xD;
&#xD;
The job of a sewer man includes several occupational risks that pose a serious threat to the worker&amp;#39;s health and life. Accidental risks like gassing, injury, and immersion are common among sewer workers (flooding). Other health issues that affect them include occupational lung diseases, upper respiratory tract infection (URI), contact dermatitis, neurological problems such as headache and dizziness, eye problems such as burning or watering that can turn into redness, parasitic infections in the gut, and musculoskeletal problems such as fatigue and backache. Workers tended to have reduced lung function. 5 Sewer cleaning employees aren&amp;#39;t properly trained, and the city doesn&amp;#39;t enforce safety measures like wearing safety gear and utilising suitable equipment. They are inadequate for the employees even if it is provided, which leads to worker compromises and diseases and accidental fatalities. States often underreport the number of fatalities in these situations. Almost a century has passed since the working circumstances of sanitation employees changed.6&#xD;
&#xD;
From permanent public or private employees with health benefits and retirement to some of the most marginalised and mistreated elements of society who take up low-grade and risky employment. It is financially unstable for individuals who work informally, with little compensation and minimal benefits. As a result of inadequate legal protection, a lack of or ineffective standard operating procedures, and lax enforcement of laws safeguarding their rights and health, sanitation employees often suffer. According to a comparative study of the instances, reducing the occupational health and safety concerns along the sanitation service chain (whether manual or mechanised) requires a systematic approach. 6,7&#xD;
&#xD;
This study explored challenges faced by sanitation workers. In Pakistan with the advent of drainage machinery and trucks the manual scavenging and sanitation in Government departments is decreasing but this problem is persistent with the individual mobile sanitation workers who work individually without protective measures. Moreover, in congested urban areas, mechanized trucks cannot reach for sanitation purposes. A large part of the problems sanitation employees confronts stems from the fact that they are largely invisible in society. Only a small number of nations in the developing world have any kind of rules to safeguard these people. Governments may not have the financial or technological resources to implement laws, and the informality of positions creates further obstacles to implementation. Many more sanitation employees with safe, healthy, and decent working conditions will be needed in the future. To provide us with safe sanitation, employees who manage and maintain the sanitation services must have a safe and dignified working environment. &#xD;
&#xD;
Understanding what sanitation hazards are is the first step in reducing them. It is important to avoid direct exposure to the hazards previously stated by taking sufficient health and safety measures. Sanitation risk assessment at the local level can identify the most important risks at each stage of the service delivery process Improved management practices, technology, and worker behaviour will be used to decrease exposure. PPE, such as gloves, full-body suits, boots, glasses, and gas detectors, are examples of suitable PPE. Included in this is also technology that will reduce the need for sanitation personnel to go into the pits or sewers. All personnel must be educated in the use of technology following standard operating procedures, and measures to guarantee they are followed must be in place to minimize hazards.&#xD;
&#xD;
Sanitation employees should be given vaccinations, have regular health checks, and be covered by insurance, according to the findings of this study. As a result of this study, standard operating procedures and local-level sanitation standards may be established and approved at the city level. Training on occupational risks and the usage of personal protective equipment (PPE) are included, as well as safeguards for the employees&amp;#39; health and livelihoods. Monitoring of sanitation personnel&amp;#39; work and behaviour is required to ensure that standard operating procedures are followed. To safeguard the most vulnerable sanitation employees, standard operating procedures and standards that include manual emptying techniques are needed. However, informal, unlicensed, and temporary employees are more prone to violate the rules. Several systemic factors are at play in this situation: Caste and gender-based discrimination, a lack of technology alternatives, difficulties in implementing the legislation, entrenched behaviour that perpetuates the practice, and a lack of worker understanding of their rights and other employment opportunities are some of the obstacles that employees face.&#xD;
&#xD;
Jaiswal away from the social horrors, these sewage employees are also subjected to various occupational health dangers such as exposure to toxic gases, drowning, musculoskeletal disorders, infections, skin difficulties and respiratory system issues as well as cardiovascular disease. Toxic gases that come from sewages and have a direct effect on the health of sewer workers such as hydrogen sulphide, carbon monoxide (CO), ammonia gas, carbon dioxide (CO2), and methane gas.7&#xD;
&#xD;
Watt&#xA0;et al. researchers discovered that the majority of sanitation employees had sub-acute symptoms such as a sore throat, cough and chest discomfort. Dosage seems to be a factor in symptom severity. A year after the event, individuals who were more badly impacted are still unable to work due to deteriorating respiratory symptoms and lung function. Patil and Kamble survey and peak expiratory flow rate (PEFR) analysis were used to determine the occupational health risks of sanitation employees. In the workplace, workers were exposed to a variety of environmental and occupational risks that resulted in musculoskeletal diseases (85%), exposure to hazardous gases (65%), respiratory issues (45%), headaches (40%) and dermatological problems (35%).7,8 As a result, 90 per cent of the employees suffered from cough and colds, while 50 per cent had skin problems, 15 per cent had allergies, 15 per cent had malaria, and 15 per cent had typhoid, while 10 per cent suffered from bronchitis, lung difficulties, and hearing issues, etc.&#xD;
&#xD;
Quansah investigated musculoskeletal problems. The common observations were bent backs, bent legs, heavy manual handling and the poor design of the workplace which was causing problematic working postures. Ntatamala, said sanitation workers are an occupational group commonly affected by shoe dermatitis.8&#xD;
&#xD;
RESEARCH QUESTIONS&#xD;
&#xD;
&#xD;
	&#xD;
	What are the challenges in executing the work?&#xD;
	&#xD;
	&#xD;
	What are the implications of the work on the social and health status of workers?&#xD;
	&#xD;
	&#xD;
	What are the typologies of sanitation work? What is the scale of the problem?&#xD;
	&#xD;
	&#xD;
	What is the level of knowledge of the workers about occupational hazards?&#xD;
	&#xD;
	&#xD;
	Is there a relationship between workers using personal protective devices and their health problems?&#xD;
	&#xD;
	&#xD;
	Is there a relationship between worker&#x2019;s knowledge about occupational hazards and their health problems?&#xD;
	&#xD;
&#xD;
&#xD;
OBJECTIVES OF THE STUDY&#xD;
&#xD;
&#xD;
	&#xD;
	Assessing the knowledge of the workers about occupational safety and health hazards related to Sanitation work. &#xD;
	&#xD;
	&#xD;
	Assessing the workers&amp;#39; health problems. &#xD;
	&#xD;
	&#xD;
	Assessing the workers&amp;#39; use of personal protective devices.&#xD;
	&#xD;
	&#xD;
	Assessing the worksite, environmental safety and hazards&#xD;
	&#xD;
&#xD;
&#xD;
THEORETICAL FRAMEWORK&#xD;
&#xD;
In the theoretical framework, researchers have made two general parts. In the first part, it is shown theoretically why the sanitation workers opt to choose this work as informal work. In the second part, it is showed with the help of theory that how a disease can be caused by any sociological phenomenon.&#xD;
&#xD;
&#xD;
	&#xD;
	Structuralist perspective &#xD;
	&#xD;
&#xD;
&#xD;
Informal sanitation labour is seen as an economic activity carried out by underprivileged people excluded from the official employment market because they have no other choices. According to this definition, informal sanitation workers are persons who labour for low salaries in poor circumstances with no job security. Due to vulnerabilities such as disability, illness or accident, and the death of family members, sanitation workers are obliged to labour merely to pay the daily expenditures of their homes. In addition, family size and unemployment have a major influence on the poor salaries and exploitative working conditions of sanitation workers in general. &#xD;
&#xD;
&#xD;
	&#xD;
	Neo-liberal perspective&#xD;
	&#xD;
&#xD;
&#xD;
Unlike structuralists, neoliberal researchers argue that informal labourers choose to work in Sanitation of their own. In this view, the rise of informal labour is regarded as a direct response to the need to avoid the expense, time, and effort of finding an official job. Because they choose to work in the informal sector, sanitation employees choose to do so. &#xD;
&#xD;
&#xD;
	&#xD;
	Post-structuralist perspective&#xD;
	&#xD;
&#xD;
&#xD;
According to this view, informal workers participate in the informal sector willingly for reasons other than what neo-liberals claim. In contrast to neo-liberals, post-structuralists think that informal sanitation workers chose informal employment because of social ties, such as friends and acquaintances, neighbours and relatives. It is believed that informal sanitation workers are largely social actors who participate in such labour for redistributive, communal, and cultural reasons rather than for merely economic ones according to post-structuralist researchers. Children are inspired by their parents or other family members who are already involved in Sanitation work.9&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
A Sociological Model of Disease&#xD;
&#xD;
&#xD;
&#xD;
Prof. Peter Davis from Christchurch University in New Zealand is one of the sociologists who has created this type of illness model which emphasises social factors rather than disease mechanisms (Davis, 1994). While health research and policy should not focus just on individual diseases and bodies, Davis argues that they should be directed at the economic and political structures that create sickness rather than the individuals themselves. His categorization of sickness is therefore based on economic, social, cultural and political factors.&#xD;
&#xD;
&#xD;
	&#xD;
	As a result of a capitalist economic system that prioritises profit over safety, the institution of the labour market would be blamed for industrial deaths and accidents. &#xD;
	&#xD;
	&#xD;
	Hypertension and mental illness would be studied as a result of the social moulding of disease through the institutions of family and kinship in the context of urbanisation and social mobility. &#xD;
	&#xD;
	&#xD;
	In obesity, bowel and lung cancer there are cultural variables of attitudes, practices, and lifestyles that express themselves in various consumption patterns - notably of nutrition and alcohol. &#xD;
	&#xD;
	&#xD;
	As a result of power structures and unequal participation rates in society, illnesses are a result of difficulties with access to services and fairness in-service distribution. 8,9,10&#xD;
	&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Materialist Approach&#xD;
&#xD;
As a result, materialist theories of social inequality try to connect the biological and sociological aspects. In an attempt to isolate the role of material components in causing certain illnesses. Cancer, coronary artery disease, accidents and chronic obstructive pulmonary disease can all be linked to occupational and dietary factors as well as housing and environmental pollution (COAD). Each of these factors has a direct correlation to a person&amp;#39;s job and income. In addition to providing greater access to housing and food choices, higher salaries can affect where a person resides within a city. Despite this, it is possible to isolate the elements experimentally.8&#xD;
&#xD;
&#xD;
	&#xD;
	Diet&#xD;
	&#xD;
&#xD;
&#xD;
Eating habits are more of an economic decision as opposed to an emotional one. The availability of certain meals is determined by income level. Heart disease, stroke, and type 2 diabetes deaths can be increased by consuming too much or too little of specific foods and minerals.&#xD;
&#xD;
&#xD;
	&#xD;
	Housing&#xD;
	&#xD;
&#xD;
&#xD;
Living conditions are determined by your economic level, rather than by your behaviour. Water leaks, inadequate ventilation, unclean carpets, and insect infestations in substandard housing can lead to a rise in mould, mites, and other allergens that are linked to poor health and disease. Poor infrastructure may be demolished, resulting in injuries and fatalities for those who depend on it.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
	&#xD;
	Occupation&#xD;
	&#xD;
&#xD;
&#xD;
As a result of our jobs, we are subjected to a wide spectrum of physical and psychological abuse. Let&amp;#39;s use cancer-causing chemicals as an example. Asbestos, for example, is an extremely high-risk sector where occupational exposure is the exclusive cause of cancer. An estimated 340 people died in 19 states and union territories owing to manual sewer and septic tank cleaning between 2012 and 2020, with Uttar Pradesh (52), Tamil Nadu (43) and Delhi (36) leading the list. In Maharashtra, there were 34 of these deaths .7&#xD;
&#xD;
&#xD;
&#xD;
RESEARCH METHODOLOGY&#xD;
&#xD;
An explanatory, cross-sectional survey research design was followed to investigate the Occupational Health Hazards of Sanitation Workers. The research was a quantitative study by the method. This study was the explanatory study by purpose because it explained the health hazards faced by the sanitation workers; by use, this was an applied study that will help the officials to provide necessary measures to escape the severe health hazards. Multan was the area of study. By population, it is the fifth-largest city and by area, it is the third-largest city in Pakistan. The universe of this study was all Sanitation Workers of Multan. The sample size was 150. For this study, both primary and secondary data were obtained. To obtain primary data, a survey and a structured interview schedule were used. It was decided to use the probability sample approach to choose the subjects after getting a list of registered sanitation personnel in the Town Municipal Authority. A non-probability sampling technique called handy sampling was used to determine the number of Mobile sanitation employees.&#xD;
&#xD;
&#xD;
The researcher made 32 visits to the eight areas of Multan. On each visit, the researcher got data from 3 mobile sanitation workers.100 Mobile sanitation workers were included in the study while out of 150, Only 50 Government sanitation workers were available in WASA Office GolBagh which were included in the study. Researchers collected data from 20 sanitation employees to assess the questionnaire&amp;#39;s reliability and validity. As a result of the workers&amp;#39; responses, it was decided to include open-ended questions. Stata for social sciences was used to analyse the collected data to codify, convert, and recode structures (SPSS-21). The researcher analysed all the possible variables through univariate i.e. Percentage and frequency and Bivariate analysis i.e. Pearson and Spearman correlation.&#xD;
&#xD;
RESULTS AND DISCUSSION&#xD;
&#xD;
Sanitation workers&amp;#39; demographic and health features were analysed using descriptive statistics. As a result of this, the researcher utilised Pearson and Spearman correlation to determine whether or not there is a link between Demographic information, Job Nature, and distinct Health concerns of sanitation employees &#xD;
&#xD;
Univariate Analysis&#xD;
&#xD;
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&#xD;
Table No.01 Demonstrates that The table is consisting of the responses of respondents in different strata of life that are discussed with different categories. The first one is the age structure of respondents. 14.0% of the respondents belong to the category of 18-23 years of age, 28.7% of the respondents belong to the category of 24-28 years of age, 39.3% of the respondents belong to the category of 29-33 years of age and 18.0% of the respondents belong to the category of 34 or above years of age. 100.0% of the respondents belong to the category of Males. As only male sanitation workers were the sample of this study.90.0% of the respondents belong to the category of Islam, 9.3% of the respondents belong to the category of Christianity and 0.7% of the respondents belong to the category of Hinduism. 90.7% of the respondents belong to the category of No education and 9.3% of the respondents belong to the category of Primary education. 66.7% of the respondents belong to the category of Self-employed and 33.3% of the respondents belong to the category of Government employee. 18.7% of the respondents belong to the category of 5 years of experience, 37.3% of the respondents belong to the category of 10 years of experience, 38.0% of the respondents belong to the category of 15 years of experience and 6.0% of the respondents belong to the category of 20 or above years of experience.28.0% of the respondents belong to the category of 5000-10000 Rs of income per month, 38.0% of the respondents belong to the category of 11000-15000 Rs of income per month and 34.0% of the respondents belong to the category of 16000-20000 Rs of income per month. 60.7% of the respondents belong to the category of Smoker, 19.3% of the respondents belong to the category of Non-smoker and 20.0% of the respondents belong to the category of Ex-smokers. 58.0% of the respondents belong to the category of Rural area, 7.3% of the respondents belong to the category of Urban area and 34.7% of the respondents belong to the category of Peripheral area as their living areas.&#xD;
&#xD;
&#xD;
&#xD;
Table No.02 Demonstrates that 13.3% of the respondents belong to the category that they Feel No Hesitation while doing their job and 86.7% of the respondents belong to the category that they Feel Hesitation while doing their job. 81.3% of the respondents belong to the category that they are Not Given Respect for what they do and 18.7% of the respondents belong to the category that they Are Given Respect despite their profession. 61.3% of the respondents belong to the category that the attitude of their family/relatives is Not Good with them while 38.7% of the respondents belong to the category that the attitude of their family/relatives Is Good with them despite their profession. 69.3% of the respondents belong to the category that is Not Satisfied with their Income while 30.7% of the respondents belong to the category that Is Satisfied with their Income. 15.3% of the respondents belong to the category that has No Intention to Leave the job while 84.7% of the respondents belong to the category that Has an Intention to Leave the job. 8.0% of the respondents belong to the category that Does Not Perceive their job as a Hard job while 92.0% of the respondents belong to the category which Perceives their job as a Hard job. 52.7% of the respondents belong to the category that has no Major Accidents while doing the job while 47.3% of the respondents belong to the category that has Major Accidents while doing the job. 100.0% of the respondents belong to the category that they Never Received Training for their job. 82.0% of the respondents belong to the category that they Never use Protective Gears while 18.0% of the respondents belong to the category that they Use Protective Gears. 100.0% of the respondents belong to the category that they never had Medical Insurance.&#xD;
&#xD;
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Table No.03 Demonstrates that 0.7% of the respondents belong to the category that Never had Bruises.41.3% of the respondents belong to the category that Usually had Bruises. And 58.0% of the respondents belong to the category that Always had Bruises. 2.0% of the respondents belong to the category that Never had Joint Pain. 64.0% of the respondents belong to the category that Usually had Joint Pain and 34.0% of the respondents belong to the category that Always had Joint Pain. 32.0% of the respondents belong to the category that Never had Hip/Thigh Pain. 46.0% of the respondents belong to the category that Usually had Hip/Thigh Pain and 22. 0% of the respondents belong to the category that Always had Hip/Thigh Pain. 2.7% of the respondents belong to the category that Never had Lower Back Pain. 60.7% of the respondents belong to the category that Usually had Lower Back Pain and 36.7% of the respondents belong to the category that Always had Lower Back Pain. 0.7% of the respondents belong to the category that Never had Body Aches.55.3% of the respondents belong to the category that Usually had Body Aches. And 44.0% of the respondents belong to the category that Always had Body Aches.&#xD;
&#xD;
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Table No.04 Demonstrates that 16.7% of the respondents belong to the category that Never had Wheezing Breath. 65.3% of the respondents belong to the category that Usually Had Wheezing Breath and 18.0% of the respondents belong to the category that Always Had Wheezing Breath. 10.7% of the respondents belong to the category that Never had Chest Tightness. 61.3% of the respondents belong to the category that Usually had Chest Tightness and 28.0% of the respondents belong to the category that Always had Chest Tightness.80.0% of the respondents belong to the category that Never had Asthma and 20.0% of the respondents belong to the category that Always had Asthma. 58.7% of the respondents belong to the category that Never had Cough. 33.3% of the respondents belong to the category that Usually had Cough and 8.0% of the respondents belong to the category that Always had Cough. 46.7% of the respondents belong to the category that Never had Shortness of Breath. 24.7% of the respondents belong to the category that Usually had Shortness of Breath and 28.7% of the respondents belong to the category that Always had Shortness of Breath.&#xD;
&#xD;
&#xD;
&#xD;
Table No.05 Demonstrates that 68.0% of the respondents belong to the category that Never had Dermatitis. 26.7% of the respondents belong to the category that Usually had Dermatitis and 5.3% of the respondents belong to the category that Always had Dermatitis. 2.7% of the respondents belong to the category that Never had Prickly Heat. 43.3% of the respondents belong to the category that Usually had Prickly Heat and 54.0% of the respondents belong to the category that Always had Prickly Heat.&#xD;
&#xD;
30.7% of the respondents belong to the category that Never had Hair Loss. 54.7% of the respondents belong to the category that Usually had Hair Loss and 14.7% of the respondents belong to the category that Always had Hair Loss. 4.7% of the respondents belong to the category that Never had Rashes. 44.7% of the respondents belong to the category that Usually had Rashes and 50.7% of the respondents belong to the category that Always had Rashes.60.0% of the respondents belong to the category that Never had Acne. 19.3% of the respondents belong to the category that Usually had Acne and 20.7% of the respondents belong to the category that Always had Acne.&#xD;
&#xD;
&#xD;
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Table No.06 Demonstrates that 4.0% of the respondents belong to the category that Never had Nausea. 77.3% of the respondents belong to the category that Usually had Nausea and 18.7% of the respondents belong to the category that Always had Nausea. 3.3% of the respondents belong to the category that Never had Vertigos. 60.0% of the respondents belong to the category that Usually had Vertigos and 36.7% of the respondents belong to the category that Always had Vertigos. 2.7% of the respondents belong to the category that Never had Impaired Concentration. 68.7% of the respondents belong to the category that Usually had Impaired Concentration and 28.7% of the respondents belong to the category that Always had Impaired Concentration. 2.7% of the respondents belong to the category that Never had Eye Irritation. 60.0% of the respondents belong to the category that Usually had Eye Irritation and 37.3% of the respondents belong to the category that Always had Eye Irritation. 2.0% of the respondents belong to the category that Never had Sun Burn. 60.7% of the respondents belong to the category that Usually had Sun Burn and 37.3% of the respondents belong to the category that Always had Sun Burn.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Table No.07 Demonstrates that 100.0% of the respondents belong to the category that No compensation is offered by the government. 20.7% of the respondents belong to the category that is not in favour to Replace Manual Scavenging with Machinery. And 79.3% of the respondents belong to the category that is in favour to Replace Manual Scavenging with Machinery. 16.0% of the respondents belong to the category that Heart attack causes death, 29.3% of the respondents belong to the category that Suffocation causes death and 54.7% of the respondents belong to the category that Toxic gases cause death. 100.0% of the respondents belong to the category that did not get any training.61.3% of the respondents to belong to the category that does not take their medical issues seriously and 38.7% of the respondents belong to the category that takes their medical issues seriously.&#xD;
&#xD;
Bivariate Analysis&#xD;
&#xD;
&#xD;
&#xD;
Table No.08 Demonstrates that The hypothesis for the first Spearman Correlation test was that Intention to leave the job and Nature of the job is positively correlated with each other. The value for the Spearman Correlation is 0.557** it was found significant with a significance value of 0.01. So it is concluded that there is a positive correlation between Intention to Leave the Job and Nature of Job. The researcher interpreted it as when the nature of Job is hard the intention to leave the job is also increased. From the nature of Job, it is showed that whether the sanitation workers perceived their job as a hard job or not. 92% of the respondents perceived that their job was hard in terms of work and health hazards related to their job and 84.7% were having an intention to leave the job. So the hardness of jobs in economic, social and biological contexts made them think to leave the job for better job opportunities.&#xD;
&#xD;
The hypothesis for this Spearman&amp;#39;s Correlation test was that Smoking Habits and Income are positively correlated with each other. The value for Spearman&amp;#39;s Correlation is 0.325** it was found significant with a significance value of 0.01. So it is concluded that there is a positive correlation between Smoking Habits and Income. The researcher interpreted it as when the Income increases the smoking habit is also increased. From the bivariate analysis, it was showed that the higher the income the higher will be the tendency to smoke. If the income keeps on increasing the sanitation workers spend most of their income on smoking. While asking about, why do they smoke they said they use it as a source of coping strategy against stress and stigmatization. The percentage of smokers in the respondents was 60.7%. The smoking tendency was low in independent mobile sanitation workers as they had very low incomes.&#xD;
&#xD;
The hypothesis for the Pearson Correlation test was that Declined Health and Visiting Doctors are positively correlated with each other. The value for the Pearson Correlation is 0.301** it was found significant with a significance value of 0.01. So it is concluded that there is a positive correlation between Declined Health and Visiting Doctors. The researcher interpreted it as when the Health has declined the visits to the doctors are increasing. From the results, it was revealed that the health problems of sanitation workers were quite high. 52.7% of the respondents revealed that their health was declining due to their job. Their health was deteriorating due to their profession so they visited doctors most often due to the nature of their job.&#xD;
&#xD;
The hypothesis for the Spearman Correlation test was that Occupation Status and Intention to Leave the Job are negatively correlated with each other. The value for the Spearman Correlation is -0.209* it was found significant with significance value of 0.05. So it is concluded that there is an inverse correlation between Occupation Status and Intention to Leave the Job. From the nature of Job, it is showed that whether the sanitation workers are mobile sanitation workers or Govt. employees. Most of the workers were mobile sanitation workers which were unable to enjoy social security that is why the intention to leave the job was high among mobile sanitation workers as they were in search of a new good opportunity. The researcher interpreted it as when the Occupation status is increased i.e. from mobile sanitation worker to Government sanitation worker the intention to leave the job is decreased.&#xD;
&#xD;
The hypothesis for the Pearson Correlation test was that Family Attitude and Income Satisfaction are positively correlated with each other. The value for the Pearson Correlation is 0.184* it was found significant with a significance value of 0.05. So it is concluded that there is a positive correlation between Family Attitude and Income Satisfaction. The researcher interpreted it as when Income satisfaction increases the family attitude becomes good. 69.3% of the respondents were not satisfied with their income so they and similarly 61.3% of the respondents perceived that their family behaviour was not good with them so the lower-income satisfaction and bad family attitude are significantly correlated which shows that if they had higher income levels the family attitude might get changed.&#xD;
&#xD;
The hypothesis for the Pearson Correlation test was that Self-Prescription and Having Body Aches are positively correlated with each other. The value for the Pearson Correlation is .318** it was found significant with a significance value of 0.01. So it is concluded that there is a positive correlation between Self-Prescription and Having Body Aches. The researcher interpreted it as when Body aches increased the self-prescription also increased. The researcher explored that 44.0% of the sanitation workers were doing self-prescription because 55% were having body aches usually. They had no education and had low income which forced them not to go to the doctor and prescribe by themselves.&#xD;
&#xD;
The hypothesis for the Spearman Correlation test was that Experience and Self-Prescription are positively correlated with each other. The value for the Spearman Correlation is 0.288** it was found significant with a significance value of 0.01. So it is concluded that there is a positive correlation between Experience and Self-Prescription. The researcher interpreted it as when the experience in sanitation job increased the habit of self-prescription also increased. 38.0% of the respondents had an experience of 10-15 Years and 44.0% had a habit of self-prescription so from Bivariate analysis there was found a significant correlation as when the experience in sanitation field gets increased the habit of self-prescription is also increased among the sanitation workers.&#xD;
&#xD;
CONCLUSION&#xD;
&#xD;
The majority of the respondents belong to the category of 29-33 years of age. All the respondents were male. Most of them were Muslim. The majority were Illiterate living in the Rural areas. Most of them were Self Employed as Mobile Sanitation workers independent of any Institution. The majority of them had 15 years of experience and an Income of Rupees 16000-20000. They were found to be Smoker. They Felt Hesitation while doing Sanitation jobs. Due to their profession majority of the respondents Perceived that their Family Attitude is not Good with them, they are not given Respect. Due to lack of social security and small income majority were not Satisfied with their Income. Respondents Perceived sanitation jobs as Hard Job which is why they had an Intention to Leave the Job. Mostly had no Major Accident at the workplace. All of them did Not Receive Training and did not use any Protective Gear. They had no Medical Insurance at all.&#xD;
&#xD;
The majority of the respondents were Agreed concerning feeling Lethargic, feeling Anxious, getting Annoyed and having Medical Issues. Most of the respondents agreed concerning the Association of their job with Health Issues. They had a common Habit of Self-prescription and using Tranquilizers. The majority had the Perception of having More Medical Issues than Normal People and having a Declined in Health due to their profession. Most of them had a neutral response concerning Visiting Doctors often. Most of the sanitation workers always had Body Aches and Bruises. While Joint Pain, Wrist Pain, Shoulder Pain, Hip/Thigh Pain, Ankles/Feet Pain, Lower Back Pain, Upper Back Pain and Elbow Pain were usually observed. Wheezing Breath, Chest Tightness, Irritation of the Nose were usually observed in the majority of the respondents while they never had Dyspnea, Asthma, Cough, Lung Issues, Shortness of Breath, Allergic Rhinitis and Sinus Infection.&#xD;
&#xD;
The major proportion of the respondents never had Dermatitis, Frostbite, Fissures, Varicosity, Acne, Hives and Pyrosis. While they usually had Hair Loss, Blisters, Prickly Heat and Rashes. The majority of Sanitation workers had Issues of Nausea, Vertigos, Impaired Concentration, Cold, Eye Irritation, Headache, Sun Burn, Blood Pressure Issues usually. While there was no obvious majority complaining have Heart Issues. Preventive Measures were not followed by the majority and they were not provided with Safety Equi</Fulltext><FulltextLanguage>English</FulltextLanguage><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4097</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4097</Fulltext></URLs><References>&#xD;
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	Giri PA, Kasbe AM, Aras RY. A study on morbidity profile of sewage workers in Mumbai city. Int J Collab Res Intern Med Public Health.&#xA0; 2010; 2(12), 180-185.&#xD;
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	Jaiswal A. Sewage Work and Occupational Health Hazards: An Anthropological Insight.&#xD;
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	Kelly SA. Reconstructing Social Housing: The Socio-spatial Effects of Welfare State Transformation in Toronto&amp;#39;s Regent Park. University of Toronto (Canada).2008.&#xD;
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	Quansah R. &#xA0;Harmful postures and musculoskeletal symptoms among sanitation workers of a fish processing factory in Ghana: A preliminary investigation. Int J Occup Saf Ergon. 2005; 11(2): 171-180.&#xD;
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	The Hindu 340 sewer cleaning deaths in past 5 years: 2019 Government https://www.thehindu.com/news/national/340-sewer-cleaning-deaths-in-past-5-years-government/article33732992.ece&#xD;
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	Tiwari RR.Occupational health hazards in sewage and sanitary workers. Indian J. Occup. Environ. Med.2008; 12(3):112.&#xD;
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	Tsinda A, Abbott P, Pedley S, Charles K, Adogo J, Okurut K, Chenoweth J. Challenges to achieving sustainable sanitation in informal settlements of Kigali, Rwanda. Int&#xA0;J&#xA0;Environ&#xA0;Res. Public Health. 2013;10(12): 6939-6954.&#xD;
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	Watt MM, Watt SJ, Seaton A. Episode of toxic gas exposure in sewer workers. Occupational and environmental medicine.1997; 54(4): 277-280.&#xD;
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	World Bank, ILO, Water Aid, WHO. Health, safety and dignity of sanitation workers.2019.&#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>Health Related Lifestyle Among Students Living in B. Z. University Multan, Pakistan&#xD;
</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>233</FirstPage><LastPage>239</LastPage><AuthorList><Author>Alia Hussain</Author><AuthorLanguage>English</AuthorLanguage><Author> Saima Afzal</Author><AuthorLanguage>English</AuthorLanguage><Author> Kamran Ishfaq</Author><AuthorLanguage>English</AuthorLanguage><Author> Allah Daad</Author><AuthorLanguage>English</AuthorLanguage><Author> Muhammad Ashraf</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>Introduction: Hostel life is a beautiful medley of different cultural backgrounds and ambiences. The study reveals that hostel life affects the standard, ways of living of students, and because of this, they become more punctual, independent, social, realistic, sharp and disciplined. Objective: To find out health-related lifestyles among University students. Methodology: The study was conducted at Bahauddin Zakariya University Multan, Pakistan. To fulfil the purpose of this research work, the researcher tried to approach those students who were living in hostels at BahauddinZakariya University, Multan. A sample of 150 respondents (Umar Hall (25), Abu Bakr Hall (25), Usman Hall (25), Ayesha Hall (25), Amna Hall (25), Hajra Hall (25) were collected by using simple random sampling. Keeping in view the quantitative method, a questionnaire was derived and delivered to 150 male and female hostel dwellers of Bahauddin Zakariya University to find out their health status depending upon their lifestyles. The data were analyzed by using Statistical Package for Social Science (SPSS). After it, T-test and ANOVA test were applied. Results: The study reported that unhealthy nutritional behaviour, terrible sleep conduct, physical inactivity, obesity, smoking and use of drugs are a great deal worse. Living alone affected the health-related lifestyle of students living in hostels. Hostels put a negative as well as positive impact on the life of students to make them active, alert, mercurial and lazy. Conclusion: Living in hostels creates individual&#x2019;s issues such as the use of drugs and narcotics etc. Eating habits are based upon the availability of some specific food items thus affecting their health. The study suggests that proper training and awareness of good and bad, beneficial and non-beneficial can help them to prevent themselves from malnutrition and non-communicable diseases.&#xD;
</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords> Health-related lifestyle, Students, Hostel, Disease, Self-reliance, Drugs</Keywords><Fulltext>Introduction:&#xD;
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&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; A hostel is a place where novel ideas are discussed and new perceptions about life are formed. The hostel makes the student ambitious, self-reliant and confident as compared to those who don&#x2019;t reside in hostels. Hostel prepares them for practical life and they face the situation more confidently and courageously.1,2 It is a matter of discussion that hostel life has a great impact on the health-related lifestyle and pattern of learners living in hostels. Hostel life makes them more social and as a result, their behaviours are modified a lot. Hostel life is a beautiful medley of different cultural backgrounds and ambiences.3 The study reveals that hostel life affects the standard, ways of living of students, and because of this, they become more punctual, independent, social, realistic, sharp and disciplined. Students are independent in hostels. They get chances to handle different situations without the guidance of their parents. Meanwhile, hostel puts a greater impact on the health of students. Students become more lazy and lethargic in hostels. As there is no check, students male or female easily fall prey to many vices. They start using drugs and become much less careless towards their studies. It is a common practice among boarders to take drugs and show laziness.4&#xD;
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Pakistan is a developing country and it is very difficult for parents to afford the expenses of hostels so, students are leftover with a limited amount of money given to them by their parents. Thousands of students reside here and learn how to live with the money they have. Hostel life is a blend of different ambiences, cultures and values.5 Although the hostel is a place with maximum liberty and little bondage, the students are sandwiched in a hostel, university campus and time management. A lot of time is spent to avail the proper and nutritious food proper. Students go to university cafeterias and get food to their satisfaction. Students search for food, beverages and services, and if they are satisfied, they take it.6 The university and college arena are for health and nutritional education for a large number of young adults. Recent research of Kuala Lampur University, Malaysia depicted the results of dietary habits associated with skipping breakfast where a high rate of 29% was found among the respondents. Food is to eat and drink is to sustain life with energy and it promotes growth.6 Regular eating habits promote health education.7&#xD;
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Students who enter hostel life experience homesickness and carelessness resultantly they are sick and their dietary pattern is disturbed because of the change in their lifestyles and eating habits. Diet is a food plan on which a person depends to live. A balanced diet provides all the necessities of life and it makes the body healthy. The human body needs vitamins, fats, and carbohydrates for the general wellbeing of individuals. If there is a lack of abundance, and the stomach is disturbed resulting in diarrhoea, vomiting, stomachache and lost appetite, it becomes necessary to feed the human body with important components of food. The research at Alexandria University lets us know that there are hostels that accommodate a large number of students. The study aimed at identifying health-related lifestyles among students. Smokers were found in abundance in the hostels. To eliminate the prevalence percentage of smoking, daily and weekly smokers were estimated.8 Disturbed eating habits and the availability of food make students obese and overweight causes different diseases and issues among the students in hostels. Obesity is the normal and excessive disposition of adipose tissues that are hazardous for all ages.9&#xD;
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The food consumption pattern of university students is of particular concern because they tend to skip meals frequently and eat fast foods and snacks. This may be understood because students are habitual of junk foods. Fresh fruits are rarely available at university canteens. Students reported mental and physical health issues because of tension and the non-availability of proper foodstuff.10 The students living in hostels have their physicians and youth counsellors. Health services centres have been established to ensure special attention and treatment according to age and need. Here, counselling, training, information, diagnosis and treatment are provided. A study was conducted in Ameer-ud-din Medical College, Lahore where 50% were females and the canteen was also in the college arena. Many food outlets were also there. Students ate there and got tensed as well.11&#xD;
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The present study hypothesized that the effect of food will be about the quality of life where day scholars enjoy good health as compared to those not living with their families. Health professionals should also develop the style, attitudes and approaches to cope with the professional liabilities to play their role in the betterment of health and quality of life. Health professionals should be conscious enough to inform and educate the learners.12 Who focuses on poverty as a fundamental cause of poor health in hostels barely meet the expenses of studies and thus are compelled to have low priced unhealthy eateries.13 The study reported that unhealthy nutritional behaviour, terrible sleep conduct, physical inactivity, obesity, smoking and drug use are a great deal worse. Living alone affected the health-related lifestyle of students living in hostels. Hostel put negative as well as positive impact on the life of students making them active, alert, mercurial and lazy.&#xD;
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University life is accompanied by emotions that have an impact on their mental and physical health. Today there are many health care models which focus on attitudes that improve, protect, sustain and enhances the health of individuals, families and communities. It has been noted that by some authors that women&#x2019;s health is more influenced by structural and psychological factors such as stress and lower levels of self-esteem, while men&#x2019;s health was more affected by health behaviour such as smoking and physical activity.14 Health care workers have an effective role as a guide to provide services. They should be equipped with the latest knowledge and technology to practice healthy lifestyle behaviours.15 Health is a resource of everyday life, not the object of life and living. It is a basic fundamental human right that is pivotal for personal development. Keeping in view the nation&#x2019;s economic growth and internal security.16University borders face unique problems and have unique basic needs as they are away from home. Students living in hostels face multi problems because of physical, social and economic characteristics. The hostel is a shelter for all those who live here and learn differently.&#xA0; They try to live within means and face health issues. Good health is essential to achieve educational goals. The result of the study will help them to maintain balance in their lives. That&#x2019;s why the researchers choose the topic, &#x201C;Health-related lifestyle among students living in Bahauddin Zakariya University, Multan&#x201D;.&#xA0;&#xA0; &#xD;
&#xD;
Objectives of the study:&#xD;
&#xD;
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	To know student&#x2019;s points of view about hostel life.&#xD;
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	To examine the health-related lifestyle of university students.&#xD;
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	To assess the impact of academic life on health status.&#xD;
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Research Methodology:&#xD;
&#xD;
&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0;&#xA0; The present study was conducted at Bahauddin Zakariya University Multan, Pakistan. Students who were living in main university hostels, three for males and three for females, (the academic year 2018-2019) were the target population. The sample comprised 150 students from Bahauddin Zakariya University. A sample of 150 respondents (Umar Hall (25), Abu Bakr Hall (25), Usman Hall (25), Ayesha Hall (25), Amna Hall (25), Hajra Hall (25) were selected by using simple random sampling. A self-administrated questionnaire was developed by the researcher and completed by the students living in above mention hostels in 20-30 minutes. The questionnaires were dispensed to the hostel students with the hostel supervisor&#x2019;s help. The questionnaire was explained to the students. The response rate was 94%. The population of the study were all the students living in hostels. The target population was 150 students living in hostels (Umar hall, Usman hall, Qasim hall, Ayesha hall, Amna hall, Hajra hall). The data was collected through purposive sampling (Non-probability sampling). Pre-testing was done to check the validity and accuracy of the questionnaire. Therefore 10 questionnaires had been used for pre-testing. After pre-testing a few hurdles have been noticed consequently a few modifications have been made to the questionnaire. The coding procedure turned into made to have statistical analysis. The data were analyzed by using SPSS (statistical package deal for social sciences) for the inferential statistics ANOVA test was applied.&#xD;
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Results &#xD;
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&#xD;
Table I represents that the variables of gender, age, family type, the profession of father and mother, their income, the field of study, the living status of students in hostels with fee payable and the period spent in the hostels by the borders of the university. This table showed that the age of hostlers ranges from 18-19, 20-21, 25-30 years whereas a smart percentage of 64.7% of boys of universities prefer to line in a hostel while almost half of this 35.3% of the female abode in hostels. While talking about their age group 14.7% of boys and 37.3% of girls ranging the age of 20-21 live in hostels. About 36.0% of boys line in nuclear families, while 47.3% are from joint families whereas a good number of 16.7% is from extended families while talking about the profession or job status of the hostlers, the result depicted that a goodly number of parents do government job, fathers 35.3% and mothers ration is 17.3% in the government job. About 32.0% of fathers prefer their own business and 61.3% of mothers are housewives while among in 20.0% of fathers of students are jobless, while 21.3% of mothers belong to other jobs. Hostel fee also ranges from 15000-30000 per year and 16.7% of learners spend 15-20 thousand per month while 34.0% ranges from 21 to 35 thousand whereas 27.3% spend lavishly from 26000-30000 per month. In the end, the duration of living hostels ranges from 1-4 years according to their need and requirement of the subject of study.&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
&#xD;
Table II showed different statements about the health-related lifestyle that affect university students, and the result shows that most of the public is affected by university lifestyle. A great no of respondents 78.7% agreed with the statement that hostels are a great place for students to live and 65.4% agreed that hostel life affects the health of students. 48.6% were of the view that food available in hostels is not good and almost 46.6% claimed their health to be damaged by the food. 50.6% of the boarders liked me of vegetable for good health. 50.7% of students like to live in hostels better for study preparation and very interestingly 45.3% of the hostlers think that it&#x2019;s good for personality grooming and 38.7% loved to be in the hostel as it is good for university students. Almost 50.7% of the respondents were of the view that hostel life affects the health personality and behaviour of students here we find the equal status of those who rejected the statement and their ratio is almost 46%. Due to smokers, almost 44.7% of the boarders depict that smoking is injurious to health and as a result and as a result of the presence of smokers their health is depressed, 45.3% of the students claimed that drugs are daily used in hostels that depress the mental health of non-smokers while a great number of 22.7% damn care for the issue. Here almost 29.4% of the students agreed that the use of the drug is useless for the students living in the hostel and it is just a wastage of time and many 46% of students claimed that the use of narcotics/drugs damage the health status of students and change their lifestyle very badly. 46% of the students claimed that due to the unhealthy atmosphere in hostels many diseases attack the learners and affect their health very badly thus making their life miserable. 44% of the respondents were very alarming about the disease like hepatitis, aids, cancer, obesity and diabetes and they claimed that unhealthy atmosphere of the hostel is responsible for the prevalence of these diseases in society. &#xD;
&#xD;
Testing of Hypothesis&#xD;
&#xD;
Hypothesis 1&#xD;
&#xD;
Hostel life effects more on male health than female health&#xD;
&#xD;
&#xD;
&#xD;
In this research, researcher used an independent sample t-test to find out the relationship between gender and hostel life effects on health. According to the null hypothesis, it is stated that there is no relationship between gender and hostel life effects on health and according to the alternative hypothesis, there is a relationship between gender and hostel life effects on health. The mean of the male towards hostel life effects on health is high than female. These results accept the alternative hypothesis, which states that there is a relationship between gender and hostel life effects on health. And reject the null hypothesis which states that there is a relationship between gender and hostel life effects on health. So it is concluded that males are more effects on health aware than female&#xD;
&#xD;
Hypothesis 2&#xD;
&#xD;
Hostel life affects the health more of the nuclear family&#x2019;s students as compared to joint family.&#xD;
&#xD;
&#xD;
&#xD;
In this research, researcher used the ANOVA test to find out the relationship between family type and hostel life effects. According to the null hypothesis, it is stated that there is no relationship between family type and hostel life effects on health. According to the alternative hypothesis, there is a relationship between family type and hostel life effects on health. These results accept the null hypothesis, which states that there is no relationship between family type and hostel life effects on health and rejected the alternative hypothesis which states that there is a relationship between family type and hostel life effects on health. So it is concluded that family type is not associated with duration of hostel life effects on health.&#xD;
&#xD;
Discussion:&#xD;
&#xD;
As per a study carried out in the Bahauddin Zakariya University&#x2019;s hostel Multan, the Majority of the scholars are affected negatively because of the eateries available for them in the variety of hostels. No doubt, their health is badly affected. This study aimed at finding out the magnitude of eating habits among them. Most of the hostel dwellers fall victim to drug addiction.4 It is also observed that girl students adjust themselves easily to the new horizon of the hostel while boys feel much difficulty here. Hostel life puts negative as well as positive impact on the life of students making them active, alert and mercurial and lazy, careless as well. The personality of students is groomed here as they are to face different issues from diet to proper health care and they are to solve all these by themselves. They face the hardships of life more bravely and courageously.17 A direct as the close relationship among social help and wellbeing among hostel students become additionally found. They were found active in all the activities during their stay in the hostel. It is also assumed that the attitudes and behaviour of the learners are also bettered as they were habitual to select eateries during their stay at home but now they adjusted themselves with what was available in hostel canteen or cafeteria. &#xD;
&#xD;
The study shows the age of hostellers ranges of 18-19, 20-21, 25-30 years were as a smart percentage of 64.7% of boys of universities prefer to line in the hostel while almost half of this 35.3% of the female abode in hostels. The data reveals that 39.3% agreed, 19.3% disagreed, 26.0% were neutral, 12.0% strongly agree and 3.3% strongly disagreed. Most students are participating in bad things with friends. Drugs and smoking are badly affected student&#x2019;s health. Young adults inside the age organization of 18 &#x2013; 25 years are regularly the unnoticed group in any health or nutrition schooling in comparison to kids and adults. When these teens leave home and modify to impartial living, true dietary habits received from domestic decline.18 Some students live alone and do not talk with others and live alone in the room they are affected in student&#x2019;s health. In a hostel mostly students use the internet and all the time use Facebook, Twitter and WhatsApp that are badly affected in student&#x2019;s health and students behaviour. They see the bad movies and bad dramas in the hostel.&#xD;
&#xD;
Raised degrees of stress can put a toll on our framework however we can create approaches to adapt to pressure or make endeavours in our lives to evade it. Students, particularly fresher, are a gathering especially inclined to worry because of the transitional idea of school life. The strain to gain great imprints (grades) and to win a diploma is exceptionally excessive. Winning excessive evaluations isn&amp;#39;t always the primary wellspring of worry for understudies. Other potential wellsprings of stress incorporate over the top schoolwork, unclear assignments and awkward study halls. Notwithstanding scholarly necessities, associations with employees and time weight may likewise be wellsprings of stress. Associations with loved ones, eating and dozing propensities and forlornness may influence a few understudies on a normal.19&#xD;
&#xD;
The findings of the present examination regarding unhealthy nutritional behaviour, terrible sleep conduct, physical inactivity, obesity and smoking and drug use are a great deal worse.3,20 This method that university college students inside the BahauddinZakariya University hostels appear to be initiating health-risk behaviour earlier, and in most instances before they are developmentally ready to deal with the potential outcomes. The findings of our take a look at the display that almost a quarter of the students reported horrific perceived fitness; decrease proportions suffered from health conditions.10 This may explain why the majority of the students had been disenchanted with residence within the hostels, mainly those with horrific perceived health and excessive perceived symptoms. However, females were more likely than male students to be upset with residence within the hostels, and much more likely to have more issues, in all likelihood due to the fact they generally came from higher social class households and there was a higher share of disillusioned college students among the ones of excessive social class households.&#xD;
&#xD;
Conclusion:&#xD;
&#xD;
The study explored the health-related lifestyle of the hostel, college students. It highlighted the experiences, behavioural changes, and character characteristics of hostel college students. It also researches the gender differences of some of the roommates. While they&amp;#39;re living in university hostels, the student&#x2019;s fitness is inappropriately affected. The use of medicine smoking, small quarrels, use of excessive net affects the fitness of college students. It becomes also look at that maximum of the boarder&#x2019;s opted to smoke due to the fact their dad and mom were smokers. Skipping morning meals is very not unusual for many of the students of the hostel, consequently, this results in mental misery and incorrect attention towards their research and other activities as well. The study also discovered that the major cause in the back of skipping breakfast is the negative status of meals available for breakfast and other meals for eating, this puts stress and stress. As a result of this, the students prefer fast food to fill their urge for food and on occasion, they do it for flavour which is never a very good chance to healthy meals.&#xD;
&#xD;
Recommendation&#xD;
&#xD;
&#x2022; Attached washrooms have to be provided.&#xD;
&#xD;
&#x2022; Hygienic and healthy meals ought to be given to hostel students.&#xD;
&#xD;
&#x2022; Health schooling messages should be disseminated via formal or informal programmers&#x2019; to bring about behavioural adjustments in terms of smoking, bodily activity, healthy dietary habits, and sleep behaviour.&#xD;
&#xD;
&#x2022; Focus organization interviews with college students have to be performed to elicit in-depth statistics approximately students&#x2019; problems as well as their suggestions for improvement.&#xD;
&#xD;
Acknowledgement:&#xD;
&#xD;
The services of the data collection team are highly appreciated. The cooperation of the head of departments to allow the data collection was really helpful.&#xD;
&#xD;
Conflict of Interest:&#xD;
&#xD;
There is no conflict of interest regarding this study. This research was not funded by any organization. &#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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Assessment of Security Officers&#x2019; Perceived Stress in a Tertiary Care Setting&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>240</FirstPage><LastPage>244</LastPage><AuthorList><Author>Sngeeta Patil</Author><AuthorLanguage>English</AuthorLanguage><Author> Dhanjay Kamble</Author><AuthorLanguage>English</AuthorLanguage><Author> Mahadeo Shinde</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: The job of a security guard is extremely difficult because it requires working overnight shifts in a hostile atmosphere. The aggressive and violent relatives of the thieves are another factor that the security officers working in the hospital need to take into consideration. They go through stressful situations due to the nature of their employment and the amount of strain they are under. In today&#x2019;s world, day-to-day existence is fraught with demands, problems, and tight deadlines. Many people experience stress on such a regular basis that it has become a routine part of their lives. There are times when stress is beneficial. In low dosages, it has the potential to improve a person&#x2019;s performance and drive them to achieve their full potential. Aims: The purpose of this study is to determine how stressed out the security guards at the Tertiary Care Hospital in Karad feel they are. Methods: The current study involved 79 participants, and it made use of a method called convenient sampling to choose them. For the purpose of determining stress levels, a questionnaire based on the perceived stress scale (PSS 10) was utilized. The current study uses an adequate random sampling strategy to collect 79 samples from the security guards working in Karad&#x2019;s tertiary care hospital. For the purpose of this study, Cohen&#x2019;s Perceived Stress Scale (PSS 10) was utilized. Result: Majority There was a perceived level of moderate stress among 64.56% of security guards, while there was a perceived level of light stress among 20.25% of security guards. Only 15.19% of security guards reported having extreme stress levels in their jobs. There was a statistically significant connection between socioeconomic factors such family income, food pattern, and smoking behavior. There is no statistically significant connection between any of the other socio-demographic factors, such as age, gender, the kind of family, the amount of alcohol consumed, and so on. The findings of this study indicate that security guards are exposed to a significant amount of stress on the job. In order for children to be able to deal with this stress, they need to develop suitable coping techniques. Conclusion: Specific measures to alleviate the stress of security guards linked with commonly recurring causes, as well as measures to increase performance associated with compensation and independence, are effective in improving the overall quality of the employees in their work environment.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Perceived, Stress, Security Guards, Environment, Children, Hazardous</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4634</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4634</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>13</Issue><IssueLanguage>English</IssueLanguage><SpecialIssue>N</SpecialIssue><PubDate><Year>2021</Year><Month>July</Month><Day>5</Day></PubDate></Journal><ArticleType>Healthcare</ArticleType><ArticleTitle>&#xD;
	Efficacy of an Information Booklet on Menstrual Knowledge and Attitude Among Adolescent Boys and Girls in a Rural Cbse School&#xD;
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</ArticleTitle><ArticleLanguage>English</ArticleLanguage><FirstPage>245</FirstPage><LastPage>248</LastPage><AuthorList><Author>Mahadeo Shinde</Author><AuthorLanguage>English</AuthorLanguage><Author> Anagha Katti</Author><AuthorLanguage>English</AuthorLanguage></AuthorList><Abstract>&#xD;
	Introduction: The onset of menstruation coincides with the beginning of the puberty stage in females, as menstruation is a physiological process. According to the World Health Organization (WHO), the teenage phase occurs between the ages of 10 and 19. The use of sanitary pads, their appropriate disposal, and subsequently the appropriate washing of the vaginal area, followed by hand washing, are all components of good menstrual hygiene practices. Aims: The purpose of this study is to evaluate how well an information booklet can improve adolescents&#x2019; preexisting knowledge of and attitude toward menstruation in both male and female students. Methods: A descriptive research strategy was utilised for this study as the methodology for the investigation. The research was carried out at the KCT SCHOOL in Karad. Through the utilization of the Convenient Sampling Method The study included a sample size of one hundred. A questionnaire with a defined format served as the primary research instrument. Both descriptive and inferential statistics were used in the process of data analysis. Result: The findings of the current research indicate that out of a total of 100 adolescents (50 boys and 50 girls), 29 of them had average knowledge and 68 of them had inadequate knowledge before the exam. Following the presentation of the module on menstruation, the vast majority of them achieved a score of 92 or higher on the post-test. The knowledge level of the adolescent males and girls was significantly different before and after the exam, and this difference was statistically significant. The current research demonstrates that there is a statistically significant association between the source of information and the amount of knowledge demonstrated on the pre-testing phase. Conclusion: The findings of the study indicate that participants&#x2019; understanding of menstruation is inadequate, as the conclusion of the study states. They need a comprehensive orientation procedure that will help them expand their knowledge while also assisting them in making informed decisions.&#xD;
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</Abstract><AbstractLanguage>English</AbstractLanguage><Keywords>Efficacy, Information Booklet, Knowledge, Attitude, Menstruation, Adolescent</Keywords><URLs><Abstract>http://ijcrr.com/abstract.php?article_id=4635</Abstract><Fulltext>http://ijcrr.com/article_html.php?did=4635</Fulltext></URLs><References>&#xD;
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