Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Warning: Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 234
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareAnalysis of Correlations among Cognition Function, Body Function, and Risk of Falling in Elders in Nursing Hospital
English0913Nam Seung-MinEnglishIntroduction: As ageing progresses, all organs and tissues of the human body are degenerated and functionally lost. As the physical function decreases, the elderly increase instability during physical activity, increasing the risk of falls and fractures. Aims: This study was conducted to investigate the correlation between cognitive function, physical function, and fall risk of the elderly in the nursing hospital. Methodology: The subjects of the study were 38 elderly people in the nursing hospital. Tetrax was used to assess the risk of falls. To measure cognitive function, it was measured using the MMSE-K test. In addition, static balance, dynamic balance, walking ability, and lower extremity muscle strength were evaluated to measure physical function. Static balance was measured using Biorescue, the dynamic balance was time up and go, the walking ability was 10 MWT, and lower extremity muscle strength was measured using five times sit to stand test. Pearson’s correlation analysis was used to analyze the correlation between cognitive function and physical function and the risk of falls. Results: As a result of the study, there was a non-significant correlation in the correlation between cognitive function and fall risk (p>.05), and in the correlation between physical function and fall risk, there was a significant correlation in static balance, dynamic balance, gait ability, and lower extremity muscle strength. Showed a relationship (pEnglish Risk of Falling, Cognitive Function, Balance Ability, Gait Ability, Lower Extremity Strength, Elders Nursing HospitalINTRODUCTION
The elderly population in Korea continued to increase from 3.1% in 1970, and in 2019, the proportion of the elderly aged 65 and over entered 14.9%. As such, Korea's ageing population is advancing very rapidly, and it is expected to reach a post-aged society in 2025.1 In addition, due to the increase in the elderly population, medical expenses of the elderly population accounted for 40.8% of the total medical expenses in 2018.2 As such, medical expenditure and social expenditure for the elderly are increasing, and social interest in the elderly is increasing.
Generally, as ageing progresses, all organs and tissues of the human body are degenerated and functionally lost. As the physical function decreases, the elderly increase instability during physical activity, increasing the risk of falls and fractures.3 Fall means falling from the original position to the lower position or the floor, independent of one's intention, during one's daily life.4 This fall is a typical age-related accident, and the risk of falling is 10 times higher than other age groups.5 It has also been reported that falls can require significant rehabilitation costs, and even minor falls can cause serious damage and a life threat. As such, it is important to accurately evaluate the risk of falls in the elderly and to identify the risk factors that cause falls, and take measures to prevent and treat falls.6
Risk factors for falls are closely related to cognitive and physical functions following the ageing process. The first cognitive function is the ability to judge and decide by processing input information, which means mental and intellectual processes. It has been reported that in the elderly, cognitive function decreases as ageing progresses, especially attention is reduced, leading to difficulties in everyday life.7 It has also been reported that ageing of the nervous system is a major cause of falls, and it has been reported that cognitive impairment should be included in determining risk factors for falls because impairment of cognitive function is related to fall.8,9
The second physical function is the basis of physical activity and refers to the physical condition that maintains and promotes daily living performance. In general, bodily functions can be directly or indirectly evaluated bodily functions through evaluation of balance, gait, and lower extremity strength. Balance ability is the ability to maintain the body's centre of gravity on the support surface and plays an important role in preventing falls.10 In the elderly, the functions of the organs related to balance control such as vision, vestibular sense, and intrinsic water perception decrease, resulting in increased posture sway and reduced balance ability.11 It has also been reported that as the body's balance ability decreases, walking ability decreases and the risk of falls increases.12 In addition, to indirectly evaluate the level of functional independence of everyday life of the elderly, the lower extremity muscle strength is measured. Lower leg muscle strength has been reported to reduce body stability and mobility and to reduce the level of independence of everyday life, and lower leg muscle strength is an important factor in predicting the risk of falls.13,14
Although various risk factors can cause falls. There is a lack of research that has comprehensively investigated the association between the risk of falls and the various risk factors that cause falls. In addition, previous studies on the relationship between fall risk and risk factors were mainly conducted on normal elderly and community-dwelling elderly people, and research conducted on elderly people living in facilities is insufficient.
Therefore, this study objectively evaluates the risk of falls using the Tetrax balancer, rather than the subjective evaluation tool that is mainly used in clinical practice for the elderly living in the nursing hospital, cognitive ability, static balance ability, dynamic balance ability, and gait The purpose of this study is to comprehensively study the correlation between ability, lower extremity muscle strength, and fall risk, to predict factors that cause fall, and to present information on fall prevention and treatment countermeasures.
MATERIALS AND METHODS
Subjects
This study was conducted on elderly people aged 65 and over who were admitted at S Nursing Hospital in Gyeongsangbuk-do in October 2019. After explaining the purpose and contents of the study to all study subjects, the experiment was conducted after obtaining consent to participate. The experimental procedure was approved by the Institutional Review Board (1040621-201711-HRBR-004-002). The selection criteria of the subjects were selected as the elderly who can stand and walk independently or using assistive devices, the elderly who have no abnormalities in the visual, auditory and vestibular organs, and conducted a study on the final 38 subjects.
Measurement tools and measurement methods
Fall risk measurement:
Tetrax balancer (Israel) was used to measure the risk of falls. The Tetrax balancer uses a total of four force plates, one on each heel and toes on both sides of the lower limb. The subject took off his shoes and placed his feet on the power plate and tested in a total of eight positions. First, the posture facing the front with the eyes open (normal eye open; NO), then the posture facing the front with the eyes closed (normal eye close; NC), and the posture facing the head with the eyes closed head right (HR), head left (HL), head up (HU), head down (HD). The test is performed with the foam-rubber pillow under the feet and the eyes open (PO) and eyes closed (PC) facing the front.15 There is a risk of falling when eyes are closed or standing on a soft support surface, so the examiner is allowed to stand around the subject. Through these eight postures, the degree of postural agitation was measured, and the risk of falls was measured. The risk of falling is comprised of 0-100 points, and the higher the value, the higher the risk of falling.16
Korean version, Mini-Mental State Examination (MMSE-K):
The Korean version of the Mini-Mental State Examination (MMSE-K) is the most widely used dementia screening tool in Korea and has the advantage of being able to easily assess the intellectual condition and cognitive function of the subject in a short time.17 The Korean version of the MMSE-K consists of 12 questions, including five points of orientation relating to time, five points of orientation relating to place, three points about memory registration, three points to memory recall ability, five points to attention and computation, and nine points to understanding, judgment, and language. It consists of 30 points.
Biorescue:
The Biorescue biofeedback analysis system (Biorescue, France) is a device that measures the balance ability of various subjects such as patients, the general public, and athletes. It is a tool that can measure the length (mm) and average speed (cm/s). To evaluate the static balance ability, the limit of stability at the standing posture was measured. Of the eight directions indicated by the monitor, the total distance and area of the centre of gravity were measured for the weight movements before, after, left, and right. The device explained the measurement method through a monitor and first demonstrated it. The subject held a leg forward at 30° in the standing position, centred in a forward-looking position, and then used an ankle joint strategy to achieve maximum range without losing balance. The limit of their ability to move from their centre of gravity was measured.
Berg Balance Scale (BBS)
The Berg Balance Scale (BBS) can objectively assess the fall risk, static balance ability, and dynamic balance ability of the elderly by measuring the functional performance of their balance through sitting, standing, and posture changes.18 The scale is composed of 14 items, and if the task cannot be performed, the total score is 56, a maximum of four points being applied to each item if it is independently performed. In general, the higher the score, the better the balance ability, 0–20 points indicating balance disorder and 41–56 points indicating good balance.
10-Meter Walk Test (10 MWT)
The 10-meter walk test (10 MWT) is a test method that evaluates walking ability by measuring the walking speed of the examinee.19 No special equipment is required, so you can easily evaluate your walking ability in a short time. The method measures the time required to walk a distance of 10 m by taking into account acceleration and deceleration between the start and the end and measures a total of three times to obtain the average.
Lower limb strength
Five Times Sit to Stand Test (FTSST) is a test method that starts from a sitting position on a chair and measures the time to perform the sitting and sitting motion five times. FTSST is a measure that predicts the recurrence of falls and the independence of daily life performance by measuring functional aspects of the lower extremity strength.20 Subject was instructed to wake up five times as soon as possible and then sit down.
Statistical analyses
The results of the experiments obtained in this study were described as mean±standard deviation (Mean±SD). Pearson's correlation analysis was conducted to analyze the correlation between the level of cognitive function and physical function in the elderly and the risk of falls. Statistical processing was analyzed using SPSS 23.0 for Windows, and all statistical significance levels (?) were set to 0.05.
RESULTS
General characteristics of subjects
A total of 38 subjects participated in this study, and the general characteristics of the subjects are shown in Table 1. As a result of analyzing the correlation between cognitive function and fall risk, there was no statistically significant relationship (p>.05).
Correlations among Cognition Function, Body Function, and Risk of Falling
As a result of correlation analysis between physical function and fall risk, there was a statistically significant relationship between static balance ability, dynamic balance ability, gait ability, lower leg strength level and fall risk, static balance ability, dynamic balance ability, gait ability, lower leg strength The risk of falls increased with decreasing levels of (pEnglishhttp://ijcrr.com/abstract.php?article_id=3945http://ijcrr.com/article_html.php?did=39451. Korea S. Resident registration demographics. Seoul: Statistics Korea; 2019 [cited 2020 September 30].
2. Korea S. 2018 Health Insurance Statistics Yearbook. Seoul: Statistics Korea; 2019 [cited 2020 September 30].
3. Andersen CK, Wittrup-Jensen KU, Lolk A, Andersen K, Kragh-Sørensen P. Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Qual Life Outcomes. 2004;2(1):1-7.
4. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26): 1701-1707.
5. Miller CA. The connection between drugs and falls in elders. Geri Nurs. 2002;2(23):109-110.
6. Schoenfelder DP, Rubenstein LM. An exercise program to improve fall-related outcomes in elderly nursing home residents. Appl Nurs Res. 2004;17(1):21-31.
7. Kami?ska MS, Brodowski J, Karakiewicz B. Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression. Int J Environ Res Public Health. 2015;12(4):3406-3416.
8. Evans D, Hodgkinson B, Lambert L, Wood J. Falls risk factors in the hospital setting: a systematic review. Int J NursPract. 2001;7(1):38-45.
9. Jensen J, Nyberg L, Gustafson Y, Lundin?Olsson L. Fall and injury prevention in residential care effects in residents with higher and lower levels of cognition. J Am Geriatr Soc. 2003;51(5):627-635.
10. Gang TW, Kim BR. Comparison of Task-oriented Balance Training on Stable and Unstable Surfaces for Fall Risk, Balance, and Gait Abilities of Patients with Stroke. Kor Soc Phys Med. 2019;14(2):89-95.
11. Hurley MV, Rees J, Newham DJ. Quadriceps function, proprioceptive acuity and functional performance in healthy young, middle-aged and elderly subjects. Age Ageing. 1998;27(1):55-62.
12. Unsworth J, Mode A. Preventing falls in older people: risk factors and primary prevention through physical activity. Br J Community Nurs. 2003;8(5):214-220.
13. Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults: a systematic review and meta?analysis. J Am Geriatr Soc. 2004;52(7):1121-1129.
14. Schenkman M, Hughes MA, Samsa G, Studenski S. The relative importance of strength and balance in chair rise by functionally impaired older individuals. J Am Geriatr Soc. 1996;44(12):1441-1446.
15. Kohen-Raz R. Application of tetra-ataxiametricposturography in clinical and developmental diagnosis. Percept Mot Skills. 1991;73(2):635-656.
16. Kim TH, Yi JH, Oh SG. Static posture stability evaluation of female elderly using stability evaluation device. J Kor Skill. 2011;12(12):5518-5524.
17. Tombaugh TN, McIntyre NJ. The mini?mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922-935.
18. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Phys Ther. 2001;81(2):810-818.
19. Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil. 2001;15(4):415-421.
20. Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot skills. 2006;103(1):215-222.
21. Ruchinskas R. Clinical prediction of falls in the elderly. Am J Phys Med Rehabil 2003;82(4):273-278.
22. Cuevas-Trisan R. Balance problems and fall risks in the elderly. Phys Med Rehabil Clin N Am. 2017;28(4):727-737.
23. Wang S, Varas-Diaz G, Dusane S, Wang Y, Bhatt T. Slip-induced fall-risk assessment based on regular gait pattern in older adults. J Biomech. 2019;96(11):1-7
24. Nam SM, Kim SG. Effects of a Five Times Sit to Stand Test on the Daily Life independence of Korean Elderly and Cut-Off Analysis. J Kor Soc Phys Med 2019;14(4):29-35.
25. Chung JW, Choi HJ. Functional fitness and asymmetry on lower body muscle strength of elderly women with fall experience. Asian J Kinesiol. 2009;11(2):65-72.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareComparative Evaluation of the Retention of Maxillary Complete Denture Bases Made by Heat Cure Acrylic Resin Processed on High Expansion Stone and Type III Dental Stone: An In-Vivo Study
English1418Shruti Keerthi ThotaEnglish Mahalakshmi GujjalapudiEnglish Chandrasekar AnamEnglish Radha ChilukaEnglish Praveen MamidiEnglish Swaroopkumar M MagarEnglishIntroduction: Accurate fit of the complete denture is the most important factor in prosthodontic practice. The primary contributors for the retention are the good base adaptation of a denture to underlying mucosa and the border seal. Despite the success of acrylic resins as denture base materials, the dimensional changes caused by them must be accepted as one of the disadvantages of acrylic resin dentures. Objectives: The present study aimed to investigate the retention of maxillary complete denture bases made on type III and type V dental stones. Methodology: 15 completely edentulous patients who needed prostheses were included in this study. After primary and secondary impressions, two casts were prepared from the mould, one using the type-III dental stone and another with type-V stone. Thermoplastic resin gaskets of 2 mm in thickness were used to prepare denture bases models on both casts. Heat cure denture bases were fabricated on the prepared casts and retention was measured using an electronic scale. Results: It was observed that the mean retentive force increased up to 30% with denture base made on type V dental stone (mean retentive force 4.46N) than denture base made on type III dental stone (mean retentive force 3.12N). Conclusion: Based on the study findings, it was concluded that denture bases made on type V stone compensated to a substantial degree for the shrinkage of acrylic resin and plays an important role in obtaining the optimum retention of the maxillary complete denture.
EnglishMaxillary complete denture, Retention, Type III dental stone, Type V dental stoneINTRODUCTION
Denture retention is defined as “resistance of a denture to vertical movement away from the tissues”.1 In simple words, it refers to the force which resists the displacement of a denture in the occlusal direction. It is a well-known fact that the accurate fit of the denture base to the mucosal tissue and border seal plays an important role in enhancing the retention and stability of the complete denture. 2 Various factors such as adhesion, cohesion, interfacial surface tension, atmospheric pressure, viscosity, base adaption, border seal, muscular control, etc. have all been cited as major or contributory factors in affecting retention. However, it was observed that not all the factors as they claimed are responsible for affecting complete denture retention and failed to survive scientific scrutiny. 3
Acrylic polymer resins i.e. polymethyl methacrylate (PMMA) are the commonly used denture base materials for the past 60 years. Despite its drawbacks such as shrinkage and dimensional changes during polymerization, it remained as the material of choice for denture base fabrication 4,5,6 reported that the dimensional changes in the denture occur irrespective of the processing techniques or the acrylic resin is chosen. The first unavoidable dimensional change is shrinkage, which occurs during processing and finishing (0.3- 0.5%). The second change is the linear expansion of 0.1- 0.2%, which occurs due to the storage of the dentures in a water bath or due to the absorption of oral fluids while in the oral cavity.7,8,9
Various studies have been conducted in the past analyzing the retention of maxillary denture base with and without border molding, different border molding materials, different border molding techniques, different posterior palatal seals etc. 10-13 However, little research has been done, to study the influence of the type of dental stone used to fabricate the cast. It is found that the coefficient of linear expansion in type III dental stone and increased expansion of type V stone compensates for the dimensional changes resulting from shrinkage in denture bases. 14 The present study was conducted to evaluate and compare the retention of maxillary complete denture bases made on type III and type V dental stones. The null hypothesis was that there would be no significant difference in the retentive forces applied on the denture base fabricated on type III and type V dental stone.
MATERIALS AND METHODS
Sample selection:
Fifteen completely edentulous patients who required prostheses were included in this study. The study was carried out in the Prosthodontics Department of Panineeya Institute of Dental sciences. Prior approval was obtained from the ethics committee of the institution to conduct the study. Patients with maxillary edentulous arch, with a minimum of 6 months of healing period following extraction, with no signs of infection, well-healed, round, smooth, resilient and thick oral mucosa covering the ridge were included. Ridges without any unilateral or bilateral undercuts were selected. Patients who had limited mouth opening and with abnormal Salivary slow were excluded from the study.
Methodology:
The primary impression of the denture bearing area was obtained with impression compound (DPI, Pinnacle), special trays were fabricated using self-cure acrylic resin and were border molded to get an acceptable extension and border thickness. The master cast was then obtained from the final impression, which is then positioned and sealed using modeling wax in the duplicating flask and duplicated using duplicating silicone (Unisil Flow, Chennai). Two casts were prepared from the mold, one using the type-III dental stone(Kalabhai enterprises, India) and another with type-V stone (Hardrock, whip mix, USA). Thermoplastic resin gaskets of 2 mm in thickness were used to prepare denture base models on both casts (Figure 1). The clear resin bases were invested and the molds thus obtained were packed with heat cure acrylic resin(Dentsply, UK) to prepare permanent denture bases. Flasks containing the bases were kept in room temperature water, the temperature was gradually raised to 740C and maintained for 9 hours in a thermostatically controlled acrylization unit.
After polymerization, the flasks were allowed to bench cool for one hour, and the denture bases were removed carefully. Any remnants of stone or blebs of acrylic resin were removed carefully with the help of acrylic resin bur under magnification. The denture bases were polished; handles were fabricated on the trays using self-cure acrylic resin (DPI) (Figure 2). The denture bases were then subjected to evaluation of retention.
For measuring retention, an electronic scale was used (Figure 3). The maximum amount of force required to dislodge the maxillary denture bases was measured using this scale. The retention of the maxillary denture bases was tested after they remained in the patient’s mouth for a minimum of 15 to 20 minutes. The patient was then made to seat in a comfortable position and was instructed not to exert any pressure on the denture base with the tongue. The electronic scale was then attached to the specially made handle to the denture base (Figure 4). The amount of load was gradually in the electronic scale till the maxillary denture base dislodge and the readings were noted down.
Statistical analysis: Collected data were analysed with t-test statistics for statistically significant differences at the 95% confidence level. Statistical analysis was performed using software IBM SPSS version 20.0. A value of PEnglishhttp://ijcrr.com/abstract.php?article_id=3946http://ijcrr.com/article_html.php?did=3946
Nairn R I, Shapiro N M S, editors. Prosthetic Dentistry Glossary. London: Quintessence; 1995.
Darvell BW, Clark RK. The physical mechanisms of complete denture retention. Br Dent J. 2000;189:248-252.
Murray MD, Darvell BW. The evolution of the complete denture base. Theories of complete denture retention--a review. Part 1. Aust Dent J. 1993;38:216-219.
Murray MD, Darvell BW. The evolution of the complete denture base. Theories of complete denture retention--a review. Part 2. Aust Dent J. 1993;38:299-305.
Ajay R, Suma K, Ali S. Monomer modifications of denture base acrylic resin: A systematic review and meta-analysis. J PharmBioall Sci. 2019;11:112-125.
Takamata T, Setcos JC. Resin denture bases: a review of accuracy and methods of polymerization. Int J Prosthodont. 1989;2:555-562.
Sykora O, Sutow EJ. The improved fit of maxillary complete dentures processed on high expansion stone casts. J Prosthet Dent. 1997;77:205-208.
Woelfel JB, Paffenbarger GC, Sweeney WT. Dimensional changes in complete dentures on drying, wetting and heating in water. J Am Dent Assoc. 1962;65:495-505.
Patel MP, Braden M. Heterocyclic methacrylates for clinical applications. III. Water absorption characteristics. Biomaterials. 1991;12:653-657.
Kaur S, Datta K, Gupta SK, Suman N. Comparative analysis of the retention of maxillary denture base with and without border molding using zinc oxide eugenol impression paste. Indian J Dent. 2016;7:1-5.
Pachar RB, Singla Y, Kumar P. Evaluation and Comparison of the Effect of Different Border Molding Materials on Complete Denture Retention: An in vivo Study. J Contemp Dent Pract. 2018;19:982-987.
Qanungo A, Aras MA, Chitre V, Coutinho I, Rajagopal P, Mysore A. Comparative evaluation of border molding using two different techniques in maxillary edentulous arches: A clinical study. J Indian Prosthodont Soc. 2016;16:340-345.
Chandu GS, Hema B, Mahajan H, Azad A, Sharma I, Azad A. A comparative study of retention of complete denture base with different types of posterior palatal seals – an in vivo study. Clin Cosmet Investig Dent. 2014;6:95-100.
Hamdan S, Wazir G, Dannan A. Effect of Stone Cast Type on Complete Denture Based Adaptation. J Dent Mat Tech. 2016;5:59-62.
Lee CJ, Bok SB, Bae JY, Lee HH. Comparative adaptation accuracy of acrylic denture bases evaluated by two different methods. Dent Mater J. 2010;29:411-418
Ganzarolli SM, Rached RN, Garcia RC, Del Bel Cury AA. Effect of cooling procedure on final denture base adaptation. J Oral Rehabil2002; 29:787-790.
Teraoka F, Takahashi J. Controlled polymerization system for fabricating precise dentures. J Prosthetic Dent. 2000; 83:514-520.
Cagna DR, Massad JJ. Complete denture stability and Retention. Available from:https://www.dentalcare.com/en-us/professional-education/ce courses/ce360/complete-denture-stability-and retention#:~:text=Carefully%20designed%20external%20denture%20contours,to%20prosthesis%20stability%20and%20retention.&text=Successful%20denture%20wearers%20master%20patterns,rather%20than%20displace%2C%20their%20prostheses. [Date accessed: June 30, 2020].
Turakhia H, Ram SM. Rigid and resilient investing materials-expected movements of teeth in the fabrication of complete dentures: an invitro study. J Indian ProsthodontSoc. 2005;5:23–25.
Baydas S, Bayindir F, Akyil MS. Effect of processing variables (different compression packing processes and investment material types) and time on the dimensional accuracy of polymethyl methacrylate denture bases. Dent Mater J. 2003;22:206-213.
Sykora O, Sutow EJ. Posterior palatal seal adaptation: influence of a high expansion stone. J Oral Rehabil. 1996;23:342-345.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareSystematic Development of Cyclic RGD Anchored Emulsomes for Tumor Specific Delivery of Paclitaxel
English1929Dubey SEnglish Sharma REnglish Vyas SPEnglishEnglish Emulsomes, Paclitaxel, c(RGD), QbD, Integrin, TumorINTRODUCTION
Paclitaxel (Ptx) is an approved first-line drug against breast and ovarian cancers. Despite of its well-evidenced therapeutic potentials, extensive clinical use is restricted owing to the poor water solubility of drug.1 Clinically Taxol® is solubilized in 1:1 (v/v) mixture of Cremphor EL and ethanol. Cremophor- EL imposes serious side effects like hypersensitivity, nephrotoxicity and neurotoxicity and at higher dilutions it antagonizes the effect of Paclitaxel. Thus, a variety of nanocarriers have been developed in search of pharmaceutically acceptable formulation.2 However, most of these nanoparticles, presents obstacle for pre-clinical translation because of intrinsic toxicities of the synthetic material employed in manufacturing. Thus, biomimetic drug delivery vehicles emerging from rich pre-existing bio-source, are being explored for their potential to provide safe, biocompatible and readily acceptable delivery vehicles. A core- shell based nanosized system which mimics biological composition of chylomicron will provide a bio-compatible drug delivery system for hydrophobic drugs.
Emulsomes, a new class of novel lipoidal nanocarrier bearing resemblance to chylomicron (natural lipoprotein) are capable of loading both hydrophilic and hydrophobic drug. They are comprised of two structural components, a lipidic core made from solidified fatty acid and phospholipid/s forming stabilizing envelope around the core. Our research team has reported the potential of emulsome based formulations for delivery of antiviral,3 antifungal,4,5 antipsoriatic,6 antileshmaniasis7, 8 and anticancer agents9 through various routes of administration. The investigations have ascertained their higher loading capability for poorly-water soluble bioactives with subsequent protracted and sustained release of incorporated therapeutic agent from the core. Futhermore, the lipid matrix minimizes the chance of drug leakage and coalescence during systemic circulation, addressing the stability issues often observed in case of liposomes based nanocarriers.
Incorporation of active targeting functionality onto the surface of emulsomes ensures tumor specific delivery of Ptx avoiding the exposure to healthy tissue. Integrins composed of α and β subunits are highly expressed in cancer cells and present in negligible amount in normal cell. These are involved in mediating cell interaction with extracellular matrix components like fibronectin, vitronectin and collagen through their Arg-Gly-Asp (RGD) peptide motif which further promotes cell adhesion, migration, proliferation and metastasis processes vital for tumor survival.10 Therefore, synthetic peptide comprising RGD sequence either in linear or cyclic form is easily recognized by tumor cells and is extensively utilized for integrin targeting.11
The present study aims at formulating sterically stabilized cRGD conjugated Ptx bearing emulsomes for effective solid tumor therapy (R-Ptx-Es). Optimization of the formulation was performed using Design expert® 11software to evaluate the impact of independent variables (formulation variables and process variables) for obtaining the best formulation in terms of entrapment efficiency, drug release and PDI. These carriers can overcome the solubility issues of Ptx as the drug gets entrapped predominantly within the lipophilic core and additionally intercalate within phospholipid bilayers thereby; improved entrapment efficiency over liposomes can be achieved. Emulsomes are expected to offer a physiologically stable system, with minimum leakage of drug and concomitant sustained release from the solidified core, thereby evading the problems of systemic toxicity and rapid drug elimination associated with parentral administration of most of the nanocarriers.
MATERIAL AND METHOD
Paclitaxel was gifted by Neon laboratories ltd. Mumbai, India. Soya Phosphatidylcholine (PC) and DSPE-PEG-COOH were offered by Lipoid Gmbh, Germany. Cyclo(-RGDfk) was provided by Peptide Specialty Laboratory, Germany. Cholesterol, Tristearin, 1-Ethyl -3-(3-dimethylamino) propyl carbodiimide (EDC) and N-hydroxysuccinimide (NHS) were purchased from Sigma Aldrich Chemie, Gmbh. Cell line A549 was purchased from NCCS Pune. All other reagents and chemicals used were of analytical grade and purchased from local chemical supplier.
Experimental design for optimization of the formulation
Plain drug loaded emulsomes P-Ptx-Es were optimized by screening out the formulation and process related variables to achieve best average particle size, PDI, entrapment efficiency and cumulative percentage drug release for site directed delivery of Ptx emulsomes (Ptx-Es).
. Therefore, Taguchi orthogonal design at two levels (low and high) for selected variables i.e. Phospholipid to solid lipid ratio (PL:SL, w/w), Phospholipid to DSPE-PEG (PL:DSPE-PEG molar ratio), total lipid to solid lipid ratio (TL:SL, %), aqueous to organic phase ratio (Aqu:org phasev/v), stirring speed (r/pm), sonication time (sec) surfactant concentration (v/v), was applied to study the impact of selected variables on three response variables namely average particle size-PS (nm), entrapment efficiency-EE (%) and polydispersity index-PDI. It was implemented to rule out the insignificant factors from the experimental design in order to reduce the complexity in optimization design
The significant variables as per Taguchi’s orthogonal design were investigated using Box-Behnken. The design was appropriate for investigating 3-D and 2-D contour response surfaces and for creating second order polynomial order. Independent factors PL:SL ratio (X1), PL:DSPE-PEG ratio (X2) and Aqu:org phase volume (X3), TL:SL (X4) were analyzed for their effect on dependent factors, PS, EE and cumulative percentage drug release. Each design variable represented by −1, 0 and +1, analogous to the low, middle and high values respectively.
Formulation of plain and c(RGD)fk conjugated emulsomes
Tristearin based non-liganded and liganded emulsomes designated as P-Ptx-Es and R-Ptx-Es respectively were prepared by single emulsification-solvent evaporation method with slight modifications.12 The P-Ptx-Es were composed of tristearin:soya PC:Chol:DSPE-PEG-COOH in different ratios. Precisely, all the lipid components were dissolved in chloroform (organic phase). The organic solution was then added drop wise at the rate of 1ml/min to the aqueous phosphate buffer saline pH 7.4 (aqueous phase) with concomitant stirring. Ptx (5mg/ml), dissolved in 50:50 v/v mixture of methanol:PBS pH 7.4 was added to aqueous phase. After the addition of organic phase to aqueous phase, the mixture was subjected to overnight stirring to allow the evaporation of organic phase and self-assembling of emulsomes. The resultant emulsomes dispersion was sonicated using probe sonicator (Sonifield, Mumbai) under ice bath for attaining desirable size range, passed through the Sephadex-G 50 column to remove the untrapped drug, lyophilized using 2% mannitol and finally stored in refrigerator. Mannitol was added as cryoprotectant to the emulsomes at sugar to lipid ratio of 5:1. The emulsome samples were frozen at -80°C for 5 h followed by lyophilization at condenser temperature of 50-55 °C for 48 h and 5 Pa.
RGD-conjugated emulsomes were prepared by post conjugation method.13 Carboxylic group located at the distal ends of DSPE-PEG-COOH were conjugated with amine functionality of c(RGD) through amide bond formation involving carbodidimide chemistry. Firstly, DSPE-PEG was replaced by 3 mol% of DSPE-PEG-COOH and emulsomes were formulated as stated above. Then, excess of DCC and NHS (6 molar) were added to activate the –COOH group with the resultant formation of succinimidyl ester. RGD (100 mg) dissolved in PBS pH (7.4) was added to the above solution and allowed to stand overnight at room temperature to allow for conjugation through amide bond formation. To remove the unreacted components the reaction mixture was dialyzed using a dialysis membrane with molecular weight cutoff 12000 Da.
CHARACTERIZATION OF OPTIMIZED PTX-ES
Morphological Characterization of Emulsomes
The average particle size, surface zeta potential and polydispersity index values of emulsomes were determined using photon correlation spectroscopy (Malvern zetasizer Nano-ZS, UK). Measurements were conducted in triplicate at room temperature after diluting lyophilized samples with distilled water.
The shape and surface morphology of the formulation were observed by using electron microscopic techniques. Transmission Electron Microsocopy (TEM-4X, JEOL, Japan) using phosphotungastic acid (1%) based negative staining method for capturing 2-D images while the 3D view of the prepared emulsomes was photographed by Scanning Electron Microscopy, (SEM, NOVA NanoSEM 450).
Entrapment Efficiency
1 ml of the dispersion was treated with 1 ml of 0.1%v/v triton X- 100 and centrifuged to pelletize the structural components. Supernatant was used to estimate the liberated drug content by HPLC (Shimadzu) at 229 nm using following formula:
%Entrapment Efficiency (EE)=(Experimental drug loading⁄Theoritcal drug loading)×100
In Vitro Drug Release
In vitro drug release study was performed using dialysis tube method in buffer media with pH (7.4) and phthalate buffer pH (4.0) resembling physiological and tumor pH respectively. Briefly, 1 ml of the emulsome dispersion was taken in the dialysis bag with MWCO of 10,000 and dipped into 50 ml of PBS pH 7.4 maintained at 37 ±1 ºC. Samples were withdrawn at the predetermined intervals and replaced by the same volume of fresh release medium. The amount of Ptx released was quantified by using HPLC (229 nm).
Cell culture
A549 cell line was selected for tumor studies. The cells were cultured in RPMI supplemented with 10% Fetal Bovine Serum (FBS), 1% streptomycin/penicillin, 2mM of glutamine, maintained at 37±1°C and 5% CO2 under humidified conditions.
FACS analysis for quantitative cellular uptake
The cellular uptake by cell lines (cancer cells) was determined quantitatively through FACS analysis of treated A549 cells as reported by Minnelli et al., 2018.14 A549 cells at the density of 5x105 cells were seeded in a 96 well plate. FITC loaded formulations namely FPtx-Es and FR-Ptx-Es were added and incubated for 2h at 37ºC. Then after, cells were washed thrice with PBS to remove unbound emulsomes, trpsinized and centrifuged at 1500 r/pm for 2min at 4 ºC. Finally, the pelletized cells so obtained were suspended in 500µl PBS and analysed using FACS (FACA, Caliber, BD Science, USA).The fluorescence intensity was quantified relative to untreated cells which served as control.
Assesment of cellular toxicity of Ptx-Es
Inhibition of cell proliferation was studied by tetrazolium salt (3-[4,5-dimethylthiazol-2-yl]-2-5-diphenyl tetrazolium bromide, MTT assay. Briefly, cells (1x105cells/well) were seeded in a 96 well flat bottom plates and allowed to grow for 48 h. Then, the cells were incubated with increasing concentration of Ptx solution and Ptx emulsome formulation for 24 h and 48 h. After 24 h, the supernatant was removed, MTT and culture medium (100 μl each) were added to each well, incubated for 4 h at 37?C and 5% CO2 atmosphere. The unreduced MTT and medium were then discarded. Each well was washed with 200 μl of PBS, and 200 μl of DMSO was added to dissolve the MTT formazan crystals. Plates were shaken for 20 min and absorbance was read at 560 nm using a microplate reader (Molecular Devices Corporation, USA). The IC50 values (i.e., concentration resulting in 50% growth inhibition) of paclitaxel were graphically calculated from concentration-viability curves, considering the optical density of the control well as 100% viable.
Biocompatibility study
Biocompatibility of emulsomes was performed on Ptx free emulsomes. Cells were then treated with emulsomes (Es), cRGD modified emulsomes (R-Es) and Cremophor-EL:ethanol at concentrations can contain equivalent amount of paclitaxel. Cell viability was then determined to observe the cytotoxic effect of nanocarriers.
RESULTS
As per the Pareto chart and the half-normal plots obtained from the Taguchi OA design the factors namely, PL:SL, PL:DSPE-PEG, Aqu:org phase and sonication time contributes significantly over the rest of the factors to effects the responses as displayed in (fig. 1 and table 1). Four factors were put into the BBD at low (-1) and high level (1) followed by the input of response variables, PS (Y1), EE (Y2) and DR (Y3). .Table 2 summarizes the various constraints and their coded factor levels chosen for study. Table 3 records F value and P value for the ANOVA used for factorial selection. The non-significant lack of fit, model F values of 110.59, 30.67 and 36.59 for PS, EE and PDI respectively and the p valuesEnglishhttp://ijcrr.com/abstract.php?article_id=3947http://ijcrr.com/article_html.php?did=39471. Yang T, Cui FD, Choi MK, Lin H, Chung SJ, Shim CK et al. Liposome formulation of paclitaxel with enhanced solubility and stability. Drug Deliv 2007; 14: 301-8.
2. Gelderblom H, Verweij J, Nooter K, Sparreboom A. Cremophor EL: the drawbacks and advantages of vehicle selection for drug formulation. Eur J Cancer 2001; 37: 1590–1598.
3. Vyas SP, Subhedar R, Jain S. Development and characterization of emulsions for sustained and targeted delivery of an antiviral agent to liver. J. Pharm. Pharmacol. 2006; 58: 321–326.
4. Vyas SP, Khatri K, Goyal AK. Functionalized nanocarrier(s) to image and target fungi infected immune cells. Med Mycology 2009; 47: S362-S368.
5. Gupta S, Vyas SP. Development and characterization of amphotericin B bearing emulsomes for passive and active macrophage targeting. J. Drug Target 2007; 15: 206–217.
6. Gupta R, Gupta M, Mangal S, Agrawal U, Vyas SP. Capsaicin-loaded vesicular systems designed for enhancing localized delivery for psoriasis therapy. Artificial Cells, Nanomedicine, and Biotechnology 2014; 1–10.
7. Pal A, Gupta S, Jaiswal A, Dube A, Vyas SP. Development and evaluation of tripalmitin emulsomes for the treatment of experimental visceral leishmaniasis.J. Liposome Res. 2012; 22: 62–71.
8. Gupta S, Dube A, Vyas SP. Antileishmanial efficacy of amphotericin B bearing emulsomes against experimental visceral leishmaniasis. J. Drug Target 2007; 15: 437–444.
9. Paliwal R, Paliwal S, Mishra N, Vyas SP. Engineered chylomicron mimicking carrier emulsome for lymph targeted oral delivery of methotrexate. Int. J. Pharm. 2009., 380: 181-188.
10. Danhier F, Breton A Le, Preat V. RGD-based strategies to target alpha(v) beta(3) integrin in cancer therapy and diagnosis. Mol. Pharmaceutics 2012; 9: 2961–2973.
11. Gaertner FC, Kessler H, Wester HJ, Schwaiger , Beer AJ. . Radiolabelled RGD peptides for imaging and therapy. Eur J Nucl Med Mol Imaging 2012; 39: 126-38.
12. Pooja D, Tunki L, Kulhari H, Reddy BB, Sistla R. Optimization of solid lipid nanoparticles prepared by a single emulsification-solvent evaporation method. Data in Brief 2016; 6: 15–19.
13. Vaidya B, Agrawal GP, Vyas SP. Platelets directed liposomes for the delivery of streptokinase: Development and characterization. Eur. J. Pharm. Sci.2011; 44: 589–594.
14. Minnelli C, Cianfruglia L, Laudadio E, Galeazzi R, Pisani M, Crucianelli E et al. Selective induction of apoptosis in MCF7 cancer-cell by targeted liposomes functionalized with mannose-6-phosphate. J Drug Target 2018; 26: 242-251.
15. Nagayasua A, Uchiyamab K, Kiwadab H. The size of liposomes: a factor that affects their targeting efficiency to tumors and therapeutic activity of liposomal antitumor drugs. Adv. Drug Delivery Rev. 1999; 40: 75–87.
16. Haeiti H, Phillips NC, Tawashi R. Evidence for phospholipid bilayer formation in solid lipid nanoparticles formulated with phospholipid and triglyceride. Pharm Res 1996; 13: 1406-1410.
17. Madani F, Esnaashari SS, Mujokoro B, Dorkoosh F, Khosravani M, Adabi M. Investigation of Effective Parameters on Size of Paclitaxel Loaded PLGA Nanoparticles. Adv Pharm Bull 2018; 8 Suppl 1: 77-84.
18. Ucisik MH, Kupcu S, Schuster B, Sleytr UB. Characterization of CurcuEmulsomes: nanoformulation for enhanced solubility and delivery of curcumin. J. Nanobiotechnol 2013; 11 Suppl 1: 37-48.
19. Agrawal U, Chashoo G, Sharma PR, Kumar A, Saxena A. Vyas SP. Tailored Polymer Lipid Hybrid Nanoparticles For The Delivery Of Drug Conjugate: Dual Strategy For Brain Targeting. Colloids and Surfaces B: Biointerfaces 2015: 1-41.
20. Paliwal SR, Paliwal R, Agrawal GP, Vyas SP. Hyaluronic acid modified pH-sensitive liposomes for targeted intracellular delivery of doxorubicin. J. Liposome Res.2016: 1-12.
21. Suk JS, Xu Q, Kim N, Hanes J, Ensign LM. PEGylation as a strategy for improving nanoparticle-based drug and gene delivery. Adv Drug Deliv Rev 2016;99: 28-51.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareBiosorption of Cadmium and Lead through Lactobacillus reuteri and Lactobacillus plantarum and its Exopolysaccharides: A Comparative Study
English3035Singh AEnglish Saini PEnglish Srivastava UEnglish Kushwaha REnglishIntroduction: Cadmium and lead are toxic elements among the heavy metals group. Through water, it enters into the food chain and became hazardous to all living bodies, so its removal is important. Biosorption through Lactic acid bacteria is the most effective technique for the removal of these hazardous metals from water even at very low concentrations. Aims: In the present study, using two strains of Lactic acid bacteria i.e. L. reuteri and L. Plantarum and its exopolysaccharides (EPS) biosorption of Cadmium and Lead were performed due to a well-known toxicant and hazardous to humans and other living bodies. Methodology: Firstly, EPS were isolated from both strains. Biosorption tests were performed using various condition like pH (pH2.0, 4.0, 6.0, 8.0), temperature (37°C,42°C and 50 °C) and contact time (6, 24 and 48 hours). Cadmium and lead sorption were tested in both strains and their Exopolysaccharides through atomic absorption spectrophotometer (AAS). Results: Biosorption of cadmium through EPS was higher as compared to cells in both strains. Lactobacillus reuteri showed 89% biosorption of cadmium through EPS and EPS of Lactobacillus Plantarum showed 51% biosorption of lead. In the case of cells, biosorption of lead was more i.e. 57% through Lactobacillus reuteri and 43% through Lactobacillus Plantarum as compared to cadmium. Conclusion: Exopolysaccharides showed comparatively maximum biosorption as compared to cells. Both strains and their EPS biosorption may be applied in metal detoxification of the environment and different food and pharma industries.
EnglishAtomic absorption spectrophotometer, Biosorption, Exopolysaccharides, Detoxification, Heavy metals, Lactic acid bacteriaINTRODUCTION
Water is essential for all types of living moieties. However, raised anthropogenic activities are causing high Cd and Pb exposure to the water bodies. These are the most toxic heavy metals, tending to accumulate in the environment occupationally and non-occupationally. These biodegradable hazards entered into the food chain through soil and water. 1, 2 Thus food and water are the primary sources of cadmium and lead exposure among the non-smoking population. However, excessive use of fertilizers in agriculture, dumping of sewage sludge, mining and smelters are anthropogenic sources that release cadmium and lead into the environment. Chronic exposure to these metals, even in very low quantities may lead to developing adverse health effects. 3,4,5 According to WHO and the Food safety standard act of India (FSSAI) the concentrations of cadmium and lead in water should not exceed the guideline values of 0.003and0.01mg/L, respectively. According to the Expert Committee FAO/WHO has set tolerable weekly intake of Cd at 7 mg/kg body weight through Food Additives.6 So the removal of these metals from the environment and even from the human body is essential.
Numerous conventional methods are being continuously used in the eradication of these heavy metals. But recently the biotechnological innovative technique biosorption is being explored as the most promising phenomenon. It is a physiochemical, economical and eco-friendly approach towards heavy metal removal. This process involves the removal of heavy metal through adsorption, surface precipitation complexation, and ion exchange mechanism.7 The biosorption process requires an aqueous solution of heavy metals and solid inactive biomass/ biosorbent materials for accumulating these metals.
Lactic acid bacteria are the most promising and efficient biosorbents used in different studies.8-12 LAB also has the potential of being probiotic. Due to probiotic characteristics, it has a great capacity of having antioxidant, antibacterial, antibiotic properties, tolerance against gastric juice and bile juice and heavy metals. Some species of lactobacillus mainly Lactobacillus Plantarum, Lactobacillus casei and others have characteristics of folic acid and B12 synthesis.13 LAB also has managing properties of lactose intolerance, cholesterol-lowering effect, improve cholesterol removal from the body through faeces, preventing cancers and improve immunity.14,15,16 It shows different health implications like probiotic effect, anti-gastric and antiulcer effect, cholesterol-lowering effect, anti-mutagenic property, Adhesion and Colonization and anti-tumour property.17,18,19 It has also a capacity of neutralizing the effect of heavy metal-induced free radical toxicity. Many of its species produce Exopolysaccharides (EPS), which has wide application in different industrial productions like cosmetics, pharmaceuticals, food production, biodegradable packaging etc.20,21 EPS synthesized by LAB play a major role in the manufacturing of fermented dairy products such as yoghurt, cheese, fermented cream, milk-based deserts etc. The major attributes for consumer preference of dairy products are firmness and creaminess. EPS can decrease syneresis and improve product stability. Therefore, it has been reported the EPS can positively affect gut health.22 EPS have potential in heavy metal binding and removal. Heavy metal binding by EPS is a metabolism-independent process; binding of metal is depending upon functional groups presents on EPS.23 In general the biosorption phenomenon is relatively economical and simple because of the low value associated with their commercial applications.24 To explore this applicability the study has focused on the biosorption of cadmium and lead through Lactobacillus reuteri and Lactobacillus Plantarum and their EPS.
MATERIALS AND METHODS
Bacterial strains and culture
L.plantarum and L reuteri were used in the study, obtained from the National Collection of Dairy Culture (NCDC), ICAR- National Dairy Research Institute Karnal, India. The lyophilized cultures of L.plantarum and L reuteri were maintained in glycerol stock and from glycerol stocks transferred to de Man, Rogosa and Sharpe agar broth (MRS) plates and cultured anaerobically for 48h at 37°C. Bacterial strains were propagated twice at 37OC for 18 h in MRS broth with 2% (v/v) inoculum before the experiments Catalase test negative colony from the plate was transferred to MRS broth and incubated under anaerobic conditions for 48 h at 37°C. Both bacterial strains were subcultured twice before the experiment.
Extraction of bacterial culture
The bacterial strains of L.plantarum and L reuteri were cultured at 37°C for 18 h in MRS broth (Difco Laboratories, Detroit, MI) using a loopful inoculum in the Growth medium (De Man, Rogosa and Sharpe, specific media for LAB) containing glucose 10.0 g/L, peptone 5.0 g/L, yeast extract 3.0 g/L, malt extract 3.0 g/L, MgSO4 7H2O 1.0 g/L, KH2PO4 0.3 g/L, vitamin B1 0.001 g/L and pH was fixed at 6.5.25 The cells were separated by centrifugation at 5000 rpm for 15minutes. Bacterial cells after centrifugation were washed three times with sterile distilled water. Collected the cell palettes and freeze-dried.
Exopolysaccharide isolation and extraction
Both the strain were inoculated in the EPS production medium (MRS Broth) containing glucose 10.0 g/L, peptone 5.0 g/L, malt extract 3.0 g/L, yeast extract 3.0 g/L, MgSO4 7H2O 1.0 g/L, KH2PO4 0.3 g/L, vitamin B1 0.001 g/Land pH was adjusted to 7.0.25 and incubated in a rotatory shaking incubator at 120 rpm for 72 h at 40°C. After the completion of incubation time, the cultures were steamed at 10 psi for 20 min. This treatment will lose the attached polymer, and then it was centrifuged at 8000 rpm and the solution was collected. The collected supernatant solution was cooled and an equal amount of ethanol was added and agitation was done for proper mixing. This mixture was left overnight at 4°C to settle down and finally precipitated EPS were extracted after centrifugation at 10000 rpm for 20 min.26,27 The supernatant was removed and precipitates were collected and freeze-dried.
Cadmium and lead biosorption assay
Cadmium and Lead standards of 1000 ppm solution (Cd (NO3)2 and Pb (NO3)2 in 0.1 M HNO3) (HiMedia) was diluted with 10mM citrate phosphate buffer (pH 4.0) and used as a 1 ppm Cd and lead solution. 10mg of bacterial strains (Lactobacillus plantarum, Lactobacillus reuteri) as well as their EPS were suspended in 1ppm Cd and Pb solution and incubated it at 37° C, 42° C and 50° C for 6hours to 48 h using various pH conditions 2, 4, 6 and 8. After incubation the bacterial cells and EPS were removed/ separated by centrifugation at 9000 rpm, the Cd and Pb concentration of the filtrate was measured using an AAS, citrate phosphate buffer was used as the negative control. The metal biosorption potential is detected by calculating accordingly.28 Metal removal (q), from the solution, expressed as mg metal removed/g dry weight-1, which was calculated using the following formula
q (mg g-1) = V(C i - Cf )m-1
Where, V = sample volume (l), Ci and Cf = initial and final metal concentrations (mg/l), respectively; m = amount (g) of dry biomass.
RESULTS
The results showed that both the strains i.e. Lactobacillus Plantarum and Lactobacillus reuteri, and their isolated EPS were able to biosorbe heavy metals cadmium and lead. After analysing the treated samples by AAS, the cells and the EPS of isolates showed good biosorption ability of the tested metals. The biosorption ability of both strains and their EPS is species-specific but EPS showed better biosorption ability as compared to their cells. In the present study, emphasis has been laid on three major factors i.e. tempreture, pH and contact time.
Both the LAB strains and their EPS were tested for Cd (II) and Pb biosorption at different temperature ranges from 37°C, 42°C and 50°C. EPS and cells of Lactobacillus reuteri reduced 890ppm and 160ppm cadmium at 50°C and 37°C while lead was reduced to 570ppm and 360 ppm at 50°C and 37°C. EPS and cells of Lactobacillus Plantarum reduced 180ppm and 110ppm of cadmium at 50°C and 37°C were as lead reduced 630ppm and 181ppm at 50°C and 37°C (Fig. 1a-f).
The LAB strains and their EPS were tested for Cd (II) and Pb biosorption at pH 2.0, 4.0, 6.0, and 8.0. EPS and cells of Lactobacillus reuteri reduced 210ppm and 65 ppm of cadmium at pH 4.0 and pH 6.0 while lead reduced more by 480 ppm to 310 ppm at pH 4. EPS and cells of Lactobacillus Plantarum reduced 72ppm and 150ppm of cadmium at pH 4 and 510ppm and 270ppm of lead at pH8.0 and pH 4.0 (Fig. 2a-f). The results showed that pH significantly affected the Cd biosorption and lead. Both strains showed Cd (II) and Pb(II) biosorption, although the biosorption ability of each was different.
At different contact times of 6h, 24h, 48h both the LAB strains and their EPS showed Cd (II) and Pb biosorption. EPS and cells of Lactobacillus reuteri reduced 120ppm and 70 ppm cadmium at 48h while lead reduced 390ppm and 540ppm at 48h. EPS and cells of Lactobacillus Plantarum reduced 160 ppm and 130ppm cadmium at 48h while lead reduced 400ppm and 210ppm at 48h (Fig.3a-f).
DISCUSSION
Biosorption of cadmium through EPS was higher as compared to cells in both strains. Lactobacillus reuteri showed 89% biosorption of cadmium through EPS and EPS of Lactobacillus Plantarum showed 51% biosorption of lead. In the case of cells, biosorption of lead was more i.e. 57% through Lactobacillus reuteri and 43% through Lactobacillus Plantarum as compared to cadmium. It is accepted that bacterial EPSs can interact with toxic metals by various mechanisms including van der Waals’ forces, electrostatic attraction and surface complexation.29, 30 Bhakta et al.,9 reported seven and four LAB strains isolated from mud and sludge that displayed relatively elevated Cd (II) and Pb (II) removal efficiencies from water. Lactobacillus reuteri Cd70-13 and Pb71-1 showed the highest Cd (II) (25%) and Pb (II) (59%) removal capacity from MRS culture medium.8
Numbers of factors play important role in the biosorption process, which may enhance or diminish the process of biosorption of heavy metals. With heat treatment, the bacterial cells may be disrupted using heating so that intracellular proteins may bind the Cd and Pb. The study reported that exopolysaccharide of Lactobacillus Plantarum showed maximum adsorption of Pb at 50°C.31 This suggests that EPS is related to biosorption of Cd and Pb in strains, and it may be broken or modified by heat treatment. Schut et al.,12 reported that one of the lactobacillus strains on boiling at 1000C for 1 hr showed maximum biosorption of copper. The binding may be different for each strain and heavy metal.
All bacteria have the potential for biosorption of heavy metals though there is a difference in their abilities. Biosorption of both metals Cd (II) and Pb (II) tended to be high at mild acidic to slight alkali pH. This focused that the vital activity of LAB becomes weak in very low pH and Cd (II) and Pb(II) absorption are decreased and the protein that is present on the cell surface is positively charged below the isoelectric point and have difficulty adsorbing Cd (II) and Pb (II)at very low pH. Cadmium and lead removal by LAB was enhanced at higher pH.8,32 The anion of the salt that used to prepare the metallic solutions, the EPS confining system or the pH can significantly affect the biosorption.22,33
Ibrahim et al.,10 reported binding isotherms for Cd (II) and Pb (II) were characterized for Lactobacillus rhamnosus LC-705, Propionibacterium freudenreichii subsp. shermanii JS and a mix showed Cd (II) and Pb (II) sorption. This suggests LAB is potential biosorbents of heavy metals and have metal-binding proteins or EPS on the cell surface. The EPS extracted from B. licheniformis NSPA5, B. cereus NSPA8 and B. subtilis NSPA13 showed very distinct abilities as compared with lead and cadmium.34
CONCLUSION
The biosorption process is the most effective strategy for the removal of heavy metals and it can become more effective by using different strains of LAB. These probiotic bacteria have the potential to produce EPS and both bacteria as well as extracted EPS can detoxify the adverse effect of heavy metals. In this study, the comparison between the biosorption ability of cells and exopolysaccharides of the same strains are discussed. Both the strains Lactobacillus Plantarum and Lactobacillus reuteri and their EPS can bind cadmium and lead efficiently. Although both the strains have the potential to remove heavy metals the produced EPS from both the strains are more efficient to remove heavy metal 89% through L.reuteri and 63%by L.plantarum as compare to cells 54% through L.reuteri and 27% by L.plantarum. Extensive use of LAB and its EPS are seen in different food sectors and pharmaceutical industries so both the strains may be recommended as an inexpensive tool to detoxify heavy metal contamination from the environments and food products for industrial-scale applications.
ACKNOWLEDGEMENT
The authors would like to express their sincere gratitude to the Centre of Food Technology, University of Allahabad, Prayagraj and Prof. Neelam Yadav for providing all the essential help and support.
Conflict of Interest:
Authors have no conflict of Interest.
Funding:
The authors received no financial support for the research and publication of this article.
Author Contribution:
Anchal Singh: Study conception and design, writing, validation
Pinki Saini: Supervision, reviewed the results
Urvashi Srivastava: Editing
Radha Kushwaha: Statistical analysis
Englishhttp://ijcrr.com/abstract.php?article_id=3948http://ijcrr.com/article_html.php?did=3948
Järup L, Åkesson A. Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol. 2009 Aug 1;238(3):201-8.
Satarug S, Garrett SH, Sens MA, Sens DA. Cadmium, environmental exposure, and health outcomes. Environ Health Perspect. 2010 Feb;118(2):182-90.
International Agency for Research on Cancer. Beryllium, cadmium, mercury, and exposures in the glass. Apresentado em: IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: Beryllium, Lyon 1993.
Satarug S, Moore MR. Adverse health effects of chronic exposure to low-level cadmium in foodstuffs and cigarette smoke. Environ Health Perspect. 2004 Jul;112(10):1099-103.
IWG on the Evaluation IW. Inorganic and Organic Lead Compounds. Inorganic and Organic Lead Compounds. International Agency for Research on Cancer.2006.
Evaluation of certain food contaminants: 64th report of the Joint FAO/WHO Expert Committee on Food Additives. Geneva. FAO/WHO 2006; Retrieved from http:// whqlibdoc.who.int/trs/WHO_TRS_930_eng.pdf Accessed 21.01.15.
Volesky B. Detoxification of metal-bearing effluents: biosorption for the next century. Hydromet. 2001 Feb 1;59(2-3):203-16.
Kinoshita H, Sohma Y, Ohtake F, Ishida M, Kawai Y, Kitazawa H, et al. Biosorption of heavy metals by lactic acid bacteria and identification of mercury binding protein. Res Microbiol. 2013 Sep 1;164(7):701-9.
Bhakta JN, Ohnishi K, Munekage Y, Iwasaki K, Wei MQ. Characterization of lactic acid bacteria?based probiotics as potential heavy metal sorbents. J Appl Microbiol. 2012 Jun;112(6):1193-206.
Ibrahim F, Halttunen T, Tahvonen R, Salminen S. Probiotic bacteria as potential detoxification tools: assessing their heavy metal binding isotherms. Can J Microbiol. 2006 Sep 1;52(9):877-85.
Lin Z, Zhou C, Wu J, Zhou J, Wang L. A further insight into the mechanism of Ag+ biosorption by Lactobacillus sp. strain A09. Spectrochim Acta A Mol Biomol Spectrosc. 2005 Apr 1;61(6):1195-200.
Schut S, Zauner S, Hampel G, König H, Claus H. Biosorption of copper by wine-relevant lactobacilli. Int J Food Microbiol. 2011 Jan 31;145(1):126-31.
Srivastava U, Saini P, Singh A. Effect of Natural Fermentation on Antioxidant Activity of Pearl Millet (Pennisetum glaucum). Curr Nutr Food Sci. 2020 Apr 1;16(3):306-13.
Perdigon G, Galdeano CM, Valdez JC, Medici M. Interaction of lactic acid bacteria with the gut immune system. Eur J Clin Nutr. 2002 Dec;56(4):S21-6.
Lim BK, Mahendran R, Lee YK, Bay BH. Chemopreventive effect of lactobacttlus rhamnosus on the growth of a subcutaneously implanted bladder cancer cell line in the mouse. Jap J Cancer Res. 2002 Jan;93(1):36-41.
Hosono A. Bile tolerance, taurocholate deconjugation, and binding of cholesterol by Lactobacillus gasseri strains. J Dairy Sci. 1999 Feb 1;82(2):243-8.
Lam EK, Yu L, Wong HP, Wu WK, Shin VY, Tai EK, et al. Probiotic Lactobacillus rhamnosus GG enhances gastric ulcer healing in rats. Eur J Pharmacol. 2007 Jun 22;565(1-3):171-9.
Tok E, Aslim B. Cholesterol removal by some lactic acid bacteria that can be used as probiotic. Microbiol Immunol. 2010 May;54(5):257-64.
Suresh Kumar A, Mody K, Jha B. Bacterial exopolysaccharides–a perception. J Basic Microbiol. 2007 Apr;47(2):103-17.
Singha TK. Microbial extracellular polymeric substances: production, isolation and applications. IOSR J Pharm. 2012;2(2):271-81.
Singh P, Saini P, Srivastava U, Singh A. Microbial Polysaccharides as an Alternative Biodegradable Packaging Material. In Food Technology and Nutrition; 91:37.
Paperi R, Micheletti E, De Philippis R. Optimization of copper sorbing–desorbing cycles with confined cultures of the exopolysaccharide?producing cyanobacterium Cyanospira capsulata. J Appl Microbial. 2006 Dec;101(6):1351-6.
Kim SY, Kim JH, Kim CJ, Oh DK. Metal adsorption of the polysaccharide produced from Methylobacterium organophilum. Biotechnol Lett. 1996 Oct;18(10):1161-4.
Nies DH. Microbial heavy-metal resistance. Appl Microbiol Biotechnol 1999 Jun;51(6):730-50.
Banerjee D, Jana M, Mahapatra S. Production of exopolysaccharide by endophytic Stemphylium sp. Micol Aplicada Int. 2009;21(2):57-62.
Brown MJ, Lester JN. Comparison of bacterial extracellular polymer extraction methods. Appl Environ Microbiol. 1980 Aug 1;40(2):179-85.
Donot F, Fontana A, Baccou JC, Schorr-Galindo S. Microbial exopolysaccharides: main examples of synthesis, excretion, genetics and extraction. Carbohydr Polym 2012 Jan 15;87(2):951-62.
Volesky B, Holan ZR. Biosorption of heavy metals. Biotechnol Prog. 1995 May 1;11(3):235-50.
Gutnick DL, Bach H. Engineering bacterial biopolymers for the biosorption of heavy metals; new products and novel formulations. Appl Microbiol Biotechnol. 2000 Oct;54(4):451-60.
Guibaud G, van Hullebusch E, Bordas F. Lead and cadmium biosorption by extracellular polymeric substances (EPS) extracted from activated sludges: pH-sorption edge tests and mathematical equilibrium modelling. Chemosphere. 2006 Sep 1;64(11):1955-62.
Feng M, Chen X, Li C, Nurgul R, Dong M. Isolation and identification of an exopolysaccharide?producing lactic acid bacterium strain from Chinese Paocai and biosorption of Pb (II) by its exopolysaccharide. J Food Sci. 2012 Jun;77(6): T111-7.
Halttunen T, Salminen S, Tahvonen R. Rapid removal of lead and cadmium from water by specific lactic acid bacteria. Int J Food Microbiol 2007 Feb 28;114(1):30-5.
Pulsawat W, Leksawasdi N, Rogers PL, Foster LJ. Anions effects on biosorption of Mn (II) by extracellular polymeric substance (EPS) from Rhizobium etli. Biotechnol Lett. 2003 Aug;25(15):1267-70.
Shameer S. Biosorption of lead, copper and cadmium using the extracellular polysaccharides (EPS) of Bacillus sp., from solar salterns. Biotech. 2016 Dec;6(2):1-0.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareCephalo-anatomy of Meitei Males of Manipur, India: A Diachronic Study
English3640Thoudam Bedita DeviEnglish Soibam Jibonkumar SinghEnglishIntroduction: Each individual on the surface of this earth has unique anatomical features which distinguishes him from others. Among such unique features, cephalo-facial characters are the most commonly used parameters employed for personal identification. Though cephalo-facial anatomy of one ethnic group differs from another, yet within the same ethnic group it may experience diachronic change. Few works have been carried out specifically on cephalo-facial features of some selected population groups of India. But no such exhaustive study has been carried out on the Meiteis of Manipur valley from a diachronic approach. Aims and Objectives: The present work aims at profiling a database of the cephalic anatomy of the Meitei adult male population of Manipur on one hand and diachronic comparison of the present findings with the findings of Singh (1992) who carried out a similar work almost three decades back from now with a view to examine if there is any secular micro-evolutionary change taking place in cephalic on the other. Methodology: The present study is conducted on randomly selected 1600 Meitei adult males of Manipur valley whose age range from 21 to 60 years. Two direct cephalo-facial measurements i.e. maximum head length and maximum head breadth have been measured employing Weiner and Lourie (1969) technique and corresponding cephalic index was calculated and classified according to the conventional categories of Labzelter and Saller (1968). Results: Based on the findings of the measures of cephalic dimensions, Meiteis dominantly have medium to long head length and head breadth with an overall head shape ranging between mesocephalic to brachycephalic. The findings reveal that among the adult Meitei males, both maximum head length and maximum head breadth have increased from the last generation to the present generation. While the cephalic index index of the present generation have lower mean value than the previous generation showing statistically significant difference. Conclusion: The present findings therefore reveal a positive secular change towards increasing head length and head breadth while a negative secular trend in cephalic index. The database derived from the findings of the present study shall definitely have clinical applications in the field of cranio-facial surgery as well as in forensic application particularly in personal identification and of cranial reconstruction of the victims of the said ethnic community.
EnglishManipur, Meitei, Cephalo-facial, Cephalic Index, Brachycephalic, DolichocephalicIntroduction
One of the most important objectives of anatomy and anthropology lies in understanding the morphological and anatomical variation from an evolutionary and racial point of view of humankind both at the individual as well as population-level. Study of morphological and anatomical features of man, a concern of the anthropologist and anatomist have played a significant role. As far as the biological understanding of personal, ethnic and racial identity is concerned, the cephalo-facial part is the most important dissected component of the human body.
Cephalo-facial anthropology is indeed an important tool for determining the morphological and anatomical features of the head and face, which can steer the anthropological, anatomical and forensic investigations.1 At the same time, cephalo-facial dimensions and indices are the most straight forward and most efficient tool for studying racial differences2 population variations and sexual dimorphism3 identification of race, ethnicity, gender, age.4 Cephalo-facial dimensions experience change during growth and development period and reach its peak growth between 16-20 years of life and finally attains maturity after that.5, 6 Variation in head and face depend on many factors such as ethnicity, genetic influence, traditions, nutrition, certain pathological conditions, environment and climate.7
Hence driven by the need necessitates studies on the secular trend in the cephalic dimensions and indices and Meitei male populations. Secular trend in physical growth pattern is one of the biological evolutionary phenomena taking place almost in all human population groups of the world. Study on secular trend for the first time was described on human stature by Quetelet in 1835.8 But now it is not restricted to the only stature but also to axial, appendicular, facial parts of the body as well.
Though quite many scholars have worked on the secular trend in cephalo-facial measurements on different population groups of the world, the report from the Indian population is comparatively very few. With only a few such studies in North East India, little is known concerning the cephalo-facial dimension conducted on the population of Manipur. Such a scanty nature of data on Indian population more particularly among the populations of North East India and more specifically of the population of Manipur calls for undertaking a pioneering research. Steered by this fact and not having done any work inter-generational variation of cephalic anatomy, the present research work has been carried out on the Meitei male population of Manipur valley with a view to document their cephalic profile on one hand and examine if any secular trend has taken place in cephalic anatomy from earlier generation to the present generation on the other. Keeping this in view, the present study is undertaken with an objective of preparing a database of cranial profile of the studied population with a view to provide a baseline data for anatomical and clinical application in the field of cranial surgery and reconstruction as well as forensic application of personal identification.
Materials and Methods
The present study on the cephalo-facial profile has been carried exclusively on 1600 Meitei adult males who belonged to the age range of 21-60 years representing 400 each from four valley districts of Manipur i.e Imphal West, Imphal East, Bishnupur and Thoubal district selected randomly through multi stage random sampling method. This cross sectional sample comprising of 400 individuals each represents the four different age groups (21-30, 31-40, 41-50, 51-60) years of age. Only those individuals with no cephalo-facial surgery/anomalies and who volunteered and gave ethical clearance and written consent were selected as subjects of the present study. The following two cephalometric measurements were taken with the help of Martin’s sliding caliper and blunted knob Martin’s spreading caliper following the techniques laid down by Weiner and Lourie (1969) on the subjects sited on a chair in a relaxed condition with the head oriented in eye ear plane. 9
Based on the two measurements, the following four relevant indices were calculated.
The two measurements and the cephalic index were classified according to the conventional categories of Labzelter and Saller (1968).10
The statistical constants such as Mean, Standard Deviation, and their respective standard error were calculated. Independent sample t-test has been used to compare the mean values with previous works. To determine statistical significance of qualitative data, Chi-Square test has also been applied. All the statistical calculations were calculated using SPSS version 22.
Results
Steered by the hypothesis that changes might have not occurred in cephalo facial measurements between the present Meitei Population and past Meitei population of Manipur, the following section delve into detail comparison of the cephalo facial parameters of present-day adult male Meitei population of Manipur valley with that of the findings of the Singh who carried out similar work on the same population three decades back from now in a diachronic approach with an aim to see if any changes have occurred in these characters, thereby leading and directing to a secular change be it a positive one or negative one. A comparative account of these two studies is presented in the following section in a systematic and scientific approach.
As evident from table 1 that the frequency per cent distribution of maximum head length of the past and present Meitei male population fall within the classification ranging from very short to very long among the past population and short to very long among the present population. On qualitative comparison of the maximum head length of the past and present population, it is evident that highest frequency percent of maximum head length is observed in the medium class (43%), followed by short (31%), long (20%), very short (4%) and very long (2%) being the least for the past population. However, among the Meiteis of present population the highest is observed in long category (40%) followed by medium (38%), very long (13.50%) and short (8.50%). When statistically compared using chi-square test, a significant difference (χ2 = 31.651, table 2) is observed between the past and present male Meitei population of Manipur valley.
On quantitative comparison, the present population shows higher mean values (18.65±0.03 cm) than the past population (18.05±0.06 cm) thereby showing a statistically significant difference (t = 8.49, table 3). These findings, therefore reveals that a positive secular trend in the dimension of maximum head length is taking place from past generation to the present generation.
As regards the frequency per cent distribution of maximum head breadth, the highest frequency is observed in the medium-class which range between 148.0-155.0 mm in both the present (49.75%) and past (49%) populations. Medium class of maximum head breadth is followed by narrow (35%) among the past population while broad (27.00%). A very sharp variation is observed in the distribution of narrow category of head breadth between the past (35%) and present (18.25%) population. Analysis of the qualitative comparison also revealed a statistically significant difference (χ2=8.618, table 2). Comparison of the mean values of the past population (x? = 14.99±0.05cm) and present population (x? = 15.27±0.03cm) also shows a positive secular trend as revealed by the observed statistically significant difference (t=4.80, table 3).
Considering the comparison of the head shape expressed as cephalic index (table 1), brachycephalic head is predominantly the highest frequently occurring class observed in both the population (Past study 41.00% and Present study, 39.00 %). At the same time both the population displays a similar preponderance order of Brachycephalic > Mesocephalic > Hyperbrachycephalic > Dolichocephalic > Ultrabrachycephalic and Hyperdolichocephalic. The similarity in the frequency per cent distribution and preponderance order as well confirms statistically non-significant difference (χ2= 3.416, table 2).
However, when quantitatively compared, the mean value of the present population is experiencing a decreasing trend from the past. The difference of 1.36 in between the mean value of the past (x?=83.25 ± 0.43) and present (x?=81.89 ± 0.22) population reflects a statistically significant difference (t=2.84, table 3).
Discussion
Based on the objectives of the work, the data collected from 1600 (400 each from a districts) Meitei male adults within the age range 21-60 years of age have been statistically treated and the findings presented under the caption results. This section shall exclusively deal with the analytical discussion of the findings of the aforesaid results.
Many of the earlier researchers studied racial affinity of the Meiteis and described as Mongoloid owing to the presence of mongoloid features.11,12,13 The present findings too reveal that Meitei males of Manipur valley possessing mongoloid features with respect to cephalic characters in general by having medium to long head length and head breadth with an overall head shape ranging between mesocephalic to brachycephalic. All these observed anatomical features of Meitei Males are mongoloid features and is in agreement with the findings of other scholars who worked on different mongoloid populations.14,15,16,17
It has been observed that Maximum Head Length and Maximum Head Breadth of the Meitei population have experienced a positive secular change towards increasing size from the last generation to the present generation. In short Meiteis of the present generation have longer and broader head than the previous generation, Looking into the cephalic index, the Meitei population of the present generation have lower mean value than the previous generation showing a negative secular trend showing statistically significant difference (t=2.84,). Similar findings showing a negative secular trend was also reported by Golalipour et al. who studied the Japanese population.18This negative trend is because of the more significant increase in head length (0.60 mm) as compared to head breadth (0.28mm). This finding of the present study is in agreement with those reported by Sanna et al.19 who studied the Sardinian, but contrasting to that of among whom there is a more significant increase in head breadth as compared to head length and among Japanese children.20,21Therefore, as a result of decreasing cephalic index, the population is gradually experiencing debrachycephalization. Similar findings were also reported among the Sardinian Children22,23; among the Hungarian24,25; among the Zena children26; among the Croatian27 among Russian children28 and among Ogbia tribe of Bayelsa State.29 However, the mean values of the cephalic index of both the Meitei populations indicate that their head shape falls under the brachycephalic category. Though the mean value shows a significant difference, the frequency per cent distribution of different head form between the past and present population still remains more or less the same thereby revealing no statistically significant difference between the populations as evidenced from chi-square value (χ2 = 3.416). Even though the size of the head, i.e. head length and head breadth increases, head shape remains more or less unchanged in both the populations because of the fact that head shape or form depends more on pre-established constitutional hereditary factors and less on environmental factors as compared to head size for which environmental factors have a great influence on genetic fact.
Conclusion: On the basis of the results obtained, it can be concluded that the cephalic features i.e. maximum head length and maximum head breadth has experienced an increase in dimensions resulting to a diachronic positive secular change during the last generation. On the other hand the ratio between head length and head breadth i.e. cephalic index of the present Meitei males has experienced a decreasing value from the last generation thereby revealing a negative secular change even though the conventional category of head shape remains the same.
Acknowledgement
We are grateful to the Department of Anthropology, Manipur University, Canchipur for rendering us to utilize the instruments during the course of this study/work and also our heartfelt thanks to all the participants for their sincere co-operation during the work.
Conflict of Interest : Nil
Source of funding: NIL
Authors contribution : Data collection and analysis of the same was carried out by the first author and overall supervision and guidance during the course of work was done by the second author.
Englishhttp://ijcrr.com/abstract.php?article_id=3949http://ijcrr.com/article_html.php?did=39491. Cvetkovic, M., Stevo, N. and Milos, N. Secular change in cephalic index- a study of Serbian School Children, GENETIKA 2014; 46 (2), 561-568.
2. Chaturvedi, R. P, Harneja, N. K. A Cephalometric study of Human Skulls. J. Anat. Soc. India, 1963; 12, 93-96.
3. Ilayperuma, I. Evaluation of cephalic Indices: A clue for racial and Sexual diversity. Int. J. Morphol,2011; 29 (1), 112-117.
4. Sol, D. M. Cephalic Index in a group of Mapuche individuals in the IX Region of Chile.Int. J. Morphol, 2005;23 (3), 241-246.
5. Kondu, S., Wakatsuki, E., Shibagaki, H. A. Somatometric study of the head and face in Japanese adolescents. Okajimas Folia Anat Japan, 1999; 76 (4), 179-85.
6. Knutson, B., Momenan, R., Rawlings, R. R., Fong, G. W. and Hommer, D. Negative association of neuroticism with brain volume ratio in healthy humans. Biol. Psychiatry,2001; 50,685-690.
7. Rexhepi, A., Meka, V. Cephalo-facial morphological characteristics of Albanian Kosova population. Int. J. Morphol, 2008; 26 (4), 935-940.
8. Smith, B. H., Garn, S. M., Hunter, W. S. Secular trend in face size. Angle Orthod, 1986; 56, 196-204.
9. Weiner, J. S, Lourie J. A. Human Biology, A Guide to Feild Methods. IBP Handbook no.9. Blackwell Scientific Publications, Oxford;1969.
10. Labzeltar, Saller, A.. Reproduced from Singh, I. P, Bhasin, M. K. Anthropometry. New Delhi. Bhart Bhavan. Kem Publishers;1968.
11. Sanajaoba, N. Manipur Past and Present. Mital Publication, New Delhi.1; 1988
12. Singh, C. B. The Ethnonym, Meitei. In Manipur Past and Present.1; 2003; 72 – 81.
13. Kabui, G. History of Manipur. National Publishing House, New Delhi;1989.
14. Xu, B, Wang, Y, Ma, J, Li, M, Xu. L. A computer aid study on the craniofacial features of Archang race in Yunnan province of China. Hua Xi Kou Qiang Yi Xue Za Zhi,2011; 19 (6), 394-396.
15. Kroeber, A. L. American Culture and the Northwest Coast, American Anthropologist,1923; 25, 1 -25.
16. Kasika, R. L. C, Brozon, T. Comparative study of craniofacial morphology in Japanese and Australian aboriginal population. Hum Biol, 1993; 65(5),821-834.
17. Zheng, L. B. Physical characteristics of Chinese Hakka. Sci China Life Sci, 2013;56, 541-551.
18. Golalipour, M. J, Jahanshahi. M., Haidari. K. Morphological evaluation of head in Turkman males in Gorgan- North of Iran. Int. J. Morphol, 2007; 25 (1), 99-102.
19. Sanna, E, Palmas I. Change in Body and Head Dimensions in urban Sadinian children (3-5years) from 1986-2001. Ann. Hum. Biol; 2008;12: 782-791.
20. Kouchi, M, Vojdani, Z. Brachycephalization in Japan has ceased. Am J Phys Anthropol, 2000;112, 339-347.
21. Heravi, F, Zieace, H. Assessing the importance of Cephalic and Facial indices in a group of 12 years old boys in Mashhad. Behesti University. Dent. J; 2002; 20, 119-124.
22. Sanna, E, Soro, M. R. Anthropometric changes in urban Sardinian children 7-10 years between 1975-1976 and 1996.Ann. Hum. Biol; 2000; 12: 782-791
23. Sanna. E, Palmas I. Change in Body and Head Dimensions in urban Sadinian children (3-5years) from 1986-2001. Ann. Hum. Biol.; 2008;12: 782-791.
24. Gyenis G. Rapid change in head and facial measurements in university students in Hungary. Anthropol. Anz; 1994; 52, 149-158.
25. Magyar. L, Bellovits. O, Bujdoso, G. Changes in anthropological data of Hungarian child and adult population during the last thirty years based on family study conducted by the Department of Forensic Medicine at Budapest. Anthropol. Anz.;2006; 64: 227-241.
26. Zellner. K, Jaeger, U, Kromeyer. H. K. The phenomenon of debrachycephalization in Jena School Children. Anthropol. Anz.; 1998; 56, 301-321.
27. Buretic. A, Tomljanovic. A. A, Giacomett. J, Ostojic. A. S, Kapovic. A. M. Sex-specific differences of craniofacial traits in Croatia: The impact of environment in a small geographic area. Ann. Hum. Biol; 2007; 34, 296-314.
28. Godina. E. Z. Secular trend in some Russian populations. Anthropol. Anz; 2011;68, 367-377.
29. Eroje. M. A., Fawehimmi. H. R, Jaja. B. N, Yasker. I. Cephalic Index of Ogbia Tribe of Bayesla State. Int. J. Morphol; 2010; 28 (2), 389-392.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEffect of Addition of TiO2 Nanofiller and Intrinsic Pigment on Tear Strength of Cosmesil M511 and VST50F Silicone Elastomers - A Comparative Study
English4143Komal SinghEnglish Sakina Sadiqe AliEnglish Harsha HardiyaEnglish Ankita MangalEnglish Shalini KumarEnglish Palak AgrawalEnglishEnglish Elastomer, Nanofillers, Intrinsic pigmentINTRODUCTION
Facial trauma is common nowadays. Sometimes the injury is such that it requires removal of the facial bony part. The occurrence of pathologies such as cysts and tumors is also common.1 Such pathology demands the removal of bony components along with the dead and decayed bone. Silicone elastomers are the material of choice to replace missing facial parts.2 The ideal requirement of material for external facial prosthesis are tear resistance, high tensile strength, ease of molding, color stability, water absorption, non-toxic, and non-sensitivity to the host tissues.3
There are numerous materials available for creating maxillofacial prostheses. Silicone is a widely used material and is chemically polydimethylsiloxane (PDMS).4 These are of two types such as room-temperature-vulcanizing (RTV) silicone and heat-temperature-vulcanizing (HTV) silicone based on the vulcanizing process used. High temperature vulcanizing (HTV) silicones are relatively tougher, stronger, and stiffer than RTV materials. There are two major types of RTV silicones such as addition and condensation silicones.5
Maxillofacial silicone elastomers are greatly affected by the presence of intrinsic and extrinsic pigmentation.6 This pigmentation helps in making teeth identical to human tissue. Opacifiers such as CeO2, TiO2, and ZnO (nano-oxides) make maxillofacial prostheses durable and improve their mechanical properties.7 Rai et al. in their study revealed that the addition of intrinsic pigment leads to improved tear strength in Cosmesil M 511 silicone and Biomed silicone. The present study aimed at assessing the effect of the addition of TiO2 nanofiller and intrinsic pigment on tear strength of Cosmesil M511 and VST50F silicone elastomers.8
MATERIALS & METHODS
This study was done in department of Prosthodontics. It comprised of Cosmesil M511 and VST50F silicone elastomers.
Each comprised of 20 samples. Each elastomers sample was further classified into 2 equal groups of 10 each. One group had no additives (control, C HTV for the HTV elastomer and C RTV for the RTV silicone elastomers and second group had nanofillers such as TiO2 and intrinsic pigment (experimental, E HTV for the HTV silicone elastomer and E RTV for the RTV silicone elastomers). In one part, tear strength and in another part Shore, A hardness was tested.
A metal mold for the HTV elastomer and an acrylic mold for the RTV elastomer was produced. In the type C sample in each group tear strength with the universal testing machine was measured based on the formula, tear strength = F/D, where F is force (kilonewtons) and D is the average thickness (meters). The Shore A hardness value was measured with a digital durometer at 4 different areas of the sample. The mean was taken as the final reading. Data were analyzed statistically using Two-way ANOVA and Tukey test. P-value below 0.05 was considered significant.
RESULTS
Table 1, shows that mean tensile strength (kN/m) in C HTV was 11.6± 0.12, in E HTV was 13.5± 0.17, in C RTV was 24.4± 0.13 and in E RTV was 27.6± 0.16. The difference was significant (P< 0.05). Table 2, shows that mean hardness (Shore A unit) in C HTV was 25.2± 0.13, in E HTV was 28.4± 0.19, in C RTV was 27.8± 0.07 and in E RTV was 28.6± 0.14. The difference was significant (P< 0.05).
DISCUSSION
Maxillofacial prosthetic materials are used to substitute facial parts that vanished during disease or trauma.9 Facial defects require artificial maxillofacial prostheses. Silicone rubbers are the materials of choice. The average lifetime of such prostheses is 1.5–2 years.10 It shows fine and thin boundaries that bind with the surrounding facial structures. Moreover, it has got high tear strength. Polyzois et al. suggested that a high percentage elongation and high tear strength produce the most desirable combination.11 The present study aimed at assessing the effect of the addition of TiO2 nanofiller and intrinsic pigment on tear strength of Cosmesil M511 and VST50F silicone elastomers.
In the present study, we compared room-temperature-vulcanizing (RTV) silicone and heat-temperature-vulcanizing (HTV) silicone. It is comprised of Cosmesil M511 and VST50F silicone elastomers. Abdul-Ameer compared tear strength and hardness of Cosmesil M511 and VST50F silicone and found significant differences in tear strength among all tested groups. The tear strength of the study subgroups suggestively raised in comparison to the control subgroups (P < 0.05). A non-significant difference in Shore A hardness between the experimental subgroups of both materials was found whereas all tested groups showed significant difference. 12
It is suggested that the percentages and type of thermal initiator, the additives, the fillers, the temperature required for curing, and the time required for polymerization may affect the hardness between the two elastomers. There is a hydrogen bond between a chain of PDMS and surface hydroxyl groups, resulting in an increase in polymer density and producing a stronger and stiffer material. In the present study, we observed that Cosmesil M511 silicone elastomers (HTV) exhibited low tensile strength as compared to VST50F silicone elastomers (RTV). This may be due to the variation in time of curing leading to the differences in polymerization and cross-linking. We found that subgroup C HTV exhibited lower hardness as compared to subgroup C RTV. This may be due to less density of the polymer and hardness because of the low degree of polymerization and cross-linking of Cosmesil M511 silicone elastomers.
Begum et al. compared tear strength, tensile strength, percentage elongation, hardness, and water absorption of Cosmesil, Cosmesil high compliance, and Prestige elastomers. Results demonstrated that there was significantly higher tear strength of osmosis high compliance as compared to other materials and tensile strength was also higher than the other materials but not statistically significant. For all the materials, the hardness and percentage elongation were exactly similar.13 Prestige elastomer though exhibited higher water absorption than the other two materials, but it was not statistically significant.
Shakir and Abdul-Ameer assessed the outcome of adding titanium oxide (TiO2) nanofillers on the tensile strength, tear strength, hardness, and elongation percentage of high-temperature-vulcanized (HTV), room-temperature-vulcanized (RTV) VST50F, and Cosmesil M511 maxillofacial silicone elastomers. They established that VST50F and Cosmesil M511 maxillofacial silicone material's mechanical properties were enhanced with the addition of nano-TiO2 concentration. 14
Addition of intrinsic silicone liquid suspension pigment may also contribute to the increase in tear strength and hardness of the elastomers because the pigments may fully interfere with the matrix of the silicone elastomer.15
Mousa et al. evaluated the effect of hot and dry weather on the surface roughness and hardness of 4 dissimilar maxillofacial silicone elastomeric materials (MFSEM) and found the least hard MFSEM with Cosmesil M-511. A-2000 showed the hardest material and become smoother in weather followed by A-2186. 16
The shortcoming of this study is the small sample size. Only two elastomers were compared. The inclusion of different elastomers could have given different results.
Conclusion
The authors found that both tear strength and hardness increased with the addition of nanofillers and intrinsic pigment.
Conflict of interest: Nil
Source of funding: self
Authors contribution
Singh K – Data collection
Sadiqe Ali S- Analysis
Hardiya H- Investigation
Mangal A- Manuscript writing
Kumar S- Analysis
Agrawal P- Editing
Englishhttp://ijcrr.com/abstract.php?article_id=3950http://ijcrr.com/article_html.php?did=3950
Mitra A, Choudhary S, Garg H, Jagadeesh H G. Maxillofacial prosthetic materials – An inclination towards silicones. J Clin Diagn Res. 2014;8: 8-13.
Assaad HI, Hou Y, Zhou L, Carroll RJ, Wu G. Rapid publication-ready MS-word tables for two-way ANOVA. Springerplus. 2015;4:33.
Pesqueira AA, Goiato MC, dos Santos DM, Haddad MF, Ribeiro Pdo P, Coelho Sinhoreti MA, et al. Effect of disinfection and accelerated aging on color stability of colorless and pigmented facial silicone. J Prosthodont. 2011;20:305-309.
Sun L, Gibson R, Gordaninejad F, Suhr J. Energy absorption capability of nanocomposites: A review. Compos Sci Technol. 2009;69:2392-2409.
Guiotti AM, Goiato MC, Dos Santos DM, Vechiato-Filho AJ, Cunha BG, Paulini MB, et al. Comparison of conventional and plant-extract disinfectant solutions on the hardness and color stability of a maxillofacial elastomer after artificial aging. J Prosthet Dent. 2016;115:501-508.
Wypych G. Plasticizers Use and Selection for Specific Polymers. Toronto, Canada: Chem Tec Publishing; 2004.
Hu X. Analyses of Effects of Pigments on Maxillofacial Prosthetic Material. PhD Thesis. The Ohio State University; 2010
Rai SY, Guttal SS. Effect of intrinsic pigmentation on the tear strength and water sorption of two commercially available silicone elastomers. J Indian Prosthodont Soc. 2013;13:30-35.
Chi YH. Effect of Silica Filler on the Mechanical Properties of Silicone Maxillofacial Prosthesis. MSc Thesis, Indiana University School of Dentistry, Indianapolis (MI); 2014.
Abdullah HA, Abdul-Ameer FM. Evaluation of some mechanical properties of new silicone material for maxillofacial prostheses after addition of intrinsic pigments. Saudi Dent J. 2018;30:330-336.
Polyzois GL. Mechanical properties of two new addition-vulcanizing silicone prosthetic elastomers. Int J Prosthodont. 1999; 12: 359- 362.
Abdul-Ameer FM. Impact of a mixture of nanofiller and intrinsic pigment on tear strength and hardness of two types of maxillofacial silicone elastomers. Dent Res J. 2020;17:251-257.
Lewis DH, Castleberry DJ. An assessment of recent advances in external maxillofacial materials. J Prosthet Dent. 1980;43:426-432.
Begum Z, Kola Mohammed Zaheer, Joshi P. Analysis of the properties of commercially available silicone elastomers for maxillofacial prostheses Int J Contr Del. 2011; 2(4): 1-5.
Shakir DA, Abdul-Ameer FM. Effect of nano-titanium oxide addition on some mechanical properties of silicone elastomers for maxillofacial prostheses. J Taibah Univ Med Sci. 2018 Apr 3;13(3):281-290.
Han Y, Zhao Y, Xie C. Color stability of pigmented maxillofacial silicone elastomer: Effects of nano-oxides as opacifiers. Journal of dentistry. 2010; 38(2):e100-105.
Mousa MA. Influence of Weather on Hardness and Surface Roughness of Maxillofacial Elastomeric Materials. J Contemp Dent Pract 2020;21(6):678–682.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareTherapeutic Efficacy of an Unani Polyherbal Formulation in Leucorrhoea: A Prospective Pre-and Post-treatment Clinical Study
English4450Anjum AAEnglish Tabassum KEnglish Sultana AEnglishEnglishLeucorrhoea, Unani formulation, Vaginal Symptom Scale, Visual Analogue ScaleINTRODUCTION:
The concept of women’s health today has become a major concern among developing countries because of the deteriorating quality of life. Reproductive Tract Infections (RTIs) is defined as the infection of the reproductive or genital tract which causes ill-health among sexually active women of reproductive age in developing countries. 1 “RTIs usually originate in the lower genital tract as vaginitis or cervicitis and may produce symptoms such as abnormal vaginal discharge, genital pain, itching and burning micturition”.2
Excessive vaginal discharge or leucorrhoea is probably physiological or pathological. During ovulation, pregnancy, emotional stress, before menstruation, use of OCP’s, sexual arousal and nutritional deficiency are included in physiological vaginal discharge that does not necessitate precise treatment, whereas, in pathological conditions like cervicitis, cervical erosion, trichomoniasis, candidiasis, gonococcus, chlamydia or bacterial vaginosis etc and secondary infection of wounds, abrasions, burns, chemical injuries and neoplasms require management.3 Prevalence of vaginal discharge (VD) in India is about 30%.4 Poor genital hygiene is responsible for the high prevalence of excessive vaginal discharge. Abnormal vaginal discharge is used when secretions from the vulvovaginal are abnormal in colour, odour, volume, or consistency.5The discharge may be thick or thin in consistency and whitish or yellowish. Among all gynaecological complaints, AVD is the commonest complaint that is associated with the psychosomatic disorder and affects the psychology of women irrespective of socio-economic status and occupation.6 It creates irritation in women’s freedom and decreases QoL.7
Vaginitis can occur with or without true inflammation of vaginal mucosa. It is observed that 50% of vaginitis is due to Bacterial Vaginosis (BV), 20-25% due to monilial infection and 15-20% due to trichomonal infection.3 Cervicitis is a state of cervical inflammation that results in an abnormal mucopurulent discharge and cervical friability.8 Cervicitis is also described as mucopurulent cervicitis in many trials.9 The sexually transmitted infections (STIs) diseases such as chlamydia, gonorrhoea, trichomoniasis, and syphilis recognized to cause cervicitis, vaginitis, urethritis and genital ulceration. Chlamydia and gonorrhoea cause grave short- and long-term complications such as ectopic pregnancy, infertility, pelvic inflammatory disease, arthritis and chronic pelvic pain. 10 The main clinical manifestation of PID is lower abdominal tenderness and abnormal vaginal discharge. The mild or subclinical PID also has the potential for damaging the reproductive health of women.11 A low threshold for diagnosis of PID is recommended to cover milder forms of PID.12
Contemporary therapy supports the use of antimicrobial that is effective but produces adverse effects in the human body. There has been a continuous increase in the recognition of persistent, recurrent and metronidazole resistant cases of reproductive tract infections, which is of serious concern. Hence, undoubtedly there is a need for alternative medicine for the treatment of abnormal vaginal discharge including protection strategies.
According to the Unani system of medicine, leucorrhoea is due to the weakness of the retentive power of the uterus.13 A weakness of this power causes accumulation of waste material in the uterus and expel in the form of abnormal vaginal discharge. In Unani medicine, the treatment for abnormal vaginal discharge includes the change in lifestyle and following hygienic conditions and management with suitable oral or local herb mineral Unani drugs. The Unani drugs are in use for ages because of their holistic approach. For the management of disease, the Unani system of medicine takes the entire constitution of the individual and lifestyle into account for diagnosing and prescribing the treatment. In the Unani system of medicine, several drugs are available for treating leucorrhoea.
Treatment goals encompass not only the amelioration of signs and symptoms of leucorrhoea but also the prevention of long-term reproductive sequelae. The Unani formulation containing Orchis latifolia L., Phaseolus mungo L., Bambusa arundinacea Retz, Portulaca oleracea L., Pistacia lentiscus L. and Boswellia serrata Roxb 13 were selected as they exhibit the properties of habis (styptic) and qabiz (astringent), muhallil auram (anti-inflammatory), and dafe taffun (anti septic), muqawwi jigar aur meda (tonic to liver and stomach), musammin Badan (nutritive) and mumsik (retentive) properties.14 Further, these drugs contain flavonoids, phenolic acids, lipids,15 volatile oils, glucosides, 16 and tannins which probably may resolve the inflammation and help in the reduction of vaginal discharge and its associated symptoms. Since it has not been validated and documented to date, therefore, an attempt was made to validate the efficacy of the aforementioned polyherbal formulation in relieving the sign and symptoms of leucorrhoea.
METHODOLOGY:
Study design, location and duration: A single centre prospective pre and post-treatment clinical study was carried out in the outpatient Dept. of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine and Hospital, Bengaluru, during the year 2017-2018. The study protocol was approved by Institutional Ethical Committee, NIUM, Bengaluru under IEC No: NIUM/IEC/2016-17/015/ANQ/07 after which the clinical trial was registered in CTRI with registration number: CTRI/2018/04/013148.
Participants:
Inclusion and exclusion criteria: A total of 30 married patients between 18- 45 years of age who had abnormal vaginal discharge associated with low backache, pruritus vulvae, lower abdominal pain or dyspareunia were included. Patients with systemic and metabolic diseases, syphilis, gonorrhoea, HIV and malignancy were excluded. Patients who used contraceptives within 3 months before enrolment, pregnant and lactating women were also excluded.
Procedure:
Data collection: Patients informed consent was obtained from the patients who fulfilled the inclusion criteria. After consenting, demographic data such as age, occupation, education, socio-economic status, habitation, parity, contraceptive practice and BMI were recorded in case record form. The symptoms were recorded in the vaginal symptoms scale questionnaire. Pain assessment was done on VAS score for dyspareunia, low backache and abdominal pain. Every patient was subjected to a pelvic examination. The patient was advised to empty the bladder and then in lithotomy position vulva and perineum were examined for any discharge, erythema, excoriation, oedema etc. Cleaning of genitalia was done with 10% savlon and a Cusco’s speculum was gently introduced to note the condition of the vagina and cervix. The bimanual examination was done to assess the cervical position, consistency, cervical motion tenderness, size, shape, position, surface and tenderness of the uterus. Then the patients were subjected to routine investigations such as complete blood picture, random blood sugar and the biochemical safety profile (AST, ALT and Alkaline Phosphatase, blood urea and serum creatinine) were performed pre-and post-treatment. Specific investigations which include ultrasound pelvis to exclude pelvic pathology, VDRL and HIV I and II was done to exclude STD’s. A vaginal smear was done to diagnose the type of vaginal infection pre-and post-treatment. A Pap smear was performed to exclude cervical malignancy before treatment.
Intervention:
The polyherbal formulation included Salab Misri (Orchis latifolia Linn), Arade Moong (Phaseolus mungo Linn), Tabasheer (Bambusa arundinacea Retz), Tukhme Khurfa (Portulaca oleracea Linn), Mastagi (Pistacia lentiscus Linn) and Kundur (Boswellia serrata Roxb) in the equal quantity that was selected from the classical text.13 This formulation was selected as it was useful in leucorrhoea on the basis aforementioned Unani properties.14 Moreover, these drugs are pharmacologically proven for anti-inflammatory, anti-bacterial, anti-trichomonal activity, anti-fungal, antiseptic, analgesic, hepatoprotective and antioxidant activities. 16, 17, 18, 19,20, 21
Method of preparation and dispensing of the test drug: The medicines were provided by the pharmacy of the Institute. The drugs were identified by a pharmacognosist of FRLHT (Foundation for Revitalization of Local Health Traditions) Bengaluru. All six drugs in equal quantity were cleaned and powdered. The powder was dispatched in self-locking plastic sachets. To avoid any confusion regarding dosage, one self-locking sachet was used to dispatch. Six grams was given twice daily with water for 21 days. All patients were strictly advised to follow the instructions which were given regarding the drug dosage, diet and hygiene.
Follow-up cum assessment during and after trial: Initially at baseline vaginal discharge and its associated symptoms were thoroughly assessed by using vaginal symptoms score (VSS) and visual analogue scale for pain. Determination of vaginal pH and vaginal smear was repeated after the completion of the treatment. Patients were advised to follow-up every week during the trial and one follow up after 15 days of trial completion. During follow-up visits, the patients were assessed in the improvement of signs and symptoms using the same scales. The patients were also enquired about any adverse effects noted during the trial period. Pre- and post-treatment parameters were statistically analyzed to evaluate the efficacy of the test drug.
Assessment tools
Vaginal Symptom Scale (VSS): The VSS is a 19-question survey focusing on symptoms, self-treatment, and impact on social life, concerns about health, smell and relationship difficulties. It is available in both Spanish and English. The scoring of the scale ranges from 0-43. It is a type of questionnaire which includes symptom subscale (sum score, range 0-15), self-care subscale (sum score, range 0-4), social discomfort subscale (sum score, range 0-9), worry subscale (sum score, range 0-9) and relationship subscale (sum score, range 0-6). The grading of VSS was scored as 0-10 as no symptoms, mild score as 11-20, moderate score as 21-30 and severe score as 31-43.22
Visual Analogue Scale (VAS) for pain intensity for low backache: VAS is a methodologically sound instrument for quantitative assessment of pain. Woodforde and Merskey first reported the use of the VAS scale with the descriptor extremes “no pain at all” to “severe pain”. The VAS is self-completed by the respondent, providing a range of scores from 0–10, the ‘0’ score indicates no pain at all and the ‘10’ score indicates severe pain. Further, VAS score was graded as score 0 as No, mild as score as 1-3, moderate as score 4-6, and severe score as 7-10.23
Grading of therapeutic response:
Mild was rated as 1+, with a VSS score 0-15 and a VAS score of 0-3.
Moderate was rated as 2+, with a VSS score of 16-31 and a VAS score of 4-7.
Severe was rated as 3+, with a VSS score of 32-43 and a VAS score of 8-10.
2.6. Therapeutic outcome: Based on the improvement of the parameters before, during and after the trial, the response was graded as follows
Relieved: It was scored as 1 if the VSS score was 0-15 and the VAS score was 0-3.
Partially relieved: It was scored as 2 if the VSS score was 16-31 and the VAS score was 4-7
Not relieved: It was scored as 3 if the VSS score was 32-43 and the VAS score was 8-10.
Outcome parameters for evaluation of the efficacy of polyherbal formulation:
The outcome parameters included were the Vaginal Symptom Scale (VSS) or Vaginal Complaint Scale (VCS) to assess the severity of the sign and symptoms associated with vaginal discharge, Visual Analogue Scale (VAS) for pain intensity for low backache (LBA). The secondary outcome parameter was the safety parameters. The results were categorized into three groups i.e., relieved, partially relieved and not relieved. Assessment of safety was done by clinical assessment at every visit and biochemical assessment pre-and post-treatment.
Statistical Analysis:
Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented as mean±SD (Min-Max) and results on categorical measurements are presented in Number (%). The significance was assessed at a 5 % level of significance.
RESULTS:
Participant recruitment: Participant’s recruitment was carried out from March 2017 to November 2018. A total of 99 patients were initially screened, 17 patients refused to participate and 52 patients were excluded because of ineligibility and exclusion at the time of evaluation [(IUCD (n=13), OCPs (n=7), Lactating (n=4), pregnancy (n=2), hypertension (n=5), diabetes (n=8), endometriosis (n=3), fibroid (n=4), malignancy (n=2) and hypothyroid (n=4)]. Thus, 30 patients were enrolled.
Baseline characteristics: The age of the patient was 30.20±6.24 years. In this study maximum respondents i.e., 14(46.7%) belonged to upper lower socioeconomic status as per Kuppuswamy’s socioeconomic scale, whereas 12(40%) to lower-middle, 3(10%) to upper and only 1(3.3%) to upper-middle class. The baseline characteristics are summarised in Table 1. The pap smear showed inflammatory smear in 18 (46.6%), bacterial vaginosis in 6 (20%) and candidiasis in 1 (3.3%) patients.
Primary outcome:
Vaginal Symptom Scale (VSS): The mean±SD of total VSS score before trial was 33.03±3.26. During the trial mean±SD of VSS score was 30.83±3.41, 25.73±4.45 and 19.63±5.47 in the first, second and third week respectively with significant difference (p Englishhttp://ijcrr.com/abstract.php?article_id=3951http://ijcrr.com/article_html.php?did=3951
Kafle P, Bhattarai SS. Prevalence and factors associated with reproductive tract infections in Gongolia Village, Rupandehi District, Nepal. Advances in Public Health. 2016: ID 8063843: 1-5.
Rabiu KA, Adewunmi AA, Akinlusi FM, Akinola OI. Female reproductive tract infections: Understandings and care-seeking behaviour among women of reproductive age in Lagos, Nigeria. BMC Women's Health. 2010;10(8): 1-7.
Kumar P, Malhotra N. Jeffcoate’s Principles of Gynaecology, 8th ed. New Delhi: Jaypee Brothers Medical Publishers;2016; 23(4): 315-17.
Thulkar J, Kriplani A, Agarwal N, Vishnubhatla S. Aetiology & risk factors of recurrent vaginitis & its association with various contraceptive methods. Indian J Med Res. 2010; 131(1): 83-7.
Monif GR, Baker DA. Infectious diseases in Obstetrics and Gynaecology. London: The Parthenon Publishing Group; 2005;546-54.
Panda G, Mohapatra KB. Clinical effect of Kukkutanda Twak Bhasma in the management of Sweta Pradara. J Ayu. 2011;32(3):370-74.
Lakshmi V, Gupta RK. Ayurvedic Concept of Leucorrhoea: Sweta Pradara. Int J Ayur Pharma Res. 2014;2(3):119-23.
Polk J, Mattson S, Nyirjesy P. 28: Chronic cervicitis: presenting features and responses to therapy. Am J Obstet Gynaecol. 2015; 213(6):907.
Sánchez A, Rivera A, Castillo F, Ortiz S. Cervical erosion as result of infectious vaginitis. Eur J Exp Biol. 2012; 2(5): 1659-63.
Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization. 2019;97(8):548-62.
Hemsel DL, Ledger WJ, Martens M, Monif GRG, Osborne NG, Thomason JL. Concerns regarding the centres for disease control’s published guideline for pelvic inflammatory disease. Clin Infect Dis. 2001;32(1):103-07.
Crossman SH. The challenge of pelvic inflammatory disease. J Am Fam Physician. 2006; 73(5): 859-64.
Khan A. Al-Akseer (Urdu trans.by Kabeeruddin). Vol II. New Delhi: Aijaz publishing house; 2003.p.715, 1382-84.
Kabiruddin H. Makhzanul Mufradat. New Delhi: Idarae Kitabus Shifa; 2007;153-54:168-69.
Tang D, Dong Y, Ren H, Li L, He C. A review of phytochemistry, metabolite changes, and medicinal uses of the common food mung bean and its sprouts (Vigna radiata). Chem Cent J. 2014; 8(4): 1-9.
Khare CP. Indian Medicinal Plants: An Illustrated Dictionary. Berlin: Heidelberg Springer; 2007;80(1):98-9.
Eldin HM, Badawy AF. In vitro anti-Trichomonas, vaginalis activity of Pistacia lentiscus mastic and Ocimum basilicum essential oil. J Parasit Dis.2015;39(3):465-73.
Kaikini AA, Dhande SR, Kadam VJ: Overview of Indian medicinal tree: Bambusa Bambos (Druce). Int Res J Pharm. 2013:4(8):52-6.
Prabhavathi K, Chandra US, Soanker, R, Usharani P. A randomized, double-blind, placebo-controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using a mechanical pain model. Indian J Pharmacol.2014;46(5):475-9.
Sultana A, Rahman K, Padmaja AR, Rahman S. Boswellia serrata Roxb. a traditional herb with versatile pharmacological activity: a review. Int J Phar Res. 2013;4(6):2106-17.
Sultana A, Rahman K. Portulaca oleracea Linn. A global Panacea with ethno medicinal and pharmacological potential. Int J Pharm Pharm Sci. 2013;5(Suppl2): S33-S9.
Anderson M, Cohrssen A, Klink. K, Brahverd. Are speculum examination and wet mount necessary in patients with vaginal symptoms? J Am Fam Med. 2009; 22 (6):617- 24.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain). Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011; 63(11): S240-52.
Jaimik DR, Nimish LP, Ritesh GP, Jivani NP, Nayna MB. Phytopharmacological Properties of Bambusa arundinacea as a Potential Medicinal Tree: An Overview. J Appl Pharm Sci. 2011; 1(10): 27-31
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Review on Esophageal Cancer Detection and Classification Using Deep Learning Techniques
English5157Kumar C AEnglish Mubarak M N DEnglishIntroduction: Esophageal cancer (EC)is the sixth most common cancer with a high fatality rate. Early prognosis can improve the survival rate of the patients. The sequence of the progress of the EC is from Esophagitis to Non-Dysplasia Barrett’s Esophagus to Dysplasia Barrett’s Esophagus to Esophageal Adenocarcinoma (EAC). Computer-Aided Diagnosis (CAD) has become a primary tool of the decade to diagnose various diseases. Objective: The recent advances in Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) have enriched the potential of detection, localization, and classification of the medical image pattern. Here, we have compiled multiple research works based on supervised DL architectures. Methods: This review focuses on the application of DL techniques for the detection, segmentation, and classification of the various stages leading to the EAC. The surveyor concentrates on the pre-trained classification detection and segmentation models. Results: The advancements in AI have enhanced the contributions in the medical field applications. The technological progress in AI and DL led to a large number of researches in the medical field. The new algorithms and DL models resulted in many automated systems for the detection segmentation and classification of oesophagal cancer. Conclusion: This review discusses the various challenges, limitations, and future aspects of analysing endoscopic images based on DL methods. Further investigations are to be carried out to improve the performance of CAD systems for successful real-time detection of oesophagal and associated stages. It is essential to formulate more collaborated studies with experts in the field.
EnglishBarrett’s Esophagus, Computer-Aided Diagnosis, Convolution Neural Networks, Deep Learning, Esophageal Adenocarcinoma, Machine LearningINTRODUCTION
Acid reflux disease (GERD) is a condition that causes acidity and indigestion.1 The stomach acid's backwash will gradually replace the healthy oesophagal tissue with the tissue that resembles the intestinal/gastric tissues. Figure:1 shows the EC progression as a continuum variation from Esophagitis to Non-Dysplasia Barrett's Esophagus to Dysplasia Barrett's Esophagus to EAC. The change in the texture of the oesophagal tissue lining in Barrett’s Esophagus (BE)may lead to dysplasia. Based on the variation in the texture pattern of the oesophagus lining, the abnormal tissue cells can be categorized as non-dysplastic (noncancerous), High-grade dysplasia (HGD), and Low-grade dysplasia (LGD).2 The condition of BE with High-grade dysplasia is an advanced pre-cancer stage leading to EAC. and EAC's occurrence has drastically increased in Western countries, especially in industrial countries. One of the main reasons for the drastic increase in the rate is due to society's unhealthy lifestyles. The sixth most common cancer with a high fatality rate is EC3. An early prognosis can improve the survival rate of the patient ( Fig 1).
CAD is one of the most prominent tools for providing an improved prognosis for EC. In recent years AI has made remarkable progress in the medical domain. The deep neural network's ability to automatically learn significant low-level features and combine them with high-level features enhances DL performance in medical applications.4 DL with CNN is one of the most efficient and standard tools to perform multiple tasks like object recognition, classification, and segmentation.3-6 We aim to review and study the feasibility of DL for a CAD system using CNN for the prognosis of premalignant and malignant stages of BE (Fig 2).
DEEP LEARNING MODELS
AI is an area of rapid technological advancement, especially in medical applications. AI equips the computer to emulate human intelligence5. Both Machine Learning (ML) and DL are a subset of AI. The DL technique addressed all the major concepts involved in image processing.6 The DL structure has deep CNN networks with a significant number of hidden layers as shown in Figure:2. In health care applications, the DL is considered state-of-the-art technology by its performance.7 Figure:3 depicts the supervised DL models for medical image processing.
Classification Models
The input image traverse through a set of convolutional kernels with down-sampling. A softmax layer towards the end of the model will generate the class probability for classification.8 The model performs the classification process based on the category, subcategory, lesion-based analysis, and lesion morphology like invasion depth. The various classification models are AlexNet,9 VGG,10 GoogLeNet,11 Inception V4,12 Residual Network (ResNet)13and DenseNet.14
Segmentation Models
The segmentation process is the delineation of the lesions' borders under consideration15. Generally, all the segmentation models have two modules, an encoder and a decoder8. The encoder performs the convolution of the image with kernels and downsamples the feature maps. The decoder module performs the deconvolution and the up-sampling process. The model performs both the Semantic and Instance segmentation. Some of the popular segmentation models are Fully Convolution Network (FCN),16 SegNet,17 U-Net,18 Deep Lab,19 DeepLabV3.20
Detection Models
The complete knowledge of an image is conceived when we accurately understand the object's nature and location in the picture.21 The object detection model needs to establish the object location (localization) and the category of the object(classification). A deeper analysis needs to be done by the model to predict the subcategory of the objects. The detection will be based on the object scores obtained from the feature extracted by the fully connected layers in some models. Multiple object detection can also be performed based on the class and object score derived from the feature extracted. The R-CNN,22 Fast R-CNN,23 Faster R-CNN,24 Mask R-CNN,25 Single Shot Multi-BoxDetector (SSD)26 and YOLO27are some of the prevalent detection models used.
SURVEYED WORKS
Takiyama et al.28 propose a GoogLeNet model trained by a back-propagation algorithm for the organ's anatomical classification, larynx, oesophagus, stomach, and duodenum. The network is fine-tuned with an ADAM optimizer with a learning rate of 0.0002.
Kumagai et al.29proposes a DL model for the classification of ESCC. Endocytoscopy(ECS) is a magnified endoscopic method that enables the observation of surface epithelial cells in real-time. The ECS enables a real-time optical biopsy. The ECS performs tissue analysis and perceives the histological features in real-time. The diagnosis can be made without performing biopsy reference of the histology using GoogLeNet trained by a back-propagation algorithm. Ada Delta fine-tunes the training of the model with a learning rate of 0.004.
In Tokai et al.30 the ESCC detection is performed with SSD at a rate of 95.7% in 10sec. The GoogLeNet evaluated the measure of invasion depth of ESCC and the sub-classification for WLI and NBI. The network was trained with all the CNN layers fine-tuned by stochastic gradient descent (SGDM) with a learning rate of 0.0001.
Van der Putten et al.31 proposes a combination of multiple modalities to analyze early neoplasia in BE for better localization accuracy. The sweet spot and soft spot is predefined, and the image registration technique is applied for aligning BLI to WLI. The Canny edge detection is applied for enhancing image pairs.Resnet18 is used for the classification of the patches, which is fine-tuned with an ADAM optimizer.
Tomita et al.32proposes an attention-based model with Resnet18 for the tissue level classification of the histological image into normal, BE with no dysplasia, BE with dysplasia, and EAC. Grid-based feature extraction performed with Resnet18, followed by a 3D CNN kernel to build an attention map. The attention map with the attention feature weights is combined to obtain the feature vector for the tissue classification. The model is trained with high-resolution images and fine-tuned with an ADAM optimizer.
Liu et al. 33proposes an Inception- ResNet model to classify premalignant cancer and EC lesions. The original and preprocessed image is applied as input to the Inception -ResNet model separately for feature extraction. The features obtained are concatenated through a concatenation fusion function. The model achieved better performance when trained and fine-tuned with SGDM optimization with a learning rate of 0.001.
Ebigbo et al. 34 proposed a ResNet network for BE analysis. The pathologically validated images served as a reference for classification. The images labelled by experts serve as the standard of reference for the segmentation process. All validation was carried out using Leave-One-Patient-Out Cross-validation (LOpOCV). The small patches are extracted from the endoscopic colour images, and augmentation is applied to obtain diversified images of a similar class. The classification of the full image was attained by culminating the probability of each patch class.
Hong et al.35proposes a simple CNN architecture to differentiate between sub-classes IM, GM, and NPL. The proposed CNN yielded 80.77 per cent classification accuracy among sub-classes of IM, GM, and NPL.
Van Riel et al.36proposes a new technique for achieving real-time performance in early EC diagnosis using CNN and transfer learning. Performance analysis of some of the popular pre-trained networks such as AlexNet, VGG'16, and GoogLeNet was evaluated using the knowledge transferred from the ImageNet dataset with classifiers such as Support Vector Machine and Random Forest individually. The window-based approach out-performed the existing methods and achieved an AUC of 0.92 (area under the curve).
Mendel et al.37proposes an automated CNN model for the early diagnosis of EAC from High-definition endoscopic images using transfer learning. The ResNet architecture was used to train the models and leave one patient out cross-validation (LOPO-CV) method for evaluation.
Rezvy et al.38focus on a modified Mask-RCNN to detect and segment the Precancerous, BE, High-GradeDysplasia (HGD), EAC and Polyps trained with feature representation in transfer learning mode. The network head of ResNet101 trained on the COCO dataset is used to replace the network head of the AI model. The new model is acquainted with the augmented dataset and fine-tuned with ADAM optimization with a learning rate of 0.0001 for the detection.
Gao et al.39 explore the viability of attaining synchronized processing of endoscopic video for determining the pre-cancer status of squamous cell cancer. The detection architectures, mask-RCNN, and YOLOv3 are used to detect and segment endoscopic images. The images are classified as SCC's 'cancer,' 'high risk,' and 'suspicious.' The Mask RCNN outperformed YOLOv3 both in generating the masks and classification accuracy. YOLOV3 processed the video frames at a rate of 0.1spf, which is ten times faster than Mask RCNN.
Hori et al.40 proposed an AI-based diagnostic system with SSD for diagnosing EAC and Squamous Cell Carcinoma (SCC). CNN precisely diagnosed all the cases of ECs from the combined analysis of WLI and NBI images. The diagnostic system was able to recognize even the smallest lesions (200µm, which requires surgical treatment. The double-labelled FCN model has a better performance with improved diagnostic accuracy.
Liu et al.43proposes a DeepLabV3+ model for early EC detection and segmentation. DeepLabV3+ has an Xception architecture with Atrous Convolution (AC) and Atrous Spatial Pyramidal Pooling(ASPP). The encoder stage extracts in-depth features by applying AC, and then the feature map is applied to ASPP for generating multiscale features. The decoder stage refines the segmentation process. The feature from the AC in the encoder is simplified via a 1x1 CNN and concatenated with multiscale features. Again, these features are applied to a 3x3 CNN and up-sampled to generate a binary semantic segmentation. The binary segmented image is further processed using the morphological and hole filling process to obtain the annotated image.
Guo et al.44 explore a CAD SegNet model for real-time identification and segmentation of pre-cancerous lesions and early ESCC. SegNet is a deep encoder-decoder module for multiclass segmentation. The encoders extract the low-resolution features with the boundary information stored in the max-pooling indices. The decoders consist of a pixel-wise classifier. It up-samples the attribute maps using the max-pooling indices of the analogous encoder for generating sparse attribute maps. The up-sampling feature map obtained is then convolved to achieve the dense feature map. The dense feature map will reduce the number of parameters, so SegNet needs less memory space and requires less computational time.
Van der Putten. et al.45AI proposes a network Gastro Net model with multi-task learning is proposed to obtain better localization, classification, and semantic segmentation of the BE. A ResNet replaces the CNN network in the encoder and decoder path of the U-Net. The fully connected feature layer and classification layer is added to the bridge network to multi-task learning. Both the classification and segmentation processes perform simultaneously in a single training. Pseudo Labeling, a semi-supervised learning algorithm with Bootstrapping and Ensemble learning, provides more suitable descriptive attributes for enabling multi-stage transfer learning. The model is trained and fine-tuned with ADAM and AMS grad with a weight decay of 10-5 with a cosine cyclic learning rate schedule.
Omura et al.46 focus on a DL model for early EAC detection using a four-layer neural network with the feature extraction performed by Dyadic Wavelet Transform (DYDWT). The input RGB image is converted into HSV and CIELa*b*. A fusion image is constructed by normalizing the S, a*b* components. This fusion image undergoes a contrast enhancement to obtain Sa*bhist*. The new image undergoes a 3-level decomposition using DYDWT. The Inverse DYDWT is applied for image reconstruction. The reconstructed image is the input to the neural network for classification. The DYDWT reduces the input features resulting in faster learning and high computational speed.
Ghatwary et al.47proposed a DL method for the automatic detection and classification of oesophagal abnormalities. The local features extracted through the Gabor filters and the CNN(DenseNet) are concatenated for enhancing the detection of abnormal regions using Faster RCNN. The overview of the DL analysis of endoscopic images for the different stages of Esophageal Cancer is shown in Table :1.
DISCUSSIONS
The technological progress in AI and DL led to a large number of research in the medical field. The new algorithms and DL models resulted in many automated systems for the detection, segmentation, and classification of EC. CNN is currently the backbone of all the DLarchitectures.
Many new network models are based on the multi-dimensional arrangements of CNN layers. Most of the currently used DL models are supervised learning type models. The researchers need to work on the semi-supervised and unsupervised models for the diversified analysis of EC. Studies need to be done on the combination of tasks and networks for better feature extraction. One of the significant drawbacks of medical image analysis is the lack of availability of medical data. The labelling or annotation of the available dataset using experts is a more challenging task. The data augmentation and annotation methods need to be experimented with to combat these challenges. The researchers must have a substantial public dataset of medical images only. A pre-trained network trained in the medical dataset provides more relevant attributes and better diagnostic accuracy through transfer learning.
CONCLUSION
The advancements in artificial intelligence and DL have contributed a lot to develop many CAD techniques for detecting EC in the early stage itself. This review concentrates on some of the recent studies on the diagnosis of different EAC stages with DLtechniques using CNN. More research works are to be carried out with the semi-supervised and unsupervised learning methods for the widespread analysis of the EC. With the invention of the deep generative models and application of hybrid networks, more evaluation and estimation of early oesophagal cancer features can be performed. One of the significant limitations is the lack of availability of data set in the medical fields. The DL approach using CNN and the transfer learning techniques can resolve this problem. Data augmentation seems to be a suitable solution to this unbalanced data availability. The development of many unsupervised network architectures is to be initiated in the future to overcome the dataset availability.
ACKNOWLEDGMENT
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.
Conflict of Interest
The authors have no competing conflict of interest to declare.
Source of Funding
There is No funding obtained from any organization for carrying out this research work.
Author Contribution
CHEMPAK KUMAR. A - Conceptualization, Formal analysis, Visualization, Writing -original draft, Writing
-review & editing.
D.MUHAMMAD NOORUL MUBARAK- Writing -review & editing.
Englishhttp://ijcrr.com/abstract.php?article_id=3952http://ijcrr.com/article_html.php?did=3952
https://wwwmayoclinic.org[Online]. [14August2019] Available from: https:// www. mayoclinic.org/diseases-conditions/ esophagitis / diagnosis-treatment/drc-20361264
www. cancer. org [Online] [4 August 2020] Available from: https: // www.cancer.org/cancer/esophagus-cancer/causes-risks-prevention/risk-factors.html
Pakzad R, Mohammadian-Hafshejani A, Khosravi B, Soltani S, Pakzad I, Mohammadian M, Salehiniya H, Momenimovahed Z. The incidence and mortality of oesophagal cancer and their relationship to development in Asia. Annals of translational medicine. IEEE Access. 2017: 9375-9389.
Fourcade A, Khonsari RH. Deep learning in medical image analysis: A third eye for doctors. Journal of stomatology, oral and maxillofacial surgery. 2019 Sep 1;120(4):279-88.
Hatt M, Parmar C, Qi J, El Naqa I. Machine (deep) learning methods for image processing and radiomics. IEEE Transactions on Radiation and Plasma Medical Sciences. 2019 Mar 1;3(2):104-8.
Du W, Rao N, Liu D, Jiang H, Luo C, Li Z, Gan T, Zeng B. Review on the applications of deep learning in the analysis of gastrointestinal endoscopy images. Ieee Access. 2019; 30(7):142053-69.
Alom MZ, Taha TM, Yakopcic C, Westberg S, Sidike P, Nasrin MS, Hasan M, Van Essen BC, Awwal AA, Asari VK. A state-of-the-art survey on deep learning theory and architectures. Electronics. 2019 Mar;8(3):292.Krizhevsky, Alex, Ilya Sutskever, and Geoffrey E. Hinton. "Imagenet classification with deep convolutional neural networks." In Advances in neural information processing systems.2012; 1097-1105.
Simonyan K, Zisserman A. Very deep convolutional networks for large-scale image recognition. 2019; 9(4): 231.
Szegedy C, Liu W, Jia Y, Sermanet P, Reed S, Anguelov D, Erhan D, Vanhoucke V, Rabinovich A. Going deeper with convolutions. InProceedings of the IEEE conference on computer vision and pattern recognition 2015; 1-9.
Szegedy C, Ioffe S, Vanhoucke V, Alemi A. Inception-v4, inception-resnet and the impact of residual connections on learning. InProceedings of the AAAI Conference on Artificial Intelligence. 2017; 02(12):321.
He K, Zhang X, Ren S, Sun J. Deep residual learning for image recognition. InProceedings of the IEEE conference on computer vision and pattern recognition. 2016;770-778.
Huang G, Liu Z, Van Der Maaten L, Weinberger KQ. Densely connected convolutional networks. InProceedings of the IEEE conference on computer vision and pattern recognition. 2017;4700-4708.
Ebigbo A, Palm C, Probst A, Mendel R, Manzeneder J, Prinz F, de Souza LA, Papa JP, Siersema P, Messmann H. A technical review of artificial intelligence as applied to gastrointestinal endoscopy: clarifying the terminology. Endoscopy international open. 2019 Dec;7(12):E1616.
Long J, Shelhamer E, Darrell T. Fully convolutional networks for semantic segmentation. InProceedings of the IEEE conference on computer vision and pattern recognition 2015;3431-3440.
Badrinarayanan V, Kendall A, Cipolla R. Segnet: A deep convolutional encoder-decoder architecture for image segmentation. IEEE transactions on pattern analysis and machine intelligence. 2017 Jan 2;39(12):2481-95.
Ronneberger O, Fischer P, Brox T. U-net: Convolutional networks for biomedical image segmentation. InInternational Conference on Medical image computing and computer-assisted intervention. 2015; 5 :234-241. Springer, Cham.
Chen LC, Papandreou G, Kokkinos I, Murphy K, Yuille AL. Deeplab: Semantic image segmentation with deep convolutional nets, atrous convolution, and fully connected crfs. IEEE transactions on pattern analysis and machine intelligence. 2017 Apr 27;40(4):834-48.
Chen LC, Zhu Y, Papandreou G, Schroff F, Adam H. Encoder-decoder with atrous separable convolution for semantic image segmentation. InProceedings of the European conference on computer vision (ECCV). 2018; 801-818.
Zhao ZQ, Zheng P, Xu ST, Wu X. Object detection with deep learning: A review. IEEE transactions on neural networks and learning systems. 2019 Jan 28;30(11):3212-32.
Girshick R, Donahue J, Darrell T, Malik J. Rich feature hierarchies for accurate object detection and semantic segmentation. InProceedings of the IEEE conference on computer vision and pattern recognition. 2014;580-587.
Girshick R, Fast RC. IEEE Int. Conf. Comput. Vis. Santiago, Chile, December. 2015:7-13.
Ren S, He K, Girshick R, Sun J. Faster R-CNN: towards real-time object detection with region proposal networks. IEEE transactions on pattern analysis and machine intelligence. 2016 Jun 6;39(6):1137-49.
He K, Gkioxari G, Dollár P, Girshick R. Mask r-cnn. InProceedings of the IEEE international conference on computer vision 2017; 2961-2969.
Liu W, Anguelov D, Erhan D, Szegedy C, Reed S, Fu CY, Berg AC. SSD: Single shot multibox detector. In European conference on computer vision 2016;10(8):21-37.
Redmon J, Divvala S, Girshick R, Farhadi A. You only look once: Unified, real-time object detection. InProceedings of the IEEE conference on computer vision and pattern recognition 2016;779-788.
Takiyama H, Ozawa T, Ishihara S, Fujishiro M, Shichijo S, Nomura S, Miura M, Tada T. Automatic anatomical classification of esophagogastroduodenoscopy images using deep convolutional neural networks. Scientific reports. 2018 May 14;8(1):1-8.
Kumagai Y, Takubo K, Kawada K, Aoyama K, Endo Y, Ozawa T, Hirasawa T, Yoshio T, Ishihara S, Fujishiro M, Tamaru JI. Diagnosis using deep-learning artificial intelligence based on the end cystoscopic observation of the oesophagus. Oesophagus. 2019 Apr;16(2):180-7.
Hirasawa T, Aoyama K, Tanimoto T, Ishihara S, Shichijo S, Ozawa T, Ohnishi T, Fujishiro M, Matsuo K, Fujisaki J, Tada T. Application of artificial intelligence using a convolutional neural network for detecting gastric cancer in endoscopic images. Gastr Canc. 2018 Jul;21(4):653-60.
van der Putten J, Wildeboer R, de Groof J, van Sloun R, Struyvenberg M, van der Sommen F, Zinger S, Curvers W, Schoon E, Bergman J, de With PH. Deep learning biopsy marking of early neoplasia in Barrett’s oesophagus by combining WLE and BLI modalities. In2019 IEEE 16th International Symposium on Biomedical Imaging. 2019; 4(8):1127-1131). IEEE.
Tomita N, Abdollahi B, Wei J, Ren B, Suriawinata A, Hassanpour S. Attention-based deep neural networks for detection of cancerous and precancerous oesophagus tissue on histopathological slides. J Ame Mat Netw Open. 2019 Nov 1;2(11):e1914645-.
Liu G, Hua J, Wu Z, Meng T, Sun M, Huang P, He X, Sun W, Li X, Chen Y. Automatic classification of oesophagal lesions in endoscopic images using a convolutional neural network. Annal Transl Med. 2020 Apr;8(7).
Ebigbo A, Mendel R, Probst A, Manzeneder J, de Souza Jr LA, Papa JP, Palm C, Messmann H. Computer-aided diagnosis using deep learning in the evaluation of early oesophageal adenocarcinoma. Gut. 2019 Jul 1;68(7):1143-5.
Hong J, Park BY, Park H. Convolutional neural network classifier for distinguishing Barrett's oesophagus and neoplasia endomicroscopy images. In2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) 2017;7( 11): 2892-2895.
Van Riel S, Van Der Sommen F, Zinger S, Schoon EJ, de With PH. Automatic detection of early oesophagal cancer with CNNS using transfer learning. In 2018 25th IEEE International Conference on Image Processing (ICIP) 2018; 7: 1383-1387. IEEE.
Mendel R, Ebigbo A, Probst A, Messmann H, Palm C. Barrett’s esophagus analysis using convolutional neural networks. InBildverarbeitung für die Medizin. 2017 ;80-85. Springer Vieweg, Berlin, Heidelberg.
Rezvy S, Zebin T, Braden B, Pang W, Taylor S, Gao X. Transfer learning for Endoscopy disease detection and segmentation with mask-RCNN benchmark architecture. In2020 IEEE 17th International Symposium on Biomedical Imaging 2020;17.
Gao X, Braden B, Taylor S, Pang W. Towards real-time detection of squamous pre-cancers from oesophageal endoscopic videos. In2019 18th IEEE International Conference On Machine Learning And Applications (ICMLA) 2019;12(16):1606-1612.
Horie Y, Yoshio T, Aoyama K, Yoshimizu S, Horiuchi Y, Ishiyama A, Hirasawa T, Tsuchida T, Ozawa T, Ishihara S, Kumagai Y. Diagnostic outcomes of oesophagal cancer by artificial intelligence using convolutional neural networks. Gastroint Endsc. 2019 Jan 1;89(1):25-32.
Ghatwary N, Zolgharni M, Ye X. Early oesophagal adenocarcinoma detection using deep learning methods. Int J Comp Assi Rad Surg. 2019 Apr;14(4):611-21.
Zhao YY, Xue DX, Wang YL, Zhang R, Sun B, Cai YP, Feng H, Cai Y, Xu JM. Computer-assisted diagnosis of early esophageal squamous cell carcinoma using narrow-band imaging magnifying endoscopy. Endoscopy. 2019 Apr 1;51(04):333-41.
Liu DY, Jiang HX, Rao NN, Luo CS, Du WJ, Li ZW, Gan T. Computer-aided annotation of early esophageal cancer in gastroscopic images based on deeplabv3+ network. InProceedings of the 2019 4th International Conference on Biomedical Signal and Image Processing (ICBIP 2019) 2019; 8 (13):56-61.
Guo L, Xiao X, Wu C, Zeng X, Zhang Y, Du J, Bai S, Xie J, Zhang Z, Li Y, Wang X. Real-time automated diagnosis of precancerous lesions and early oesophagal squamous cell carcinoma using a deep learning model (with videos). Gastroint Endosc. 2020 Jan 1;91(1):41-51.
van der Putten J, de Groot J, van der Sommen F, Struyvenberg M, Zinger S, Curvers W, Schoon E, Bergman J. Pseudo-labeled bootstrapping and multi-stage transfer learning for the classification and localization of dysplasia in Barrett’s oesophagus. International Workshop on Machine Learning in Medical Imaging 2019;10(13): 169-177. Springer, Cham.
Omura H, Minamoto T. Detection Method of Early Esophageal Cancer from Endoscopic Image Using Dyadic Wavelet Transform and Four-Layer Neural Network. information Technology-New Generations 2018: 595-601. Springer, Cham.
Ghatwary N, Ye X, Zolgharni M. Esophageal abnormality detection using descent-based faster r-CNN with Gabor features. IEEE Access. 2019 Jun 27;7:84374-85.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareAlkaline Phosphatase: Reliability as a Predictor of Common Bile Duct Pathologies?
English5863Shankarraman DEnglish Singh KBEnglish Mohanapriya TEnglish Manuneethimaran TEnglish Nitesh NEnglish Ganesh PEnglish Chandrasekharan AEnglishIntroduction: Choledocholithiasis is the presence of gall stones within the biliary tree which can lead to obstructive jaundice. Alkaline phosphatase, an enzyme secreted by the biliary canalicular cells, is reflective of bile obstruction. Aims: This study aims to identify the dependability of Alkaline phosphatase in predicting choledocholithiasis by assessing sensitivity, specificity, predictive values, false positive and negative values. Methodology: A retrospective, cross-sectional study carried out in Sri Ramachandra Institute of Higher Education and Research, Chennai. The sample size was calculated to be 162 based on the sensitivity (75%) and specificity (37%) of Alkaline phosphatase,1 using a precision of 10% and a confidence interval of 95%. 162 patients who had undergone Magnetic Resonance Cholangio-Pancreatogram (MRCP) from January to December 2019. Results: Of 162 patients who had undergone MRCP,72 (50.39 ± 16.487) had choledocholithiasis and 90 (49.92± 14.875) had other pathologies. Graphical representation of the ALP values revealed that the area under the curve in ROC was found to be 0.641. A clinical cut-off of ALP as >130IU/L had a sensitivity of 70.8% and specificity of 48%. Conclusion: ALP having a low specificity, combined with a normal value in a significant number of patients can lead to a missed diagnosis of choledocholithiasis. The non-universal practice of intra-operative cholangiogram and MRCP adds to these numbers. Hence, more widespread use of MRCP without a selection bias based on ALP values is advocated for suspected choledocholithiasis or bile duct pathologies.
EnglishIntroduction
Choledocholithiasis is one of the most common pathologies affecting the bile duct system. It is defined by the presence of gall stones within the biliary tree. These may be primarily formed within the tree or can be secondarily present having slipped out of the gall bladder. It can cause bile outflow obstruction. Obstructive jaundice that develops can further lead to complications such as hepatitis, cholangitis and pancreatitis. Timely intervention is the dictum. The obstruction leads to failure of drainage of bile via the extra-hepatic ductal system, leading to increased serum conjugated and total bilirubin. Deposition of bile salts in the dermis of the skin, as well as release of endogenous opioids, are thought to be the causes of pruritus. Failure of bile drainage into the intestine leads to a lack of stercobilin component in the stools producing clay-coloured stools. These cardinal symptoms offer a clinical diagnosis of obstructive jaundice.
The presence of obstruction can cause derangement of liver function test (LFT) parameters. Serum bilirubin, alkaline phosphatase, Gamma-glutamyl transpeptidase and 5’-nucleotidase are used in the assessment of biliary obstruction. Serial evaluation of LFT can hint at the spontaneous passage or the persistence of stones causing obstruction. Our study aims to identify the relation of one such cholestasis indicators, Alkaline Phosphatase with CBD stones by assessing sensitivity, specificity, predictive values and false negative and positive results.
Materials and methods:
Study design
A cross-sectional retrospective study to assess the reliability of ALP was undertaken. Institutional Ethics Committee clearance was obtained and consent from the Departments of Medical Gastroenterology and Radiology were obtained. The sample size was calculated based on the formula below (figure 1).
The sample size was calculated to be 162 based on the sensitivity (75%) and specificity (37%) of Alkaline phosphatase, using a precision of 10% and a confidence interval of 95%.1
Participants
Eligibility criteria included all patients who had undergone Magnetic Resonance Cholangio-Pancreatogram (MRCP) in January 2019-December 2019. Exclusion criteria included Patients with non-hepatobiliary pathologies causing elevated ALP such as Bone diseases such as Osteomalacia, metastases, Paget’s disease, Hyperthyroidism, Hyperparathyroidism, Chronic renal failure, Pregnancy, Lymphoma. Amongst this, 162 patients (potentially eligible participants) were selected at random. These patients were identified from a registry containing detailed records of all patients who had undergone MRCP in the specified time frame. MRCP records and Liver Function Test results of these patients were retrieved from the hospital computer data systems retrospectively (figure 2).
Test Methods
MRCP was performed for all patients with Siemens MAGNETOM® MRI systems (1.5-Tesla)/SIGNATM GE Healthcare. All patients were imaged with a Torso array receive coil, rotating 90 degrees to eliminate wrap-around artifact. Sections of 5 mm thickness with 0 gap slices were taken from right dome of diaphragm to lower edge of liver. Sequences used include 3 plane Locator Breath Holding, Axial 2D FIESTA FATSAT, Coronal 2D FIESTA FATSAT, Axial T2 SSFSE Breath Holding, Coronal T2 SSFSE Breath Holding, 3D MRCP RTr ASSET, Axial DWI 800b, Axial Dual Echo FSPGR Breath Holding Asset, Thick slab MRCP ASSET, 3D MRCP RTr ASSET, Axial T2 SSFSE BH. A 3D reconstruction was performed by MIP post processing.
Imaging assessed the size of the liver, presence of focal lesions and dilatation of intrahepatic biliary radicles. The gall bladder size, wall thickness, presence of calculi if any, size of calculi and presence of any pericholecystic fluid was noted. The biliary tree was assessed for the presence or absence of filling defects within the right and left hepatic ducts, common hepatic ducts, cystic ducts, common bile ducts. The pancreatic size, texture and ducts were noted. In completion, the duodenum, spleen, and kidneys were also visualised.
The diagnosis of choledocholithiasis was made based on the presence of filling defects within the biliary tree. Common bile duct and common hepatic duct diameters were measured. CBD diameter was defined as per age-appropriate criteria: “Decade of life +1” –e.g. for a 30-year-old patient, normal CBD diameter was taken as 3+1 = 4mm. The MRCP reports were categorised into those with choledocholithiasis and those without – i.e. any other diagnosis such as pancreatitis, cholangiocarcinoma, pancreatic neoplasms etc.
Analysis
LFT reports of all patients were collected and ALP values were correlated with the MRCP findings and diagnosis. 2x2 contingency table was created and results assessed. A Chi-square test was used to assess independent variables. The Receiver Operating curve was plotted for the significance of ALP. Statistical analysis was performed using SPSS Statistics version 16.
Results:
Of the total 162 patients, 72 were those with choledocholithiasis and 90 were those with other diagnoses – e.g. pancreatitis, cholangiocarcinoma, gall bladder carcinoma, pseudocyst of pancreas etc (Figure 3 – Sample size and data collection pathway).
The data was computerised and analysed. The Receiver Operating Curve was plotted using the ALP levels of all patients. The area under the curve was found to be 0.641 (significant if area is >0.70) (figure 4 and Table 1). This indicated that ALP had low reliability in predicting choledocholithiasis.
The test result variable(s): ALP has at least one tie between the positive actual state group and the negative actual state group. Statistics may be biased.
a. Under the nonparametric assumptionNull hypothesis: true area = 0.5
The mean age of those with choledocholithiasis was found to be 50.39 with SD ± 16.487. The mean age of those without choledocholithiasis was 49.92 with SD ± 14.875 (Figure 5 and Table 2). The Chi-square test performed revealed no significant relation with age.
Gender distribution was as follows: The total number of females were 59 and males were 103. Amongst the 59 women, 32(54.7%) had choledocholithiasis and among the males, 40(38.8%) had choledocholithiasis (Table 3 and Figure 6).
Of the total 162 patients, 72 had choledocholithiasis. Out of the 72, 51 patients had raised ALP beyond 130 IU/L and 21 patients (30%) had a normal ALP value (1.20mg/dl in 9 out of 21. Clinically evident jaundice (>3mg/dl) was present only in 1 patient. SGOT and SGPT (normal Englishhttp://ijcrr.com/abstract.php?article_id=3953http://ijcrr.com/article_html.php?did=39531. Barlow AD, Haqq J, McCormack D, Metcalfe MS, Dennison AR, Garcea G. The role of magnetic resonance cholangiopancreatography in the management of acute gallstone pancreatitis. Ann R Coll Surg Engl. 2013 Oct;95(7):503–6.
2. Anciaux ML, Pelletier G, Attali P, Meduri B, Liguory C, Etienne JP. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Dig Dis Sci. 1986 May 1;31(5):449–53.
3. Van Santvoort HC, Bakker OJ, Besselink MG, Bollen TL, Fischer K, Nieuwenhuijs VB, et al. Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis. Endoscopy. 2011 Jan;43(1):8–13.
4. Qiu Y, Yang Z, Li Z, Zhang W, Xue D. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to the missed diagnosis of choledocholithiasis by preoperative ultrasound. BMC Gastroenterol. 2015 Nov 14;15:158.
5. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for the diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014 Apr;96(3):224–8.
6. Zare M, Kargar S, Akhondi M, Mirshamsi MH. Role of liver function enzymes in the diagnosis of choledocholithiasis in biliary colic patients. Acta Med Iran. 2011;49(10):663–6.
7. Zidi S, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, et al. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut. 1999 Jan;44(1):118–22.
8. Karakan T, Cindoruk M, Alagozlu H, Ergun M, Dumlu S, Unal S. EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a prospective randomized trial. Gastrointest Endosc. 2009 Feb 1;69(2):244–52.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Novel Method for Diagnostic and Prognostic Detection of Alzheimer's Disease
English6471Antony Jasmine DinuEnglish Ria ManjuEnglishIntroduction: Alzheimer’s is a degenerative neurological disease and is difficult to diagnose with early symptoms. Nowadays, the number of people diagnosed with Alzheimer’s disease is increasing rapidly due to lifestyle changes. Alzheimer’s disease can be diagnosed from MRI brain images. It requires medical expertise and the failure to identify the disease at an early stage will result in permanent disabilities. The automatic and accurate identification of Alzheimer’s disease from MRI images helps to eliminate the above issues and dispense better results. Objectives: This work intends to develop an algorithm that could detect the presence of Alzheimer’s disease at an early stage by extracting the brain features of MRI images using a point-based feature extraction method. Methods: Here, a new algorithm is proposed using combined point detection based feature extraction techniques like SURF, FAST, BRISK, Harris, Min Eigen and HOG methods and feature selection using Principal Component Analysis for early prediction of various stages of Alzheimer’s disease. An analysis of the proposed method is done by combining it with different classifiers and the performance parameters are evaluated. The performance of the proposed method is evaluated and analyzed using parameters such as classification accuracy, sensitivity, specificity andF1 score. Results: From the analysis of the experimental results, the proposed algorithm was found to have a high accuracy rate of 98.62% for the detection and classification of Alzheimer’s disease. Conclusion: The proposed method was found to be superior to the methods which use single feature extraction which is developed for the prediction and classification of Alzheimer’s disease.
EnglishAlzheimer’s disease, Mild Cognitive Impairment, Feature Extraction, Feature Selection, Naïve Bayes, Principal Component Analysishttp://ijcrr.com/abstract.php?article_id=3954http://ijcrr.com/article_html.php?did=3954Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEfficacy of Transcutaneous Electrical Nerve Stimulation (TENS) with Muscle Energy Technique (MET) on Quadratus Lumborum in Acute Unilateral Lumbar Strain
English7276Ganesh Sundaram SubramanianEnglish Jency ThangaseelaEnglish Mahendran SekarEnglishIntroduction: Lumbar strain is characterized as pain subsequently arising in the region between the lower rib margin and the proximal thighs. However, relapses and recurrences are normal, occurring within six months in about 40% of patients. Studies of physical therapy for lumbar strain are heterogeneous because the intervention method differs, it can include education, exercises, manipulation, as well as modalities such as heat. Transcutaneous Electrical Nerve Stimulation (TENS) and Muscle Energy Technique (MET) are widely used physiotherapy techniques to reduce unilateral lumbar strain. It would be interesting to study the treatment outcome when these two techniques have combined. Objective: The present study aimed to evaluate the effectiveness of TENS with MET on quadratus lumborum in acute unilateral lumbar strain. Methods: In the total of 30 volunteers including males and females with no history of musculoskeletal disease has been selected based on the specific inclusion and exclusion criteria’s. They were recruited for the study based on unilateral back pain experiencing around or near lumbar and thoracolumbar segments and positive muscle length tests for erector spinae and quadratus lumborum. All the subjects were assigned into three groups, Group-1 patients undergone TENS treatment, Group-2 patients treated by MET and Group-3 patients were treated by a combination of TENS with MET in the lumbar spine. All these treatments were given five consecutive days a week for a total of three weeks. Pain intensity and discomfort were evaluated before and after the treatment programme. The outcome of the treatment was measured after three weeks from each patient’s pain and disability using the Numerical Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODI) were considered for assessment and analysis. Results: There was a reduction in disability index and pain were observed when TENS, MET and TENS with MET treatments. However, the combined treatment of TENS with MET showed a significant reduction (pEnglishINTRODUCTION
Low back pain (LBP) is an incredibly common symptom that individuals of all ages encounter.1The multifidi, erector spine, the psoas and the quadratus lumborum provide muscle support for the low back.2 Muscles that tend to become tight are usually those that span more than one joint namely, quadratus lumborum and erector spinae (especially lumbar and thoracolumbar segments). Any acute pain in the lumbar motion segment can initiate muscle responses which, if they persist, can alter the patients’ pattern of movement and in turn perpetuate adverse strains on the lumbar spine.3 The most commonly overlooked muscular source of low back pain is the quadratus lumborum muscle.4 Based on the information obtained from the literature review, it was found that joint and muscle dysfunction occur together. Franca et al., 1991 stated that a taut and painful quadratus lumborum, as well as articular dysfunction in the lumbar spine, requires appropriate therapy to provide relief and restore function.5
In patients with low back pain, the goals of physiotherapy include pain elimination, restoration of the lost extent of movements, functional improvement, and quality of life.6These goals are achieved by different techniques of exercise, electrotherapy, and relaxation protocols. One of the most common therapeutic modalities aimed at improving elasticity in contractile and non-contractile tissues is the muscle energy technique (MET).7Greenman defined MET as a manual medicine treatment technique involving the voluntary contraction of the subject's muscle in an appropriately guided direction, at varying strength rates, against the therapist's distinctly performed counterforce. MET has shown improvements in range of motion, reducing pain-relieving muscle tension and spasm. Fryer has suggested that MET will activate joint and muscle proprioceptors, enhancing muscle deep segment recruitment, motor control and joint stability.8-9
Transcutaneous electrical nerve stimulation (TENS) is used as a treatment modality because it offers a non-invasive procedure to reduce both acute and chronic pain by attaching two or more electrical pads to a person’s skin. High-frequency (HF; P10 Hz), low-frequency (LF; Englishhttp://ijcrr.com/abstract.php?article_id=3955http://ijcrr.com/article_html.php?did=39551. Hoy D, Bain C, Williams G. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028-2037.
2. Sions JM, Elliot JM, Pohling RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, psoas and quadratus lumborum in older adults with and without chronic low back pain. J Orthoped Sports Physiother2017;47(3):173-179.
3. Twomey L and Taylor J. Physical Therapy of the Low Back. Churchill Livingstone. 1987; pp 328.
4. Travell J, Simmons DG. Myofascial pain and dysfunction the trigger point manual. Lippincott Williams and Wilkins, 1999; pp 437.
5. Franca GD, Levine L. The quadratus lumborum and low back pain. J ManipulPhysiolTherapeut991;14(2):142-149.
6. Szulc P, Wendt M, Waszak M, Tomczak M, Cieslik K, Trzaska T. Impact of McKenzie method therapy enriched by muscular energy techniques on subjective and objective parameters related to spine function in patients with chronic low back pain. Med SciMonit2015;21:2918-2932.
7. Chaitow L. Muscle energy technique. (4th Ed.), Churchill Livingstone, 2014.
8. Fryer G. Muscle energy concepts – A need for a change. J Osteopath Med 2000;3(2):54-59.
9. Greenman PE. Principles of manual medicine. (3rd Ed.) Baltimore; Williams and Wilkins, 2003.
10. Melzack R, Vetere P, Finch L. Transcutaneous electrical nerve stimulation for low back pain – A comparison of TENS and massage for pain and range of motion. Physical Therapy. 1983;63(4):489-493.
11. Binny J, Wong NLJ, Garga S, Christine Lin CW, Maher CG, McLachlan AJ, et al. Transcutaneous electrical nerve stimulation (TENS) for acute low back pain: Systematic review. Scand J Pain. 2019;19(2):225-233.
12. Lenehan KL, Fryer G, McLaughlin.P.The effect of muscle energy technique on gross trunk range of motion. J Osteopath Med. 2003;6(1):13-18.
13. Naka A, Keilani M, Loeffler S, Crevenna R. Does transcutaneous electrical nerve stimulation (TENS) have a clinically relevant analgesic effect on different pain conditions? A literature review.Eur J Translation Myol - Basic Appl Myol. 2013;23(3):95-104.
14. Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: a randomized clinical trial. Sao Paulo Med J. 2011;129(4):206-216.
15. Alyazedi1 FM, Khan S, Ghamdi AH, Toriri N, Shamsi S. Effect of ultrasound and exercise together and TENS alone in the management of chronic back pain. IOSR J Nurs Health Sci. 2015;4(5):110-114.
16. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry lows backs pain disability questionnaire and the Quebec back pain disability scale. Physic Therapy. 2001;81(2):776-788.
17. Selkow NM, Grindstaff TL, Cross KM, Pugh K, Hertel J, Saliba S. Short-term effect of muscle energy technique on pain in individuals with non-specific lumbopelvic pain: A Pilot Study. J Manual Manipul Therap.2006; 17(1):14-18.
18. Sharma D, Sen S. Effects of muscle energy technique on pain and disability in subjects with SI joint dysfunction. International J Physiother Res. 2014;2(1):305-311.
19. Kumar P, Moitra M. Efficacy of muscle energy technique and PNF stretching compared to conventional physiotherapy in the program of hamstring flexibility in chronic nonspecific low back pain. Indian J Physiother Occupation Ther. 2015;9(3):103-107.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareHoloprosencephaly: Four Case Reports and Review of Literature
English7780Forci KhenataEnglish Alami Mohamed HassanEnglish Bouaiti El ArbiEnglish Mdaghri Alaoui AsmaaEnglish Thimou Izgua AmalEnglishIntroduction: Holoprosencephaly (HPE) is a complex cerebral malformation due to an incomplete division of the forebrain, occurring between the 18th and the 28th day of embryonic life and affecting both the brain and the face. There are 3 increasing degrees of severity: the lobar, semi-lobar, and alobar holoprosencephaly. Case Report: We report 4 cases of holoprosencephaly identified following natural childbirth, in 75% of cases in patients of low socioeconomic level, with the first-degree consanguinity in 25% of cases. The pregnancies were not properly monitored, no folic acid supplementation had been provided and, in 25% of cases, consumption of fenugreek was reported. The antenatal diagnosis was performed in 25% of cases with a male predominance, a sex ratio at 2. Discussion: Holoprosencephaly is a complex human brain malformation resulting from incomplete cleavage of the prosencephalon. HPE is usually associated with facial abnormalities, such as cyclopia, proboscis, or cleft lip/palate in severe HPE cases. In our study, the prevalence is assessed at 0.9/10,000 births, l’HPE is associated with hexadactyly in 50% of cases and with sexual ambiguity in 25% of cases. Prenatal diagnosis is based on ultrasound and MRI. The aetiology of HPE is multifactorial, and the prognosis depends on the type of HPE and the associated facial anomalies. Conclusion: Holoprosencephaly is a complex brain malformation. For the majority of cases, the prognosis is grim. Indeed, 75% of cases were fetal death in utero (FDIU) and one case died immediate post-partum.
EnglishAntenatal diagnosis, Cyclopia, Holoprosencephaly, Proboscis, Nodal/Hedgehog signalling, PrognosisIntroduction
Described for the first time by Kundrat in 1882, who used the term arhinencephaly for this entity.1 In the early 1960s, DeMyer and colleagues named the malformation holoprosencephaly.1-4
Holoprosencephaly is a complex human brain malformation resulting from incomplete cleavage of the prosencephalon into right and left hemispheres, occurring between the 18thand the 28thday of gestation. The estimated prevalence of HPE is less than 1/10,000 live births and the incidence may be as high as 1/250 in first-trimester conceptuses.5Three levels of increasing severity are described: lobar HPE, semi lobar, and alobar HPE. The middle interhemispheric variant (MIH), also known as syntelencephaly, is classified as a variant of HPE with midline interhemispheric fusion. HPE is most often associated with facial abnormalities; such as cyclopia, proboscis, Median or bilateral cleft lip and palate in severe cases, solitary ocular or median hypotelorism central incisor in minor forms. These latter midline defects can occur without the brain malformations and are then called microforms.
The aetiology of HPE is heterogeneous and complex. It can be due to cytogenetic aberrations and/or of syndromic origin, sometimes isolated in familial and sporadic forms. Loss-of-function heterozygous mutations in components and regulators of the Nodal and Hedgehog (Hh) signalling pathways are associated with HPE. Complications of HPE are characterized by developmental delay and feeding difficulties, epilepsy, instability of temperature, heart rate and breathing. Treatment is symptomatic and supportive and requires multidisciplinary management. The prognosis depends on the type of HPE and the facial anomalies associated. Severely affected children have a very poor prognosis. Child outcome depends on the HPE severity and the medical and neurological complications associated.
Case Reports:
We report four (4) cases of holoprosencephaly that are identified following natural childbirth at the “Les Orangers” Maternity and Reproductive Health Hospital of Rabat. They are listed as follows:
1st Case:(Figures: 1 & 2)
26-year-old, G1P0, and reporting the following elements:
Firstdegree inbreeding;
Intake of Fenugreek and plants during the first trimester of pregnancy;
No followup during pregnancy, and no supplement of iron or folic acid
Ultrasound performed at 27 weeks of amenorrhea (WA) by a general practitioner objectifying a hydramnios, no morphological ultrasound was performed
Admitted to the maternity ward in the expulsion phase at 29WA + 5 days, stillborn female, birth weight = 770 g, Apgar = 0
Particular aspect: the confluence of the orbits with a fusion of the eyeballs, a proboscis between the eyes with a single nostril, hypotelorism, microcephaly and sexual ambiguity.
A karyotype was proposed to the couple but was not performed
All contact was unfortunately lost with the young couple.
2nd Case:
30-year-old, G1P0, low socio-economic level, and reporting the following elements:
Inbreeding = 0, Diabetes = 0
Intake of Fenugreek and plants = 0
No follow-up during pregnancy, and no supplement of iron or folic acid
Antenatal diagnosis not performed,
Having consulted at 30WA with general practitioner, where the diagnosis of a hydramnios was made
Cytotec initiation, male stillborn, birth weight=1000g, Apgar=0
Clinical examination at birth = holoprosencephaly
Karyotype: not performed due to lack of financial means
3dCase:
42-year-old, gravida 3 para 3, average socio-economic level, and reporting the following elements:
Inbreeding = 0, Diabetes = 0
Intake of Fenugreek and plants = 0
Poor follow-up of pregnancy, iron-supplemented at T3, and no intake of folic acid
Antenatal diagnosis not performed
Vaginal delivery at 38WA of a newborn male, birth weight=2700g, Apgar=3 to 1 minute, apparent death, died in immediate post-partum
Clinical examination at birth = holoprosencephaly, with agenesis of the nose and the two eyeballs, cyclopia, hexadactyly.
4thCase: (Figures 3 & 4)
35-year-old, gravida 6 para 4, followed for high blood pressure since 32WA, low socio-economic level, and reporting the following elements:
Inbreeding = 0, Diabetes = 0
Intake of Fenugreek and plants = 0
Pregnancy follow-up, intake of Methyldopa 500x3/day during the third trimester
Antenatal diagnosis made at 26WA= objectified polymalformatif syndrome, with cyclopia, hexadactyly
The birth occurred at 39WA, female stillborn, hypertrophic, birth weight=2070g
Clinical examination at birth confirms the prenatal diagnosis.
Discussion:
In our context, the prevalence is assessed at 0.9/10,000 births. Three levels of increasing severity are described:(i) lobar HPE, where the right and left ventricles are separated, but with some continuity across the frontal cortex; (ii) semilobar HPE with a partial separation; and (iii) the most severe form, alobar HPE, with a single brain ventricle and no interhemispheric fissure. The middle interhemispheric variant (MIH), also known as syntelencephaly, is classified as a variant of HPE with midline interhemispheric fusion.HPE is usually associated with facial abnormalities, such as cyclopia, proboscis, or cleft lip/palate in severe HPE cases. In our study, HPE is associated with hexadactyly in 50% of cases and with sexual ambiguity in 25% of cases, with a male predominance, the sex ratio at 2.
The aetiology of HPE is multifactorial. Chromosomal and genetic abnormalities, teratogen exposure, and/or syndromic association have been reported in the literature. Karyotype study finds a chromosomal abnormality such as trisomy 13, in 24%–45% of all HPE cases.6While 10% of “normal” karyotype have microdeletions or duplications, heterozygous, loss-of-function mutations in components and regulators of the Nodal and hedgehog (Hh) signalling pathways are associated with HPE.7,8Ethanol9, maternal diabetes - potentially increasing the risk 200-fold, ethyl alcohol, smoking, and retinoic acid have been described as possible causes of HPE.10In our cases, we have determined the following risk factors:75% patients are of low socioeconomic level, with the first-degree consanguinity in 25% of cases. The pregnancies were not properly monitored, no folic acid supplementation was provided and, in 25% of cases, consumption of fenugreek was reported.
Prenatal diagnosis is based primarily on ultrasound and MRI in the third trimester of pregnancy, at birth on clinical, ETF, CT and especially brain MRI, and genetic diagnosis involves the karyotype. The contribution of prenatal imaging in the assessment and diagnosis of embryological abnormalities, in particular of the CNS, was demonstrated by Lekshmiet al.which classified them in category A.11Prenatal ultrasound can detect the central nervous system and facial abnormalities of severe HPE as early as the first trimester, but is less sensitive for detection of milder forms of HPE. Fetal MRI would provide better characterization of the malformations in the third trimester of the pregnancy. In our study, the prenatal diagnosis has been established in 25% of cases, i.e. the case of pregnancy followed for arterial hypertension started from 32 weeks on Methyldopa 500 three times a day.
Treatment is symptomatic and requires multidisciplinary management. The prognosis depends on the type and the severity of HPE and the medical and neurological complications associated. For the majority of cases, the prognosis is grim. Indeed, 75% of our cases were FDIU and one case died in immediate post-partum.
Conclusion
HPE is a complex developmental brain malformation commonly associated with facial anomalies, whose prognosis depends on the type of HPE and facial anomalies associated. The best diagnostic procedure is ultrasound examination, completed eventually by MRI. There are a number of causes of HPE, including genetic alterations and environmental effects. In our context, the four (4) cases represented severe forms of HPE, explaining the poor prognosis, and thus prompting the need for a systematic follow-up of any pregnancy and the implementation of an antenatal ultrasound screening program allowing the early diagnosis of these anomalies and adequate care at birth for viable forms on the one hand and on the other hand, the indication of a possible medical termination of pregnancy for lethal forms if the parents so request and legislation allow this (note that the text of the law is being revised to include in addition to the indication of the maternal prognosis, severe lethal congenital malformations).
Acknowledgements
We would like to thank everyone who has contributed to this study.
Ethical approval and consent to participate
The Ethics Committee for Biomedical Research, University Mohammed V – Rabat, Faculty of Medicine and Pharmacy – Rabat, approved the study, n°: 20/16. The oral consent to participate was obtained from the parents.
Funding
Not applicable
Competing interests
The authors declare that they have no competing interests.
Authors ‘contributions
ATI was responsible for the study concept and design. KF coordinated the study and interviewed the parents. KF and EB analyzed the data. KF led the drafting of this manuscript, with input from all authors. ATI and MHA supervised analysis of the data and contributed to the writing. ATI, MHA, EB, and AMA contributed to the revision and final approval of the manuscript.
All the authors have approved the present version of the manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=3956http://ijcrr.com/article_html.php?did=3956
Marcorelles P, Laquerriere A. Neuropathology of holoprosencephaly. Am J Med Genet C Semin Med Genet. 2010;154C (1):109–119. PMID: 20104606 http://doi : 10.1002 / ajmg.c.30249.
DeMyer W, Zeman W. Alobar holoprosencephaly (arhinencephaly) with median cleft lip and palate: clinical, electroencephalographic and nosologic considerations. Confiner Neurol. 1963; 23:1–36. PMID: 14026941. http://doi : 10.1159 / 000104278
DeMyer W, Zeman W, Palmer CG. Familial alobar holoprosencephaly (arhinencephaly) with median cleft lip and palate: report of a patient with 46 chromosomes. Neurology. 1963; 13:913–918. PMID: 14079950. http://doi: 10.1212 / wnl.13.11.913
DeMyer W, Zeman W, Palmer CG. The face predicts the brain: diagnostic significance of median facial anomalies for holoprosencephaly (arhinencephaly). Pediat. 1964; 34:256–263. PMID: 14211086
Mercier Sandra, Dubourg Christèle, [...], and Odent Sylvie. New findings for phenotype-genotype correlations in a large European series of holoprosencephaly cases. J Med Genet. 2011 Nov; 48(11): 752-760. PMID: 21940735 http://doi : 10.1136 / jmedgenet-2011-100339.
Winter Thomas C, Kennedy Anne M, Woodward Paula J. Holoprosencephaly: A Survey of the Entity. Embry Fetal Imaging.Radiogr. 2015;35(1):275–290. PMID: 25590404 http://doi : 10.1148 / rg.351140040.
Roessler E, Muenke M. The molecular genetics of holoprosencephaly. Am J Med Genet C Semin Med Genet. 2010; 154C(1):52-61. PMID: 20104595 https://doi.org/10.1002/ajmg.c.30236
Hong Mingi and Krauss Robert S. Modeling the complex etiology of holoprosencephaly in mice. Am J Med Genet C Semin Med Genet. 2018 June; 178(2): 140–150. PMID: 29749693 http://doi:10.1002/ajmg.c.31611
Hong M, Krauss RS. Ethanol itself is a holoprosencephaly-inducing teratogen. PLoSOne. 2017; 12(4): e0176440.PMID: 28441416 https://doi.org/10.1371/journal.pone.0176440
Vaz SS, Chodirker B, Prasad C, Seabrook JA, Chudley AE, Prasad AN. Risk factors for nonsyndromic holoprosencephaly: a Manitoba case-control study. Am J Med Genet. 2012;158A(4):751–758.PMID: 22419615 http:// doi: 10.1002 / ajmg.a.35240
LekshmiARV, Raju G, Chandrakumari K.Foetal Anomalies: Correlative Study of Sonography and Autopsy.Int J Cur Res Rev. 2021;13(2):143-147 http://dx.doi.org/10.31782/IJCRR.2021.13218
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10Healthcare"Effect of Two Ended Slider Neurodynamic Technique on Pain and Disability in Patients with Cervical Radiculopathy" - An Experimental Study
English8188Gamit HimaniEnglish Hingarajia DhartiEnglishIntroduction: Cervical radiculopathy (CR) is a dysfunction of a nerve root in the cervical spine, is a broad disorder with several mechanisms of pathology. The average annual age-adjusted incidence rate of CR is 83/ 100,000 for the population in its entirety. There is a paucity of literature about the effectiveness of two ended slider Neurodynamic technique in CR. Objective: To compare the effect of two ended slider Neurodynamic technique along with conventional physiotherapy and conventional physiotherapy alone in patients with CR. METHODS: Total 58 patients included. Patients were evaluated before, after 2 weeks and post intervention for pain intensity and disability. Data were statistically analyzed at the significance level of English Neck Disability index (NDI), Visual Analogue Scale (VAS), Cervical Radiculopathy (CR), Median Neurodynamic Test (MNT), Nerve Mobilization (NM), Cervical Nerve Roots (CNRs)INTRODUCTION
Cervical Radiculopathy is a peripheral nervous system disorder affecting the normal function of Cervical Nerve Roots and is often associated with chronic pain and functional limitations in daily life.1,2,3,4,5 Mostly Result of a compressive or inflammatory pathology from disc herniation, spondylitis spur or cervical osteophytes resulting from inflammation of CNRs.6
Clinical signs and symptoms of cervical radiculopathy include numbness, tingling, pins & needle, radiating, shooting pain along the nerve root distribution7& also triggered by additional stress on weakened core muscles of spine structures. 8,9,10
The average annual age-adjusted incidence rate of CR is 83/100,000 (107.3 for men and 63.5 for women) for the population in its entirety with the peak incidence in the 5th and 6th decade (203 per 1000) in both genders has been reported.8 It's estimated 50% of the population will experience neck and upper extremity pain.11 Epidemiological research studies notify annual prevalence between 15%- 50%.9, 12, 13, 14
Conservative treatment for CR typically includes therapeutic exercise (ROM, strengthening), manual therapy (NM, non-thrust mobilization etc.), modalities (Heat & cold therapy, traction, TENS) cervical collar etc.15, 16, 17, 18, 19
Pain is typically generated when microvascular alterations result of compression lead to up-regulation of inflammatory mediators ultimately lead to adhesions between herniated disc & nerve root will impair gliding of the nerve root.20
Radicular pain is not always associated with vertebral or intervertebral pathology but the decrease in excursion of the nerve is another cause of radicular symptoms which is not purely based on the nerve root.21 This suggests mobilizing neural course is not enough at root level but the sliding pattern of the neural pathway concerning surrounding soft tissues or relation inter neural tissues is required.
Neurodynamics based on the biomechanical structure of peripheral nerves& a set of techniques designed to restore plasticity of the nervous system.22 There are two types of neurodynamic techniques i.e. tensioners (i.e. produce increase tension in neural structures) and sliders (i.e. produce a sliding movement of neural structures relative to their adjacent tissues & based on the neural excursion). There are two types of sliders i.e. one ended as moves the neural structures with the use of body movements at one end of the neural system and two-ended slider as applying tension at one end of the nervous system whilst letting it go at the other.23
Although the literature supports the utilization of NM in the treatment of CR and other conditions, only a few have especially utilized two ended slider nerve mobilization. There are currently a lacks good-quality studies in the literature that describe the use of two ended slider neurodynamic and the literature is also limited due to a detailed description of this technique performed. And so, the potency of this intervention is needed to know the effect of two ended slider neurodynamic technique.
MATERIALS AND METHODS:
Number of subjects: 58
Based on the pilot study, the calculated effect size was 0.82. Sample size calculated in G power 3.1.9.2. Power was kept at 80, α was selected at 0.05, and the level of significance was 95%. The sample size calculated from these parameters was 48. With drop out chances of 20%, 29 subjects in each group.
Number of Group A. Control Group
B. Experimental Group
3. Study Design: Pre - Post experimental design
4. Population: Patients with cervical radiculopathy
5. Sampling Technique: Purposive sampling
6. Study Duration:1 year
7. Inclusion Criteria:
Subjects were diagnosed with CR by orthopaedicdic Surgeon.
Age between 30 to 60 years
having pain for >3 months
Below elbow radiating pain in one upper extremity
positive Median Neurodynamic test 1(MNT1)23
Ethical clearance ref. No. : EC/SPB/018
8. Exclusion Criteria:
Traumatic injuries/other musculoskeletal disorders of the upper extremity and cervical spine within 6 months
Dizziness, asymptomatic for pain but symptomatic for tingling and paraesthesia
Circulatory disturbances of upper extremity
Known history of high-level spinal cord injury
peripheral nerve injury, neuropathy and Malignancy
Severe Osteoporosis, Canal stenosis and cord compression
Cervical instability, Hypermobility, Vertebrobasilar insufficiency
Spondylolysis and spondylolisthesis, Rheumatoid arthritis
The person currently taking medication
9. Materials & Tools:
Pen, Paper, Plinth, Stool, Mechanical traction unit, Neck disability index, Visual analogue scale, Stadiometer, Weighing machine
10. Outcome Measures:
Pain measured in a 10 cm Visual Analogue scale.24 VAS is a 10 cm line with pain descriptors marked “no pain” at one end and “the worst pain imaginable” at the other. Patients were asked to mark which best suits their pain level at rest.
Disability measured by the NDI scale.25 NDI scale is a questionnaire designed to better understand how neck pain affects the ability to manage everyday life activities. Patients were instructed to answer every section and in each section only the one box which applied to them.
Before the beginning (0 weeks) then after 2 weeks and after 4 weeks intervention period, all patients were evaluated for the above-mentioned outcome measures.
11. Procedure:
Ethical clearance was taken from the institutional ethical committee. Subjects were preliminary screened based on the inclusion and exclusion criteria. The purpose of the study was explained and written informed consent and demographic details were obtained from all the subjects. They were randomly allocated into two groups by the sealed envelope method.
The procedure of blinding: Subjects were blinded on either type of intervention and to which group they belonged. Throughout the treatment sessions, subjects from both groups were not allowed to have any interaction with each other and subjects were not aware of what kind of treatment they received and its effects.
Descriptions of groups are Group A: Conventional physiotherapy and Group B: Two ended slider neurodynamic technique + Conventional physiotherapy.
GROUP A (CONTROL GROUP):
Received the conventional physiotherapy and given for 30 minutes in each session for 3 days/week for 4 weeks.
ISOMETRIC EXERCISES OF CERVICAL MOTIONS:
Total 10 repetitions with 10-sec hold were given of isometric exercises for each motion. 2 minutes rest period between each exercise sitting position with neck and back straight. Exercise for flexors, extensors, side flexors (left and right), lateral rotators (left and right) )(Figure 1 to 6)
CERVICAL TRACTION:
The patient position was a supine relaxed position with the neutral spinal position for 15 minutes (Figure 7) with mechanical intermittent traction. Dosage: force - 7% of body weight with 10 seconds hold time and 5 seconds rest time.
GROUP B (EXPERIMENTAL GROUP):
Receiving two ended slider neurodynamic technique and conventional physiotherapy
Two Ended Slider Neurodynamic Technique23: Total 3 sets of 6-8 repetitions were given in one set with 10 seconds rest in between sets for 10 minutes in each session for 3 days/week for 4 weeks.
Procedure: The patient was supine whilst the symptomatic upper limb was placed in the appropriate position for the relevant upper limb neurodynamic test (e.g. MNT1).
Starting position of MNT1 for two ended slider neurodynamic technique was shoulder 90° abduction.
The degrees of shoulder abduction and elbow extension is particularly important. In deciding on the extent to which the nerves are moved and was selected judiciously. The therapist position was standing at the head of the patient.
Step 1: The therapist had supported the patient's head and neck to be able to glide the patient's neck in an ipsilateral direction. The patient was asked to performed elbow extension whilst the therapist glides the head in the ipsilateral direction. (Figure 8)
Step 2: The therapist had supported the patient's head and neck to be able to glide the patient's neck in a contralateral direction. The patient was asked to performed elbow flexion whilst the therapist glides the head in the contralateral direction. (Figure 9)
STATISTICAL ANALYSIS
Statistical analysis was done using SPSS version 15.00 Software.
This study included AGE, GENDER, BMI, DURATION, VAS and NDI as quantitative variables. Shapiro-Wilk test was applied to check the normality of data. All quantitative data of this study follow the normality (p≥0.05). (Table 1)Baseline characteristics were compared to check homogeneity between intervention groups.
An Independent t-test was used for all the demographics and outcome measures like AGE, GENDER, BMI, DURATION, VAS and NDI before the training.
One way ANOVA was used to analyze the pre-intervention (week 0), after 2 weeks (week 2) and post-intervention (week 4) differences within each group and an independent t-test were used for between groups pre and post-intervention comparison. The confidence interval was kept at 95% and the level of significance for all statistical data was set at 0.05.
Lost to follow up 3 and 1 in group A at 2 weeks and 4 weeks and 4 and 1 in group B at 2 weeks and 4 weeks respectively. Total of 84 patients were assessed for eligibility. 58 patients were enrolled in the study and randomized to one of the treatment groups - 29 in group A and 29 in group B. Outcome measurements were completed on 49 participants (25 in group A and 24 in group B) after post-intervention. The baseline characteristics were similar between groups. All the parameters showed no significant difference (P>0.05) before intervention.
Both the groups were matched in terms of age, BMI, duration of symptoms, VAS and NDI before intervention. The baseline characteristics showed no statistically significant difference between the intervention groups before intervention. (P >0.05)
Intra Group Comparison of Two Outcome Measures (Table 2)
One way ANOVA was used to analyze the pre-intervention (week 0), after 2 weeks (week 2) and post-intervention (week 4) differences within each group for the mean values of outcome measure i.e. VAS and NDI within the groups. Result of the test that there is a significant difference between pre and post VAS in both the groups (pEnglishhttp://ijcrr.com/abstract.php?article_id=3957http://ijcrr.com/article_html.php?did=3957
Young IA, Cleland JA, Michener LA, Brown C. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phar Med Res. 2010 Oct 1; 89(10):831-9.
Costello M. Treatment of a patient with cervical radiculopathy using thoracic spine thrust manipulation, soft tissue mobilization, and exercise. J Man Manip Ther. 2008 Jun 1; 16(3):129-35.
Thoomes EJ, Scholten-Peeters GG, de Boer AJ, Olsthoorn RA, Verkerk K, Lin C et al. Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. Eur Spine J. 2012 Aug; 21(8):1459-70.
Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, Van Kleef M. Cervical radicular pain. Pain Practice. 2010 Jan; 10(1):1-7.
Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin. J. Pain. 2013 Dec 1; 29(12):1073-86.
Langevin P, Roy JS, Desmeules F. Cervical radiculopathy: Study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044]. BMC Musculoskel Disord. 2012 Dec; 13(1):1-8.
Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery. 2007 Jan 1; 60(suppl_1):S1-28.
Radhakrishnan K, Litchy WJ, O'fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr 1; 117(2):325-35.
Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009 Jul 1; 89(7):632-42.
Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J.2006 Jun; 15(6):834-48.
Hult L. The Munkfors investigation: a study of the frequency and causes of the stiff neck-brachialgia and lumbago-sciatica syndromes, as well as observations on certain signs and symptoms from the dorsal spine and the joints of the extremities in industrial and forest workers. Acta Orthopaed Scandinavica. 1954 Aug 1; 25(sup16):3-76.
Hogg-Johnson S, Pierre Côté DC, Guzman J. The Burden and Determinants of Neck Pain in Whiplash-Associated Disorders after Traffic Collisions. Eur Spine J. 2008; 17(1):S52-9.
Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Care Res. 2007 May 15; 57(4):656-65.
Tampin B, Briffa NK, Goucke R, Slater H. Identification of neuropathic pain in patients with neck/upper limb pain: application of a grading system and screening tools. Pain. 2013 Dec 1; 154(12):2813-22.
Costello M. Treatment of a patient with cervical radiculopathy using thoracic spine thrust manipulation, soft tissue mobilization, and exercise. J Man Manip Ther. 2008 Jun 1; 16(3):129-35.
Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. J Ortho Spin Tech. 2005 Dec; 35(12):802-11..
Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Oorth Pharma Tech. 2000 Dec; 30(12):728-44.
Waldrop MA. Diagnosis and treatment of cervical radiculopathy using a clinical prediction rule and a multimodal intervention approach: a case series. J Oorth Pharma Tech. 2006 Mar; 36(3):152-9.
Cleland JA, Fritz JM, Whitman JM, Heath R. Predictors of short-term outcome in people with a clinical diagnosis of cervical radiculopathy. Physical Therapy. 2007 Dec 1; 87(12):1619-32.
Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression Part 2: morphological and immunohistochemical changes of dorsal root ganglion. J Orth Res.2004 Jan; 22(1):180-8.
Hough AD, Moore AP, Jones MP. Reduced longitudinal excursion of the median nerve in carpal tunnel syndrome. Archiv Phys Med Rehab. 2007 May 1; 88(5):569-76.
Butler DS. Mobilisation of the Nervous System, Churchill l Livingston. Melbourne, Australia. 1991.
Shacklock M. Clinical neurodynamics: a new system of neuromusculoskeletal treatment. Elsevier Health Sci. 2005 May 6.
Scrimshaw SV, Maher C. Responsiveness of visual analogue and McGill pain scale measures. J Manipulative Physiol Ther J Manip Phy. 2001 Oct 1; 24(8):501-4.
Kamdar K, Kakkad A. A Study To Find Out Test Retest Reliability And Validity Of Gujarati Version Of Neck Disability Index Among Gujarati Speaking Indian Population With Neck Pain–A Correlational Study. Ind J Physiother Occup Ther. Jul-Dec. 2014; 2(2): 218.
Kachanathu SJ, Philip S, Nuhmani S, Natho M, Melam G, Buragadda S. A comparative study on the effect of different positional isometric neck exercise training on neck pain and functional abilities in patients with neck pain. J Appl Dent.; 2014, 2:91-5.
Constantoyannis C, Konstantinou D, Kourtopoulos H, Papadakis N. Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks. J Manipulative Physiol Ther J Manip Physio Ther. 2002 Mar 1; 25(3):188-92.
Elvey RL. Treatment of arm pain associated with abnormal brachial plexus tension. J. Physiother. 1986 Jan 1; 32(4):225-30.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEfficacy of Cervical Manipulation on Hand Grip Strength and Upper Limb Function: A Randomized Controlled Trial
English8994AnjaliEnglish Malik MEnglish Gera CEnglish Kaur JEnglishBackground: Non- specific neck pain is the most common health concern among the general population. It leads to functional disabilities of upper limb and pain. Assortment of approaches includes manual therapy has been used for the management of neck pain. Improving Grip strength, reducing functional disabilities of upper limb and reducing pain intensity are important objectives in the treatment of non-specific neck pain. Methods: A randomized, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors in which patients were randomly allocated into 2 groups; Experimental group (n=26) and Control group (n=26). Patients in experimental group were received the cervical manipulation session; hot pack and TENS for two weeks. Patients in control group were received the hot pack and TENS alone for two weeks Participants were recruited from different clinics and hospitals of Hisar. The outcomes were DASH Score and hand grip strength. All subjects were evaluated at the baseline and post session (after 2 weeks). Results: A total of 52 subjects were participated in the study, including 18 males and 33 females. The mean ages of the subjects were 33.05 years old. Data analysis was done by using paired t –test. This study resulted that the grip strength and DASH Score after the intervention were significantly improved in experimental group as compared to control group. In addition, the performance of hand grip strength [left (p≤0.000) (95% CI= -13.11, -9.85) and right (p≤0.000) (95% CI= -12.57, -9.85] and upper limb functions [DASH Score (p≤0.000) (95% CI= -14.25, -19.46] was superior in experimental group as compared to that of the control group. Ethics and Dissemination: The proposed examination was done after moral endorsement from the Institutional Ethics Committee, Departmental Research Committee, and B.O.S. & R. of the Department of physiotherapy, G.J.U.S&T, Hisar in September 2019, Vide letter no. PTY/2019/1014, dated 11.09.19. Conclusion: Cervical manipulation can improve the Hand grip strength and upper limb functions in non-specific neck pain.
EnglishCervical manipulation, Manualtherapy, Gripstrength, Upper limb function, Non-specific neck pain and DASH scoreIntroduction
“Non-specific neck pain (NP) is characterized as pain in the back and parallel part of the neck between the superior nuchal line and the spinous process of the thoracic vertebra without any signs or indications of major basic pathology and no significant impedance with exercises of everyday life just as with the absence of neurological signs and explicit pathologies like fracture and tumor”.1
Non – explicit neck pain may radiate down to the shoulder, arm, and fingers giving "a tingling sensation", crunching sound when turning the neck, functional limitation, and pain while moving the neck.2 Upper appendage disability can be estimated utilizing the inability of the arm, shoulder, and hand (DASH) scale which is a reliable outcome measure in estimating upper appendage incapacity in vague neck pain. Handgrip strength can be evaluated by estimating the measure of static power that the hand can press around a dynamometer.3
The primary symptom of non-specific neck pain is the pain around the cervical area, occipital area, suboccipital muscles, shoulders, and upper appendages. Numbness, paresthesia, tingling, and weakness also occur in upper appendages. Tenderness is also present, mainly in the lower cervical areas (C5-C6), where disc degeneration is progressively obvious.4 The cause of neck pain can be disc herniation, extreme movement of the cervical spine, long term awkward posture and lifestyle choices, and tissue injury in the neck. Cervical stability continuously diminishes and can prompt the loss of cervical lordosis.5Assortment of approaches has been successful for the management of neck pain. These strategies of treatment include home exercise programs, manual therapy, endurance training, strength training, and electrotherapy modalities.6
Manual therapy such as cervical mobilization and cervical spinal manipulation (CSM) are used as an effective treatment of patients with neck pain and headache. CSM is defined as low amplitude and high velocity thrust that applied passively to articular surfaces of a joint within its anatomical limit to restore functionsand to reduce pain. 7 Manipulation of the spine involves a high –velocity thrust that is applied through either a long or short lever arm. The “long lever” method involves numerous vertebral articulations at the same time (e.g. rotatory manipulation of the thoracolumbar spine) while the “short –lever” method include a low amplitude thrust that is aimed at a particular degree of the vertebral segment. Manipulation has been utilized in the treatment of muscle tension-type headache, migraine, neck pain, and stiffness. Mobilization includes low -velocity passive movement which can be halted by patient. The speed of the technique (not really the measure of power), in this manner, separates manipulation from mobilization.8 Literature suggests that the use of manual therapy (manipulation & mobilization) can reduce pain and functional limitation in patients suffering from non-specific neck pain.
The present study was done to evaluate the efficacy of cervical manipulation on handgrip strength and upper limb functions in patients of non-specific neck pain.The study includes Grip strength as an outcome measure because in this study we want to show the impact of neck pain on hand grip strength and if the neck disability index was considered as an outcome measure than the focus of the study would be neck disability instead of hand grip strength.As the title of the study was "Efficacy of Cervical Manipulation on Hand Grip Strength and Upper Limb Function" so in this study grip strength took as primary outcome measure.
Methodology:
A randomized controlled preliminary was conducted after approval from the Institutional Ethics Committee of the Department of Physiotherapy, G.J.U.S&T, Hisar. The RCT was registered with the Clinical trial registry of India (Registration no. CTRI/2020/01/022638.
Consent was taken from each participant. Following study enrollment and completion of baseline evaluation, members were arbitrarily designated into the experimental or control group using computer generated random number tables and delineated by gender.
Sample size calculation
The sample size was calculated using (Minimally Clinical Important Difference) MCID of DASH score=13.0 along with standard deviation of DASH score=17.6 from previous studies considering a dropout rate of 5%. 9 Using the following formula.10
Here, Z1-α/2 = is standard normal variate as in most of the studies P esteems are viewed as huge underneath 0.05, thus 1.96 is utilized in equation
p = Expected extent in population dependent on past investigations or pilot considers
d = Standard deviation.
Selection criteria
Patients suffering from non -specific neck pain were included in this study. In the study patients with radicular and withoutradicular pain both were included. Patients having a complaint of neck pain with age group between 18-65 years who did not receive any concomitant intervention for neck pain were included in this study. Patients having a past history of stroke or transient ischemic attack, severe neck pain due to infection, fracture, progressive neurological deficiency, herniated nucleus pulposus, and myelopathy were excluded from selection criteria.
Procedure:
52 subjects took part in the examination, including 19 guys and 33 females. The participants were randomly allocated into 2 groups i.e. Experimental group (n=26) and the Control group (n=26) respectively as explained in the flowchart of Figure -2. Grip strength was evaluated by using a handheld dynamometer and upper limb functions were assessed by the DASH (disabilities of the arm, shoulder, and hand) scale. To measure grip strength we used a Jamar hydraulic dynamometer that is an easy, fast, and reliable method. The Jamar hydraulic dynamometer was seen as exceptionally dependable (ICC= 0.98) i.e. 98% and substantial (ICC =0.99) i.e. 99% for estimating handgrip strength. 11 The dynamometer was lightly held around the readout dial by the examiner to prevent inadvertent dropping. As shown in Figure-1 the subjects were in sitting situation with their shoulder adducted, impartially pivoted elbow flexed at 90° lower arm in nonpartisan position, wrist between 0-30° dorsiflexion and 0-15° ulnar deviation for each strength test scores were recorded for each treatment. The therapist was standing in front of the subject.
Assessment and examination: Patients were thoroughly assessed and examined by using palpation and prone leg length test to evaluate cervical malalignment. Functional movements were examined for any limitation and dysfunction. Special tests like the Spurling test and slump test were used to exclude specific pathologies.
Intervention: Before giving any intervention, the pre-intervention data was collected in which the handgrip was measured Experimental group received sessions of cervical manipulation, hot pack, and TENS for two weeks, thrice weekly. Cervical manipulations include: Axis lateral correction technique, Atlas correction, and Diagonal correction atlantoid arch, “The Pistol”- Ventral malaligned vertebrae, Rotational adjustment of the axis, Rotational correction of C3-C6 and C7 rotation correction.
The subjects in the Control group received only a hot pack and TENS for two weeks, thrice weekly. After 2 weeks post-intervention of handgrip strength and upper limb functions were re-evaluated. Data so obtained was analyzed for any statistical significance ( Figure 2).
Data analysis:
Outcome measures were analyzed for any statistical significance. SPSS latest version 26 programming was utilized to break down the information. Assessment for the differences between pre- and post- grip strength and DASH score of experiment and control group was done by Paired t-tests. The mean change in grip strength and DASH score between groups was compared to the independent t-test. P esteem was set at ≤ 0.05 level. 95% certainty 95% confidence interval was also Calculating
RESULTS:
A total number of 52 patients with non-specific neck pain were randomized into experimental (n=26) or control group (n=26). Intention to treat analysis was done. The mean age of patients in the experimental group was 31.15 and in the control group was 35.12. Three patients dropped out of the study. The post-intervention data were collected for ‘Intention to treat analysis’.Baseline characteristics were similar between the two groups
Baseline Comparisons-
As shown in Table 1 the baseline comparisons of outcome measure between the Experimental and Control Group. Baseline data was analyzed for any statistically significant difference. The Analysis shows that the baseline data was similar (p-value= 0.113, 0.130 and 0.04 respectively)
Data normality was evaluated through Kolmogorov-Smirnov (K-S) test andLilliefors corrected K-S test. Results showed that the data was normally distributed.
Pre-Post comparison-
Results show a statistically significant improvement in Experimental group as compared to control group. As shown in Table-2 the grip Strength left (p≤0.000) (95% CI= -13.11, -9.85) and right (p≤0.000) (95% CI= -12.57, -9.85) as well as DASH Score (p≤0.000) (95% CI= -14.25, -19.46) were improved significantly in experimental Group. However, there was no significant improvement in control group.
Comparison between Groups:
The examination between the experimental and control groups as shown in Table 3. Results show a statistically significant improvement of Experimental group (p≤0.00)in terms of grip strength right (MD=10.96; 95% CI= 7.65, 11.49), left (MD=11.42; 95% CI= 7.94, 11.75) and DASH score (MD=-16.85; 95% CI= 10.34, 15.52) as compared to control groupin grip strength right (MD=1.38), left (MD=1.57) and DASH score(MD=-3.92).
DISCUSSION:
The essential goal of this examination was to explore the impact of cervical manipulation on handgrip strength and upper limb functions. Effect of grip strength was evaluated using a hand-held dynamometer and upper limb function was evaluated using DASH questionnaires. DASH is a valid and reliable tool for testing upper limb disability.3
Data was analyzed by using a t-test and significant positive improvements in handgrip strength and upper limb functions were observed. Results of the present study suggest that cervical manipulation is effective in the improvement of grip strength and upper limb function in patients with non-specific neck pain. The Experimental group had a statistically significant increase in grip strength and decreases in hand and shoulder disability. The grip strength is a decline in subjects suffering from severe neck pain. 12 Reduction of hold quality and continuance is because of the impedance with the capacity of the nervous system to start hand muscle through motor units. Besides, fear-avoidance reaction was found in patients with incessant neck torment inspired by a paranoid fear of injury prompts disuse atrophy and decreases the inability to produce and retain force.2
Cervical manipulation can be beneficial in non-specific neck pain patients. Spinal manipulation works via neurophysiological and biomechanical mechanisms. During manipulation, the application of mechanical force may start many neurophysiological reactions that cause an increase in range of motion and decrease in pain.13 The experimental group end up being more helpful in all terms in treating mechanical Neck Pain and pain referred to the upper limb. Firstly, this can be since grip strength had straightforwardly identified with neck pain as grip strength was diminished in neck pain with serious neck disability. Hence, neck pain, grip strength, and neck inability are negatively correlated. 14 Grip strength was influenced by motor control. The neck muscles in the presence of neck pain and isometric muscle fatigue affect the handgrip. 15
Results showed a significant decrease in the DASH Score of experimental group i.e. improvement in useful exercises as per DASH with (pEnglishhttp://ijcrr.com/abstract.php?article_id=3958http://ijcrr.com/article_html.php?did=39581. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil. 2017;30(6):1149–69.
2. Gauns S V, Gurudut P V. A randomized controlled trial to study the effect of gross myofascial release on mechanical neck pain referred to upper limb. Int J Heal Sci (Qassim). 2018; 12(5): 51–59.
3. Roh YH. Clinical evaluation of upper limb function?: Patient’s impairment, disability and health-related quality of life. J Exercise Rehabil. 2013;9(4):400-405.
4. López-de-Uralde-Villanueva I, Sollano-Vallez E, Del Corral T. Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability. Disab Rehabil. 2018;40(21):2495–504. https://doi.org/10.1080/09638288.2017.1337239
5. Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain?: a Systematic Review and Meta-Analysis. Curr Rev Musculosk Med. 2019;12:562–577. https://doi.org/10.1007/s12178-019-09594-y.
6. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain?: Clinical Outcomes From the UCLA Neck-Pain Study. Am J Public Health. | 2002;92(10):1634–41.
7. Kranenburg HA, Schmitt MA, Puentedura EJ, Luijckx GJ, Schans CP Van Der. Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: A systematic review. Musculosk Sci Pract . 2017; 28:32-38.http://dx.doi.org/10.1016/j.msksp.2017.01.008
8. Griswold DW, Learman K, Kolber MJ, Relief P, Cleland JA. Pragmatically Applied Cervical and Thoracic Non-thrust versus Thrust Manipulation for Patients with Mechanical Neck Pain?: A Multicenter Randomized Clinical Trial. J Orthop Sports Physical Ther.2018;48(3):137-145.
9. Koorevaar RCT, Kleinlugtenbelt Y V., Landman EBM, van’t Riet E, Bulstra SK. Psychological symptoms and the MCID of the DASH score in shoulder surgery. J Orthop Surg Res. 2018;13(1):1-7. https://doi.org/10.1186/s13018-018-0949-0.
10. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Ind J Psych Med. 2013;35(2):121–6.
11. Bellace J V., Healy D, Besser MP, Byron T, Hohman L. Validity of the Dexter Evaluation System’s Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther. 2000;13(1):46–51.
12. Kalra S, Pal S. Correlational study of chronic neck pain and hand grip strength in physiotherapy practitioners.Int J Yoga, Physioth Phys Edu. 2017;2(4):30–2.
13. Anderst WJ, Ms TG, Ms CL, Bs SR, Dc KG, Dc MS. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation.The Spine J.2018 Dec;18(12):2333-2342. https://doi.org/10.1016/j.spinee.2018.07.026
14. Ramdati V, Soni N. The correlation between chronic neck pain and hand grip strength indentists of gujaraT.Int J Curr Adv Res.2019;8(09):8–10.
DOI: http://dx.doi.org/10.24327/ijcar.2019.3899.20029
15. Egwu MO, Ajao BA, Mbada CE, Adeoshun IO. Isometric Grip Strength and Endurance of Patients With Cervical Spondylosis and Healthy Controls: A Comparative Study. Hong Kong Physiother J. 2009;27(1):2–6. Available from: http://dx.doi.org/10.1016/S1013-7025(10)70002-6
16. Vance CGT, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197–209.
17. Bautista-aguirre F, Oliva-pascual-vaca Á, Heredia-rizo AM, Boscá-gandía JJ, Ricard F, Rodriguez-blanco C. Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial.Eur J Physic Rehab Med. 2017 June;53(3):333-41 doi: 10.23736/s1973-9087.17.04431-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareWhich Concomitant Arterial Injury in the Forearm Tends to Mess Up the Hand More
English9599Mirzazada JEnglish Kucuk LEnglishIntroduction: This study focuses on the differences of concomitant single forearm arterial (radial & ulnar) injuries. The ulnar artery has been being consented to be the dominant one of the hand for a long time despite more recent and controversial studies clinical observations might be supporting it. Material and Method: We assessed 108 consecutive, minimum 1-year followed-up, concomitant single artery lacerated forearm injuries operated in our clinic retrospectively, and 38 cases attended. After attendees filled subjective questionnaires, we evaluated their hand circulation, hand sensation, handgrip, pinch-grip, and thermo-distribution. Results: Most common injury type was glass cut (62%), followed by power saw injury (26%). Cases associated with the ulnar artery lacerations were referred to the hospital with significantly (pEnglish Radial, Ulnar artery, Ulnar nerve, Forearm injury, Glass punch, Hand functionality INTRODUCTION AND BACKGROUND
Forearm arteries have been a dispute over years and still, there is not a strong consensus on whether radial or ulnar artery is dominant regarding the hand perfusion or at least which one is of an anatomically critical area. Our opinion was that hand perfusion was singular and all the anatomical structures were at the same significance level, yet the medial side of the forearm should be considered more vulnerable, and the ulnar artery should attain more critical care when injured. This was the baseline of our study.1,2
We coped with serious cooperation issues throughout the study due to the nature of trauma with thickly involved glass punchers and the attendance was similar to the literature.1
Nearly half (45,4%) of all upper extremity injuries happen indoors2. Penetrating traumas are responsible for 80% of all upper extremity injuries, and upper extremity vascular traumas are for 50% of all peripheral vascular injuries.3 Postoperative arterial patency rates are reported as diverse as 50-77%.4 Glass-punchers are usually young adults with 28,5 mean age with their dominant hands affected 5, 6 whereas power-tool users frequently injure their non-dominant hands due to the most common usage style.7 A study on teenagers and young adults has shown that 86% of all disability-causing injuries are related to the hand and upper extremity, also hand injury is the top reason accounting for work-related disabilities.8 Trybus et al.9 reported that 26,6% of all cases consumed alcohol before the hand injury, 89,3% of them were young adults and 74,3% manual workers, 65,9% of injuries happened at home, mostly by glass and healthcare expenses of these patients altered twice that of non-alcohol related injuries. Another study reports that with a 48% majority among all power-tool related injuries, upper extremity dominates the list of injured organs including craniofacial and torso, males lead 95% of this population and it takes them at least 3 months to recover.10
Despite the anatomical prominence of any given structure in the forearm regarding the hand, in some cases, a well-perfused hand becomes an excuse for ignoring a single arterial rupture which we think should not even be considered ligating if mangled extremity is not present.
MATERIAL AND METHODS
The study was approved by the local ethical committee under case no: 18-12.1T/35. The study is retrospective. The main objective was to assess the clinical outcomes of forearm injuries with a neurovascular component and assign the prominence of one major artery in hand perfusion.
Initially, 3908 individual case files with upper extremity trauma operated in our clinic, between September 2014 – March 2018 were revealed. Any single forearm artery laceration of any age and sex was included. Regarding homogeneity, patients with severe injuries requiring emergent revascularization such as total or subtotal amputation, with irregular or incomplete outpatient clinic visits, severely senile, immobilized, debilitated, also hardly cooperating pediatric ages under ten years old and any concomitant hand injuries were excluded. Eventually, 108 cases were registered and 38 people attended the further examination.
According to dossier research, all the cases were operated under a 4.3x magnifying loupe. Microsurgical procedures were done with non-absorbable 8/0 and 9/0 polypropylene sutures. All the cases were treated at least 5 days with the same regimen:
Full immobilization
Pentoxifylline added Dextran 40 solution infused throughout 72 hours
HMWH daily
Salicylate daily
Arterial patency was assessed via 8.0 MHz probe Mobile Doppler Ultrasonography (MDU) 11-13. Meanwhile, minimal reverberations in perfusion were monitored via a portable pulse oximeter put on the third finger pulp. 14,15
Each MDU examination was recorded and rendered via audio-analyzer (Figure 1).16 Non-directional MDU audios were designated as triphasic, biphasic and monophasic/non-patent.
Figure 1 - Non-directional manual doppler ultrasound audio files. a-monophasic, b-biphasic, c-triphasic.
Concomitant nerve damage was assessed via Semmes-Weinstein17,18,19 monofilaments and Weber’s20 two-point discrimination and tactile gnosis. Posttraumatic cold-related (cold intolerance) symptoms21 were also evaluated. Palmar grip and key-pinch forces were assessed. FLIR ONE® was used to establish warm-cool divergence values. Images were generated at standard 30cm apart with 0-30° angle, then analyzed via FLIR Tools App. and processed through ANOVA to distinguish temperature variance between healthy and pathologic specimens.
A well-known scoring system MHISS (Managed Hand Injury Severity Score)1 designed especially for forearm lacerations was used to assess the severity of the injury. Also, a well-known patient-reported outcome QDASH (Quick – Disabilities of Arm, Shoulder, and Hand) 22 scoring for clinical assessment was used.
STATISTICAL ANALYSIS
SPSS 25 was used for statistical analysis (CI=95%,pEnglishhttp://ijcrr.com/abstract.php?article_id=3959http://ijcrr.com/article_html.php?did=39591. Urso-Baiarda F, Lyons RA, Brophy S, et al. prospective evaluation of the Modified Hand Injury Severity Score in predicting a return to work. Int J Surg. 2007;6(1):45-50. doi:10.1016/j.ijsu.2007.09.001
2. Ootes D, Lambers KT, Ring DC. The Epidemiology of Upper Extremity Injuries Presenting to the Emergency Department in the United States. HAND. 2012;7(1):18-22. doi:10.1007/s11552-011-9383-z
3. Sheppard J, Thai J, Massey B, et al. Evidence-based Comprehensive Approach to Forearm Arterial Laceration. West J Emerg Med. 2015;16(7):1127-1134. doi:10.5811/westjem.2015.10.28327
4. Bacako?lu A, Co?kunol E, Özdemir O, et al. Multifactorial effects on the patency rates of forearm arterial repairs. Microsurgery. 2002;21(2):37-42. doi:10.1002/micr.1006
5. ?ahin F, Akkaya N, Kuran B, et al. Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthop Traumatol Turc. 2015;49(4):361-369. doi:10.3944/AOTT.2015.14.0255
6. Elliott D, O’Donohue P, Phillips A, et al. Punching Glass. Plast Reconstr Surg - Glob Open. 2015;3(6):e436. doi:10.1097/gox.0000000000000410
7. Judge C, Eley R, Miyakawa-Liu M, et al. Characteristics of accidental injuries from power tools treated at two emergency departments in Queensland. EMA - Emerg Med Australas. 2018;(October). doi:10.1111/1742-6723.13201
8. Barker M, Power C, Roberts I. Injuries and the risk of disability in teenagers and young adults. Arch Dis Child. 1996;75(2):156-158. doi:10.1136/adc.75.2.156
9. Trybus M, Tusinski M, Guzik P. Alcohol-related hand injuries. Injury. 2005;36(10):1237-1240. doi:10.1016/j.injury.2004.09.003
10. Judge C, Eley R, Miyakawa-Liu M, et al. Characteristics of accidental injuries from power tools treated at two emergency departments in Queensland. EMA - Emerg Med Australas. 2018;(October). doi:10.1111/1742-6723.13201
11. Alavi A, Sibbald RG, Nabavizadeh R et al. Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease. Vascular. 2015;23(6):622-629. doi:10.1177/1708538114568703
12. Vowden K, Vowden P. Hand-held Doppler Ultrasound?: The assessment of lower limb arterial and venous disease. Vascular. 2002:1-8.
13. Davlouros P, Ziakas A, Tassi V, et al. Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates. Angiology. 2018;69(9):755-762. doi:10.1177/0003319718754466
14. Al-Metwalli RR. Perfusion index as an objective alternative to the Allen test, with flow quantification and medico legal documentation. Anaesthesia, Pain Intensive Care. 2014;18(3):245-249.
15. Umutoglu T, Zengin SU, Bakan M, et al. Comparison of SpO2 values from different fingers of the hands. Springerplus. 2015;4(1):2-4. doi:10.1186/s40064-015-1360-5
16. Https://twistedwave.com/online. online soundwave analyzer. https://twistedwave.com/online. 2019
17. Weinstein S. Tactile Sensitivity of the Phalanges. Percept Mot Skills. 1962;14(3):351-354. doi:10.2466/pms.1962.14.3.351
18. Weinstein S. Fifty years of somatosensory research: from the Semmes-Weinstein monofilaments to the Weinstein Enhanced Sensory Test. J Hand Ther. 6(1):11-22; discussion 50. http://www.ncbi.nlm.nih.gov/pubmed/8343870.
19. Levin S, Pearsall G, Ruderman RJ. Von Frey’s method of measuring pressure sensibility in the hand: An engineering analysis of the Weinstein-Semmes pressure aesthesiometer. J Hand Surg Am. 1978;3(3):211-216. doi:10.1016/S0363-5023(78)80084-7
20. Carterette EC, Friedman MP. Handbook of Perception. New York: ACADEM?C PRESS, INC; 1978. https://books.google.com.tr/books?id=PKBGBQAAQBAJ&pg=PA5&lpg=PA5&dq=vierordt%27s+law+1870&source=bl&ots=_CshAE5QaB&sig=ACfU3U3y4P2YdP7bqgEE_Xw2NJnBK7CPZg&hl=tr&sa=X&ved=2ahUKEwieno3t9a_iAhVFyqQKHcdDD8IQ6AEwAXoECAkQAQ#v=onepage&q=vierordt’s law 1870&f=fals.
21. Roseén B, Lundborg G. A model instrument for the documentation of outcome after nerve repair. J Hand Surg Am. 2000;25(3):535-543. doi:10.1053/jhsu.2000.6458
22. QUASH. http://www.dash.iwh.on.ca/about-quickdash. 2019
23. Dacombe PJ, Amirfeyz R, Davis T. Patient-Reported Outcome Measures for Hand and Wrist Trauma. Hand. 2016;11(1):11-21. doi:10.1177/1558944715614855
24. Beaton DE, Katz JN, Fossel AH, et al. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 14(2):128-146. http://www.ncbi.nlm.nih.gov/pubmed/11382253.
25. Beaton DE, Davis AM, Hudak P, et al. The DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure: What do we know about it now? Br J Hand Ther. 2001;6(4):109-118. doi:10.1177/175899830100600401
26. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11. doi:10.1186/1471-2474-4-11
27. Office for National Statistics. Standard Occupational Classification 2000 (SOC2000) - Summary of structure. 2000;1(June):1-17. http://www.ons.gov.uk/ons/guide-method/classifications/archived-standard-classifications/standard-occupational-classification-2000/index.html.
28. Ballard JL, Bunt TJ, Malone JM. Management of small artery vascular trauma. Am J Surg. 1992;164(4):316-319. doi:10.1016/S0002-9610(05)80895-5
29. Keles MK. Evaluation of Forearm Arterial Repairs: Functional Outcomes Related to Arterial Repair. Turkish J Trauma Emerg Surg. 2016;23(2). doi:10.5505/tjtes.2016.36080
30. Scissons R. Characterizing Triphasic, Biphasic, and Monophasic Doppler Waveforms. J Diagnostic Med Sonogr. 2008;24(5):269-276. doi:10.1177/8756479308323128
31. Steinberg D, Gans I, Levin LS, Lin I, Bozentka D, Park MJ. Timing of Forearm Arterial Repair in the Well-perfused Limb. Orthopaedics. 2014;37(6):e582-e586. doi:10.3928/01477447-20140528-60
32. Ero?lu O, Koçak OM, Co?kun F, et al. Cama Yumruk Atan HastalarinDemografi?Özelli?kleri? Ve Hava Ko?ullariII?li??ki?si?. K?r?kkale Üniversitesi T?p Fakültesi Derg. 2017;19(1):1-1. doi:10.24938/kutfd.289300
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareRisk of Developing Knee Medial Compartment Osteoarthritis in Subjects with Piriformis Tightness
English100105M JinilEnglish Mohanty PEnglish Pattnaik MEnglishIntroduction: This study was conducted to examine the association between knee osteoarthritis and hindfoot angle, medial tibiofemoral angle, piriformis tightness and hip internal rotation. Aims: To examine the association between knee osteoarthritis and hindfoot angle, medial tibiofemoral angle, piriformis tightness and hip internal rotation. Methodology: A quantitative study with a non-experimental relational design was conducted on a total sample consist of 132 knees of 89 subjects ( 31 males and 58 females) age range (45– 70). Result: On multiple regressions with entering model (R=.708, R2= .501 and p=.000), a good (R=.655) and significant correlation (p.000) lead to linear regression analysis between medial tibiofemoral angle and hindfoot angle. Pearson correlation between hindfoot angle and medial tibiofemoral angle was R=.655, R2 =.429, p=.001, beta= -.822. Pearson chi-square (p=.000), likelihood ratio (p=.000) and Fisher’s exact test (p=.000) show that there is a significant association between piriformis tightness and OA grade, phi coefficient was .595 and Cramer’s V was .343 which shows the association is strong. Conclusion: Medial compartment osteoarthritis of the knee joint is characterised by genu varum. It is often associated with hindfoot varus. Both genu varum and hindfoot varum can biomechanically be linked with the tightness of the piriformis muscle.
English Knee osteoarthritis, Piriformis, Genu varum, Hindfoot varus, Hip internal rotation, Tibiofemoral angle, Grades of osteoarthritisINTRODUCTION
Osteoarthritis is characterized by progressive degeneration of articular cartilage and subchondral bone that involves the weight-bearing joint with the knee being more prevalent. There develop synoptic to clean the necrosed cartilage. Osteoarthritis poses a significant personal and global economic burden.1 The pathogenesis of OA is characterized by the destruction of cartilage and subchondral bone and by synovial inflammation.1 Osteoarthritis typically presents in the weight-bearing joints of the lower limb, with knee osteoarthritis being the most prevalent.1Pain and difficulty in ADL are the main symptoms in patients with OA.2 The medial compartment of the knee is the most commonly affected. 3 Varus malalignment is seen most commonly in knee OA.4The femoral and tibial longitudinal axes normally form an angle medially at the knee joint of 180° to 185°. If the medial tibiofemoral angle is greater than 185°, an abnormal condition called genu valgum (“knock knees”) exists. If the medial tibiofemoral angle is 175° or less, the resulting abnormality is called genu varum (“bow legs”) .5 Risk factors of osteoarthritis were described in various researches. These include both generalized constitutional factors (age, female sex, obesity, family history) and local adverse mechanical factors (trauma, occupational and recreational wear, malalignment, generalized laxity).4 But no studies described specifically the cause of varus knee alignment. Neutral lower limb alignment a vertical line drawn from the center of the head of the femur passes through the centre of the knee and centre of the ankle joints. In the case of Genu-varus, this line passes through the medial compartment of the tibiofemoral joint thus medial compartment is loaded more, predisposing to degeneration of articular cartilage. External rotation of the hip, both in weight-bearing and non-weight-bearing, results in genu varum and foot supination.6
The exact cause of OA is not known, however, increased loading, malalignment, altered biomechanics, nature of functional activities etc. contribute significantly to the development of degeneration. Though primarily it involves the articular cartilage, secondarily joint capsules ligaments, ligaments, muscles synovium and bone get affected.7The six “short external rotators” of the hip are the piriformis, obturator internus, gemellus superior, gemellus inferior, quadrates femoris, and obturator externus. Piriformis tightness results in external rotation of hip.8
Deformities of the hip, knee, and/or ankle all play a role in determining overall lower extremity alignment. As alignment shifts either toward varus or valgus at the knee, the hindfoot may compensate to restore neutral hip-knee-ankle coronal plane alignment.9 It is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee.10 So the objective of the study is to find out the association of biomechanical factors at the hip(internal rotation range, piriformis tightness) and ankle(hindfoot alignment and angle) to the genu varum and grades of knee osteoarthritis.
AIM AND OBJECTIVES
Aim of the study:
To examine the association between knee osteoarthritis and hindfoot angle, medial tibiofemoral angle, piriformis tightness and hip internal rotation
Objectives:
To find out the association between hip internal rotation, hindfoot angle & piriformis tightness with genu varum in subjects with knee osteoarthritis
To find out the association between piriformis tightness and OA grade, the relationship between genu varum and hindfoot angle, between genu varum and hip internal rotation, genu varum and piriformis tightness.
METHODOLOGY
Type of study: Quantitative study
Research design: Non-experimental relational study
Research setting: The study was conducted at the department of physiotherapy, SVNIRTAR, Olatpur, Cuttack.
Sample: A total sample consisted of 89 subjects ( 31 males and 58 females) age range (45– 70) years with Osteoarthritis
Inclusion criteria: A diagnosis of Primary osteoarthritis according to ACR criteria.Age between 45 and 70 years.
Exclusion criteria: Secondary osteoarthritis, Surgical conditions, Inflammatory arthritis, Congenital deformity
Institutional ethical clearance
Instruments:
Universal Goniometer: According to a study, a universal goniometer is moderate to excellent reliable to measure the joint range of motion.11Aluminium wire was used to measure the angle to quantify piriformis tightness.
Procedure: 132 knees (89 subjects) of both males and females (31 males and 58 females) were selected for study based on American college of rheumatology criteria to diagnose Knee Osteoarthritis. Medial tibiofemoral angle: In standing position subject’s anterior superior iliac spine(ASIS), the centre of patella and midpoint between two malleoli are marked, goniometer fulcrum placed on the centre of the patella, one arm placed towards ASIS and another arm placed towards midpoint between two malleoli and angle is noted.12
Hip internal rotation: Hip internal rotation was measured subject in the prone position with both knee flexed to 90°, hip in 0° abduction and adduction and flexion. Centre the fulcrum over the anterior aspect of the patella. Both arms of the instrument are together vertically. At the end of the hip, the internal rotation mobile arm move using the crest of the tibia and a point midway between the two malleoli for reference.13
Hindfoot angle: The first subject was brought into the measurement area by an assistant and stepped onto the measurement area. The subject was then instructed to march in place approximately 10 steps to assume a comfortable, natural position while aligning the heels with the posterior edge of the area. The midpoint between medial and lateral malleoli was determined. Goniometer fulcrum was placed on that mark. Hindfoot angle was measured as the angle between the bisectors of the calf and the calcaneus using a goniometer.14
Piriformis test: Subject in crook lying. Affected limb crossed over other limb and hip flexed to 60° and knee in flexion. Then it is adducted in an externally rotated position while the therapist keeping sound limbs in adduction to avoid pelvic rotation by the therapist’s knee. If there is pain over the piriformis muscle at the end of the range suggestive of piriformis test positive.15 Angle to quantify piriformis tightness: As mentioned above in the same position of piriformis test subject positioned close to the wall where greater trochanter of affected limb touching the mark drew on the wall. A 60° line was already marked on the wall for hip joint keeping accurately, Hip is flexed to 60° by following the line drew on the wall, hip is adducted in external rotation. The angle between wall and thigh measured using aluminium wire which will be in “V” shape. It was measured by a protractor and noted.
KneeOA grade: Kellegren Lawrence scale is used to grade OA knee from X-RAY.16
Grade 1: doubtful narrowing of joint space and possible osteophytic lipping.16
Grade 2: definite osteophytes, definite narrowing of joint space.16
Grade 3: moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour.16
Grade 4: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour.16
DATA ANALYSIS
Statistical analysis was performed using SPSS version 23.0. Multiple regressions with entering model were done with medial tibiofemoral angle as the dependent variable and hip internal rotation, hindfoot angle, angle to quantify piriformis tightness as independent variables Pearson correlation was done for medial tibiofemoral angle and hindfoot angle. A good and significant correlation leads to linear regression analysis. Chi-square tests were done between piriformis tightness and OA GRADE. Symmetric measures Phi coefficient and Cramer’s V were also calculated. All variables were analyzed using a 0.05 level of significance.
RESULTS
Multiple regressions
As a table, I show multiple regressions with entering model was done with medial tibiofemoral angle as the dependent variable hip internal rotation, hindfoot angle, angle to quantify piriformis tightness as independent variables. R=0.708, R2= 0.501 and p=0.000 .As R2 is 0.501 approximately half of the variation of dependent (medial tibiofemoral angle) can be explained by the independent variables (hip internal rotation, hindfoot angle, angle to quantify piriformis tightness). It may be because only hindfoot angle shows a significant relationship with medial tibiofemoral angle (p=0.000); hip internal rotation (p=0.113) and angle to quantify piriformis tightness (p=0.088) doesn’t show a significant relationship with medial tibiofemoral angle.
Relationship between hindfoot angle and medial tibiofemoral angle
Pearson correlation was done for medial tibiofemoral angle and hindfoot angle. A good (R=0.655) and significant correlation (p=0.000) lead to linear regression analysis between medial tibiofemoral angle and hind foot angle. Pearson correlation between hindfoot angle and medial tibiofemoral angle was R=0.655, R2 =0.429, P=0.001, beta= -0.822(Table II). Linear regression with medial tibiofemoral angle as dependent variable and hindfoot angle as independent variable shows that when there is a 1° change in the hindfoot angle there are -0.822 changes in medial tibiofemoral angle.
Relationship between and piriformis tightness and osteoarthritis of the knee
Table III shows Chi-square tests were done to find an association between piriformis tightness and OA Grades. Pearson chi-square (p=0.000), likelihood ratio (p=0.000) and Fisher’s exact test (p=0.000) show that there is a significant association between piriformis tightness and OA grade. Symmetric measures were calculated to find the strength of association. Phi coefficient was 0.595 and Cramer’s V was 0.343 which shows the association is strong (Table IV).
DISCUSSION
The overall results of this study with multiple regressions with entering model showed that as r2 is 0.501 approximately half of the variation of dependent variable medial tibiofemoral angle can be explained by the independent variables angle to quantify piriformis tightness, hindfoot angle, hip internal rotation.
Medial tibiofemoral angle and hindfoot angle
In the present study, the Pearson correlation between hindfoot angle and medial tibiofemoral angle was R=0.655, R, p=0.000. Linear regression with medial tibiofemoral angle as dependent variable and hindfoot angle as independent variable shows that when there is a 1° change in the hindfoot angle there is a -0.822 change in medial tibiofemoral angle. It means that when there is a 1° increase in the hindfoot angle (varus) there will be a 0.822° decrease in the medial tibiofemoral angle (varus), which may result in genu varum.
According to Otis A-C, the motion of the hindfoot is coupled to the motion of the leg and the forefoot. Hindfoot varus is a component of supination hence supination of the subtalar joint with the foot on the ground produces lateral rotation of the tibia with inversion of the calcaneus, cuboid, and navicular. Lateral rotation of the tibia causes lateral rotation of the femur which eventually results in the shift of the mechanical axis medially which results in a decrease in the medial tibiofemoral angle. Inadequate or excessive pronation or supination may contribute to complaints of the knee, hip, and even back pathologies by interfacing with the coupling between the foot and rest of the lower extremity during weight-bearing.17
The study carried out by Chang C. B., Jeong, J. H., Chang, M. J., Yoon, C., Song, M. K., & Kang, S. B.hypothesized that most patients who undergo TKA have varus malalignment of the lower limb, which, theoretically, may exert a force that tilts the ankle joint line into varus. The ankle joint and/or hindfoot, therefore, have to compensate for the varus malalignment of the lower limb to obtain a plantigrade foot.18
Piriformis tightness and OA
In this study Pearson chi-square (p=0.000), likelihood ratio (p=0.000) and Fisher’s exact test(p=0.000) show that there is a significant association between angle to quantify piriformis tightness and OA grade. In the symmetric measures, the phi coefficient was 0.595 and Cramer’s V was 0.343 which shows the association is strong. It means that while piriformis tightness increases the severity of OA may increase.
It may be because according to Norman, T. L., Hutchison, J. D., & Gardner, M. R external rotation of the hip and knee compared to the direction of gait is a form of malalignment. External rotation may be caused by piriformis tightness. The centre of the knee joint, corresponding to the tibial fossa, is displaced laterally when the hip is in external rotation.19 In external rotation, the knee displaces from the midline at the stance phase. According to Kapandji varus or valgus deviations of the knee are harmful as they cause osteoarthritis with time, in effect, the mechanical loads are not evenly spread over the lateral and medial two compartments of the knee joint, leading to premature erosion of their respective articular surfaces and culminating in medial femorotibial osteoarthritis in the presence of genu varum or lateral femorotibial osteoarthritis in the presence of genu valgum.6
CONCLUSION
Medial compartment osteoarthritis of the knee joint is characterised by genu varum. It is often associated with hindfoot varus. Both genu varum and hindfoot varus can biomechanically be linked with the tightness of the piriformis muscle. Stretching of the piriformis may be included in the management of osteoarthritis of the knee joint.
LIMITATION
To quantify piriformis tightness an innovative method with aluminium wire was used. Inter and interrater reliability of the measurement tool was not done.
ACKNOWLEDGEMENT
The authors express their sincerest gratitude and warm appreciation to the patients who participated in this study. Authors acknowledge immense help received from the scholars whose articles are cited and included in the manuscript. The authors are grateful to all the authors/ editors/publishers of those articles, journals, and books from where the literature of this article has been reviewed and discussed.
NO CONFLICT OF INTEREST AND SOURCE OF FUNDING
Englishhttp://ijcrr.com/abstract.php?article_id=3960http://ijcrr.com/article_html.php?did=3960
Deasy M, Leahy H, Semiciv A I. Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop. Sports Phys. Ther; https://doi.org/10.2519/jospt.2016.6618: 2016, 46(8), 629–640.
R K Mahato, D Panchal, Vyas N J. Exercise interventions in Knee Osteoarthritis in Aging adults: A Systematic Review of Randomized Clinical Trials, Int J Curr Res. Rev. 2019: 11(23)
Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R. 2012 May;4(5 Suppl):2012,S3-9. doi: 10.1016/j.pmrj.2012.01.020. PMID: 22632700; PMCID: PMC3635670.
Hussain SM, Neilly DW, Baliga S, Patil S, Meek R. Knee osteoarthritis: a review of management options. Scott Med J. 2016 Feb;61(1):7-16. doi: 10.1177/0036933015619588. Epub 2016 Jun 21. PMID: 27330013.
Snyder-Macker L, Lewk M, Joint structure and function; a comprehensive analysis, fourth edition; 2005, 396-397
Kapandji AI. The kinesiology of joints; the lower limb. 2011; 2:70-71;
Egloff C, Hügle T, Valderrabano V. Biomechanics and pathomechanisms of osteoarthritis. Swiss Med Wkly. 2012 Jul 19;142:w13583. doi: 10.4414/smw.2012.13583. PMID: 22815119.
Neuman DA. Kinesiology of the musculoskeletal system: Foundation for rehabilitation,second edition, 2010: 520-523.
Norton J. J., Amendola, A., Ba, C. F . Correlation of Knee and Hindfoot Deformities in Advanced Knee OA?: Compensatory Hindfoot Alignment and Where It Occurs, Clin Orthop Relat Res. 2015:166–174. https://doi.org/10.1007/s11999-014-3801-9; 2015,166–174.
Kim, C., Gwak, H., Kim, J., Lee, C., Kim, J., Oh, M., Park, J. Radiologic Factors Affecting Ankle Pain Before and After Total Knee Arthroplasty for the Varus Osteoarthritic Knee. J Foot Ankle Surg. 2018Oct;57(5):865-869,https://doi.org/10.1053/j.jfas.2018.02.002;
Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther. 1987 Feb;67(2):192-5. doi: 10.1093/ptj/67.2.192. PMID: 3809242.
Singh, O., Sharma, B., Ramphal, S. K. A Study of Tibiofemoral angle among Healthy Female Maharashtrian Population, Int J Res Med Surg. 2018; 17(5): 12–18; https://doi.org/10.9790/0853-1705021218
Norkin C.C. Measurement of joint motion; A guide to goniometry,fourth edition, 2011; 210-211.
Donatelli RA., The biomechanics of the foot and ankle. 2nd ed.Philadelphia: FA Davis; 1996;178–9
Mohanty PP, Pattnaik M. Effect of stretching of piriformis and iliopsoas in coccydynia, J Bodyw Mov Ther. 2017;03:024;
Kohn, M.D., Sassoon, A.A., Fernando, N.D. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474: 1886–1893. https://doi.org/10.1007/s11999-016-4732-4
Oatis CA, Kinesiology; the mechanics and pathomechanics of human movement, Second edition. 2009: 808-832
Chang CB, Jeong JH, Chang MJ, Yoon C, Song MK, Kang SB. Concomitant Ankle Osteoarthritis Is Related to Increased Ankle Pain and a Worse Clinical Outcome Following Total Knee Arthroplasty. J Bone Joint Surg Am. 2018 May 2;100(9):735-741. doi: 10.2106/JBJS.17.00883. PMID: 29715221.
Norman TL, Hutchison J, Gardner MR, Knee Loading due to Varus and External Rotation in Gait Supports Medial Compartment Wear in Total Knee Arthroplasty. J Orthop Rheumatism. 2017; 1(1):8-18.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcarePrevalence of HCV Infection and its Genotype among High-Risk Children in Tertiary Care Centre
English106111S. BalasubramanianEnglish D. SelvakumarEnglish D. NirmalaEnglish SumathiEnglish W. S. SumathiEnglish T. PradeebaaEnglishIntroduction and Objective: Hepatitis C infection (HCV) is one of the important causes of chronic liver diseases (CLD). This causes significant morbidity and mortality in developing countries like India due to its low-level infection control. The destinations of the examination were to investigate parenterally transmitted, HCV in recently analysed haematological disorders, CKD and CLD patients from Madras Medical College and Hospital, Chennai, and further, explore the HCV genotype appropriation in those patients. Materials and Methods: Clinical examination, socio-demographic history, and risk factors exposure and clinical details of each patient were recorded in the proforma. Identification of hostile to HCV antibodies was undertaken using enzyme immunoassay (ELISA KIT). Anti-HCV- seropositive samples were tested for HCV RNA. Hepatitis C virus-ribonucleic acid (RNA) was detected using a Reverse Transcriptase polymerase chain reaction (PCR) assay. HCV genotyping was determined by HCV RT-PCR genotyping test by using the COBAS AMPLICOR LINEAR ARRAY method. Results: Prevention and control of Hepatitis C Virus infection were troublesome as a result of the intricacy present in geological dissemination of HCV and its genotypes, related danger elements and cofactors. HCV type 1 frequently [43/45 = 96% CI (85%- 99%)] more overwhelming in our investigation Conclusion: This study concluded that transfusion of blood and blood products and therapeutic intervention by infected needle are two important preventable modes of spread of hepatitis C virus infection. This made a high risk in children in our country. Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent this blood-borne virus and its genotype distribution.
English Chronic hepatitis, Haematological disorders, Genotype, Hepatitis C, Transfusion, Prevalence and chronic kidney diseaseINTRODUCTION:
Hepatitis C virus (HCV) is an RNA virus member of the family Flaviviridae.1Approximately 170 million people in the world are infected with HCV. HCV creates an antiviral state, by inhibiting interferon-mediated response. Hence nearly 80% of infections become chronic, among those 20% develop cirrhosis in 5-20 years.
Hepatitis C virus causes continuing inflammation of hepatocytes because of its chronicity leading to CLD, Chronic hepatitis and hepatocellular carcinoma.
Children with chronic disorders like haematological disorders, Chronic Liver disease [CLD], Chronic Kidney disease [CKD] who receives a frequent transfusion of blood, blood products, dialysis and Chemotherapy drugs as a part of their treatment for the above problems are prone to get this blood-borne virus.1
Determining HCV genotype is also important, particularly when therapy is considered because the response to the current therapeutic agents varies greatly. Genotype 1 and genotypes 2, 3 are more reliably responsive to therapy. HCV infection is incessant in patients going through chronic chemo dialysis (HD), with a predominance somewhere in the range of 8 and 10%, and there is a specific concern as a result of the great danger for ongoing liver sickness, inconveniences in renal transplantation, and demise in these patients.2,3
The broad utilization of recombinant erythropoietin to address renal weakness in HD patients brought about a critical decrease in blood bondings. Notwithstanding, past examinations have shown that once more diseases in single HD units may, in any case, happen without other parenteral danger factors.4 It has been proposed that disease could be communicated from one patient to another in the emergency clinic, and there is presently backhanded proof that HCV contamination happens among HD patients during rehashed dialysis methodology, but not through the equipment, probably due to procedural errors. 5Viral titers should be checked yearly to document spontaneous remission. Most patients develop chronic hepatitis.6Progressive liver damage is higher in those with additional comorbid factors such as alcohol consumption, viral genotypic variations, obesity, and underlying genetic predispositions. Referral to a pediatric gastroenterologist is strongly advised to take advantage of up-to-date monitoring regimens and to optimize their enrollment in treatment protocols when available.
With this background, we investigated the proportion of HCV infection in newly diagnosed CLD patients from a Child care institute. In addition, we determined the HCV genotypes and examined their relevance concerning the clinic laboratory presentation. By far most of the patients are tainted with HCV genotypes 1a and 1b. In this examination, we discovered genotype 1a to be the most predominant genotype in the patients contemplated.
Materials and Methods:
This was a hospital-based descriptive study conducted from June 2014 to November 2014 from Madras Medical College and Hospital, Chennai. Ethical approval to offer HCV testing to high-risk children was obtained from the Institutional Ethics Committee, Madras Medical College, Chennai. [Ethical clearance number: 51062014]
Study population:
High-risk children attending the PediatricHematology, Pediatric Nephrology and Pediatric Gastroenterology outpatient department and inpatient wards at the Institute of child health during the study period.
Sample size:
Consecutive samples presenting to the institution during the study period
The sample size was calculated using the formula,
95% confidence interval Zα = 1.96 ≅ 2
Anticipated error α =5 %
n – Required sample size
P – Prevalence of Hepatitis c virus infection from previous studies
Q – (1-p)
L – Allowable error
Using the above formula the sample size was calculated as Minimum required sample n= 4× 50×50 /25 =400
High-risk children were examined and assessed for
Socio-demographic status including age, sex and residence (urban or rural population),
Exposure to risk factors like the previous history of hospitalization, duration of illness, transfusion details, dialysis details, multiple injections (chemotherapy ) and other therapeutic interventions done in the past.
Clinical status like Anemia, jaundice, lymphadenopathy, hepatomegaly splenomegaly.
After explaining the procedure, Blood samples of about 3 ml of venous blood were collected under strict aseptic precautions and Serum was separated and tested for the presence of hepatitis B surface antigen (HBsAg). Liver enzymes aminotransferases (SGOT, SGPT) and BILRUBIN were also measured in seropositive cases.
Detection of anti-HCV antibodies was undertaken using third-generation enzyme immunoassay (ELISA KIT) and the tests were performed according to the manufacturer’s instructions provided in the kit.
Anti-HCV- seropositive samples were tested for HCV RNA.
Hepatitis C virus-ribonucleic acid (RNA) was detected using a Reverse Transcriptase polymerase chain reaction (PCR) assay.
HCV genotyping was determined by HCV RT-PCR genotyping test by using the COBAS AMPLICOR LINEAR ARRAY method.
Statistical Analysis
The present study clinical data and laboratory data (ANTI HCV positive - 116, HCV RNA positive -45, GENOTYPE -45) were collected and entered in MS OFFICE EXCEL spreadsheet and the data were analyzed by using the statistical package for social science (SPSS) 17 Version. The results are presented in percentages.
Results:
The present study was undertaken on 435 children during the study period.
Sociodemographic analysis:
Maximum age 9yrs-12 yrs children constitute 30% of the study population and minimum age 1 yrs -3 yrs children constitute 20% of the study population as shown in figure:1
37% of the study population were female sex and 63 % of the study population were male sex as shown in the figure: 2
118 children from an urban area, 317 children from the rural area were included in the study population.
435 children had a history of the previous hospitalization in the study population Figure :3 showing the maximum duration of illness in the population studied was 11 years and the Minimum duration of illness was 1 month
Exposure to risk factors
Table 1 showing 43% of the children had exposure to blood transfusion in the study population and 7.4% of children had been exposed to chemotherapy (Multiple injections)
43% of the study population received transfusion, of which maximum number of 30% children received PRBC transfusion and 12% received blood products (FFP, Platelets and Cryoprecipitate)
58% of hematological disorder children, 31% of chronic kidney disease children, 11% of chronic liver disease children were included in this study population as showed in Table 2
Maximum per cent of the study population were haematological disorder children, of which a maximum of 20% percentage children have acute lymphoid leukaemia and a minimum of 0.2% children have chronic myeloid leukaemia.87 ALL children and 80Thalassemia children and 23 Hodgkin’s Lymphoma children constitute the majority of haematological disorders of the studied population.
Among the total study population, 371 children were anaemic whereas 64 children were normal. Out of 435 children studied 40 children had Lymphadenopathy; Figure: 4 showing that 91% of the study population were normal but 9% had Lymphadenopathy.
Table 3 shown 71 children were icteric whereas 364 children were anicteric among the total study population. Among the study population, 16% were icteric whereas 84% were anicteric. Out of 435 children, Hepatomegaly was present in 279 children whereas 156 children were normal.
Among the total population studied, splenomegaly was present in 155 children whereas 280 children were normal. Figure: 5 demonstrated that 36% of the total population had splenomegaly; 64% of them were normal.
116 children were seropositive for anti HCV antibodies whereas 319 children were seronegative for Anti HCV antibodies among 435 high-risk children studied as shown in table 4
Out of 435 High-risk children attending tertiary care, the hospital studied the seroprevalence of Anti HCV antibodies was 27% whereas 73% of them were seronegative for anti HCV antibodies.
Among 116 seropositive cases, 57 were tested for HCV RNA positivity due to the unavailability of testing kits. The results showed that 45 cases were positive for HCV RNA whereas 12 cases were HCV RNA negative as shown in table 5.
Among 57 children who were positive for HCV RNA 45 children were tested for HCV genotype. Out of 45 children tested a maximum of 43 children had genotype 1, 1 child had genotype 2 and 1 child had genotype 3 as shown in table 6.
Figure: 6 shows that the prevalence of HCV genotype 1 was 96%, genotype 2 was 1% and genotype 3 was 1% among 45 HCV RNA positive children studied. Hence the most predominant genotype was type 1 in our study involving high-risk children.
Discussion:
In this study prevalence of Hepatitis C virus (HCV) among hospital-based high-risk children is = 26.67%; CI (23%-31%)
The age and sex distribution among the high-risk population are shown in 116 of 435 children who tested positive for antibodies to HCV.
The prevalence among males 25.64% CI (20.82% - 31.13%) and females and 3.3% (95% CI=1.2-5.4%) respectively.
HCV genotype 1 is common in south India which responds well to therapy, whereas genotype 3 predominates are common in the east and west part of India.
There was no statistically significant difference in the exposure rates of males and females (p>0.05). RaghuramanSet al.7conducted a study on the distribution of different genotypes among adult patients attending a tertiary care hospital in south India Christian Medical College and Hospital, Vellore, Tamil Nadu, and they have concluded that HCV genotypes 1 and 3 accounted for 81% of HCV infections in patients from South India region.
J Christmas et al.8 conducted a study of the different genotypes among adults with HCV-related CLD attending a tertiary care hospital in south India during 2002—2012 and concluded that HCV genotype 3(63.85%) and genotype 1 (25.72%), genotypes were detected in their study.
Narahari Set al.9conducted a study on the distribution and prevalence of different genotypes in the Indian patient cohort, in Navi Mumbai, the eastern part of India.
In their study, they have examined and included 2118 patients from different geographic regions of India. Results were analyzed and HCV genotype 3 (3a/3b primarily) in 62% and HCV genotype 1(1a/1b primarily) in 31% of patients were found to be the predominant genotypes in India. They have concluded their study that the predominance of HCV3 was significant in northern (p=0.01) and eastern (p=0.008) regions of India.
Ponamgi SP et al. 10 conducted a study titled Prevalence of hepatitis C virus (HCV) co-infection in HIV infected individuals in South India and characterization of HCV genotypes in a tertiary care hospital in Hyderabad, Andhra Pradesh, India. In their study, they have concluded that the most prevalent genotype in co-infection was genotype 1b.
Anita Chakravarti et al. 11conducted a study on the distribution of different genotypes among adult patients attending various tertiary care hospitals in New Delhi, the northern part of India. HCV Genotype 3 was found to be the most predominant (63%) genotype followed by infection with HCV genotype 1 in 30.98 per cent (22/71) and genotype 2 in 5.63 per cent (4/71) of cases. They have concluded that HCV genotype 3 and 1 accounted for approximately 95% of the HCV infection in Delhi and surrounding areas.
All of the above studies conducted in various parts of India showed HCV genotype 3 followed by genotype 1 were the Predominant Genotypes identified in the adult population whereas Mathavi Chandra et al. study12 showing HCV genotype 1 followed by genotype 3 were the predominant genotype present in south India. Mathavi Chandra et al conducted a study titled Genotyping of Hepatitis C virus (HCV) in infected patients from South India in a tertiary care hospital (Deccan College of Medical Sciences and Allied Hospitals, Kanchanbagh), Hyderabad, and Andhra Pradesh, India. In their study, they have observed that 60% of the patients (30 patients with chronic hepatitis) were infected with HCV genotype 1 and 40% of the patients (4 chronic hepatitis patients, 12 patients with chronic renal failure and 4 cirrhosis) were infected with genotype 3 of HCV.
They concluded that predominant genotypes of HCV in South India include types 1 and 3. In our study, the most predominant genotype present is genotype 1 followed by genotypes 2 & 3. Our study is conducted in high-risk children with haematological disorders, chronic kidney disease and chronic liver disease.
Prevalence of HCV genotype in high-risk children (haematological disorders, chronic kidney disease, chronic liver disease) HCV type 1 prevalence 43/45 = 96% ci (85%-99%). Type 1 is more predominant in our study
Our study finding shows the most predominant genotype is genotype 1 which is similar to Mathavi Chandra et al. 12 studies which are Conducted on adult population in south India, Andhra Pradesh
Conclusion:
This study concluded that unsafe transfusion of blood and blood products and unsafe therapeutic intervention by infected needle are two important preventable modes of spread of hepatitis c virus infection in at-risk children in our country.
Prevention and control of Hepatitis C Virus infection are difficult because of the complexity present in the geographical distribution of HCV and its genotypes, associated risk factors and cofactors.
Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent this blood-borne virus and its genotype distribution.
ACKNOWLEDGEMENT:
This research was supported/partially supported by Madras medical college and hospital. We are thankful to our colleagues who provided expertise that greatly assisted the research.
AUTHORS CONTRIBUTION:
S.Balasubramaniamand D.Selvakumarmade substantial contributions to conception, acquisition of data, took part in drafting the article or revising it critically for important intellectual content, D Nirmala, Dr. Sumathi, WS Sumathi and T Pradeepamade Statistical analysis and final approval of the version to be published, and agreed to be accountable for all aspects of the work
SOURCE OF FUNDING: No funding sources
CONFLICT OF INTEREST: None declared
ETHICAL APPROVAL: The study was approved by the Institutional Ethics Committee and the IEC letter number is MMC/IEC- 321/2020
Englishhttp://ijcrr.com/abstract.php?article_id=3961http://ijcrr.com/article_html.php?did=3961
Lavanchy D. The global burden of hepatitis C. Liver Int. 2009; 29(1):74-81.
Ghany MG. Diagnosis, management, and treatment of hepatitis C: An update. Hepatology. 2009; 49(4): 1335-74.
Choo QL. Isolation of a cDNA clone derived from a blood-borne non-A, non-B hepatitis genome. Sci. 1989; 244(4902): 359-62.
Tokita H et al. Hepatitis C virus variants from Thailand are classifiable into five novel genotypes in the sixth (6b), seventh (7c, 7d) and ninth (9b, 9c) major genetic groups. J. Gen. Virol 1995; 76(Pt 9): 2329-35.
Sievert W et al. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int. 2011; 31(2):61–80.
Zein NN. Clinical significance of hepatitis C virus genotypes. Clin Microbiol Rev. 2000; 13(2): 223-35.
Raghuraman S. Distribution of the different genotypes of HCV among patients attending a tertiary care hospital in south India. J Clin Virol. 2003; 26: 61-9.
Christdas J, Sivakumar J, David J, et al. Genotypes of hepatitis C virus in the Indian sub-continent: a decadelong experience from a tertiary care hospital in South India. Indian J Med Microbiol. 2013;31(4):349-53.
Narahari S, Juwle A, Basak S and Saranath D. Prevalence and geographic distribution of Hepatitis C Virus genotypes in Indian patient cohort. Infect, Gen J. 2009; 9(4):643-645.
Ponamgi SP. Prevalence of hepatitis C virus (HCV) co-infection in HIV infected individuals in South India and characterization of HCV genotypes. Indian J Med Microbiol. 2009; 27(1):12-16.
Anita Chakravarti. Distribution pattern of HCV genotypes & its association with viral load. Indian J Med Res. March 2011; 2: 326-331.
Madhavi Chandra. Prevalence of hepatitis C virus (HCV) genotypes among positive south indian patients. Molec Biol Rep. 2011; 38(4):2719–22.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma
English112115Chandran AnandEnglish T.V. SyamaprasadEnglish K PavithranEnglish Vijayan MeenuEnglishIntroduction: Hepatocellular carcinoma (HCC) is the leading primary liver malignancy and is a major reason of cancer related death worldwide. Sorafenib is considered as the approved drug of choice in advanced HCC, which is an oral multikinase inhibitor with effective anti-proliferative and antiangiogenic effects. Currently, only limited data is available in India regarding the safety and effectiveness of Sorafenib for the management of HCC. Objectives: To evaluate the clinical profile of Sorafenib for treating advanced HCC. Methods: A prospective study of 66 patients who received Sorafenib for advanced HCC was carried out for a duration of 1 year with a mean follow up of 3 months. Effectiveness was analyzed based on Alpha- Fetoprotein (AFP) levels from laboratory findings. The adverse events (AEs) were graded using the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. In addition, the quality of life (QoL) was analyzed using: EORTC-QLQ-HCC18 (European organization for research and treatment of cancer- Quality of life group questionnaire) and FACT-Hep (Functional assessment of cancer therapy). Result: The patients’ median age was 63 years (range 61-70) with the male to female ratio of 16:1. The major adverse effects observed were fatigue (31.81%), hand foot syndrome (24.24%) and diarrhea (24.24%). A statistically significant decline in Alpha Fetoprotein (AFP) level was observed with Sorafenib treatment (p=EnglishHepatocellular Carcinoma, Sorafenib, Alpha Fetoprotein, Quality of Life, Adverse event, CTCAEINTRODUCTION
Globally Hepatocellular Carcinoma is a common primary hepatic malignancy with an increased risk of mortality.1HCC is the eleventh and sixth leading cancer worldwide in women and men, respectively. Majority of the patients with HCC has been observed to have chronic liver diseases as a result of infections due to hepatitis virus.2 HCC accounts for about 85% to 90% of all primary hepatic malignancies. Currently, the overall survival (OS) rate for HCC patients is below par, with only 2% of patients with advanced-stage disease and 26% of those with early-stage disease surviving for over five years.3 Surgical resection offers a cure but is not an option in the majority of the patients due to underlying liver disease and the extent of tumour at the time of diagnosis.4 Sorafenib is an oral multi-targeted tyrosine kinase inhibitor with anti-proliferative and antiangiogenic effects for advanced HCC.1 Serum Alpha-Fetoprotein (AFP), neutrophil-lymphocyte ratio (NLR), vascular endothelial growth factor (VEGF), as well as des-c-carboxy prothrombin (DCP), has been investigated as therapeutic biomarkers of Sorafenib. However, AFP is the most commonly used prognostic factor for Sorafenib due to its ease of measurement.5 Based on the promising results seen in clinical trials, Sorafenib has been favoured as first-line therapy in advanced HCC patients. Apart from its effectiveness, the use of Sorafenib, in turn, can cause some adverse drug reactions particularly hand-foot syndrome, fatigue, diarrhoea, weight loss, hypertension, abdominal pain, decreased appetite, fever.6
In India, clinical studies involving evaluation of effectiveness and safety as well as quality of life (QoL) studies of Sorafenib treated patients are less. On these grounds, a study on the clinical profile of Sorafenib is required for designing a treatment plan for the patients.
MATERIALS AND METHODS
A single-centre prospective study was carried out after the approval of the Institutional Review Board. A total of 66 patients who received Sorafenib were selected for a study period of 1 year.
Inclusion and exclusion criteria
The eligibility criteria for the selection of patients were the following: histologically proven HCC, patients who have received Sorafenib during the study period. The exclusion criteria were as follows: patients allergic to Sorafenib, patients with malignancies other than HCC and patients who had a psychiatric illness.
The occurrence of ADR was determined by direct interview with patients/ bystanders and from electronic medical records and their probability was measured using Naranjo ADR Probability Scale. The ADR severity was assessed by using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Basal serum AFP and serum AFP at 6-8 weeks were monitored and recorded to assess the effectiveness of treatment. EORTC-QLQ HCC18 and FACT- Hep questionnaires were used to evaluate the Health-Related Quality of Life (HRQoL).
STATISTICAL ANALYSIS
The information recorded on the data collection forms were uploaded in an excel sheet and data was analyzed using IBM SPSS 20.0 (SPSS Inc, Chicago, USA). The results are given in mean ± SD for all the continuous variables, and as a percentage for categorical variables. Paired t-test was done to test for statistical significance of differences in mean values from baseline to follow-up period and the Wilcoxon Signed Rank test was applied for non-parametric data. The treatment duration was determined (in months), along with the onset of any adverse effects.
RESULTS
The study group included 66 patients with a mean age of 63 years. The present study showed a male predominance (96.6%) with a male to female ratio of 16:1. Alcohol consumption (50%) was observed to be the major cause of HCC development, followed by smoking (29.16%), HBV (18.75%), HCV infection (2.08%). Most of the patients had maintained hepatic function with Child-Pugh B (74.2%) and Child-Pugh A (25.8%).
Safety Profile
With regards to the safety of treatment, 49 patients experienced several ADR with grades varying from I to IV according to the to CTCAE grading system. The primary adverse reactions were hand-foot syndrome 16 (24.24%), diarrhea 16 (24.24%), fatigue 21 (31.81%), hepatic failure 6 (9.09%) and rash 12 (18.18%) (Table 1).
All of the ADRs were confirmed as Definite (55.1%), Probable (42.85%) and Possible (2%) based on the Naranjo probability scale. According to the CTCAE scale, the incidence of Grade II ADR was 50%, Grade III ADR was 27.02%, Grade I ADR was 21.62% and Grade IV ADR was 1.35%. All these ADRs were managed by dose reduction and drug discontinuation for a short period (4 patients). Dose reduction were done in 13 patients (19.69%) (7 patients from 200mg BD to 200mg OD, 1 patient from 400mg OD to 200mg BD, 1 patient from 200mg TID to 200mg BD, 1 patient from 400mg BD to 400mg OD and 3 patients from 400mg OD to 200mg OD) and the dose escalation were done in 11 patients. Among these 24 patients, 4 subjects ceased and continued the dose for a specific period until the severity of ADRs was reduced.
Effectiveness
Regarding the basal AFP levels, significant differences in survival were observed. Mean AFP was found to be 19789.088 ± 69329.269 at baseline and 6720.637 ± 22545.4962 at final follow-up ( 0.05, it is proven that there is no significant difference between Pre and Post FACT - Hep scores, i.e., there is no improvement in the quality of life of the patients.
Significant relationships were observed between differences in the AFP levels from baseline to 3-month follow-up on the PWB, HepCS and TOI subscales. For all of these subscales, the improvement in AFP was linked with a slight negative change in HRQoL. When AFP was reduced from baseline to 3 months, patients reported a considerable increment in HRQoL. One explanation of this finding could be associated with the fact that those patients who responded to treatment also suffered greater adverse effects, thereby resulting in poorer HRQoL i.e., SWB, EWB, FWB, FACT- G and FACT-Hep.
CONCLUSION
This study emphasizes the superiority of Sorafenib in improving the clinical status and Quality of life in advanced HCC patients. Our study shows that the change in AFP level despite adverse reactions is an important parameter in measuring the effectiveness of Sorafenib. Thus, proving that in addition to its diagnostic and tumour staging function, AFP can also be used as a predictive factor of early response to Sorafenib in HCC patients.
Conflict of interest: The authors have no conflicts of interest, financial or otherwise.
ACKNOWLEDGEMENT
We express our respect and thanks to Amma, the Chancellor of Amrita Vishwa Vidyapeetham; Dr. Sabitha. M, Principal, Amrita School of Pharmacy, Kochi; Dr. Prem Nair, Medical Director, AIMS; Dr. Shantikumar Nair, Dean of Research, AIMS. We extend our sincere thanks to Dr KR Sundaram, HOD, Department of Biostatistics, AIMS for helping us in the statistical works related to the dissertation.
Source of Funding: None.
Authors’ Contribution:
Englishhttp://ijcrr.com/abstract.php?article_id=3962http://ijcrr.com/article_html.php?did=39621. Balogh J, Victor D 3rd, Asham EH, Burroughs SG, Boktour M, Saharia A, et al. Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:41–53.
2. Furuse J. Sorafenib for the treatment of unresectable hepatocellular carcinoma. Biolog. 2008;2:779–88.
3. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: Consider the population. J Clin Gastroent. 2013;47:S2–6.
4. Tinkle CL, Haas-Kogan D. Hepatocellular carcinoma: natural history, current management, and emerging tools. Biologics. 2012;6:207–19.
5. Shiozawa K, Watanabe M, Ikehara T, Shimizu R, Shinohara M, Igarashi Y, et al. Evaluation of sorafenib for advanced hepatocellular carcinoma with low α-fetoprotein in arrival time parametric imaging using contrast-enhanced ultrasonography. J Med Ultrason. 2017;44:101–7.
6. He AR, Goldenberg AS. Treating hepatocellular carcinoma progression following first-line sorafenib: therapeutic options and clinical observations. Therap Adv Gastroent. 2013;6:447–58.
7. Abou-Alfa GK, Schwartz L, Ricci S, Amadori D, Santoro A, Figer A, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006;24:4293– 300.
8. Bai W, Wang YJ, Zhao Y, Qi XS, Yin ZX, He CY, et al. Sorafenib in combination with transarterial chemoembolization improves the survival of patients with unresectable hepatocellular carcinoma: A propensity score matching study: Sorafenib and TACE for HCC. J Dig Dis. 2013;14:181–90.
9. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc J-F, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.
10. Grignani G, Palmerini E, Ferraresi V, D’Ambrosio L, Bertulli R, Asaftei SD, et al. Sorafenib and everolimus for patients with unresectable high-grade osteosarcoma progressing after standard treatment: a non-randomised phase 2 clinical trial. Lancet Oncol. 2015;16:98–107.
11. Personeni N, Bozzarelli S, Pressiani T, Rimassa L, Tronconi MC, Sclafani F, et al. Usefulness of alpha-fetoprotein response in patients treated with Sorafenib for advanced hepatocellular carcinoma. J Hepatol. 2012;57:101–7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEffect of Remnant Lipoprotein Cholesterol and Nitric Oxide in Young Coronary Heart Disease Subjects
English116121Thirunavukkarasu JaishankarEnglish Meera ShivasekarEnglish V.M. VinodhiniEnglish Sriram VeeraragavanEnglishIntroduction: The remnant lipoproteins Cholesterol are highly atherogenic, because of their lesser size along with high cholesterol content, and increased residence period in the blood which may not be reflected by the levels of LDL-C. Elevated Remnant lipoprotein cholesterol and decreased level of Nitric oxide is the novels atherosclerotic risk factors that stimulate the immune and inflammatory reactions associated with the progression of coronary heart disease. Aim and Objective: The study aims to assess the role of remnant lipoprotein cholesterol associated with nitric oxide in the development of coronary heart disease. Materials and Methods: This cross-sectional study was conducted in SRM Medical College Hospital and Research Centre on subjects appearing the master health check-up and medicine OP. The study was conducted on 97 CHD patients and 97 healthy control in the age group of 30 to 55 years and was age and sex-matched. After overnight fasting body fluid samples were collected for analysis for Lipid Profile, Nitric oxide was measured by ELISA method and Lipid Profile is measured using Auto Analyser AU480. Statistical analysis was done using Student‘t’ test and Pearson correlation analysis for the comparison between two groups. Result: The mean levels of FBG, Total cholesterol, Triglyceride, LDL-C, VLDL, TC/HDL-C Ratio, LDL-C/HDL-C Ratio, RLP-C, were significantly increased in CHD subjects when compared to controls. And the mean Nitric Oxide levels were decreased significantly in the CHD group compared to controls (PEnglishCoronary Heart Disease, High-Density Lipoprotein, Low-Density Lipoprotein, Nitric Oxide, Remnant lipoprotein cholesterol, Endothelial functionINTRODUCTION
The prevalence of Coronary Heart Disease in India is very high and has a maximum number of CHD patients in the world putting India in the state of a CHD epidemic. The high degree of mortality, morbidity, and prematurity of CHD has put a great burden on society and health care expenditure, and it is the most common cause of death worldwide.1 Coronary Heart Disease is one of the most common diseases and the major cause of death worldwide. Many traditional lipid markers such as lipoproteins (Total Cholesterol, TG, HDL, and LDL) and their subfractions helps for better diagnosis of CHD.2
Recently RLP-C and Nitric oxide are used as emerging risk markers which helps to rule out the CHD risk and predict cardiac events.3 Remnant cholesterol is the cholesterol content of triglyceride-rich lipoproteins that is IDL and VLDL in the fasting state, and chylomicron remnants in a non-fasting state.4 Remnant cholesterol acts as a potent contributor towards Coronary heart disease and stroke risk.5 Cholesterol in atherogenic particles other than the low-density lipoproteins (LDL-C) is currently emerging as a major risk factor for ischemic heart disease and is mostly found in fasting and non-fasting triglyceride-rich lipoproteins (TRLs).6 Surplus amounts of remnant lipoproteins present in plasma affect the lipoprotein metabolism cause obesity, diabetes, CVD and genetic variants.7
Alteration in the lipid profile (decreased HDL and Apo-A1) & (increased LDL, VLDL, and Apo-B 100) inhibits Nitric Oxide [NO].8Increase in RLP-C bind to scavenger receptor and uptake by macrophages from foam cell. All these cause oxidative stress and endothelial dysfunction in CHD patients.9 Nitric Oxide is a signal-transducing molecule and prominent free radical that maintains vasodilating tone, in-vitro modulation of lipid peroxidation, and alteration of pro-in?ammatory gene expression. LDL accumulation in arterial intima depicts an early stage in atherosclerosis.10Nitric Oxide produced from eNOS react with O2- ions and form ONNO- which induce biotin oxidation and uncoupled the eNOS resulting in decreased NO and increased O2- generation elevate the level of oxidative LDL.11Hypercholesterolemia is an essential pathogenic aspect of dysfunction in endothelium caused by impairment of endothelial nitric oxide (NO) production through mechanisms that remain poorly characterized. 12 Reduced NO level promotes endothelial dysfunction the earliest event in Coronary Heart Disease.13
Materials and Methods
Study design and population
This cross-sectional study was conducted from Nov 2019 to Feb 2020 at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India on subjects attending the Cardiology and medicine outpatient. Totally 194 subjects were included who were age and sex match in the age group 30-55 years. 97 CHD subjects and 97 normal healthy subjects were selected as control. The control subjects were also taken from Master health check-up Programme and General Medicine OP in SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. This study obeys the Declaration of Helsinki and was approved by the institutional ethical committee at SRM Medical College Hospital and Research Centre (ECN: 1513/ICE/2018). Written informed consent was collected from all participants at the time of enrolment.
Inclusion Criteria:
The CHD subjects were selected based on coronary angiography and subjects with chest pain, ECG changes, increased cardiac markers such as creatinine phosphokinase (CPK-MB) and troponin levels.
The control group consists of persons with no clinical and ECG evidence of CHD and negative history of the past of CHD or stroke, Diabetes mellitus, hypertension, smoking, dyslipidemia, and family history of CHD.
Exclusion Criteria:
The subjects who were on treatment for autoimmune diseases, pregnancy, arthritis, rheumatoid arthritis, acute/chronic infection subjects were excluded
Anthropometric Measurement
Weight (Kg), height (meters), waist circumference (cm) and hip circumference (cm) were measured. The anthropometric indices, BMI and waist-hip circumference ratio were calculated.
Baseline measurement
Medical and demographic data were collected during the period of enrolment, and documents were de-identi?ed before investigation. Basic info on age, gender, a history of diabetes, hypertension, and the use of medications were collected using a questionnaire during the clinical appointment. Questionnaires were evaluated by an expert questioner for lost data and entirety, before shifting the data to a database. Arterial blood pressure was measured using standard methods in triplicate, and the averaged values were used for the analysis. Information on laboratory reports was noted for all the subjects. The fasting samples from cases and controls were taken in the morning taking all aseptic precautions from the antecubital vein. The blood was centrifuged for 15 minutes at 2500rpm; and serum was separated and used for the estimation of routine lipid profile, Nitric Oxide. Lipid Profiles were estimated using Direct Antibody Inhibition. Total Cholesterol and Triglycerides were estimated by the enzymatic end-point cholesterol esterase-peroxidase method (Beckmann Coulter AU480 Analyser).
The RLP-C was calculated using the formula: RLP-C=TC-(HDL-C+LDL-C). 14
Measurement of Nitric Oxide
Serum NO was measured as nitrite/nitrate levels in subjects using Griess reagent. Cayman’s Nitrate/Nitrite Colorimetric Assay Kit provides an accurate and convenient method for the measurement of total nitrate/nitrite concentration in a simple two-step process. The first step is the conversion of nitrate to nitrite utilizing nitrate reductase. The second step is the addition of the Griess Reagents which convert nitrite into a deep purple azo compound. Photometric measurement of the absorbance due to this azo chromophore accurately determines NO2- concentration. Absorbance is measured at 540 or 550 nm using a plate reader.
Statistical analysis
Data were analysed using a statistical package for social sciences (SPSS 25.0). The data collected from the study were shown as mean and standard deviation. Differences were considered as significant if the p-value was Englishhttp://ijcrr.com/abstract.php?article_id=3963http://ijcrr.com/article_html.php?did=3963
M.N. Krishnan. Coronary heart disease and risk factors in India on the brink of an epidemic? Indian Heart J. 2012; 64: 364-367.
Ravi Kant U, Perona, Javier S. Emerging Risk Biomarkers in Cardiovascular Diseases and Disorders. J lipids. 2015; 12(01): 971453-50.
Katsuyuki Nakajima, L.Adrienne C and Paulesh KS. Remnant-like particle (RLP) cholesterol is an independent cardiovascular disease risk factor in women: Results from the Framingham Heart Study. Atherosclerosis.1999; 154(1):229-36
Alan C, Henry N. Ginsberg, Tomas V. Remnants of the Triglyceride-Rich Lipoproteins, Diabetes, and Cardiovascular Disease. Diab. 2020; 69(4): 508-516.
Børge GN and Anette V. Triglyceride-rich Lipoprotein Cholesterol (Remnant Cholesterol) as a Therapeutic Target for Cardiovascular Disease Risk. Therapy Lipidology. 2020; (12): 139-158
Hermans MP, Ahn SA, and Rousseau MF. Novel unbiased equations to calculate triglyceride-rich lipoprotein cholesterol from routine non-fasting lipids. Cardio Diabet. 2014; 13, 56. https://doi.org/10.1186/1475-2840-13-56
Hirano, Tsutomu. Pathophysiology of Diabetic Dyslipidemia. J Atheroscler Thromb. 2018; 25(9):771-782. doi:10.5551/jat.RV17023
Brites F, Martin M, Guillas I, Kontush A. Antioxidative activity of high-density lipoprotein (HDL): Mechanistic insights into potential clinical benefit. BBA Clin. 2017 Aug 19;8:66-77. doi: 10.1016/j.bbacli.2017.07.002. PMID: 28936395; PMCID: PMC5597817.
Ooi BK, Goh BH and Yap WH. Oxidative Stress in Cardiovascular Diseases: Involvement of Nrf2 Antioxidant Redox Signaling in Macrophage Foam Cells Formation. Int J Mol Sci. 2017 Nov 5;18(11):2336. doi: 10.3390/ijms18112336. PMID: 29113088; PMCID: PMC5713305.
Bloodsworth A, O'Donnell VB, Freeman BA. Nitric oxide regulation of free radical- and enzyme-mediated lipid and lipoprotein oxidation.Arteriosclerosis, Thromb Vasc Bio. 2000 July;20(7):1707-15. doi: 10.1161/01.atv.20.7.1707. PMID: 10894807.
Zou MH, Cohen R, Ullrich V. Peroxynitrite and vascular endothelial dysfunction in diabetes mellitus. Endo. 2004 Mar-Apr;11(2):89-97. doi: 10.1080/10623320490482619. PMID: 15370068.
Olivier F, Chantal D and Stephane M. Hypercholesterolemia decrease nitric oxide production by promoting the interaction of caveolin and endothelial nitric oxide synthase. J Clin Invest. 1999; 103(6):897-905.
Minako Y-T. Endothelial Function for Cardiovascular Disease Prevention and Management. Int J Cardiol. 2017; (4):103.
Kuriyama K, Doi H, Takazoe K. Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease. Circul. 1999 Jun 8;99(22):2858-60.
Elena B, Mariarosaria N, Kathleen MB. Postprandial Lipid Metabolism: The Missing Link between Life-Style Habits and the Increasing Incidence of Metabolic Diseases in Western Countries. Open Transl Med J. 2010; (2): 1-13.
Galicia-Garcia U, Benito-Vicente A, Jebari S. Pathophysiology of Type 2 Diabetes Mellitus. In. J Mol Sci. 2020 Aug 30;21(17):6275. doi: 10.3390/ijms21176275. PMID: 32872570; PMCID: PMC7503727.
Ramasamy, Indra. Recent advances in physiological lipoprotein metabolism. Clin Chem Lab Med. (CCLM) 2014;52(12): 1695-1727.
Anette V, Marianne B, Anne T-H.Elevated Remnant Cholesterol Causes Both Low-Grade Inflammation and Ischemic Heart Disease, Whereas Elevated Low-Density Lipoprotein Cholesterol Causes Ischemic Heart Disease Without Inflammation. Circulation. 2013; (128):1298–1309.
Ruth McPherson. Remnant Cholesterol: “Non-(HDL-C + LDL-C)” as a Coronary Artery Disease Risk Factor. J Am Coll Cardiol. 2013; 61 (4): 437–439.
Cristina M.SenaAna M.PereiraRS. Endothelial dysfunction — A major mediator of diabetic vascular disease. BBA Molec Basis Disease. 2013;1832(12): 2216-2231.
Zhang Y, Zhang W, Edvinsson L. Apolipoprotein B of low-density lipoprotein impairs nitric oxide-mediated endothelium-dependent relaxation in rat mesenteric arteries. Eur J Pharmacol. 2014; 725(Jan 18), 10-17. https://doi.org/10.1016/j.ejphar.2014.01.008
Herrero-Fernandez B, Gomez-Bris R, Somovilla-Crespo B, Gonzalez-Granado JM. Immunobiology of Atherosclerosis: A Complex Net of Interactions. Int. J. Mol. Sci. 2019 Oct 24;20(21):5293. doi: 10.3390/ijms20215293. PMID: 31653058; PMCID: PMC6862594.
Schulz, E., Gori, T. and Münzel, T. Oxidative stress and endothelial dysfunction in hypertension. Hypertension Res. 2011; 34, 665–673.
Paolo S, Andrea D'A and Mariateresa P. Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction. Int J Mol Sci.2020; 21(21): 8118.
Ren X, Ren L, Wei Q. Advanced glycation end-products decrease expression of endothelial nitric oxide synthase through oxidative stress in human coronary artery endothelial cells. Cardioid Diab. 2017 Apr 20;16(1):52. DOI: 10.1186/s12933-017-0531-9. PMID: 28427390; PMCID: PMC5397770.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcarePrevalence of Helicopter Parenting and its Effect on Academic Performance and Oral Hygiene Status in Adolescents - A Cross-Sectional Study
English122126Jeepalyam SEnglish Nirmala SVSGEnglish Elicherla SREnglish Challa RREnglish Nuvvula SEnglishBackground: The present study will help to understand the importance of the helicopter parenting style. The term is used to describe a phenomenon of a growing number of parents who pay too close attention and are obsessed with their children’s success, particularly in areas of decision-making, academic studies, and social relationships. Aim: This study aimed to evaluate the prevalence of helicopter parenting (HP) and its influence on adolescents’ academic performance and oral hygiene status. Materials and Methods: The study was carried out with 301 children aged 12-17yrs. HP’s prevalence was assessed using the Helicopter parenting scale, and the children’s academic performance was recorded from school records. Oral hygiene status using the oral hygiene index- simplified (OHI-S), and Frankl’s behaviour rating was assessed during the examination. Data were analyzed using SPSS software (version 21.0, IBM Corp., Armonk, NY, USA). Independent student t-test and chi-square test were used to test the statistical significance (PEnglishAcademic outcome, Frankl’s behaviour rating, Helicopter parenting, Overparenting, Oral health, Parenting styleIntroduction:
Child-rearing in the modern world has gained utmost importance, with parents and educators focusing on various parenting styles.1Researchers have interrelated parenting styles directly to a child's social, physical, psychological development. Moreover, parenting styles play a pivotal role in building a child's character. 2, 3Delving into the history of parenting styles, one discovers four main types of 'Parenting styles’ as defined by Baumrind 4 and Maccoby 5 such as: Authoritative, Authoritarian, Permissive, and Neglectful. A new subgroup of these parenting styles is emerging rapidly in recent years, such as HP, little emperors, tiger moms, free rangers, and concentrated cultivation.
The most commonly knowledgeable parenting style is Helicopter Parenting (HP), also called cosseting parents or hovering parents. 6, 7HP is a metaphor that describes a type of parenting where parents act as helicopters hovering or shadowing over their children.8 The word hovering concerning parenting initially appeared in 1969 in a book called "Between Parent and Teenager" by Dr.Haim G. Ginott. Moreover, Foster Cline and Jim Fay coined the term 'Helicopter parenting' in 1990.
Helicopter parenting is also termed as over-involvement2, intensive parenting,9 over parenting,10overprotection,11 intense parental support,12intrusiveParental involvement, black Hawk parent, and stealth missiles. 13
The most popular press articles and books have suggested that parents are too involved in their children's lives and influence their behaviour.14-17 HP has deleterious effects on the child's development.18Helicopter parents are in continuous contact with their children and the school administration, making children lack emotional resilience and independence. Furthermore, parents feel bad about themselves when their adult children do not perform well. 8
HP in young children is also known to be responsible for anxiety, depression, and insecurity. Moreover, it is also related to narcissism, negative impact on Psychological well-being, lower academic success, lower self-efficacy, lower coping skills, neuroticism, and a higher sense of entitlement.18, 19
Aims and objectives: The present study aimed to evaluate the prevalence of HP and its effect on academic performance, oral hygiene status, and the behaviour assessed during the dental examination.
Materials and methods:
Study design and setting: This is a descriptive cross-sectional study conducted with children aged 12 to 17 years in two randomly selected Nellore district schools, Andhra Pradesh.
Sample size: A systematic sampling method was used to select the participants, and every third child took to a total sample size of 301. The sample size was calculated by using the following formula
It was estimated based on the pilot study, which revealed an estimated prevalence of 27% for helicopter parenting on academic performance at a marginal error of 5%. The estimated final sample was 301.
Duration of the study: The study was conducted between 21-8- 2019 to 28-10-2019.
Eligibility criteria:
Inclusion criteria:Children with,
Age 12 -17 years of same geographic distribution.
good general health condition
acceptance for participation in the study and whose caregiver gave informed consent
Exclusion criteria: Children,
With any systemic disease.
Who was absent on the day of examination or who did not give consent.
Data collection:
Informed consent was obtained from the school authorities, and forms were given to students to get consent from their parents. An appointment was made for children to examine; the only children who had their consent to participate in the survey were examined within their school premises. In this survey, a questionnaire was initially given to all the children, followed by a clinical examination.
Measures:
Helicopter parenting:
According to Padilla-Walker and Nelson HP scale,8 HP's prevalence was assessed using a ten-item questionnaire. Children responded on a five-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree), which gives a score of 10 to 50. The highest score represents a high level of HP.
Each question was translated into the native language. The time given for completion of the questionnaires was 15–20 min. The children were instructed to read the statement carefully and choose the answer that best suited them. The academic performances of the children were collected from the school records.
Clinical examination:
The children were examined using a mouth mirror, probe, and daylight as per the WHO survey recommendations. Each examination took about 10 to 15 minutes, and an Oral hygiene assessment was performed using the oral hygiene index simplified (OHI-S),20which can be interpreted as good, fair, poor. At the time of oral examination, the child's behaviour was assessed by employing the Frankl Behavior Rating Scale.21
Statistical analysis:
Entries were double-checked to minimize the data entry errors. Data were collected on predefined case record sheets that were transferred into a Microsoft Excel spreadsheet and statistically evaluated using the SPSS software (version 21.0. by IBM Corporation). Descriptive statistics were presented in the form of frequency, mean, and standard deviation. Chi-square test and Independent standard 't' test was used to know the significant difference among categorical variables and continuous variables, respectively. The level of significance was set at PEnglishhttp://ijcrr.com/abstract.php?article_id=3964http://ijcrr.com/article_html.php?did=3964
Joseph MV, John J. Impact of parenting styles on child development. Glob Academic Soc Jour: Soc Sci Ins. 2008;1:16-25.
Givertz M, Segrin C. The association between overinvolved parenting and young adults’ self-efficacy, psychological entitlement, and family communication. Commun. Res. 2014;41:1111-36.
Segrin C, Woszidlo A, Givertz M, Bauer A, Taylor Murphy M. The association between overparenting, parent?child communication, and entitlement and adaptive traits in adult children. Fam Relat. 2012;61:237-52.
Baumrind D. Child care practices anteceding three patterns of preschool behavior. Genet Psychol Monogr. 1967.
McCoby EE. Socialization in the context of the family: Parent-child interaction. Hand Child Psych. 1983; 4:1-01.
Janssen I. Hyper-parenting is negatively associated with physical activity among 7–12 year olds. Prev Med. 2015; 73:55-9.
Van Ingen DJ, Freiheit SR, Steinfeldt JA, Moore LL, Wimer DJ, Knutt AD, Scapinello S, Roberts A. Helicopter parenting the effect of an overbearing caregiving style on peer attachment and self?efficacy. J Coll Couns. 2015;18:7-20.
Padilla-Walker LM, Nelson LJ. Black hawk down? Establishing helicopter parenting as a distinct construct from other forms of parental control during emerging adulthood. J Adolesc. 2012;35 :1177-90.
Schiffrin HH, Godfrey H, Liss M, Erchull MJ. Intensive parenting: Does it have the desired impact on child outcomes? J Child Fam Stud. 2015; 24:2322-31.
Kouros CD, Pruitt MM, Ekas NV, Kiriaki R, Sunderland M. Helicopter parenting, autonomy support, and college students’ mental health and well-being: The moderating role of sex and ethnicity. J Child Fam Stud. 2017; 26:939-49.
Leung JT, Shek DT. Validation of the perceived Chinese overparenting scale in emerging adults in Hong Kong. J Child Fam Stud. 2018; 27:103-17.
Fingerman KL, Cheng YP, Wesselmann ED, Zarit S, Furstenberg F, Birditt KS. Helicopter parents and landing pad kids: Intense parental support of grown children. J Marriage Fam. 2012; 74:880-96.
Wartman KL, Savage M. Parental Involvement in Higher Education: Understanding the Relationship among Students, Parents, and the Institution. ASHE Higher Edu. ASHE Higher Edu Rep. 2008; 33:1-25.
Lease SH, Dahlbeck DT. Parental influences, career decision-making attributions, and self-efficacy: Differences for men and women?. J Career Dev. 2009; 36:95-113.
O'Bryan ST, Jomills Henry Braddock II, Dawkins MP. An examination of the effects of school-based varsity sport participation and parental involvement on male academic behaviors. Challenge Onlin. 2008; 14:1-27.
Brussoni M, Olsen LL, Pike I, Sleet DA. Risky play and children’s safety: Balancing priorities for optimal child development. Intj Envt Res Public Health. 2012; 9:3134-48.
Schiffrin HH, Liss M, Miles-McLean H, Geary KA, Erchull MJ, Tashner T. Helping or hovering? The effects of helicopter parenting on college students’ well-being. J Child Fam Stud. 2014; 23:548-57.
Segrin C, Givertz M, Swaitkowski P, Montgomery N. Overparenting is associated with child problems and a critical family environment. J Child and fam Stud; 24:470-9.
Segrin C, Woszidlo A, Givertz M, Montgomery N. Parent and child traits associated with overparenting. J Soc Clin Psychol. 2013; 32:569-95.
Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Am Dent Assoc. 1960 1; 6:172-9.
Frankl SN. Should the parent remain with the child in the dental operatory? J. Dent. Child. 1962; 29:150-63.
Finkenauer C, Engels R, Baumeister R. Parenting behaviour and adolescent behavioural and emotional problems: The role of self-control. Int J Behav Dev. 2005; 29:58-69.
Bradley-Geist JC, Olson-Buchanan JB. Helicopter parents: An examination of the correlates of over-parenting of college students. Education+ Training. 2014 - 6.
Deci, E., & Ryan, R. (2008). Facilitating Optimal Motivation and Psychological Well- Being Across Life's Domains. Can Psychol. 49:14-23.
Ryan, R. M., &Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Ame psychol. 55: 68–78.
Vansteenkiste M, Niemiec CP, Soenens B. The development of the five mini-theories of self-determination theory: An historical overview, emerging trends, and future directions. In The decade ahead: Theoretical perspectives on motivation and achievement 2010: 12.
Wei M, Shaffer PA, Young SK, Zakalik RA. Adult attachment, shame, depression, and loneliness: The mediation role of basic psychological needs satisfaction. J counsel psychol. 2005; 52:591.
Mills JS, Blankstein KR. Perfectionism, intrinsic vs extrinsic motivation, and motivated strategies for learning: A multidimensional analysis of university students. Person individ differ. 2000; 29:1191-204.
Bernardo AB. Perceived legitimacy of parental control over academic behaviors and adolescent students’ academic adjustment. Eur jour psychol. 2012; 27:557-71.
Nelson LJ, Padilla-Walker LM, Nielson MG. Is hovering smothering or loving? An examination of parental warmth as a moderator of relations between helicopter parenting and emerging adults’ indices of adjustment. Emerging Adulthood. 2015; 3:282-5.
Kim SY, Wang Y, Orozco-Lapray D, Shen Y, Murtuza M. Does “tiger parenting” exist? Parenting profiles of Chinese Americans and adolescent developmental outcomes. Asian Am jour psychol. 2013; 4:7.
Shoup, R., Gonyea, R.M. and Kuh, G.D., 2009, June. Helicopter parents: Examining the impact of highly involved parents on student engagement and educational outcomes. In 49th Annual Forum of the Association for Institutional Research, Atlanta, Georgia.
Schiffrin HH, Liss M. The effects of helicopter parenting on academic motivation. J Child Fam Stud. 2017; 26:1472-80.
Schiffrin HH, Godfrey H, Liss M, Erchull MJ. Intensive parenting: Does it have the desired impact on child outcomes? J Child Fam Stud. 2015; 24:2322-31.
Garst BA, Gagnon RJ. Exploring overparenting within the context of youth development programs. J Youth Devel. 2015; 10:5-18.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareCurrent Trends in Utilization of Antidepressants in a Tertiary Care Teaching Hospital: An Observational Study
English127132Nayak JyotiranjanEnglish Swain Sarada PrasannaEnglish Das PritiEnglishEnglishDepression, Antidepressants, Selective serotonin reuptake inhibitors, Serotonin and norepinephrine reuptake inhibitors, Sertraline, Tricyclic antidepressantsINTRODUCTION:
Depression is a pervasive and impairing illness that affects the body, mood and thoughts.1 More than 300 million people are affected worldwide and it is fourth among the leading causes of disability and premature death.2 According to WHO figures, the total cases of depressive disorders in 2015 in India were over 50 million which was 4.5% of the population in 2015 and the total Years Lived with Disability (YLD) in India was over 10 million years (7.1%).3 In the management of depression, antidepressants like TCAs (tricyclic antidepressants), SSRIs (selective serotonin reuptake inhibitor), SNRIs (serotonin-norepinephrine reuptake inhibitors), MAOIs (monoamine oxidase inhibitors) and various newer agents which collectively can be grouped as atypical antidepressants have been instrumental.4 Historically tricyclic antidepressants were one of the first drugs to become first-line antidepressants.5 With time SSRIs became first-line drugs.5
Due to our gradually increasing understanding of mental health and depression over the years as well as new drug discoveries, many different antidepressants have come to be used. Some of these drugs have stood the test of time and are still in use and some are no more marketed or are not preferred by clinicians.6 Over some time changes in the utilization pattern of these drugs is expected and the understanding of the factors affecting this change is a valuable tool. By studying utilization patterns we can evaluate drug use according to sex, age, social class and any comorbid conditions among other characteristics.
As there is little recent data available in terms of utilization of antidepressant drugs in the local population, the present study was conducted to analyze the current pattern of utilization of antidepressant drugs in a tertiary care teaching hospital of Odisha.
METHODS & MATERIALS:
This was a hospital-based, cross-sectional, observational study.
The study was conducted in the Department of Pharmacology in collaboration with Mental Health Institute(Centre of Excellence), SCB Medical College and Hospital, Cuttack.
A study team was constituted comprising of the principal investigator, study guide and co-guide. The study protocol was designed by the team.
Study Period:
The research work was carried over a period of 2 years from September 2017 to September 2019.
Study Population:
All patients receiving antidepressants, both as outpatient or inpatient, in the Mental Health Institute, SCB Medical College and Hospital, Cuttack.
Sample Size:
Sample size was calculated to be 180 using the formula
Where ‘a is the prevalence of antidepressant use and ‘d’ is an allowable error.
Ethical Permission:
The Institutional Review Board at S.C.B Medical College, Cuttack gave approved the study with reference letter no. 13351.
The study was conducted after getting approval from the institutional ethics committee.
Study Subjects:
This study was conducted on patients receiving antidepressants in the Mental Health Institute fulfilling the following criteria:
Inclusion criteria-
All subjects receiving antidepressant medication attending the department of Psychiatry and willing to participate.
Patients of all age groups and both sexes.
Study Procedure
Demographic details of selected subjects like age, sex, educational, marital and employment status are noted in prestructured case record form (CRF). Clinical details like diagnosis, an antidepressant used, dosage, route of administration, frequency and duration of treatment noted in CRF.
Statistical Analysis
Results were analyzed using descriptive statistics like mean + SD, percentages and proportions. Significance, when required, was tested using the chi-square test at the two-sided α level at 5%. All the analysis was done by using Microsoft Excel and SPSS v.20.
RESULTS.
Our study had a total of 180 patients enrolled. Of them majority were females, i.e. 99 (55%) compared to males, i.e. 81(45%). The mean age of the study subjects was 47.5 + 6.7 years. Most of the subjects, i.e. 70 (38.9%) belonged to the age group of 36-50 years, followed by 51-64 years age group with 55 (30.5%). Females were taking antidepressants significantly more than males only in the age group of 36-50 years. (Chi-Square Test, p = 0.03). [Table-1]
Among the study subjects a significantly higher number of patients, i.e. 106 (58.9%) did not have any employment (Chi-Square Test, p= 0.017). Of the 106 unemployed subjects, 41(39%) were males and 65 (41%) were females. There was no significant effect of unemployment on the rate of antidepressant usage between the genders. (Chi-Square Test, p= 0.19) [Fig.- 1]
Most of the participants of our study belonged to the ‘Lower’ socioeconomic class in the modified Kuppuswamy Scale, i.e. 80 (44.4%) followed by the ‘Upper Lower’ socioeconomic class with 66 (37.7%). [Figure – 2]
Depressive disorders were the primary reason for taking antidepressants (42%) followed by anxiety disorders with 28%. [Table – 2]
A total of 212 antidepressant prescriptions were given to 180 patients. Monotherapy was practiced to a greater extent, i.e. 148 (82.2%). Polytherapy was seen in 32 (17.8%) patients and comprised of patients receiving two drugs, an SSRI along with a TCA or a newer antidepressant. [Figure – 3]
Altogether 107 (50.5%) prescriptions were for SSRIs followed by 57 (27%) for SNRIs. A total of 18 (8.5%) prescriptions contained TCAs and 30 (14%) contained newer atypical antidepressants. Sertraline was the most common drug prescribed (19.3%) followed by Escitalopram (17.4%) and Duloxetine (14.2%). Among the atypical antidepressants, Bupropion with 14 (6.6%) prescriptions was most common. In the combinations, Sertraline plus Bupropion was most common followed by Fluoxetine plus Bupropion. [Table – 3]
DISCUSSION:
The current study is a cross-sectional observational study focusing on the sociodemographic profile of patients receiving antidepressants and the pattern of their utilization. A total of 81 males and 99 females were our study subjects. This slight (1.2:1) female preponderance in antidepressant use is consistent with findings of Ghosh et al (1.2:1), Mukherjee et al (1.3:1) and Mishra et al (1.3:1).6,7,8 However some studies by Avanthi et al (1.9:1), Chattar et al (1.6:1) and Gummadi et al (1.5:1) have found a much higher female preponderance.9,10,11 Some even have found higher male preponderance by Tripathi et al.12
In this study majority of the subjects belonged to the middle-aged group of 36 – 50 years (39%) followed by the 51 – 64 years age group (30.5%). The average age of participants was 47.5 years. Mishra et al have similar findings with the majority of study subjects in 36-50 years age group and 41.7 years of average age.8 However many studies by Ghosh et al, Mukherjee et al, Avanthi et al and Gummadi et al found a lower age group of about 18-40 years taking the most amount of antidepressants with an average age ranging from 35 to 39 years.6,7,9,11
Among our study subjects, almost 59% did not have any employment suggesting a relationship between unemployment and consumption of antidepressants. However, a study by Grover et al finds the rate of unemployment at 23%.13 This drastic difference could be due to demographic differences, as most patients visiting our center come from a semi-urban to rural background compared to the multicentric study by Grover et al involving bigger Indian cities like Delhi, Bengaluru, Chennai, Lucknow, Mumbai, Ahmedabad etc. Based on the modified Kuppuswamy scale of socioeconomic status 44% of our subjects belonged to the ‘Lower’ class and about 38% to the ‘Upper Lower’ class. These findings are in congruence with findings by Van Soest et al which claims higher rates of antidepressant prescription with lower socioeconomic status.14 Only 3% of all subjects belonged to ‘Upper Middle’ and ‘Upper’ class which may not be a true reflection of their antidepressant prescription. This could be due to the factor of affluent people opting to avail treatment in a more private set-up.
Our study suggested that depressive disorders (42%) and anxiety disorders (28%) were the most common diagnoses where antidepressants were used. These results are similar to findings by Mukherjee et al which suggested corresponding numbers of 54% and 26% respectively.7 This study also confirmed that more than half of the patients who were receiving antidepressants had diagnoses other than depression. An earlier international study by Uchida et al reported that 38.4 percent of prescriptions of antidepressants were for patients with diagnoses other than depressive disorders.15
Monotherapy was the most common modality of treatment in our study suggesting that the patients responded well to single drugs. These findings are similar to many Indian studies.7,8,12 This effect could be because using more than one antidepressant drug increases the cost of therapy as well as the chances of drug interactions and side effects resulting in loss of compliance.
SSRIs (51%) were the most commonly prescribed medications among antidepressants in comparison to other groups, a finding similar in all recent studies. Among individual drugs, Sertraline (19%) was the most commonly used drug very closely followed by Escitalopram (17%). In studies by Grover et al, Tripathi et al, Mukherjee et al and Mishra et al Escitalopram is the most commonly used drug.7,8,12,13Among SNRIs Duloxetine was the most prescribed drug and was also the third most prescribed drug overall with 14.2% prescriptions. Desvenlafaxine was the other SNRI with 12.7% prescriptions. Among the atypical antidepressants, Bupropion with 6.6% prescriptions was most common. TCAs were the least used drug class. This is similar to studies by Grover et al, Mishra et al and Tripathi et al8,12,13but in contrast with findings by Mukherjee et al. and Siddiqui et al where TCAs were the second most prescribed drug class after SSRIs.7,16 In the combinations Sertraline plus Bupropion was most common followed by Fluoxetine plus Bupropion. The reason for higher usage of SSRIs and SNRIs compared to TCA could be their better safety profile while having similar efficacy.17
Though 180 prescriptions were studied, it is not sufficient to generalize to a state’s population. Also being done in a tertiary set up this study may not be a proper indicator of the utilization pattern of smaller rural areas.
CONCLUSION:
Among the prescribed antidepressants SSRIs were the most common class of drug followed by SNRIs.Sertraline was the most common drug to be prescribed followed by Escitalopram. More than half of the patients receiving antidepressants suffered from non-depressive disorders. Monotherapy was preferred over combination therapy.
Acknowledgment: 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
Source of Funding: Nil
Conflict of Interest: None declared.
Authors’ Contribution: Dr. Jyotiranjan Nayak was the principal investigator. He along with the co-authors designed the study. He questioned the participants, reviewed their case record forms and collected all relevant data from the participants. Dr. Sarada Prasanna Swain was the psychiatrist involved in the study. He guided in the clinical aspects of the study. Dr Priti Das is the corresponding author of this study. She provided valuable inputs in the design and conduct of the study.
Englishhttp://ijcrr.com/abstract.php?article_id=3965http://ijcrr.com/article_html.php?did=39651. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. [Internet]. 2011 Dec 26 [cited 2019 Dec 14];9(1):90.
2. Becker AE, Kleinman A. Mental Health and the Global Agenda. N Engl J Med. [Internet]. 2013 Jul 4 [cited 2019 Dec 12];369(1):66–73.
3. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
4. Kupfer DJ. The pharmacological management of depression. Dialog Clin Neurosci. 2005;7:191–205.
5. Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: From monoamines to glutamate. Exp Clin Psychopharmacol. 2015 Feb 1;23(1):1–21.
6. Ghosh S, Roychaudhury S. Prescribing pattern of antidepressant drugs in a tertiary care hospital of eastern India. J Chem Pharm Res. 2014;6(6):2593–7.
7. Sen S, Tripathi S, Chatterjee S, Era N, Ghosal M, Mukherjee S. Adverse drug reaction monitoring of antidepressants in the psychiatry outpatient department at tertiary care teaching hospital in India: A cross-sectional observational study. Eur J Psychol Educ Stud. 2015;2(1):14.
8. Mishra S, Swain T, Mohanty M. Patterns of prescription & efficacy evaluation of Antidepressants in a tertiary care teaching hospital in Eastern India. Asian J Pharm Clin Res. 2012;5(SUPPL. 3):193–6.
9. Avanthi E, Somashekar H, Kumar L, Sushma H, Sudarshan C, Raja B. Prescribing pattern of antidepressants in psychiatric unit of a tertiary care hospital. Int J Basic Clin Pharmacol. 2014;3(4):667.
10. Chattar KB, Karve A V., Subramanyam A, Tondare SB. Prescription pattern analysis of antidepressants in psychiatric outpatient department of tertiary care hospital in India. Asian J Pharm Clin Res. 2016;9(4):77–9.
11. Gummadi T, Harave VS, Aiyar LN, Rajalekshmi SG, Kunnavil R. Adverse drug reaction monitoring in a tertiary care psychiatry setting: A comparative study between inpatients and outpatients. Indian J Psychol Med. 2017;39(3):306–11.
12. Tripathi A, Avasthi A, Desousa A, Bhagabati D, Shah N, Kallivayalil RA, et al. Prescription pattern of antidepressants in five tertiary care psychiatric centres of India. Indian J Med Res. 2016;143(April):507–13.
13. Grover S, Avasth A, Kalita K, Dalal P, Rao G, Chadda R, et al. IPS multicentric study: Antidepressant prescription patterns. Indian J Psychiatry. 2013;55(1):41–5.
14. Von Soest T, Bramness JG, Pedersen W, Wichstrøm L. The relationship between socio-economic status and antidepressant prescription: A longitudinal survey and register study of young adults. Epidem Psych Sci.2012;21:87–95.
15. Uchida N, Chong MY, Tan CH, Nagai H, Tanaka M, Lee MS, et al. International study on the antidepressant prescription pattern at 20 teaching hospitals and major psychiatric institutions in East Asia: Analysis of 1898 cases from China, Japan, Korea, Singapore and Taiwan. Psychiatry Clin Neurosci. 2007 Oct;61(5):522–8.
16. Siddiqui RA, Shende TR. Prescription Pattern of Antidepressant Drugs in a Tertiary Care Centre of Central India. J Contemp Med Dent. 2014;2(2):14–6.
17. Richelson E. Pharmacology of antidepressants. Mayo Clinic Proceedings. 2001;76: 268-279.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEvaluation of the Antibacterial Activity of the Leave Extract of Oroxylum Indicum Against Multidrug-Resistant Bacteria Causing Urinary Tract Infection
English133138Debasmita DubeyEnglish Mahesh Chandra SahuEnglish Pradeep Kumar NaikEnglishAim: Evaluation of antibacterial efficacy of the methanolic leaf extract of Oroxylum indicum against isolated MDR strains viz. Acinetobacter sp., Citrobacter sp., Enterobacter sp., Escherichia coli, Klebsiella pneumonia, Proteus Vulgaris, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus fecalis causing urinary tract infections (UTI). Methods: Pathogenic bacteria were isolated and identified using the routine microbiological procedure. All the bacteria were MDR as determined from the antibiotic sensitivity test. Agar well diffusion and microbroth dilution methods were used for determining antibacterial efficacy and the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was of O. indicums methanolic leaf extract were determined. Cord blood lymphocytes. were used to determine, the in vitro toxicity of the leaf extracts. Results: The leaf extract of O. indicum exhibited good antibacterial activity against both Gram-positive and Gram-negative MDR bacteria. The MIC value of the plant extract ranges from 0.19 to 0.78 mg/ml and the MBC value ranges from 0.78 to 1.56 mg/ ml with all the isolated bacterial pathogens. Plant extracts were found to be very effective against these MDR strains. The plant extract also revealed no toxicity even at a very high concentration of 1800 mg/l with lymphocytes isolated from the cord blood. Surprisingly, the MIC value was found to be 600 mg/l with lymphocytes. Conclusion: O. indiucm’s methanolic leaf extract can be used as a potential antibacterial drug. Similarly, other medicinal plants can also be explored for their possible antibacterial efficacy over the antibiotic resistance problem.
EnglishUTI (Urinary Tract infection), O. indicum, Antibacterial Activity, Toxicity Study, Alternative MedicineIntroduction
Urinary tract infections (UTI) caused by both “Gram-negative (GN) and Gram-positive (GP) pathogenic bacteria increase the rate of morbidity and mortality throughout the globe. The first antibiotic, penicillin, or 6-aminopenicillins acid (6-APA) controls bacterial infections, however, certain bacteria have developed resistance against it.1,2 Further, pathogenic bacteria have been shown to develop resistance to newly introduced antibiotics.2-4 Thus, multidrug-resistant (MDR)bacteria must be controlled with an iron hand, which has been giving impetus to search for newer antibacterial from conventional and non-conventional sources, apart from a chemical modification of existing antibiotics. Several phytochemicals were reported to have antibacterial and antifungal activities and lend themselves to the preparation of mainstream medicine.5,6
Oroxylumindicum(L.) Vent. is commonly known as shyonaka or sonpatha, is a small to medium-sized deciduous tree of the family Bignoniaceae. It is distributed throughout India, upto an altitude of 1200 M and found mainly in the ravine and moist places in the forests and also in Himalayan foothills, Eastern and the Western Ghats, and North-East India.7,8 Different plant parts of O. indicumare being used in Ayurveda and traditional medicine for the treatment of different ailments such as fevers, cough, cancer, diarrhoea, ulcer, dropsy, jaundice and preventing other respiratory disorders.9 Root extract has been used for ayurvedic preparations like Dashmularisht and Chyawanprash.10 It is also one of the important ingredients in an ayurvedic formulation such as Amartarista, Dantyadyarista, Narayana taila, Dhanawantaraghrita, Brahma Rasayana and Awalwha.11 It possesses antioxidant, antifungal, antimicrobial, anti-inflammatory, antibacterial, anti-arthritic and anti-cancer properties.12 The leaves and stem bark are reported to contain flavonoids namely chrysin, oroxylin-A, scutellarin, baicalein.13,14 Root bark is reported to contain chrysin, baicalein, biochanin-A, and ellagic acid.15 Seeds are reported to use in the perfume industry.9 Baicalein is reported to possess an anti-inflammatory, anti-ulcer, antioxidant, hepatoprotective, and immunomodulatory activity.16-20. Baicalein is also reported to check the proliferation of human breast cancer cell line MDA-MB-435.16-21
In the present study, we have attempted to investigate the antibacterial activity of the leaf extract of O. indicum against both the GP and GN MDR strains of bacteria isolated from the clinical samples of patients suffering from UTI.
Materials and methods
Collection, processing, storage and solvent extract preparation
Leaf of O. indicium was collected from Gandhamardhan, Western Odisha. The plant species were identified with the help of regional flora books (Haines, 1921-25, Saxenaand Brahman, 1994-96). Voucher specimens are deposited in the herbarium of Centre of Excellence in Natural Products and Therapeutics, Dept. of Biotechnology and Bioinformatics, Sambalpur University, Odisha, India. The collected leaf samples were processed and solvent extracts were made and stored as described previously.4
Bacterial Strain isolation, identification and antibiogram
Two GPs, Enterococcus faecalis, and Staphylococcus aureus, as well as 8 GNs viz. Acinetobacter sp, Citrobacter sp, Enterobacter sp, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Proteus vulgaris, and Pseudomonasaeruginosawere isolated from the patients with UTI from a private hospital, Odisha, India. The bacteria were identified based on the conventional colony and biochemical characteristics. Further, Kirby-Bauer’s disk diffusion method was utilized to evaluate the antibiotic sensitivity of the isolated bacteria.22, 23
Evaluation of antibacterial activity and determinations of MIC and MBC of plant
Agarwell diffusion method was used for determining the antibacterial efficacy of the methanolic leaf extract against the isolated UTI MDR bacterial strains.24Further, the microbroth dilution method was determining the MICand MBC values of the methanolic leaf extract, following the protocol described previously.24
Phytochemicals screening
Phytochemical screening tests of the methanolic leaf extract was done according to the protocol described earlier. 24
Evaluation of toxicity of plant extract with lymphocytes
Toxicity of the methanolic leaf extract of O. indicum was evaluated based on in vitro lymphocyte culture isolated from umbilical cord blood as described before. The proliferation oflymphocytes in the presence of graded concentrations of the plant extract was monitored by MTT assay as reported earlier.4The toxicity of plant extracts to isolated lymphocytes was also studied by comet assay as reported earlier.4
Statistical Analysis
The observed percentage of the lethality of the plant extract was determined based on probit analysis.
Results
Antibiotic susceptibility screening of the isolated bacterial strains
All the isolated bacteria were screened with 18 antibiotics from 6 different groups. The antibiogram of the isolated bacteria is collated in (Table 1). It was found that all the bacterial strains have shown resistance to most of the antibiotics.
Antibacterial activity of the plant extract
The results of the antibacterial activity of the methanolic leaf extract of O. indicum against isolated MDR strains viz. Acinetobacter sp., Citrobacter sp., Enterobacter sp., E. coli, K. pneumonia, P. vulgaris, P. mirabilis, P. aeruginosa, S. aureus and enterococcus faecalis from patients suffering from UTI infection are presented in (Table 2). The plant extract could effectively inhibit the growth of the bacteria as indicated by the zone of inhibition. The methanolic leaf extract was used for qualitative evaluation of the composition of various secondary metabolites using traditional biochemical characterization.
Toxicity evaluation of the plant extract
We have used human cord blood lymphocyte culture to evaluate the toxicity of the crude leaf extract. No evidence of toxicity was found even at the concentration of 1800 mg/l leaf extract using comet assay (Figure 1). The experimental MIC value of the crude extract was determined to be 600 mg/l and the computed LC25 value was found to be 1698.24 mg/l during cytotoxicity (Figure 2, Table 3).
Discussion
UTI is considered one of the major problems for hospitalized patients. It is Aside from the advancement of UTI from the fecal issue, it is more promptly in females in comparison to males.25,26The bacterial pathogens involved in UTI are mostly Klebsiella, E. coli, Pseudomonas and Enterobacter. Additionally,Candida sp. is also widely recognized as a pathogen that causes UTIs.27,28 In quest of finding bacterial pathogens from the patients suffering from UTI, we have identified 2 GP bacteria, S. aureus and Enterococcus faecalis as well as 8 GN bacteria viz. Acinetobacter sp., Citrobacter sp., Enterobactersp., E coli, K. pneumonia, P. vulgaris, and P mirabilis. Most of these isolated bacterial strains revealed resistance to most of the antibiotics. These isolated bacterial strains were screened for their susceptibility against the methanolic leaf extract of O. indicum, which revealed good antibacterial activity against all the isolated bacterial strains. The MIC value ranges from 0.19 to 0.78 mg/ml and MBC value ranges from 0.78 to 1.56 mg/ml for the crude extract. The antibacterial activity of O. indicum fruit extracts was successfully proven previously against gram-positive bacteria.29Another Indian study also proved the antibacterial efficacy of the stem bark and root extracts against both gram-positive, gram-negative bacteria and pathogenic Candida species.30Similarly, Talari et al, 2013, reported the antibacterial activity of stem bark extracts against clinically important Gram-positive bacteria.31Further, Singh et al., 2002 in his study reported the antibacterial and antifungal efficacy of ethanolic extracts of various Himalayan medicinal plants.32Toxicity evaluation of the methanolic leaf extract of O. indicum failed to reveal any toxicity using lymphocytes isolated from cord blood even at a very high concentration of 1800 mg/l. Parenthetically the MIC value was found to be 600 mg/l with lymphocyte which revealed no severe toxicity. The antibacterial activity of O. Indicum is mainly because of the presence of various phytochemicals in its extract. Bark extract showed the presence of various secondary metabolites in the alcoholic extracts of bark of O. indicum.33Similarly, many other studies revealed plants contains secondary metabolites and many other trace elements, which can be attributed to their antibacterial and other therapeutic efficacy along with a possible treatment option for Covid -19 virus too.34-36
Conclusions
In conclusion, UTI in patients was caused by MDR bacteria, hence cannot be controlled by antibiotics. Methanolic leaf extract of O. indicum proved to be a potent crude drug in this study as it was able to inhibit the growth of all the MDR bacteria. Crude extract failed to reveal any toxicity at very high concentrations. Therefore, it is can be concluded O. indiucm’s methanolic leaf extract can be further used as a potential antibacterial drug. Similarly, other medicinal plants can also be explored for their possible antibacterial efficacy over the antibiotic resistance problem.
Acknowledgements: The authors acknowledge the authors of the article cited in this article.
Funding: The authors would like to thank OHEPEE, Govt. of Odisha for providing financial support through the World Bank under the Centre of Excellence in Natural Products and Therapeutics, Sambalpur University. We are grateful to IMS & Sum Hospital for providing the clinical samples.
Conflicts of Interest: None
Authors Contribution: D Dubeyand MC Sahu conducted the experiments, collected the data and drafted the manuscript. PK Naik is finalized the data and manuscript.
Ethical Issues: This paper includes no human or animal subjects, hence no ethical approval is required.
Englishhttp://ijcrr.com/abstract.php?article_id=3966http://ijcrr.com/article_html.php?did=3966
Chambers HF, Deleo FR. Waves of resistance: Staphylococcus aureus in the antibiotic era. Nat Rev Microbiol. 2009;7(9):629-41.
Cantón R, Morosini MI. Emergence and spread of antibiotic resistance following exposure to antibiotics. FEMS Microbiol Rev. 2011;35(5):977-91.
Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010;74(3):417-433.
Sahu MC, Patnaik R, Padhy RN.In vitro combinational efficacy of ceftriaxone and leaf extract of Combretum albidum G. Don against multidrug-resistant Pseudomonas aeruginosa and host-toxicity testing with lymphocytes from human cord blood. J Acute Med. 2014; 4: 26–37.
Cowan MM. Plant products as antimicrobial agents, Clin MicrobiolRev 1999; 12: 564–582.
Vázquez-Sánchez D, Cabo ML, Rodríguez-Herrera JJ. Antimicrobial activity of essential oils against Staphylococcus aureus biofilms. Food Sci Technol Int. 2015 Dec;21(8):559-70.
Radhika LG, Meena CV, Peter S, Rajesh KS, Rosamma MP. Phytochemical and antimicrobial study of Oroxylum Indicum, Anc. Sci Life. 2011; 30: 114–120.
Jayaram K, Prasad MN. Genetic diversity in Oroxylum Indicum(L.) Vent. (Bignoniaceae), a vulnerable medicinal plant by random amplified polymorphic DNA marker, Africa. J Biotech. 2008; 7: 254–262.
Harminder VS, Chaudhary AK. A Review on the Taxonomy, Ethnobotany, Chemistry and Pharmacology of Oroxylum Indicum Vent, Indian J Pharm Sci. 2011; 73: 483–490.
Yasodha R, Ghosh M, Santan B, Gurumurthi K, Importance of biotechnological research in tree species of Dashmula. Indian Fore. 2004; 130: 79–88.
Dinda D, SilSarma I, Dinda, Rudrapaul MP.Oroxylum indicum (L.) Kurz, an important Asian traditional medicine: from traditional uses to scientific data for its commercial exploitation. J Ethnopharm 2015; 161:255–278.
Deka DC, Kumar V, Prasad C, Kumar K, Gogoi BJ, Singh L, Srivastava RB. Oroxylum Indicum –a medicinal plant of North East India: An overview of its nutritional, remedial, and prophylactic properties. J App Pharm Sci. 2013; 3 (S1): 104-112.
Sankara S, Nair AG, Flavanoid of stem bark of Oroxylum Indicum.Curr Sci. 1972; 41: 62–63.
Chen LJ, Song H, Lan XQ, Games DE, Sutherland IA. Comparison of high-speed counter-current chromatography instruments for the separation of the extracts of the seeds of Oroxylum Indicum. J Chromatograph A. 2005;1063(1-2):241-245
Zaveri M, Khandhar A, Jain S. Quantification of Baicalein, Chrysin, Biochanin-A and Ellagic Acid in Root Bark of Oroxylum Indicum by RP-HPLC with UV Detection. Eurasian J Analytical Chem. 2008;3(2):245-257.
Zhong X, Surh YJ, Do SG, Shin E, Shim KS, Lee CK, Na HK. Baicalein Inhibits Dextran Sulfate Sodium-induced Mouse Colitis. J Cancer Prev. 2019;24(2):129-138.
Khennouf S, Benabdallah H, Gharzouli K, Amira S, Ito H, Kim TH, Yoshida T, Gharzouli A. Effect of tannins from Quercus suber and Quercus coccifera leaves on ethanol-induced gastric lesions in mice. J Agric Food Chem. 2003 Feb 26;51(5):1469-73.
Ng TB, Liu F, Wang ZT. Antioxidative activity of natural products from plants.Life Sci. 2000; 66: 709–723.
Niedworok J, Jankowstia B, Kowalczy E, Okroj W. A comparative investigation of hepatoprotective effects of baicalein and sylimarol.Herb Pol. 1999; 45:199–205.
Chiang LC, Ng LT, Chiang W, Chang MY, Lin CC, Immunomodulatory activities of flavonoids, monoterpenoids, triterpenoids, iridoid glycosides and phenolic compounds of Plantago species.Planta Med. 2003; 69: 600–604.
Lambertini E, Piva R, Khan MT, Lampronti I, Bianchi N, Borgatti M, Gambari R. Effects of extracts from Bangladeshi medicinal plants on in vitro proliferation of human breast cancer cell lines and expression of estrogen receptor alpha gene. Int J Oncol. 2004 Feb;24(2):419-23.
CLSI, Performance standard for antimicrobial susceptibility testing: twenty-first informational supplement. Wayne (PA): Clinical and Laboratory Standards Institute, 2019.
Sahu MC, Swain SK. Surveillance of antibiotic sensitivity pattern in chronic suppurative otitis media of an Indian teaching hospital. World J Otorhin Head Neck Surg. 2019; 5: 88–94.
Sahu MC, Debata NK, Padhy RN. Antibacterial activity of Argemone mexicana L. against multidrug-resistant Pseudomonas aeruginosa, isolated from clinical samples. Asian Pacific J Trop Biomed. 2012; 2: S800–S807.
Iosifidis E, Antachopoulos C, Tsivitanidou M, Katragkou A, Farmaki E, Tsiakou M, Kyriazi T, Sofianou D, Roilides E. Differential correlation between rates of antimicrobial drug consumption and prevalence of antimicrobial resistance in a tertiary care hospital in Greece. Infect Contr Hospit Epidem. 2008;29(7):615-622.
Hsu LY, Tan TY, Tam VH, Kwa A, Fisher DA, Koh TH; Network for Antimicrobial Resistance Surveillance (Singapore). Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals. Antim Agents Chemother. 2010;54(3):1173-8.
Jaggi N, Sissodia P, Sharma L. Control of multidrug-resistant bacteria in a tertiary care hospital in India. Antim Resist Infect Contr. 2012;1(1):23.
Chopra I, Schofield C, Everett M, O’Neill A, Miller K, Wilcox M, Frere JM, Dawson M, Czaplewski L, Urleb U, Courvalin P. Treatment of health-care-associated infections caused by Gram-negative bacteria: a consensus statement. Lancet Infectious Dis. 2008;8(2):133-139.
Sithisarn P, Nantateerapong P, Rojsanga P, Sithisarn P. Screening for Antibacterial and Antioxidant Activities and Phytochemical Analysis of Oroxylum Indicum Fruit Extracts. Molec. 2016 Apr 7;21(4):446.
Mat Ali R, Houghton PJ, Raman A, Hoult JR. Antimicrobial and anti-inflammatory activities of extracts and constituents of Oroxylum Indicum (L.) Vent. Phytomed. 1998 Oct;5(5):375-81.
Talari S, Sampath A, SujathaK, Nanna RS. Antibacterial activity of stem bark extracts of Oroxylum Indicum and endangered ethnomedicinal forest tree. J Pharm Biol Sci. 2013; 7: 24-28.
Singh HB, Prasad P, Rai LK Folk medicinal plants in the Sikkim Himalayas of India, Asian Fol Stud. 2002; 61: 295–310.
Dev LR,Ranjeeta P, Anurag M, Rajiv G. Pharmacognostic and phytochemical studies of the bark of Oroxylum Indicum.Pharmacogno J. 2010; 2: 297–303.
Samatha T, Srinivas P, Shyamsundarachary R, Rajinikanth M, Swamy NR, Phytochemical analysis of seeds, stem bark, and root of an endangered medicinal forest tree Oroxylum Indicum(L) Kurz.IntJ Pharm Bio Sci. 2012; 3:1063–1075.
Balakrishna M, Seetharam P. Qualitative and quantitative evaluation of trace elements in Amaranthaceae family medicinal plant using ICP-MS. Int J Cur Res Rev. 2021; 13 (5); 58-63.
Devi SK, Brundha MP, Smiline Girija. Structural Basis of SARS COV 2 3CL PRO Drug And anticovid-19 discovery from medicinal plants - A review. Int J Cur Res Rev. 2020; 12 (21): S101-105.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareStructural Characterization of Gold Based Ayurvedic Medicine
English139142Anushka TyagiEnglish Nayan MishraEnglish Aziz Mohammad KhanEnglishIntroduction: Ayurvedic herbs-mineral medicines are being used as therapeutic drugs since the Vedic era. These medicines are prepared from many sources like minerals, plants and animals through various unique methods. Objectives: This research aims to synthesize the Gold bhasma (Swarna) by traditional Indian Ayurvedic method and to characterize the Gold nanoparticles by Scanning electron microscopy (SEM), X-ray diffraction (XRD), Photoluminescence spectroscopy and optical absorption. Methodology: Synthesis of the Gold bhasma was carried out using the unique methods mentioned in Rasashastra like Shodhana (purification), Marana (calcination), Jarana (polling). Characterization of prepared gold nanoparticles was accomplished through X-ray diffraction (XRD), Scanning electron microscopy (SEM), optical absorption and photoluminescence spectroscopy Result: Swarna bhasma or nanometer-sized gold compound with diameters in the range of 1-20 nm have generated a great deal of interest due to fundamental and technological applications in the drug discovery area. Conclusion: From this present research work, it can be concluded that prepared Gold Bhasma is an important medicine and has been characterized using scientific characterization methods.
EnglishSwarna bhasma, gold nanoparticles, X-Ray Diffraction, Scanning Electron, Microscopy, Optical studiesIntroduction
Ayurveda means the science of the human’s internal & external health. It incorporates the total sweep of biological sciences and pursues the quest for understanding life in all its aftermath. Ayurveda has advised the use of metals (Cu, Ag, Au etc) therapeutically in classical texts of Charak Samhita as old as 1500 BC. In Ayurveda, mainly seven metals are used therapeutically. These metals are iron, tin, gold, copper, silver, lead, zinc.1These metals are passed through many purification processes and finally changed into medicinal drug form, called Bhasma. Nanotechnology is considered to be the emerging technology for the current century in the medical field. The basics of nanotechnology lie in the fact that the properties of materials change dramatically when their size is below 50 nanometers.2
Ayurvedic bhasmas are ancient nanomedicines.3 Importance of Ayurvedic medicine is due to the presence of some bioactive compounds which make them promising medicinal agents for the treatment of all diseases. 4, 5 Ayurvedic bhasmas or metal oxide nanoparticles are believed to be more efficacious than any other healing system because these small particles being insoluble can enter into the bloodstream and are more biocompatible as compared to any chemically or biologically generated nanomaterials. The Bhasmas or metal oxide nanoparticles are combined with herbs which help in the assimilation and delivery of the ingredient drugs into human body.6
Materials and methods
The metal oxide and mineral preparation called bhasma, is also extensively used in Indian traditional ayurvedic medicines. Rasashastra may be defined as a fork of Ayurveda which deals with the various pharmaceutical processes of Shodhana (purification), Marana (calcination), Murchana (the procedure by which substances especially mercury is transformed for therapeutic application), Jarana (polling) and other detail description of metals, minerals, herbal drugs and animal products used therapeutically in practice of Ayurveda. The metal gold are heated and dipped in sesam oil when they are red hot, and the process is continued seven times separately. The soft leaves of gold are processed in the same manner with buttermilk, cow’s urine, and the extraction of kulatha, kanji and radish. Finally, the leaves are dried by heat. The process of triturating and drying in sunlight is repeated 7-14 times using fresh aliquots of latex and the final product is obtained. An aliquot of the above product is poured into liquefied metallic gold in a closed earthen pot and the mixture is heated above ~8500C. The content is gently stirred and the heating is continued until the mass becomes disintegrated and a homogenous red-brown powder is formed.7
Experimental Techniques
Bhasmas nanoparticles can only be detected through imaging methods like Electron Microscopy (EM), Scanning Electron Microscopy (SEM), Grazing angle X-Ray diffraction and Rietveld analysis (GXRD). X-ray diffraction analysis was recorded in the grazing angle mode of XRD 6000 SHIMADZU powder diffractometer, using CuKα line. Beam divergence was restricted with the help of a 0.15 mm slit on the source site. Drive axis was 2θ for scan range 200-700 covered in 20/minute with a step size of 0.020 for nanocrystalline swarna bhasma (Au nanoparticle). However, for accurate measurement of peaks and position, X-Ray diffraction data were subsequently recorded using a scan rate of 0.50/minute. The instrument propagation error in the d-value was ±0.002 Å.8
Results and discussion:
The crystalline phase identification of the synthesized Swarna bhasma (Gold) nanoparticles was analyzed employing X-ray diffraction. The X-ray diffraction patterns of synthesized Swarna bhasma revealed that Au nanocrystals corresponded to the crystalline gold face-centred cubic (FCC) phase. The diffraction peaks obtained at 2θ=38.40°, 44.26° and 64.55° are identical with those reported for standard gold metal (JCPDS, USA). Similarly, the diffraction pattern of Swarna bhasma revealed the existence of peaks (111), (200) and (220) which matched with the standard JCPDS data-04784.9
The effect of reduction of the metallic gold particle size was manifested as broadening of the line width and systematic weakening of the intensities of reflexes. The X-ray diffraction peak positions, corresponding interplanar spacing, peak intensities, FWHM, lattice parameter and mean particle size for Swarna bhasma (Au nanoparticles) sample have been summarized in Table 1 and Fig 1.
The lattice parameter ‘a’ for all the samples were calculated using the following expression
where (hkl) is miller indices and ‘d’ is more interplane spacing.
The standard value of the lattice parameter for gold is 4.080 Å. It is clear from table 3 that the average value of the lattice parameter for copper nanoparticles is close to the corresponding standard value.10
The mean particle size (d) of the Swarna bhasma sample was estimated from the X-ray pattern by using (111) peak according to the Scherrer equation.
Where is relative broadening (FWHM).
λ is the wavelength of CuKα (1.5402 nm), 2θ diffraction angle, Bm is measured broadening and BS is the standard broadening determined for standard silicon sample.
The texture coefficient Tc(hkl) is the preferred orientation indicator for (hkl) plane and is given by the following relationship.
Where is measured intensity, is standard intensity and N is the no. of reflections. Table 2 compares the calculated texture coefficient for all the observed miller planes in our Swarna Bhasma X-ray diffraction results. It is clear from Table 1 that the value of texture coefficient for (111) lattice plane is greater than unity for all Swarna bhasma samples indicating the tendency of (111) preferred orientation in nanoparticles.
We have also investigated the effects of Shodhana, Marana and Bhawna processes on the surface morphology of crystalline gold using scanning electron microscopy. Figure 2 represents the SEM micrograph of Swarna bhasma. It is clear from blue circles in the figure that the sample of crystalline gold after bhasmikaran process are seen to form spherical type clusters in approximately 200 nm size.11,12
The surface Plasmon resonance of Swarna Bhasma particles is blue-shifted with the reduction in particle size according to Mie theory. The specific optical properties of Swarna Bhasma or gold are due to the valence electron of 5d and conduction e- of 6sp orbital’s. The outermost orbital d and s electrons of the constituent atoms must be treated together leading to six energy bands. The five energy bands are fairly flat, lying a very few eV below Fermi level and are usually denoted as d energy bands and the sixth one which is almost free-electron like is known as the conduction band Figure 3.13 The nanostructure of Ayurvedic medicine can be used to study the importance of Ayurvedic medicine concerning traditional literature.14,15
Conclusion
We have synthesized Swarna bhasma (Gold) nanoparticles using the Ayurvedic (traditional Indian medicinal method practice) and studied the crystallographic and morphological characterization using X-ray diffraction(XRD) Scanning electron microscope (SEM) and Photoluminescence (PL) techniques. All the analyses confirmed the formation of Swarn Bhasam (Gold) particles in the nanometer regime. The optical absorption showed the intense peak of Swarna bhasma (Gold) nanocrystals at 520 nm with signs of surface plasmon states near. As prepared Swarna bhasma (Gold) nanoparticles thin film gave rise to another interesting feature with higher intra-band transition were predicted around 490 nm. The XRD, SEM and PL analysis further confirmed the size of nanoparticles is around ~8nm. Swarn bhasma nanoparticles are showing emission spectra near 600 nm. The nanostructure medicine is a newly used word but in Indian traditional medicine or Ayurvedic therapy in the form of Bhasma, the nanostructures of herbal and minerals are being used as bioavailable and effective medicines.
Acknowledgement
The authors are thankful to Jayoti Vidyapeeth Women’s University, Jaipur. The authors gratefully acknowledge this research to Jayoti Vidyapeeth Women’s University, Jaipur. UGC-DAE CSR, Indore for providing facilities for XRD and SEM experiments
Conflicts of interest
The authors express No conflicts of interest
Source of funding
No funding sources
Englishhttp://ijcrr.com/abstract.php?article_id=3967http://ijcrr.com/article_html.php?did=3967
Yeh YC, Creran B, Rotello VM. Gold nanoparticles: preparation, properties, and applications in bionanotechnology. Nanoscale. 2012;4(6):1871-80.
Dance A. Medical histories. Nature. 2016 Sep;537(7619): S52-3.
Singh RK, Kumar S, Aman AK, Karim SM, Kumar S, Kar M. Study on physical properties of Ayurvedic nanocrystalline Tamra Bhasma by employing modern scientific tools. J Ayurv Integ Med. 2019 Apr 1;10(2):88-93.
Khan AM, Bhadauria S, Yadav R. Phytochemical Screening and Antioxidant activity of extract of different parts of Adhatoda vasica. Res J Pharm Techn. 2019 Dec 1;12(12):5699-705
Khan AM, Bhadauria S. Isolation of some potential phytocompounds from Adhatoda vasica through Gas Chromatography-Mass Spectroscopy analysis. Asian J Pharm Clin Res. 2017;10(12):328-32.
Mukherjee PK, Harwansh RK, Bahadur S, Banerjee S, Kar A, Chanda J et al. Development of Ayurveda–tradition to trend. J Ethnopharm. 2017; 2,197:10-24
Chaudhary A. Ayurvedic Bhasma: nanomedicine of ancient India—its global contemporary perspective. J Biomed Nanotech. 2011 Jan 1;7(1):68-9.
Cullity BD. Elements of X-ray Diffraction. Addison-Wesley Publishing; 1956.
Ren X, Song Y, Liu A, Zhang J, Yang P, Zhang J, An M. Experimental and theoretical studies of DMH as a complexing agent for a cyanide-free gold electroplating electrolyte. RSC Adv. 2015;5(80):64997-5004.
Daniel NJ, Thangaraj N, Suresh DM, John NJ. Electrical Measurements on Cadmium Selenite Nano Composites. Int J Cur Res Rev.2017; 26;9(24):1.
Khedekar S, Anupriya GR, Patgiri B, Prajapati PK. Chemical characterization of incinerated gold (Swarna Bhasma). Adv Appl Sci Res. 2015;6(12):89-95.
Sundarrajan M, Jeelani A, Santhanam V, Durgadevi S, Abirami S. Effect of concentration, ph and time on the morphology of silver nanoparticles synthesized by the green method using Phyllanthus niruri and solanum nigrum leaf extracts. Int J Curr Res. Rev. 2018 Nov;10:25-9.
Jain PK, Lee KS, El-Sayed IH, El-Sayed MA. Calculated absorption and scattering properties of gold nanoparticles of different size, shape, and composition: applications in biological imaging and biomedicine. J Phys Chem B. 2006 Apr 13;110(14):7238-48.
Beaudet D, Badilescu S, Kuruvinashetti K, Kashani AS, Jaunky D, Ouellette S, Piekny A, Packirisamy M. Comparative study on cellular entry of incinerated ancient gold particles (Swarna Bhasma) and chemically synthesized gold particles. Scientific Rep. 2017 Sep 6;7(1):1-2.
Bhaskaran JK, Patel KS, Srikrishna R. Immunomodulatory activity of Swarna Prashana (oral administration of gold as electuary) in the infants-A randomized controlled clinical trial. Int J Res Ay. 2019 Oct 1;40(4):230.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareAn Experimental Study on Classification of Brain Images
English154157Pranati SatapathyEnglish Sarbeswara HotaEnglish Sateesh Kumar PradhanEnglishIntroduction: The brain is the major and vital organ of the central nervous system. After the age of 60 or in old age, the human brain may suffer from various disorders. Brain diseases may also occur due to some inevitable causes in the normal human body. As the brain stops functioning, the human body goes into a paralyzed state. To treat various brain diseases, neurologists use different brain imaging techniques. Aims: Magnetic Resonance Imaging (MRI) technique is one of the promising imaging techniques used in recent days for analyzing brain diseases. Manual analysis and classification of brain images into normal or deceased is a tedious task. So different supervised learning techniques are used for this purpose. Methodology: This paper focuses on the experimental study on feature selection using PCA and LDA and classification of two of the brain image datasets i.e. Glioma and Alzheimer. Result: The experimental study suggested that the PCA+MLP classifier obtained accuracy values of 92.68% for the Glioma dataset and 90.023% for the Alzheimer dataset. PLC is used for feature reduction and MLP is used as a classification task. Conclusion: The results suggested that PCA with MLP outperformed the other models.
EnglishINTRODUCTION
The nervous system is the major constituent of the biological structure of the human body. The vital component of the nervous system is the brain which controls all the operations of the human body. The brain can be affected by several diseases in the life cycle.1 The brain disorders may sometimes lead to death. So it poses a major challenge for neurologists in the treatment of brain diseases. Brain imaging procedures are adopted in this context. Out of the different imaging techniques, the Magnetic Resonance Imaging (MRI) technique is the noninvasive method used in the analysis and identification of brain diseases in recent days. 2, 3
The manual study and interpretation of brain MRI images by medical practitioners is infeasible and may lead to erroneous diagnoses. So the computer-assisted methods are beneficial in this context. Various researchers have used machine learning techniques in classifying the brain images as normal and pathological. 4 The authors applied random forest as the classifier for the brain MRI image classification.5 PCA and neural networks are widely used in the classification of brain images.6,7 The authors adopted Principal Component Analysis (PCA) for feature selection from the extracted brain images.8 They applied Multilayer Perceptron (MLP) for the classification purpose that outperformed k-Nearest Neighbor (k-NN) classifier. Independent Component Analysis (ICA) has also been used as dimension reduction technique. 9, 10 From the literature study, the various steps involved in the brain MRI image classification process can be listed as follows:
Brain Image dataset collection
Data preprocessing with feature extraction and feature reduction
Classification and performance measurement.
The objective of this study is to collect the brain MRI image datasets and then perform data preprocessing. PCA and ICA have been used for dimension reduction purposes. Then three different classifiers i.e. Random forest, k-NN and MLP are applied for the classification purpose. The accuracy values are compared for determining the efficient classifier. This paper is organized as follows. The methodologies are described in the second section. The experimental work is described in the third section. Finally, section 4 discusses the conclusion.
METHODOLOGY
The different feature reduction and classification techniques are discussed in this section.
Independent component analysis (ICA)
ICA is one of the unsupervised dimension reduction strategies used in neuroimaging studies. It groups the original dataset into a set of independent features.11, 12 These independent components are also most relevant to the classification task.
Principal component analysis
PCA is one of the dimension reduction techniques used frequently in the data science and machine learning field. The high-dimensional dataset is reduced to different principal components based on the variance values. 13, 14 No data are lost during the reduction to the low dimensional features. The principal components are the uncorrelated variables and the given initial features are the set of correlated variables.15
Random forest classifier
This is one of the learning approaches used for classification tasks. This is constructed by combining several decision trees. 16 The basic purpose of this ensemble approach is to enhance the training process and classification accuracy. 18 The number of classification trees considered in the random forest approach is chosen randomly.
K-nearest neighbor (k-NN) Classifier
the k-NN classifier is the common classifier used in pattern recognition. The number k is chosen randomly and is very small. The training sample is assigned with the class label that has a minimum distance within the k neighbors. The weights are assigned for different neighbors. It can be stuck at local optima.
Multilayer perceptron (MLP)
MLP is one of the feed-forward neural network structures used for classification purposes. It is completely based on the functionality of the human brain. It belongs to the group of supervised learning. It has one input layer, one or more hidden layers and one output layer. During classification, the number of input neurons will be the number of features. The number of hidden nodes is randomly determined. For the binary classification problems, there is only one output neuron. 16
Proposed Model
The work proposed in this paper is summarized in figure 1. The brain images of the two diseases are collected and preprocessed using 2D-DWT, PCA and ICA. Then the three different classifiers are used for classifying the brain images into normal or diseased. The accuracy values are recorded for the performance measurement ( Figure 1).
SIMULATION STUDY
The experimental study is conducted on MRI image datasets of two brain diseases i.e. Glioma and Alzheimer. These two datasets are collected from the Website of Harvard School of medicine. The Glioma dataset contains 122 images and the Alzheimer dataset contains 100 images where each image is of size 288 X 288. The sample MRI images of these two brain diseases are shown in Figure 2-(b) and 2-(c) respectively. Figure 2-(a) shows the normal brain MRI image.
2D DWT is used for feature extraction. Using this procedure, 1296 features are extracted.
FEATURE REDUCTION
In this work, two feature reduction techniques i.e. PCA and ICA are used. The number of reduced features are shown in Table 1 and Table 2 for PCA and ICA respectively.
CLASSIFICATION
The datasets are divided into train and test datasets for supervised learning. In this work, the Glioma and Alzheimer data sets are divided as 75% for training and 25% for testing purposes. The three types of classifiers i.e. random forest, k-NN and MLP classifiers are considered for the experimental study. 15,16
The loss occurred during training of the datasets using PCA+MLP and ICA+MLP classifiers for the Glioma and Alzheimer datasets are shown in Figure 3 and 4.
The accuracy values found during the classification of the brain diseases are stored in Table 3 and Table 4 for Glioma and Alzheimer image datasets.
From Table 3, it is found that PCA with MLP and PCA with k-NN classifier has same accuracy values i.e. 92.68% for classification of Glioma images into normal and pathological brain.
From Table 4, it is found that PCA with MLP classifier has highest accuracy i.e. 90.023% values for classification of Alzheimer images into normal and pathological brains.14,15
CONCLUSION
This work focuses on the experimental study on the performances of different standard classifiers i.e. random forest, k-NN and MLP classifiers for the brain MRI image classification of Glioma and Alzheimer datasets. The 2D DWT is used to extract the features from the brain images. Then two different feature reduction techniques i.e. PCA and ICA are employed in this work to reduce the feature sets. The experimental results suggest that the PCA with MLP produced the highest accuracy values and hence outperformed the other models for the classification of brain images for these two brain diseases.
ACKNOWLEDGEMENT
We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest
NIL
Source of Funding
NIL
Englishhttp://ijcrr.com/abstract.php?article_id=3969http://ijcrr.com/article_html.php?did=3969
Duyn JH. Study of brain anatomy with high-field MRI recent progress,” Magnetic resonance imaging (MRI).2010;28(8):1210–1215.
Bauer S, Wiest R, Nolte LP, Reyes M. A survey of MRI-based medical image analysis for brain tumour studies. Phys Med Bio.2013; 58(13):93.
Nayak DR, Dash R, Majhi B. Brain MRI image classification using two-dimensional discrete wavelet transform and AdaBoost with random forests. Neurocompt. 2016;177: 188–197.
Zhang Y, Dong Z, Wu L, Wang S. A hybrid method for MRI brain image classification. Expt Syst Applic. 2011;38(8):10049–10053.
Bartlett M. S., Movellan J. R., Sejnowski T.J., “Face recognition by independent component analysis”, IEEE Transactions on neural networks, 13(6), 1450-1464, 2002.
Stone JV. Independent component analysis: an introduction. Tren Cogn Sci. 2002; 6(2): 59-64.
Salimi-Khorshidi G. Automatic denoising of functional MRI data: combining independent component analysis and hierarchical fusion of classifiers. Neuroim. 2014; 90: 449-468.
Yu SN, Chou KT.Integration of independent component analysis and neural networks for ECG beat classification. Expert Syst Applic.2008; 34(4): 2841-2846.
Nandi D., “Principal component analysis in medical image processing: a study”, (IJIM), 1(1), 65-86, 2015.
Zhang YD, Wu L. An MR brain images classifier via principal component analysis and kernel support vector machine. Progr Electrom Res. 2012;130:369-388.
MingRu K, Zheng Q, Yan SK, Arunkumar N. Medical image classification algorithm based on principal component feature dimensionality reduction”, Future Generation Compt Syst. 2019; 98: 627-634.
Khatami A, Khosravi A, Nguyen T, Lim CP, Nahavandi S. Medical image analysis using wavelet transform and deep belief networks. Expt Syst Appl.2017; 86: 190-198.
Wei S. Medical image super-resolution by using multi-dictionary and random forest. Sust Citi Soc.2018; 37: 358-370.
Ko BC, Kim SH, Nam JY. X-ray image classification using random forests with local wavelet-based CS-local binary patterns. J Digit Imag. 2011;24(6):1141-1151.
Aci M, ?nan C, Avci M. A hybrid classification method of k nearest neighbour, Bayesian methods and genetic algorithm. Exp Syst Appl. 2010;37(7):5061-5067.
Hassanien AE, Moftah HM, Azar A,Shoman TM. MRI breast cancer diagnosis hybrid approach using adaptive ant-based segmentation and multilayer perceptron neural networks classifier. Appl Soft Comp. 2014;14: 62-71.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareAesthetic Rehabilitation of Ellis Class II Fracture Using the Templatetechnique: A Case Report
English158160Sanjana SonetaEnglish Shweta KajjariEnglish Shivayogi M. HugarEnglish Chaitanya UppinEnglish Priya MeharwadeEnglish Pooja MalavalliEnglishIntroduction: Coronal fracture in permanent dentition is the most common type of dental injury in children. It creates a serious social and psychological barrier for both the child and the parent. The clinician should take into consideration aspects of esthetics and should extract the exact treatment plan. Case Report: A 10-year-old boy reported to the outpatient Department of Paediatric and Preventive Dentistry, KLE VKIDS, Beagave, Karnataka, India for the treatment of a fractured upper front tooth with aesthetic concern. Intra-orally a clinical try-in of the template was done to ensure adequate fit. After appropriate shade selection of the composite material, this crown former was used to restore the fractured tooth with minimal post-restoration finishing and polishing. Conclusion: This case report describes an aesthetic rehabilitation of fractured anterior teeth using the template technique.
EnglishChildren, Composite, Esthetics, Rehabilitation, Trauma, Template techniqueINTRODUCTION
The second most common cause of tooth loss is orofacial trauma, it has a significant negative effect on a patient’s appearance, mastication and speech. A majority of these fractures involves the maxillary central incisors, with boys outnumbering girls almost two to one.1,2 The well-known risk factors are falls, automobile/bicycle accidents, collisions, gender and age, some behavioral characteristics, physical and sporting activity. The worldwide prevalence of traumatic dental injuries ranges between 6%-37%. Seasonal variations in the prevalence of trauma have also been reported .3
Dental trauma of the incisors and their supporting tissues, which is one of the most challenging dental emergencies, requires immediate assessment and management due to psychological and physical reasons. Treatment for trauma in young permanent teeth is crucial because of its continuing development to minimize undesired complications. The treatment of dental trauma is sometimes neglected, although it might lead to pain, difficulty in articulation and mastication as well as having considerable negative effects on the patient’s self-esteem. However, aesthetics of the anterior teeth are very important aspects of human appearance and could be affected by many factors including the presence of fillings, tooth colour, position, alignment, shape and number.3
Trauma to the anterior teeth requires proper functional and aesthetic repair.4 A complete understanding of the desire of the patient is critical for success. The treatment of a fractured tooth with the help of crown and bridge requires high financial expenses, more time consuming, needs multiple sitting and is a less conservative approach. The initial treatment option should be always the most conservative one that will achieve all the desired objectives of both the patient as well as the dentist. The treatment plan advocated in this report is the Putty index restoration technique which is minimally invasive, economical and successful in repairing the fractured teeth with excellent longevity in carefully selected cases and with superior matching ability.5,6,7 In the present article, an esthetic rehabilitation of fractured anterior teeth restored with putty index composite restoration is presented.
CASE REPORT
A 10-year-old boy reported to the outpatient Department of Paediatric and Preventive Dentistry, KLE VKIDS, Belagavi, Karnataka, India for the treatment of a fractured upper front tooth with aesthetic concern. A patient gave a history of trauma three months back due to hit by a pole while playing. Clinical examination revealed Ellis class II (uncomplicated) fracture irt 11 (Figure 1). The tooth was asymptomatic without any associated soft or hard tissue injuries to the supporting tissues and responded to Electric Pulp Test and Cold test. Intraoral periapical radiograph of 11 reveals the absence of pulpal or periapical pathosis. So, it was planned to restore the fractured segment with direct composite restoration using the template technique. Oral prophylaxis of the teeth was done to remove calculus and stains. A rubber dam isolation was achieved and a 45° level was given to remove the unsupported enamel and to increase the surface area of the tooth. A preliminary impression of the upper and lower arches was made using fast setting alginate and diagnostic dental stone study models were prepared. On the prepared cast, the crown build-up was done using inlay wax mimicking its natural anatomy and further, it was checked for any occlusal discrepancy. The tooth was duplicated by using Polyvinyl siloxane putty impression material, in the labial aspect the impressions were taken up to the incisal third and a template was obtained (Figure 2 and 3). Intra-orally a clinical try-in of the template was done to ensure adequate fit. After appropriate shade selection of the composite material, this crown former was used to restore the fractured tooth with minimal post-restoration finishing and polishing. (Figure 4)
DISCUSSION
Fracture of a permanent incisor is a traumatizing experience for a young patient and creates a psychological and social impact on both the parents and in children that make him target by other children. Management of patient’s with anterior tooth fracture provides a great challenge to the clinicians both from a functional and an esthetic perceptive. Treatment objectives may vary depending on the age, socio-economic status of the patient and intraoral status at the time of treatment planning.
There are various treatment options available for restoration of fractured teeth like composite restoration, fixed prosthesis, reattachment of the fracture fragment (if available)followed by post and core supported restorations.8,9 Well known treatment options such as laminated veneers or full-coverage restoration may be considered after multiple fragments rebonding/composite resin restorations have been done and this option is no longer functional. They also tend to sacrifice the healthy tooth structure and challenges the clinician to match with the adjacent unrestored teeth.10
In the present case, Considering the age of the patient where the fractured tooth is in its active eruption phase, anaesthetic direct composite restoration was planned. Various techniques were
considered to restore the tooth with the composite restoration which includes direct technique; freehand composite restorations; indirect technique; usage of preformed crowns/ thermoplastic moulds as templates. The usage of preformed crowns/thermoformed templates gave good results, but there are certain drawbacks like requirement of specialized instruments like vacuum former, availability, time-consuming and most importantly proper incremental layering of the composite material is not possible thus in the present case a novel method which includes both direct and indirect method of restoring was designed by using Polyvinyl Siloxane (PVS) Rubber base impression material (putty) as a template. This method is simple, quick and economical when compared to other invasive procedures.
The usage of the PVS template allows incremental layering of the composite material; optimal depth of cure; accurate reproducibility of the anatomic contours and minimal polishing and finishing procedures.10,11 The patient was reviewed after one week for any minimal adjustments to the restoration.
CONCLUSION
Wise use of skills, knowledge of the materials and methods should be done to achieve desired aesthetics in the patients. Esthetic Restoration of a fractured tooth is a complex procedure; this technique can prove as a simple, effective and appropriate technologies that will fulfil all the requirements of both the patient and the dentist.
Conflict of Interest: Nil
Source of Funding: Nil
Acknowledgement:
The authors are thankful to the Department of Pediatric and Preventive Dentistry, KLE VKIDS, KLE Academy of Higher Education and Research, Belagavi for the support and also 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.
Authors’ Contribution:
1. Dr Sanjana Soneta: Designing of Manuscript
2.Dr Shweta Kajjari: Manuscript editing and plagiarism check
3.Dr Shivayogi M. Hugar: Discussion of Treatment Plan
4.Dr Chaitanya Uppin: Manuscript proofing
5.Dr Priya Meharwade: Manuscript Reframing
6.Dr Pooja L. Malavalli: Manuscript Grammar check
Englishhttp://ijcrr.com/abstract.php?article_id=3970http://ijcrr.com/article_html.php?did=39701Andreasen JO, Ravn JJ.Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg. 1972;1(5):235-9.
2. Martens LC, Beyls HM, de Craene LG, D’Hauwers RF. Reattachment of the original fragment after vertical crown fracture of a permanent central incisor. J Pedod. 1988;13(1):53-62.
3. Azzaldeen A, Mai A, Muhamad AH, Fractured Anterior tooth using direct composite restoration: A case report. IOSR-JDMS. 2017; 16(10):61-65.
4. Baratieri LN, Monteiro S Jr, Andrada MAC. Esthetics: direct adhesive restorations on fractured anterior teeth. Chicago: Quintessence Books. 1998:3–32.
5. Chan DCN, Cooley RL. Direct Anterior Restorations. In: Schwartz RS, Summitt JB, Robbins JW, editors. Fundamentals of operative dentistry. A contemporary approach. Illinois: Quintessence Publishing; 1996:187–205.
6. Abu-Hussein Muhamad, Abdulgani Azzaldeen, Abdulgani Mai3; Step-by-Step Approaches for Anterior Direct Restorative. Int J Dent Health Sci. 2015; 2(6): 1305-1310.
7. Abu-Hussein M., Watted N., Abdulgani A; Esthetics, biological and restorative consideration in coronal segment reattachment for fractured teeth. Int J Dent Health Sci. 2015; 2(4): 998-1004.
8. Samadi F, Jaiswal JN, Pandey S, Bansal N. Restoration of fractured anterior teeth by using thermoformed templates-A Case Report. J Clin Diagn Res. 2012; 1(2): 25-8.
9. TerryDA. Adhesive reattachment of a tooth fragment: The biological restoration. Pract Proced Aesthet Dent. 2003; 15(5): 403-09.
10.K Rajavardhan, Sankar AJ, Shaik TA, V Naveen K, K Rajkumar. A novel technique in restoring fractured anterior teeth. J Clin Diagn Res. 2014 Feb;8(2):244-5.
11. Pahuja H, Mittal GK, Agarwal S, Verma A, Tomar H. Restoring esthetics in fractured anterior teeth- Template technique. Int J Cont Med Res. 2016; 3(5): 1283-84.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareClinical Spectrum of the Patients Receiving Palliative Care at Wardha District - A Retrospective Study
English161165Nitin RaisinghaniEnglish Sunil KumarEnglish Shravani DeoliaEnglish Shyam ChandakEnglish Aditi GadegoneEnglish Sourya AcharyaEnglishIntroduction: Palliative care is needed by every needy patient in a different aspect (medical, nursing, psychological, social, cultural and spiritual). Aim: To describe the clinical spectrum of the patients in patients receiving palliative care. Methodology: A retrospective study was conducted on the patients reported to the Palliative Unit of a tertiary care hospital, India from 2016 to 2018. With the help of standardized proforma patient’s information were collected. A total of 1584 patients were reported during this period out of which complete information of 610 patients were retrieved which was used for the analysis. Statistical analysis was conducted with SPSS using the chi-square test to compare the difference between gender at a significance level pEnglishPalliation, Retrospective, Rural, SymptomsINTRODUCTION:
Palliation is a stage when the focus lies in the improvement or maintenance of the quality of life rather than cure and control of the disease in the patients who are facing life-threatening illnesses.1,2,3 The necessity of enormous palliative care can be comprehended from the evidence that every year in India there is an addition of approximately a million cases of cancer. To add to the graveness of the situation is the fact that more than 80% of them present at stages III and IV .4
Nevertheless, to a great extent, the occurrence and severity of the symptoms of the disease decide the suffering of these patients.5 The most common and dreadful symptom in patients with cancer is pain. 6,7 Recent literature depicts that pain is prevalent in 62%–86% of patients having cancer of advanced stage, emphasising the vital need to address the problem .8
Focus on the more prevalent symptoms by the clinician can be accomplished by a thorough knowledge of prevalent symptoms. This may also help to foresee the problems and efficient planning of patient care, preparing competent clinical staff by educating them, to evaluate health care needs, and to plan services.5 Moreover profile of palliative patients also helps us plan more cost-effective treatment plans which is the need of the hour in developing countries like India.9,10 The literature search shows that there is a scarcity of information of these patients in the Vidarbha region and the increasing number of cancer and terminally ill patients in this region makes it necessary to know the profile of patients reporting to the palliative department making us more prepared to deal with such patients. Therefore, the present study was conducted to describe the prevalence and the patterns of symptoms in the patient receiving palliative care.11,12
METHODOLOGY:
This retrospective study was conducted in a tertiary care rural hospital in the Wardha district from January 2019 to July 2019.
The approval was taken from the institutional ethical committee and informed consent was waived off. [DMIMS(DU)/IEC/2018-19/936] Data of all the patients reporting to the palliative care department, referred by the other departments within the hospital from July 2016 to December 2018 was retrieved.
The information of the patient was recorded by palliative care on the first clinical assessment in a standardized proforma, which included the demographics like age, sex along with the primary diagnosis, presence or absence of metastatic disease (in case of cancer), and the site of referral (hospital or community) and symptoms. For the patients with pain, pain score was recorded on the 10 points Visual Analogue Scale (VAS) scale (ranging from no pain at all “score 0” to severe pain “score 10”) and it was also described in terms of duration, whether continuous/ intermittent, radiation, quality, provoking and palliating factors.
Pain scores were further grouped into three categories: 1–4 (mild pain), 5 or 6 (moderate pain) and 7–10 (severe pain). A potential list of symptoms was compiled and grouped.
A total of 1584 patients reported to the unit within the aforementioned period out of which 610 patients data was found complete that was used for the analysis.
Statistical analysis:
Upon completion of data collection, it was transferred to MS Excel (MS Office version 2007 developed by Microsoft, Redmond, WA) and analyzed using SPSS for comparing the difference between gender by chi-square test and keeping the level of significance at Englishhttp://ijcrr.com/abstract.php?article_id=3971http://ijcrr.com/article_html.php?did=39711. Kaur J, Mohanti BK. The transition from curative to palliative care in cancer. Ind J Palliat Care. 2011;17(1):1-5.
2. “WHO Definition of Palliative Care”. Geneva, World Health Organization. Available from: http://www.who.int/cancer/palliative/definition/en [Accessed on 2012 Mar 02].
3. Teunissen SC, Wesker W, Kruitwagen C, Voest EE. Symptom Prevalence in Patients with Incurable Cancer: A Systematic Review. J Pain and Symptom Mang.2007; 34( 1):94-104
4. Khosla D, Patel F & Sharma S. Palliative Care in India: Current Progress and Future Needs. Ind J Palliative Care. 2012;18(3):149-154.
5. Grond S, Zech D, Diefenbach C, Bischoff A. Prevalence and pattern of symptoms in patients with cancer pain: A Prospective Evaluation of 1635 Cancer patients Referred to a pain clinic. J Pain and Symptom Mang.1994;9(6):372-382
6. Kaye P. Notes on symptom control in hospice and palliative care. Essex, CT: Hospice Education Institute, 1991.
7. Levy MHI, Catalan RB. Control of common physical symptoms other than the pain in patients with a terminal disease. Semin Oncol 1985;12:411-439.
8. https://academic.oup.com/annonc/article/18/9/1437/204575 [Last accessed on 30/06/2020]
9. Ghoshal A, Damani A, Salins N, Deodhar J, Muckaden MA. Economics of Palliative and End-of-Life Care in India: A Concept Paper. Ind J Palliat Care. 2017;23(4):456-461.
10. Kraemer D, Rintamaa M., Assessment and management of cancer pain in palliative care.2018 (https://www.theseus.fi/bitstream/10024/147326/1/thesis.pdf)
11. Perron V, Schonwetter RS. Assessment and management of pain in palliative care patients. Cancer control.2001;8(1):15-24
12. Miller AJ. Hospice Nurses- Attitudes and Knowledge about Pain Management.Graduate Theses and Dissertations.2012. ( http://scholarcommons.usf.edu/etd)
13. Potter D, Hami F, Bryan T. Symptoms in 400 patients referred to palliative care services: prevalence and patterns. Palliative Med.2003;17:310-314
14. Higginson J, Hearn J. A Multicenter Evaluation of Cancer Pain Control By Palliative Care Teams. J Pain and Symptom Mang.1997;14( 1):29-35
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareImaging Interpretation of Complications after Cesarean Section Delivery
English143148Jan Mohd. SuhailEnglish Obaid AshrafEnglish Sumiaya KiranEnglishIntroduction: Cesarean section delivery is one of the most common abdominal surgeries performed on women and saves the lives of both mother and fetus in many complicated cases. Aim: The aim of this study was early identification of post-cesarean section complications through various imaging studies. Methods: This was a retrospective cohort study conducted on the patients who were admitted for post-cesarean-section complications and underwent different imaging studies from January 2020 till November 2020. Our study group comprised of 140 women who had undergone elective or emergency C-sections and developed complications for which imaging was imperative. Result: Among the 140 Post C-Section patients which were sent for emergency USG abdomen or CT and even MRI in some cases, it was observed that complications were higher among emergency C-Section patients (60.7%) than elective C-section patients(28.5%). These patients had developed various symptoms after C-sections and were sent for imaging studies. It was observed that endometritis was the most common complication secondary to retained products of conception followed by a wound infection. Conclusion: The rate of increase of Cesarean section assisted deliveries have resulted from an increased rate of complications with infection seen as the most common (36%) complication among which Endometritis (20%) seen as the most common imaging finding.
English Cesarean section, Rates, Complications, Abnormal imaging features, Postpartum haemorrhage, Endometritis, Retained products of conceptionINTRODUCTION
Cesarean deliveries are necessary surgical procedures in the advent of pregnancy and delivery complications.¹ Although the rise of caesarean deliveries is associated with reduced maternal and infant mortality in high risk groups, but recent evidence suggests that cesarean rates beyond 15% threshold given by WHO, may lead to increased perinatal mortality and morbidity.²,³ In one cross-sectional study done in India, of 699 686 adolescent girls and women aged 15 to 49 years, the cesarean birth rate was 17.2%( higher than the WHO threshold of 15%) in 2010 through 2016, with variations ranging from 3% to 70% according to regions and socioeconomic groups.? The most common acute post-CS complication, that are encountered, included; infections, hematomas, uterine dehiscence and rupture, pelvic vein thrombosis/thrombophlebitis with an overall rate of 14.5%.Infection is the commonest among these with Endometritis being the most common (6.6%), followed by wound infection (1.6%).? Severe complications like uterine rupture are uncommon. ?,? Patients who are anaemic or obese or had increased duration of labour or prolonged ruptured membranes are predisposed to postoperative morbidity.? Patients may complain of intermenstrual bleeding, pelvic or abdominal pain as symptoms of healed cesarean delivery scar. There is a relative increased chance of retained products of conception, placenta accrete, cesarean scar ectopic pregnancy, malpositioned intrauterine devices(IUDs), and endometriosis in successive pregnancies in such patients. ?,¹?,¹¹ Imaging modalities used to evaluate such chronic complications include US, Sono-hysterography, magnetic resonance imaging, and occasionally CT.
The normal postprocedural findings (Table 1) should be differentiated from early significant complications such as haematomas, infections, abscesses, uterine dehiscence and rupture, and pelvic thrombophlebitis. Patients usually present with fever, decreased hematocrit value, heavy vaginal bleeding, pelvic pain in the post-procedural period prompt for imaging studies. ¹²,¹³In the emergency setting ultrasonography (US) and computed tomography (CT)remain the mainstay imaging modality, while Magnetic resonance (MR) is limited in terms of acquisition time and availability. ?
AIM
The aim of this study was early identification of complications that developed after Cesarean section assisted deliveries and differentiate normal imaging findings from abnormal.
MATERIALS AND METHODS.
Study design
This retrospective cohort study was done on patients who were admitted for post-procedural complications and sent for imaging studies from Jun 2020 to November 2020. The study was conducted in SMHS Srinagar, which is a government tertiary care hospital.
Participants and inclusion/exclusion criteria
This study included 140(n=140) patients who developed symptoms like fever, heavy vaginal bleeding or odorous discharge, severe abdominal pain, deranged blood counts, reduced hematocrit after cesarean section delivery. These patients were sent for Usg or CT abdomen and in some disputable diagnostic cases for MRI abdomen for identification of complications.
The inclusion criteria was determined as being between the age of 20 to 45 years , not having undergone other abdominal surgery and the patient data being complete.
The patients who gave births under 20 weeks of gestation or 500g were excluded from this study .
Data formulation
140 patients met the required criteria. They were divided in two main groups, those who had emergency C-Section(group 1) and those who underwent elective procedures (group 2). Then it was categorized into the following sections,(a) according to abnormal imaging findings like overtly enlarged uterine size, features of endometritis, pelvic haematoma (bladder flap, Subfascial haematoma), pelvic collection, uterine dehiscence or rupture, retained products of conception, morbidity adherent placenta ;(b)according to demographic data i.e, maternal age, BMI, parity and gravidity; (c) clinical features like puerperal pyrexia, abnormal vaginal bleeding, odorous vaginal discharge ; (d)Finally the imaging characteristics were compared with the clinical picture and in some cases surgical intervention for relevance and standardization.
Ethical approval
Their authors faced no ethical issue while conducting this study. Also, all the identifiable variables were removed from this study to safeguard the privacy and confidentiality of the participants.
Statistical method
The data were coded, checked and entered into the Statistical Package for Social Sciences version 22 (IBM Corp, Armonk ). Categorical variables, including, imaging features, clinical features, mode of CS, type of anaesthesia, type of incision, and complications were described using frequencies. Continuous variables, including maternal age, body height, body weight, parity, gravidity, GA at delivery were described using mean and standard deviation (SD). Chi-Square and independent t-tests were used to assess the association between the variables of the study. For all statistical tests, p-values ≤ of 0.05 were considered significant.
RESULTS
The hospital records were reviewed and about 850 patients underwent cesarean section from June 2020 to November 2020 among which 140 patients developed various complications (16.4%). Two study groups were made, group 1, which underwent emergency C-Section (n=95) and group 2 which had elective C-sections (n=45).
Accordingly, the groups were distinguished based on abnormal imaging findings(table 2) and it was found that infection was overall the most common complication in both groups particularly endometritis with p-value of less than Englishhttp://ijcrr.com/abstract.php?article_id=3973http://ijcrr.com/article_html.php?did=3973
MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008 Jun 1;35(2):293–307. doi: 10.1016/j.clp.2008.03.007. [PubMed] [CrossRef] [Google Scholar]
Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. Bri J Oor Gynacol. 2016;123(5):745-753. doi:10.1111/1471-0528.13592 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Molina G, Weiser TG, Lipsitz SR. Relationship between cesarean delivery rate and maternal and neonatal mortality. J Am Med Ass. 2015;314(21):2263-2270. doi:10.1001/jama.2015.15553 [PubMed] [CrossRef] [Google Scholar]
JAMA Netw Open. 2019 Mar; 2(3): e190526.Published online 2019 Mar 22. doi: 10.1001/jamanetworkopen.2019.0526PMCID: PMC6583298 PMID: 30901040Christophe Z. Guilmoto, PhD1 and Alexandre Dumont, MD, PhD1
Nielsen TF,Hökegård KH. Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol 1983;146(8):911–916. Crossref, Medline, Google Scholar
Rivlin ME, Carroll CS Sr, Morrison JC. Infectious necrosis with dehiscence of the uterine repair complicating cesarean delivery: a review. Obstet Gynecol Surv 2004; 59:833–837
Auh YH, Rubenstein WA, Schneider M, Recker JM, Whalen JP, Kazam E. Extraperitoneal paravesical spaces: CT delineation with US correlation. Radiology 1986;159(2):319–328. Link, Google Scholar
Rodgers SK, Kirby CL, Smith RJ, Horrow MM. Imaging after cesarean delivery: acute and chronic complications. Radiogr. 2012; 32(6):1693–1712.
Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. Bri J Org Gynocol 2001; 108:927–930
Sadan O, Golan A, Girtler O. Role of sonography in the diagnosis of retained products of conception. J Ultrasound Med. 2004; 23:371–374
Weydert JA, Benda JA. Subinvolution of the placental site as an anatomic cause of postpartum uterine bleeding: a review. Arch Pathol Lab Med. 2006; 130:1538–1542
Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv 2005; 60:761–767 Paspulati RM, Dalal TA. Imaging of complications following gynecologic surgery. Radio Graphics. 2010; 30(3):625–642Shamash AH, Ahmed AG, Abdel Latif MM, Abdullah SA. Routine postpartum ultrasonography in the prediction of puerperal uterine complications. Int J Gynaecol Obstet. 2007; 98:93–99
Ustunyurt E, Kaymak O, Iskender C, Ustunyurt OB, Celik C, Danisman N. Role of transvaginal sonography in the diagnosis of retained products of conception. Arch Gynecol Obstet. 2008; 277:151–154
Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, Ceylan Y. Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases. Taiwan J Obstet Gynecol. 2010 Dec 1;49(4):425–431. doi: 10.1016/S1028-4559(10)60093-9.
Rodgers SK, Kirby CL, Smith RJ, Horrow MM (2012) Imaging after cesarean delivery: acute and chronic complications. Radiograp. 32(6):1693–1712.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareEffect of Tibial Length Discrepancy on the Pelvic List During Human Gait
English149153Shaw DEnglish Andrabi SMHEnglishIntroduction: Tibial length discrepancy (TLD) is an anatomical leg length discrepancy in which tibia length differs in the same individual. Current literature has not documented the TLD as the source of discrepancy for studying the biomechanics of walking. Instead of TLD studies have considered the total leg length discrepancy for studying the biomechanics of walking. Objective: The objective of the study was to investigate the motion of the pelvis in the frontal plane during walking with various degrees of TLD. Settings and Design: Musculoskeletal modelling Material and Methods: The study used the Stanford-based software (Opensim) in which several levels of TLD were manipulated to a generic musculoskeletal model of gait and subsequently the simulations were carried out using the inverse kinematics tool. A data set of the pelvic lists during a complete gait cycle was generated which was exported to the database for statistical operations. Statistical Analysis Used: Mann Whitney’s U test for independent samples was used to test the difference between the groups with Tibial Length Discrepancy less than 2% (n=8) and TLD more than 2% (n=8). Results: The Pelvic list was significant (pEnglishBiomechanics, Gait Analysis, Musculoskeletal Modeling, OpenSim, Pelvis Kinematics, Tibial Length DiscrepancyINTRODUCTION
Tibial length discrepancy (TLD) is a type of anatomical leg length discrepancy in which the length of the tibia differs from the tibia of another leg.1 The difference in tibial length amounts to a discrepancy in the effective length of the whole leg which is generally called leg length discrepancy (LLD). Leg length discrepancy is common and can affect up to 70% of the population with varying degrees of discrepancy.2,3 There is enough evidence that LLD can develop deviant patterns during gait which are known to be the underlying causes of various musculoskeletal problems.4,5,6
Leg length discrepancy has been extensively studied during gait with a focus to understand the pathomechanics of the condition. The majority of the studies have investigated the condition by inducing a heel lift or an insole to acutely simulate leg length discrepancy(LLD) with lower limb kinematics and kinetics being the most sought out.7-15 However very little attention has been put to understanding the kinematics of the pelvis.
The pelvic list has been reported to be a common strategy in subjects with LLD. During static standing, it was found that LLD caused significant pelvic obliquity.16 However during walking the dynamics of pelvis kinematics get increasingly complex with the literature providing contradictory findings. Furthermore, the studies that have looked at the pelvis motion of LLD have shown no regard to whether the discrepancy lies in tibial length or femoral length.17,18 Thus a comprehensive understanding of the pelvic list is needed to clearly understand how TLD affects the biomechanics of a person during gait.
We took an alternative approach in this study by adopting musculoskeletal modeling using a Stanford-based software program (OpenSim). The musculoskeletal modeling provides the flexibility of manipulating the length of the bones and thus enables us to study the effect of TLD on the kinematics of the human body during gait, whilst also controlling for the individual differences.
MATERIAL AND METHODS
The simulations were carried out in Opensim (version 4.1) software program. The tibia length was manipulated in the 2392 model with 0.25 percentage increments to produce a total of 16 levels of TLD ( Fig.1). The “inverse kinematic” tool was used to generate the plot for the pelvic list for the selected levels of TLD during a gait simulation.
Statistical Analysis
The Mann-Whitney’s U for independent samples was used to test the difference between the two groups (n=16) of data which were produced by splitting the data set at the median. The value pEnglishhttp://ijcrr.com/abstract.php?article_id=3974http://ijcrr.com/article_html.php?did=3974
Shapiro F. Developmental patterns in lower-extremity length discrepancies. J Bone Joint Surg Am. 1982 Jun;64(5):639–51.
Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects, and clinical significance. Chiropr Osteopat. 2005 Jul 20;13:11.
Maske S, Kamble P. Anthropometric study of bilateral variability and percent directional asymmetries of thigh bones of Marathwada region. Int J Curr Res Rev. 2012;4(19):122–7.
Rannisto S, Okuloff A, Uitti J, Paananen M, Rannisto P-H, Malmivaara A, et al. Leg-length discrepancy is associated with low back pain among those who must stand while working. BMC Musculoskelet Disord. 2015 May 7;16:110.
Murray KJ, Molyneux T, Le Grande MR, Castro Mendez A, Fuss FK, Azari MF. Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine. J Manipulative Physiol Ther. 2017 Jun;40(5):320–9.
Papaioannou T, Stokes I, Kenwright J. Scoliosis associated with limb-length inequality. J Bone Joint Surg Am. 1982 Jan;64(1):59–62.
Kim Y, Jo PDS, Kwon YBJ. Effects of Artificial Leg Length Discrepancies on the Dynamic Joint Angles of the Hip, Knee, and Ankle During Gait. 2019;14(1):53–61.
Azizan NA, Salhani DA, Basaruddin KS, Salleh AF, Rusli WMR, Sulaiman AR. Leg Length Discrepancy Effects on Range of Motion in Lower Limb During Walking. Int J Engg Techn. 2018 Nov 30;7(4.30):374–6.
Azizan NA, Basaruddin KS, Salleh AF, Sulaiman AR, Safar MJA, Rusli WMR. Leg Length Discrepancy: Dynamic Balance Response during Gait. J Healthcare Engg. 2018 Jun 10;2018:1–9.
Sheha ED, Steinhaus ME, Kim HJ, Cunningham ME, Fragomen AT, Rozbruch SR. Leg-Length Discrepancy, Functional Scoliosis, and Low Back Pain. J Bri Ser Rev. 2018 Aug;6(8):e6.
Resende RA, Kirkwood RN, Deluzio KJ, Cabral S, Fonseca ST. Biomechanical strategies were implemented to compensate for mild leg length discrepancy during gait. Gait Posture. 2016 May;46:147–53.
Needham R, Chockalingam N, Dunning D, Healy A, Ahmed EB, Ward A. The effect of leg length discrepancy on pelvis and spine kinematics during gait. Stud Health Tech Inform. 2012;176:104–7.
White SC, Gilchrist LA, Wilk BE. Asymmetric limb loading with true or simulated leg-length differences. Clin Orthop Relat Res. 2004 Apr;(421):287–92.
O’Toole GC, Makwana NK, Lunn J, Harty J, Stephens MM. The effect of leg length discrepancy on foot loading patterns and contact times. Foot Ankle Int. 2003 Mar;24(3):256–9.
Kakushima M, Miyamoto K, Shimizu K. The effect of leg length discrepancy on spinal motion during gait: three-dimensional analysis in healthy volunteers. Spine. 2003;28(21):2472– 2476.
Swaminathan V, Cartwright-Terry M, Moorehead JD, Bowey A, Scott SJ. The effect of leg length discrepancy upon load distribution in the static phase (standing). Gait Posture. 2014 Sep;40(4):561–3.
Bangerter C, Romkes J, Lorenzetti S, Krieg AH, Hasler C-C, Brunner R, et al. What are the biomechanical consequences of a structural leg length discrepancy on the adolescent spine during walking? Gait Post. 2019 Feb;68:506–13.
Needham R, Chockalingam N, Dunning D, Healy A, Ahmed EB, Ward A. The effect of leg length discrepancy on pelvis and spine kinematics during gait. Stud Health Techn Inform. 2012;176:104-7.
Gurney B, Mermier C, Robergs R, Gibson A, Rivero D. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am. 2001 Jun;83(6):907-15.
Wretenberg P. Hip joint load about leg length discrepancy. MDER. 2008 Aug;13.
Morscher E. Leg Length Discrepancy the Injured Knee Etiology and Pathophysiology of Leg Length Discrepancies. In: Hungerford DS, editor. Leg Length Discrepancy The Injured Knee. Berlin, Heidelberg: Springer; 1977 . p. 9–19.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Case Report of Severe Aortic Stenosis in Pregnancy
English172174Madan AnitaEnglish Kaur JagdeepEnglish Yadukula YashasviniEnglish Neki NSEnglishIntroduction: Aortic stenosis in pregnancy is rare. It may be congenital or rheumatic in etiology. Stenosis of mild to moderate grade is tolerated well in pregnancy, but severe stenosis with a valve area of EnglishCesareansection, Heart disease, Pregnancy, Severe aortic stenosis, Valvular disease, Pulmonary hypertensionINTRODUCTION :
Cardiovascular disease is one of the causes of maternal morbidity and mortality. With advancements in medicine and surgery, more women with acquired and congenital heart diseases are reaching childbearing age and desiring pregnancy.1Valvular heart diseases due to rheumatic heart disease remain the leading cause of maternal cardiovascular morbidity and mortality.
In women of childbearing age, AS is secondary to congenital bicuspid valve, which may be associated with coarctation of aorta. Patients with AS develop left ventricular hypertrophy to generate the increased pressure necessary to pump blood through noncompliant valvular leaflets. Eventually, the left ventricular function fails to overcome the resistance to flow and patient develops CHF. Adverse maternal and fetal outcomes increase with severity of AS. The World Health Organisation (WHO) classification divides women with congenital and acquired heart disease into four classes, ranging from low risk to high risk. Women who fall into class IV i.e. in which there is extremely high risk of maternal morbidity and mortality, pregnancy is contraindicated in them such as Pulmonary arterial hypertension of any cause, previous history of peripartum cardiomyopathy, severe mitral and aortic stenosis, Marfans syndrome and severe coarctation.2Women with severe AS are more likely to develop heart failure and atrial arrhythmias and have adverse fetal outcomes such as preterm birth and low birth weight.3. Multidisciplinary approach before and throughout pregnancy is required, because of the complexity of valvular heart diseases.4Cesarean section should be considered in severe particularly symptomatic aortic stenosis.
On account of its rarity and associated maternal complications, pregnancy with severe aortic stenosis needs effective management. We present a case of G3P2L2 with a known severe aortic stenosis and mild PAH.
CASE REPORT:
A 28-year-old G3P2L2 at 39 weeks period of gestation reported to outpatient unit of Department of Obstetric and Gynaecology, Government medical college, Amritsar referred from Civil Hospital, Beas with complaints of on and off chest pain, breathlessness and palpitations since 2months.
WHO RISK CLASSIFICATION :
No detectable increased risk of maternal mortality and no/mild increase in morbidity.
Small increase risk of maternal mortality or moderate increase in morbidity.
Markedly increased risk of maternal morbidity and mortality. Counselling of the experts required. Intensive cardiac and obstetric monitoring is required throughout pregnancy, delivery and puerperium.
Extremely high risk of maternal morbidity and mortality. Pregnancy is contraindicated in this women. Termination of pregnancy is advised if pregnancy occurs. If there is continuation of pregnancy, care as class III.
On General examination, pallor was present. No signs of icterus, cyanosis, clubbing, lymphadenopathy and oedema present. The a wave in Jugular venous pressure was raised. Patient had previous history of similar complaints in previous pregnancy but did not get any medical help. Family history was non-significant.Vitals of the patient were BP: 110/70 mm Hg PR: 85/min (regularly regular) with slow raising peak pulse, RR: 20/min SpO2= 94% at room air with no signs of distress and was afebrile. Dyspnea was of NYHA class II (on increased exertion). Systemic examination of the patient revealed a palpable thrill over the carotid arteries, more commonly on the left, Pan systolic murmur on auscultation at Aortic area, an audible S4 at the apex due to left ventricular hypertrophy and elevated left ventricular end diastolic pressure. Bilateral air entry was normal with no added sounds. Examination of other systems revealed normal findings.
A 12 lead ECG and a 2D echo of the patient was done.
ECG findings showed left axis deviation with left ventricular hypertrophy with left ventricular strain.
Echo findings revealed mild MR, mild TR, severe AS with area of valve 0.9cm2, mean gradient of 42mm Hg and mild PAH.
Chest X-ray findings were unremarkable.
Class I: No limitation of physical activity.
Class II: Slight limitation of physical activity.
Class III: Marked limitation of physical activity.
Class IV: Dyspnea at rest.
NYHA : New York Heart Association.
Patient had spontaneous onset of labor. She was managed by a team of specialists including obstetricians, cardiologist and intensivists. A propped up position with oxygen support was given. Restricted fluid was infused (75ml/hr). Vitals of the patient like BP, PR and auscultation of lung bases were monitored every half hourly. Antibiotic prophylaxis of Inj. Ceftriaxone 1gm IV was given. Second stage of labor was cut short with forceps delivery. Neonatologist was present during the delivery. Baby cried immediately after birth and was kept under observation in NICU. Active management of third stage of labor was done. Inj. Furosemide 40mg IV was given after delivery of the placenta to avoid pulmonary oedema. Tab. Misoprostol 800mcg was kept per rectum to prevent postpartum hemorrhage.
Patient was closely monitored for 24 hours after delivery in labor room. The patient and newborn were discharged in satisfactory condition. Counseling regarding the correction of the stenosis by surgery and contraception was done prior to discharge.
DISCUSSION:
Normal area of aortic valve is: 2-3cm2.
Size of Englishhttp://ijcrr.com/abstract.php?article_id=3975http://ijcrr.com/article_html.php?did=3975
Ntiloudi D, Giannakoulas G, Parcharidou D, Panagiotidis T, Gatzoulis MA, Karvounis H. Adult congenital heart disease: a paradigm of epidemiological change. Int J Cardiol. 2016 Sep 1;218:269-74.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018 Sep 7;39(34):3165-241.
Orwat S, Diller GP, van Hagen IM, Schmidt R, Tobler D, Greutmann M, et al. Risk of pregnancy in moderate and severe aortic stenosis: from the multinational ROPAC registry. J Am Coll Cardiol. 2016 Oct 18;68(16):1727-37.
Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, et al. Management of pregnancy in patients with complex congenital heart disease: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2017 Feb 21;135(8):e50-87.
Regitz-Zagrosek V, Gohlke-Ba C, Iung B, Pieper PG. Management of cardiovascular diseases during pregnancy. Current Probl Card. 2014 Apr 1;39(4-5):85-151.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Study of Mental Health of Ph.D. Students in Relation to Research Environment and Other Demographic Variables in Haryana State Universities
English175180Madhuri HoodaEnglish Menka ChoudharyEnglishIntroduction: Mental Health is a very comprehensive term that different psychologists, psychiatrists, psychopaths, health experts have tried to define in their unique ways. But a single and best definition is well-nigh possible. The study of mental health has become the chief course of study of modern time in almost all the countries across the globe, especially in India, a fast-developing economy. Initially, a Ph.D. student joins the doctoral program with zeal to learn, discover, and contribute to the stock of knowledge. He/she does so out of creative urges, hidden potential and sometimes out of unemployability and good incentives provided by funding agencies. But afterwards, the existing research culture and practices impose on him several limitations and the student does not get the expected and required environment, guidance and support, supervision, etc. All this continue to burden his mind and consequently, the student starts showing declined motivation and interest in the study which further result in depression and fear of failure. Aim: In this study, the researcher wants to study the mental health of students about the research environment and other demographic variables in Haryana state universities. Methodology: A sample of 500 PhD students were taken by using random sampling. A self-prepared questioner in the form of google form was used for data collection. Result: The result of the study revealed that gender and year of registration were significantly affected mental health. On the other hand, it also revealed that marital status, stream and gender of supervisor was not significantly affected mental health. The study also showed a positive significant correlation between mental health and the research environment. Conclusion: After going through the research result investigator conclude that for improving the mental health of students, every institute should organise workshops, seminars and counselling sessions.
EnglishDemographical variables, Haryana State universities, Mental health, PhD students, Research environmentINTRODUCTION:
As it is not a hidden fact that the 21st century is known for the growth and expansion of science and technology in almost all walks of life on this globe. This rapid and unplanned invention and expansion of technologies, especially internet and communication technologies, has not come for India less than a thunder-stroke. Not only the technological advancements, but the unplanned and unpredicted explosion in higher education and higher education institutions have left India shocked. Undoubtedly, quality of education and then research at higher education institutions are certain to improve the quality of life, the standard of living, and ethics of life and to make India a global knowledge economy.1 Equally worth noticing is that India is the youngest nation on the globe. Though full of cultural, regional, linguistic diversity, India has in abundance creative, young and aspiring minds. Higher education is the one way to channelize their creative urges and impulses through qualitative education and research to yield productive outcomes that will certainly contribute towards the prosperity of our nation. For the effective growth of a nation, Mental Health is a very comprehensive term that different psychologists, psychiatrists, psychopaths, health experts have tried to define in their unique ways. But a single and best definition is well-nigh possible. The study of mental health has become the chief course of study of modern time in almost all the countries across the globe,2 especially in India, a fast-developing economy. The progress and prosperity of a nation directly depend upon the overall health of its citizen, of which psychological makeup is the main component. It becomes inevitable for stakeholders in all circumstances to ensure sound mental health for its incoming generation by providing better education and health care services. The present paper as it studies the relationship between mental health and research environment, is significant from many points of view, especially for improving the ongoing mechanical and stereotyped research culture. Research, as it is regarded inevitable in a nation’s development, is an intellectual activity that is incomplete without the researcher of a sound mental makeup.3 Therefore, it becomes more pertinent to understand the meaning of this important variable of the study.
The mental health of PhD. Students:
It is pre-assumed that a student looking forward to pursuing a PhD is likely to display outstanding general and research aptitude. He/she is also expected to possess sound physical and mental health. Undertaking research projects is not everyone’s cup of tea but it demands on the part of the researcher a high level of calibre, interest and enthusiasm, zeal to discover, untiring efforts, the smart and well-thought economy of resources. Searching and discovering problems, exploring and explaining the day and night keep a researcher in a state of constant turmoil, stress and strain, anxiety and other unwanted psychological fears.4 A research may feel at times broken down and depressed. Such a situation may take him/her out of routine making him ill or uneasy. A researcher with sound mental makeup can easily cope-up with incoming stress and depression and can keep himself self-managed. Research outcomes are also a function of the researcher’s well-being, especially emotional and psychological ones. Research is a very systematic, organised, well planned and problem-solving activity and is likely to produce outcomes that will solve problems of locality, society, nation, environment and economy and humanity at large.5 In brief, we can say that the mental health of a PhD student is of great importance and can never be overlooked as it may result in the wastage of resources along with personal harm to the student.6
The rationale of the Study:
There have been many studies on mental health and well-being of different stakeholders of education namely students, teachers, managers, administrators, etc. and sufficient literature exists that could guide a researcher in getting hold of the concept of mental health, possible causes, measures to reduce the mental disorders and so on. It is also true that there is a great shortage of studies regarding the mental health of PhD students about their research environment. Equally worth mentioning is the fact that, in India, there is a terrible dearth of academic guidance and counselling at the university level, especially at the research level. In the lack of suitable literature and counselling facilities, researchers have to undergo a variety of mental disorders ranging from slight fear and depression to severe health malfunctioning. There is ample evidence that many students undergoing research have to face different hardships during their studies in terms of academic load, lack of finance, imposed decisions, emotional breakdown, mental blackmailing, sexual harassment, and many more. These issues should be given due focus and share and it is high time when multiple studies should be conducted for the well-being of researchers at various levels of education, especially at the PhD level. The present paper aims at exploring the concept of mental health and research environment and their possible co-relationship on different demographic variables with sufficient well-proven evidence. The result of the studies could provide the base for academic guidance and counselling facilities and many newer future studies. It will contribute toward new knowledge and literature and enrich the existing literature over the issue of mental health of PhD students. The results of the project study will provide a professional ground for the study, classification, treatment of mental health of PhD students and provide an insight to plan strategies to improve and build up an effective research environment.
OBJECTIVES OF THE STUDY:
To study and compare the mental health of PhD students based on gender.
To study and compare the mental health of PhD students based on the stream.
To study and compare the mental health of PhD students based on marital status.
To study and compare the mental health of PhD students based on year of registration.
To study and compare the mental health of PhD students based on the gender of the supervisor.
To study the relationship between Research Environment and Mental Health of PhD students.
HYPOTHESIS OF THE STUDY:
There is no significant difference between the mental health of PhD students based on gender.
There is no significant difference between the mental health of PhD students based on the stream.
There is no significant difference between the mental health of PhD students based on marital status.
There is no significant difference between the mental health of PhD students based on the year of registration.
There is no significant difference between the mental health of PhD students based on the gender of the supervisor.
There is no significant relationship between the Research Environment and the Mental Health of PhD students.
REVIEW OF THE RELATED LITERATURE:
Nami, Nami and Eishani conducted a study on “The Students' Mental Health Status” and found that 37.37% of students having mental disorders.7Irfan carried out a study on “Mental health and factors related to mental health among Pakistani university students” and revealed a positive correlation between mental health and another variable like extraversion, father’s warmth, self-esteem along significant gender differences. This study also showed that the mental health of male students was more than female students and the students having parents with the lowest income also showed lower mental health levels.8Peterse carried out a study on “Addressing the mental health crisis among doctoral researchers”. This study revealed that early-career students faced significant mental health issues and the study also recommended some measures for improving the mental health of doctoral students.9Hazell, et al. conducted a study on “Understanding the mental health of doctoral researchers: A mixed-methods systematic review with meta-analysis and meta-synthesis.” This study showed that PhD students having significantly higher stress than the normal population and the female students were at more risk than the male students. This study also revealed a positive relationship between students and supervisor is helpful for positive mental health.10Mattijssen studied “In the eye of the storm: The mental health situation of PhD candidates” during lockdown. The result of the study revealed that 47% of candidates found on the risk of developing the psychiatric disorder and More than one-third of the total sample i.e. 39% showed symptoms related to burnout.11
RESEARCH METHODOLOGY, SAMPLING AND TOOL:
In the given study the investigator used a survey method so a sample of 500 PhD students from Haryana state universities was taken by using simple random sampling (lottery method). The tool used in this study was prepared by investigators. This tool has three basic parts i.e., demographic information, mental health-related questions, and research environment-related questions. The self-prepared questionnaire was shared with scholars by using Google Forms.
RESULT AND INTERPRETATIONS:
1.Objective: To study and compare the mental health of PhD students based on gender.
Interpretation: As the table 1 & figure 1 clearly show that t-value for the mental health of male PhD students and the mental health of female PhD students is 5.19, which is significant at 0.01 level of significance with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on gender.” is rejected. The difference between both means is trustworthy and the mean of male PhD students is significantly high. It shows that male students have a high level of mental health than their counterparts.
Interpretation: As table 2(a), 2(b) & figure 2 clearly show that the F-value for the mental health of PhD students based on stream is 2.61, which is not significant at 0.05 level of significance with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on the stream.” is accepted. It means the level of mental health does not affect by the type of stream.
Interpretation: As table 2(a), 2(b) & figure 2 clearly show that the F-value for the mental health of PhD students based on stream is 2.61, which is not significant at 0.05 level of significance with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on the stream.” is accepted. It means the level of mental health does not affect by the type of stream.
3Objective: To study and compare the mental health of PhD students based on marital status.
Hypothesis: There is no significant difference between the mental health of PhD students based on marital status.
Interpretation: As table 3 & figure 3 clearly show that the t-value for the mental health of married PhD students and the mental health of unmarried PhD students is 0.76, which is not significant at 0.05 level of significance with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on marital status.” is retained. It revealed that the marital status of students does not affect the level of mental health.
Interpretation: As table 4(a), 4(b) & figure 4 clearly show that the F-value for the mental health of PhD students based on the year of registration is 18.28, which is significant with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on the year of registration.” is rejected. The difference between the mean is trustworthy and showed that third-year students have a lower level of mental health. On the other hand, fourth-year students have a higher level of mental health.
Hypothesis: There is no significant difference between the mental health of PhD students based on the gender of the supervisor.
Interpretation: As table 5 & figure 5 clearly show that the t-value for the mental health of PhD students under the supervision of a male supervisor and the mental health of PhD students under the supervision of a female supervisor is 1.66, which is not significant at 0.05 level of significance with df 499. So, the null hypothesis, “There is no significant difference between the mental health of PhD students based on the gender of supervisor.” is retained. It revealed that the gender of the supervisor does not affect the level of mental health of students.
6 Objective: To study the relationship between Research Environment and mental health of PhD students.
Hypothesis: There is no relationship between Research Environment and mental health of PhD students.
Interpretation: Table 6 & figure 6 depicted that the relationship between research environment and mental health is significant. The calculated value for this is 0.509 which is larger than the critical value (i.e., 0.354 at 0.01 level of significance). So, the hypothesis, “There is no relationship between Research Environment and mental health of PhD students” is rejected. The result revealed a positive co-relationship between the research environment and the mental health of the students.
Discussion:
After going through this research, investigators found a significant difference in the level of mental health of PhD students based on gender and year of registration. Male students are more healthy than female students and fourth-year students are more mentally healthy than their counterparts. This finding is also in agreement with the study conducted by Irfa and Hazell. This research also revealed that stream, marital status and gender of supervisor does not affect the mental health of students. The finding related to marital status is found in disagreement with the study conducted by Gaur which endorses that marital status significantly affects mental health.11 A positive relationship between mental health and research environment was found in this research. This result agrees with the study conducted by Deb which examine the depression among Indian students and its association with perceived university academic environment, living arrangement and personal issues.12
Conclusion:
The overall conclusion of this research revealed that mental health is the basic pillar of any research and only a person having good mental health can contribute to health research. So, every institution should organise some workshops, seminars etc to aware people for positive mental health. Institutions should provide mental health counselling to students on a compulsory basis.
Acknowledgement: Thank you to the Students’ Welfare Department (DSW) for their funding to support this work; and thank you to Maharshi Dayanand University, Rohtak (Hr.) India for providing fund under Radhakrishnan fund of DSW for project titled “A Study of Mental Health of PhD students concerning Research Environment and other demographic variables in Haryana State Universities.”
Conflict of Interest: There is no conflict of interest.
Source of funding: This paper has been published under the funding provided by DSW, Maharshi Dayanand University, Rohtak-124001, Haryana (India).
Contribution of authors: The Project Investigator (Dr. Menka Choudhary) worked with all the administrative and academic work with the help of Co-PI (Dr. Madhuri Hooda). The administrative work included submission of the project proposal to the funding Department of the institute i.e under Radhakrishnan Fund of DSW, M.D.U. Rohtak, giving a presentation for the proposal in Departmental Committee, receiving funds to carry out the project, entire expenditure to carry out the project. The academic work included; reviewing the related literature and working for delimiting the study, framing design of the study, data collection and analysis of data and reporting of findings was done by PI jointly with Co-PI.
Englishhttp://ijcrr.com/abstract.php?article_id=3977http://ijcrr.com/article_html.php?did=3977
Bland, C, Ruffin IV, Mack. (1992). Characteristics of a productive research environment: A literature review. Academic medicine: Journal Ame Med Coun. 67. 385-97. 10.1097/00001888-199206000-00010.
Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J., Sartorius, N. (2015). Toward a new definition of mental health. World psychiatry: Official J WPA, 14(2), 231–233. https://doi.org/10.1002/wps.20231
Guthrie S, Lichten CA, Van Belle J, Ball S, Knack A, Hofman J. Understanding mental health in the research environment: A Rapid Evidence Assessment. Rand Health quarter. 2018; 7(3): 2.
Leighton, Sharon, Dogra, Nisha. (2009). Defining mental health and mental illness.
Katia L, Anseel F, Beuckelaer AD, Heyden JV. Work organization and mental health problems in PhD students. Res Policy. 2014; 46(4), 868-879.
Slobodan L, Sosic B. Environment and mental health. Psychiatria Danubian. 2014;24 (3). 272-6.
Nami Y, Nami MS, Eishani KA. The Students' Mental Health Status. Procedia - Social and Behavioral Sciences.2014;114: 840 – 844.
Irfan U. Mental health and factors related to mental health among Pakistani university students (Doctoral Thesis) Christchurch, New Zealand. 2016.
Peter Y, Lasser J, Caglio G, Stoltmann K, Rusiecka D, Schmidt M. Addressing the mental health crisis among doctoral researchers. The elephant in the Lab.2018; 4(3): 451. https://doi.org/10.5281/zenodo.1402423
Hazell CM, Chapman L, Valeix SF, Roberts P, Niven JE, Berry C.Understanding the mental health of doctoral researchers: a mixed-methods systematic review with meta-analysis and meta-synthesis. Syst Rev. 2019; 9: 197. https://doi.org/10.1186/s13643-020-01443-1
Mattijssen, L.M.S., Bergmans, J. E., Weijden, I.C.M.V., Teelken, J.C. (2021). In the eye of the storm: the mental health situation of PhD candidates. Perspect Med Edu.2021;10: 71–72. https://doi.org/10.1007/s40037-020-00639-4
Deb S, Banu PR, Thomas S, Vardhan RV, Rao PT, Khawaja N. Depression among Indian university students and its association with perceived university academic environment, living arrangements and personal issues. Asian J Psychiar.2016; 23, 108-117. DOI: 10.1016/j.ajp.2016.07.010
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareStudy of Biological Efficiency Biological Active Additive "Avena-Uz"
English181183Farmanova Nodira TakhirovnaEnglish Nurullayeva Dilobar Khamid QiziEnglish Sultanova Rano KhakimovnaEnglish Abdurahmonova Sabohat AbdugabarovnaEnglishIntroduction: To expand the range of domestic biologically active additives, the composition of dietary supplements "Avena-Uz" was developed, which includes dry extracts of sowing oats and rose hips. As a result of the research, the quality standards of the studied dietary supplement were established. Aims: Study of the specific effectiveness of "Avena-Uz". Methodology: The study of choleretic activity was carried out according to the generally accepted method of N.P. Skakun and A.N. Oleinik Results: The research results showed that the rate of bile secretion in rats receiving choleretic dietary supplements compared with healthy animals for 4 hours of the experiment significantly increased on average by 25.6%. At the same time, there was an increase in the content of bile acids in bile by 39.8% and cholesterol by 3.1% in comparison with the control animals. Conclusions: The study of the specific efficacy of "Avena-uz" showed that the dietary supplement can stimulate the exocrine function of the liver, and also normalizes cholesterol, triglycerides in the blood, the content of digestive enzymes - alkaline phosphatase and amylase.
EnglishBAA (Biologically active additives), Control group, Efficiency, Oat extract, Bile cholesterolINTRODUCTION
All over the world, in recent years, there has been an increase in interest in drug-free methods of prevention and treatment of the body. At present, biologically active additives can be attributed to a fairly large part of the pharmaceutical industry - compositions of biologically active substances intended for direct intake with food or introduction into food products.2,3,4 Not being drugs, they are used to improve and normalize the function of organs, reduce the risk of diseases, are used as enterosorbents, etc.5,6,7 To expand the range of domestic biologically active additives at the department of the Tashkent Pharmaceutical Institute, a composition of dietary supplements "Avena-uz" was developed, which includes dry extracts of oats and rose hips.8
As a result of the research, the quality standards of the studied dietary supplement were established, which served as the basis for the preparation of the corresponding regulatory documentation.3,5
To recommend the developed dietary supplement "Avena-uz" in medical practice, an assessment of its biological effectiveness was carried out.
EXPERIMENTAL PART
The effectiveness of the Avena-uz dietary supplement was evaluated on non-fertile white rats with a weight of 200-210 g. Animals were kept under vivarium conditions on a standard diet. 24 hours before the start of the experiment, the animals were deprived of food. The experimental animals were divided into 2 groups of 6 animals. Animals of the first group (control) were injected intraventricularly with purified water in a volume of 1 ml per 200 g. Animals of the second group (experimental) were treated with BAS bile "Avena-uz" at a dose of 5 ml/kg for 30 days. After 30 days, the bile function of the liver was examined: the abdominal cavity was opened, the common bile duct of the addicted animals was isolated and cannulated. The choleretic effect of the preparation was judged by the total amount of bile isolated, the concentration and the number of its components (cholesterol and total bile acids).2,4
RESULTS
The animals of the experimental group remained active, tidy, willingly ate food, the hair was smooth, shiny, and the animals responded adequately to external stimuli. The results of the experiment are shown in Table 1.
The research results showed that the rate of bile secretion in rats receiving choleretic dietary supplements compared with healthy animals for 4 hours of the experiment significantly increased on average by 25.6%. At the same time, there was an increase in the content of bile acids in bile by 39.8% and cholesterol by 3.1% in comparison with the control animals. Consequently, the introduction of dietary supplements stimulated bile secretion, which is expressed not only in an increase in bile secretion but also in an increase in the content of its main components. The morphological composition of peripheral blood (the number of erythrocytes, leukocytes, platelets, haemoglobin level), biochemical parameters (the level of cholesterol, triglycerides, alkaline phosphatase, amylase) were studied before the introduction, as well as 30 days after the start of the drug administration. The counting of blood cells was performed on an automatic blood counter. Biochemical parameters and enzyme activity were determined using a biochemical semi-automatic analyzer.
The complex laboratory data obtained in each observation from rats treated with dietary supplements were compared with the data of control animals. During the experiment, no statistically significant differences were found in the number of erythrocytes, leukocytes, platelets, haemoglobin levels in animals that received the studied dietary supplement compared to the control.
As can be seen from the table, intragastric administration of dietary supplements to rats daily for 30 days reduces the level of cholesterol and triglycerides in the blood of experimental animals.
CONCLUSION
Thus, the study of the specific effects of the biologically active supplement "Avena-uz" showed that biologically active additives have the property to stimulate the external secretive function of the liver, does not show statistically significant differences in the number of red blood cells, white blood cells, platelets, haemoglobin levels in animals.
The biologically active supplements received compared to the control, as well as normalizes the cholesterol, triglycerides in the blood, the content of digestive enzymes - alkaline phosphatase and amylase.
ACKNOWLEDGEMENT
The authors are grateful for the help in carrying out this study to the head of the pharmaceutical enterprise "Novopharmkomplekt" Nurullaev A.A. and Ibragimov K.A.
Conflict of Interest:
The authors declared that there is no conflict of interest.
Source of Funding: NIL
Contribution:-
Farmanova NT. - development of the composition of the biologically active additive, writing and correction of the article.
Nurullaeva DH.- development of composition and technology of biologically active additive, preparation of samples.
Sultanova RK - conducting studies on the effectiveness of a biologically active additive, interpreting the results.
Abdurakhmanova SA - conducting studies on the effectiveness of a biologically active additive.
Englishhttp://ijcrr.com/abstract.php?article_id=3978http://ijcrr.com/article_html.php?did=3978
Bespalov VG, Nekrasova VB, Iordanishvili AK. Modern view of biologically active food additives and their use for therapeutic and prophylactic purposes in clinical medicine. Med. XXI Century. 2007; (9): 86-94.
Mavlanov Sh.R., Khakimov 3.3., Rakhmanov A.Kh. The influence of lesbohol on the glycogen content in the liver during its acute toxic lesion. Inf Jimmu Pharmac. 2017; (1):129-134.
Severina AS, Shestakova MV. The place of dietary supplements in the treatment of diabetes mellitus. Diab. 2007; (2):147-151.
Stefanov AV. Preclinical studies of drugs. Avic. 2002; (7):356-373.
Farmanova NT, Pulatova LT. To the issue of studying the quality and safety indicators of a biologically active additive of choleretic action. III International Scientific and Practical Conference «Harmonization of Approaches to Pharmaceutical Development». 2020:177-178.
Farmanova NT, Nurullaeva DKh. On the question of studying the chemical composition of the biologically active additive "Avena-uz". J Izv GSTU. 2020; 4(4):288-289.
Johnson M, Olufunmilayo LA, Anthony DO, Olusoji EO. Hepatoprotective Effect of Ethanolic Leaf Extract of Vernoniaamygdalina and Azadirachtaindica against Acetaminophen-Induced Hepatotoxicity in Sprague-Dawley Male Albino Rats. Am J Pharmac Sci. 2015; 3(3):79-86.
Rane J, Kadhai R, Bakal RL. Liver diseases and herbal drugs: A review. J Innov Pharm Bio Sci. 2016;13 (2):2349-2759.
Irani R, Khaled KL. Quantitative Analysis of Nutrients in the Gum Exudates of Acacia nilotica. Int J Cur Res Rev. 2020;12(08):11.
Okamoto T, Kajino K, Hino O. Hepatoprotective drugs for the treatment of virus-induced chronic hepatitis: from hyper carcinogenic state to hypo-carcinogenic state. J Pharm. 2001 Nov;87(3):177-80. doi: 10.1254/jjp.87.177. PMID: 11885965.
Wang FS, Fan JG, Zhang Z, Gao B, Wang HY. The Global Burden of Liver Disease: The Major Impact of China. Hepat. 2014; 60(6):2099-2108.
Kugaler Ganesan Parthiban, Balakrishnan Senthil Kumar, Ponnaiyah Ramajayam Institute of Science & Technology, Thanjavur, Tamil Nadu Rangasamy Manivannan and Natesan Senthil Kumar. Herbal drug comprehensive approach for treating liver disease and focus towards herbal medicine. Int J Cur Res Rev. 2021;13(03):60.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcarePerspectives of Using Artificial Intelligence in Preventing and Regulating COVID-19: A Letter to the Editor
English0101Harish Kumar BangaEnglishEnglishhttp://ijcrr.com/abstract.php?article_id=3979http://ijcrr.com/article_html.php?did=3979Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareInsights into the Developmental Journey of Robotic Medical Surgery
English0202Harish Kumar BangaEnglishEnglishIntroduction
Medical robotics has been in use for approximately 30 years. Robotic surgery is called “revolutionary” by many surgeons who value it for its many advantages, both real and potential. Its origin owes much to the weaknesses of the minimally invasive surgery (MIS) technologies that preceded it.
Robotic surgical operation yet clinical simulators hold dramatically modified the strategies because of the greater than having a whole bunch of common: each makes use of a mechanized interface as affords visible affected individual reactions among answer according to the strikes of the fitness care professional (although simulation additionally consists over touch feedback); every usage video show units after thinking out the development concerning the procedure; last, each utilizes personal computer software program reasons through which the health ponderable specialist interacts. Both utilized sciences are experiencing fast receiving or are regarded as like modalities that enable doctors to work in accordance with functioning more and extra tricky minimally invasive procedures even as enhancing affected individual safety.
Robotic surgeries are generally minimally invasive. This characteristic has been round prolonged previously than the beginning regarding robots. It is a widespread thought so encompasses dense standard procedures, such namely a laparoscopic cholecystectomy, and gall bladder excisions. The behavior refers to an approach so avoids lengthy cuts by means concerning deed concerning the physique through little (usually 1 cm) entrance incisions. Surgeons use long-handled devices to function over the interior of the body. Such operations are guided by the usage of viewing equipment referred to in conformity with endoscopes. These are skinny tubes together with a DigiCam linked according to the cease on such so much approves the healthcare professional in conformity with considering highly magnified real-time 3-dimensional pictures about the process internet site on line over a monitor. The contemporary benefits over the robotic surgical process embody higher accuracy, precision, dexterity, tremor corrections, scaled motion, and larger these days haptic corrective feedback. These benefits stop end result into extra profitable surgical procedures and smaller indispensable intersection cuts. Overall, the robotic buildings bear higher truth or directness than unbacked surgeons. Surgical robots are successful in accordance with the role of the surgical gear nearer according to the “right spot” and deviate a lot less out of the “right trajectory.” The robot's end-effectors do be a brush smaller than increased skills than an ethical hand. They perform file yet filter outdoors a surgeon's herbal limb briskness yet rescale motion after make bigger candidness yet reduce the chance because of error. Lastly, the robotic needs to keep in the surgeon's pace among undesired instructions via haptic feedback.
Researchers are formulating latter techniques in conformity with address job yet skill resistance. For example, the surgical robotic may additionally want in imitation of synchronically go together with a death coronary bravery such to that amount their supporter pace is suppressed according to zero. Another possible enhancement is the ability because of the robotic according to robotically Inure in conformity with the dynamical art arrest atop time so the sensitivity association on it tactics goes previous ethnic capabilities. Typically, the robotic surgical functions may be labeled as much each (i) supervisory-controlled, (ii) telesurgical, and (iii) shared-controlled. The supervisory-controlled method is near computerized concerning the ternary methods. The RoboDoc beside Integrated Surgical Systems Inc. is an occasion concerning a supervisory-controlled gadget ancient into orthopedic surgeries. After the overall merchant positions, the RoboDoc's bone-milling system at the right function inner the patient, the robotic mechanically cut the bone in conformity with virtually the honest measurement for the orthopedic implant.
Prior in accordance with the surgical procedure, the physician wants in imitation of put collectively the action through the planning yet registration phase. In the planning phase, photographs on the patient's frame are chronic in accordance with determining the proper surgical approach. Common imaging methods consist of laptop computer tomography (CT) scans, magnetic resonance imaging (MRI) scans, ultrasonography, fluoroscopy, and X-ray scans. Next, of the fixation phase, the fitness merchant ought in imitation of discovering the factors about the patient's corpse so much correspond in imitation of the photos constructed at the partial podium in the dodge phase. These factors are matched in imitation of a 3D model, who can be over to persimmon by way of using portraits considered by means of cameras or different real-time imaging strategies every via surgery. After the robotic find the amazing in the form of the mannequin yet reality, the surgical manner is performed.
The telesurgical strategy permits the surgical robotic to remain teleoperated, so is, operated out of a reach through an ethical surgeon. In practice, the robotic yet the healthcare expert are fully a doublet on meters apart. Tele-operation is additionally manageable all through big distances. However, issues certainly so period delays (i.e., telesurgical latencies) or the reachable bandwidth (i.e., the volume concerning facts so much perform lie transferred through soloist time) need after stand considered. The telesurgical method is ancient with the aid of course concerning the da Vinci Surgical System, which back according to stand invented by Philip S. Green then promoted with the aid of Intuitive Surgical Inc. This system in modern times dominates the surgical robotic market. Initially dubbed Mona (after Leonardo's Mona Lisa), the system used to be once rechristened the da Vinci Surgical Robot in 1999; among pursuance in conformity with Mr. Green “…in honor of the personality any had invented the advance robot.” Although da Vinci via no skill invented then manufactured an authentic robotic (credit because of as goes after Tesla), he made many drawings on a variety of mechanisms
The da Vinci System consists of ternary principal components: (1) a viewing then manipulate explain so much is back including the useful resource of the surgeon, (2) a blazing yet prescient cart so much holds the endoscopes and offers seen remarks yet (3) a surgical robot's manipulator side unit so consists regarding ternary or four arms, relying on the model. The units to that amount are devoted according to the palms are especially specialized. Functions because of to them correspond over clamping, cutting, suturing, plantain manipulation, cauterizing, etc. It takes a partial period because surgeons after reach used to according to the da Vinci System. According to a study, too along with a preliminary teaching program, supplied through Intuitive Surgical, such takes as regards 12–18 operations earlier than surgeons sense unembarrassed performing the procedure.
The shared-controlled method refers in conformity with the strategy via skill on which the robotic is no longer truly assignment teleoperated namely that execute determine out in accordance with standing up to the surgeons’ meant pace postulate it deems up to the expectation it would in modern times now not be beneficial. Typically, the labor residence is smashed on between a range of segments and the system behaves within a one-of-a-kind pathway primarily based completely over certain on a sort localization of accordance in imitation of safe, close, boundary, and forbidden classification. For example, salvo physician strikes a reducing device of the route concerning plantain as want according to at last now not be damaged, the robotic intention acts the stress haptic feedback as will improve higher as like the reducing system comes nearer after the fragile tissue. Indistinct words, here, scientific professional once more “feels” the digital instance over tissue up to expectation might also hold preprogrammed specs wonderful beyond the authentic adroitness namely properly as like rather one-of-a-kind localization in space.
Englishhttp://ijcrr.com/abstract.php?article_id=3980http://ijcrr.com/article_html.php?did=3980
Gifari MW, Naghibi H, Stramigioli S, Abayazid M. A review on recent advances in soft surgical robots for endoscopic applications. Int J Med Robot Comp Assist Surg. 2019;15(5):e2010.
Ginoya T, Maddahi Y, Zareinia K. A historical review of medical robotic platforms. J Robot. 2021;2021:6640031.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10HealthcareA Clinical Guide for Vertical Positioning of Bracket
English166171Rathi Amey JEnglish Ahmed S FayyazEnglish Kalladka GauthamEnglish Iyer KavithaEnglishIntroduction: Bonding in orthodontics is a major and important part of treatment and any error in this procedure creates an impact on the outcome of treatment, esthetics and function. Aim: The aim is to provide a clinical guide for vertical positioning of the bracket. Methodology: Brackets was positioned with help of an MBT Boone gauge on the right central incisor and checked with a bracket holder. This is reconfirmed with the MBT Boone gauge and vice versa with the bracket holder on the right central incisor. Result: This clinical innovation with the use of bracket holding plier helps prevent and minimizes the error of vertical positioning of brackets measured from the incisal edge. Conclusion: Bracket holding plier helps to prevent and minimizes error and it is an easy, convenient and simple method for bonding and reducing chair side time.
EnglishBoone Gauge, Bracket holder, Bracket position, Bracket prescription, Esthetics, OrthodonticINTRODUCTION
Clinicians often find it difficult and time-consuming to bracket positioning indirect bonding on consultation. Use of bracket positioner gauge on consultation becomes hectic. All the more the bonding takes time if there is severe crowding or highly/palatally/rotated teeth in the arch.
In Orthodontics as we know the position of the bracket plays an important role. The correct placement of the bracket is essential to finish treatment with an excellent occlusion and beautiful smile. Errors in bracket position could lead to an improper finish, hampered esthetics and altered function of a case.
Angle recommended that the ideal position to place the bracket should be at the Centre of the labial surface of the tooth.1 Andrews developed the straight-wire appliance and proposed that the brackets should be placed at the midpoint of the facial axis [FA] point, as the midpoint of all the clinical crowns are located on the same plane [Andrews Plane], it was felt that the FA point was readily and consistently located.2Ricketts, and later Kalange advocated the use of marginal ridges to guide the vertical positioning of brackets and bands.3,4 McLaughlin et al., advocated the positioning of brackets at a measured distance from the incisal edge, with different vertical positions recommended for different sized tooth.5, 6
The following way is described which is easy, simple and convenient to use with the least error in the vertical positioning of bracket for a clinician.
This case report was done to check the clinical guide for vertical positioning of the bracket. The objective of this paper is to help position the bracket accurately in the vertical dimension, fasten bonding, reduce chairside time.
MATERIAL AND METHOD
It's a one time marking to be made on a Bracket holder with a flat end
Material required:
1. MBT Boone Gauge { Clinician can use any gauge}
2. Bracket Holder with the flat posterior end
3. Divider with Scale
4. Air-rotor handpiece with Long Tapered fissure bur
5. Dental model
6. Anterior brackets [MBT]
Step 1:-
First, position the brackets with help of the MBT Boone gauge on the right central incisor and bond it.[fig. 1] Then measure the distance from the incisal edge to the lower border of the bracket with help of Vernier calliper or divider { to note that for canine, the tip is considered for measurement}. These measurements will serve as guidelines for the vertical positioning of the brackets on anterior teeth. [fig. 2]
Step 2:-
Now transfer the measured distance from the divider to the flat end of the bracket holder, [fig. 3 a] and mark parallel lines on the posterior end of bracket holder with a gap of 0.5mm each with help of divider and later groove those markings with air rotor and tapered fissure bur to prevent it from smudging.[fig. 3 b]. The markings are confirmed by placing the flat end of the bracket holder on the right central incisor.[fig 4]. The markings should be made for the position for Central [ X mm], Lateral [X-0.5mm], Canine [X mm]
Usually, when we place the bracket on central at 4.5 mm by MBT Boone gauge, the distance from incisal edge to bracket edge is 2.5 mm, for laterals at 4mm bracket placement corresponds to 2mm from incisal edge to bracket edge and so on concerning canine as well as in posteriors too.
Start marking from 1.5mm, 2mm, 2.5mm, 3 mm and 3.5 mm on the bracket holder on both sides. This gives an option to the operator to place brackets depending on the severity of the bite [ deep bite, open bite, normal bite].
Step 3:-
The next bracket is placed on the left central incisor and checked with a bracket holder with the grooved markings on the flat end for vertical height [fig 4]. This is reconfirmed with the MBT Boone gauge and vice versa with the bracket holder on the right central incisor. [fig 5a, fig 5b respectively]
RESULT
The net result is the addition of an extra function to the already existing bracket holder i.e. the function of vertical positioning of bracket and reduction of an instrument from an Orthodontists consulting bag.
DISCUSSION
The above technique can be used as per the clinicians/operators choice of bracket placement, depending on which bracket prescription he/she follows [eg:- MBT versatile appliance bracket placement guide]. Fukuyo et al., digitized the models of 40 patients with normal occlusion and compared three methods of bracket placement (FA, height, and marginal ridge method). The bracket positions relative to a constructed virtual bracket plane were determined. They found that even if the brackets were positioned ideally for each technique, vertical errors will still count and therefore, suggested modifications to bracket positions for each technique.7
Incorrectly positioned brackets can render even the most customized prescription ineffective and increase treatment time and the number of archwire adjustments necessary.8 Placement of brackets in the positions determined by measuring the distance from the incisal edge appears to be more accurate in the vertical dimensions for anterior teeth.9
Special consideration has to be made while positioning on premolar and canine due to curvature of the buccal surface where while positioning the bracket, the bracket holder should be perpendicular to bracket. Also one should know the total width of the flat end of the bracket holder to divide it into scales.
Although this method only helps in preventing or minimizing the error in the position of brackets in vertical parameters, the operator has to be cautious and manage the mesiodistal positioning of brackets through years of experience gained by practice.
This technique has the following advantages;
1. A reduction in error in vertical positioning, which can be avoided due to better precision, reproducibility and predictability of the bracket bonding.
2. It allows a practical standardized bonding procedure
3. Avoids bracket repositioning for vertical errors and/or the introduction of excessive corrective wire bends
4. Reduces chair time and unnecessary discomfort to the patient
5. It's easy, simple, convenient and cheap.
Conclusion
Bracket holding plier helps to prevent and minimizes error and it is an easy, convenient and simple method for bonding and reducing chairside time. In general, this method of using bracket holder for positioning allows orthodontists to obtain adequate bracket positioning leading to a finer finish with fewer errors, good occlusion and better esthetics.
Acknowledgement: Nil
Financial support and sponsorship: Nil
Conflicts of Interest: There are no conflicts of interest
Authors contribution
.1. Dr. Amey J Rathi: design
2.Dr. S Fayyaz Ahmed: manuscript writing
3. Dr. Gautham Kalladka: editing
4. Dr.Kavitha Iyer: review
Englishhttp://ijcrr.com/abstract.php?article_id=3981http://ijcrr.com/article_html.php?did=3981
Angle EH. The latest and best in orthodontics mechanism. Dental Cosmos. 1928; 70; 1143-1158
Andrews LF. The straight wire appliance: Origin, controversy, commentary. J Clin Orthod.1976; 10: 99-114
Ricketts MR. Big progressive therapy as an answer to orthodontic needs. American J Orthod. 1976; 70:241-267
Kalanga JT. Ideal appliance placement with APC brackets and indirect bonding. J Clin Orthod.1999; 33: 516-526
McLaughlin R P, Bennett J C. Bracket placement with the pre-adjusted appliance. J Clin Orthod. 1995; 29; 302-311
McLaughlin RP, Bennett JC. Finishing and pre-adjusted appliances. Seminar in Orthodontics.2003; 9; 165-183
Fukuyo K, Nishii Y, Nojima K, Yamaguchi H. A comparative study of three methods of bracket placement. Orthodontic Waves.2004; 63; 63-70
Carlson SK, Johnson E. Bracket positioning and resets: Five steps to align crowns and root consistently. American J Orthod Dentofac Orthoped. 2001; 119; 76-80
Armstrong D, Shen G, Petocz P, Darendellier MA. A comparison of accuracy in bracket positioning between two techniques- localizing the centre of the clinical crown and measuring the distance from the incisal edge. European J Orthod. 2007;29:430-436.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10Healthcare
A Study to Evaluate the Impact of a Planned Teaching Programme on Nursing Students’ Knowledge, Attitude, and Practice in Concerning New Coronavirus
English184189Prabhuswami HiremathEnglish Mahadeo ShindeEnglish Rohini KattiEnglish
Introduction: Taking a look at how well-informed KIMSD nursing students are about the coronavirus can provide light on how people in the area currently think and act, which in turn can lead to a better understanding of the factors that encourage the adoption of healthy habits. Aims: The purpose of this study is to evaluate the impact of a planned education programme on nursing students’ understanding, attitudes, and behaviour toward the newly discovered coronavirus. 1) One goal is to determine how well KINS students understand and apply information they learn about COVID-19. 2) Assess the impact of the COVID-19 education programme on student learning, attitudes, and behaviour at the undergraduate level. Material and Method: The study’s methodology relied on an evaluative research strategy. The study employs a one-group pre-post test design. Ninety samples were used in the analysis. The research was done at the Krishna Institute of Nursing. The method of sampling utilised here is the random sampling method. A knowledge, attitude, and practise questionnaire was used to gather the information. The KAP lesson for COVID-19 was presented to the students following the pre-test, as was originally scheduled. Result: One-fifth of the students in the survey were between the ages of 17 and 18, while the remaining 62% were between the ages of 18 and 19. Additionally, 74% of the students were female, 64% were Hindu, 64% were from Maharashtra, and 44% got their news from the media. On average, students scored 11 (with a standard deviation of 5.3) on the pretest, and 18.8 (with a standard deviation of 4.79) on the post-test. The mean attitude score was 6.03 (SD = 2.86) on the pre-test and 9.01 (SD = 2.36) on the post-test. The average practise score was 6.27 (with a standard deviation of 2.35) on the pretest, and 10.26 (with a standard deviation of 2.35) on the posttest. There was no statistically significant correlation between nursing students’ knowledge, attitude, and practise with respect to the new coronavirus and a variety of demographic factors. Knowledge, as measured by the post-test, increased by t = 10.88, P 0.0001; attitude, by t = 7.62, P 0.0001; and practise, by t = 11.38, P 0.0001, indicating that the proposed instruction programme was effective. Conclusion: We conclude that the knowledge, attitudes, and practises of nursing students before and after the implementation of a structured training programme are statistically different. Nursing students can benefit from a more informed perspective on COVID-19 after participating in a well-planned education programme.
EnglishKnowledge, Attitude, Practice, Covid-19, WHO, Nursing studentshttp://ijcrr.com/abstract.php?article_id=4640http://ijcrr.com/article_html.php?did=4640Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411315EnglishN2021August10Healthcare
A Study to Teach Breast Feeding to Caesarean Mothers at Tertiary Hospitals to Develop a Protocol
English190194Mahadeo ShindeEnglish Anagha KattiEnglish
Introduction: Having a caesarean section is one of the obstacles to getting started with breastfeeding at an earlier age. When a mother gives birth via caesarean section, she typically needs some more time to heal before she can physically feel ready to hold and nurse her newborn child. This typically results in a delay in the beginning of breastfeeding for the mother. The nurse is responsible for assisting the mother in the development of the required skills in order for her to be able to feed her baby on her own. Breastfeeding is the method of choice since it fulfils both the psychological and physiological requirements of the newborn. As a result of its one-of-a-kind physical, metabolic, and immunological properties, it is the ideal nourishment for newborn infants. Aims: This study is to better understand how breastfeeding can be improved for mothers who have had caesarean sections. The goals of this study were to determine the level of breastfeeding expertise among women who had caesarean sections and were hospitalised in tertiary care facilities. Methods: Using a non-probability convenient sampling technique, a quantitative approach with a quasi-experimental design was used to choose sixty moms who had given birth after LSCS. Result: The study’s findings showed that out of 60 postnatal caesarean women, only 15 (23.33%) have strong understanding about the technique of breastfeeding, while 31 (51.67%) mothers have average knowledge and 14 (25%) caesarean mothers had low knowledge regarding breastfeeding technique. Conclusion: The findings of the study indicate that there is a requirement for education for moms who have had caesarean sections regarding proper nursing technique following delivery.
EnglishAssessment, Knowledge, Breastfeeding technique, Caesarean mothers, Supplementary foods, Childrenhttp://ijcrr.com/abstract.php?article_id=4641http://ijcrr.com/article_html.php?did=4641
1. Mohan C. Assessment of knowledge regarding exclusive breastfeeding among primigravida and primipara mothers. Int. J. Adv. Res. Dev. 2018;3(8):1-28.
2. Maqsood S, Jafar S, Mudgil P. Nutraceutical Properties of Bioactive Peptides. InFood biopolymers: Structural, functional and nutraceutical properties 2021 (pp. 251-267). Springer, Cham.
3. Correspondent S. India ranks 56th in early initiation of breastfeeding, say UNICEF, WHO. The Hindu. 2018.
4. Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC pregnancy and childbirth. 2016 Dec;16(1):1-9.
5. Brown A, Jordan S. Impact of birth complications on breastfeeding duration: an internet survey. J. Adv. Nurs. 2013 Apr;69(4):828-39.
6. Rowe?Murray HJ, Fisher JR. Baby-friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth. 2002 Jun;29(2):124-31.
7. Aditi A, Jaiswal AK, Qamar A. Gap in breastfeeding practices between caesarean and normal deliveries. Int J Pregn and Chi Birth. 2022;8(3):48-53.
8. Patel A, Banerjee A, Kaletwad A. Factors associated with prelacteal feeding and timely initiation of breastfeeding in hospital delivered infants in India. J. Adv. Nurs 2013 Nov;29(4):572-8.
9. Rowe?Murray HJ, Fisher JR. Baby-friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth. 2002 Jun;29(2):124-31.
10. Bhanderi DJ, Pandya YP, Sharma DB. Barriers to exclusive breastfeeding in rural community of central Gujarat, India. Fam. Med. Prim. Care Rev. 2019 Jan;8(1):54.
11. Horta BL, Bahl R, Martinés JC, Victora CG, World Health Organization. Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses.
12. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment. 2007 Apr 1(153):1-86.
13. Chapman DJ, Perez-Escamilla R. Identification of risk factors for delayed onset of lactation. J. Am. Diet. Assoc. 1999 Apr 1;99(4):450-4.
14. Aruna G, Radhika IS, Indira S. Effectiveness of breastfeeding protocol among caesarean mothers admitted in Narayana Medical College Hospital, Nellore. J. Health Sci. Res.
15. Shete SS, Tata SH. Study to assess the effectiveness of planned teaching programme on knowledge regarding exclusive breastfeeding among the primi antenatal mothers in antenatal clinic of selected hospital of Karad. Int. J. Sci. Res. Publ 2014;3(5):590- 94.
16. Aruna G, Radhika IS, Indira S. Effectiveness of breastfeeding protocol among caesarean mothers admitted in Narayana Medical College Hospital, Nellore. Int. J. Health Sci. Res.
17. Evans KC, Evans RG, Royal R, Esterman AJ, James SL. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2003 Sep 1;88(5):F380- 2.
18. Gedefaw G, Goedert MH, Abebe E, Demis A. Effect of cesarean section on initiation of breastfeeding: Findings from 2016 Ethiopian Demographic and Health Survey. PloS one. 2020 Dec 18;15(12):e0244229.