Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareApplicability of Moyers’ Mixed Dentition Probability Tables and Development of New Prediction Equation in South Indian Population
English0107Murugesan ArathiEnglish Subramanian Aravind KumarEnglishIntroduction: Moyers’ mixed dentition space analysis is the most commonly used analysis to detect the tooth size-arch length discrepancy in patients with mixed dentition. At the same time Moyers’ method of prediction is said to have population variations. Aim: The present study aimed to evaluate the applicability of Moyers’ mixed dentition probability tables in the South Indian population and to frame a new regression equation to predict the sum of mesiodistal tooth widths of the permanent canine and the premolars. Methods: Mesio-distal tooth measurements of teeth were measured using digital vernier calliper from the study models of 50 orthodontic patients. The tooth sizes were compared between males and females using statistical analysis. The new regression equation was formulated from the standard linear regression equation y=a+bx, where a and b are constants, x is the sum of the mesiodistal width of mandibular incisors and y is the sum of widths of canine and premolars. Results: • There was no significant difference between the tooth sizes of the males and females according to the data collected from the current study sample. • TMoyers’ prediction tables are not suitable for predicting the mesiodistal widths of the unerupted canine and premolars in the South Indian population. Conclusion: New linear regression equations were formulated separately for males and females, to predict the sum of mesiodistal width of unerupted canine and premolars, using the sum of mandibular permanent incisors. The following are the new prediction equations: Males: Maxilla-8.50 + 0.57 (X) Mandible-6.06 + 0.64 (X) Females: Maxilla-2.08 + 0.84 (X) Mandible-7.25 + 0.59 (X), where X is the sum of the mesiodistal width of mandibular permanent incisors.
English Moyers probability tables, Mixed dentition space analysis, South Indian population, Prediction equationINTRODUCTION
Tooth size- arch length discrepancy is one of the common reasons for malocclusion. In a growing child with mixed dentition, the developing malocclusion can be well assessed and managed by accurately predicting the tooth size of the unerupted teeth. This can help us analyse whether the available space is sufficient to allow the permanent teeth to erupt without causing any crowding.1
The mixed dentition space analysis (MDSA) helps in determining any tooth size- arch length discrepancy and also to decide the type of interceptive orthodontic treatment to be employed. This type of orthodontic treatment involves serial extractions, space regainers, space maintainers, guiding the path of eruption and also periodic observation of the patient.2
Three different types of prediction methods have been used.
(i) Radiographic method 3,4
(ii) Prediction equations and tables 5,6,7
(iii) Combination of both radiographic method and prediction tables 3,8,9
Of these methods, it is argued that Moyers’ method is more widely used.7,10,11 This MDSA is used to assess the mesiodistal width of unerupted canine and premolars using probability charts at the 75th percentile.12The Moyers’ probability tables were developed at the University of Michigan based on the data obtained from American white subjects of North-western European descent.5 Therefore it is not relevant to all races because it has been observed that tooth dimension differs among various ethnicities, races, and genders.9,12–18Thus the objectives of this study were to evaluate the applicability of Moyers’ mixed dentition probability tables in the South Indian population and to frame a new regression equation that would aid us in accurately predicting the summed width of the unerupted canine and premolars.
MATERIALS AND METHODS
The study models of 50 subjects (25 male, 25 female) of age group 13 to 25 years and South Indian origin, were obtained from the patient records in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai. The study design and methodology was approved by the Institutional Scientific Review Board (IHEC/SDC/ORTHO-1801/21/22).
The inclusion criteria for sample selection were the following:
All subjects were of South Indian origin.
The permanent mandibular incisors, maxillary and mandibular canines and premolars were all fully erupted.
The study casts were free of distortion.
The subjects had no previous history of orthodontic treatment.
The exclusion criteria were the following:
Tooth material loss due to interproximal caries, interproximal attrition, congenital defects, and fractures.
Presence of prosthesis.
Severe crowding of more than 8mm.
Mesio-distal tooth measurements of the mandibular central and lateral permanent incisors, the maxillary and mandibular permanent canines, and the maxillary and mandibular first and second premolars were measured. Measurements were made according to Moorrees et al.19 using a digital Vernier calliper, with an accuracy of 0.1mm. The calliper was held at the tooth’s greatest mesiodistal diameter (contact points), parallel to the occlusal surface and perpendicular to the tooth’s long axis.5,8,19
Statistical Analysis
Descriptive statistics, independent sample t-test and regression analyses were done using IBM SPSS software version 2.0.
RESULTS
Descriptive statistics, including the mean, standard deviation, and, minimum and maximum values for the sum of mandibular incisors, the sum of maxillary canine and premolars, and mandibular canine and premolars for males and females were calculated (Table 1).
Independent sample Student t-test was carried out to compare the mesiodistal crown widths of males and females for the 3 tooth groups. The statistical values showed no significant difference between the mesiodistal tooth widths of males and females with a p-value being greater than 0.05 (Table 2).
Regression parameters such as correlation coefficient, regression constants, coefficient of determination and standard error of estimate were calculated. Table 3 records the various regression parameters. Using these parameters, new standard linear regression equations of the form Y=a+b(X) were derived, to evaluate the relationship between the combined mesiodistal widths of the mandibular permanent incisors (X) and the mesiodistal widths of canine and premolars in maxilla and mandible. In the equation Y+a+b(X), a and b are the regression constants, where a is the y-intercept, and b is the slope of the regression line.
The new prediction equations to calculate mesiodistal crown widths of maxillary and mandibular unerupted canine and premolars using the sum of erupted mandibular permanent incisors for males and females are shown in Table 4. Tables 5 and 6 show the probability table for males and females at the 50th percentile.
Figures 1&2 and 3&4 graphically represent the comparison between Moyers’ prediction table and the new prediction tables at the 50th percentile levels for males and females in the maxilla and mandible respectively. The figures represent that the slopes of the two sets of data differ and the lines tend to cross each other. This implies that the predicted size of the maxillary canine and premolars for males is greater and mandibular canine and premolars for males is smaller than by the Moyers’ table. For females, the predicted size of maxillary canine and premolar is greater than Moyers’ value when the sum of the incisors is greater than 21.5mm. The predicted size of mandibular canine and premolars for females was also greater than that by Moyers’ table.
DISCUSSION
Moyers’ mixed dentition analysis is one of the most commonly used space analyses to predict the mesiodistal width of the unerupted canine and premolars. Moyers’ prediction tables were formulated based on the values obtained from the North American population.5,6,8 The tooth dimensions and craniofacial characteristics are said to differ among people of different racial and ethnic origins.2,7,9,13,15,19,20 Therefore, the present study was aimed to assess the reliability of the Moyers’ prediction table as well as to formulate a new prediction equation and table suitable for the South Indian population.
Multiple regression analyses have indicated that the sum of the mesiodistal width of the four mandibular permanent incisors is the best predictor for unerupted canines and premolars, as these are the teeth that are among the first to erupt during the early mixed dentition.21 considering this we have also used the sum of mandibular permanent incisors to predict the mesiodistal width of the unerupted canine and premolars in our study. The present study attempted to formulate a prediction table at the 50th percentile for the South Indian children since the literature was lacking in the formulation of prediction tables at different percentile values.
Table 7 shows prediction equations from various studies at the 50th percentile.
All the above-mentioned studies except the Tanaka Johnston study showed that the Moyers prediction tables either underestimated or overestimated the sizes of the unerupted canine and premolars for their respective study population. Tanaka and Johnston6 stated that the probability tables generated by them were practically similar to those of the Moyers’ at all percentile confidence levels, probably because of the similar North American white samples used in the two studies.
The importance of accurate prediction of the mesiodistal crown widths of unerupted canines and premolars during mixed dentition space analysis should be apparent, because the decision to treat, or not treat or the type of the treatment, is based on the results of the analysis. The space management protocol will be badly affected if it is based on a wrong estimation of the unerupted tooth sizes, ultimately resulting in poor treatment results. Developing new probability tables on the Moyers pattern, specifically for different population groups, can aid in achieving a more accurate estimation of the unerupted tooth sizes.22 The prediction table formulated based on the data from the Chennai population should be accurate when applied to the local children. Further investigation has to be done to evaluate the accuracy of the proposed prediction equation in the local population.
CONCLUSION
There was no significant difference between the tooth sizes of the males and females according to the data collected from the current study sample.
Moyers’ prediction tables are not suitable for predicting the mesiodistal widths of the unerupted canine and premolars in the South Indian population.
New linear regression equations were formulated separately for males and females, to predict the sum of mesiodistal width of unerupted canine and premolars, using the sum of mandibular permanent incisors. The following are the new prediction equations:
Males: Maxilla-8.50 + 0.57 (X)
Mandible-6.06 + 0.64 (X)
Females: Maxilla-2.08 + 0.84 (X)
Mandible-7.25 + 0.59 (X),
where X is the sum of mesiodistal widths of mandibular permanent incisors.
The accuracy of the prediction equation should be tested in a large sample of the local population and various other ethnic groups in South India.
ACKNOWLEDGEMENT
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
CONFLICT OF INTEREST
Nil
SOURCE OF FUNDING
Nil
Englishhttp://ijcrr.com/abstract.php?article_id=4099http://ijcrr.com/article_html.php?did=40991. Kirschen RH, O’higgins EA, Lee RT. The Royal London Space Planning: an integration of space analysis and treatment planning: Part I: Assessing the space required to meet treatment objectives. Am J Orthod Dentofacial Orthop. 2000; 118(4): 448–55.
2. Bishara SE, Staley RN. Mixed-dentition mandibular arch length analysis: a step-by-step approach using the revised Hixon-Oldfather prediction method. Am J Orthod. 1984; 86(2): 130–5.
3. Staley RN, O’Gorman TW, Hoag JF, Shelly TH. Prediction of the widths of unerupted canines and premolars. J Am Dent Assoc. 1984; 108(2): 185–90.
4. de Paula S, de Oliveira Almeida MA, Lee PCF. Prediction of the mesiodistal diameter of unerupted lower canines and premolars using 45° cephalometric radiography. Am J Orthod Dentofacial Orthop. 1995; 107(3): 309–14.
5. Moyers RE. Analysis of the dentition and occlusion. Handbook of orthodontics. 1988.
6. Tanaka MM, Johnston LE. The prediction of the size of unerupted canines and premolars in a contemporary orthodontic population. J Am Dent Assoc. 1974; 88(4): 798–801.
7. Ferguson FS, Macko DJ, Sonnenberg EM, Shakun ML. The use of regression constants in estimating tooth size in a Negro population. Am J Orthod. 1978; 73(1): 68–72.
8. Hixon EH, Oldfather RE. Estimation Of The Sizes Of Unerupted Cuspid And Bicuspid Teeth. Angle Orthod. 1958; 28(4): 236–40.
9. Bishara SE, Jakobsen JR, Abdallah EM, Fernandez Garcia A. Comparisons of mesiodistal and buccolingual crown dimensions of the permanent teeth in three populations from Egypt, Mexico, and the United States. Am J Orthod Dentofacial Orthop. 1989; 96(5): 416–22.
10. Al-Khadra BH. Prediction of the size of unerupted canines and premolars in a Saudi Arab population. Am J Orthod Dentofacial Orthop. 1993; 104(4): 369–72.
11. Yuen KK, Tang EL, So LL. Mixed dentition analysis for Hong Kong Chinese. Angle Orthod. 1998; 68(1): 21–8.
12. Agarwal N, Shashikiran N D, Singla S, Kulkarni V K, Ravi K S.Moyer's Mixed Dentition Predictable Values Correlation Among Hindu Children of Bhopal City. Ann Essenc Dentis. 2013; 5: 6-10.
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17. Diagne F, Diop-Ba K, Ngom PI, Mbow K. Mixed dentition analysis in a Senegalese population: elaboration of prediction tables. Am J Orthod Dentofacial Orthop. 2003; 124(2): 178–83.
18. de Carvalho Beckman CK, Costa Bezerra AA, Araujo PH, Araujo MA. Ethnic and gender aspects involved in craniofacial growth for the validation of Moyers and Tanaka-Johnhton analysis. Archives of Health Sci. 2020; 27: 42-6.
19. Moorrees CFA, Thomsen SØ, Jensen E, Yen PK-J. Mesiodistal Crown Diameters of the Deciduous and Permanent Teeth in Individuals. J Dent Res. 1957; 36(1): 39–47.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareEnamel Wear of Teeth Against Polished and Glazed Monolithic Zirconia Crowns at 3 and 6 Months: A Clinical Study
English0815Prathap AnanthEnglish V. Vidyashree NandiniEnglish M. Dilip KumarEnglish KM ThamaraiselvanEnglishEnglishCrowns, Dentition, Monolithic, Superimposition, Tooth Wear, ZirconiaIntroduction:
Zirconia-based restorations have gained popularity over the years and are currently used in day-to-day dental practice. They are considered the strongest of tooth-coloured restorations because of their high flexural strength, hardness, and fracture toughness values. They present as an ideal material for the replacement of anterior and posterior teeth and also for implant prostheses.
The conventional zirconia restorations were usually layered with veneering porcelain to mask the opaque nature of the zirconia core. This often led to the fracture of the veneering ceramic as a result of weak interphase. Currently, fully contoured monolithic zirconia restorations are widely being used as they do not require a veneering ceramic and therefore offers a better advantage like minimal tooth reduction and fewer reported failures due to veneer chipping.
These restorations were harder than the natural teeth and had a compressive strength of 2000 Mpa, thereby increasing the potential for opposing enamel wear. Since, these restorations mandatorily required surface finishing after chairside occlusal adjustments to reduce the wear of opposing enamel, a polishing system or glazing process had to be routinely used to achieve the necessary surface finish.
The ideal surface finish for these restorations is still debatable as various in-vitro studies1-14 and a few in vivo studies15-18 are there, comparing the effects of surface finish of monolithic zirconia on antagonistic enamel wear. Also, the result from in-vitro studies varied compared to an in-vivo setup due to the dynamic nature of the oral environment. It was important to assess the long-term effects of the commonly employed polishing and glazing process of monolithic zirconia on the opposing enamel surface wear. This clinical study was conducted with the research hypothesis that the surface finishing procedures employed like the polishing and glazing of monolithic zirconia caused different/dissimilar rates of wear of opposing enamel. The study aimed at assessing the wear of enamel opposing polished and glazed monolithic zirconia restorations and also the restorative wear at 3 and 6 months of clinical use.
Materials and Methods:
The present study was designed and ethical clearance was obtained from the institutional ethical committee (Ethics clearance no. 1248/IEC/2017) before the start of the study. A comparative interventional study design was adopted where the patients were allotted into two groups based on the type of crowns that they received (i.e polished (PO) or polished and glazed (PG) monolithic zirconia crowns). Participants were selected from the outpatient Department of Prosthodontics and Implantology, requiring crowns after endodontic management and included in the study after obtaining informed consent. 18 participants, between 21-45 years of age were chosen for the study. The selection of the participants was based on the inclusion and exclusion criteria.
Participant Selection Criteria
Inclusion Criteria:
Participants between 21-45 years of age, who belonged to ASA I and II and those who required single posterior monolithic zirconia crowns in the molar or premolar region, were selected. The opposing natural dentition should be free of wear facets and periodontally sound. Patients with minimal caries risk based on caries index and those with small occlusal restorations were also considered. A clinical crown height of at least 6 -8 mm was required.
Exclusion Criteria:
Patients who belonged to ASA III and IV and those who showed signs of parafunctional habits, temporomandibular joint disorders and poor periodontal health were excluded from the study. Patients with missing antagonistic natural teeth and those with large occlusal restorations (Class II or IV) and untreated caries were also excluded from the selection process.
Clinical and Laboratory Steps for crown fabrication:
For each patient, two sets of diagnostic impressions were made of the opposing arches using irreversible hydrocolloid (Zelgan plus, Dentsply India Pvt. Ltd, Gurgaon) and cast obtained in type III dental stone (Goldstone, Asian chemicals, Rajkot, India). The putty index was made (Aquasil, Dentsply, Konstanz, Germany) of the unprepared tooth (Buccolingual and Mesiodistal) on the diagnostic cast. This served as a reference for tooth preparation. Mock preparation was done on the diagnostic cast and a previously made putty index (mesiodistal and buccolingual) was used to standardize the preparation (Fig.1a,b).
Shade selection was done using a shade guide (VITAPAN Classic, VITA Zahnfabrik, Germany) before the tooth preparation procedure. The core build-up for the lost tooth structure was done with bulk-fill composite resin (Filtek Z350 XT, 3M ESPE, USA). Tooth preparation guidelines for monolithic zirconia crowns were followed (axial reduction of 1.5 mm and occlusal reduction of 2 mm). 15 A convergence angle of 4 degrees was achieved with the help of the previously formed putty index. Equigingival, heavy chamfer finish line was given for the tooth preparations in all the subjects. The prepared tooth was thoroughly isolated, gingival retraction performed and a definitive impression of the prepared tooth was made with a custom tray using monophase polyvinyl siloxane impression material (Aquasil Monophase, Dentsply, Konstanz, Germany). The prepared tooth was restored with a provisional crown made from tooth-coloured chemically cured acrylic resin (DPI, India) by indirect technique.
The impression of the prepared tooth was poured using a type IV dental stone (UltrarockKalabhai Karson, Mumbai). A bite registration record was also made using Aluwax (Maarc bite registration wax, Dwaraka, Maharashtra, India). The models with the bite record were scanned and digitized using a CAD-CAM blue light LED scanner (D900 L, 3 Shape, Denmark). The working cast was analysed with the CAD-CAM software (3 Shape Dental System, Denmark) and the final restoration was designed and milled from pre-shaded monolithic zirconia blanks (NEXXZrT, Sagemax, USA) using a milling unit (Zenotec Hybrid Select, Wieland, Germany).
The restoration was subjected to a sintering process (Zenotec Fire cube, Wieland, Germany) at a temperature of 1520?C for 7 hours 20 minutes. A total of 20 crowns were milled and sintered.
Surface Finishing and Crown Cementation:
The crowns were checked for their fit and aesthetics intraorally. Occlusal adjustments were made after identifying interferences initially with a 100-micron articulating paper and later using a 12-micron articulation foil for the final elimination of the interferences (12-micron Arti-Fol metallic BK 28 and 100 microns- Bausch progress 100, Dental Co, USA) in maximum intercuspal position and excursive movements. Necessary adjustments were made with fine-grit sintered diamond point (TR -13 EF, Oro, Pune, India) under copious irrigation and light pressure. The adjusted crown surfaces were either just polished or polished and glazed before cementation.
All the 20 monolithic zirconia crowns were divided among 18 participants (two of the participants’ required 2 crowns in the same arch) and categorized into two groups (Group PO and Group PG) randomly. Group PO comprised of 10 polished monolithic zirconia crowns and group PG comprised of 10 polished and glazed monolithic zirconia crowns. Each participant received a minimum of one and a maximum of two monolithic zirconia crowns with either of the two surface finishes. For group PO specimens, the polishing procedure was only employed following occlusal corrections. Zirconia polishing kit (Zilmaster, Shofu dental corporation, USA) which comprised of coarse (green band), medium (blue band) and fine (yellow band) diamond
impregnated silicone points were used sequentially on a slow speed contrangled micromotor handpiece at 15000 rpm and with minimal pressure application in a unidirectional motion to achieve the necessary surface polish.
For the group PG specimens, similar occlusal adjustments and polishing steps were performed followed by glazing of the restoration. Glaze in the form of powder and liquid (Ceramco3, Dentsply, Canada) was used for the process. Glazing was done by applying a thin even coat of glaze mixture over the crown surface with a glaze brush (Skyists No.0 brush, Japan). The crowns were subjected to 850?C for 10 minutes in a porcelain firing furnace (Programat P300, Ivoclar Vivadent, Germany). After the necessary surface finish was achieved, the crowns were cemented using Type I Glass Ionomer cement (Gold label, GC Products, Japan) following a proper isolation technique.
Follow Up and Wear Evaluation:
To check for opposing tooth enamel wear and also the crown material wear, a 3D superimposition technique was employed.15-18 Impressions were made of upper and lower arches at baseline i.e., 1 week, 3 months and 6 months after cementation using custom trays and monophase impression material (Aquasil Monophase, Dentsply, Konstanz, Germany). Type IV dental stone (Ultrarock, Kalabhai Karson, Mumbai, India) casts were prepared. The casts were obtained at 1 week, 3 months and 6 months post cementation for 3D scanning and wear analysis (Fig.2).
The occlusal contact points of the zirconia crowns and their antagonists were intra-orally marked using articulating paper (100 µm, Bausch progress 100, Bausch Dental Co, USA). The clinical status, particularly the marked occlusal contact points were photographed using a DSLR camera (EOS 600D 19 MP, Canon, Japan) to determine the occlusal contact areas (OCA) for wear measurement and the reference areas for occlusal matching (Fig.3 a,b). The cast obtained at baseline, 3 months and 6 months were scanned and digitized using a 3D blue light led scanner (D900, 3shape, Denmark) which had a scanning accuracy of 15 µm. The scanned data were analysed using three-dimensional analysis software (Geomagic Control X, 3D Systems, USA). The follow-up scan data of the upper and lower arches at 3 and 6 months were superimposed with the baseline data (1week) using the global auto aligning option to check for surface changes or wear on the antagonistic enamel and zirconia restoration.
A maximum of 25-micron deviation between two scanned images was allowed. Three wear points were selected on the functional cusps of the tooth of interest i.e. (tooth with the crowns and the antagonistic tooth) on the superimposed images at 3 months and 6 months after correlating it with the previously photographed occlusal contact points. The wear values were depicted as negative coordinates in millimeters on the selected contact points. (Fig.4a, b)(Fig.5a,b)
The extent of surface change of the 3 months and 6 months data from the baseline data was also represented as a colour deviation map. The green regions on the colour map represented superimposed areas within 25 µm of positive or negative deviation. The regions marked as yellow, orange or red represented regions more than 25 µm and regions marked in blue represented areas below 25 µm of deviation (Fig.4a,b) (Fig.5a,b). The regions in the yellow, orange, red and blue regions were not considered for the evaluation of wear.
Statistical Analysis:
The data thus obtained were subjected to statistical analysis using the SPSS (IBM SPSS Statistics for Windows, Version 19.0: IBM Corp, Armonk, USA). Significance level was fixed at 5% (α = 0.05). Normality tests (Kolmogorov-Smirnov and Shapiro-Wilks tests) revealed that variables do not follow a normal distribution. Therefore, non-parametric tests namely, unpaired t-test and paired t-test was used to compare the data.
Results:
The mean wear of the polished and glazed enamel antagonists and crown groups were compared at 3 and 6 months statistically using the unpaired- t-test. The mean ± SD wear values at 3 months for the natural tooth opposing polished crowns was 0.016± 0.005 mm and for those opposing glazed crowns was 0.023±0.006 mm which was statistically significant (pEnglishhttp://ijcrr.com/abstract.php?article_id=4100http://ijcrr.com/article_html.php?did=4100
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareDigit Ratio and Arterial Stiffness in Males: A Novel Observation
English1620Arjun MEnglish Vinita AEnglish Nitin SEnglish Naidu BANMEnglishEnglish Digit Ratio, Arterial Stiffness, Pulse Wave velocity, Central Aortic Pressure, Prenatal androgen ExposureINTRODUCTION
Measuring blood pressure is a particularly important vital parameter to assess cardiovascular function. Clinicians routinely record arterial blood pressure non-invasively from the brachial artery and the obtained value of systolic & diastolic blood pressure is commonly assumed as the same throughout the arterial tree. But there is a significant difference in contour & amplitude of pressure waves in ascending aorta and proximal & distal peripheral arteries.1
Measuring systolic BP at various points throughout the arterial tree provides useful information for diagnosing Peripheral arterial disease. A reduced ankle-brachial index, A systolic interarm difference is also associated with peripheral arterial disease, cerebrovascular disease, and increased cardiovascular and all-cause mortality.2 General interventions are based upon peripheral pressure and often central aortic pressure is neglected. Central aortic pressure is a key determinant of coronary perfusion and left ventricular afterload.3 Central Aortic Pressure can be assessed non-invasively by oscillometry or applanation tonometry,4 using specific transfer function from peripheral pulse wave.3 Central Pressures better predict the target organ damage situations. Central Aortic Systolic pressure and or central pulse pressure are strongly affecting vascular damage, cardiovascular events or mortality whenever compared to peripheral blood pressure parameters.5 Hypertension, Diabetes Mellitus atherosclerosis, ageing causes vessel remodelling. Functional and morphological changes to vessels alter the conduction of blood to the peripheral tissues and alteration in shock-absorbing function lead to arterial stiffness (Arteriosclerosis) and thus increase in the Systolic Blood Pressure and Pulse Pressure and decreased Diastolic Pressure. Due to the stiffening of vessels, the reflected wave moves faster through the arterial tree and thereby increase the Left ventricular afterload.6 Pulse wave velocity is the most used measure of arterial stiffness. It is defined as the speed of travelling pressure waves along the aorta and large arteries. Pulse Wave Velocity is calculated by dividing the distance with pressure wave travelling time between two sites of the arterial system. Depending upon the sites of measurement two most commonly used measurements are Carotid to femoral and Brachial to ankle Pulse Wave Velocity.7 In some recent studies digit ratio (2D:4D) as a putative marker of prenatal androgen exposure have been linked with cardiovascular diseases such as myocardial infarction, hypertension etc. Manning & Bernard reported a weak negative relationship between MI and right-hand digit ratio (2D:4D). It was suggested that low prenatal testosterone and high prenatal estrogen may be the reason behind predisposing males to the onset of early MI.8 It has been observed in an Indian study that hypertensive males tend to have a higher digit ratio(2D:4D) for both hands when compared to normal controls.9 In an autopsy-based study it was observed that atherosclerotic plaque formation was found to be more pronounced in Turkish young men with a high digit ratio.10 Present study is aimed to find out the relation of peripheral and central blood pressures in the normal healthy population. The effect of prenatal androgen exposure on arterial stiffness has not been studied earlier. The present study also explores the relation of digit ratio as a proxy marker of prenatal androgen exposure with noninvasive hemodynamic parameters which may point towards the early detection of cardiovascular alterations.
MATERIALS & METHODS
Study population:
The study was conducted in the Department of Physiology Mayo Institute of Medical Sciences, Barabanki and was approved by the Institutional Ethics Committee vide approval letter number MIMS/Ex2019/198. This is a cross-sectional study comprised of 32 healthy volunteers who responded to be part of the study. Informed consent was taken, and the volunteers were screened as per study protocol. 25 subjects were found to be fit for inclusion in the study. Though invitation was open for both sexes only male candidates responded.
Exclusion Criteria:
Any kind of arthropathy, History of Cardiac disease, Hyper/hypothyroidism, Diabetes, hypertension, tuberculosis, any kind of restrictive or obstructive disease of lung, present history of liver disease, viral myositis, and other muscular diseases. Female subjects with hormonal disorders including polycystic ovarian disease and adrenal hyperplasia. Subjects, who are a smoker or using tobacco in any form, were excluded from the study.
Body Mass Index (BMI) Estimation:
Height and weight were measured for each subject using a standard calibrated stadiometer and Body Mass Index (BMI) was calculated using formula where m is mass in Kgs and h is height in meters.
Digit Ratio Calculation:
The lengths of the 2nd digit (index finger-2D) and 4th digit (ring finger-4D) of both hands were measured with a digital Vernier calliper (accuracy 0.01mm) from the palmer aspect. The length of each finger was defined as the distance between the Proximal crease of the digit to the tip of the digit in millimetres. The ratio was calculated as Length of 2D/Length of 4D for both hands.
Pulse wave Analysis:
Periscope, Arterial health & Cardiovascular analysis system by Genesis Medical Systems Pvt. Ltd. India, was used for simultaneous recording of all 4 limbs noninvasive blood pressure and ECG, Pulse wave analysis was done with dedicated PeriscopeTM (Version 3.0) software. Subjects were instructed to restrict themselves from use of caffeine products for 24 hrs before participating in the study.
Statistical Analysis:
Data were analyzed using Microsoft Excel 365 Statistical plugin software & statistical package provided by www.stats.blue. Results are expressed as Mean, Standard deviation. T-test and regression analysis were performed with data obtained. Results were considered statistically significant whenever P < 0.05.
RESULTS
Descriptive statistics of Anthropometric variables and age is explained in Table 1. Details of various blood pressures are depicted in Table 2.
Peripheral Systolic Blood Pressure appeared to be significantly more (p=0) than the Central Aortic systolic Pressure. The same observation was not true for the Diastolic pressure (p=0.42). Central Aortic Pulse pressure was found to be significantly low (p=0.02) compared to Peripheral Pulse Pressure. There was no significant difference observed between Right & Left ABI (Ankle to Brachial index) (p=0.829) supportive to the observation of the absence of any Peripheral Arterial Disease among the study subjects. Descriptive data regarding hemodynamic parameters are depicted in Table 3. Regression analysis showed that there is a significant trend (p=0.037) between Carotid to femoral Pulse wave velocity (PWV) and central aortic systolic pressure and no significant trend (p=0.097) observed with Peripheral Systolic pressure. Pulse wave velocity was found to be significantly associated with age (r = 0.58, p=0.022) but not with BMI. Left hand Digit ratio was significantly associated PWV (r = 0.63, p = 0.01). Correlation for right hand also shown a moderate association but was not significant (r = 0.44, 0.09) Table 3.
Difference of measured PWV and predicted normal PWV was found to have significant moderate association (r = 0.45, p = 0.021) with right hand digit ratio and similar association also established for left hand digit ratio (r = 0.44, p = 0.024)
DISCUSSION
This study shows that the peripheral Systolic Blood Pressure is significantly higher than the Central Aortic Blood Pressure. No significant difference in Diastolic blood pressure was observed for peripheral and central sites. Systolic pressure and diastolic pressure represent dynamic and tonic components of the pulsatile pressure component respectively. Being the dynamic component as the distance from the aortic root increase systolic pressure also increases at the peripheral site whereas the diastolic pressure change is minimal.11 Peripheral Pulse pressure also found to be significantly higher than the central pulse pressure. Pulse wave velocity which is a marker for arterial stiffness positively correlates with age in our study. PWV is inversely linked with arterial distensibility,12 with aging the arterial walls become rigid due to continuous fatigue fracture of elastic elements and collagen cross-linking.13 Obesity is one of the conditions that envelopes the complete spectrum of cardiovascular diseases. BMI is considered as a common tool to assess obesity in common practice, despite studies, has proved that BMI is not always associated with adiposity.14 Most of the studies showed inverse relationships between PWV & Obesity.15 In our study we did not observe any relationship between BMI and arterial stiffness.
We did observe a significant association between PWV with left-hand digit ratio, but no significant association was observed for the right-hand digit ratio. Interestingly significant association observed with the right-hand digit ratio and the difference of measured PWV and predicted normal PWV. The difference between predicted and measured PWV is suggestive of the extent of increase in arterial stiffness in the individual. Several indirect studies explored the relationship with neck circumference, Waist Hip Ratio, BMI and Digit ratio and concluded that digit ratio may correlate with Cardio Vascular Disease. Manning and Bundred observed the age of onset of MI and Digit ratio maintains a negative relationship.8 In a Greek study it was observed that digit ratio may be a biomarker for predisposition to MI in men, but not in women.16 A recent study showed that Digit ratio (2D:4Dratio) is uncorrelated with CVD or CVD risk factors in menopausal women.17 Digit ratio and circulating Testosterone have shown controversial relationships18,19 and majorly one does not correlate with other. Circulating high Testosterone has been reported with low arterial stiffness in males.20 Manning et al, had shown digit ratio is strongly predictive of performance in endurance running and speculated that prenatal Testosterone may have some organizational effect on the vascular system.21 It has been well appreciated that receptors for androgens, estrogen and progesterone are expressed on the vascular tissues. Though the exact molecular mechanism behind the effect of prenatal androgen on adult body function and disease predisposition is still unknown it can be hypothesized that Prenatal androgen may alter the receptor sensitivity towards the androgen resulting in a modification in the body systems. These initial findings are interesting and our study probably for the first time reporting the significant moderate relationship between digit ratio and arterial stiffness to the scientific community. Our study extends support with observable data to the speculation that digit ratio may correlate with vascular function and thereby may be used as a marker of predisposition to CVD in males.
ACKNOWLEDGEMENT
The authors acknowledge the immense help received from the Mayo Institute of Medical Sciences and Nims University for the conduction of this research. The authors also acknowledge the help 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.
CONFLICT OF INTEREST
None
SOURCE OF FUNDING
Self-financed research project
AUTHOR’S CONTRIBUTION
All the authors contributed to this article significantly
Author 1: Designing, data collection, data analysis, article writing
Author 2: Designing, data verification, article editing
Author 3: Data collection, article writing
Author 4: Data collection, article editing.
Englishhttp://ijcrr.com/abstract.php?article_id=4101http://ijcrr.com/article_html.php?did=41011. Karamanoglu M, O’Rourke MF, Avolio AP, Kelly RP. An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J. 1993;14(2):160 – 167.
2. Clark CE. Four-limb blood pressure measurement: a research tool looking for clinical use. Hypertens. 2013;61(6):1146–1147.
3. Scolletta S, Herpain A, Romano SM, Taccone FS, Donadello K, et al. Estimation of central arterial pressure from the radial artery in patients undergoing invasive neuroradiological procedures. Bri Med J Anesthesiol. 2019;19(1):173.
4. Millasseau S, Agnoletti D. Non-invasive estimation of aortic blood pressures: A close look at current devices and methods. Curr Pharm Des. 2014;21(6):709 – 718.
5. Wang K-L, Cheng H-M, Chuang S-Y, Spurgeon HA, Ting C-T, et al. Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? J Hypertens. 2009;27(3):461 –467.
6. Ageenkova O, Ageenkova O, Purygina. Central aortic blood pressure, augmentation index, and reflected wave transit time: reproducibility and repeatability of data obtained by oscillometry. Vasc Health Risk Manag. 2011;649.
7. Kim H-L, Kim S-H. Pulse wave velocity in atherosclerosis. Front Cardiovasc Med. 2019;6:41.
8. Manning JT, Bundred PE. The ratio of second to fourth digit length and age at first myocardial infarction in men: A link with testosterone? Brit J Card. 2001;8(12):720 –723.
9. Yadav RK, Bala M. A study of 2nd to 4th digit ratio (2D: 4D) concerning hypertension in north Indian males and its implications for risk factors in coronary heart disease. Indian J Clin Anat Physiol. 2016;3(1):24.
10. Ozdogmus O, CakmakYO, Coskun M, Verimli U, Cavdar S, et al. The high 2D:4D finger length ratio effects on atherosclerotic plaque development. Atheroscl. 2010;209(1):195 –196.
11. Williams B, Lacy PS. Central aortic pressure and clinical outcomes. J Hypertens. 009;27(6):1123–1125.
12. Millasseau SC, Kelly RP, Ritter JM, Chowienczyk PJ. Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin Sci (Lond). 2002;103(4):371 – 377.
13. McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol. 2007;34(7):665 – 671.
14. Mukherjee D, Ojha C. Obesity paradox in contemporary cardiology practice. JACC Cardiovasc Interv. 2017;10(13):1293–1294.
15. Shah NR, Braverman ER. Measuring adiposity in patients: the utility of body mass index (BMI), per cent body fat, and leptin. PLoS One. 2012;7(4):e33308.
16. Kyriakidis I, Papaioannidou P, Pantelidou V, Kalles V, Gemitzis K. Digit ratios and relation to myocardial infarction in Greek men and women. Gend Med. 2010;7(6):628 –636.
17. Fischer Pedersen JK, Klimek M, Galbarczyk A, Nenko I, Sobocki J, et al. Digit ratio (2D:4D) is not related to cardiovascular diseases or their risk factors in menopausal women. Am J Hum Biol. 2020;e23505.
18. Crewther B, Cook C, Kilduff L, Manning J. Digit ratio (2D:4D) and salivary testosterone, oestradiol and cortisol levels under challenge: Evidence for prenatal effects on adult endocrine responses. Early Hum Dev. 2015;91(8):451 – 456.
19. Kowal M, Sorokowski P, ?ela?niewicz A, Nowak J, Orzechowski S, et al. No relationship between the digit ratios (2D:4D) and salivary testosterone change: Study on men under an acute exercise. Sci Rep. 2020;10(1):10068.
20. Hougaku H, FlegJL, Najjar SS, LakattaEG, Harman SM, et al. Relationship between androgenic hormones and arterial stiffness, based on longitudinal hormone measurements. Am J Physiol Endocrinol Metab. 2006;290(2): E 234–242.
21. Manning JT, Morris L, Caswell N. Endurance running and digit ratio (2D:4D): implications for fetal testosterone effects on running speed and vascular health. Am J Hum Biol. 2007;19(3):416 –421.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcarePattern Intensity Index, Dankmeijer’s Index and Furuhata’s Index of Palmar Dermatoglyphics in Patients with Bronchial Asthma
English2126Deepa T KEnglish Sampson UrsulaEnglish Sreedharan RanjithEnglishIntroduction: Asthma is a chronic airway inflammation, characterised by variable airway obstruction and reduced lung function and leading to wheezing and shortness of breath. Both asthma and dermatoglyphics are influenced by genetic factors. Objective: This study was done to find out the Pattern intensity index, Dankmeijer’s index and Furuhata’s index of palmar dermatoglyphics in patients with bronchial asthma. Methodology: Palm prints were obtained from both hands of 250 clinically diagnosed bronchial asthma patients who attended the OPDs of Respiratory medicine and Pediatrics of M E S Medical College, Perinthalmanna. Age and sex-matched controls were selected from the staff and students at the same college, without any respiratory or chronic diseases. The study included the dermatoglyphic parameters like a-b ridge count, distance, breadth, pattern intensity index, Dankmeijer’s index and Furu Hata's index. Result: The Pattern intensity index and Furuhata’s index was more in bronchial asthma patients and male patients showed higher value than females. Dankmeijer’s index was less in bronchial asthma patients than controls, female cases showed higher value than male cases. Conclusion: Decrease in the mean value of a-b count, distance, breadth and an increase in the value of Pattern intensity and Furuhata’s index can be used as a tool for early identification of at-risk individuals with or without a family history of bronchial asthma.
English a-b count, Bronchial asthma, Dankmeijer’s index, Dermatoglyphics, Furuhata’s index, Pattern intensity indexIntroduction
Dermatoglyphics is the study of configurations of epidermal ridges on the fingers, palms, soles and toes. The word dermatoglyphics is a Greek word, 'derma' means skin and 'glyphic' means carvings, which was coined by Cummins and Midlo in 1926.1The fingerprint, once formed, is very resistant to later prenatal or postnatal influences, thus making it an ideal feature for genetic studies and also for the identification of individuals. Ethnic and racial groups manifest highly significant variations in the occurrence of dermatoglyphic configurations. These include pattern frequencies on the palm, finger ridge counts, and differences between frequencies of patterns on the right and left fingers.
Asthma is a complex, chronic inflammatory disease of the airways of the lungs and its clinical control rate is at present lower than that recommended in the GINA guide, making this a serious public health issue.2It has been evaluated that more than 300 million people across the globe suffer from this disorder.3Recently, the morbidity and mortality rates of asthma have been constantly rising worldwide, and 1–18% of the populations of different countries are known to have asthma .4,5The increasing prevalence of asthma is related with genetic changes and gene-environment interactions.6 It has a complex pathogenesis and is dependent on immunological, genetic and environmental factors, and recent studies indicate a hereditary basis.
The dermatoglyphic study has now been established as a useful diagnostic tool in medicine and provides important insights into the inheritance and embryologic development of many clinical disorders. As dermatoglyphic patterns and bronchial asthma are determined genetically, both may have a link that could help identify individuals with bronchial asthma.
Dermal ridges are formed between the 10th to 16th weeks of fetal development and, once formed remains permanent and never changes throughout the life, unless the skin is damaged to a depth of 1mm.7Its development coincides with the regression of embryonic volar pads on fingers. The type and size of patterns are mostly determined by the size and timing of subsidence of these pads.8 Palmar dermatoglyphics has been studied in various diseases and alterations in normal patterns have been noted which is genetically determined. The importance of dermatoglyphics is to identify those people with a genetic predisposition to the development of certain diseases like bronchial asthma. The present study was conducted to elucidate Pattern intensity index, Dankmeijer’s index and Furuhata’s index of palmar dermatoglyphics in bronchial asthma patients.
Materials and Methods
A case-control study was performed in the Department of Anatomy, MES Medical College, Perinthalmanna, Kerala. The study population includes 500 subjects. Among them, 250 were clinically diagnosed bronchial asthma patients, who attended the OPD’s of Pediatric and Respiratory medicine department, M E S Medical College. Age and sex-matched 250 controls were selected from the students, staff and their children of the same institution. Ethical clearance was obtained from the Institutional Ethical Committee of MES Medical College for conducting the study. The details of the study were explained to the participants, and informed consent was taken from them and, parents in the case of children. The demographic data were collected from the medical records and a questionnaire was given to the participants.
Inclusion criteria
Clinically diagnosed case of bronchial asthma.
Both male and female patients in the age group 6 – 60 years.
Subjects were residents of North Kerala.
Exclusion criteria
Subjects with a known case of chromosomal abnormalities.
Subjects who failed to deliver legible fingerprint patterns of one or both hands.
Subjects whose finger ridges were obscured by scars, deformities, birth defects and diseases on one or both hands.
Any other systemic diseases
Methodology
The palm print from both hands of case and control was done using the Ink and paper method adopted from Cummin and Midlo.9The subjects were asked to wash their hands with soap and water. A small paste of the link was spread as a thin film on a glass sheet using a roller. With a relaxed arm, they were required to place their palm on the inking sheet so that the entire palm was evenly covered with ink. Then the right palm was placed from the wrist to the tip of the fingers on the printing sheet, with minimum pressure applied on the dorsum of the hand. The same procedure was repeated for the left palm using another finger and a palm printing sheet. The print for each fingertip was taken on the same paper for the second time. The subjects were asked to keep their thumb with the ulnar edge downward and rolled toward the body. Other digits were placed with the radial edge downward and rolled away from the body. The fingerprints were taken onto the respective pre-labeled squares, one for each of the ten fingers. The palmprint obtained were subjected to detailed dermatoglyphic analysis with the help of a magnifying hand lens. The fingertip patterns were then classified into whorls, loops, and arches, according to the number of triradiiasper Galton’sbasic pattern.10 The dermatoglyphic parameters like a-b count, distance, breadth, Pattern intensity index (PII), Dankmeijer’s index (DI) and Furuhata’s index (FI) were calculated.
Ridge Counts: - They were counted between two digital triradii. a, b, c and d are alphabets described to the triradial point located at the base of the index, middle, ring and little finger respectively. The ridge counts most frequently obtained is between triradii a and b, and is referred to as the a-b ridge count.11The a-b distance is measured in millimetres between the triradius and the b triradius. Ridge breadth is the distance from the centre of one ridge furrow to the centre of the next furrow, along a line at the right angle to the ridges. The ridge breadth is obtained by the following calculation.12,13
DL + DR / (CL + CR + 2)
where
DL = left a-b distance in millimeter
DR = right a-b distance in millimetre
CL = left a-b count
CR = right a-b count
plus 2, as the two triradii are not counted.
Pattern Intensity Index (PII): - It is calculated by counting the triradii present in a given area. The value of pattern intensity is stated either as the number of triradii per individual or the average number of triradii per finger.14
The PII is calculated after Cummins and Midlo as follows.9
Dermatoglyphics can be used as a useful adjunct to aid in preliminary medical diagnosis. The present study shows an increased PII, FI and a decreased DI, a-b count and distance in bronchial asthma patients compared with controls. In the dermatoglyphic pattern, any deviation from the regular pattern will be strongly indicative of a particular anomaly. Although no dermatoglyphic patterns can be studied alone in making a diagnosis, several patterns, when combined, can be used to establish an uncertain diagnosis or point to a disorder that could be identified only later. We can conclude that increase in the number of whorls and a decrease in the number of arches in bronchial asthma patients can be used as a tool for the early identification of at-risk individuals with or without a family history of bronchial asthma.Where ‘n’ is the number of fingers.
Dankmeijer’s Index (DI): - It is an index expressing the total frequency of arches divided by the total frequency of whorls x 100 as follows.15
Furuhata’sIndex (FI): - It is calculated by dividing the total frequency of whorl with loops x 100 as follows.1
Result
The dermatoglyphic parameters of 250 bronchial asthma patients and 250 healthy controls were studied, compared, and analyzed statistically.
Table 1 shows the comparison of a-b count, a-b distance and a-b breadth in case and controls. It was seen that the mean value of a-b count of the right hand (30.93±5.76) and left hand (32.76±4.79) hand were less in bronchial asthma patients compared with controls (34.04±4.00, 34.59±4.10) and shows highly significant p-value (P≤0.001) on both sides. The mean value of a-b distance was less in the case on both hands (right 2.12±1.48, left 2.12±0.21) than the controls (right 2.38±2.78, left 2.25±0.26) but the value is significant only on the left side (P≤0.001). The a-b breadth in the case was statistically insignificant (P=0.617) when compared with the controls.
Table 2 shows the comparison of a-b count, a-b distance and a-b breadth with gender. In both sexes, a significant reduction was observed in the mean values of a-b count on both palms (Right, P≤001; Left P=0.011) and a-b distance on the left palm (P=0.003).The mean value of a-b breadth among the groups in both genders were found to be statistically insignificant (Female, P=0.455; Male, P=0.512).
Table 3 shows the frequency percentage of fingertip patterns in both hands combined in case (46.52% of whorls, 4.76% of archers and 48.72% of loops) and controls (35.32% of whorls, 7.96% of archers and 56.72% of loops). The Pattern intensity index (14.18) and Furuhata’s index (95.48) were higher in bronchial asthma patients than controls (12.74, 62.27). But the Dankmeijer’s index was less in bronchial asthma cases (10.23) than in controls (22.54).
Table 4 shows the various indices compared with gender. Male cases (14.51) showed a higher value for Pattern intensity index and Furuhata’s index (106.70) than female cases (PII 13.89, FI 86.64). The Dankmeijer’s index is more in the female cases (11.69) than the male cases (8.73).
Discussion
Dermatoglyphics is presently being investigated to demonstrate not unique individual differences but also to give insight into group differences. Therefore, it appears that dermatoglyphics are a part of the picture that can bring some understanding to how persons are developmentally different. It turned the attention of medical researchers when it was found that many patients with chromosomal aberrations had unusual ridge formation. By the advancement of human genetics, dermal pattern indices, together with clinical features, are being employed for the diagnosis of many inherited diseases.
In the present study, the a-b count, distance and breadth is less in bronchial asthma patients than in controls. Sreenivasuluet al.16 and Amrut et al.17 found that the a-b count was more in bronchial asthma patients and their first-degree relatives. Melloret al.18 found that the digital-palmar dermatoglyphics in schizophrenics exhibited significantly higher levels of fluctuating asymmetry in palmar a-b count than controls. Shirahatti et al.19 found that the a-b count difference between diabetes mellitus cases and the controls in both right and left hand was statistically not significant. In the present study, when we compare with gender, in both sexes a significant reduction was observed in the mean values of a-b count on both palms and a-b distance on the left palm. Since no previous study was available on a-b distance and a-b breadth in respect to gender in bronchial asthma, the present results could not be compared.
The Pattern intensity index and Furuhata’s index is more in bronchial asthma patients and male patients show higher value than female cases. Dankmeijer’s index is less in bronchial asthma patients than controls, female cases showed higher value than males. Bansal et al.20conducted a study in Jat-Sikh Males and found that there is not much difference in the values of various indices calculated for patients suffering from bronchial asthma. The increased value of PII and FI in the present study envisaged a higher prevalence of whorls in bronchial asthma patients.
In both gender, PII and FI were more in cases as compared to controls whereas DI was less in cases. This shows an increased frequency percentage in the number of whorls in both hands combined and a decrease in the number of arches in male patients. Several studies were conducted among the various groups for the PII, DI and FI. Ibewuikeet al.21 found that the PII of right and left hands was higher in uterine leiomyoma patients as compared to the controls. Wijerathne et al.claimed that the PII, DI and FI are found higher in males compared to females in the Sinhalese when compared with other populations. Shirahatti et al.19 found that the DI was significantly more in both male and female diabetes mellitus cases compared with controls, FI significantly more in cases of both sexes and Pattern intensity index significantly more in female cases and controls as compared to males.
Conclusion
Acknowledgement
The authors are thankful to all the individuals who donated their prints for the study. We are incredibly grateful to the Respiratory Medicine and Pediatric department of MES Medical college for allowing us access to individuals used in the study. We also express our deepest gratitude to all authors of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of Funding- None
Conflict of Interest - There are no conflicts of interest.
Ethical Clearance Letter No. IEC/MES/76/2014
Authors’ Contribution
Author 1- Carried out the experiment.
Author 2 and Author 3- Conceived and designed the study.
Englishhttp://ijcrr.com/abstract.php?article_id=4102http://ijcrr.com/article_html.php?did=4102
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Sreenivasulu K, Kumar PA, Nagaraju GC, Ravindranath G, Gaikwad MR. A study of palmar dermatoglyphics of bronchial asthma patients and their first-degree relatives in Kurnool district. Indian J Allergy Asthma Immunol. 2012 Jan 1;26(1):2-5.
Mahajan AA, Gour KK, Thakare AE. The dermatoglyphic patterns in patients of the bronchial asthma-a qualitative study. Int J Biol Med Res. 2011;2(3):806-07.
Mellor CS. Dermatoglyphic evidence of fluctuating asymmetry in schizophrenia. Br J Psychiatry. 1992 Apr 1;160(4):467-72.
Shirahatti A, Dixit D. A cross-sectional study of palmar dermatoglyphic pattern in patients with type 2 diabetes mellitus at a hospital in South India. Indian J Clin Anat Physiol. 2019 Dec 15;6(4):503-8.
Bansal IJ, Bector I. A comparative study of the finger dermatoglyphics of normal and asthmatic patients (male jatsikhs). Anthropologie. 1975 Jan 1:213-8.
Ibewuike OH, Olotu EJ, Paul JN. Dermatoglyphic Digital Patterns and Pattern Intensity Index in Uterine Leiomyoma. Int J Pharma Res Health Sci. 2019;7(2):2923-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareA Case of Cryptococcal Osteomyelitis in a Solid Organ Transplant Patient
English2729Sushanth KEnglish Goyal SEnglish Jeganathan JKEnglish Pavan MREnglishIntroduction: Infections in transplant patients may be missed as they do not present with the usual clinical features. This leads to a delay in the diagnosis and thereby resulting in delayed treatment. Atypical organisms are also responsible for a variety of infections in these immunosuppressed individuals. The following case illustrates these points. Aim: To report an unusual manifestation of cryptococcal infection. Case Report: This is a case of a 63-year post-renal transplant lady. Three years after the transplant, she presented with a headache. CNS examination did not reveal any abnormality. Non-contrast CT showed well-defined hypodense collection measuring 2.8x 4.1x 3.5 in the right suboccipital region deep to the muscular plane with erosion and defect in the subjacent right occipital bone. Pus culture showed cryptococcus. She underwent drainage of abscess and surgery for osteomyelitis. She received 3 weeks of treatment with liposomal amphotericin B, followed by oral fluconazole. Discussion: Bone involvement occurs in only 5% of cases of cryptococcus. It most often affects the lumbar spine or lower extremities and rarely at other sites. Conclusion: It is important to be aware of this entity especially when managing immune-compromised individuals.
EnglishAmphotericin, Cryptococcus, Fungus, Osteomyelitis, Renal transplant, Occipital boneIntroduction: Transplant patients are susceptible to a variety of organisms. Due to this reason, atypical organisms like viruses and fungi form an important aetiology in these individuals. These patients may not develop overt symptoms and signs as exhibited by immune-competent individuals. Hence the diagnosis of infection is more challenging in these cases. In addition to this, graft rejection is also an important problem in these individuals which presents with a variety of clinical pictures and further complicates the clinical presentation. These two issues need a different set of approaches in their evaluation and treatment. Diagnosing these entities early and treating them early will have a significant impact on the morbidity and mortality of these individuals.
Case report:
A 63-year-old female, known case of focal segmental glomerulosclerosis (biopsy-proven), Hypertension, end-stage renal disease underwent the deceased renal transplant in 2016 with no history of acute or chronic rejection. She was on dialysis for a year before the renal transplant. Post-transplant she was initiated on triple-drug immunosuppressants with tacrolimus, azathioprine, prednisolone along antihypertensive tablets. After 3 years post-transplant, she developed new-onset diabetes mellitus. This time patient presented with complaints of headache. On examination, she did not have any positive findings. CT head done showed nothing significant. She was treated with broad-spectrum antibiotics but she continued to have the same complaints mainly confined to the occipital region even after 2 months so a repeat non-contrast CT head was done. It showed well-defined hypodense collection measuring 2.8x 4.1x 3.5 in the right suboccipital region deep to the muscular plane with erosion and defect in the subjacent right occipital bone as shown in Fig 1. The defect was16mm suggestive of osteomyelitis. There was no intracranial extension of the abscess. Other routine investigations were done, renal function was normal with a creatinine of 1.02 mg/dl. She underwent drainage of abscess and surgery for osteomyelitis under general anaesthesia with broad-spectrum antibiotic coverage. Tacrolimus dose was reduced as per tacrolimus levels. Bony chips were sent for histopathological examination and cultures. After post-procedure, she was started on empirical antifungal treatment with liposomal amphotericin B with a dose of 100mg/day for 3 weeks under strict monitoring of renal function and serum potassium levels.
Results: During treatment histopathology was suggestive of suppurative granulomatous inflammation of fungal aetiology, morphology was similar to cryptococcus. She received 3 weeks of treatment with liposomal amphotericin B and was symptomatically better. On discharge her renal functions were normal and she was advised oral fluconazole for the next 3months. She completed the 3 months course of fluconazole. Presently she is on triple-drug immunosuppressant along with anti-hypertensives and insulin. Her renal functions are normal. She is asymptomatic & the wound has healed completely.
Discussion: Cryptococcus neoformans is an encapsulated yeast organism that can cause severe illness or death.1 It predominantly causes significant infections in immune-compromised individuals.2 It is associated with high mortality and hence early diagnosis is necessary to improve the prognosis.3 The incidence of cryptococcal infection in solid organ transplant patients is around 2.8%.4 Osteomyelitis is a rare manifestation of cryptococcal infection for which there is often a significant delay in reaching a diagnosis and treatment. Predisposing factors for cryptococcal osteomyelitis include solid organ transplant, immunosuppressant medication use, diabetes mellitus and HIV.Cryptococcal infection in solid organ transplant patients most frequently occurs in the late post-transplant period, often between 16 and 21 months.5It can be due to reactivation of pre-existing host colonisation or can represent primary infection after new exposure. Infectious diseases society of America (IDSA) recommends a three-stage treatment regimen. This begins with an induction phase consisting of liposomal amphotericin (3–5 mg/kg/day) and flucytosine (100 mg/kg/day) for at least 2 weeks.6 This can be extended if the infection is refractory to treatment. However, it is important to closely monitor the patient for nephrotoxicity during this treatment, as it is a common side effect of amphotericin. The induction phase is followed by a consolidation phase consisting of fluconazole 400–800 mg/day for 8 weeks.7 Finally, it is recommended that the patient undergoes a period of prolonged maintenance using lower dose fluconazole at 200–400 mg/day for 6 to 12 months.8 As cryptococcusneoformans is not a common organism responsible for bone lesions and with the clinical and radiological signs being non-specific, the diagnosis often gets delayed and hence results in significant morbidity and mortality.
Conclusion: This case stresses the importance of considering underlying osteomyelitis even in an unusual location such as the occiput in post-transplant patients. Additionally, atypical organisms such as fungal infections can cause osteomyelitis or abscess in these patients. This case also shows the importance of following up with these patients carefully and repeating investigations if the initial evaluation does not pick up the abnormality so that the diagnosis is not missed.
Authors’ Contribution
Dr B Sushanth Kumar: Case report conception, supervision, revision
Dr GoyalShanki: Conception, background literature and discussion.
Dr JeganathanJayakumar: Conception, data collection, writing the manuscript, revision of the article.
Dr M R Pavan: Conception, preparation of the manuscript, revision of the article.
Source of funding: Self
Conflict of interest: Nil
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=4103http://ijcrr.com/article_html.php?did=4103
Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy.Clin Infect Dis. 2001;33(5):690-9.
Charmi NS, Mannu RJ, Manish GP, Parul V. Isolation of Cryptococcus neoformans from abscess aspirate in a pulmonary tuberculosis patient. Int J Cur Res Rev. 2016;8(4):47-49.
Rajani S, Nandini D, Shalini M, Dinesh S, Charoo H. Prevalence of cryptococcal meningitis amongst HIV seropositive cases from a tertiary care hospital. Int J Cur Res Rev. 2014;6(14):32-37.
Henao-MartínezAF, Beckham JD. Cryptococcosis in solid organ transplant recipients.CurrOpin Infect Dis 2015;28(4):300-7.
Wood L, Miedzinski L. Skeletal cryptococcosis: Case report and review of the literature. Can J Infect Dis. 1996;7(2):125-32.
Medaris LA, Ponce B, Hyde Z, Delgado D, Ennis D, Lapidus et al.Cryptococcal osteomyelitis: a report of 5 cases and a review of the recent literature. Mycoses. 2016;59(6):334-42.
Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America Clin Infect Dis. 2010;50(3):291-322.
Singh N, Forrest G; AST Infectious Diseases Community of Practice. Cryptococcosisin solid organ transplant recipients. Am J Transplant. 2009;9(4):S192-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareParental Perspectives on a Heteronormative and Heterosexist Schooling Space for Children with Same-Sex Sexual Orientations: A Qualitative Research Approach
English3034Nichols HenryEnglish Ugwuanyi ChristianEnglishIntroduction: Homophobia, discrimination, and victimization in South African schools as well as globally, have been well documented. Little to no studies have been conducted on the inclusivity of school youths with same-sex sexual orientations. Objective: This paper explored parents’ perspectives on a heteronormative and heterosexist schooling space for children from same-sex sexual orientations. Method: The study employed a qualitative research approach and case study research design using six (6) parents in South Africa. A semi-structured interview guide was used to gather necessary information from the participants. Data collected were analysed using thematic analysis. Results: The findings highlighted that schools remain heteronormative and heterosexist and that parents’ perspectives of what an inclusive, safe, and supportive school setting is in contrast to their experiences. Conclusion: Parents were proactively engaged with schools to address possible challenges that may emanate as a result of the same-sex sexual orientations of their children.
English Heteronormativity, Heterosexism, Parents perspectives, Same-sex sexualities, Schooling space, Sexual orientationIntroduction
Despite the South African Schools Act (SASA) of 1996 which prohibits all forms of discrimination and intolerance, schools remain unsafe spaces for the same-sex oriented group of learners where they are not only discriminated against by their heterosexual peers, but that school staff turn the blind eye to this. 1,2 In South African schools, sexual minority youths are at higher risk for compromised school outcomes.1,3,4Samesex-oriented people’s experiences are restricted because of gender stereotypes associated with family activities and heteronormative occupations.5 The complex landscapes that lesbian, gay, bisexual, transgender, or queer navigate can create ambivalence in institutional settings.6 Stigma can have a negative impact on the same-sex parented families children’s health within a same-sex family context.5 Heteronormativity presents risks to children and families who identify themselves as gay or lesbian or gender diverse and as a result cannot be left unchecked within the school settings.8 Based on this premise, the researchers sought parental perspectives on a heteronormative and heterosexist schooling space for children from same-sex sexual orientations within the theoretical framework of Bronfenbrenner’s Socio-Ecological theory.
Historically, teachers who do not conform to gender and sexual orientation norms have been the subject of persecution and form major problems to normalize heterosexuality.9 Patterns of thinking and ideologies of dominant heteronormative practices that ultimately result in discrimination among same-sex orientated youths have been explained in emerging research.3 Parents used resilience building to construct a positive environment for child health due to lack of understanding and discrimination among youths with same-sex orientation.6 Learners are expected to be identified as heterosexual and embody heteronormative gender expression and expectations due to proliferation which makes explicit gender and sexuality binaries in the curriculum, and school culture.3 Unlike before when children have salient sexual identities of their own, children through interactions with their teachers and peers in preschool have started to make sense of heteronormativity and rules associated with sexuality.7 Gay fathers were actively engaged with school-based, home-based, and community-based educational opportunities for their children.8 Providing sexual information that covers a wide range of sexual orientations and behaviours is beneficial to all teens, most especially those who are not heterosexual.9
There is constant harassment of school youth with same-sex sexual orientations in and around their learning institutions.10 To ensure safe and inclusive schooling space for teaching and learning of their non-heterosexual children, parents wanted to get actively involved through communication and collaboration with school authorities.4 Parents have positive views on the use of children’s picture books featuring same-sex as powerful resources in leading change in the struggle against heteronormativity in early childhood education.8 The ugly experiences of school youth with same-sex sexual orientations have been neglected by the appropriate authorities in South Africa.11 Based on the work experiences of same-sex teachers, there is the need to establish a policy to manage their identities in school contexts characterised by a culture of heteronormativity.12
There are negative associations for sexual minority women between their heteronormative behavioural attitudes and personal growth.14Francis's10 study highlights how race contributes to a normalising view of heterosexuality in some contexts. Hostile reactions to non-heteronormative behaviour reinforce heteronormative beliefs and there is the need for interventions to address both prejudice and its underlying mechanisms.13 Same-sex relationships are negated by life orientation sexuality education which is a gendered, heteronormative and moralistic approach to youth sexuality.2 In recent years, family’ as a ‘child-friendly through the incorporation of their inclusive range of different family’s resources into lessons, has been used to encourage primary educators to broach same-sex relationships.14 Discrimination and exclusion resulting from current political and socio-cultural conditions have led to the restriction on the occupational transition towards motherhood/fatherhood for same-sex couples.5
TheunfortunaterealityinSouthAfricaisthatheterosexualnormsandpatriarchalvalues influence traditional binaries of male and female sexuality expressions.10 In South Africa as well as other parts of the world, oppression and resistance have been associated with the history of same-sex sexual orientated people.15 The social reality associated with same-sex orientations is quite due to harassment and discrimination from institutional service providers not minding the protection and legal quality of such people.16 In South Africa, the is gross negligence by multi-disciplinary adolescent research and service provision of the experience of school youth with same-sex sexual orientations.11 However, no study in South Africa has explored the views of stakeholders on the inclusive and supportive learning environments for children from same-sex sexual orientations. Based, on the foregoing, the researchers sought the views of parents on inclusive and supportive learning environments for children from same-sex sexual orientations. The following two questions guided us in this study:
What are the parents’ experiences with children of same-sex sexual orientation?
What are the parents’ perspectives on a heteronormative and heterosexist schooling space for children with same-sex sexualities?
Materials and Methods
Research approach and design
A qualitative research approach was adopted for this study using a case study research design. The qualitative research approach has been used recently.17 A case study research design was used to carry out in-depth interviews with the participants. This design was used to explore the views on inclusive and supportive learning environments for children from same-sex sexual orientations.
Participants
The participants for this study comprised Six parents of youths with same-sex sexual orientations. The participants were selected through purposive sampling technique from a population of parents on same-sex sexual orientations youths in Free State and Gauteng Province of South Africa. Each of the participants had a child who is still in school and is identified as having same-sex sexual orientation and must have affirmed the child’s non-heterosexual orientation. Those served as the inclusion criteria.
Instrumentation and procedure
Data for this study were collected using a semi-structured interview guide. The semi-structured interview guide allowed the research to restore the age of the participants. To ensure the credibility of the data collection instrument, the researchers made provisions to promote confidence by accurately recording the phenomena under scrutiny. Telephonic communication was used at the initial stage of communication with participants to brief them about the purpose and objectives of the study. Based on that arrangement, the participants consented to participate in the research as sought by the researchers. Each interview was conducted within 20-30 minutes at a convenient venue for the participant.
Ethical measures
The ethical approval for the conduct of this research was granted by the Research Ethics Committee of the University of Johannesburg. Besides, the researchers ensured that informed consent forms were given to the participants to fill and sign before the commencement of the data collection procedure. Also, the researchers further explained to the participants that they are free to end the interview at any stage. Pseudonyms were used to avoid the use of real names of participants during the interview for the sake of confidentiality.
Statistical Data analysis
This study employed thematic analysis to analyse the data, allowing the researchers to examine themes and patterns to make meaning of the data. The data were analysed using the step-by-step procedure involving reading and re-reading through the recording interview scripts. That approach is normally called transcription.
Results
The results were presented based on the two themes that emerged from the thematic data analysis.
Theme 1:Parents’ experiences with children of same-sex sexual orientation.
This theme emerged from the individual interviews with the 6 participants for the study. Each of the participants was interviewed and below are the extracts from their responses on their experiences with children of same-sex sexual orientation.
#1: Since she was very small, maybe six years old, I knew. I knew from the start. She acted and did things different from children, I mean like the other boys. She refused to wear trousers as boys do. She was adamant about it. I tried to teach her and even reprimand her. Then I gave up (giggling). But now I am so proud of who she is and what she stands for. She has the courage and she is happy now. And when my child is happy, I am happy. She is my daughter (transgender) and I am proud to call her that. I don’t care what other people say.
#2: At first, to be bluntly honest, she was just a bit weird. I compared her with other girls both in school and in our community. She was just different. I considered her to be weird at that stage. She talked different like she spoke about girls in a way that caught my attention. I thought to myself, this is not how other girls talk about girls in general. Later I realised, and confirmed my suspicion, that by the way, she chose to dress and all the other things that she was a lboy’san. I was confused and didn’t know what to do and how to react towards my child because she was still my child even though she was different. One thing I was sure of was that she is still my child and that I loved her, no matter what. I will never abandon my child. I became very protective over her since I knew that the life that she is going to live will not be an easy one. She might be rejected at school and even by her other family members.
#3: When my child was 11, he told me. It wasn’t a shock to me since I always had a suspicion that there might be a chance of him being gay. My husband and I sat down with him, spoke to him about it and tried our utter best to say the right things to make him realise that we love him no matter what. I think it came as a shock to him that we accepted him. We got the idea that he thought we will chase him out of the house or something. We would never do that. We love him too much. He stays our son, whether he likes girls or boys.
#4, #5 & #6: We didn’t know what was going on. We didn’t even know what it was, and the doctor didn’t explain to us what was going on. All he (the doctor) said was that we should raise Grace as a girl (intersex). Remember, we didn’t even know what intersex was at that stage. He advised us to never tell Grace about the choice we made because it will confuse her when she grows up. We had to lie to her when we took her to the doctor. We told her that there were problems with her kidneys, and she needed to go for regular check-ups. Later when she got to the puberty stage, she told us she does not want to wear dresses and that she didn’t feel comfortable wearing them.
Theme 2: Parents’perspectivesonaheteronormativeand heterosexist schooling space.
The parents in this study recalled instances and experiences of discrimination and violence reported by their children and had the following to say.
Participants #1 and #2 for example narrated thus:
I knew that Thabo was in danger, especially in school. Remember, the other children and the school staff had never had to deal with issues of people who are transgender. Children can be awful and with no doubt, we knew that he will not be safe there but there was nothing we could do. Just hope for the best. Happiness is all that we wanted for him. Thabo would come home and cry and this broke my heart. He said that the kids called him names, and even though he never said it, we knew that there was more involved than just mere name-calling.
Similar memories were shared by participants #3, #4, #5 & #6
They didn’t want to go to school and started to pretend to be sick. But we knew they weren’t sick. Home-schooling was an option and we discussed this. They never mentioned exactly what happened, but they just said that there were things that the other boys did to them. We were scared because we knew that it wasn’t only name-calling. On numerous occasions, we contacted the school, and we specifically spoke to the teachers, but this was all in vain because no change happened. We were angry about this because it was their job to protect our children. Our hands were tied.
Discussion of the Findings
The findings showed that parents are very much aware of the same-sex sexual orientation of their children. However, most of the parents narrated the ugly experiences of their children in schools as a result of their same-sex sexual orientation. This buttresses the fact that gender and sexual diversity are not addressed in schools even though they are included in the formal curriculum. These findings are consistent with the findings of the following recent studies. There is constant harassment of school youth with same-sex sexual orientations in and around their learning institutions. 10 To ensure safe and inclusive schooling space for teaching and learning of their non-heterosexual children, parents wanted to get actively involved through communication and collaboration with school authorities.4 Parents have positive views on the use of children’s picture books featuring same-sex as powerful resources in leading change in the struggle against heteronormativity in early childhood education.8 The ugly experiences of school youth with same-sex sexual orientations in South Africa have been neglected by the appropriate authorities.11 Based on the work experiences of same-sex teachers, there is the need to establish a policy to manage their identities in school contexts characterised by a culture of heteronormativity.12
There are negative associations for sexual minority women between their heteronormative behavioural attitudes and personal growth.14Francis's10 study highlights how race contributes to a normalising view of heterosexuality in some contexts. Hostile reactions to non-heteronormative behaviour reinforce heteronormative beliefs and there is the need for interventions to address both prejudice and its underlying mechanisms.13 Same-sex relationships are negated by life orientation sexuality education which is a gendered, heteronormative and moralistic approach to youth sexuality.2 In recent years, family’ as a ‘child-friendly through the incorporation of their inclusive range of different family’s resources into lessons, has been used to encourage primary educators to broach same-sex relationships.14 discrimination and exclusion is resulting from current political and socio-cultural conditions discrimination and exclusion resulting from current political and socio-cultural conditions have led to the restriction to occupational transition towards motherhood/fatherhood for same-sex couples.5
Conclusion and recommendations
The data shows that parents were proactively engaged with schools to address possible challenges that may emanate as a result of the same-sex sexual orientations of their children. However, most parents were ready to change schools for their children due to the kind of harassment and discrimination experienced by their children in school. Based on the findings of the study, it was recommended that:
To ensure effective involvement of parents in the affairs of the school, certain strategies must be promoted and popularized within the school community
Certain channels must be created by the school to assess all parents’ opinions regularly and gather informal suggestions.
Acknowledgement
The researchers appreciate all the parents who participated in this study for their active and honest participation.
Conflict of interest
The researchers declared no potential conflict of interest.
Source of Funding
There was no available source of funds for this research
Authors’ contribution
Both Dr Henry and Dr Christian initiated this research and followed it to the completion stage.
Englishhttp://ijcrr.com/abstract.php?article_id=4104http://ijcrr.com/article_html.php?did=41041. Brown A, Diale B. You Should Wear to Show what You Are: Same-sex Sexuality Student Teachers Troubling the Heteronormative Professional Identity. Gend Quest. 2018;5(1):1–19.
2. Mayeza E, Vincent L. Learners’ perspectives on Life Orientation sexuality education in South Africa. Sex Educ [Internet]. 2019;19(4):472–85. Available from: https://doi.org/10.1080/14681811.2018.1560253
3. Francis DA. Homophobia and sexuality diversity in South African schools: A review. J LGBT Youth [Internet]. 2017;14(4):359–79. Available from: https://doi.org/10.1080/19361653.2017.1326868
4. Nichols HJ, Brown A, Diale BM. School involvement expectations of parents who accept and embrace their child’s same sex sexual orientation. Gender and Behaviour. 2019; 17(4): 14287-14295.
5. Morrison R, Araya L, Valle JD, Vidal V, Silva K. Occupational apartheid and human rights: Narratives of Chilean same-sex couples who want to be parents. J Occup Sci. 2020;27(1):39–53.
6. Crouch SR, McNair R, Waters E. Parent Perspectives on Child Health and Wellbeing in Same-Sex Families: Heteronormative Conflict and Resilience Building. J Child Fam Stud [Internet]. 2017;26(8):2202–14. Available from: http://dx.doi.org/10.1007/s10826-017-0796-3
7. Cloughessy K, Waniganayake M. Lesbian parents’ perceptions of children’s picture books featuring same-sex parented families. Early Years [Internet]. 2019;39(2):118–31. Available from: http://doi.org/10.1080/09575146.2017.1342225
8. Kahn M, Gorski PC. The gendered and heterosexist evolution of the teacher exemplar in the united states: Equity implications for LGBTQ and gender nonconforming teachers. Int J Multicult Educ. 2016;18(2):15–38.
9. Gansen HM. Reproducing (and Disrupting) Heteronormativity: Gendered Sexual Socialization in Preschool Classrooms. Sociol Educ. 2017;90(3):255–72.
10. Leland AS. Navigating gay fatherhood: the experiences of four sets of gay fathers with their children’s education. Gend Educ. 2017;29(5):632–47.
11. Estes ML. “If There’s One Benefit, You’re not Going to Get Pregnant”: the Sexual Miseducation of Gay, Lesbian, and Bisexual Individuals. Sex Roles. 2017;77(9–10):615–27.
12. Msibi T. Passing through professionalism: South African Black male teachers and same-sex desire. Sex Educ [Internet]. 2019;19(4):389–405. Available from: https://doi.org/10.1080/14681811.2019.1612346
13. Habarth JM, Wickham RE, Holmes KM, Sandoval M, Balsam KF. Heteronormativity and women’s psychosocial functioning in heterosexual and same-sex couples. Psychol Sex [Internet]. 2019;10(3):185–99. Available from: https://doi.org/10.1080/19419899.2019.1578994
14. Francis DA. ‘Oh my word; for us African gays it’s another story.’ Revealing the intersections between race, same-sex-sexuality and schooling in South Africa. Race Ethn Educ [Internet]. 2019;00(00):1–17. Available from: https://doi.org/10.1080/13613324.2019.1679752
15. Van DTJ, Pliskin R, Morgenroth T. Not quite over the rainbow: the unrelenting and insidious nature of heteronormative ideology. Curr Opin Behav Sci [Internet]. 2020;34:160–5. Available from: https://doi.org/10.1016/j.cobeha.2020.03.001
16. Hall JJ. Permissible progress: Sexual(ities that) progress in and beyond English primary schools. Environ Plan C Polit Sp. 2020;0(0):1–21.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareAnti-diabetic, Anti-oxidant, Fluorescence and Filter Characterizations of Bis Glycine Lithium Bromide Monohydrate (BGLBMH) Macro and Nano-scaled Crystals
English3539Alphonse Arockia JeneciusEnglish Ramachandra Prasad DivyaEnglish Kannuswamy Senthil KannanEnglish Irudaya Antonat SophiaEnglish Balaraman RavindranEnglish Ramamurthi KrishnaveniEnglishEnglishAD, AO, Crystals, Fluorescence, Influx, Nano1. Introduction
Complexes of glycine have recently attracted attraction due to their potential applications in ferroelectricity,1-3 dielectric properties4 and nonlinear optical properties.5-9 Nonlinear optical materials10-14 are very important for the current researchers due to their importance for producing the second and third harmonic generations.15-17 Single-crystal X-ray beam structure arrangement examination uncovers that the hydrated type of glycine lithium bromide takes shape in the monoclinic framework, with spacegroup P21/c. Fluorescence, filter utility and AD and AO work for BGLBMH macro and nano scalings.18-22.
2. Experimental
2.1. Synthesis
Bis-glycine lithium bromide (BGLBMH) salt was combined by dissolving Analar grade glycine and lithium bromide in a 1:1 proportion in double-distilled refined water as indicated by the accompanying response:
LiBr + CH2NH2COOH
Li+[CH2NH2COOH].Br−
The temperature of the arrangement was kept up at a consistent temperature of 52°C, and the BGLB salt was acquired by the dissipation of the dissolvable. The immaculateness of the salt was expanded by progressive recrystallizations by suitable solutions.
2.2. Crystal growth
BGLBMH crystals were developed, at first by slow evaporation was utilized to develop single crystals of BGLBMH at room temperature. A saturated solution of 250 ml was set up as per dissolvability information. It was kept in an undisturbed territory for evaporation to get fine crystals of BGLBMH.
3. Results and Discussions
3.1 SXRD and PXRD studies and milling scheme
The Single-crystal XRD (SXRD) and Powder XRD (PXRD) for macro and nanocrystals of BGLBMH crystals are represented by data of SXRD by Table.1 and PXRD pattern by Fig.1 and macro crystals are of size as 13 x 7 x 5 mm3 and powder XRD pattern shows the indexed data of BGLBMH with the 2θ territory value extended from 10-80 degrees at a pace of 1°/min and the macro crystals are off with the crystalline system of monoclinic in nature and PXRD intensity from 0-100000 values and the different planes of reflections were regulated utilizing the product AUTOX93 and matched up with powder XRD pattern of the existing one with the earlier cases.
The nano scaling is obtained from milling the macro crystals using Milling type as Retsch mill for the time extent of above 40 hours with a milling swiftness of 250 rpm as given in Table.2 and the variations of time Vs nm scaling is given in Fig.2.
3.2. Fluorescence (FL) and NLO - SHG
Fluorescence (FL) is the practice of emanation of radiance by a particle after absorbing preliminary radiation (excitation level). Much of the time, the discharged light has a more drawn out frequency, and in this way lower vitality, than the assimilated radiation.
The bandgap is 3.08 eV which is the emission of 403 nm as emission FL value for macro scaling and 397 nm for nano scaling with the band gap of 3.12 eV. As the size of the sample from macro to nano of 34 nm, the FL value varies by 6 nm in decremented value and energy value varied by 0.04 eV as incremental one, the Fig.3 and Fig.4 represents the FL value for macro scaling and nano scaling for BGLBMH crystals.
The SHG of BGLBMH is analysed and from that, the crystal shows efficient output related to lasers for frequency doubling and is of 1.25 times than the referenced specimen of KDP for the non-linear effect and is mainly due to the strongest hydrogen bond present in the specimen.
3.3. Anti-diabetic (AD) study and influx study
The Anti-diabetic (AD) studies for the grown BGLBMH crystals were carried out. The IC 50 values for macro and nano scales are 37.5 and 30.4 correspondingly for the AD of BGLBMH crystals and the inhibition values are increased as the macro is converted to nanoscale and in IC 50 case its decreased from macro to nano scaling, which is suitable for AD work as mentioned in Table.3 and the graphical representation for macro and nano scaling is shown in Fig.5 as well as Fig.6-7.
The AD activity of BGLBMH is mainly due to the presence of Glycine and bromide and not due to the lithium by the chemical structure and properties. The cumulative column chart is shown in Fig.7 with a concentration in macro and nanoscale.
Influx value of 1.9752 microns of BGLBMH represents that the macro influx refers that BGLBMH is a good NLO crystal as it is less than 10 microns as the case represents the non-centrosymmetricity and 2.4325 microns is a nano-level influx. So, the BGLBMH macro and nanocrystals are used in filter applications also as the data are represented in Table.4.
3.4. AO-DPPH, FRAP and the total value of Antioxidant activity
DPPH radical explore ability assay represented is carried out [21]. DPPH outlines violet or the purple colour in methanolic solution and become lighter out to shadows of yellowish colour in the existence of antioxidants. 250µl of the test solution and 1ml of DPPH solution was added all along with 0.4 ml of 50 mM tris HCl buffer and the amount was made up to 2 ml with purified water and the tube was protected in dark arrangement for 0.5-1 h and the reading was measured at 517 nm using spectro-photometer of make LT 291 labtronics microprocessor. Ferric reducing capability of the extorts was explore using the potassium ferricyanide-ferric chloride technique. 1 ml of the extorts was assorted with 0.1M phosphate-buffered solution and also with 2 ml of the 0.1% potassium ferricyanide. The assortment was protected at 500oC for 0.5-1 h and 2 ml of the 10% trichloroacetic acid solution was supplemented to stop the effect, by centrifugation at 5000 rpm for around 8 minutes the clear solution was estranged and added 0.1% FeCl3 solution (2 ml) this was measured at 700 nm using a spectrophotometer. The total antioxidant activity of the trial was resolved by using the phosphor molybdenum process. The assay was mainly on the reduction of Mo (VI) to Mo (V) by the trial and succeeding creation of green phosphate composite at the value of acid pH. 0.2 ml trial was collected with 2 ml of reagent solution (0.6 M sulphuric acid, 28 mM sodium phosphate and 4 mM ammonium molybdate). The solution was protected at 90°C for 1.5 h. following the action of cooling in room warmth; the absorbance of the solution was measured at 695 nm using a spectrophotometer. The totality antioxidant action is articulated as the amount of gram equivalent of ascorbic acid as shown in Table.5.
Conclusion
BGLBMH crystals are put in order by slow evaporation solution growth method and nanocrystal by milling method. BGLBMH are of the system as monoclinic with space group of P21/c by SXRD and the nano outline of BGLBMH crystals are reported for 34 nm likewise indexed by PXRD and crystals speciality is THG and band gap is 3.08 eV which is of 403 nm as emission FL value for macro scaling and 397 nm for nano scaling with the bandgap of 3.12 eV. Influx value of 1.9752 microns of BGLBMH represents that the macro influx refers that BGLBMH is a good NLO crystal and is 1.25 times than KDP, the non-centrosymmetricity and 2.4325 microns in nanoscale represents that it is good and better prospects in filter utility. The macro crystals have good scope for anti-diabetic by the Glycine, bromide presence and have increased in inhibition rate as concentration increases and the IC value as 37.5 and in a nano form, it is 30.4 and has good AD activity of BGLBMH crystals. Both macro and nano BGLBMH crystals are increased in inhibition values while concentration increases as shown in column chart and AO for BGLBMH is also analyzed and reported.
Acknowledgements
Author(s) is grateful to EGSP management for R&D collaborative work - permission to complete this paper and for the permission to publish.
Declaration of interest statement & conflict statement
All authors are equally contributed and there are no conflicts to declare.
ORCID ID (Dr K.SenthilKannan) 0000-0002-8935-6470
Funding
No funding is received and authors contribute their own funding for studies
Author’s contribution
Alphonse Arockia Jenecius 1 - Antioxidant study
Ramachandra Prasad Divya2* - crystal growth
Kannuswamy SenthilKannan3* - crystal growth and studies and write up and nano scaling work
Irudaya Antonat Sophia4 - FL study and write up
Balaraman Ravindran5 - Overall corrections & suggestions
Ramamurthi Krishnaveni6 - AD work and write up
Englishhttp://ijcrr.com/abstract.php?article_id=4105http://ijcrr.com/article_html.php?did=4105
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SenthilKannan K, Venkatachalam K, Thamarikannan P, Kalaipoonguzhali V, Kannan S, and Jothibas M, Computational and experimental studies of acetoacetanilide crystals. AIP Conf Proc. 2020; 2270, 040014: 1-4 https://doi.org/10.1063/5.0019332
SenthilKannan K, Thamaraikannan P, Kannan S, Kalaipoonguzhali V, Ashok KR, and Venkatachalam K, Computational analysis of LPNPTH anisotropies for dementia for Alzheimer’s syndrome by DFT and molecular harbouring. AIP Conf Proc. 2020;2270, 040008:1-5 https://doi.org/10.1063/5.0019331
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareRelationship between Drug Craving and High-Risk Situations for Relapse Among Inmates with Substance Abuse Issues
English4043Nurulatiqah YunosEnglish Fauziah IbrahimEnglish Ezarina ZakariaEnglish Wan Shahrazad Wan SulaimanEnglish Nazirah HassanEnglish Mohammad Rahim KamaluddinEnglish N.K. TharshiniEnglishIntroduction: Relapse occurs when there is a strong desire for repeating drug-seeking behaviour due to high-risk situations such as social environment, interpersonal conflict, and negative emotions. Objective: This article aims to analyse the relationship between drug craving and high-risk situations for relapse among inmates with substance abuse issues serving in Malaysian prisons. Material and Methods: This study was conducted using a quantitative approach. A total number of 407 inmates with substance abuse issues were randomly selected as respondents of the study. The data were analysed using descriptive and inferential analysis via SPSS software. Results: The result indicates that there is a positive and significant moderate relationship between drug craving and high-risk situations for relapse (r=0.452, p?0.01). Therefore, it can be concluded that drug craving is associated with high-risk situations for relapse among inmates with substance abuse issues. Conclusion: The findings of this study is expected to provide implications to the stakeholders such as counsellors and drug rehabilitation officers to improvise the existing rehabilitation modules and programs to address relapse issues among inmates in Malaysia.
EnglishDrug craving, High-risk situation, Inmates, RelapseINTRODUCTION
Relapse is defined as a repeated drug-seeking behaviour faced by the former drug addicts even after completing the rehabilitation process.1Statistics obtained from the National Anti-Drugs Agency (AADK) show that around 7,867 drug addicts were involved in prison’s drug treatment and rehabilitation programs in 2010.2AADK also reported that around 4,800 drug addicts’ relapses in the year 2012. The figure sharply increases every year where a total number of 7,793 relapse cases were recorded in the year 2018.3 Due to the high escalation in drug relapse rate, the government of Malaysia has taken various steps to create a drug-free community especially by allocating a large sum of money every year for drug treatment and prevention programs. 4,5.
Drug craving is a major risk factor contributing to relapse among inmates with substance abuse issues.6 In fact, drug craving has been identified as a key characteristic to predict future relapse among former drug addicts.7 The inability to control craving and managing stressful situations might increase the risk of relapse.8 A substantial body of literature indicates that the challenges to secure employment opportunity leads the majority of the former inmate to commit street crimes such as stealing and snatch theft to cover the costs of buying drugs. 9,10,11Moreover, lack of access to advanced rehabilitation care is also one of the reasons that contribute to drug addicts’ relapse.8 Admittedly, if this situation is left unaddressed it may cause a negative effect on the mental well-being of the inmates12 and bring harm towards public safety.13
Craving for drugs is driven by high-risk situations.14Individuals who experience high-risk situations usually encounter issues such as negative emotions, interpersonal conflict and social pressures from their surroundings.15 Correspondingly, there is a significant relationship between individuals with negative emotions, interpersonal conflicts and social pressure with drug relapse.16 In fact, a study shows that drug addicts who relapsed display negative emotions such as feeling depressed, sad, easily gets irritated and bored.14Moreover, intense pressure from the social environment and interpersonal conflicts such as misunderstandings with family members/partners/spouses/co-workers, or community members further increase the probability of relapse. Since individuals with a drug addiction history encounter various obstacles throughout the rehabilitation process thus this study is conducted to analyse the relationship between drug craving and high-risk situations for relapse among inmates with substance abuse issues who are currently serving in Malaysian prisons. Therefore, this study is conducted to (1) ensure the level of drug craving and high-risk situations for relapse among inmates with substance abuse issues and (2) to analyse the relationship between drug craving and high-risk situations for relapse among inmates with substance abuse issues.
METHODOLOGY
Research Design
The study employed a quantitative research design and a cross-sectional approach to collect data. According to 16quantitative research, the design uses numerical data to interpret the finding of a study.
Population, Sample and Survey Locations
In this study, the population is referred to all the inmates with substance abuse issues who are currently serving in the Malaysian prisons. A total number of 407 inmates with substance abuse issues from five prisons in Malaysia were selected as the sample of the study. Data were collected at various zones in Malaysia including the Southern Zone (Melaka Prison), Central Zone (Selangor Prison), Northern Zone (Perak Prison), Eastern Zone (Pahang Prison), and East Malaysia (Sabah Prison).
The inclusion criteria for this research include (1) Inmates with substance abuse issues who are currently serving for at least six months and (2) Malaysian male inmates with substance abuse issues.
Data Analysis
The data were analysed using the Statistical Package for the Social Science (SPSS). The research instrument used in this survey are as follows:
Drug Craving Scale: This instrument comprises 10 item questions measuring drug craving among inmates with substance abuse issues with the reliability score of 0.94.18 The instrument uses 4-point Likert scale scoring; (1) strongly disagree, (2) disagree, (3) agree, and (4) strongly agree.
The High-Risk Situations for Relapse Scale: This instrument is divided into three sections including; (i) social environment pressure (9 items), (ii) interpersonal conflicts (10 items), and (iii) negative emotions (10 items) to measure high-risk situations for relapse among inmates with substance abuse issue. The reliability score of 0.88.18 The instrument uses 4-point Likert scale scoring; (1) strongly disagree, (2) disagree, (3) agree, and (4) strongly agree.
In terms of scoring, the minimum score is 1 and the maximum score is 4. The level of drug craving among inmates with substance abuse issues is divided into three categories namely; (i) low level, (ii) intermediate level, and (iii) high level as shown in Table 1:
A descriptive analysis was employed to illustrate the results of the study. Frequency and percentage were used to present the first objective of the research whereas inference analysis (correlation test) was used to display the second objective of the research. The interpretation of the correlation is based on table 2 below19:
Procedure
Upon getting permission from the Director-General of the Malaysian Prison Department the researcher’s contacted the Prison administration to fix a suitable date for data collection. On the day of data collection, the researchers brief the Prison Officer on duty and the respondents involved in this study regarding the procedure to answer the survey form. To ease the data collection process, the respondents were divided into two main groups namely; (i) inmates who can read and write and (ii) inmates who are unable to read and write. The respondents who could read were monitored by the Prison Officer whereas respondents who are unable to read were monitored by the researchers. Researchers guided the respondents who are illiterate by verbally reading to them each question to help them to fill up the survey form. All the returned survey form was checked thoroughly by the researchers. The incomplete questionnaire was given back to the respondent to re-answer again.
RESULTS AND DISCUSSION
The Level of Drug Craving and High-Risk Situations for Relapse
Drug craving refers to the factors that initiate longing among inmates with substance abuse issues. Table 3 show the results of the survey related to the level of drug craving among inmates with substance abuse issues who are currently serving in Malaysian prisons. The survey results disclosed that the majority of the inmates exhibited a moderate level (55.8%) to a high level (23.1) of drug craving. Findings also unveiled that only 21.1% of inmates with substance abuse issues displayed a low level of drug craving. It can be fairly concluded that the level of drug craving among inmates with substance abuse issues is at an alarming stage. Therefore, stakeholders such as counsellors, social workers, and drug rehabilitation officers who are working in the prison setting need to revamp the existing drug rehabilitation module to help the inmates to handle the drug craving issues effectively.
High-risk situations for relapse refer to a condition such as pressure from the social environment, interpersonal conflict, and emotional disorder that influences inmates with substance abuse issues to relapse. The result indicates that high-risk situations for relapse among inmates who are currently serving at the Malaysian prisons are at a moderate (74.9%) to the low level (19.2%). Only 5.9% of inmates with substance abuse issues displayed high-risk situations for relapse (Table 4). The finding also shows that the majority of the inmates with substance abuse issues are still able to control the high-risk situations for relapse. To further reduce the relapse rate, new feasible programs/approaches to control drug craving should be created in no time. It is suggested that the new programs/approaches should place more emphasis on the risks of relapse and strategies for coping with the drug craving. In addition, former drug addicts should also be educated to seek treatment if they begin to show relapse signs.
The Relation between Drug Craving and High-Risk Situations for Relapse
Table 5 shows the correlation result pertaining to the relationship between drug craving and high-risk situations for relapse among inmates with substance abuse issues.
H1: There is a significant relationship between drug craving and high-risk situations for relapse.
The result shows that there is a positive and significant moderate relationship between drug craving and high-risk situations (r = 0.452, p ? 0.01) for relapse among inmates who are currently serving at the Malaysian prisons. The alternative hypothesis of this study is accepted. The positive relationship indicates that the greater the high-risk situations, the higher the craving for drugs and tendency to relapse among inmates with substance abuse issues. The results of this study are in line with a study conducted with another researcher that the drug craving is positively associated with the risk of addiction relapse (r = 0.509, p Englishhttp://ijcrr.com/abstract.php?article_id=4106http://ijcrr.com/article_html.php?did=4106
Mattoo SK, Chakrabarti S & Anjaiah M. Psychosocial Factors Associated with Relapse in Men with Alcohol or Opiate Dependence.Indian J Med Res.2019; 130(6): 702-708.
National Anti-Drugs Agency (AADK). Buku Maklumat Dadah 2010. https://www.adk.gov.my/en/ public/drugs-information-books/. [12 October 2019].
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Normala AB &Mohd Azhar AH. Kepentingan Peristiwa Pencetus dalam Transformasi Perspektif Bekas Penagih Dadah. Sains Humanika,2017, 9:1-5.
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Mchugh RK, Fitzmaurice GM, Carroll KM, Griffin ML, Hill KP & Wasan AD& Weiss RD. Assessing Craving and its Relationship to Subsequent Prescription Opioid Use among treatment-seeking Prescription Opioid Dependent Patients. Drug Alcohol Depend.2014; 1(145): 121-126.
Mohd Alif J, Siti Hajar AB, Jal Zabd MY, Khairiyah MS, Noralina O & Zaiton A. Kekurangan Akses kepada Jagaan Lanjutan dan Faktor-Faktor Risiko yang Membawa kepada Relaps Dadah dalam Kalangan Bekas Banduan. Jurnal Perspektif. 2018; 10 (2): 34-44.
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Fauziah I, Suzana MH, EzarinaZ, Salina N, Norulhuda S, Khadijah A, NasrudinS & Mohd Suhaimi M. Drug Abuse and the Involvement of Prisoners in Street Crimes Int. J. Psychosoc. Rehabil. 2020, 24(4): 4508-4516.
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Marlatt GA & Gordon JR. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. 1985 New York: Guildford Press.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareGiant Renal Angiomyolipoma with Incidental Finding of Serous Cystadenoma - A Rare Case Report
English4447Bhalsod Harsh DEnglish Khan Imran AliEnglishIntroduction: Angiomyolipoma (AML) also known as hamartoma is a rare benign tumour composed of an admixture of adipose tissue, smooth muscle and abnormal blood vessels. AMLs of the kidney are seen in 20% of patients with tuberous sclerosis. In an enlarged form, an angiomyolipoma mimics a renal cell carcinoma, therefore it is imperative to rule it out. Surgery management is recommended for confirmatory histological diagnosis and additionally helps by preventing the risk of haemorrhage or malignancy. In our case, we report a 48-year-old female with complaints of lump and pain in the abdomen. Case Report: Contrast-enhanced Computed Tomography (CECT) was suggestive of left renal mass with large cystic lesion over the right ovary. The patient was taken for exploratory laparotomy and a left nephrectomy with right oophorectomy was carried out. On histopathological examination, renal angiomyolipoma with serous cystadenoma of the ovary was seen. Conclusion: Renal angiomyolipoma by itself is a rarity. Therefore, the simultaneous occurrence of a renal AML with serous cystadenoma of the ovary makes us wonder whether this is an isolated incident or a part of a genetic complex yet to be discovered.
EnglishRenal hamartoma, Renal cell carcinoma, Nephrectomy, Oophorectomy, Exploratory laparotomy, Tuberous sclerosisINTRODUCTION
Angiomyolipoma (AML) is an uncommon, benign, mesenchymal tumour1which has an incidence of 0.3- 3%.2 Earlier, AMLs were classified under hamartomas, however, they now are listed in the family of perivascular epithelioid cell tumours (PEComas).3 They are composed of adipose tissue cells, smooth muscle cells and abnormal blood vessels in varying proportions.4
AMLs are primarily found in 2 forms; sporadic (80%) and associated with tuberous sclerosis (20%).3 Sporadically occurring AMLs are usually unilateral, unifocal2 and have a preponderance towards women in the 4th- 7th decade of life.1 When associated with tuberous sclerosis, AMLs may be either bilateral or multifocal and tend to occur in a younger age group (3rd decade); hence careful screening is necessary while monitoring for the presence of renal masses.5
Lenk’s triad is formed by the classical symptoms; flank pain (53%), palpable mass (47%) and gross hematuria (23%).2 But most AMLs are small, asymptomatic and are found incidentally from Ultrasonography or CT scans which are performed for other clinical conditions.2 If an AML is more than 4 cm in size it is likely to produce symptoms due to mass effect and therefore requires intervention.3 Other less commonly occurring symptoms include nausea, vomiting, fever, anaemia and blood pressure changes.5
We hereby present a clinical case of a giant renal AML inclusive of investigation and management and an incidental finding of a right serous cystadenoma.
CASE REPORT
A 48-year-old female, with no previous surgical history, got admitted under the Department of General Surgery with complaints of a lump in the abdomen for 2 months along with pain in the abdomen for 10 days. The patient had no complaints of hematuria or weight loss with no family history of malignancy.
On physical examination of the patient, there were 2 masses palpable over the abdomen. One lump measured 20 x 13 cm seen in the umbilical region extending over the hypogastrium, soft, fluctuant with well-defined margins.
Another ballotable lump measuring 15 x 8 cm was palpable over the left lumbar region. Blood profile and urine examination were within normal range. USG abdomen and pelvis was done suggestive of a heterogeneous lesion involving a mid-lower pole with few cystic areas and calcific foci, suggestive of renal neoplasm. Large multiloculated, cystic lesion with thick septation seen arising from right adnexa extending up to lower abdomen s/o right ovarian cyst.
CECT- abdomen & pelvis was s/o well defined exophytic, heterogeneously enhancing soft tissue mass measuring 9.3 x 7.4 x 6.9 cm arising from the mid-lower pole of a left kidney showing central stellate scar with multiple calcifications s/o renal carcinoma along with large multiloculated, multiseptated cystic lesion arising from right adnexa measuring 20.5 x 13.5 x 21.7 cm s/o right ovarian cyst (Fig 1,2 and 3).
Right oophorectomy and left nephrectomy were carried out and the specimens were sent to the Pathology department (Figure 4,5,6). The post-operative period was uneventful, and the patient was discharged on a postoperative day 10 after complete removal of sutures.
On histopathology, grossly the left kidney measured 13 x 10 x 6 cm with intact hilum with perinephric fat attached. On cut section greyish white area to brownish hemorrhagic area, cystic area, solid variegated to the dark blue area with intact capsule identified. Mass is identified occupying the lower pole extending to the upper 2/3rd of the kidney. The upper pole appears normal. While the right ovarian cyst measured 22 x 18 x 10 cm in size and 50 cm in circumference. On the cut section, it shows a unilocular cyst with a thin wall and blood vessels. No solid areas are identified. On microscopy, AML shows thick-walled blood vessels along with myoid component (Fig 7), multiple abortive tubules at the periphery with colloid-like material along with my myoid component (Fig 8). On microscopy, serous cystadenoma shows a cyst wall lined by a single layer of ciliated columnar epithelium with bland nuclear features. Subepithelial, fibro collagenous tissue with few congested blood vessels are seen (Fig 9).
DISCUSSION
Angiomyolipoma is a rare benign tumour of the kidney.1It was originally described by Fischer in 1911 and was named by Morgan in 1951.6 AMLs are classified under Perivascular Epithelioid Cell Neoplasms (PEComas). PEComas have been defined by the World Health Organization (WHO) as “mesenchymal tumours composed of histologically, ultra-structurally and immunohistochemically distinctive perivascular epithelioid cells”.2 Differential diagnoses of AMLs are subtypes of sarcomas - fibrosarcoma, leiomyosarcoma and renal cell carcinoma.1 Earlier report stated that a renal AML could grow by about 4 cm annually in its maximum diameter. When the diameter of renal AML reaches >10 cm, the tumour is referred to as ‘giant’. Renal AMLs growing to a diameter more than 10 cm, have been termed as ‘giant’. Citations of giant renal AMLS are few to be found, with the largest renal AML (39x25cx9 cm) being reported by Taneja et al.,2013.7
It is of paramount importance to differentiate angiomyolipoma from renal cell carcinoma.8 Renal cell carcinomas and AMLs are both hypervascular lesions that share many radiological findings and may be indistinguishable.8 Hence, radiological investigations are imperative for the diagnosis of AMLs. On USG, AMLs normally display a mass with high or mixed echogenicity. On CT, an AML is shown to be well-circumscribed, with adipose and soft tissue is present in varying proportions.5The presence of fat inside a renal nodule, although not pathognomonic, virtually leads to the diagnosis of AML. CT presents a 95% accuracy rate for diagnosis of AMLs.6
The majority of AMLs are less than 4 cm in size and are not accompanied by any signs or symptoms. Management for these patients is mainly conservative. If required, radiofrequency ablation can also be carried out.7 A half-yearly follow-up CT is required for asymptomatic lesions > 4 cm in size. Symptomatic lesions are usually >8cm in size.5Several reports in the literature suggest that surgical treatment should be used in tumours measuring larger than 4.0 cm.6 In high-risk patients, with lesions more than 4cm, prophylactic embolization is advised, before surgery.5 However, the primary objective of management is always to retain maximal renal function and to prevent haemorrhage.5 It has been observed that as the size of angiomyolipoma increases, symptoms associated with mass effect begin to appear and there is an increased risk of bleeding. Studies indicate that there is a risk of 13% and 51% risk of bleeding if the lesion is < 4 cm or > 4 cm respectively.5 In our case report, the size of the lump measured 12 cm, therefore, classifying it as a “giant” AML. Hence, a left nephrectomy was carried out.
CONCLUSION
The unusual occurrence of two benign neoplasms, renal angiomyolipoma and serous cystadenoma of the ovary has not been reported in the literature. This unique occurrence whether an accidental case or it carries any genetic implication may be discovered in future years.
Englishhttp://ijcrr.com/abstract.php?article_id=4107http://ijcrr.com/article_html.php?did=4107
Singh LO, Singh SO, Chongtham C, Maibam C, Singh TS. Renal Angiomyolipoma: A case report, Int J Res Health Sci. 2016; 4(3):73-76.
Sarma U, Sangma RA, Deka R. Angiomyolipoma of kidney–a case report. Medico Res Chron. 2015 ;2(3):311-314.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareComparative Evaluation of Neem, Cinnamon and its Combination as an Intracanal Medicament on E. Faecalis - An Invitro Real-time Polymerase Chain Reaction Study
English4851Chakravarthy VineethaEnglish Jayakumar SrilekhaEnglish John Bindu MeeraEnglish Sridhar DineshEnglish Arumugam KarthikeyanEnglishIntroduction: Intracanal medicaments play a vital role in disinfecting the root canals. Considering the ineffectiveness, potential side effects of synthetic drugs, the herbal alternatives for endodontic usage prove to be advantageous. Currently, very few pieces of literature are available on which combination of herbs are used as an intracanal medicament. Hence in this study, the effectiveness of neem, cinnamon and its combination against E.faecalis is evaluated. Aim: The objective of this study is to evaluate the antibacterial efficacy of neem, cinnamon and its combination and to compare these with chlorhexidine and calcium hydroxide as intracanal medicaments against Enterococcus faecalis (E. faecalis). Methodology: A total of 75 freshly extracted teeth specimens (n=15) were inoculated with E. faecalis for 21 days. Specimens were divided into five groups (Group 1: Neem paste, Group 2: Cinnamon paste, Group 3: Combination of Neem and Cinnamon paste, Group 4: Calcium hydroxide; Group 5: 2% chlorhexidine gel (CHX). The intra-canal medicaments were packed inside the tooth. After 7 days, the remaining microbial load was determined by using real-time PCR. Results: The threshold cycle (Ct) values of Neem, Cinnamon, Neem with Cinnamon, Calcium hydroxide & 2% CHX were found to be 21.51, 20.48, 22.11, 22.46 & 23.42 respectively. The mean bacterial load of these samples was 8.56, 12.45, 7.24, 0.83 &0.13 respectively. Conclusion: Combination of Neem with Cinnamon has better antibacterial efficacy against E-Faecalis when compared to individual pastes of Neem and Cinnamon, the efficacy of the combination was comparable to that of calcium hydroxide. However, 2% Chlorhexidine had the highest antibacterial property.
English Calcium Hydroxide, Chlorhexidine, Cinnamon, E-Faecalis, Neem, RT-PCRINTRODUCTION:
Anatomical complexities and microbiological factors often constitute serious threats to adequate root canal disinfection.1
Irrigants and intracanal medicaments play a pivotal role in reducing the number of residual bacteria. Calcium hydroxide has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans.2
Studies reported that 2% CHX gel had greater activity against E. Faecalis by causing cell membrane damage. However few literature state the toxic effects of CHX on human neutrophils.3
Herbal alternatives have the least ability to develop resistance against microbes and also have the least side effects, considering these two properties the herbal extracts will pave a pioneer disinfection strategy in the domain of endodontics.4,5
Several studies have shown neem6,7 and cinnamon to possess antibacterial properties, but there is currently very little literature available on which combination of herbs are used as an intracanal medicament.8Hence in this study the effectiveness of neem, cinnamon and combination of neem-cinnamon paste targeted against E.faecalis is evaluated.
Currently, there is a need for a material that would completely disinfect the root canal. Herbal medicaments are gaining keen interest due to their good antibacterial property with the least side effects.9
Hence Neem and Cinnamon with known antibacterial properties were chosen for this study. This study can pave the way for the development of newer herbal agents which can also be manipulated and incorporated in various endodontic materials like irrigants, sealers and coated on gutta-percha as disinfecting agents.
Amongst the currently available methods of microbial growth assessment, PCR is the most rapid and best suited molecular method for studying microbial count and gene expression. In our study, Real-time PCR was used to assess the gene expression of E.faecalis after using the herbal intracanal medicaments. The results of the current study will aid in evaluating the efficacy of newer herbal intracanal medicaments against E. Faecalis, thus improving the prognosis of root canal therapy.10
MATERIALS AND METHODS:
Preparation of the block
Fifty freshly extracted mandibular premolars were collected and the middle third of the root was sectioned using a diamond disk under copious irrigation to be used for the study. The sectioned portion of the dentin was standardized to its internal diameter with GG drill no.3 (Mani Inc, Tachigiken, Japan). Following the routine irrigation protocol using 3% sodium hypochlorite and 17% EDTA for smear layer removal and a final rinse with saline, the samples were autoclaved at 121°C for 15mins.
Contamination of the dentin blocks:
The samples were contaminated overnight by the laminar flow method using a pure strain of Enterococcus faecalis, cultured in a brain heart infusion broth at 37 degrees Celsius for 24 hours. 1ml of the inoculum was transferred to sterile microcentrifuge tubes containing the samples and broths and fresh inoculum was transferred after 48 hours.11
Preparation of Extracts
The fresh leaves of neem and barks of cinnamon were dried under shade for 7 days. The herbs were spread flat in a single layer to ensure even drying. The dried leaves were then ground into a powder with the grinding time for each grinding operation kept constant at 30 seconds.12The powdered herbs were taken on a sterile glass slab and mixed with 2-3 drops of methylcellulose. 0.5 g of neem and cinnamon powder were mixed with 0.5 mL of a 1.66% solution of carboxymethylcellulose to form an aqueous paste.13
Anti-microbial assessment
After the incubation period, saline (5ml) was used as the final irrigant and the dentin blocks were divided into 5 groups (n=10) as follows:
Group 1: Neem extract with methylcellulose
Group 2: Cinnamon extract with methylcellulose
Group 3: Combination of Neem with Cinnamon extract with methylcellulose
Group 4: Calcium hydroxide
Group 5: 2% chlorhexidine gel
After treatment with intracanal medicament, all the samples were sealed and placed in the aerobic incubator at 37°C for 24 hours. Then the samples were rinsed with saline. Using a GG no.5, the dentinal debris was harvested at a depth of 400 um. The debris was collected in 1 ml of PBS buffer solution and incubated at 37C for 24 hours. After this, the samples were evaluated by real-time PCR.
RESULTS:
The study revealed the highest antibacterial efficacy by 2% Chlorhexidine and the least efficacy in the cinnamon group. The following chlorhexidine, Ca (OH)2 showed the highest antibacterial ?(Table1) property which was equipotential to that of the combination paste of Neem with Cinnamon. Table 2 showed the multiple comparisons of the mean threshold cycle (Ct) among groups. 2% Chlorhexidine had the highest antibacterial efficacy followed by Ca (OH)2 and Neem with Cinnamon (Table 3). Table 4 shows that the percentage of bacterial loads was reduced in all the tested groups.
DISCUSSION:
The root canal treatment aims to eliminate microorganisms from the root canal space to provide a good environment for tissue healing. E. faecalis is chosen for this study because it is the major cause of treatment failure. Its virulence factors and survival mechanisms make it an important pathogen in post-treatment diseases. It is the most common micro-organism found in secondary root canal infection and the major cause of treatment failure.14
Synthetic intracanal medicaments like calcium hydroxide cause collagen breakdown and hence weakening of radicular dentin. 2% Chlorhexidine is effective against E. faecalis, but its effectiveness is questionable hence there is a search for a better alternative.
The development of antibiotic-resistant strains and side effects of chemical irritants and intracanal medicaments has led to exploration for alternative herbal medicaments. Herbal alternatives have gained attention due to their antioxidant, antimicrobial, sedative, anxiolytic, and anti-inflammatory properties, thereby making them ideal for root canal disinfection.15,16,17
Neem also called “Indian neem / Margosa tree / Indian lilac” and tetranortriterpenes extracted from neem are nimbidin, Nimbin, nimbolide, Azadirachtin, gallic acid, epicatechin, catechin, and margolone. All these exhibit potent antibacterial activities. The chief active constituent of neem is azadirachtin, which has antimicrobial action against many gram-positive and gram-negative microorganisms. The study by Bohra et al. revealed that the aqueous and ethanolic extract of neem leaf has potential action against E. faecalis.18,19,20
Cinnamon (Lauraceae family) includes more than 250 species among which 2 are the most studied types- 1) Cinnamomum verum or 2) Cinnamomum zeylanicum. The main components of cinnamon extracts are cinnamaldehyde, eugenol, phenol, and linalool. Cinnamon bark has a higher cinnamaldehyde content (65–80%) and a low eugenol content (5–10%).21
Panchal et al. revealed ethanolic extract of C. zeylanicum was found to be even more effective against E. faecalis ATCC 29212 when compared to Neem, whereas in our study neem was found to be more effective, this may be due to difference in the synthesis parameters of the extracts.22,23,24,25
In the current study, the combination of herbs was found to be more effective than the individual herbs which were similar to the study conducted by Mathew et al. in which Endopam a combination of herbs (Ingredients: Clove, Eucalyptus, Cinnamon and Peppermint) showed the better antibacterial property.8
CONCLUSION:
From the results of our study, we conclude that 2% chlorhexidine has the highest antibacterial efficacy. However, the combination of Neem with Cinnamon extract in Methylcellulose base also possesses better antibacterial activity than the individual herbal component. Thus, it can be considered as an alternative intracanal medicament. Further in-vivo studies are essential to validate the results of the current study.
ACKNOWLEDGEMENT: We express our sincere thanks to the head of the institution and management for their constant support.
CONFLICT OF INTEREST: Nil
AUTHOR’S CONTRIBUTION:
Englishhttp://ijcrr.com/abstract.php?article_id=4108http://ijcrr.com/article_html.php?did=41081. Slowey RR. Root canal anatomy. Road map to successful endodontics. Dent Clin North Am. 1979;23(4):555–73.
2. Jena A, Sahoo SK, Govind S. Root canal irrigants: A review of their interactions, benefits, and limitations. Compend Contin Educ Dent; 2015;36:256–61.
3. Agarwal S, Piesco NP, Peterson DE, Charon J, Suzuki JB, Godowski KC, et al. Effects of sanguinarian, chlorhexidine and tetracycline on neutrophil viability and functions in vitro. J Periodontal Res. 1997;32(3):335–44.
4. Abul N, Karthick K, Mathew S DN. Herbal extracts in endodontics. J Indian Acad Dent Spec Res. 2017;4:23–7.
5. Gupta-Wadhwa A, Wadhwa J, Duhan J. Comparative evaluation of antimicrobial efficacy of three herbal irrigants in reducing intracanal E. faecalis populations: An in vitro study. J Clin Exp Dent. 2016;8(3):230–235.
6. Dutta A, Kundabala M. Antimicrobial efficacy of endodontic irrigants from Azadirachta indica: An in vitro study. Acta Odontol Scand. 2013;71(6):1594–8.
7. Dutta A KM. Comparative anti-microbial efficacy of Azadirachta indica irrigant with standard endodontic irrigants: A preliminary study. J Conserv Dent. 2014;17(2):133–7.
8. Mathew J, Pathrose S, Kottoor J, Karaththodiyil R, Alani M, Mathew J. Evaluation of an Indigenously Prepared Herbal Extract (EndoPam) as an Antimicrobial Endodontic Irrigant: An Ex Vivo Study. J Int oral Heal JIOH. 2015;7(6):88–91.
9. Parle M BN. Herbal medicines: Are they safe? Nat Prod Radiance. 2006;5(6):14.
10. Williams JM, Trope M, Caplan DJ, Shugars DC. Detection and Quantitation of E. faecalis by Real-time PCR (qPCR), Reverse Transcription-PCR (RT-PCR), and Cultivation During Endodontic Treatment. J Endod. 2006 Aug;32(8):715–21.
11. Kalaiselvam R, Soundararajan K, Rajan R M, Deivanayagam K, Arumugam C, Ganesh A. Comparative Evaluation of the Anti-bacterial Efficacy of Herbal Medicaments and Synthetic Medicaments Against Enterococcus faecalis using Real-time Polymerase Chain Reaction. Cureus. 2019;11(7).
12. Sejali SNF, Anuar MS. Effect of drying methods on phenolic contents of Neem (Azadirachta indica) leaf powder. J Herbs, Spices Med Plants. 2011;17(2):119–31.
13. Fava LRG, Saunders WP. Calcium hydroxide pastes classification and clinical indications. Int Endod J. 1999;32(4):257–82.
14. Love RM. Enterococcus faecalis - A mechanism for its role in the endodontic failure. Int Endod J. 2001;34(5):399–405.
15. Saha S, Nair R, Asrani H. Comparative evaluation of propolis, metronidazole with chlorhexidine, calcium hydroxide and Curcuma longa extract as an intracanal medicament against E.Faecalis– an invitro study. J Clin Diagnostic Res. 2015;9(11): ZC19–21.
16. Vinothkumar TS, Rubin MI, Balaji L, Kandaswamy D. In vitro evaluation of five different herbal extracts as an antimicrobial endodontic irrigant using real-time quantitative polymerase chain reaction. J Conserv Dent. 2013 Mar;16(2):167–70.
17. Tewari R, Kapoor B, Mishra S, Kumar A. Role of herbs in endodontics. J Oral Res Rev. 2016;8(2):95.
18. Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of neem (Azadirachta indica). Curr Sci. 2002;82(11):1336–45.
19. Bohora A, Hegde V KS. Comparison of the antibacterial efficiency of neem leaf extract and 2% sodium hypochlorite against Faecalis, C. Albicans and mixed culture – An in vitro study. Endodont. 2010;22(8):12.
20. Lakshmi T, Krishnan V, Rajendran R, Madhusudhanan N. Azadirachta indica: A herbal panacea in dentistry - An update. Pharmac Rev. 2015.9:41–4.
21. Yanakiev S. Effects of Cinnamon (Cinnamomum spp.) in Dentistry: A Review. Molec. 2020;25(18):4184.
22. Gupta A, Duhan J, Tewari S, Sangwan P, Yadav A, Singh G, et al. Comparative evaluation of antimicrobial efficacy of Syzygium aromaticum, Ocimum sanctum and Cinnamomum zeylanicum plant extracts against Enterococcus faecalis: A preliminary study. Int Endod J. 2013;46(8):775–83.
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24. Panchal V, Gurunathan D, Muralidharan N. Comparison of antibacterial efficacy of cinnamon extract, neem extract as irrigant and sodium hypochlorite against Enterococcus fecalis: An in vitro study. Indian J Dent Res. 2020;31(1):124–8.
25. Gruenwald J, Freder J, Armbruester N. Cinnamon and health. Crit Rev Food Sci Nutr. 2010;50(9):822–34.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareA Study on Perceived Sources of Stress among Final Year Dental Students During the Covid 19 Pandemic - A Questionnaire Based Survey
English5258Nanda MadhurimaEnglish Bagga Dinesh KumarEnglish Tiwari SakshiEnglish Singh AartikaEnglish Shahi Prashant KumarEnglishIntroduction: The dental profession can be highly demanding and stressful as practising dentistry requires the acquisition of certain academic, clinical and interpersonal skills. Due to the current situation of the COVID 19 pandemic in the country, dental students especially in the final year are highly susceptible to increased stress and anxiety due to the added factors during these times. The purpose of this survey was to identify the stressors among final year dental students so that various methods can be advocated to minimize the stress level among students. Methods: A cross-sectional study using an online questionnaire was conducted among final year dental undergraduate students of North India. A link was created and distributed to the students. A total of 163 students participated in the survey out of which 161 students responded to all questions. Results: Responses were collated, and average percentages were calculated. The main stressors among students were, the mode of examination (95.7%), insufficient exposure to clinical work (92.5%), lack of preclinical and clinical skills(85.1%), compromised clinical learning (88.8%). 91.9% of students were also stressed about spreading the disease to their family or closed oneswhereas85.1%studentswerestresseddue to the uncertainty regarding their career. Conclusion: The results of our study indicated that the Covid-19 pandemic has significantly impacted dental education resulting in enormous stress among dental students. This study can provide an insight to the faculty and dental schools regarding the problems faced by students and can help in strengthening the current educational system.
English Covid 19, Pandemic, Stress, Online learning, Clinical skills, Dental studentsIntroduction
Coronavirus is a highly infectious disease caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). The first case of Coronavirus was reported in Wuhan China in December 2019. Since its first case in China, it has now spread to almost every country. World health organization declared it as a “pandemic” on 11th March 2020.1 To curb the spread of Coronavirus, most governments around the world have taken preventive measures such as social distancing and self -isolation leading to closures of all educational institutions like schools, colleges, and universities.
The first case of Coronavirus in India was reported in Kerala on 30th January 2020. The government of India announced its first lockdown on 24h March 2020 as a preventive measure to control the spread of the pandemic. This led to the closure of all educational institutions. The 1st lockdown was announced for 21 days and then it was further extended till 31st May in 4 phases after which the restrictions started to ease in a phased manner.2 However, the educational institutions continued to remain closed resulting in changes in the teaching-learning methods from conventional classroom teaching to online teaching. This also resulted in a halt in the clinical and hands-on training experienced by the dental students
Globally, an increased level of stress is seen among the students pursuing professional courses, especially the medical and dental students.3,4,5 The dental profession can be highly demanding and stressful as practising dentistry requires the acquisition of certain academic, clinical and interpersonal skills. Studies conducted previously have shown increased stress and anxiety levels in dental students especially the final year students.5-9The frequently encountered stressors include factors relating to the fear of failure in examinations, poor grades, not being able to meet the academic and clinical requirements, frequent assignments and examinations, interactions with faculty and support staff, family pressures, personal relationships and financial burdens.7-12These stressors are consistent with most dental students globally. Different factors can affect an individual in different ways but chronic stressors can cause increased anxiety and depression which can further lead to poor academic performance amongst students.
It is also evident from the previous studies that stress levels among the students usually increases as they progress from their initial years of graduation to the final year of studies.6-9In India, the bachelor of dental surgery course is of 4 years duration followed by one year of rotatory internship. The basic sciences and the preclinical courses are taught in the first two years whereas the 3rd and 4th years are mainly focused on clinical education. At the end of the final year, the student has to undergo examinations in 8 subjects and due to the increased academic and clinical load, it is considered to be the toughest year.
Since the start of the pandemic, studies have also been carried out in various parts of the world to assess the impact of Covid -19 on dental education.13-19 The authors have not come across any study identifying the sources of stress among the dental undergraduates during the Covid-19 pandemic in North Indian students. The purpose of this study, therefore, is to identify the perceived sources of stress among final year dental undergraduate students during the COVID 19 pandemic.
Materials & Methods:
Study design: A cross sectional study was conducted among final year dental undergraduate students of North India.
Study Sample: An online survey was conducted using google forms. A Questionnaire was made using google forms and a link was created and distributed to final year dental undergraduate students studying in various government and private colleges in North India. The link was shared via Whatsapp.
Ethical Considerations: The participation was voluntary. Informed consent was obtained and only those students who agreed to participate were included in the study. A total of 163 students participated in the survey out of which 161 students responded to all questions.
Questionnaire
A detailed structured questionnaire was created using google forms consisting of 3 sections. The first section introduced the research to the participants and collected the informed consent of the participants. The forms were created so that only the participants who gave informed consent could participate in the study. The second section collected the demographic and academic details of the participants including gender, age, year of study, name and type of the institution. The third section comprised of a modified DES (Dental Environmental stress)4with 20 items under 4 different headings including Mode of Teaching, Academics and Performance Pressure, Preclinical and Lab work and Professional training. A 3 point Likert scale (agree, neutral, disagree) was used to assess the responses. At the end, there was an open-ended question where students were asked to specify the reasons for stress during this period other than mentioned in the questions.
Results
Responses were collated, and average percentages were calculated.
Demographic details: Out of the 163 total respondents, 98.8% (161) who gave informed consent were included in the study.Out of the 161 respondents, 78.9%(n=124) were females and 21.1% (n=34) were males.The mean age of the students was 22.72 years with a range from18-29 years.85.7% (n=135)students were studying in private institutions whereas 14.3% (n=23) were in government institutions.
Mode of Teaching (Figure1, Table 1)
When asked about the mode of teaching, 57.8% (n=93) of the students found conventional classroom teaching better as compared to the online teaching mode (Figure1a). Issues with increased screen time were faced by 79.5%(n=128) of the students (Figure 1b ). 28.6% (46) students faced problems due to the unavailability of gadgets(Figure 1c). Almost half of the students (55.3%;n=89) faced problems in attending classes due to distractions at home (Figure1d ).75.8% (n=122) students faced problems due to connectivity issues (Figure 1e). 54.7%(n=88) students felt that there is a lack of two-way communication in the online mode (Figure1f).
Academics and Performance Pressure(Figure2, Table 2)
58.4% felt the increased burden of assignments during this period(n =94) (Figure 2a), whereas 49.1% (n=79)faced difficulty in understanding the subjects at home (Figure 2b).67.1% (n=108) students felt that due to the lockdown,they are lacking the guidance required from teachers and mentors(Figure 2c).
67.7% (n=109) students faced problems due to a lack of an ideal study environment at home (Figure 2d). 77.6% (n=125 ) students felt that due to absence from campuses and inability to access the libraries, they lacked the study material for preparation (Figure 2e). Another important stressor was uncertainty regarding the mode of exams which was felt by 95.7% (n=154)of the students(Figure 2f).
Pre -Clinical and Lab work(Figure3, Table 3)
Out of 161 respondents,92.5% (n=154) students felt that there has been insufficient exposure to clinical/patient work due to absence from the campuses during the lockdown period (Figure 3a). Also, 85.1% (n=137) students felt that they would be lacking the skills required in the preclinical and clinical work as they were unable to complete their clinical and lab postings due to the Covid 19(Figure 3b). 88.8% ( n=143) of the respondents felt that due to the lack of understanding of clinical procedures and protocols, their clinical learning would be compromised (Figure 3c).
Professional Training (Figure4, Table 4)
85.1%(n=137) respondents were stressed about the fact that during the internship period they may not be able to acquire the required clinical skills because of the drop in dental patients due to the ongoing pandemic(Figure 4a). Many of the students (84.5%;n=136) feared getting exposed while performing clinical procedures in patients (Figure 4b). Another reason for stress during the pandemic among 83.9% (n=135)students was the lack of clinical training required for handling patients during the pandemic (Figure 4c).
The majority of the students (91.9%;n=148) were also apprehensive of the fact that being a dental professional while caring for patients they may spread the disease to their family or closed ones. (Figure 4d). Regarding the career placement, 85.1% (n=137) students were stressed due to the uncertainty regarding their career/ placement because of the current situation(Figure 4e).
In the open-ended question where the students had to mention the reason for stress, many students were stressed for not being able to practice their laboratory or clinical skills for a long time which in turn could greatly affect their manual dexterity skills.
Discussion
Dentistry is considered a stressful and demanding profession. Previous studies have identified the main stressors among dental students like workload, peer competition, examination and grades, patient care responsibilities, difficulty in learning clinical procedures, reconsideration of dentistry as a proper choice, fear of failure, faculty relations and financial responsibilities.19-22 The present study was carried out to identify the perceived sources of stress amongst the final year dental undergraduate students of North India during the Covid-19 pandemic so that targeted interventions can be suggested and implemented.
The modified DES (dental environmental stress ) scale used in our study has also been used previously by many authors to assess the stress level among dental students.
Assessing the current mode of teaching, students have adapted to the new online mode but still more than half of the students find the conventional classroom teaching to be better as compared to the online mode. Most of the students also faced issues due to the increased screen time, connectivity issues at home, distractions at home. Similar findings have been reported from other studies23, 24questioning the blended mode of teaching suggested in upcoming times.
In the survey conducted, academics and performance pressure was also a reason for stress for many of the students. Almost half of the students felt burdened due to the increased number of assignments being given during this period and also faced difficulty in understanding the subjects at home. Many of the students were anxious as they felt the lack of guidance from their teachers and mentors due to absence from the schools /colleges during this period and also felt that they do not have the required study materials as they were unable to access the libraries. Students also felt that at home, they lacked an ideal study environment required for professional studies. However, the major stressor among the students was fear related to the examinations 95.7%. Most of the students felt quite apprehensive about their upcoming exams. The findings are similar to the other studies conducted in different parts of the world.14,15
Clinical and professional training seemed to concern the majority of the students as most of the students agreed that due to their physical absence from the campuses during this period, they are going to lack the manual dexterity skills required for the dental profession. Similar results were reported in other studies20-25 suggesting that the majority of students expressed deep concerns regarding graduating without gaining practical experience in certain clinical procedures. A significant concern among the students due to the clinical care education emphasizes the need for consideration of strategies like a demonstration, simulated clinical learning. Also, prolonged suspension of clinical training is likely to have an impact on the clinical confidence and competence of dental students. Another major stressor among dental students was the fear of acquiring and transmitting infections to their families and loved ones. This has also been reported in previous studies.22-30Most of the students were also found to be anxious regarding their career and future placements.
Conclusion:
The findings of the present study indicate that Covid -19 pandemic has resulted in a significant amount of stress among dental students. Many stressors were identified during this period, the important ones being related to the examination fear, clinical training and career placements. Stress due to any reason can result in diminished efficiency and learning among students. It can also lead to emotional exhaustion and substance misuse. This suggests the need for counselling and behavioural support for students and also the implementation of various strategies by the dental schools and professional councils. The impact of lockdown on education has also been carried out in other areas of education other than dental and significant stress levels has been seen among the students and strategies has been advised by the experts.
Limitations & Future Recommendations
The present study was a cross-sectional study limited to fewer participants. The findings of the study might not apply to other dental schools. Also, the study was conducted considering the current pandemic situation, at the time of publication of the article, the situation might be different as pandemics can change their course resulting in changes in guidelines and recommendations.
Future studies with larger sample size and assessing the pandemic situation at that time should be conducted so that professional schools and councils can come up with strategies that will help in reducing the stress level among dental students. Based on the current study following recommendations are provided :
Considering the constantly changing situation of the pandemic, dental schools and councils after discussion with the faculty and students, should improvise the teaching-learning methods and implement policies and protocols to protect the students, staff and the patients.
Institutions should make the necessary changes in the clinical settings to ensure a safe and infection-free environment for the stakeholders(students and patients). This will ensure a sense of security and confidence among the students, patients and also the faculty.
A reform in educational systems is required so as overcome the current pandemic scenario and also to be prepared for similar future events.
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. We would also like to thank the students for their participation in the study.
Conflict of interest: NIL
Source of funding: NIL
ORCHID
Madhurima Nanda: http://orcid.org/0000-0001-9035-2971
Authors ‘contributions
Conceptualization: Madhurima Nanda
Data curation: Sakshi Tiwari, Aartika Singh, Prashant Kumar Shahi
Formal analysis: Dinesh Kumar Bagga
Methodology: Madhurima Nanda
Project administration: Sakshi Tiwari, Aartika Singh, Prashant Kumar Shahi
Visualization: Madhurima Nanda
Writing – original draft: Madhurima Nanda
Writing – review & editing: Madhurima Nanda, Dinesh Kumar Bagga
Englishhttp://ijcrr.com/abstract.php?article_id=4109http://ijcrr.com/article_html.php?did=4109
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Sangiorgio J, Araujo P, Navarro C, Zen I, Costa S, Ribeiro P, et al. Dental Environment Stress: Findings among Lusophone Dental Students. Pesqui Bras Em Odontopediatria E Clínica Integrada. 2016;16(1):411–24.
Abu-Ghazaleh SB, Sonbol HN, Rajab LD. A longitudinal study of psychological stress among undergraduate dental students at the University of Jordan. BMC Med Educ. 2016 Dec;16(1):1-6.
Kumar S, Dagli RJ, Mathur A, Jain M, Prabu D, Kulkarni S. Perceived sources of stress amongst Indian dental students. Eur J Dent Educ. 2009 Feb;13(1):39–45.
Telang LA, Nerali JT, Telang A, Chakravarthy PV. Perceived sources of stress among Malaysian dental students. Eurp J Gen Dent. 2013 Sep 1;2(3):300.
Alzahem AM, van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH. Stress amongst dental students: a systematic review. Eur J Dent Educ. 2011 Feb;15(1):8-18.
AlAteeq DA, Aljhani S, AlEesa D. Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA. J Taibah Univ Med Sci. 2020 Oct;15(5):398–403.
Agius AM, Gatt G, Vento Zahra E, Busuttil A, Gainza?Cirauqui ML, Cortes AR, et al. Self?reported dental student stressors and experiences during the COVID?19 pandemic. J Den Edu. 2021 Feb;85(2):208-15.
Van Doren EJ, Lee JE, Breitman LS, Chutinan S, Ohyama H. Students’ perceptions on dental education in the wake of the COVID?19 pandemic. J Den Educ. 2020 Jul 5.
Loch C, Kuan IB, Elsalem L, Schwass D, Brunton PA, Jum'ah A. COVID?19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact. J Den Educ. 2021 Jan;85(1):44-52.
Jum’ah AA, Elsalem L, Loch C, Schwass D, Brunton PA. Perception of health and educational risks amongst dental students and educators in the era of COVID?19. Eur J Den Educ. 2020 Nov 14.
Doughty F, Moshkun C. The Impact of COVID-19 on dental education and training. Dent Update. 2020 Jun 2;47(6):527–8.
Desai BK. Clinical implications of the COVID-19 pandemic on dental education. J Dent Educ. 2020 May;84(5):512.
Bennardo F, Buffone C, Fortunato L, Giudice A. COVID?19 is a challenge for dental education—A commentary. Eur J Dent Educ. 2020 Nov;24(4):822–4.
Chang TY, Hong G, Paganelli C, Phantumvanit P, Chang WJ, Shieh YS, et al.Innovation of dental education during COVID-19 pandemic. J Dent Sci. 2021 Jan 1;16(1):15-20.
Galibourg A, Maret D, Monsarrat P, Nasr K. Impact of COVID?19 on dental education: How could pre?clinical training be done at home? J Dent Educ. 2020 Sep;84(9):949–949.
Hakami Z, Khanagar SB, Vishwanathaiah S, Hakami A, Bokhari AM, Jabali AH, et al. Psychological impact of the coronavirus disease 2019 (COVID?19) pandemic on dental students: A nationwide study. J Dent Educ. 2020 Oct 31.
Iyer P, Aziz K, Ojcius DM. Impact of COVID-19 on dental education in the United States. J Dent Educ. 2020 Jun;84(6):718–22.
Lingawi HS, Afifi IK. COVID-19 Associated Stress Among Dental Students. Open Dent J. 2020 Nov 13;14(1):554–62.
Quinn B, Field J, Gorter R, Akota I, Manzanares M, Paganelli C, et al. COVID?19: The immediate response of European academic dental institutions and future implications for dental education. Eur J Dent Educ. 2020 Nov;24(4):811–4.
Schlenz MA, Schmidt A, Wöstmann B, Krämer N, Schulz-Weidner N. Students’ and lecturers’ perspective on the implementation of online learning in dental education due to SARS-CoV-2 (COVID-19): a cross-sectional study. BMC Med Educ. 2020 Dec;20(1):1-7.
Özdede M, Sahin S. Views and anxiety levels of Turkish dental students during the COVID-19 pandemic. J Stomatol. 2020;73(3):123–8.
Hung M, Licari FW, Hon ES, Lauren E, Su S, Birmingham WC, et al. In an era of uncertainty: Impact of COVID?19 on dental education. J Dent Educ. 2020 Feb;85(2).148-156.
Kapasia N, Paul P, Roy A, Saha J, Zaveri A, Mallick R, Barman B, Das P, Chouhan P et al. Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India. Children and Youth Services Review. 2020 Sep 1;116:105194.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareCorrelation between Placental Morphometric Parameters and Birth Weight of Neonates
English5963John K MartinEnglish Sreedharan RanjithEnglish Sampson UrsulaEnglishEnglish LBW, NBW, Neonates, Placental morphometry, Fetoplacental ratio, Placental coefficientIntroduction
The placenta, a transient extracorporeal organ, unites the developing fetus to the wall of the uterus. It is a single dynamic organ derived from two separate individuals, the mother and the fetus. The placenta is the prime regulator for the organs, including the lungs, liver, gut, kidneys and endocrine glands of the fetus necessary to fetal development.1 According to Kinare et al., fetal growth and birth weight are related to placental development.2 Low birth weight (LBW) is defined as the birth weight of live-born infants below 2500 g irrespective of gestational age.3 Yearly more than 20 million low birth weight neonates are born worldwide, which accounts for 15 to 20% of all births.4 The prevalence of LBW ranges from 7.2% in developed nations to 17.3% in undeveloped countries. In Asia itself, the prevalence is 5.6% in central Asia and 27.2 % in southern Asia.5 In India, the prevalence of LBW has significantly declined from 20.4% to 16.4% in the last decade.6 In 2012, the World Health Assembly (WHA) endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition, which specified six global nutrition targets, including an ambitious 30% reduction in LBW prevalence between 2012 and 2025 hoping to reduce 20 million to about 14 million.7
Normal growth of the fetus is mainly reliant on normal placental function, normal morphometry, and normal structure of the placenta.8 Morphometric parameters of the placenta were significantly affected by low birth weight deliveries.9 LBW babies have a higher probability of dying within the first month of life or are connected with adverse health outcomes like stunted growth.10
The morphological parameters such as placental weight, volume, thickness, surface area, number of cotyledons, fetoplacental ratio, and placental coefficient give an idea about intrauterine and intrapartum events of gestation and help to understand the postnatal health of the neonates.11 Placental morphometry has been considered as an indicator of its growth and function. The placental weight which reflects the development and function of the placenta, correlate with birth weight, maternal age, and history of pregnancy complications, parity, gender, and fetal distress.12 Placental volume varies according to fetal weight; the observed values were compared with the expected values (50th percentile) for the appropriate fetal weight.13 Goldy et al. reported a significant positive correlation between placental thickness and estimated fetal weight.14 The placental surface area at term was positively correlated with the weight of a baby at the time of birth.15
Fetoplacental ratio (F/P ratio) was introduced as a predictor of perinatal outcome.16,17 A relationship has been reported between a low F/ P ratio and the risk of adult cardiovascular diseases.18 The altered growth of the placenta will give valuable information about the state of the fetal well-being, and examination of the placental morphology could be a predictor of adult-onset diseases. There are meagre studies on placental morphometry in the northern part of Kerala, which differs in ethnicity, socioeconomic status, maternal education, and cultural practices. Hence, this study on placental morphometric parameters and their correlation with the birth weight of neonates was undertaken.
Materials and methods
A case-control study was conducted in the Department of Anatomy, MES Medical College, Perinthalmanna. The subjects for the study were recruited from the Obstetrics & Gynaecology department of the same medical college. Placentae were collected from 350 births (Low Birth Weight N=175 and Normal Birth Weight, N=175) that occurred from December 2014 to November 2017. Permission for the study was taken from the Institutional Ethics Committee (IEC/MES/75/ 2014). Written consent was obtained from mothers. The data regarding the demographic and clinical parameters of the mothers and their offspring were recorded.
Inclusion criteria
Cases: – Low Birth Weight (LBW).
Neonates with birth weight Englishhttp://ijcrr.com/abstract.php?article_id=4110http://ijcrr.com/article_html.php?did=4110
Burton GJ, Fowden AL. The placenta: A multifaceted, transient organ. Philosophical Transactions of the Royal Society B: Bio Sci. 2015, March 5; 370 (1663):20140066.
Kinare AS, Natekar AS, Chinchwadkar MC, Yajnik CS, Coyaji KJ, Fall CH et al. How mid-pregnancy placental volume in rural Indian women: A cause for low birth weight? Am J Obstet Gynecol. 2000, Feb 1; 182 (2):443-8.
Shrestha S, Shrestha S, Shakya Shrestha U, Gyawali K. Predictors of Low Birth Weight at Lumbini Provincial Hospital, Nepal: A Hospital-Based Unmatched Case-Control Study. Adv Prev Med. 2020, Mar 26; 2020 (8459694): 1-7
Bekela MB, Shimbre MS, Gebabo TF, Geta MB, Tonga AT, Zeleke EA et al. Determinants of Low Birth Weight among Newborns Delivered at Public Hospitals in Sidama Zone, South Ethiopia: Unmatched Case-Control Study. J Pregnancy. 2020, Apr 16; 2020 (4675701): 1-8
Talie A, Taddele M, Alemayehu M. Magnitude of low birth weight and associated factors among newborns delivered in Dangla primary hospital, Amhara regional state, Northwest Ethiopia, 2017. J Pregnancy. 2019; 35(8): 1-6
Khan N, Mozumdar A, Kaur S. Determinants of low birth weight in India: An investigation from the national family health survey. Am J Hum Biol. 2020 May;32(3):e23355.
World Health Organization. Global Nutrition Targets 2025: Low birth weight policy brief (No. WHO/NMH/NHD/14.5). World Health Organization; 2014.
Salavati N, Smies M, Ganzevoort W, Charles AK, Erwich JJ, Plösch T et al. The possible role of placental morphometry in the detection of fetal growth restriction. Front Physiol. 2019 Jan 8; 9:1884.
Sunkesula SB, Lingeswara RB, Tamil AD. Low birth weight lives births: An insight into placental pathology. J Evol Med Dent Sci. 2015 Feb 23;4(16):2645-52.
Scharf RJ, Stroustrup A, Conaway MR, DeBoer MD. Growth and development in children born very low birthweight. Arch Dis Child Fetal Neonatal Ed.2016 Sep.1;101 (5):433-38.
Kowsalya V, Vijayakumar R, Valli G, Bharath KP, Srikumar R, Kishor Kumar C et al. Morphometry examination of the placenta in birth weight of full-term newborns in
Puducherry, India. Pakistan J Biol Sci. 2013 Sep 1; 16: 895-97.
Asgharnia M, Esmailpour N, Poorghorban M, Atrkar-Roshan Z. Placental weight and its association with maternal and neonatal characteristics. Acta Medica Iranica2008; 46(6): 467-72.
Abulé RM, Bernardes LS, Doro GF, Miyadahira S, Francisco RP. Reduced placental
volume and flow in severe growth-restricted fetuses. Clinics. 2016 Jun; 71(6):332-7.
Goldy SJ, Victor SR, Bewin Oral J, Thangam A, Christopher U, Rose A et al. Placentalthickness and its correlation with estimated foetal weight: a cross-sectional study in a tertiary care centre in South India. Int J Reprod Contracept Obstet Gyneco 2019;8(4):1348.
Sivarao S, Vidyadaran MK, Jammal AB, Zainab S, Goh YM, Ramesh KN et al. Weight, volume and surface area of placenta of normal pregnant women and their relation to maternal and neonatal parameters in Malay, Chinese and Indian ethnic groups. Placenta. 2002 Sep 1;23 (8-9):691-6.
Itoh H, Kanayama N. Nutritional conditions in early life and risk of non-communicable diseases (NCDs) from the perspective of preemptive medicine in perinatal care. Hypertension Res Preg. 2015 Apr 30; 3(1):1-2.
Matsuda Y, Itoh T, Itoh H, Ogawa M, Sasaki K, Kanayama N, Matsubara S et al. Impact of placental weight and fetal/placental weight ratio Z score on fetal growth and the perinatal outcome. Int J Med Sci. 2018; 15 (5):484-91
Shehata F, Levin I, Shrim A, Ata B, Weisz B, Gamzu R, Almog B et al. Placenta/birthweight ratio and perinatal outcome: A retrospective cohort analysis. Bri J. 2011 May; 118 (6):741-47.
Scherle W. A simple method for volumetry of organs in quantitative stereology. Mikroskopie.1970; 26:57- 60
Balihalimath RL, Shinde V, Tyagi N, Patil AS. Maternal anthropometry determines pregnancy outcome. J Evol Med Dent Sci. 2015 Jul 6;4(54):9347-58.
Kishwara S, Ara S, Rayhan KA, Begum M. Morphological changes of placenta in preeclampsia. Bangladesh J of Anat. 2009;7 (1):49-54.
Ghodke S, Dharwadkar S. Hypertensive disorders affecting the morphometry of placenta. Journal of Scientific Society. 2012; 39: 17-8.
Virupaxi RD, Potturi BR, Shirol VS. Morphology of placenta and its relation with small for date babies in 950 Live births. Recent res sci technol. 2011 Apr 13; 3 (2). 123-6
Thompson J, Irgens L, Skjaerven R, Rasmussen S. Placenta weight percentile curves for singleton deliveries. BJOG 2007; 114(6): 715-20.
Freedman AA, Hogue CJ, Marsit CJ, Rajakumar A, Smith AK, Goldenberg RL, et al. Associations Between the Features of Gross Placental Morphology and Birthweight. Pediatr Dev Pathol 2018; 22(3): 194-204.
Salafia CM, Maas E, Thorp JM. Measures of placental growth in relation to birth weight and gestational age. Am J Epidemiol. 2005;162:991–8
Barker DJP, Eriksson JG, Kajantie E. Chapter 2: The maternal and placental origins of chronic disease In: Burton GJ, Barker DJP Moffet A, et al. (Eds.) The Placenta and Human Developmental Programming. Cambridge, England: Cambridge University Press; 2011: pp. 5–12.
Sirpurkar M, Anjankar VP. Study of correlation between placental morphology and adverse perinatal outcome in different conditions affecting pregnancy. Int J Reprod Contracept Obstet Gynecol. 2015;4 (4):1166-68
Salafia CM, Zhang J, Charles AK. Placental characteristics and birthweight. Paediatr Perinat Epidemiol. 2008;22: 229–39.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareEfficacy of Cervical Spine Manipulations in Patients Suffering from Migraine
English6471Punia SEnglish Malik MEnglish Singh VEnglish Rastogi VEnglish Kaur JEnglishObjective: Evaluate the effect of cervical spine manipulation therapy in patients suffering from migraine headaches. Methodology: It was a randomized control trial. Total 62 Subjects suffering from migraine headache and fulfilling the international classification of headache disorders-3 (International headache society) were included in the study. The trial started with 40 participants and in the experimental group, there were 20 participants, with mean age 31.10±6.54 and 20 participants in the control group, with mean age 25.9±4.19. Group A received cervical spine manipulation therapy (CSMT) and group B received sham manipulation, thrice per week for 2 weeks. The subjects were asked to fill headache impact test, headache disability index questionnaire, and VAS pre and post-intervention. Descriptive statistics were conducted by means and standard deviations for variables like age, gender, visual analogue scale (VAS), and headache impact test (HIT), and headache disability index (HDI). Paired t-test was used to compare the pre and post-treatment values of the groups for statistical significance. An independent t-test was used to compare both groups. Result: The findings obtained by comparing both groups were, VAS reduced significantly after 2 weeks (MD= -1.27; 95% CI -2.05 to -.48; p=0.002), HIT reduced significantly after 2 weeks (MD= -8.86; 95% CI -11.34 to -6.39; pEnglishIntroduction
Migraine is a usual health problem that causes ensuing physical, psychological, social & financial loss.1 Recently, the global burden of disease survey gave rank to migraine as the 3rd most occurring condition worldwide and has a prevalence of 14.7%. It is thought to be the 2nd most incapacitating disease across the globe.2 Migraine impacts 959 million people across the globe, with the majority being women of childbearing age.3 Researchers have also established that it is the 2nd most usual and incurable primary headache with a prevalence of 11%-14.3% worldwide.4 Out of 69% of primary headaches, migraine affects 15% of the population. Between half and three-quarters of adults have suffered headaches in the past year, and over 10% of this group has suffered a migraine.1
Migraine occurs with a male: female ratio of 3:1.3 The international headache society reported that women are being more affected by migraines i.e. 2 to 4 times than men.5-6 Women of childbearing age are more commonly undergo migraines because of the large underlying hormonal influence.7 Factors such as stress, illness, emotions, or menstrual cycle trigger a severe migraine attack in females.8 Migraine is said to be the 7th leading cause of years lived with disability (YLDs) and is a usual neurological disorder.9
Migraine is usually moderate to severe headache; unilateral & throbbing in nature10 which is intensified by daily physical activity and more often it is accompanied with increased sensitivity to light and sound, nausea, and occasionally vomiting.1, 8, 9
Migraine is characterized by its hemicranial feature recurrence, presence of aura, and sensory symptoms.11 Migraine also affects the ability to perform activities of daily living as well as missed workdays.6, 12
Although Migraine headache is mainly connected with dysfunction of central pathways, many clinical findings are considered peripheral because peripheral nociceptive stimuli can cause the Migraine attack. Nuchal symptoms such as tenderness, stiffness, and weakness are reported by individuals suffering from Migraine.7, 13
About 12% of the world's adult population is affected by migraine as it is a prevalent disease. It is a burdensome disease that affects individuals, their families, and society14. Migraine is thought to be a common cause of public health and socio-economic burden across the globe.15 The ailment is known to be disabling, with more than half of people experiencing a disturbance in daily activities during some of the attacks of the migraine.4
Manual therapy (MT) is one of the most common physical therapy interventions for headache management, which is defined as treatments including 'spinal manipulation (as usually executed by chiropractors, osteopaths, and physical therapists), and spinal mobilization, therapeutic massage, and other manipulation and body-based techniques.11
The mechanism of action of spinal manipulative therapy (SMT) on migraine is not known. It is debated that migraine may arise from the complexity of nociceptive afferent responses associated with the upper cervical spine (C1-C3) leading to a hypersensitivity state of the trigeminal pathology expressing sensory information to the face and head.1
The present randomized controlled trial (RCT) was designed based on previous supporting studies assessing the effect of cervical spine manipulation therapy in the patient suffering from migraine headache. By examining VAS, HIT-6, and HDI assessment scores respectively, therefore study hypothesized that the effectiveness of cervical spine manipulation therapy (CSMT) with superior to that of sham manipulation and pharmacological management for improving the pain and disability caused by a migraine headache.
Materials and Methods:
The study was a randomized controlled trial with two parallel groups assessing the efficacy of cervical spine manipulation in the management of migraines. This randomized controlled study was conducted in Hisar, an urban area of Haryana. Total 62 Subjects suffering from migraine headache and fulfilling the international classification of headache disorders-3 (International headache society) were included in the study. Eligible participants were patients suffering from migraines of age 18-65 years with at least one migraine attack per month and were allowed to have a concomitant tension-type headache but no other primary headache. The participants were diagnosed according to the international classification of headache disorders-3 beta version (ICHD-3) of the International headache society.
The participants were excluded if patients having headaches occurred due to spinal radiculopathy, a congenital deformity of the vertebral column, degenerative diseases, recent surgery or fracture of the cervical spine, depression, and patients also excluded if they were un-cooperative patients, osteoporotic, had pregnancy and CSMT within 6 months of intervention.
A total of 62 patients suffering from migraines were approached. Out of which 40 met the inclusion criteria and enrolled in the study as shown in figure 1. The 40 subjects who met all the inclusion criteria were randomly allocated into two groups [cervical spine manipulation therapy (CSMT) and non-CSMT], with 20 patients in each group. A computer-generated random number table was used to allocate the participants in the experimental and control group.
This present trial was approved by GJUS & T (Guru Jambheshwar University of Science & Technology) research ethical committee vide letter no PTY/2019/1014. Each participant of the study gave informed consent after an explanation of the procedure in their local language. This trial has also registered under CTRI (Clinical trial registry-India) via reference number 2019/12/022414.
The participants of group A received CSMT thrice per week for two weeks. CSMT is defined as a passive high-velocity low amplitude thrust applied to a joint complex within its anatomical limits with the intent to restore optimal motion, function, and/or to reduce pain. The use of manipulation of the spine is to treat patients with pain involves a high-velocity thrust that is exerted through either a long or short lever arm.
40 participants suffering from migraine headache and fulfilling the international classification of headache disorders-3 (International headache society) were included in the study. The subjects were randomly allocated into 2 groups i.e. group A (experimental group) and group B (control group). The subjects were asked to fill headache impact test (HIT), headache disability index (HDI) questionnaire, and VAS before the start of the intervention. The subjects were also asked to keep a headache diary in which they noted down the details of migraine headaches (i.e frequency, duration, and intensity of pain) experienced by them. Baseline reading of all outcomes measures was noted before the start of the intervention.
The long lever technique moves many vertebral articulations simultaneously whereas the short lever technique involves a low amplitude thrust that is directed at a specific level of the vertebral column. The patient lies in the supine position and the thrust is applied in a short lever arm to restore the mal-alignment of the cervical spine which is thought to be the culprit causing the headache.
The participants of group B received a placebo effect i.e sham manipulation and continue their pharmacological drugs for 2 weeks. Sham manipulation is termed as a broad non-specific contact low velocity, low amplitude sham pushover manoeuvre in a non-intention and non-therapeutic direction line of the lateral edge of the scapula or the gluteal region.
The subject was in a sitting or side-lying position. Lateral push manoeuvre to the lateral edge of the scapula is done for both sides. In the side-lying position, the patient's with the bottom leg straight and the top leg flexed with the top leg ankle resting on the bottom leg's flexed knee and a pushover manoeuvre was delivered in the gluteal region.
Utilizing an established and reliable pain measuring tool is a cornerstone for achieving a sufficiently precise assessment.VAS is a powerful research tool in the field of pain research due to its practicability, reproducibility, sensitivity to treatment effects, and ease of analysis. We used VAS to quantify the pain from baseline to after intervention and later analyzed it for statistical significance.
The HIT-6 questionnaire is a simple, easy-to-administer assessment that can be used as a clinical evaluation of the impact of headaches on a patient's quality of life. We used HIT-6 to measure the intensity and frequency of headaches caused to the sufferers, from baseline and post-intervention. Later the values are statistically analyzed.
The HDI questionnaire is useful in assessing the impact of headache, and its treatment on daily living. We used HDI to assess the disability caused by migraine headaches from baseline to post-intervention.
Statistical Methods
Data were analyzed using the SPSS software (version 21). Descriptive statistics were conducted by means and standard deviations for variables like age, gender, VAS, HIT-6, and HDI. Normality was checked done for all the variables using the Kolmogorov-Smirnov test. Significance was set at a p-value of >0.05. Paired t-test was used to compare the pre and post-treatment values of the groups for statistical significance. An independent t-test was used to compare both groups.
Results
All patients in a different group of this trial had done almost all exercise sessions. The trial started with 40 participants and in the experimental group, there were 20 participants, with a mean age of 31.10±6.54 years and 20 participants in the control group, with a mean age of 25.9±4.19 years. All participants had given their outcome reading (100% Compliance rate). 16 males and 23 females were included in the study. There were 20 participants (Males: 6; Females: 13) in the experimental group and 20 (Males: 10; Females: 10) in the control group as shown in table 1. The outcome measures i.e VAS, HIT-6, and HI were analyzed pre and post-treatment.
Females showed a more significant reduction in post value of VAS, HIT, and HDI than males in both groups.
Effect of experimental group exercise on VAS, HIT AND HDI
Paired t-test was used to determine the effectiveness of CSMT and pharmacological treatment on VAS, HIT-6, and HDI variables after 2 weeks. As shown in table 2 & figure 2, a statistically significant difference was found in all outcome variables. VAS reduced significantly after 2 weeks (MD= -4.6; 95% CI -4.16 to -5.04; pEnglishhttp://ijcrr.com/abstract.php?article_id=4111http://ijcrr.com/article_html.php?did=4111
Chaibi A, Šaltyt Benth J, Tuchin PJ, Russel MB. Chiropractic spinal manipulative therapy for migraine: a study protocol of a single-blinded placebo-controlled randomized clinical trial. Eur J Neurol. 2015;5(11):e008095.
Viana M, Khaliq F, Zecca C, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol. 2019; 27(3): 536-541.
Afridi SK. Migraine: navigating the hormonal minefield. Pract Neurol. 2020;20(2):115-121.
Harris S, Rasyid A. Objective diagnosis of migraine without aura with migraine vascular index: A novel formula to assess vasomotor reactivity. Ultrasound Med Biol. 2020;46(6):1359-1364.
Chaibi A, ŠaltytBenth J, Tuchin PJ, Russel MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo randomized controlled trial. Eur J Neurol. 2017;24(1):143–153.
Hubbard TA, Kane JD. Chiropractic management of essential tremor and migraine: A case report. J Chiropr Med. 2012;11(2):121-126.
Espi´-Lopez GV, Ruescas-Nicolau MA, Nova-Redondo C, Benitez-Martinez JC, Dugailly PM, Falla D. Effect of Soft Tissue Techniques on Headache Impact, Disability, and Quality of Life in Migraine Sufferers: A Pilot Study. J Altern Complement Med. 2018;24(11):1099-1107.
Voigt K, Liebnitzky J, Burmeister U, Sihvonen-Riemenschneider H, Beck M, Voigt R et al. Efficacy of Osteopathic Manipulative Treatment of Female Patients with Migraine: Results of a Randomized Controlled Trial. J Altern Complement Med. 2001;17:225–230.
Davidson I, Crooks K, Newington L, Pilling M, Todd C. Assessing the feasibility of mobilisation of C0-C3 cervical segment to reduce headache in migraineurs. Int J Ther Rehab. 2018;25:8.
Wayne PM, Bernstein C, Kowalski M, Connor JP, Osypiuk K, Long CR, et al. The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation. Contemp Clin Trials Commun. 2020 Mar 1;17:100531.
Moore C, Adams J, Leaver A, Lauche R, Sibbritt D. The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors. BMC Complement Altern Med. 2017;17(1):519.
Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headach. 2019;59(4):532-542.
Ferracini GN, Dach F, Chaves TC, Pinheiro FC, Grossi DB, Fernandez-de-las-penas C, et al. Cervico-occipital Posture in Women With Migraine: A Case-Control Study. J Orthop Sports Phys Ther. 2016;46(4):251-257.
Bevilaqua-Grossi D, Carvalho GF, Dach F, Bigal ME. Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients with Migraine and Associated Neck Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016;97(6):866-874.
Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2017;372:307-315.
Moore C, Leaver A, Sibbritt D, Adams J. The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC Neurol. 2018;18(1):171.
Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2003;23(2):91-95.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareImpact of Covid-19 Pandemic on Accredited Social Health Activists (ASHA) in Karnataka: A Empirical Analysis
English7278Devarajappa SEnglish Khalida Khanum AEnglish Nagaraja SEnglishIntroduction: Accredited Social Health Activist (ASHA) programme has been acknowledged and the service utilization has been expanded among Indian Communities since its commencement in 2005 under National Rural Health Mission (NRHM). ASHA workers have been recognized as a viable connection between the community and the health framework regardless of the financial status of community members. Objectives: The present paper discusses the impact of Covid-19 on ASHA workers special on their social and economic status and also examined the challenges faced by ASHA Workers during this pandemic period. Methodology: The researcher has studied 250 ASHA workers randomly from various districts in Karnataka and collected information regarding work difficulties during the Covid-19 pandemic lockdown and its impacts on socio-economic status. For analysis, statistical tools like mean percentage and ANOVA has been employed. Results: It is found in this study that, on average 165 of the respondents faced difficulties frequently during this pandemic and which is also proved in the ANOVA test (i.e., F, 6.39, 3.25> sign) and 80 to 90 per cent of ASHA s opine that Covid-19 has a lot of impact on social and economic status. Conclusion: The present study discusses the economic impacts of the Covid-19 pandemic, majority of respondents felt financial difficulty during the pandemic situation, and said that this situation had also impacted their savings, regular expenditure and jobs of their family members. From this study, it is suggested the Government take some steps to improve the conditions of the ASHA Workers by the means of enhancing their socio-economic status.
EnglishASHA workers, National Rural Health Mission, Covid-19 Pandemic, Lockdown, Socio-Economic Status.INTRODUCTION
ASHA workers are serving as the first line of defence during the covid-19 pandemic in Karnataka, where around 42000 odd ASHA workers are working in Karnataka. They have successfully mapped 15.9 million households by screening vulnerable persons for covid-19, despite their measly pay and no safety gear. True to the names they have served and spread hopes during this time according to Nalini R.1 In 2005, the National Rural Health Mission (NRHM) had introduced the Accredited Social Health Activists (ASHA), female cadres of India’s community health workers program. The main goal of the ASHA programme is to promote uptake of skilled birth attendance in collaboration with facility-based auxiliary nurse midwives (ANMs) and Anganwadi workers. Each ASHA worker is meant to cover 1000 population and receives the performance and service-based compensation for facilitating immunizations, referral and escort services for institutional deliveries. Other common tasks of ASHA workers in promoting institutional delivery under the national scheme Janani Suraksha Yojana (JSY), providing informal counselling, support and following up, advocating for local health needs etc. by Supril et.al.2
The ASHA programme guidelines envisage three different roles for ASHAs. First, ASHAs function as “Link Workers” a bridge between the rural and vulnerable population within the health service centres. Second, ASHAs are to function as a “Service Extension Worker”; whereby they are trained and provided with a kit, that includes commodities such as condoms, oral Chloroquine. Third, they are conceptualized as “Health Activists” in the community to create awareness on health and social detriments and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.
REVIEW OF LITERATURE:
Accredited Social Health Activists (ASHAs) are community health workers under the national rural health mission of the government of India. They have been contributing and devoting the majority of their time in Covid-19 work as warriors. It is affecting them a lot both socially and economically and they have also faced a lot of health issues not only in India all over the world. The study of Bandyopadhyay S et. al. infection and mortality of health workers worldwide from Covid-19 reveals that 1, 52,888 health workers are infected and 1413 deaths were reported. Infection was mainly in women but deaths mainly in men with 71.6% and 70.8% respectively.4 Niyati and Mandela SN have studied the impact of the pandemic on ASHAs in India. The study is based on the available secondary data, which highlights the various problems faced by the ASHA worker during this pandemic.4 Kingsley JP et. al. in their study of the changing aspects of motherhood in face of the covid-19 pandemic in low and middle-income countries have found that multi-sectorial investments providing high-quality care and available to all segments of the population are needed and pandemic preparedness programme must include action plan resilient material health service.5 Azeez EP et. al. examined the impact of covid-19 on migrant women workers in India. The study reveals that the dismal state of women migrant workers and their families and argues that urgent policy intervention is required to address the impoverishment. Dutta & Fischer studied local governance of covid-19 and social security in rural areas of a developing country. They have examined the elected rural government in coordinating state response in Rajasthan, Kerala and Odisha.6 Bawza V et. al. experienced the covid-19 pandemic in rural Odisha and examined the various challenges faced by the rural people in India. Gumber and Nebhinani examined the impact of covid-19 pandemic child and adolescent mental health and identified that they have been struggling with fear, anxiety and uncertainty, depression and constant worries about their future and they have to face the psychological and emotional brunt of this pandemic. Jelly P et. al. in their study impact of the covid-19 pandemic on the psychological status of pregnant women. The survey result reveals that around 73.6% of pregnant women have a minimal psychological impact and a minimal level of anxiety.7,8 Vora KS et. al. examined the impact of covid-19 women and children and the need for a gendered approach in the vaccine. Taking into account gender-based biological differences; the inclusion of pregnant women is of vital importance for the development of the covid-19 vaccine.9
It is observed from the above literature is that most of the researchers have concentrated the impact of covid-19 on women concerning their health issues. No studies have researched the impact of covid-19 on the socio-economic status of the ASHA workers in India. Therefore the present study gets most important to study the impact of covid-19 on the socio-economic status of ASHA workers.
THE RESEARCH PROBLEM
As of 20th May 2021, Karnataka recorded 23 lakhs Covid-19 cases of which 17.8 Lakhs cases recovered and 23, 854 deaths. During this period, ASHA workers workloads became fourfold and they have been facing many problems socially and economically. In July 2020 all ASHA workers boycotted their work and had indefinite strikes to fulfil their demands.
At present, ASHA workers receive a fixed salary of Rs. 4000 Pm from the state government of Karnataka and the central government gives incentive-based pay which depends on 30 plus components but now they are demanding a fixed salary of Rs. 12,000 pm.
Every day, they leave home at 9.30 AM after wearing the mask and done by around 2 PM, until that, they don’t drink water even in the scorching heat. On average they cover 25 houses a day, most of the time on the field no washrooms are available ( Reported The Hindu Paper April-2020, Tanu Kulkarni).
In Karnataka, two attacks on ASHA workers happened in Bengaluru and Belagavi District in April 2020 while doing service of Covid-19. Therefore the children and husbands of ASHA workers worry a lot about their safety.
Many of the ASHA workers infected Covid-19 and the state have lost two ASHA workers in Kalburgi and Yadgeri districts.
Many more problems have been faced by ASHA workers socially and economically. Against this backdrop, there is a need to study the impact of the Covid-19 pandemic on the socio-economic status of ASHA workers in Karnataka. 10
OBJECTIVES OF THE STUDY
The present study “impact of Covid-19 pandemic on the socio-economic status of ASHA workers” sets forth the following objectives;
To study the challenges faced by the ASHA workers during the Covid-19 period.
To analyse the effects of the Covid-19 pandemic on the socio-economic status of ASHA workers.
RESEARCH HYPOTHESIS
Based on the Objective of the study the following research hypothesis is formulated:
H0: There is no significant impact of the Covid-19 pandemic on the socio-economic status of ASHA workers.
H1: There is a significant impact of the Covid-19 pandemic on the socio-economic status of ASHA workers
RESEARCH METHODOLOGY
Karnataka is a state in the southwestern region of India. It is the largest state in the south of India having a 6.41 crore population. In this state, more than 42000 ASHA workers are working. Randomly 250 ASHA workers have been taken in select districts of Karnataka for the study from both rural and urban areas. This qualitative study will consist of both primary and secondary data. The qualitative data will be collected through structured interview schedules concerning their socio-economic status and the required secondary data will be collected through Government reports and health Department reports, articles, magazines etc. The Likert scale has been adopted for measuring the opinion of the respondents. Statistical tools like Percentage and mean have been employed for the analysis of the data. And two-way ANOVA was used for testing of hypothesis.
RESULT AND DISCUSSION:
In this section, the researcher has examined the demographic profile of the respondents and perception of ASHA workers towards covid-19 works and the impact of covid-19 on the social and economic status of the ASHA workers.
Demographic analysis of the respondents:
In the demographic analysis, the researcher has examined the religion, family pattern, age, education and marital status of the respondents which have been presented in Table-1.
Primary data was collected from 250 ASHA workers working in various villages of the Tumkur District. The study found that 220 (88%) of the respondents belongs to the Hindu religion, 20 (8%) belongs to Islam and 10 respondents belong to others. With regards to the family pattern of the respondents, the majority 230 (92%) of them belongs to nuclear families while 20 (8%) living in joint families. The data were collected concerning the age of the respondents in which the majority 200 (80%) of the respondents belongs to the age group of 30-40 years, 30 (12%) belongs to the age group of 20-30 years and 20(8%) belongs to 40-55 years of age. Concerning the education level of the respondents, the study found that the majority 200 (80%) of the respondents are having educational qualifications of high school while 50 (20%) are graduates. The study also collected information related to the marital status of the respondents and the study found that all respondents that are 250 (100%) were married.
Perception of ASHA workers towards covid-19 work
ASHA workers are facing a lot of problems while doing covid-19 work. They are working as warriors in the country. Their perception was collected and presented in Table-2; which represents the data about the respondents’ working conditions during the Covid-19 lockdown. The study found that 200 (80%) of the respondents frequently felt it was tough to work during the Covid-19 lockdown situation. 250 (100%) respondents opine that it was frequently drained a great amount of their energy to work during the Covid-19 lockdown situation. The majority of 200 (80%) of the respondents rarely felt hesitant to work during the Covid-19 lockdown pandemic period. 230 (92%) of the respondents occasionally thought the Covid-19 pandemic situation had created an extra burden in their usual work. 130 (52%) of the respondents occasionally felt depressed working during lockdown situations. 110 (44%) of the ASHA workers frequently felt while treating covid-19 positive patients might be impacted on their health, while 100 (40%) occasionally and 20 (8%) of the respondents rarely felt for same. From this discussion, it is clear that the covid-19 lockdown caused abnormal working situations for many ASHA workers. In table 3, Two-way ANOVA is calculated, which indicates that both between column and rows H0 is rejected. Therefore ASHA workers do have a negative perception towards covid-19 work.
Impact of Covid-19 on Social Status of ASHA workers:
Table No 4 discusses the social impact of the Covid-19 pandemic on ASHA workers. The study found that the majority 160 (64%) of the respondents occasionally felt the corona outbreak harmed their relationships, while 40 (16%) and 20 (8%) very rarely and never felt the same respectively. The study also focuses on the issue of domestic violence experienced by ASHA workers, in this regard 190 (76%) of the respondents frequently experienced an issue of domestic violence during the pandemic period, 40 (16%) of them rarely experienced such problems. The question had been asked regarding the adverse effect of the covid-19 pandemic on the upbringing of children of their family, the study found that 180 (72%) frequently, 40 (16%) very frequently and 30 (12%) occasionally felt covid-19 pandemic harmed the upbringing of their children. 150 (60%) of the respondents opine that their work nature frequently caused frustrations among the family members. The calculated F (Table 5) test both between the column and rows F > Critical value @ 5% level of significance, hence H0 is rejected, hence it can be concluded that covid-19 does have any impact on the social status of ASHA workers.
Impact of Covid-19 on Economic Status of ASHA workers:
Table No 6 represents economic impact of the covid-19 pandemic on ASHA workers, the majority 200 (80%) of the respondents frequently felt problem of the fulfilment of basic needs during the covid-19 pandemic. It is evident from the above study that all respondents 250 (100%) frequently felt some sort of financial difficulty during the Covid-19 pandemic. Information was also collected regarding the impact of the Covid-19 pandemic on the savings of the respondents, as per this, results showed that 200 (80%) of the respondents opine that the Covid-19 pandemic has frequently affected their savings. With regards to the pandemic effect on regular expenditure, the study found that 160 (64%) of the respondents are frequently affected during the pandemic lockdown. Finally, questions had been asked regarding the pandemic effect on the jobs of their family members. The study found that 200 (80%) of the respondents’ family members were lost their jobs or mode of income that they were dependent on like business and they have unquestionable relies on the salary of ASHA workers. From table 7, it is clear that the F value between rows and between columns is p>0.05. Hence H0 should not be rejected, therefore it can be concluded that covid-19 does not have an impact on the economic status of ASHA workers.
CONCLUSION
ASHA Workers playing an important role in realizing the objectives of the National Rural Health Mission (NRHM). Their role is remarkable during the situations like Covid-19 pandemic. As found in the present study, out of 250 ASHA Workers selected, 200 of them frequently felt it was tough to work during Covid-19 lockdown situation still they performed their duties properly, which is proved through the present study that 200 respondents rarely felt hesitate to work during this situation and 230 of them occasionally thought that pandemic situation had created an extra burden on their usual work. But concerning the social impacts of the Covid-19 pandemic, some of the respondents felt negative impacts on their relationships, experienced domestic violence and felt negativity about the upbringing of the children of their families. The present study also discusses the economic impacts of the Covid-19 pandemic, 200 respondents frequently felt the problem of the fulfilment of basic needs during the Covid-19 pandemic, all most all respondents felt financial difficulty during the pandemic situation and said that this situation had also impacted their savings, regular expenditure and jobs of their family members. From this study, it is suggested the Government take some steps to improve the conditions of the ASHA Workers by the means of enhancing their socio-economic status other initiatives.
Acknowledgement: We acknowledged gratefully all 250 ASHA workers who have responded promptly to our research questions and we are also grateful to the authors, editors and publishers of all the articles cited in this manuscript.
Source of Funding: The research has been done with the own funds of the authors.
Conflict of Interest: There is no conflict of interest in this study. The study is confined to examine the impact of Covid-19 on ASHA Workers.
Authors Contribution: The study examined the challenges faced by ASHA Workers during this Covid-19 period and its impact on their socio-economic status, the results of this research is suggested to the Government to take appropriate action.
Englishhttp://ijcrr.com/abstract.php?article_id=4112http://ijcrr.com/article_html.php?did=41121. Articles by Nalini Ravichandran | The Wire: The Wire News India, Latest News, News from India, Politics, External Affairs, Science, Economics, Gender and Culture [Internet]. [cited 2021 Jul 9]. Available from: https://m.thewire.in/byline/nalini-ravichandran
2. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realizing their multiple roles | Human Resources for Health | Full Text [Internet]. [cited 2021 Jul 9]. Available from: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0094-3
3. Bandyopadhyay S, Baticulon RE, Kadhum M, Alser M, Ojuka DK, Badereddin Y, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Global Health. 2020 Dec 1;5(12):e003097.
4. RAS | Impact of the Pandemic on Accredited Social Health Activists (ASHA) in India [Internet]. [cited 2021 Jul 9]. Available from: http://www.ras.org.in/impact_of_the_pandemic_on_accredited_social_health_activists_%28asha%29_in_india
5. Kingsley JP, Vijay PK, Kumaresan J, Sathiakumar N. The Changing Aspects of Motherhood in Face of the COVID-19 Pandemic in Low- and Middle-Income Countries. Matern Child Health J. 2021 Jan;25(1):15–21.
6. P AAE, Negi DP, Rani A, P SKA. The impact of COVID-19 on migrant women workers in India. Eurasian Geography and Economics. 2021 Jan 2;62(1):93–112.
7. Experience of the COVID-19 pandemic in rural Odisha, India: knowledge, preventative actions, and impacts on daily life | medRxiv [Internet]. [cited 2021 Jul 9]. Available from: https://www.medrxiv.org/content/10.1101/2020.11.20.20235630v1
8. Gumber A, Bulsari S. COVID-19 Impact on Indian Economy and Health: The Emergence of Corona-Economics. :6.
9. (PDF) Impact of COVID-19 on women and children health and the need for a gendered approach for vaccine development [Internet]. [cited 2021 Jul 9]. Available from: https://www.researchgate.net/publication/343017053_Impact_of_COVID-19. _on_women_and_children_health_and_the_need_for_a_gendered_approach_for_vaccine_development
10. Kulkarni T. ASHA workers in Karnataka spend hours tracing COVID-19 contacts daily. The Hindu [Internet]. 2020 Apr 24 [cited 2021 Jul 9]; Available from: https://www.thehindu.com/news/cities/bangalore/they-go-where-others-fear-to-tread/article31428115.ece
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareThe Micrometric Analysis of Zone Wise Proportion of Human Adrenal Glands in Hanging and Poison Death Autopsy Cases in Different Age Groups
English7986Manivannan KEnglish Kafeel HussainEnglish Krishna Rao H.REnglish Sasikumar REnglish Rama Manohara Reddy DEnglish Janaki Raman PEnglishEnglishManivannan K, Assistant Professor, Department of Anatomy, PES Institute of Medical Sciences and Research, Kuppam Pin-517425, Chittoor District, Andhra Pradesh, IndiaIntroduction
Suicide is the complex interaction of biological, psychological, socio-economic and environmental factors in India and all around the world. National Crime Records Bureau of India has reported official suicide rates based on police reports – estimated only 1,35,000 suicides in the year 2017 due to frustration, sudden emotional outbursts, unemployment, poverty, failure to cope with stress at times of unexpected circumstances.2 Worldwide, more than 9, 00, 000 deaths are annually reported of suicide, of which 20% are Indians. Suicide is one of the three leading causes of death among people aged 15–44 years in some countries and the second-leading cause of death among those aged 10–24 years; these figures do not include the suicide attempts, which are up to 20 times more than complete suicide.3
Stress is common in the people of the united states and one in ten, age 12 and more and one in four among women in their age 40 and 50 are using antidepressant drugs due to modern lifestyle, multitasking and overburden in their work.4,5 Suicide is a leading cause of death among teenagers and adults 15 to 49 years of age and is graded among the top thirteen causes of death for human individuals of all ages worldwide by the World Health Organization (WHO).6
Stress plays a vital role in alterations in the structure and function of suprarenal glands which may have been related to depression and suicidal behaviour. The human adrenal gland is composed of two parts, the cortex(87%) and the medulla(13%). Both parts differ from each other by structure, function and development. The cortex consists of three zones; Zona Glomerulosa (ZG-15%), Zona Fasiculata ZF-65%) and Zona Reticularis(ZR-7%).7-10 Adrenal glands are a pair of endocrine glands and target structure of Hypothalamo Pituitary Adrenal(HPA) axis and stress system. Depression, anxiety, nervousness and fear plays an important role in affecting the structure and function of the adrenal gland, which may have a connection with suicidal behaviour in depressed individuals.
The cortisol level is increased in blood circulation due to sudden fear and severe pain at the time of sudden death and failure of long loop negative feedback mechanism leads unable to balance the cortisol level by the HPA axis11&12 and leads changes takes place in dimensions and volumes of adrenal glands.
The effect of trauma through nociceptor pathways, afferents from Nucleus tractus solitaries(NTS), Emotion via the Limbic system and drive for circadian rhythm are initiatives for stimulation of the Hypothalamus to release Corticotrophin Releasing hormone(CRH), which passing through the hypothalamic hypophyseal portal circulation to stimulate the pituitary gland to secrete and release ACTH in turn which control and regulate the secretions from the adrenal cortex(only ZF and ZR) to release the glucocorticoids (Fig-3). The Zona glomerulosa is controlled by the renin-angiotensin -aldosterone mechanism. The adrenal medulla is sympathetic in origin, which regulates increased heart rate, cardiac output by secreting adrenalin and noradrenalin at the time of stress and fear.11
This study was carried out to find the Micrometric changes of human adrenal glands of hanging and poison death cases in different age groups within a limited period after death. This study will be useful for forensic surgeons, medical-legal fraternity, forensic pathologists and entire medical faculty to determine the alterations in suprarenal glands between hanging and poison death autopsy cases.
Aims/objectives
To analyze the micrometric changes in thickness and zone-wise proportion of adrenal glands in hanging and poison death autopsy cases in different age groups.
Materials
The analytical study was done in the department of Anatomy after approval from the institutional human ethical committee at PES Institute of medical sciences and research, kuppam(IHEC Number-021). A total of 186 suprarenal glands was collected from 93 cadavers aged 20 to 50 years and both genders belong to hanging (52) and poison(41) death cases with due consent from close blood relatives of the deceased when undergone postmortem examination at Sri Venkateswara hospital, Chittoor district, Andhra Pradesh in the years 2018 and 2019.
Inclusion Criteria: Both genders of hanging and poison death autopsy cases, three age groups 20-30 years, 30-40 years and 40-50 years and time of autopsy in between 12-24 hours after death were included.
Exclusion Criteria: The adrenal abnormalities, burns cases, chronic debilitating illness, Accident cases, decomposed autopsy cases, pregnant women, age group less than 20 and more than 50years, commence of autopsy less than 12 hrs and more than 24 hrs were excluded.
(Institutional Human Ethical Clearance Number-21)
Methods
The samples of adrenals were divided into three age groups as 20-30 yrs (43 cases), 30-40yrs (26cases) and 40-50yrs (24 cases). The specimens were stored at 10% formalin immediately after collection for the preservation of tissues and fixation up to 12 to 24 hours to prevent distortion, autolysis and to reduce the shrinkage. The dissection kit was used to clean the adipose tissue and fascia around the glands. The cut section was made at the level of the hilum of adrenal glands ( fig- 1) to maintain the uniformity then fixed again in 10 % formal saline up to 12-24 hours duration for infiltration of the tissue in formalin. The histological slides were prepared after the processing, embedding, sectioning, staining with haematoxylin and eosin stains.
Micrometric Analysis
The term micrometry means the measurement of macroscopic objects. The standard unit of measurement of structures as accepted in the histological study is called a micron or micrometry.
The Micrometric changes in the thickness of Zona Glomerulosa(ZG), zona fasciculata (ZF), Zona Reticularis(ZR) and adrenal medulla were measured with the use of stage micrometre (SM) and ocular micrometre (OM) after preparing the histological slides.
Calibration under 4x objective
The thickness of zone wise adrenal cortex was measured (as in Fig-4) after calibration with stage and ocular micrometre under the 4 x objective. The scale in stage micrometre (SM) is 1 mm and divided into 100 units which are equal to 1000 micron
The scale in ocular Micrometer(OM) is divided into 100 equal units(Fig-4). The SM was placed in the stage of the microscope and the OM was placed in the diaphragm of the eyepiece. The units of SM overlapped by units of OM were counted under the 4 x objective. The 100 units of SM were equal to 40 units of OM in the count.12 The distance between the two units of OM was 25 micrometres in calculation by using the formula
40 ocular units =1000 micron
1 ocular unit = 25 micron.
The SM was removed from the stage and a measurable histological slide was placed. The thickness of each layer of the adrenal cortex was measured by OM (Fig-3), multiplied by 25 and divided by 1000 to convert into millimetres. All the 186 slides belong to hanging and suicidal cases were measured in the same method.13 ,14
The thickness in mm was converted into percentage by calculating the thickness of the individual zone divided by the total thickness of the medulla and 3 zones of cortex multiplied by 100.
Statistical Analysis
The data was analysed by an Independent t-test using the Statistical Package for Social Sciences (SPSS) and Window version 21.0 software. Values of p Englishhttp://ijcrr.com/abstract.php?article_id=4113http://ijcrr.com/article_html.php?did=41131. World Health Organization. Prevention of suicide: guidelines for the formulation and implementation of national strategies. Geneva, Switzerland: World Health Organization, 1996.
2. National Crime Records Bureau. Accidental Deaths and Suicides in India. New Delhi: Government of India; 2008.
3.World Health Organization Report. Suicide prevention. ; 2009 accessed 13.08.19.
4.US Public Health Service. The Surgeon General’s call to action to prevent suicide. Washington, DC: US Public Health Service, 1999.
5. Laurie Mueller. The science of stress. The American chiropractor, Nov-2017;27.
www.The American Chiropractor.com
6. Meier RF, Clinard MB. Sociology of deviant behaviour. 14th ed. Belmont, CA: Wadsworth Cengage Learning; 2008. p169.
7. Datta AK. Essentials of Human Anatomy: Thorax and Abdomen. 4th ed. Kolkata(India): Current Books International; 2005;147-49.
8. Susan standring. Gray‘s Anatomy-the Anatomical basis for clinical practice. 41st international ed. Elsevier Ltd; 2016;1194.
9. BD Chaurasia. Textbook of Human Anatomy: Volume (2) Lower limb, Abdomen and pelvis. 4th ed. Bengaluru(India): CBS Publishers and distributors; 2004;305.
10. T.S. Ranganathan. A Textbook of Human Anatomy. 6th ed. New Delhi(India): S.Chand & Company Ltd; 2006;343-6.
11. Guyton AC and Hall JE. The adrenocortical hormones In Textbook of medical physiology. 11th ed. New Delhi: Elsevier; 2006; 869-83.
12. Sembulingam K and PremaSembulingam. Essentials of Medical Physiology. 4th ed. New Delhi(India): Jaypee Brothers Medical Publishers P(Ltd); 2006;393-408.
13. Singh D R. principles and techniques in histology microscopy and photomicrography. 1st ed. CBS publishers and distributers; 2003: p153.
14. Gilles bolduc. Calibration of the microscopic ocular micrometre. Available from: https://www.youtube.com/watch?v=HaqgCtA-ioI (Last cited on 2018 December 21)
15. Smita P, Rath S, Dutta BK. Morphological study of the adrenal gland in case of suicidal deaths. Indian J Applied Res 2015;5:333–7.
16. Fawcett DW. Bloom & Fawcett-a textbook of histology. 12th ed. New York: Chapman & Hall; 1994;503.
17. Maitra A. The endocrine system. Robbins and Cotran pathologic basis of disease. 8th ed. New Delhi: Elsevier Saunders. 2010. p1148.
18. Ross MH, Pawlina W. Histology: a text and atlas with correlated cell and molecular biology. 6th ed. Baltimore: Lippincott Williams & Wilkins; 2011. p762.
19. Mescher AL. Junqueira’s basic histology: text and atlas. 13th ed. New York: McGraw-Hill; 2013. p414.
20. Gartner LP, Hiatt JL. Colour atlas and text of histology. 6th ed. Baltimore: Lippincott Williams & Wilkins; 2014. p246.
21. Deepti G, Meena G, Bichitrananda R. Sequential Postmortem histological changes in human adrenal gland up to thirteen hours and thirty minutes post mortem interval. Int J Advanced Res .2015;3(7):1138-55.
22. Sarkar A, Chatterjee M, Batabyal S. A post mortem study on the weight and morphology of adrenal glands in victims of suicide. Int J Cur Res Rev. 2014; 6(1):21-27.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareTo Assess The Ability of CBCT in Evaluating Osteoporotic Bone Changes in Type 2 Diabetes Mellitus Patients in Comparison to Bone Mineral Density using DEXA
English8793Deepti AwasthiEnglish Upasana SethiEnglish Nidhi PuriEnglish Akshay RathoreEnglish Manu DhillonEnglish Seema AhujaEnglishEnglish CBCT, BMD, DEXA scan, osteoporosis, radio-morphometric indices, type 2 diabetes mellitus.Introduction
Diabetes mellitus (DM) is an ametabolic disorder1characterized by persistent hyperglycemia. It may be due to resistance to peripheral actions of insulin, impaired insulin secretion, or both. An important complication of type 2 diabetes is osteoporosis, which is characterized by low bone mass2 and deterioration of bone micro-architecture3. According to World Health Organization (WHO), osteoporosis is defined as a bone mineral density t-score value of − 2.5 or lower4 at any one location or having a previous fracture. Due to changes in lifestyle and sedentary habits, even males are found to be prone to osteoporotic changes. Dual-energy x-ray absorptiometry (DEXA scan) is the best non-invasive5technique for bone mineral density measurement. But in few cases for instance impaction, implant placement and curved canals 3D imaging such as CBCT is used for better treatment planning as it provides 3-dimensional representation6 of the maxillofacial skeleton. Therefore, this study was conducted with the purpose to assess the ability of CBCT to evaluate osteoporotic bone changes in type 2 diabetes mellitus patients in comparison to bone mineral density using a DEXA scan.
Methodology
The prospective study (ITSCDSR/IIEC/2017-20/OMR/01) was performed at the Centre for Advanced Imaging in the Department of Oral Medicine and Radiology, I.T. S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India from June 2018 to July 2019. The study group involved 30 diabetic patients (15 males and 15 females) within the age range between 50 to 80 years with a known history of type II diabetes, of more than 10 years of duration who had undergone CBCT imaging for various reasons.
The control group included 30 healthy subjects (15males and 15 females) aged 50 to 80 years with no history of the systemic disease who underwent CBCT scans for different reasons.
Patients with other systemic disorders such as hyperparathyroidism, hyperparathyroidism, osteomalacia, thyrotoxicosis, renal disease or any disorder known to cause osteoporosis and with a history of taking any long-term medications for any other systemic problem were excluded. Consent was taken from the participants who had joined this study. The study was approved by the institutional ethical board.
All those patients who were suffering from diabetes underwent blood sampling by venipuncture of the antecubital vein to establish fasting and postprandial glucose values in a fully automated clinical chemistry analyzer.
Patients and healthy subjects were subjected to DEXA scan [DEXA Scanner LUNAR DPX (GE,
USA)] of lumbar vertebrae (L1-L4) for the measurement of bone mineral density. Based on the
lumbar spine bone mineral density measurement t- score value (‹-2.5) was classified as osteoporotic and a t- score value (›-1.0) was classified as normal7.
CBCT images of the left mandible were obtained using CBCT Unit-New Tom GiANO (CEFLA)-SC, CEFLADENTAL GROUP, ITALY with a voxel size of 150 microns, tube voltage -85-90kvp, tube current-10 mA, exposure time- 9 seconds and field of view-5x5cm.
Axial, sagittal and coronal images were reconstructed on the multiplanar reformation screen (MPR) using NNT software (New Net technologies Ltd. Naples) version by scrolling through sequential axial slices the mental foramen was identified and the slice with the widest mesiodistal dimension of the mental foramen was utilized. Two experienced maxillofacial radiologists recorded the measurements and readings were repeated after 2 weeks.
As per recommendation by Koh and Kim20118, the radio-morphometric indices, were recorded on the angled coronal sections, the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), computed tomography mental index (CTMI) (Fig1, 2and 3) and computed tomography cortical index (CTCI) (Fig4, 5 and6). On angled sagittal sections the CTCI score was measured using a modification of the Klemetti et al.,19949 scoring system.
Statistical analysis
All the data were analyzed on the statistical software SPSS 16.0 (SPSS Inc, Chicago, IL, USA) for Windows. The descriptive statistics like mean, median, SD and frequency distribution of data was calculated. P-value Englishhttp://ijcrr.com/abstract.php?article_id=4114http://ijcrr.com/article_html.php?did=4114 1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1): S62-9.
2. Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes.Int J Endocrinol. 2014 Oct;2014.
3.Sözen T, Özisik L, Basaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017 Mar;4(1):46.
4. Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. J Bone Joint Surg Am. 2010 Mar;92(3):743.
5. Garg MK, Kharb S. Dual-energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab. 2013 Mar;17(2):203.
6. John GP, Joy TE, Mathew J, Kumar VR. Fundamentals of cone-beam computed tomography for a prosthodontist. J Indian Prosthodont Soc. 2015 Jan;15(1):8.
7. Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J.2007 Aug 1;83(982):509-17.
8. Koh KJ, Kim KA. Utility of the computed tomography indices on cone-beam computed tomography images in the diagnosis of osteoporosis in women.Imaging Sci Dent. 2011 Sep 1;41(3):101-6.
9. Klemetti E, Kolmakov S, Kröger H. Pantomography in the assessment of the osteoporosis risk group.Scand J Dent Res.1994 Feb;102(1):68-72.
10. Humadi A, Alhadithi RH, Alkudiari SI. Validity of the DEXA diagnosis of involutional osteoporosis in patients with femoral neck fractures. Ind J Orthop. 2010 Feb;44(1):73-8.
11.Kling JM, Clarke BL, Sandhu NP. Osteoporosis prevention, screening, and treatment: a review. J Womens Health (Larchmt). 2014 Jul 1;23(7):563-72.
12. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic
radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of
inferior cortex of the mandible. Der Med Res.1996 Nov;25(5):263-7.
13. Pallagatti S, Parnami P, Sheikh S, Gupta D. Suppl-1, M3: Efficacy of Panoramic Radiography in the Detection of Osteoporosis in Post-Menopausal Women When Compared to Dual Energy X-Ray Absorptiometry. Open Den J. 2017;11:350.
14. Gau RB, Chaudhary A, Wanjari PV, Sunil MK, Basavaraj P. Evaluation of panoramic radiographs as a screening tool of osteoporosis in postmenopausal women: a cross-sectional study. Journal of clinical and diagnostic research: J Con Den Res. 2013 Sep;7(9):2051.
15. Vijay G, Chitroda PK, Katti G, Shahbaz S, Baba I. Prediction of osteoporosis using dental radiographs and age in females. J Mid-life Health. 2015 Apr;6(2):70.
16.Kayipmaz S, Akçay S, Sezgin ÖS. Osteoporotic mandibular changes caused by type 2 diabetes mellitus: a comparative study by cone-beam computed tomography imaging. Oral Radiol. 2017 May;33(2):108-16.
17. Sharma B, Singh H, Choudhary P, Saran S, Mathur SK. Osteoporosis in otherwise healthy patients with type 2 diabetes: a prospective gender-based comparative study, Indian J Endocr Metab. 2017 Jul;21(4):535.
18.Mostafa RA, Arnout EA, Abo el-Fotouh MM. Feasibility of cone-beam computed tomography radio-morphometric analysis and fractal dimension in assessment of postmenopausal osteoporosis in correlation with dual X-ray absorptiometry.Den Med Res. 2016 Sep;45(7):20160212.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareThe Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review
English94105Kholis ErnawatiEnglish Heramitha AzahraEnglish Alya NamiraEnglish Lathifah H. YuhenEnglish Asa G. KaruniawanEnglish Ali A. MeccaEnglish Raudha KasmirEnglish NurmayaEnglish Muhamad FathurrahmanEnglish Dewi SusannaEnglish Zwasta P. MahardhikaEnglishEnglish Mobile application, Dengue fever, Control of Dengue Fever, Health promotion, Health education, Community participationINTRODUCTION
Dengue fever is a severe public health problem that causes outbreaks in Indonesia's various regions with high morbidity and mortality rates. Dengue fever is an infection caused by the dengue virus and transmitted by the Aedes aegypti and Aedes albopictus mosquitoes. Based on data from the Ministry of Health, nearly 390 million people are infected each year, until April 2020, the number of dengue cases in Indonesia has reached 39,876 cases.1At the beginning of 2019, data entered until January 29, 2019, 13,683 dengue sufferers, reported from 34 provinces with 132 cases of whom died. Several regions were recorded to have reported extraordinary events of dengue fever, including Manado City (North Sulawesi) and seven districts/cities in NTT, namely East Sumba, West Sumba, West Manggarai, Ngada, South Central Timor, Ende, and East Manggarai.2
Global control strategies have been developed in the form of vector control, including chemical control, biological, and physical.3In controlling dengue fever, Indonesia implements mosquito nest eradication. Mosquito nest eradication is a program to prevent the breeding of the Aedes aegypti mosquito, which acts as a carrier for the dengue virus through 3M-Plus, such as draining or cleaning water reservoirs, closing water reservoirs tightly, burying used goods, raising mosquito larvae-eating fish, spreading larvacides in water storage, using mosquito repellent and fogging using malathion and fenthion.4
The success of mosquito nest program can be measured by the larva free rate. If the larva free rate ≥ 95% is expected to prevent or reduce cases of dengue transmission.5In 2017, the larva free rate amounted to 46.7%, so that it has not met the program target.4Indonesia is starting to handle dengue fever by using mobile-based applications in the form of education (educational game applications) and mapping of areas with dengue cases (SICANTIK and Citra Quickbird).6,7,8 These applications are expected to assist in the prevention and control of dengue fever cases.6,7Meanwhile, in the world, Brisbane's method is almost the same as in Indonesia, which shows successful regulation because larvae habitat is regulated and possible. Government decisions are assisted by public compliance so that mosquito control in Brisbane can affect Aedes aegypti.9For neighbouring countries such as Malaysia, they still use dengue fever control techniques with WHO recommendations, namely vector control, active disease surveillance, emergency preparedness, room capacity, and vector control training and research.10,11With the results of vector control of dengue fever in Malaysia, it is considered a slow reaction.12Meanwhile, in Brazil, handling dengue fever has been carried out by developing unique technologies such as the transgenic mosquito and the Wolbachia bacteria and supported by the Brazilian national program. This control method is increasing and demonstrating the potential success that science supports.13,14
In Nicaragua, researchers found maps that allow health workers to identify areas at greater risk of an outbreak. The smartphone is a product of technological innovation that offers essential features to spread the disease to follow. It can consolidate almost instantly when reports from the public use smartphone-based surveillance applications for health workers. It can shorten response times and provide authorities with a more accurate picture of the disease situation for intervention planning and execution.15
Based on the explanation above, this article will discuss mobile-based information technology to prevent dengue fever in the community using a systematic review approach.
METHOD
The research method used a systematic review approach based on the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocol.16 The PRISMA protocol is used to identify research articles relevant to the purpose of writing articles. The article search process was accessed on three electronic databases, namely PLOS ONE, PubMed, and Google Scholar. The keywords used in the search for journal articles are mobile applications, control of dengue fever, health promotion, and community.
The criteria for the articles used are primary data, year of publication (January 1, 2019 - October 6, 2020), in English, have gone through the peer review stage, full-text articles, and discuss the use of mobile applications in controlling dengue fever. Data extraction was carried out through the identification stage by searching for articles from the database, screening to determine the period, feasibility, and screening in determining the title of the item to be selected based on inclusion criteria. The search results for articles are then grouped by; (a) research location, research design, respondent involvement, and research results, (b) article frequency distribution based on socio-demographic factors, and (c) health applications based on components, strengths, weaknesses, benefits, and recommendations for improvement.
The descriptive narrative analyses are based on the utilization of information technology in the health sector, advantages and weaknesses of using information technology in the health sector, the effect of information technology media on increasing knowledge of dengue fever, the effect of education with mobile-based media on knowledge of dengue fever, and the influence of knowledge of dengue fever on changes in dengue fever management behaviour.
RESULT
The selection results based on keywords and following the PRISMA protocol obtained 36,187 articles. Furthermore, at the screening based on the year of publication (January 1, 2019 - October 6, 2020), there were 5,474 articles. Screening of journals in English, full text, and the peer review phase obtained from PLOS ONE, PubMed, and Google Scholar, received 212 articles. An eligibility study was conducted to eliminate articles that did not meet the established inclusion criteria. In the last stage, seven articles were obtained according to the inclusion criteria.
DISCUSSION
Utilization of Information Technology in the Health Sector
People are increasingly using the use of information technology at various economic and social strata levels.23 To overcome challenges in the health sector due to limited resources and sustainability, the strategy that can be taken is increasing information and communication technology (ICT).24 In recent years, in fighting dengue, public health authorities worldwide have adopted new technology and developed and implemented a different digital vector surveillance system where public members can participate in some form of active surveillance of mosquitoes in the field.15
Given the complexities of modern medicine, it cannot be denied that information technology will increase the quality of health care.25 The world health organization has urged its member countries to develop the infrastructure for information and communication technology (ICT). The use of ICTs in health care has shown great potential in improving the quality of life by facilitating community support for independent living.26
Technology information has the potential to improve the quality, safety, and efficiency of health services. Delivering quality health care requires providers and patients to integrate complex information from multiple sources. For example, Telehealth uses telecommunications technology to provide health-related services and information supporting patient care, administrative activities, health education, health services, and private information.27Mirzayi and Rafe stated that Health Information Technology (HIT) is an information processing application that involves computer hardware and software that can be used to manage information about individuals and groups of patients' health and medical care.28
In Thailand, there is a technology called a geographic information system (GIS). The technology is an initiative to support dengue fever control with an automated computer-based system to capture, retrieve, manage, display, and analyze large amounts of spatial and temporal data in a geographic context. Roads, residential buildings, and other relevant data can be obtained and mapped to form a base map layer using Arcview GIS software.29Data with mapping in an area and monitoring the severity of dengue cases can be quickly identified. Epidemiological analysis of the Application can reduce the impact severity when an outbreak occurs.30
Advantages and Weaknesses of Using IT in the Health Sector
The use of technology in the dengue epidemic in several journals has made research participants get practical and satisfactory information. In Japan, the Mozzify Application (Table 3) has succeeded in getting the research participants' satisfaction. 37 of the 50 people whose data were taken gave a value of 4 out of 5 indicators of satisfaction.17Even in Thailand, an application called ThaiDengue Application (Table 3) succeeded in providing satisfaction to the 400 people tested.21
Information technology application-based systems can increase public awareness to take preventive measures, especially dengue fever attacks. 31 An application called RadarAedes App was even developed independently by a local community in Brazil to assist local governments in monitoring their area from the potential spread of dengue fever infection.32
Technology-based preventive measures provide users with various information about dengue fever, such as case reports, spread areas, and preventive procedures.17In Nepal, a study was conducted that compared the community who received information on knowledge of dengue virus prevention conventionally with those who received information from applications based on short message services (SMS), and it turned out to have significant results compared to people who received conventional information.18
An application-based early warning system was developed and tested in Brazil, Malaysia, and Mexico to make the early warning system more effective and efficient for dengue fever cases. As a result, this system proved to be pragmatic in making the early warning system more effective and efficient.31,33 In Saraphi, Thailand, a digital data collection application called GIS, which functions to collect geographic data, was tested. It was proven that the data collected was more accurate and undoubtedly more efficient.34 A digital data collection application called GeoApps, which was tested in Brazil, has been proven to be able to collect data related to health in this case, including dengue fever cases to make it faster and more efficient and to be able to help Brazil's integrated health service provider (SIAB).35
Effect of Information Technology Media on Increasing Knowledge of Dengue Fever
Over the past ten years, mobile phones have provided innovative and cost-effective strategies for the global health community to address dengue prevention and management challenges. Marquez's research in 2020, the Mozzify Application (Table 3) is useful as an integrated strategic health intervention system that promises to report and map dengue fever cases, and disseminating information about dengue among the general public and health professionals.17
Besides, there is also a Mobile Short Message Service (SMS), a low-cost health promotion intervention that can increase knowledge and implementation in preventing dengue in affected communities. Mobile SMS is a practical, acceptable, and appropriate health intervention tool to improve dengue fever prevention in the community. These interventions can be used as promising tools in health education regarding dengue and other diseases. People are accustomed to using mobile phones daily, so shifting health promotion via SMS is an appropriate and realistic step.18
In addition to helping the more comprehensive community access information more quickly, information technology media can also be designed to make it easier for doctors and medical personnel to increase compliance with clinical practice guidelines in managing and preventing diseases such as arbovirus infection in health care settings. For example, the mHealth FeverDx Application shows adequate performance in simulated emergency consultations. The guide module allows general practitioners to quickly get an offline reference to practical clinical guides for acute fever symptoms such as Zika, dengue, Chikungunya, and various infections commonly found in tropical regions.20
In the future, researchers must develop more modern designs to become more interesting virtual games for children.36Advances in information technology have introduced new design approaches that support health care delivery and patient education. Health care information technology can empower patients and support the transition from a role in which the patient is a recipient of passive care services to an active role in which the patient is informed, has choices, and is involved in the decision-making process.37
The Effect of Education with Mobile-based Media on Knowledge of Dengue Fever
Knowledge is an essential determinant that becomes the final determinant of health behaviour, such as attitudes, subjective norms, risk perception, and independence often begins with knowledge.38 The utilization of knowledge about dengue fever to the community using the mHealth application in videos, diagnosis, management, management of dengue and mosquito vector control methods, and having an online discussion forum. This feature can increase awareness of symptoms, management of dengue fever, and vector control.17The use of e-learning in education is easier to understand and can provide information quickly so that health education can be received via mobile phones.19This shows that the quality of active dengue fever prevention behaviour increases after health education with mobile application-based media.39,40The effect of education on knowledge of dengue fever is in line with research conducted by Ernawati et al. in 2019, which said that there was a relationship between knowledge and exposure to information in the vector control of dengue mosquitoes (p-value = 0.000) dengue fever in Koper Village, Kresek District, Tangerang Regency.41In the research of Elsa et al. in 2017, health education for the community can increase the level of knowledge and participation in eradicating mosquito nests (p-value = 0.000).42Education does not necessarily change people's knowledge. As found in research conducted by Ernawati et al. in 2018, there is no difference in knowledge about dengue fever before and after counselling conducted to homemakers in Serdang, Kemayoran, and Jakarta (p-value = 0.087).43
The Influence of Knowledge of Dengue Fever on Changes in Dengue Fever Management Behavior
Knowledge of the mosquito that spreads dengue fever and its control is an essential factor in controlling transmission.44Although efforts have been made to stop dengue outbreaks in various parts of the world and particularly in tropical countries such as India and Southeast Asian countries, concerning the importance of entomological surveillance, The findings of the current literature study agree that behaviour in controlling dengue fever during an outbreak is also very crucial.45The knowledge possessed by a person to promote positive behaviour change in the prevention and control of dengue fever tends to share information and achievements with family and friends.46
Lack of awareness of dengue problems tends to reduce behaviour in preventive measures.47Lack of awareness of dengue symptoms in the community can lead to delays in patients getting appropriate medical attention.48Public knowledge and preventive behaviour regarding the causes, transmission, prevention, and treatment of dengue fever are significant socio-cultural factors that have influenced dengue fever control measures.49Behavioral-influenced activities must be supported by proper education regarding a healthy home environment that will reduce the risk of spreading dengue fever.50
The health belief model is a model of social cognition that is widely used to predict health behaviour. This model shows that a change in behaviour or action can be expected if a person feels at risk or susceptible to disease (perceived vulnerability).51People who feel they are at risk of dengue fever immediately visit a health care provider compared to those who feel otherwise.52Health care-seeking behaviour is also greatly influenced by the inadequacy of primary health care facilities in providing adequate services to dengue fever patients.53
People with better knowledge are more likely to have a more severe attitude towards dengue and better prevention practices.54Knowledge of dengue fever symptoms, modes of transmission, prevention practices, and disease management tends to change their belief that dengue fever is a severe and threatening disease.17This is in line with research conducted by Ernawati et al. found that increased knowledge can improve mosquito nest eradication behaviour in Kresek village, rural areas (t-value = 4.68) and information sources mosquito nest eradication behaviour in Kresek village, Tangerang Regency, Indonesia (t-value = -3.32).55
CONCLUSION
There are seven mobile-based health applications developed in 2019-2020, namely Mozzify, SMS, e-learning, FeverDX, Mobuzz, ThaiDengue, and VECTOS. The application functions as an educational medium (Mozzify, SMS, e-learning, and Mobuzz), a reporting system (FeverDX, ThaiDengue, and VECTOS), and prediction of dengue cases (ThaiDengue and VECTOS). As an educational medium, health applications that have been tested on the public are proven to be accepted by the community and can increase people's knowledge. The use of mobile-based dengue fever health applications can help increase community early awareness in handling dengue fever. However, not all people can access these health applications because there is limited internet coverage.
RECOMMENDATION
The research results need to be followed up by the government in each country using these health applications worldwide. The limited reach of the internet network, which can become an obstacle in the use of health applications by all society components, also needs to get the local government's attention so that a solution to the problem is immediately sought.
Authors' Contribution: The document should identify all individuals who meet authorship requirements as authors and who are willing to accept public responsibility for the material, design, or revision of the manuscript. The manuscript was revised and reviewed by all contributors and given the final okay by them as well.
Acknowledgement
Thanks to YARSI University and the Ministry of Research and Technology Indonesia for their financial support for the publication. Thanks to the authors of the seven articles (i.e., Marquez Herbuela et al., Bhattarai et al., Mahalingam et al., Rodríguez et al., Lwin et al., Somboonsak, and Ocampo et al.), whose articles were used as material for this writing.
Conflict of Interest: None of the authors declared any conflict of interest.
Source of Funding: The Study was self-financed.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareA Study on the Sexual Dimorphism in Freshwater Himalayan Endangered Fish Labeo Dyocheilus
English106111Verma RakeshEnglishIntroduction: Labeo dyocheilus is one of the main freshwater species, significant food and game fish of Uttarakhand. Sexual dimorphism is characterized as variation in outside morphology among males and females. This research would be useful to adopt a better plan for its mono-sex culture, fish identification and to determine the eco-behaviour of fish. Objectives: Various researchers in the past about breeding biology, morphological characters and scientific taxonomy but literature gap are still present concerning sexual dimorphism. To study the age and sex-dependent morphological variation were the objectives to fulfil the literature gap. Methods: Sampling was done in Western Ramganga River Uttarakhand, for this study we use wild-got fishes and laboratory-reared fishes. Measurement of various morphometric parameters was according to protocol and analyzed statistically as well. Results: Labeo dyocheilus show sexual dimorphism at various life stages. During our examination, various findings came out about the variation mainly in colour, morphometric count and appearance of special structures in the body of fish. Colour variation was noticed differently in the different age groups of fishes and this colour variation was also found in breeding and nonbreeding fishes. A total of five morphometric characters were specifically taken for this study, which shows a positive correlation when these boundary plots are against the total length of the fish. While, various unique external appearances were found in some of the fishes mainly in pectoral, pelvic and caudal fin areas. Conclusions: Studied fish was showing age and sex-dependent sexual dimorphism in colour structure and appearances.
EnglishLabeo dyocheilus, Sexual dimorphism, Morphometric count, Endangered species, Central Himalaya, ConservationIntroduction
Labeo dyocheilus (McClelland, 1839) is one among the significant freshwater food fishes having a place with the family Cyprinidae, inhibiting State Uttarakhand in India with discontinuous circulation in the streams of river Ramganga Central Himalayas.1 Generally, for the taxonomical identification, the study of variation in morphological characters and the external feature as well as sexual dimorphism of fish is important 2. Diverse niche, reproductive roles between the sex, inclination of one sex for specific traits over the other sex, and intra-sexual rivalry can make a sexual variation in external structures.3, 4 Variation in selective pressing factors faced by the sex can eventually bring about the evolution and development of sexual dimorphism among the morphological traits.4 Sexual dimorphism is common in animal taxa and results from an assortment of variables together with sexual determination, natural selection, and the genders involving dimorphic niches. 5-7
Various researches had been conducted in the past related to the aspect of sexual dimorphism. In the expanse of literature, we had chosen few for this examination. As Darwin 3, discusses regular natural selection to sex, Andersson,4 runs after sexual choice in fishes. Zelditch, 8 research centred morphometric examination for the scientific classification in fishes. Walker, 9, research findings were about the ecological and biological impact on fish morphology. Another supportive literature in this field was of Jyoti and Sharma 2 research in the fish scientific classification. Various research works had been done before regarding the morphometric characters, ecology, evolution and sexual dimorphism in fishes in different fishes at various areas 5- 11.
Fishes show evidence of sexual dimorphisms as they show variations in size, fins, body proportions, and colour 12. To summarize the body shape and structure of fishes, geometric morphometric measurements of fish was used 13. Females and males fish generally show variation in reproductive organs, and also in external structures that were not directly related to reproduction known as sexual dimorphism. Therefore, this helped understand the behaviour, habitat ecology, and life history of fish species.3,4 The quantitative morphometric study of variation in biological shape plays an integral role in the study of organismal biology 13. The geometric morphometric method continues to be widely used to investigate questions regarding the effects of ecology and evolution on body shape.8 Sexual dimorphism is widespread in animal taxa that results from including a variety of factors like sexual selection, natural selection, and the sexes occupying dimorphic niches.6,7 In addition, knowledge of sexual dimorphism and its appearance is also necessary to make the morphological comparison between populations during ontogeny. 14
Information on sex differences in fishes is significant for farmers in mono-sex culture. To understand the ecology, behaviour, and life history of a species, data regarding sexual dimorphism is needed. Examining the distinctive part of sexual dimorphism was the main objective of the study. Likewise, information on the appearance of fish and sexual dimorphism is essential during ontogeny, while making morphological correlations between populations. In this research, at first, we analyzed the sexual dimorphism in external structures within fish populations, and any kind of colour variation among individuals and the appearance of the special structure of Labeo dyocheilus. Although sexual dimorphism-related differences in external appearance have been noticed in many populations literature surveys revealed no such information on Labeo dyocheilus. Hence this present research work was conducted to analyze the variations in different morphometric and meristic characters towards sexual dimorphism of the species.
Materials and Methods
The specimens of Labeo dyocheilus were freshly collected from River Western Ramganga Uttarakhand, India for 1 year. A total of 102 specimens of different sizes and age groups were subjected for measurement of morphometric and meristic counts following Lowe McConnel 15. All the measurements for our study were taken by using Vernier and digital callipers point to point to the nearest of 0.10 mm.
We gathered and examined the sample in two unique ways. The initial one is wild-gotten fish, in which fishes were gathered directly from the waterway and we broke down the wild population in regular, which were browsed wide scope of stream geological territory. The second way was laboratory-reared fish, to analyze sexual dimorphism before and after reproductive maturity.
These morphometric estimations were estimated with the assistance of divider, estimating board, estimating tape and single dish equilibrium to follow the strategy 15. Morphological examination of both kinds of fish samples; Standard length (SL), head length (HL), maximum body depth (MBD), snout length (SnL), eye diameter (ED), pectoral-fin length (PC), pelvic- fin length (PV), and anal fin length (AN) was estimated to recognize sexual dimorphism.
The relationship of various logarithm transformed morphometric parameters on total length was obtained by least square method with the formula Y = a + b X where 'Y' is the dependent variable (other morphometric boundaries like standard length, head length and so on), 'a' is the intercept value, 'b' is the regression coefficient and X is the independent variable (total length). The total length of the fish was recorded with a precision of ± 0.5 cm. The morphometric readings were then converted into percentages and were expressed concerning total length and the actual values were used to calculate correlation coefficients (r).
Results
Sexual dimorphism in Labeo dyocheilus was studied throughout the year. Various findings come out during this research that was summarized pointwise in (Table 1), including colour variation, fluctuations in the morphometric count and a special appearance on the external body in both male and female fishes.
We observed that the male and female fishes show variations in their body colour. This colour variation was under five categories; young 2-year females have darker body colour (Fig. 1), young 1-year males and females have no colour variation (Fig. 2), the reproductive female has very darker body colour as compared to male fish (Fig. 3), radish colour around the lateral line in only adult male (Fig. 4), radish colour show variation around the lateral line in some adult male fishes (Fig. 5).
We observed that male and female fish also differed in their Morphometric count. The Morphometric count we observed during our study includes standard length, head length, body depth, snout length and eye diameter explained in (Table 2). Variations were observed in; body size, head size, mouth size, pelvic girdles size, dorsal fin size, pelvic fin size, and anal fin size. All eleven types of Morphometric count related variations are summarized pointwise in (Table 1). The total length of fish shows a positive and significant correlation with all other studied Morphometric parameters (Table 3) that was 0.871 with standard length, 0.677 with head length, 0.800 with body depth, 0.743 with snout length, and 0.561 with eye diameter.
We had also observed that the male and female fish were showing some special character; that was nature of pectoral fin in mature male fish was rough while smooth in female, bulging in the abdomen of reproductively mature female fish (Fig. 6), Dot-dot like structure that was tubercles around the upper lip (Fig. 7), and snout structure in different sex in a different age (Fig. 8). Variations in three main fin related external appearances were explanted in (Table 4) while findings summarized pointwise in (Table 1) also shows the story of sexual dimorphism in Labeo dyocheilus.
Table 1- List of major findings to explain sexual dimorphism; variation in Colour, Morphometric count and special appearance noticed in male and female fishes.
Discussion
In our study male and female fish show sexual dimorphism, Labeo dyocheilus show clear sexual dimorphism as in fishes it was extremely normal 16, 17. In animals, sexual dimorphism occurs generally based on size and appearance 18 likewise during the investigation of sexual dimorphism we saw variety in different body structures and body shape and colour in Labeo dyocheilus. In our investigation changes in shading of fishes were seen at various periods of life history though numerous specialists have detailed that morphological sexual dimorphism in fish goes from changes in body colouration 10.
Fishes additionally show variety in their different fins that was dorsal, pectoral, pelvic and anal fins. This finding was similar to the result observed by Conway and Britz 19 who depicted outrageous osteological sexual dimorphism of the pivotal skeleton. Anal fin of fish Puntius binotatus was recorded and which was also showing variations 20. Variety in different fins in male and female was additionally referenced in literature by different scientific workers. This point is coordinate with Park et al., 10 discoveries about the rapid growth in the first and second spines of the dorsal fin at the degree of various sexes.
Different extraordinary characters were likewise reported during the clarification of sexual dimorphism in Labeo dyocheilus, correspondingly development of tubercles on the fins during reproducing season 2. We noticed male and female fish of Labeo dyocheilus having different morphological varieties, however restraining or having a similar ecological niche. Sexual dimorphism could likewise be a practical change for various propensities for the genders 11, 21. Labeo dyocheilus show sexual dimorphism during breeding season likewise comparative report additionally distributed by another researcher who told that effect of physio-chemical factor and sexual dimorphism is the conceptive necessities of the adults 7, 22.
Reproductively mature female fish show external bulging in ventral side only during the breeding season, it was also expected that the body shape of a fish matures especially the shape of the abdomen as reproductive structures develop in the fish body 7. Young males and females showed no colour variation, reproductive mature darker colour, and radish colour in male were reported in our study, this study was mainly supported by various previous literature 6, 13.
Conclusions
In this piece of composing, we are going towards the conclusion of the finding regarding the aim and objectives. Labeo dyocheilus show sexual dimorphism at different levels so this information would be helpful to receive better arrangement for its mono-sex culture by the mature fish identification. Information on a different part of sexual dimorphism was useful to decide the eco-behaviour of the fish all through life history. This examination satisfies the gap concerning writing in the particular zone.
Acknowledgement
The author is thankful to his research scholars for giving their precious time for helping during the writing and formatting of this work.
Conflict of Interest
The author is grateful to the Department of Zoology of LSM Government Post Graduate College Pithoragarh for giving the laboratory, technical and specialized help during the exploration.
Funding Information
The author is grateful to the L.S.R.B. – D.R.D.O. (R & D), New Delhi organization for technical and financial support under the major project, during our research work.
Author’s Contribution
The author confirms sole responsibility for the following; study conception, design, data collection, analysis, interpretation of results, writing, formatting, plagiarism removal and final drafting of manuscript preparation.
Englishhttp://ijcrr.com/abstract.php?article_id=4116http://ijcrr.com/article_html.php?did=4116
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareA Rare Large Odontogenic Keratocyst of the Mandible: Surgical Management and a Long Term Follow Up of 10 Years
English112116Balani MEnglish Ustad FEnglish Bhavikatti SKEnglish Abouzeid HLEnglish Karobari MIEnglishIntroduction: The commonly found developmental cysts are the dentigerous cysts of the maxilla and mandible, which are often related to impacted third molar teeth in the mandible and impacted canines. Bilateral dentigerous cysts are rare and occur typically in association with a developmental syndrome or systemic diseases such as mucopolysaccharidosis and cleidocranial dysplasia. Case Presentation: The following is a report of management of a case of unusual bilateral, non-syndromic dentigerous cysts associated with right mandibular canine and first premolars and left mandibular canine and both premolars. The most unusual aspect of the case was that contrary to the radiologic appearance of a developmental dentigerous cyst and with permanent teeth impacted and deciduous teeth present in the oral cavity, histopathologic examination on the right side revealed an aggressive follicular odontogenic keratocyst which was mimicking a dentigerous cyst. The case had a long term follow up of 10 years. Conclusions: This case report strongly emphasizes the importance of the fact that the final diagnosis of an odontogenic cyst requires proper clinical, radiographic and histopathological coordination as was seen in the above case, failing which a diagnostic dilemma arises.
English Dentigerous, Follicular odontogenic keratocyst, Impacted, Bilateral, Segmental resectionIntroduction
A dentigerous cyst is an epithelial-lined developmental cavity that covers the impacted tooth crown at the cementoenamel junction, the third molar in the mandibular and maxillary canine is most frequently involved. There is usually no pain or discomfort. When cysts are small, they are usually discovered in radiographic examinations that are taken to investigate other symptoms or a failure of tooth eruption, but when cysts enlarge there are asymptomatic facial swellings. The radiographs taken with the impacted tooth show the association of the crown with a radiolucent lesion (unilocular) having a sclerotic margin (well-defined). One common finding at the lesion is radicular resorption. Following the radicular cysts, the most common type of odontogenic cysts, dentigerous cysts are second. Which is approximately 24% of all true cysts in the jaws.1Furthermore, their incidence has been evaluated at 1.44 cysts for every 100 unerupted teeth amongst the general population. 2The treatment of choice will be the removal of the lesion and the involved teeth as the cyst size may keep increasing. 3Histologically, the cyst is lined by non-keratinized stratified squamous epithelium and the connective tissue is usually flat, but it often becomes highly irregular with inflammation, 4 The odontogenic keratocyst is a distinctive type of developmental odontogenic cyst with specific histopathologic features and clinical behaviour. 5
Keratocysts differ from other odontogenic cysts in that they have a biologically aggressive behaviour because of a high-proliferative activity of the lining epithelium, a tendency to expand along with bony cancellous spaces and a considerably high rate of recurrence.6 Keratocyst may impede the eruption of teeth, resulting in dentigerous appearance radiologically. Such lesions are frequently misdiagnosed as dentigerous cysts. Altini and Cohen introduced the term “follicular keratocyst” for this group of lesions.7
Because of the aggressive growth pattern and neoplastic nature of the OKC, it is now designated by the World Health Organisation (WHO) as a keratocystic odontogenic tumour (KCOT) and is defined as “a benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinised stratified squamous epithelium and potential for aggressive infiltrative behaviour”.8
Follicular OKCs are relatively uncommon. They account for 25 to 40% of all the OKCs.9 This paper tries to emphasize the importance of multiplicity of appearance and occurrences wherein a very rare manifestation of the bilateral dentigerous cyst was initially diagnosed and only after histopathological and 3D-CT investigations a surprising diagnosis of follicular odontogenic keratocyst on one side and a dentigerous cyst on the other side was made. Another very rare and interesting finding was the presence of multiple impacted permanent teeth associated with cysts in a patient in the fifth decade of life.
CASE REPORT
A 57-year-old female patient reported a complaint of swelling in the right lower jaw for 6 months. The swelling had gradually increased in size and there was associated pain since the last 2 months. Extra-oral examination revealed that the swelling extended anteriorly to about 1cm from midline in the right lower jaw region and posteriorly to about 2cm from the angle of the mandible, superiorly about 1cm above the corner of the mouth and inferiorly to the base of the mandible (Figure1). Intraoral examination revealed obliteration of the mesiobuccal fold in the right vestibule and swelling extended in the mandible from mesial aspect of right lateral incisor to mesial aspect of the right first molar (Figure 2).
The mandibular right lateral incisor showed gross displacement. Despite the age of the patient, deciduous teeth were present (Teeth number: 72, 73, 75 and 83) (Figure 3). Palpation revealed a hard swelling. Aspiration was done and it yielded thick blood-tinged cream coloured fluid. Panoramic radiograph revealed unilocular radiolucency extending from distal aspect of tooth number 41 to mesial aspect of 46 with expansion and thinning of the lower border and impacted canine and premolar within the radiolucency. Tooth number 42 showed gross displacement and radicular resorption (Figure 4).
Another radiolucency on the other side of the midline was seen extending from the distal aspect of 31 to the mesial aspect of 36 but with no expansion or thinning of the lower border and presence of impacted canine and first and second premolars within the radiolucency. Displacement and radicular resorption of 31was observed(Figure 5).
A provisional diagnosis of bilateral dentigerous cysts associated with multiple impacted permanent teeth was made. Considering previous literature an incisional biopsy before actual surgery was planned for both sides under local anaesthesia and the specimen was sent for histopathology.
Surprisingly the report revealed typical cystic lining of uniform thickness (6-8 cell layer thickness) with corrugated parakeratinized stratified squamous epithelium with palisaded polarized basal cell layer giving a picket fence appearance and suggestive of odontogenic keratocyst on the right side. On the left side, the report revealed cystic lining with 2-3 cell layered thick non-keratinized stratified squamous epithelium. Retepegs were absent and the connective tissue showed inflammatory cell infiltrate suggestive of a dentigerous cyst.
Considering the presence of odontogenic keratocyst mimicking a dentigerous cyst a diagnosis of odontogenic keratocyst was arrived at. Since odontotogenic keratocysts are known to be aggressive and since delineation of the lesion at the midline was to be done to ascertain whether it was one lesion with the difference in histologic lining or two separate lesions a 3D-CT scan was advised.
3D-CT SCAN
It revealed a highly expansile multilocular radiolucent lesion involving the right side of the mandible with expansion and perforation of both buccal and lingual cortical plates. Beyond the midline, the bone was intact with not much expansion or thinning and the two lesions were distinctly separate from each other with no connection at the midline( Figures 5,6,7).
Considering the aggressiveness of the lesion and the chances of recurrence at a later age when the patient may not be able to withstand a major surgical procedure it was decided to go in for segmental resection (Figures 8,9,10) of the lesion on the right side and subsequent enucleation and curettage of the lesion on the left side considering the morbidity associated with the first procedure.
Histopathology report of the resected specimen confirmed the diagnosis of an odontogenic keratocyst with impacted teeth present within the cystic lumen and with cystic lining attached to the necks of the teeth (Figure 11). The patient was followed up for 10 years with no signs of recurrence. (Figure 12).
DISCUSSION:
Follicular odontogenic keratocysts were first described by Browne in the year 1970 as that which occurred when an enlarging OKC involved the follicle of an unerupted tooth and fused with the reduced enamel epithelium. He pointed out that in such cysts the epithelium immediately around the neck of the tooth was not keratinized and showed inflammatory changes in the underlying capsule.10
An odontogenic keratocyst may envelop an adjacent impacted tooth (envelopment keratocyst). Sometimes a true dentigerous cyst lining relationship might be similar when compared with an odontogenic keratocyst. 11
Altini et al termed this follicular primordial cyst (follicular keratocyst) and which may arise after the tooth eruption within the pre-existing keratocyst cavity similarly to that a tooth erupts into the oral cavity. 7,10,12,13
In a study done by Altini and Cohen in the year 1987, they were able to support their hypothesis in a series of experiments done on velvet monkeys, recipient sites were prepared by drilling holes in the alveolar bone and autogenous palatal mucosa was placed in them. In one of the animals killed after 52 weeks, the follicle of an erupting premolar tooth collided with one of the cysts, the lining of which became incorporated into the follicle, partly replacing the follicular reduced enamel epithelium and forming an integral part of this follicle of the erupting tooth.14 Thus, in the above case, on correlating all findings the confirmed diagnosis of a follicular odontogenic keratocyst was made.
CONCLUSION: This case report strongly emphasizes the importance of the fact that the final diagnosis of an odontogenic cyst requires proper clinical, radiographic and histopathological coordination as was seen in the above case, failing which a diagnostic dilemma arises. Very few case reports of follicular odontogenic keratocysts mimicking a dentigerous cyst and with concurrent existence of a dentigerous cyst in the same jaw in a patient in the fifth decade have been reported which makes this case a very rare occurrence.
CONSENT: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
ACKNOWLEDGEMENTS: 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.
CONFLICTS OF INTEREST: Authors declare no conflict of interest with this paper
SOURCE OF FUNDING: None
Englishhttp://ijcrr.com/abstract.php?article_id=4117http://ijcrr.com/article_html.php?did=41171. Daley TD, Pringle GA. The relative incidence of odontogenic tumours and oral and jaw cysts in a Canadian population. Oral Sur Oral Med Oral Patho 1994; 77:276-80.
2. Mourshed F. A roentgenographic study of dentigerous cysts. I. Incidence in a population sample. Oral Surg Oral Med Oral Pathol 1964; 18:47-53.
3. Motamedi MH, Talesh KT. Management of extensive dentigerous cysts. Br Dent J 2005; 198: 203–206.[CrossRef][Medline]
4.Shafer WG, Hine MK, Levy BM. A textbook of oral pathology, 4th ed. Philadelphia: WB Saunders; 1983;260-5
5. Neville, Damm, Allen, Bouquot. Oral and maxillofacial pathology 2nd edition. WB Saunders; 2016;636-8
6. Vered M, Buchner A, Dayan D, Shteif M, Laurian A. Solid variant of odontogenic keratocyst. J Oral Pathol Med. 2004;33(2);125-128.
7. Altini M, Cohen M. The follicular primordial cyst - Odontogenic Keratocyst. Int J Oral Surg. 1982; 11(3): 175-182.
8. Madras J, Lapointe H. Keratocystic odontogenic tumour: Reclassification of the Odontogenic keratocyst from Cyst to Tumour, J Can Dent Assoc. 2008; 74(2): 165a-165h.
9. Kim DK, Ahn SG, Kim J, Yoon JH. Comparative ki-67 expression and apoptosis in odontogenic keratocyst associated with or without an impacted tooth in addition to multilocular and unilocular varieties. Yonsei Med J.2003;44(5):841-846.
10. Browne RM. The pathogenesis of odontogenic cysts: a review. J Oral Pathol 1975 Jul; 4(1):31-46.
11. Hajj G, Anneroth G: Odontogenic keratocysts – a retrospective clinical and histologic study. Int. J.OralMaxillofac. Surg. 1996; 25:124-129.
12. Shear M. Cysts of the oral regions. 3rd ed, Wright, 1992:5-45.
13. Altini M, Cohen M. Experimental extra-follicular histogenesis of follicular cysts. J Oral Pathol.1987;16:49-52.
14. Altini M, Cohen M. Experimental extra-follicular histogenesis of follicular cysts. J Oral Pathol.1987;16:49-52.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareA Survey on Analysis and Classification of Breast Cancer
English117123Nandish SonaliEnglish Prathibha Ramapura JavaregowdaEnglishEnglish Breast Cancer, Digital Image Processing, Scoring System, Natural Language Processing, Pathology, Cytopathology, HistopathologyIntroduction
Cell division is a normal process in the human body where cells grow old or become damaged and die and new cells take their place.. Breast cancer develops from breast tissue when cells in the region grow out of control.1
Diagnosis and prognosis of breast cancer are very important for its effective clinical management and treatment. It is noted that the lack of proper detection of breast cancer has increased the number of cases in India and the World. Breast cancer affects nearly 34% of women between the age of 20 and 100 years worldwide2 and it is expected to cross 1,00,000 patients annually in India.3
Computer-Aided Diagnosis (CAD) is used to enhance the diagnosis and prognosis of breast cancer. Under pathology, breast cancer detection is mainly based on the cell morphology and architecture distribution. Breast cancer can be classified into benign and malignant by considering nuclei detection, nuclei segmentation and the number of nucleoli using Digital Image Processing.4 The standard approach to analysing the image dataset includes analysis of Haematoxylin (H) & Eosin (E) images.5 Natural Language Processing approaches are used for text report segmentation, clinical information retrieval, part-of-speech tagging, named entity recognition and context extraction.6 We can observe that authors Fushman et al.,7 have discussed that Clinical Decision Systems (CDS) have improved practitioner’s performance by 60% in the reviewed cases of breast cancer. Most commonly, the binary classification is made which divides breast cancer into benign and malignant classes. Another approach used for breast cancer diagnosis is the grading system.8,9,10 A review of the classification of breast cancer on different types of datasets using machine learning approaches is given in the next section.
Methodology
An extensive literature review has been made on the analysis of breast cancer considering Histopathology and Cytology data in numeric, image and text form. The data is obtained from standard datasets, cancer registries and real-time data from various hospitals.
Review on Classification of Breast Cancer using Standard Datasets
Classification of Breast Cancer using Histopathological Numerical Data
Authors Delen et al., have made survival analysis of breast cancer on Surveillance, Epidemiology and End Results (SEER) dataset and classified them into survivability and non-survivability of the patient using Artificial Neural Network (ANN), Decision Tree (DT) and Logistic Regression (LR) approaches and obtained accuracy of 91.2%, 93.6% and 89.2% respectively.11 Authors Qin et al., have analyzed the imbalanced SEER dataset and obtained an accuracy of 76.59% and Area Under the Curve (AUC) of 76.78%, respectively.12 Authors Rajesh et al., have used the C4.5 classification algorithm on SEER dataset to classify patients into either the ‘Carcinoma in situ’ group or ‘Malignant potential’ group and obtained an accuracy of 92.2%.13
Rathore et al., have analyzed SEER dataset by using an ensemble classification approach using DT, Naïve Bayes (NB), Multiple Association Rule for predicting the survivability of breast cancer patients and the best accuracy obtained is 71.87%.14 Swetha Karya has analyzed SEER dataset with DT classifier and achieved a classification accuracy of 93.62% with a sensitivity of 96.02% and a specificity of 90.66%.15 The authors Umesh et al., have analyzed SEER dataset using the association rule mining method and obtained a sensitivity of 56.32%, specificity of 91.78% and accuracy of 87.72%.16,17 The authors Yeulkar et al., have used C4.5 and NB classifier on SEER dataset containing breast cancer samples for the period 1975 till 2013 and obtained an accuracy of 98.1% for C4.5 and 95.85% for NB approach.18
Classification of Breast Cancer using Cytological Numerical Dataset
Various researchers have worked on publicly available standard datasets of University of California Irvine Machine Learning Repository like Breast Cancer (BC) Dataset, Wisconsin Breast Cancer (WBC) Dataset, Wisconsin Breast Cancer Diagnostic (WBCD) Dataset, Wisconsin Breast Cancer Prognostic (WBCP) Dataset with 286, 699, 569 and 198 Samples Respectively.19
BC and WBC dataset
Lavanya et al., have used the Classification and Regression Technique (CART) for analysis on BC and WBC datasets and obtained an accuracy of 69.23% and 94.84% respectively.20 Authors Paulin et al., have analyzed the WBC dataset using Feedforward Neural Network (FNN) to obtain the highest diagnostic performance of 99.26 % using 6 neurons.21 The authors Salama et al., have analyzed the WBC dataset and obtained the highest accuracy of 97.5% by using an ensemble classifier containing five classifiers viz., i) J48, ii) MultiLayer Perceptron (MLP), iii) NB, iv) SVM and v) k-NN classifier with Principal Component Analysis (PCA).22 The authors Inan et al., have analyzed the WBC dataset using a hybrid approach including Apriori Algorithm and PCA together with ANN classifier. They have used 10-fold cross-validation and obtained average classification accuracy of 98.29%.23 Authors Tintu et al., have analyzed the WBC dataset using MLP, SVM, NB, Fuzzy C-Means (FCM) for breast cancer diagnosis. The best accuracy was obtained for FCM with a training accuracy of 97.13 % and a testing accuracy of 98.62%.24 Ravikumar et al., have analyzed the WBC dataset and obtained the best results for the SVM classifier with an accuracy of 97.59%, the sensitivity of 98.10% and specificity of 96.60%.25
The authors Grewal et al., have analysed the WBC dataset and obtained a sensitivity of 95% and specificity of 98.8%.26 The authors Kathija et al., have analysed the WBC dataset by using NB and SVM classifier along with 10-fold cross-validation technique. The best accuracy of 95.6% is obtained with the sensitivity of 97% and specificity of 100% using the NB Classifier.27 Chaurasia et al., have proposed prediction of benign and malignant conditions on standard WBC dataset. The authors have used six classifiers viz., i) NB, ii) RBF, iii) J48, iv) SVM, v) K-NN and vi) RBF tree. The highest accuracy obtained is 97.36% for NB.28
WBCD dataset
Lavanya et al., have used CART for analysis on the WBCD dataset and obtained an accuracy of 92.97%.20 The authors Salama et al., analyzed the WBCD dataset and obtained the highest accuracy of 97.7% by using an ensemble classifier containing SVM and MLP classifier.22 Shweta Karya has analyzed the WBCD dataset using a decision tree classifier and obtained the best accuracy of 93.62%.15 Menaka et al., have analyzed WBCD datasets using SVM with RBF and obtained an accuracy of 97.37% respectively.29
The author Leena Vig has applied SVM, NB and Random Forest (RF) classifiers with 100 decision trees on the WBCD dataset and achieved the best accuracy of 95.64% with a sensitivity of 97 % and specificity of 94 %.30 Hazra et al., have analyzed data by considering only 5 features on 32 features from the WBCD dataset using an ensemble of NB and SVM classifiers and obtained an accuracy of 97.4%.31 The author Agarap has proposed a model with MLP that gave the best performance measure with an accuracy of 99.04%.32
WBCP dataset
Authors Tintu et al., have analyzed the WBCP dataset using MLP, SVM, NB, FCM for breast cancer prognosis and obtained 100% True Positive (TP) and 87% True Negative (TN) rates.24 The authors Wolberg et al., have built a neural network model on the WBCP dataset for prognosis prediction. They obtained a probability that 50% of patients would be disease-free when the period considered for breast cancer recurrence was less than or equal to 5 years from the time of occurrence of cancer and 90% of patients would be disease-free when the period considered was greater than 5 years.34 Senturk et al., have made their analysis on these standard datasets using Rapid Miner 5.0 data mining tool with an accuracy of 98.4%.35
The best performance obtained by various approaches on each type of standard dataset is given in Table 1.
Review on Classification of Breast Cancer using Grades or Scoring System
In recent years, the analysis of breast cancer has been expanded from binary to multiclass classification. Hence, the concept of grading or scoring the lesions has been considered.36 The known methods of grading or scoring include Bloom-Richardson Score (BRS), Modified Bloom-Richardson Score (MBRS), Masood Score (MS), Modified Masood Score (MMS) and many others. Under these methods, the characteristics of breast lesions are measured and an interval of value is fixed with a particular grade or score.37, 38
Classification of Breast Cancer on Histopathological Numerical Dataset
The authors Meyer et al., have classified 631 patients from St. Luke’s Hospital, USA using BR Score and have obtained a kappa statistic of 0.38.39 Rekha et al., have proposed an MBR grading system on 50 breast carcinoma cases from a tertiary centre at Mysore, India and have obtained a histopathological correlation of 86%.40
Classification of Breast Cancer using Cytological Numerical Dataset
Authors Mridha et al., have used Masood’s score on 62 breast cancer patients from the All India Institute of Medical Sciences and obtained specificity for FNAC technique for carcinoma between 89% to 98% and sensitivity between 93% to 98%.41 Nandini et al., have proposed an MMS system to classify 100 lesions samples into four categories with an accuracy of 96%.42 Sheeba et al., have made the comparison of both MS and MMS methods on 100 cases collected at Kilpauk Medical College, Chennai, India. The Cyto-histological correlation is 88% and the accuracy of MMS is 84%.43 The authors Cherath et al. have collected a dataset of 207 cases in a tertiary health centre in South India, to analyse the samples using the MS and MMS approaches and obtained an overall accuracy of 97.5%, the sensitivity of 94.5% and specificity of 100%48. It is also validated that MMS is a better scoring system than MS.44-45
Review on Classification of Breast Cancer using Image Dataset
A computer-Aided Diagnosis (CAD) algorithm has been developed for the detection and prediction of diseases and to assist the pathologist for better clinical decision making. Under pathology, histopathological analysis is considered as the golden standard by pathologists.46
Classification of Breast Cancer using Histopathological Image Dataset
The authors Jelen et al., have used a database that consists of 110 FNA Biopsy (FNAB) images from the University of Wroclaw, Poland. There are 44 images with high malignancy and 66 images with intermediate malignancy. They have used the SVM framework to assign a malignancy grade based on pre-extracted features with an accuracy of up to 94.24%.46 The authors Cosatto et al., have used 208 histopathological images from St Luke's Hospital, Chesterfield, USA, to identify the Cancer Nuclei, using the Hough transform and Active Contour Model for segmentation. The authors have used an SVM classifier for morphology and texture-based classification and obtained 92% of True Positive Rate and 72% of Kappa statistical measure.47 Fatakdawala et al., have considered H&E stained breast biopsy cores at The Cancer Institute of New Jersey. For a total of 62 HER2+ breast biopsy images, the Expectation-Maximisation based segmentation with Geodesic Active Contour with Overlap Resolution (EMaGACOR) was found to have a detection sensitivity of over 90% and a positive predictive value of over 78%.48
The authors Basavanhally et al., have used a total of 41 H&E stained breast biopsy samples from 12 patients at The Cancer Institute of New Jersey, USA. to successfully distinguish the samples of high and low lymphocytic infiltration levels with classification accuracy greater than 90% using SVM Classifier.49
The authors' Beck et al., have developed a Computational Pathologist (C-Path) system to measure a rich quantitative feature set from the breast cancer epithelium and stroma which has 6642 features, from two independent cohorts of breast cancer patients namely the Netherlands Cancer Institute (NCI) cohort, with 248 samples and the Vancouver General Hospital (VGH) cohort, with 328 samples where both cohorts had the value of Probability P ≤ 0.001.50
Wang et al., have done colour recognition by applying a fuzzy inference system and combining RGB and CIE LAB colour space. The approach is used on a standard ICPR12 dataset with the combination of Hand Crafted (HC) features and features derived from Convolutional Neural Networks (CNN). The data has been analyzed using a combination of HC and CNN and obtained an F-Measure of 73.45% .51 Spanhol et al., have classified breast cancer images of Breakhis dataset by using deep features also called DeCAF. DeCAF features are neither HC nor fully automated in nature. They have obtained a classification accuracy of 90%.52 The authors Beevi et al. have proposed a Krill Herd Algorithm to differentiate mitotic and non-mitotic groups. They have obtained a Precision of 62.50% and a Recall of 93.75%.53 Jiang et al., have developed Breast cancer Histopathology image Classification Network (BHCNet) for binary classification of images using Breakhis dataset and obtained performance between 98.87% and 99.34%.54 The authors Dabeer et al., have analyzed 7909 images stained by H&E and paraffin on Breakhis dataset and classified using CNN and obtained an accuracy of 99.86%.55
Review on Classification of Breast Cancer containing Text Data
Electronic Health Records are most commonly available in the form of text data. Text data contains a lot of valuable clinical information to ascertain the exact cause and status of any disease. For diagnosis and prognosis of breast lesions, clinical data in the form of text can be extracted to obtain conclusions about the exact condition of breast cancer using machine learning approaches.56, 57
Classification of Breast Cancer using Histopathological Text Data
The authors Carell et al.,58 have designed an abstraction search for breast cancer recurrence using clinical notes of 1472 patients obtained from Group Health Research Institute, Seattle, USA to identify the recurrence of breast cancer. The clinical Text Analysis and Knowledge Extraction System (cTAKES) method is used for analysis and achieved 93% of sensitivity and 95% of specificity.
Rani et al.,59,60 have used 150 de-identified reports from the Christian Medical College, Vellore, India and proposed a pTNM classifier where T denotes Tumour, N denotes Lymph Node and M denotes Metastases and obtained performance measures for cancer stage was 61.48% for logistic regression and decision tree and 100 % for RF.
NLP-based clinical analysis is carried out by Buckley et al, on breast pathology reports obtained at the Massachusetts General Hospital, USA and obtained had a sensitivity of 99.1% and specificity of 96.53%.61 Authors Zeng et al., have considered a dataset from North Western University Feinberg School of Medicine to retrieve data for pTNM classification and the measurement is made by measuring feature co-efficient. The authors obtained partial sentences from Meta Map with a feature coefficient of 0.66 for recurrent breast cancer and 0.46 for non-infiltrating intra-ductal carcinoma.62
The authors' Ling et al., have used records from Stanford Health Care, USA using regularized logistic regression model for recurrent Metastatic Breast Cancer (MBC) classification on 146 patients. The MBC classifier achieved an AUC of 91.7%.63
Xie et al., have used an end to end NLP technology to process pathology reports. A total of 249 breast cancer cases from the Cancer Registry (CANREG) were considered. The authors have interpreted 437 breast cancer concept terms and 14 combinations of cancer terms to identify terms related to breast cancer and obtained an accuracy of 96%.64
Further, the authors Banerjee et al., have used many NLP modules namely Report Segmentation, Sentence Splitter, Named Entity Tagging and Sentence Selection on the Onco SHARE database. They obtained a sensitivity of 83% and a specificity of 73%.65 In the paper by author Minerd, all the NLP approaches including Rule-based and ML-based approaches for breast cancer on text report analysis has been elaborately reviewed.66
Results
In literature, it is observed that the breast cancer dataset has been analyzed by researchers using various machine learning approaches on standard datasets and obtained the best accuracy of 99.26%. For image data, the best accuracy of 99.86% is obtained by using CNN on 7909 Histopathology images that are collected from Breakhis dataset. Considering the grade or scoring system, the best accuracy of 97.5% is obtained by MMS on 207 samples collected from a tertiary centre in South India. The best accuracy of 96% is obtained by using TIES on 249 reports that are taken from the cancer registry database.
Discussion
From the literature review, it is observed that breast cancer is manifested by abnormal growth of tumours in various parts of the breast. Some of the common areas of tumour growth observed under histopathology include the nipple, areola, lymphocytes, nodes, etc. Under cytology, it is observed by morphological changes in cell, nucleus and nucleoli.
Conclusion
Most of the existing classifiers are binary classifiers to classify breast cancer data into a benign and malignant classes. However, it is necessary to design multiclass classifiers on breast cancer datasets for precise clinical decision support to provide targeted therapy for cancerous patients.
Source of Funding: We hereby declare that there is no funding involved in our work.
Conflict of Interest: Nil
Acknowledgement
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
The author Nandish Sonali has contributed by reviewing the papers related to the topic and submitted the inference. The author Prathibha Ramapura Javaregowda has contributed by editing the content of the paper.
Englishhttp://ijcrr.com/abstract.php?article_id=4118http://ijcrr.com/article_html.php?did=4118
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Buckley JM, Coopey SB, Sharko J, Polubriaginof F, Drohan B, Belli AK, et al. The feasibility of using natural language processing to extract clinical information from breast pathology reports. J Pathol. Inform. 2012; 3(1)1-8.
Ling AY, Kurain AW, Caswell-Jin JL, Sledge Jr GW, Shah NH, Tamang SR, et al. Using Natural Language Processing to Construct a Metastatic Breast Cancer Cohort from Linked Cancer Registry and Electronic Medical Records Data. J Am Med Ass. 2019 Dec;2(4):528-37.
Zeng Z, Espino S, Roy A, Li X, Khan SA, Clare SE, et.al. Using natural language processing and machine learning to identify breast cancer local recurrence. BMC Bioinform. 2018 Dec; 19(17):65-74.
Xie F, Lee J, Munoz-Plaza CE, Hahn EE, Chen W. Application of Text Information Extraction System For Real-Time Cancer Case Identification In An Integrated Healthcare Organization. J Pathol Infor. 2017 Jan; 8(48); 1-15.
Banerjee I, Bozkurt S, Caswell-Jin JL, Kurain AW, Rubin DL. Natural Language Processing Approaches to Detect the Timeline Of Metastatic Recurrence Of Breast Cancer. JCO Clin. Cancer Inform. 2019 Oct; 3:1-2.
Minerd J. A Novel Strategy for Mining Medical Records. Recent Res.2020.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareEfficacy of Proprioceptive Neuromuscular Facilitation on Posture in Parkinson’s Disease: A Randomized Controlled Trial
English124128Punia SEnglish Malik MEnglish Singh VEnglish Bodwal KEnglish Kaur JEnglishEnglishIntroduction
Parkinson’s disease was described by James Parkinson in 1817. ‘An essay on shaking palsy. In 1912, firstly it was recognized as an extrapyramidal disorder by Kinner Wilson.1 It is a chronic, progressive degenerative disorder of the nervous system characterized by cardinal features of rigidity, akinesia, bradykinesia, tumour, postural stability and muscle weakness.2 About 10 million people are affected worldwide.3 Parkinson’s disease affected about 3% of the population. It is characterized by the loss of dopaminergic function and consequently diminished motor function, leading to the clinical presentation of the disease.4 Nigrostriatal dopaminergic pathway degeneration leads to primary motor symptoms of Parkinson’s.disease that includes inflexibility, bradykinesia, resting tremor & gait disturbances.5 Motor symptoms include disturbances in the posture of gait & posture is responsible for functional disability in individuals with Parkinson’s disease.3
Forward head posture (FHP) is the increase in the extension of the cervical spine in the upper region with an increase in flexion of the cervical spine in the lower region and upper thoracic spine, the position of the head is around the sagittal plane shows forward deviation through gravity line. Assessment of FHP is done in mainly two positions: a sitting position and a standing position. In each position, a picture of each subject was taken from the lateral view and the craniovertebral angle (CVA) is calculated which is a reliable and valid indicator for FHP.6,7
The Researcher illustrated proprioceptive neuromuscular facilitation (PNF) exercise pattern consists of a diagonal movement that places greater prominence on functional training. Past studies evidence suggest that optimization of PNF as an exercise training protocol, especially in the elderly can improve proprioception, muscle strength, physical-functional, coordination, mobility, balance & gait of patients.8,9 Previous research finding evaluated the effect of stretching &strengthening exercise to improve FHP but the PNF & resisted exercise can also beneficial to increase range of motion & FHP in Parkinson’s patients.3 several theories show the significant result of either resistance training or PNF training to improve stability (balance) and correct FHP in Parkinson’s condition8,9,10. Therefore, we hypothesized to differentiate between the effect of resistance training and PNF to improve FHP in participants with Parkinson’s disease. So this randomized controlled trial was designed for assessing the effect of PNF techniques & strengthening exercise in forwarding head posture in patients suffering from Parkinson’s disease.
Material and Methods
The present study was a randomized control trial, with the flow diagram shown in Figure 1. The proposed study was done after moral endorsement from the Institutional Ethics Committee of the Department of Physiotherapy, Guru Jambheshwar University of Science & Technology, Hisar via letter-number PTY/2019/1014. This trial is also registered under the clinical trial registry of India (CTRI/2019/12/022415). Each participant of the study gave informed consent after an explanation of the procedure in their local language and we followed Helinski's 2000 declaration. All subjects had given verbal information about the purpose, risk & benefits of the study.
Study participants: 40 subjects fulfilled the eligibility criteria for the study. The Patient suffering from Parkinson's disease with forwarding head posture and CVA less than 500 should be included in the study. Patients with any metabolic disorders, heart disease, congenital anomaly of the cervical spine, and un-cooperative behaviour were excluded. Subjects were randomized and allocated into 2 groups: the experimental group (N=20) and the control group (N=20). The selection of the flow of participants was summarized in figure 1.
The outcome variable was non-significant at the start of the intervention. Post interventions reading of outcome variables after intervention were compared between the two groups using an independent t-test. The outcome measure shows significant improvement in the outcome variable.When we compared means (pre-post) of both groups, CVA increased significantly after 2 weeks (MD= 2.63; 95% CI -2.16 to -1.13; t38= -6.50; pEnglishhttp://ijcrr.com/abstract.php?article_id=4119http://ijcrr.com/article_html.php?did=41191. Lindsay KW, Bone I, Fuller G, Callander R. Neurology and neurosurgery illustrated. Edinburgh: Churchill Livingstone; 2010.
2. Borrione P, Tranchita E, Sansone P, Parisi A. Effects of physical activity in Parkinson's disease: A new tool for rehabilitation. World J Methodol. 2014 Sep 26;4(3):133-43.
3. Ball N, Teo WP, Chandra S, Chapman J. Parkinson's disease and the environment. Front Neurol 2019 Mar 19;10:218.
4. DeMaagd G, Philip A. Parkinson’s disease and its management: part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. Pharm Therap. 2015 Aug;40(8):504.
5. Borghammer P, Van Den Berge N. Brain-first versus gut-first Parkinson’s disease: a hypothesis. J Parkinsons Dis. 2019 Jan 1;9(s2): S281-95.
6. Ahmadi A, Maroufi N, Sarrafzadeh J. Evaluation of forwarding head posture in sitting and standing positions. Eur Spine J. 2016 Nov;25(11):3577-82.
7. Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, et al. Assessment of forwarding head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014 Jan 1;27(2):131-9.
8. Gholop A, Chitra J. A comparative study on the effectiveness of resistance training and PNF to improve balance in Parkinson’s patients - A randomized clinical trial. Int J Sci Res. 2014;3(7):1535-1539.
9. Carvalho EL, Queiroz IP, Queiroz IP, Batista IM, Maciel TD, Arêas FZ. Effects of proprioceptive neuromuscular facilitation on the functional independence measure in patients with Parkinson’s disease. Ther Posturology Rehabil J .2015 Nov 18;13.
10. Shah P. Effectiveness of PNF along with stair gait training on dynamic balance assessed by functional reach test in patients with idiopathic Parkinson’s Disease. Int J Yoga, Physioth Phys Edu. 2018;3(5):4-6.
11. Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculosk Disor. 2017 Dec;18(1):1-10.
12. Suvarnnato T, Puntumetakul R, Uthaikhup S, Boucaut R. Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial. J Pain Res. 2019;12:915.
13. David FJ, Rafferty MR, Robichaud JA, Prodoehl J, Kohrt WM, Vaillancourt DE, et al. Progressive resistance exercise and Parkinson's disease: a review of potential mechanisms. Parkinsons Dis. 2012 Jan 1;2012.
14. Kisner C. Therapeutic exercise foundation and technique. New York: Churchill Livingstone; 2002.
15. Yoshii F, Moriya Y, Ohnuki T, Ryo M, Takahashi W. Postural deformities in Parkinson's disease -Mutual relationships among neck flexion, fore-bent, knee-bent and lateral-bent angles and correlations with clinical predictors. J Clin Mov Disord. 2016;3:1.
16. Candace WY, Kennis CK, Evelyn KY, Jeffrey TH, Margaret LY, Hwang SS, et al. Effect of a 4-week Theraband exercise with PNF pattern on improving mobility, balance and fear of fall in community-dwelling elderly. J Korean Soc Phys Med. 2017 Nov 30;12(4):73-82.
17. Abdollahzade Z, Shadmehr A, Malmir K, Ghotbi N. Effects of 4 weeks postural corrective exercise on correcting forward head posture. J Mod Rehab. 2017 Apr 1:85-92.
18. Al Dajah SB. Soft Tissue Mobilization and PNF Improve Range of Motion and Minimize Pain Level in Shoulder Impingement. J Phys Ther Sci. 2014;26(11):1803-1805.
19. Bandekar M, Rao K. Effectiveness of Kinesiological taping and PNF stretching in students with forwarding shoulder posture. Int J Multidisc Res Develop. 2019;6(2):106-109.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareFluorescence in-situ Hybridization: Technology to Detect Genetic Mutation
English129136Dave KrutiEnglish Prajapati MitaliEnglish Pathak DeepikaEnglish Alisagar LuluaaEnglish Suthar KrutishEnglishEnglishGenetic mutations, Fluorescence In Situ Hybridization, Probes, MFISH, RNA FISH, Q FISHINTRODUCTION:
Human cells are estimated to contain approximately 10 double-strand breaks per cell cycle as estimated by the incidence of spontaneous sister chromatid exchanges by the DNA replication process which is remarkably accurate. If it is left unrepaired, such damage results in the loss of chromosomes and/or the induction of cell death. If imprecisely repaired, the damage leads to mutations and chromosomal rearrangements.1
During the cell cycle, DNA double-strand breaks are readily mediated to alter the superhelical state in DNA by ubiquitous enzymes also known as topoisomerases. For this enzyme temporary cleavage is essential to carry out their primary cellular functions including their roles in DNA replication, transcription, segregation, the maintenance of genome stability and chromosome condensation. However, these enzymes can promote chromosomal aberrations by illegitimate recombination. Through disincorporation during DNA replication or exposure to exogenous mutagens such as ionizing radiation or endogenous mutagens, mutations can occur in the genomes of all dividing cells. The diversity of mutations(aberration) that can initiate human cancer. Intrageneric mutations highlighted are small nucleotide changes that may be inherited by the cancer progeny from the progenitor cell, resulting in either a loss-of-function of genes or a gain-of-function of genes.
Mutated genes are identified in cancer called oncogenesis. Cancers are caused by various types of mutations shown in fig.1.2
karyotyping is considered as the gold standard method which is used to confirm the presence or absence of mutations but has some considerable limitations such as low resolution of the cell-treated field, time-consuming and laborious cell cultivation, and in the detection of chromosome abnormalities which are less than 5 mb in length.FISH became a powerful technique that has high sensitivity and specificity as well as with the performance speed it has considered as a clinical laboratory tool.3
The objective of fluorescence In- situ hybridization is to determine the presence or absence of DNA or RNA sequences of interest and to localize these sequences to specific cells or chromosomal sites as well as small deletions and duplications. It offers the possibility to specifically mark individual chromosomes over their entire length or defined chromosome regions in meta- and interphase preparations.‘Chromosome painting competitive hybridization was one of the first applications of FISH using entire chromosome-specific libraries for chromosomes as probes and human genomic DNA as the competitor.4
MECHANISM OF FISH:
The main steps of FISH are the binding of fluorescently labelled target-specific nucleic acid probes to their complementary DNA or RNA sequences. Also the visualization of these probes within cells in the tissue of interest. The steps of FISH are as below.5
PREPARATION OF PROBE AND TARGET SEQUENCE:
Probe and a target Sequence are the basic elements of any FISH technique. The first step is to make short sequences of single-stranded DNA that should match a portion of the gene that is of interest. These are called probes. After cooling of strands, they will anneal with complementary nucleotides making bonds back together with their homologous partners. The higher the number of nucleotides in a probe, it will mostly attach with its homologous target sequences. The choice of the probe is the important thing that must take account in the FISH analysis. There is a wide range of probes available, from whole genomes to small cloned probes (1–10 kb).6 (Table:1)
Now, these probes are usually directly or indirectly labelled. 1. Directlylabelled: Fluorochromes are directly attached to probes.2. Indirectly Labelled: Here a hapten (such as biotin or digoxigenin) is used for attachment. In indirect labelling, for detection fluorescently labelled antibodies (such as streptavidin and anti-digoxigenin) are used. Direct labelling is faster than indirect labelling. But in indirect labelling, there is the advantage of signal amplification by using several layers of antibodies and because it is produced by indirect labelling brighter compared with background levels.
FIXATION OF TARGET SAMPLE:
The fixation methods are formalin-based, paraffin-based or freshly prepared frozen tissue. For adherence of tissue sections, a specially treated glass slide is used to ignore the loss of tissue during the hybridization process. For this purpose, various “adhesives'' are available like poly-l-lysine, gelatin chrome alum and aminopropyl-triethoxysilane. For fixation of metaphase chromosome spreads methanol/acetic acid is used. For sections like cryostat 4% formaldehyde (~30 min), Bouin’s fixative, or paraformaldehyde vapour fixation may be used. Most often, tissue specimens are regularly fixed in 10% buffered formalin, procedures overnight in an automatic tissue processor, and embedded in paraffin wax. The optimal fixation time is 8-12 hours. Sections are voided well and then air-dried at room temperature. After de-paraffinization, slides are put down in an alcohol-cleaned staining container of diethylpyrocarbonate water. The staining container is then put down in the heated water bath at 23-37°C. The formaldehyde-based fixatives are used before paraffin embedding to cover up nucleic acid sequences. Digestion enhances probe penetration by expanding cell permeability with minimal tissue degradation.
DENATURATION OF PROBE AND TARGET SEQUENCE:
Both the labelled probe and the target DNA are denatured. The annealing of complementary DNA sequences occurring because of the combining sequences of the denatured probe and target DNA. In indirect labelling, one extra step is required for visualization of the non-fluorescent hapten that requires an enzymatic or immunological detection system. Although, the FISH probes are selected according to the diseases or anomalies under the field of interest. Before hybridization, if both the target and the probe are double-stranded, they must be denatured to make them single-stranded and this can be attained by heat or alkali treatment.7
HYBRIDIZATION:
In the molecular hybridization process, a single-stranded target sequence is annealed to a complementary single-stranded probe to make a double-stranded hybrid. In the denaturation process,
Single-stranded target and probe sequences are incubated in a hybridization mixture, which supplies an optimal environment for re-annealing of single-stranded sequences. Hybridization is done after denaturation. During cooling, a complementary probe and target sequence forms hydrogen bonding of the two strands of nucleic acids. The probe must make stable hydrogen bonds with the target. At the same time heating the probe and target to high temperatures may increase the stability and sensitivity of detection. For this, care must be taken to fully control this step of the FISH procedure.
DETECTION:
For the detection of hybridized probes, enzymatic reactions that generate a coloured precipitate at the site of hybridization is used. The most often used enzymes for this application are alkaline phosphatase (AP) or horseradish peroxidase (HRP). The radioactively labelled probes are detected by autoradiography. This detection procedure is based on the emission of fast electrons or beta-particles from the probe. Autoradiography for radioactive labels is reported to be more sensitive than the immune enzyme systems. After hybridization, fluorophores can be connected with nucleic acid probes by chemical conjugation to the nucleic acid or chemical conjugation of the nucleic acid with a non-fluorescent molecule that can attach fluorescent material. There are four common fluorophore classes-fluoresceins, rhodamines, cyanines, or coumarins used. For the detection of tumour morphology, conventional light microscopy and fluorescence microscope is also used. For the hapten detection immunohistochemically by a fluorophore-tagged antibody against the hapten is used.8
TYPES:
The diversification of real FISH protocol forms different types of FISH. Here the Table.3 represents the types of FISH, mostly used probes by these types and their functions.
Among all these types, some types have major importance in the scientific field. These types are M FISH, Q FISH and RNA FISH.
MFISH (Multicolour FISH)
By using different colours, FISH contains the ability to find several regions or genes simultaneously. Multicolour FISH, which can locate many different probes on chromosomes simultaneously, is an important branch of FISH techniques. Using M-FISH to construct FISH karyotype has been applied in many plant species, for example, Lotus japonicus, Pinus sp., Picea abies and Silenelatifolia. Ribosomal RNA genes (rDNAs) belong to a highly conservative repeat sequence family with hundreds of copies and locate on one or more pairs of chromosomes. FISH mapping of rDNA on chromosomes can provide important clues for molecular markers of karyotype analysis, the evolution of karyotype and phylogenetics research.10
The power of M-FISH (and SKY) lies in its ability to resolve complex karyotypes and identify the origin of marker chromosomes as evidenced by its many applications in tumour diagnostics and research, evolutionary cytogenetics and the study of chemical and radiation-induced aberrations. Impressively, even quite complex karyotypes of individual cells within a nonclonal population can be resolved with a high degree of confidence. One should give more attention before choosing probes in FISH analysis. The pe of the chromosome. This type of probes are flow-sorted (or microdissected), amplified and labelled by an oligonucleotide polymerase chain reaction to generate a ‘paint’ that highlights the entire chromosome.11
QFISH (Quantitative FISH)
Telomeres are nucleoprotein like structures, which cap and protect linear chromosome ends. They comprise ~1500 TTAGGG repeats, a single strand overhang and a complex of six shelters in proteins. Telomeres prevent chromosomes from degradation and fusions by preventing the ends from being falsely recognized as DNA double-stranded breaks. However, the intrinsic inability of the replicative machinery to complete replication of linear DNA leads to progressive telomere reduction upon cell division which imposes a limit on the number of times a cell can divide. 90% of cancer cells survive this crisis due to upregulating telomerase, the enzyme that lengthens telomeres. Still, in stem and progenitor cells, telomerase activity is crucial for tissue maintenance and regeneration.12
Telomeres may represent a powerful readout of oxidative stress, a potential biomarker of exposures and disease risk. Three common techniques are widely used by laboratories to measure telomere length. The telomere restriction fragment (TRF) analyzed by the southern blot is considered the gold standard. Although this technique only yields average telomere length, generally requires one to three micrograms of genomic DNA. The quantitative Polymerase chain reaction is another common method that requires very low amounts of DNA but yields a ratio of telomeric DNA content relative to a single-copy gene. Telomere length analyzed by quantitative fluorescence in situ hybridization (qFISH) on metaphase chromosomes provides the ability to examine the length and integrity of individual telomeres. Q-FISH allows for the evaluation of the telomere length heterogeneity within the cell population and distinguishing of critically short telomeres. Moreover, qFISH also offers the ability to assess telomeric aberrations like telomere fragility, losses and fusions, associated with any illness, hence allowing the recording of multiple telomere parameters in a single experiment.13
Q-FISH uses peptide nucleic acid (PNA) probes; they are synthetic molecules formed by DNA bases linked, to a backbone by peptide bonds. Telomeric PNA probes can be Supportive to the G-rich or to the C-rich telomeric DNA strand which provides the possibility for simultaneous application and two-colour, staining required for chromatid orientated FISH.14 In this context, Q-FISH is specifically relevant because it can identify and quantify critically short telomeres.
RNA FISH
RNA molecules have an extensive range of characters in the cell. RNAs control all features of cell metabolism and thus be important regulators of physiologic and disease activity. Genome is crowded with a huge amount of long noncoding RNAs (lncRNAs) that have been correlated with a large number of cellular activities like differentiation and the beginning of the disease. RNA fluorescence in situ hybridization (RNA FISH) is a technique that provides a convenient supplement to label RNA molecules in the cell by labelled nucleic acid probes hybridization with target RNA for the detection of RNA.
Transcripts are present either in the nucleus or in the cytoplasm. The method also called expression-FISH, has been used to examine the transcriptional action taken by endogenous genes, exogenous genes like those belonging to integrated viral genomes and transgenes. RNA-FISH has also been used in studying different functional aspects of genome organization and nuclear architecture, also as a prenatal diagnosis tool for myotonic dystrophy type.
Single-particle RNA FISH depends on pools of short, marked DNA oligonucleotides that can identify singular atoms of RNA in situ, by managing its affectability to distinguish even low abundance lncRNA. In addition, it is enabling quanti?cation of the number and area of each target molecule inside the cell. Specialists have utilized single-atom RNA FISH to recognize lncRNA with progress and in two cases, it has demonstrated basic to unravelling the system of activity. In an ongoing methodical investigation of the use of single-particle RNA FISH to lncRNA, researchers found that lncRNAs can introduce special difficulties regarding recognizing nonspeci?c background from valid signals.15
APPLICATIONS:
There are diverse applications on FISH based which are from different fields of investigation, including clinical genetics, evolutionary biology, neuroscience, cellular genomics, toxicology, microbial ecology, reproductive medicine, comparative genomics, and chromosome biology. FISH consumes less time than other techniques so makes easy diagnosis and also increases the life span of people.
CONCLUSION:
Fish has been developed to the next level and is a powerful technique for detecting mutation and alternation in gene expression at the microscopic level. Moreover, the application of Fish lies in the diagnostic and research. The use of fish is a game-changing method for the diagnosis of diseases like cancer as where chromosomal abnormality detection became very crucial for further treatment and monitoring of disease. Novel FISH techniques and types like M FISH, Q FISH, and RNA FISH are introduced with their wide range of applications that have been discussed in genetic research. The single-molecule FISH technique in cell-based genetic diagnosis is expected to enhance the capacity of the spectrum of genetic defaults from chromosomal and genetic abnormalities. Also, this technique helps to develop biomarker research and personalized medicine.
Acknowledgement: Nil
Conflict of interest: Nil
Funding: Nil
Individual author’s contribution:-
Dave Kruti: Overall review and compilation
Prajapati Mitali: Methods and M-FISH
Pathak Deepika:Q-FISH
Alisagar Luluaa: R-FISH
Suthar Krutish: Application
Englishhttp://ijcrr.com/abstract.php?article_id=4120http://ijcrr.com/article_html.php?did=4120
Pfeiffer P, Goedecke W, Obe G. Mechanisms of DNA double-strand break repair and their potential to induce chromosomal aberrations. Mutagenesis. 2000 Jul 1;15(4):289-302.
Greenman C, Stephens P, Smith R, Dalgliesh GL, Hunter C, Bignell G, et al. Patterns of somatic mutation in human cancer genomes. Nature. 2007 Mar;446(7132):153-8.
Hurd D. Delving deep into the genetic basis of disease. American Biotech Lab. 2010;28(3):22.
Gozzetti A, Le Beau MM. Fluorescence in situ hybridization: uses and limitations. In Seminars in Hematology. 2000; 37(4): 320-333). WB Saunders.
Elbassiouni FE, Salim EI, Zineldeen DH. The Effect of the Combination of Cetuximab (Erbitux®) and Sodium Butyrate on Mucous Secreting Cells during Rat Colon Carcinogenesis. Am J Biotech Lab. 2018 Jul 23;6(2):18.
Liehr T, Pellestor F. Molecular cytogenetics: the standard FISH and PRINS procedure. InFluorescence In Situ Hybridization (FISH)—Application Guide 2009:23-34. Springer.
Rittié L, Perbal B. Enzymes used in molecular biology: a useful guide. J Clin Sci. 2008 Jun 1;2(1-2):25-45.
Tenover FC. Diagnostic deoxyribonucleic acid probes for infectious diseases. Clin Microb Rev. 1988 Jan 1;1(1):82-101.
Karhu R, Ahlstedt-Soini M, Bittner M, Meltzer P, Trent JM, Isola JJ. Chromosome arm?specific multicolour FISH. Genes, Chrom Canc. 2001 Jan;30(1):105-9.
Ratan ZA, Zaman SB, Mehta V, Haidere MF, Runa NJ, Akter N. Application of fluorescence in situ hybridization (FISH) technique for the detection of genetic aberration in medical science. Cureus. 2017 Jun;9(6).
Berrieman HK, Ashman JN, Cowen ME, Greenman J, Lind MJ, Cawkwell L. Chromosomal analysis of non-small-cell lung cancer by multicolour fluorescent in situ hybridisation. Br. J. Cancer. 2004 Feb;90(4):900-5.
Kaul Z, Cesare AJ, Huschtscha LI, Neumann AA, Reddel RR. Five dysfunctional telomeres predict the onset of senescence in human cells. EMBO Rep. 2012 Jan;13(1):52-9.
Maciejowski J, de Lange T. Telomeres in cancer: tumour suppression and genome instability. Nature reviews Molecular cell biology. EMBO Rep. 2017 Mar;18(3):175-86.
Rai R, Multani AS, Chang S. Cytogenetic analysis of telomere dysfunction. InTelomeres and Telomerase 2017 (pp. 127-131). Humana Press, New York, NY.
He L, Hannon GJ. MicroRNAs: small RNAs with a big role in gene regulation. Nature Rev Gen. 2004 Jul;5(7):522-31.
Narimatsu R, Patterson BK. High-throughput cervical cancer screening using intracellular human papillomavirus E6 and E7 mRNA quantification by flow cytometry. Am J Clin Path. 2005 May 1;123(5):716-23.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26HealthcareRelationship between Intermolar Width and Tooth-Bone Discrepancy in Children: A Cross-Sectional Study
English137143Ramos-Montiel RonaldEnglish Puebla-Ramos LorenzoEnglish Ribadeneira-Morales LesleeEnglish Guerra-Mendoza YolandaEnglish Sàenz-López NicolEnglishIntroduction: The tooth-bone discrepancy or dental crowding occurs in the early, mixed and permanent stage of the dentition and is considered a frequent characteristic in malocclusion. This condition generates other structural and functional alterations in the stomatognathic system that directly influence the shape and size of the dental arch. Objective: This research aimed to determine the relationship between the intermolar width and the tooth-bone discrepancy of the upper arch in children. Material and Methods: A convenience sample was constituted, made up of 57 plaster study models of children aged 6 to 10 years, who attended the orthodontic clinic of the Catholic University of Cuenca, from Cuenca, during the period from March to August 2018. The type of study was analytical, correlational, cross-sectional and retrospective, the collected data were analyzed by correlation coefficient and Pearson’s R2. Results: The correlation coefficient of the variables was -0.046128083 and R² = 0.0021, showing that there was a null correlation between the intermolar width and the tooth-bone discrepancy of the upper arch. However, Pearson’s R2 value expressed a maximum linear precision of 3% between the study variables. Conclusion: It is concluded that there is a null statistical relationship between the intermolar width and the bone-tooth discrepancy of the upper arch of the studied sample. A certain degree of continuity of the intermolar width was evidenced in values of 39-40 millimetres.
EnglishDental arch, Dentition mixed, Intermolar width, Malocclusion, Stomatognathic System, Tooth crowdinghttp://ijcrr.com/abstract.php?article_id=4121http://ijcrr.com/article_html.php?did=4121Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021November26HealthcareNutritional Status Based on Anthropometry of Tribal Children aged 3-11 Years of Paschimanchal Area in West Bengal, India
English144150Ujjwal MollahEnglish Samiran BisaiEnglish Dilip Kumar NandiEnglishIntroduction: Nutritional status of tribal population of India is not agreeable. Therefore, present study was embraced to survey
the nutritional status among tribal children aged 3-11years of Paschimanchal area in West Bengal, India.
Methods: Present cross-sectional study was undertaken in two tribal concentrated blocks of Bankura and Purulia district during
May, 2018 – October, 2019. An aggregate of 637 (301 girls and 336 boys) children aged 3-11 years were contemplated. Weight,
height, MUAC measurements were measured and recorded by standard techniques. Body mass index (BMI) was computed by
standard equation. Children were considered as underweight, thin, and stunting of their weight-for-age, BMI-for-age, and height-
for-age Z-scores EnglishUnder nutrition, Thinness, Tribe, children, Paschimanchal, West BengalIntroduction:
Undernutrition is a stern public health problem in developing country including India. An earlier report assessed that around 165 million children worldwide were stunted, 101 million underweight, and 52 million children were wasted and assessed that approximately 70.0% of the world's undernourished children live in Asia, giving that the region with highest concentration of childhood undernutrition worldwide. 1 In the same way, a large-scale survey in India reported that 58.8% and 42.3% of preschool children were found to be stunted and underweight2. Particularly in agricultural nations like India; women, newborns, and children are more affected with malnutrition3,4,5, in light of their high nutritional requirements for physical growth and development. This may be a reason for half of all child deaths before they reach age of 5 year due to malnutrition or malnutrition persuades infections.6
India is home to around 705 tribal groups and subgroups including 75 particularly vulnerable tribal groups (PVTGs). They comprise approximately 8.6% of the total population in India.7 About 5.8% of the total population of West Bengal is indigenous and the greater part of them live in the forests region of the ‘Chhotanagpur’ plateau which we have known as 'Jungle Mahal'.8 The Paschimanchal region comprises of a huge piece of Paschim Medinipur, Jhargram, Bankura, Purulia, and a small part of Paschim Burdwan and Birbhum districts. The major tribal communities of the Paschimanchal area are Santal, Oraon, Munda, Bhunij, Kora, Lodha, Mahali, Savar and Birhar, etc. Among them, Lodha and Birhor are notified as Particularly Vulnerable Tribal Groups(PVTG). Besides this enormous number of tribal people reside in rural areas; a large portion of them were illiterate and very low-wage unskilled laborers. The tribal populations of this region are perceived as socially and financiallyinsecure.5, 9, 10Their ways of life and food propensities are not the same as those of their neighbors.11Living strategies is unique and fully dependent on settled cultivation, forest product collection, hunting, fishing, along with a small sector of Government service and business. When all is said in done, tribal populations are viewed as oppressed in India.4,12
For the most part, the tribal people are found in rural and inaccessible areas of the country and various minimum facilities are not accessed by them due to remoteness. Prior studies detailed very high rates of child malnutrition in this region.5,.10,13Therefore, the current investigation was attempted to assessed sex variations of anthropometry and nutritional status in the form of underweight, thinness, and stunting among tribal children aged 3-11years of the Paschimanchal area of West Bengal, India.
Methodology:
Study area and people:
This cross-sectional investigation was led from May 2018 to October 2019in Ranibandh block of Bankura and Bandwan block of Purulia district, West Bengal. Ranibandh block situated at 22?52'N and 86?47'E and is 83 meters above the sea level and Bandwan block located at 22?53'N and 86?30E and is 283 meters above the sea level. Ranibandh block is situated approximately 60 km south from the Bankura district headquarter and 216 km from Kolkata and Bandwan block is 61 km south-east from the Purulia district headquarter and 257 km from Kolkata, the provincial capital of West Bengal. As per the census of India 2011, the Ranibandh block had a total population of 119,089, among them 47.0% were Scheduled Tribes and Bandwan block had a total population of 94,929, among them 51.9% were Scheduled, Tribes. These two blocks are "Heartland” of ST populations of Jungle Mahal. There are two PHC in each block and the mobile health checkup facility is also available in Bandwan block. The vast majority of the adult population in the studied household is engaged in unskilled manual labor; like cultivation, wood-cutting and leaf collection, etc. So, they belong to lower socio-economic classes. The present study covered for data collection from Santal, Oraon, Bhumji, Kora, Mahali, and Savar community. Data on age, sex, family member, height, weight and mid upper arm circumference (MUAC) was measured and recorded on a pre-test questionnaire by one-to-one interview through house to house visit. Children's age was recorded from their birth certificates. Parents were informed about the objectives of the study and their written consent was obtained. The institutional ethics committee was approved the study protocol before initiation of the study.
Sample Size:
Overall 637 children, 336 boys and 301girls aged 3-11 years, were measured to evaluate the prevalence of underweight, thinness and stunting. The minimum estimated sample size was 423 calculated using a standard formula (n=z2pq/d2) found elsewhere. The calculation [(2.172×34×66) / (52)] was based on 34% prevalence (p) of stunting in rural area of West Bengal with desired precision (d) of ±5%. Where q=p-1 and value of Z is 2.17 at 97% confidence interval.
Anthropometric measurements and evaluation of nutritional status:
Anthropometric measurements, i.e. height and weight of each subject, were taken according to the standard procedures 14. Weight and height were measured using a weighing scale and anthropometric rod to the nearest 0.1 kg and 0.1 cm, respectively. An average value of three times measurements of weight, height and MUAC was considered for present analysis. Body mass index was computed following standard formula as weight in kg divided by square of height in meter. Nutritional status has been determined based on the Z-score analysis. WHO Anthro-plus software was used for monitoring growth and nutritional status of children and adolescents. Children were considered with underweight, thinness (wasting), and stunting of their weight-for-age, BMI-for-age and height-for-age Z-scores below -2 SD of the latest WHO reference standards. While severe and moderate nutritional status was categorized as Z-score below -3 and z-score between -3 to below -2, respectively. We followed the WHO criteria for assessing the severity of malnutrition by percentage prevalence ranges of these three indicators among children.15
Statistical analyses
An understudy student t-test was employed to evaluate the sex differences in height, weight and MUAC. Both One-way & two-way ANOVA was utilized to test age-sex variations of height, weight and MUAC, respectively. The proportion/chi-square test was performed to test for differences in the prevalence of underweight, thinness, and stunting between sexes. Odds ratio (OR) and 95% confidence interval (CI) were also calculated following standard methods. All statistical analyses were performed by utilizing MedCalc statistical software version 19.6. A p-value under 0.05 is viewed as statistically significant.
Result:
The age and sex-specific means of weight, height, MUAC and BMI was analyzed and introduced in table 1. After-effects of one-way analysis of variance show that average weight, height, MUAC and BMI were increased significantly with move on age in both sexes. Table 2 present results of two-way analysis of variance test to determine the effect of age, sex and age-sex interaction on weight (figure 1), height (figure 2), and BMI (figure 3). All anthropometric indicators of nutritional status showed significant effect of age. On the other hand, sex and age-sex interaction had no significant effect on all anthropometric indicators except MUAC (Table 2).
To assess the nutritional status age and sex-specific z-scores were computed by using Anthro Plus software. Age-sex combined z-scores of weight-for-age, height-for-age and BMI-for-age were presented in figure 4-6.
The prevalence of underweight (low weight-for-age), thinness (low BMI-for-age), and stunting (low height-for-age) of the studied children are presented in Table 3. Age and sex combined prevalence of underweight, thinness, and stunting was 56.2%, 56.0%, and 21.2%, respectively. Among them, the prevalence of severe underweight, thinness, and stunting was 20.4%, 24.1%, and 4.6%. The rates of stunting was significantly higher among boys (28.29%) compared with girls (14.9%). The boys had 2.25 (OR=2.25, 95% CI: 1.52-3.32) times greater risk to be developing stunted or shortness.
Discussion:
Lack of healthy sustenance is a significant health problem for coordinated advancement in India and thus many developing nations. The occurrence of a very high range of malnutrition in rural areas in India is a major public health challenge3. Undernutrition keeps on being a reason for ill health and premature mortality among children in agricultural nations including India 16. Poverty and contrasts in financial conditions are viewed as the major hidden reasons for such far and widespread malnutrition in India 12,16,17. It is by and large acknowledged that high prevalence of undernutrition in developing countries is attributed to poor socio-economic conditions, ethnicity, demographic disparities, nutrient deficiencies, and environmental issues in populations.5,9,18 In India, a range of studies were conducted to assess the nutritional of tribal children based on anthropometry. Since, anthropometry is considered a minimal expense and non - invasive tools.
In this study, overall prevalence of underweight, thinness, and stunting was 56.2%, 56.0%, and 21.2%, respectively. According to NFHS-4, the rate of underweight and stunting of rural children in India was 38.3% and 41.2%19 and West Bengal was 33.6% and 34.0% 20. Present study found the prevalence of underweight, thinness, and stunting of girls were 53.9%, 53.3%, and 14.9% and for boys it was 58.8%, 59.1%, and 28.2%. The rates of stunting were significantly higher among boys than girls, which reject male child preponderance of food allocation and or better care. A previous review reported there is presence of sex difference of childhood malnutrition.21
Studies from the 21st century in India, documented overall prevalence of underweight of tribal children ranges from 18.5% to 94.3% as tabulated in Table 4. The prevalence of underweight in the present study is much greater than the national and state average (NFHS-4) and also higher than Mishing 18 tribal children in Assam, Shabar 9 tribal children in Odisha, tribal children in Tamil Nadu 16, Kamar tribal children in Chattrishgarh22. Conversely, the prevalence of underweight of this study is lower than tribal children of Andhra Pradesh 23, Bihar 24, Santal children of Jharkhand and West Bengal 25, Kadukuruba26 of Karnataka, Bhumia of Madhya Pradesh27 and tribal children of Maharashtra.28
It is noteworthy to mentioned that the rate of stunting in the present study is lower than all the studies documented in table 4, except tribal children of Bihar 24, indicating that the rate of height growth of their age of tribal children of this area is comparatively better than tribal children as revealed others parts of India (table 4).
Moreover, the prevalence of thinness of tribal children in India fluctuated somewhere in the range of 23.4% and 96.7% (Table 4), this study found by and large pace of thinness was 56.0%. The rate is higher than Mishing tribal children of Assam18, tribal children in Bihar 24, children in Tripura 29 and Shabar of Odisha.9 In contrast, the prevalence of thinness was lower in studied children than the Santal children of Jharkhand and West Bengal 25 and Garasia children of Rajasthan.30
Also, undernutrition assumes a significant part in child mortality and morbidity in agricultural nations including India. An undernourished child is more risk of getting infection consequently impede their normal development and advancement. Numerous investigations from India reported nutritional status of the children affected by socioeconomic condition and food habits. In this way, improvement of their financial status is prime goal at national and sub-national level.
Conclusion:
Present investigation tracked down a high prevalence of underweight and thinness among the tribal children around here. Thus, further investigation in larger augmentation is required to validate the present findings.
Acknowledgement: Authors are grateful to the authority of Raja Narendra Lal Khan Women’s College (Autonomous), Vidyasagar University and Sidho-Kanho-Birsha University, Purulia for providing logistics support.
Source of funding: Partially borne by investigator.
Conflict of interest: None
Author contributions: UM collects the data. SB developed the study design and analysis of data. UM and SB contributed to writing of the manuscript; DKN critically revised the manuscript.
Ethical Clearance Letter No.: IEC/ICMR/02/IEC-ICMR/RNLKWC/2019
Englishhttp://ijcrr.com/abstract.php?article_id=4126http://ijcrr.com/article_html.php?did=4126
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26Healthcare
Stress and Physiological Variables in People with Coronary Artery Diseases
English151153Tejas S. BhosaleEnglish Samir K. ChoudhariEnglish Mahadeo ShindeEnglish
Introduction: As the number of people diagnosed with heart disease continues to rise on a daily basis, it has developed into a condition that poses a risk to one’s life. The current epidemic of coronary artery disorders can be explained, in large part, by a number of modifiable risk factors that are related with one’s way of life. According to the findings of various research studies, coronary heart disease can be a primary reason for morbidity and mortality in adults. Aims: The purpose of this study is to evaluate patients who have coronary artery diseases in terms of their physiological parameters as well as their levels of stress. Materials and Method: The research was quantitative, based on surveys, and it was conducted on patients suffering from cardiac disorders. A total of 54 samples were chosen using the Simple Random approach. Before the data collecting began, authorization from the ethical committee was acquired. After getting permission from the location, the patients were approached about their interest in taking part in the study, and informed consent was collected from each one of them. The use of structured questions allowed for the evaluation of physiological markers as well as stress. It was decided to collect the demographic variables. Statistics, both descriptive and inferential, were applied to the study of the acquired data, and the results were examined. Result: The findings showed that 51 subjects (94.44%) had a fever of 98 degrees Fahrenheit. The majority of the subjects 18, or 33.33 percent, had a heart rate that was between 71 and 80 beats per minute. Regarding blood pressure, 17-24 breaths per minute were included in the respiratory rates of 38 (70.37%). The blood pressure of the majority of the 30 individuals (55.55%) was below 140/90mmHg. According to spo2, a maximum of 28 (51.8%) of the participants belonged to the 95% group. The majority of the samples, 37.03%, exhibited mild stress, whereas 27.7% of the samples exhibited moderate stress, and 35.18% exhibited severe stress. Conclusion: The findings of this investigation imply that the majority of the samples in the present study had fluctuation in their physiological parameters, and the vast majority of the samples experienced moderate to severe stress.
EnglishPhysiological Parameters, Stress, Coronary Artery Diseases, Epidemiologically, High blood pressure, Diseaseshttp://ijcrr.com/abstract.php?article_id=4648http://ijcrr.com/article_html.php?did=4648
1. Asgari MR, Jafarpoor H, Soleimani M, Ghorbani R, Askandarian R, Jafaripour I. Effects of Early Mobilization Program on the Heart Rate and Blood Pressure of Patients With Myocardial Infarction Hospitalized at the Coronary Care Unit. Middle East J Rehabil Health. 2015; 2(1): e24168.
2. Vaccarino V, Almuwaqqat Z, Kim JH, Hammadah M, Shah AJ, Ko YA, Elon L, Sullivan S, Shah A, Alkhoder A, Lima BB. Association of mental stress–induced myocardial ischemia with cardiovascular events in patients with coronary heart disease. JAMA. 2021 Nov 9;326(18):1818-28.
3. Tak YR, McCubbin M. Family stress, perceived social support and coping following the diagnosis of a child’s congenital heart disease. J. Adv. Nurs. 2002 Jul;39(2):190-8.
4. Morera LP, Marchiori GN, Medrano LA, Defagó MD. Stress, dietary patterns and cardiovascular disease: A mini-review. Frontiers in neuroscience. 2019 Nov 12;13:1226.
5. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998 May 12;97(18):1837-47.
6. Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M. The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PloS one. 2019 Jan 15;14(1):e0210875.
7. Mok W, Wang W, Cooper S, Ang EN, Liaw SY. Attitudes towards vital signs monitoring in the detection of clinical deterioration: scale development and survey of ward nurses. Int J Qual Health Care. 2015 Jun 1;27(3):207-13.
8. Bhagyalakshmi M, Ramana BV, Suresh H, Raj JM. Assessment of the level of stress and coping strategies among patients with coronary artery disease. J Sci Ind Res (India). 2012 Sep 1;39(3):136.
9. Kurd BJ, Dar MI, Shoaib M, Malik L, Aijaz Z, Asif I. Relationship between stress and coronary heart disease. Asian Cardiovascular and Thoracic Annals. 2014 Feb;22(2):142-7
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26Healthcare
The Positive Effects of Ambulation on Stress and Physiological Parameters in Heart Disease Patients
English154157Tejas S. BhosaleEnglish Samir K. ChoudhariEnglish Mahadeo ShindeEnglish
Introduction: In the past ten years, cardiovascular diseases (CVD) have surpassed all other causes of death to become the leading cause of mortality across the globe. Cardiovascular illnesses are one of the most significant threats to global public health. It is a widely held belief that stress can have a role in the development of coronary artery disorders (CAD). Aims: The purpose of this study was to explore the effect of ambulation on patients who were diagnosed with Coronary Artery Syndrome and to determine how it affects the physiological parameters such as heart rate, breathing rate, SPO2, blood pressure, and the level of stress. Materials and Method: Patients in Krishna Hospital, Karad, who were diagnosed with coronary heart diseases were the subjects of the study, and it was designed using a quasi-experimental methodology. By using convenient sampling, a total of 54 samples were distributed, with 27 being given to both the experimental group and the control group. Before any data collection took place, approval had been granted by the Research Ethics Committee of the Krishna Institute of Medical Science Deemed University in Karad. Following the collection of demographic data, individuals diagnosed with CHD from both the experimental and control groups had their vital signs as well as their level of stress evaluated using. Following the pre-test, the experimental group had ambulation, and then they were given the post-test to complete the cycle. Result: The results showed that the mean and standard deviation of stress levels in the control group was 25.22 and 4.309 respectively. The experimental group had a mean and standard deviation of stress equal to 14.22 and 7.511, respectively. The value of the t-test statistic that was computed was 6.6008, which was judged to be statistically significant at the threshold of p less than 0.0001. Conclusion: The outcomes of the study suggest that the Ambulation programme was found to be helpful on the degree of stress among patients with CHD.
EnglishAmbulation, Physiological Parameters, Stress, Coronary Heart Diseases, Likelihood, Prolongedhttp://ijcrr.com/abstract.php?article_id=4656http://ijcrr.com/article_html.php?did=4656
1. Le Angie MM, Ku LD. Benefits of Early in Post-operative Cardiac Surgery Patients. Biomed J Sci Tech Res. 36(2)
2. Mousa AS, Ali ZH, Mahmoud BH, Mohamed KE. Effect of Early Ambulation on Post Diagnostic Cardiac Catheterization Patient’s Outcomes.
3. Tak YR, McCubbin M. Family stress, perceived social support and coping following the diagnosis of a child’s congenital heart disease. J. Adv. Nurs. 2002 Jul;39(2):190-8.
4. Nabi H, Kivimäki M, Batty GD, Shipley MJ, Britton A, Brunner EJ, Vahtera J, Lemogne C, Elbaz A, Singh-Manoux A. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study.Eur Heart J. 2013 Sep 7;34(34):2697-705.
5. Lucinda LB, Prosdócimo AC, Carvalho KA, Francisco JC, Baena CP, Olandoski M, Amaral VF, Faria-Neto JR, Guarita Souza LC. Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market. Braz J Cardiovasc Surg.. 2015 Jan;30:16-23.
6. Torpy JM, Lynm C, Glass RM. Chronic stress and the heart. JAMA. 2007 Oct 10;298(14):1722-.
7. Akkaya SB, Karacabay K. Investigation of the Effect of Time to Ambulation on Patient Outcomes, Anxiety and Depression. J. basic Clin. health sci. 2021;6(1):217-24.
8. Miwa S, Visintainer P, Engelman R, Miller A, Lagu T, Woodbury E, Lindenauer PK, Pack QR. Effects of an ambulation orderly program among cardiac surgery patients. Am. J. Med. 2017 Nov 1;130(11):1306-12.
9. Funato Y, Kono Y, Kawai H, Hoshino M, Yamada A, Muramatsu T, Harada M, Takahashi H, Otaka Y, Yanase M, Izawa H. The Acute-Phase Ambulation Program Improves Clinical Outcome for Acute Heart Failure. J. Cardiovasc. Dev. Dis. 2022 Sep 20;9(10):314.
10. Agarwal A, Mathur K. A study of perceived stress among cardiac patients. Int. J. Creat. Res. Thoughts. 2020;(8)6: 22-3
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411318EnglishN2021September26Healthcare
Pineal Gland Rhythm and Circadian Physiology
English158164Chetri RanjuEnglish
An unpaired neuroendocrine and highly vascularized organ, the pineal gland is located in the middle of the brain nearly in all vertebrates. Its main function is to synthesize the melatonin hormone (N-acetyl-5-methoxytryptamine) in the pinealocytes, which converts light and dark information to complete body physiology. Light inhibits melatonin production whereas darkness stimulates it. Melatonin is synthesized from amino acid tryptophan. Dietary amino acid tryptophan is converted into melatonin in four consecutive biochemical steps.This conversion process includes: conversion of amino acid tryptophan to 5-hydroxytryptophan (5-HTP) by tryptophan hydroxylase 1 (TPH1); synthesis of 5-hydroxytryptamine (5-HT or serotonin) by aromatic amino acid decarboxylase; formation of N-acetylserotonin (NAS) by arylalkylamine N-acetyltransferase (AANAT), and production of melatonin by hydroxyindole-O-methyltransferase (HIOMT) (also termed N-acetylserotonin methyltransferase or ASMT). The pineal gland in rat exhibits circadian rhythms of release for all four tryptophan enzymatic derivatives, with larger levels at night. 5-HTP and serotonin are both released at quite high levels during the day and increase much more at night, in contrast to NAS and melatonin, which are hardly detectable during the day.
EnglishPineal, Melatonin, Rhythm, Serotonin, Cycle, Hormonehttp://ijcrr.com/abstract.php?article_id=4720http://ijcrr.com/article_html.php?did=4720