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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcarePharmacovigilance: A Step Towards Patient Safety
English0101Dr. Pramod Kumar ManjhiEnglishEnglishhttp://ijcrr.com/abstract.php?article_id=4158http://ijcrr.com/article_html.php?did=4158Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareMicroplastics (MPs) as a Chemical Time Bomb: The New Emerging Silent Menace to Public Health
English0203Tomy M. JosephEnglishEnglishhttp://ijcrr.com/abstract.php?article_id=4159http://ijcrr.com/article_html.php?did=4159Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareRole of Greyscale Ultrasound, Colour Doppler and Ultrasound Elastography in the Evaluation of Axillary Lymph Nodes in Primary Breast Cancer - A Prospective Study
English0411PS PriyaEnglish K PrakashiniEnglish KT JyothiEnglishIntroduction: Breast cancer metastasizes, most commonly to lymph nodes of the axilla. Axillary lymph node metastasis has been one of the most important prognostic parameters in patients with breast malignancies. Differentiation between malignant and benign axillary lymph nodes is extremely important at an early stage because a delay in diagnosis leads to disease upstaging thus turning a curable lesion incurable. Hence early detection helps in improving outcomes and survival. Our study was intended to arrive at an accurate, early pre-operative diagnosis of lymph node metastasis by evaluating axillary lymph nodes in biopsy-proven primary breast carcinoma through non-invasive methods such as greyscale ultrasound, Colour Doppler and strain wave elastography and correlate it with histopathology. Aims: To evaluate axillary lymph nodes in primary breast cancer patients on greyscale ultrasound, Colour Doppler, strain wave elastography and correlate it with histopathology. To compare sensitivity, specificity, negative and positive predictive values of greyscale ultrasound with combined greyscale ultrasound and elastography findings. Materials and Methods: Seventy histopathologies proved primary breast carcinoma patients were included. Lymph nodes were assessed for size, shape, presence/absence of hilum, long /short axis ratio (L/S ratio), cortical thickness, cortical thickness/fatty hilum thickness ratio (C/F ratio) on greyscale ultrasound, for vascularity on Colour Doppler followed by elastography. A provisional diagnosis was made and compared with histopathology of the lymph node. Results: Our study showed that round shape, irregular nodular margins, eccentric/compressed or absent hilum, increased cortical thickness; decreased L/S ratio and increased C/F ratio were the morphological characteristics favouring malignancy. Vascular flow pattern type, resistivity index, pulsatility index and peak systolic velocity/end-diastolic velocity ratio helped in differentiating benign from malignant lymph nodes. The mean strain ratio was significantly higher in the malignant lymph node. Conclusions: Ultrasound evaluation (greyscale, colour Doppler and strain elastography) should be incorporated in the initial evaluation of suspected breast carcinoma patients as it is a cheap, radiation-free, easily accessible, reasonably accurate means of staging.
English Axillary lymph nodes, Primary breast cancer, Grayscale ultrasound, Colour Doppler, Elastography, Prospective studyIntroduction:
Breast carcinoma is one of the most common types of tumours affecting women worldwide with its incidence on an increasing trend. Most breast cancers are spread by local invasion, intraductal growth and into the lymphatic system in a stepwise and predictable fashion before the occurrence of distant hematogenous metastasis.
Breast cancer metastasizes, most commonly to lymph nodes of the axilla. Axillary lymph node metastasis has been one of the most important prognostic parameters in patients with breast malignancies. Differentiation between malignant and benign axillary lymph nodes is extremely important at an early stage because a delay in diagnosis leads to disease upstaging thus turning a curable lesion incurable. Hence early detection helps in improving outcomes and survival.1 Sentinel lymph node (SLN) is the earliest lymph node to receive lymphatic drainage from primary breast carcinoma and is highly predictive of the remaining axillary lymph node status.2 Sentinel lymph node biopsy (SLNB) has not found wide acceptance in developing countries because of the requirement of nuclear medicine facility, frozen section facilities, intraoperative waiting time for reports, increased post-procedure complications in the form of lymphedema, pain, limitation of shoulder movement and weakness of the arm and a 5-10% false-negative rate and cost.3 It is therefore advantageous to evaluate the efficacy of non-invasive procedures such as ultrasonography, Colour Doppler and strain wave elastography in differentiating malignant from benign lymph nodes in proven primary breast carcinoma. Early diagnosis and treatment can reduce mortality and increase survival and improve quality of life. Our study was intended to arrive at an accurate, early pre-operative diagnosis of lymph node metastasis by evaluating axillary lymph nodes in biopsy-proven primary breast carcinoma through non-invasive methods such as greyscale ultrasound, Colour Doppler and strain wave elastography and correlate it with histopathology.
Materials and Methods:
This prospective observational, hospital-based time-bound study was conducted in a tertiary care university teaching hospital from December 2017 to August 2019 over 2 years. Recruiting the subjects and data collection started after obtaining Institutional ethics committee (IEC:866/2017) and Clinical trials registry [India CTRI/2018/09/021650] approval. We enrolled a total of 70 female subjects between 34-80 years of age having histopathology proven primary breast carcinoma with axillary lymph nodes on imaging having a short axis diameter >5mm in the study. Patients with bilateral breast cancer, those who had undergone breast surgery, those scheduled for radiotherapy, neoadjuvant chemotherapy and those with prior axillary interventions were excluded.
Greyscale ultrasound, Colour Doppler and strain wave elastography of the axillary lymph nodes were done with a multi-frequency linear array transducer (8-13 MHz; AplioXG Toshiba medical systems corp. Japan). Ultrasound of the ipsilateral axilla of primary breast carcinoma was performed with the patient in supine position with external rotation and 90-degree abduction of the shoulder. This was to position the axillary vessels to have a nearly straight course and all parts of the axilla could be thoroughly examined. A variable amount of compression was applied with the transducer to thin the axillary area, further improving penetration and image quality.4
We assessed the morphology of visualized lymph nodes. If all the lymph nodes appeared normal, the most representative lymph node in the lower part of the axilla was chosen for further analysis.
Greyscale ultrasound: Lymph nodes were measured in longitudinal (long axis) and transverse (short axis) dimensions and documented using the Solbiati index (long/short axis ratio). The hilum and cortical thickness were also measured ( Figure 1). Finally, the following grayscale ultrasound qualitative criteria were described: oval or round appearance, present /absent fatty hilum, sharpness of margins and focal thickening of the cortex, long axis/short axis ratio (L/S), cortical/fatty hilum thickness ratio(C/F).
Colour Doppler ultrasonography: Sample volume was adjusted according to the vessel size in the lymph node, with the angle of insonation kept at 60 degrees or less. Spectral waveforms were recorded of the different vessels visualised in each lymph node whenever possible and the highest value was considered. The lymph nodes were initially assessed for distribution of vascularity as hilar, central perihilar, peripheral non-hilar and mixed vascular patterns. Quantitative analysis in the form of pulsed Doppler spectral analysis waveform pattern was generated where resistivity index (RI), pulsatility index (PI) and systolic/diastolic (S/D) ratio were measured where highest value was recorded (Figure 2).
Strain wave elastography (SWE): Keeping the probe perpendicular to the skin over the lymph node, repetitive manual compression and decompression (around 5-6) were applied using minimal pressure. Elastogram obtained with a well-formed wave touching the baseline was selected. One ROI was placed in the axillary fat with the highest strain value, at a depth similar to that of the lymph node being evaluated. The second ROI was placed in the lymph node cortex. The software program embedded in the ultrasound machine automatically calculated the strain ratio for the lymph node.5 We recorded 3 strain wave ratios for each lymph node and considered the mean of the ratios (Figure 3).
The results of all three imaging modalities were correlated with histopathology. Since the histopathology report states only the largest lymph node size and number of lymph nodes with tumour deposits only, the size of the lymph node according to ultrasound correlating with the histopathological size was selected for further statistical analysis. Hence, our study included 70 cases with 70 lymph nodes for assessment.
Data were entered into Microsoft excel 2013 and analysed by using software version of SPSS 22(IBM SPSS Statistics, Somers NY, USA). Categorical data were presented in the form of frequencies and proportions. The Chi-square test was used as a test of significance for qualitative data. Continuous data were presented as mean and standard deviation. Receiver operating characteristic (ROC) curves were obtained for cortical thickness, long axis/short axis ratio, cortical thickness/fatty hilum thickness ratio, resistivity index, pulsatility index, S/D ratio and mean strain ratio. The cut-off values were derived for each variable which helped in differentiating benign from metastatic lymph nodes. The sensitivity, specificity, positive and negative predictive values of greyscale ultrasound were compared with combined greyscale ultrasound and strain elastography findings.
RESULTS
Among the 70 subjects enrolled in our study, the highest proportions of cases were from the age group range of 50-59 years with a mean age of 51.47 ± 11.205 years. A family history of breast carcinoma was found only in 7 subjects out of 70 patients. A total of 65 subjects were multiparous and the remaining 5 were nulliparous. Our subjects had right-sided neoplasm in 37 (53.6%) and the remaining 32 (46.4%) had it in left. In the study, maximum breast carcinomas (47.1%) were found in the upper outer quadrant and lower outer, lower inner quadrant and upper inner quadrants had 15.7%, 14.3% and 12.9% respectively.
Out of 70 lymph nodes from the 70 subjects, 47 lymph nodes showed metastasis and the remaining 23 were benign. Our study showed that lymph nodes that were positive for metastasis on histopathology had round shapes and irregular nodular margins (81.6%) and eccentric or compressed hila (89.8%). Among the benign lesions, the majority of subjects had ovoid shape (95.2%) and maintained central echogenic hila (90.5%). (Table 1)( Figure 4)
The vascular flow patterns in the malignant nodes were found to be central perihilar, peripheral non-hilar and mixed flow patterns, the majority being mixed-flow patterns (46.9%) and among those with benign lesions on histopathology, the majority had hilar flow patterns (81%). There was a significant association between vascular flow pattern and HPE lymph node diagnosis (p 3mm or more for cortical thickness yielded a sensitivity of 87.76% and a specificity of 95.24% with a p-value of 0.69 was the best cut off value favouring malignant lymph nodes yielding a sensitivity of 89.8% and a specificity of 80.95% (AUROC 0.853 and p-value of 1.25 was the best cut off value favouring malignant lymph nodes with a sensitivity of 89.8% and a specificity of 76.19% (AUROC 0.853 and p-value of 3.97 was the best cut off value yielding a sensitivity of 75.51% and a specificity of 95.24 % (AUC 0.904 and p-value of 3.83 was the cut off value with a sensitivity of 91.84% and a specificity of 80.95 % (AUC 0.872) and a p-value of 0.7, and PI >1.4 and our cut off values of RI >0.69 and PI>1.25 were closer to their values, but in the study done by Sanjeeb Kumar et al. 7 RI of >0.8 and PI >2 were significant values. S/D ratio was not incorporated in any of the previous studies to the best of our knowledge and we have included it in our study. Thus, we found that pulsed Doppler spectral waveform for metastatic lymph nodes tend to have high RI, high PI and sharp systolic peaks.
There are not enough established studies favouring strain elastography as a modality of choice for differentiating benign from malignant lymph nodes, various studies have mostly used Colour elastography and some have used both Colour elastography and strain ratio. We used only the strain ratio in our study. Cut off the value of >3.83 for strain ratio was found to have a sensitivity of 91.84% and specificity of 80.95% for malignant lymph nodes in our study. Young Mi park et al. 9 in their study have concluded that strain elastography did not improve the diagnostic ability of conventional ultrasound in the evaluation of axillary lymph nodes. Wanying Chang et al.9 in their study concluded that elastography was a useful adjuvant tool in addition to greyscale ultrasound for pre-operative assessment of axillary lymph nodes in patients with breast cancer. Our study showed elastography as an adjuvant tool to greyscale ultrasound and Colour Doppler although less sensitive than greyscale. Our study concluded that whenever there is a mismatch between greyscale ultrasound and histopathological correlation elastography can act as an adjuvant tool and vice versa (Table 6). Most of the previous studies have one or two imaging modalities for assessing axillary lymph nodes. Our study is unique in the way, that we have combined three imaging modalities for assessing axillary lymph nodes, which could be done on a single machine in a single sitting and our study also incorporated CF ratio which we found to be very reliable, can be easily incorporated and showed statistically significant results.
However, our study had the following limitations. Our Sample size was only 70 cases and the study may give greater insight with a higher number of cases. Morphological assessment of the cortex is more solidly based on the histology of lymph node metastasis than on the size of the lymph node. Only the assessed lymph nodes in our study were not subjected to FNAC, instead, all the subjects underwent surgical excision of all the axillary lymph nodes. Histopathology report did not clarify the level of lymph node involved most of the time. Due to lack of uniformity in reporting, we had to correlate the largest lymph node size in the histopathology report with the corresponding size in our study. Hence, we had only one lymph node per subject for statistical analysis. As a result, we could not do lymph node to lymph node correlation with histopathology findings in this study.
Conclusion:
Our study showed round shape, irregular nodular margins, eccentric/compressed or absent hilum, increased cortical thickness, L/S ratio ≤1.89 and C/F ratio ≥1.08 are amongst the morphological characteristics favouring malignant lymph nodes on grayscale. Vascular flow pattern type, RI, PI and S/D ratio helps in differentiating benign from malignant lymph nodes on Colour Doppler. The mean strain ratio was significantly higher in malignant lymph nodes.
C/F ratio can improve diagnostic performance when compared to the L/S axis ratio. Among a range of US criteria, cortical thickness >3mm is one of the most reliable criteria for defining suspicious lymph node metastasis.
Greyscale ultrasound is technically sound, proven and established in several previous studies and can form a baseline for morphological analysis of lymph nodes. But it cannot be used as a single-mode and needs to be substantiated with Colour Doppler or elastography or both for additional credibility. Both Colour Doppler and strain elastography cannot be used singly as they are subjective with no standard technical guidelines. In addition, there is a lack of standardization of technique, data capture, data analysis and uniformity which needs to be addressed in the case of elastography. Overall ultrasound evaluation (greyscale, Colour Doppler, strain elastography) should be incorporated in the initial evaluation of suspected breast carcinoma patients as it is non-invasive, affordable, radiation-free, easily accessible, reasonably accurate means of staging.
Declarations
Compliance with ethical standards
Funding: Authors have not received any funding of any sort for the study
Conflict of interest: Authors declare that there are no conflicts of interest.
Conflict of interest: Informed consent was taken from all subjects for their voluntary participation.
Ethical approval: All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with animals performed by any of the authors.
Informed consent: Informed consent was obtained from all individual participants included in the study.
Acknowledgement:
NIl
Conflict of interest:
NIL
Authors Contribution:
PS Priys: Principal investigator
K Prakashini: Principal investigator and guide
KT Jyothi: Design and statistics.
Englishhttp://ijcrr.com/abstract.php?article_id=4160http://ijcrr.com/article_html.php?did=4160
Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review (Structured abstract). Am J Roentgenol. 2006;186(5):1342–8.
Liu H, Xu G, Yao MH, Pu H, Fang Y, Xiang LH, et al. Association of conventional ultrasound, elastography and clinicopathological factors with axillary lymph node status in invasive ductal breast carcinoma with sizes >10mm. Oncotarget. 2018;9(2):2819–28.
Maxwell F, De Margerie Mellon C, Bricout M, Cauderlier E, Chapelier M, Albiter M, et al. Diagnostic strategy for the assessment of axillary lymph node status in breast cancer. Diagn Interv Imaging [Internet]. 2015;96(10):1089–101. Available from: http://dx.doi.org/10.1016/j.diii.2015.07.007
Okunade K. January-March 2018. An Official Publication of The National Postgraduate Medical College of Nigeria. 2018;(January):19–26.
Latif MA, Shady M, Hegazy MAE, Abdo YM. B-mode ultrasound, sono-elastography and diffusion-weighted MRI in the differentiation of enlarged axillary lymph nodes in patients with malignant breast disease. Egypt J Radiol Nucl Med [Internet]. 2016;47(3):1137–49. Available from: http://dx.doi.org/10.1016/j.ejrnm.2016.05.018
Choudhary J, Agrawal R, Mishra A, Nandwani R. Ultrasound and Color Doppler Evaluation of Axillary Lymph Nodes in Breast Carcinoma with Histopathological Correlation. Int J Sci Study [Internet]. 2017;5(10). Available from: https://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_jan_oa13_-_2018.pdf
Pradhan SK, Das BB, Sahoo N, Das SK, Panda C. Role of Doppler Usg for Evaluation of Axillary Lymph Node Status in Carcinoma Breast. J Evid Based Med Healthc. 2016;3(33):1576–80.
Park YM, Fornage BD, Benveniste AP, Fox PS, Bassett RL, Yang WT. Strain elastography of abnormal axillary nodes in breast cancer patients does not improve diagnostic accuracy compared with conventional ultrasound alone. Am J Roentgenol. 2014;203(6):1371–8.
Chang W, Jia W, Shi J, Yuan C, Zhang Y, Chen M. Role of elastography in the axillary examination of patients with breast cancer. J Ultrasound Med. 2018;37(3):699–707
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAssessment of Renal Vasculature Variations, in Contrast, Computed Tomography Studies of 640 Patients at a Tertiary Care Centre in South India
English1219Karegowda H LakshmikanthEnglish Mathew OshinEnglish Raju VinayEnglish Pendem SaikiranEnglish PriyankaEnglish Ramprasad BolarEnglishIntroduction: Renal vasculature is affected by a spectrum of variations that bears a high clinical impact while planning transplant surgeries/biopsies. Large scale Indian data is not available and a single study assessing these variations separately in male and female populations from a different country is available in the literature. Aims: To study the prevalence of renal artery(RA), renal vein(RV) variations, and investigate their gender distribution in patients undergoing contrast-enhanced computed-tomography(CECT) abdomen study. Materials and Methods: One-year prospective study, included 640 contiguous patients (320 males and 320 females) referred for the CECT study. Statistical Analysis: Descriptive analysis of different types of RA, RV variations, and analytical analysis of the association between these variations and association between gender and renal vascular variations(RVV)using the Chi-square test. Results: RA variations (376 patients -46.71%) predominated over the RV variations (131 patients -20.46%). Additional RA(AdRA) was the most common arterial variation (315 patients – 49.21%), with occurrence in the female population dominating over the male population (52.81% and 45.62%% respectively, P>0.05). Accessory RA(AcRA) showed an increased prevalence over aberrant RA(AbRA) (29.37% and 19.68%, respectively). Unilateral AcRA and unilateral aortic-origin of AbRA(Ao-AbRA) showed female predominance; all bilateral Ao-AbRA and bilateral mixed origins (aortic and renal) of AbRA were seen exclusively in the female population (Eight patients and five patients, respectively). Among RV variations, the late confluence of RV(LcRV) was the most common variation (9.84%), with 60% being males and 40% females. No significant association between RA and RV variation(p>0.05) and between gender and vascular variations(p>0.05). Conclusion: Knowledge of RVV bears paramount importance in clinical practice, which helps radiologists/surgeons in better patient management.
English Renal artery, Renal vein, Variation, Aberrant renal artery, Accessory renal artery, Perihilar branchingIntroduction
The vascular variation that is mandatory for the uro-surgeons to know beforehand is the variations in RA and RV, especially when the surgery is planned through laparoscopy or in cases of nephrectomy performed in donor1. Most studies on renal vascular variations in literature are retrospective in nature, with unequal sample sizes among each gender. Large scale Indian data is not available and a single study assessing these variations separately in male and female populations from a different country is available in the literature.2
The study's purpose was to assess the prevalence of renal vasculature variations in patients undergoing Contrast-Enhanced Computed Tomography, investigate their gender distribution, and find any association between them.
Materials and Methods
Study type, Sample size, and Ethics:
This is a prospective cross-sectional study performed in a tertiary care centre for a year. Institutional Ethical Committee approval was obtained (No: 304/2019), and 640 contiguous patients (320 males and 320 females) referred for CECT in whom both arterial and venous phases were acquired were analysed for RA and RV variations.
Inclusion and Exclusion criteria:
Inclusion criteria included all patients referred for CECT abdomen between the age range of 18 to 70 years. The exclusion criteria were the existence of renal pathology that destroyed the anatomy of renal vasculature, ectopic or ptotic location of kidneys, prior donor nephrectomy, and recipients of renal transplantation.
CT study protocol:
CECT was performed using 128-slice Philips Incisive CT with contrast injection administered through an 18-gauge cannula placed in the antecubital vein. The scan parameters were as mentioned in the table.1.
Definitions used for interpretation of variations:
AdRA is the RA supplying the kidney apart from the main RA. AcRA is a type of AdRA that arise from the aorta and enters the kidney at the hilum. AbRA is another type of AdRA arising from the aorta or the main renal artery or any of the branches of the abdominal aorta but entering the kidney at its poles.3,4 Prehilar branching (PHB) of right RA is defined as retrocaval bifurcation or bifurcation within 1 cm of the right margin of inferior vena cava (IVC). PHB of the left RA is the bifurcation of left RA within 1.5 cms distal to its origin.5 PHB needs to be differentiated from Re-AbRA as both originate from the main renal artery. While the PHB enters the kidney at the hilum, the Re-AbRA enters the kidney at its pole.3,6(Figure 1)
RV variations included LcRV defined on the right side as the confluence of right RV within 1.5 cm from IVC and on the left side as the confluence of left RV within 1.5 cms from the aorta; multiple RVs (double or triple renal veins), circumaortic left RV (CaLRV) where left RV bifurcates and encases the aorta, retro aortic course of left RV (RaLRV) where the vein courses posterior to the aorta.5,7
Image interpretation:
The source images of both arterial and venous phases were analysed in multiplanar reconstruction (MPR), volume rendering (VR), and maximum intensity projection (MIP) images using Radiant DICOM viewer(V-19.2.3) by two experienced Radiologists having nine years and two years of experience and the interpretations were made by consensus.
The radiologists assessed RA parameters such as origin levels of main renal arteries, the total number of AdRA, AcRA, AbRA on either side, PHB on either side and the RV parameters such as the number of renal veins on either side, LcRV on either side, CaLRV and RaLRV.
Descriptive analysis of different types of RA, RV variations, and analytical analysis of the association between these variations and association between gender and renal vascular variations(RVV) using Chi-square test was performed. SPSS version 20 software was used for statistical analysis.
Observations and Results
A total of 640 patients (320 males and 320 females) were analysed. The mean age of the entire population was 42.2 (Males: 44.2 and Females: 40.5).
The overall prevalence of RA, RV variations:
Overall, the arterial variations (56.40%) dominated over the venous variations (20.46%). The male population showed higher incidences of both variations, as shown in table 2. The differences in the arterial and venous variations among the gender were not statistically significant (p>0.05).
Level of origin of renal arteries:
Levels of origin of RA varied from T12 to L2-3 levels, out of which the most common level of origin was L1 level for both sides (59.21% on right and 51.71% on the left side). The next common level of origin was the L1-2 level. Both male and female populations conferred to the same trend, which is summarised in table 3.
Prevalence of AdRA:
The count of AdRA (both AcRA and AdRA) was assessed as shown in table 4. The female population showed an increased prevalence of additional arteries as compared to the male population. A total of 315 cases showed single, double, triple and quadruple RA (Figure 2). More than 4 AdRA were not detected in any of the cases. Though the female population showed more tendency of having additional renal arteries (52.81% vs 45.62% in males), the difference was not statistically significant (p > 0.05).
Prevalence of AcRA:
A total of 188 patients showed AcRA (29.37%). Prevalence of single unilateral AcRA was the most common variation in male (24.06%), female (27.81%), and total (25.93%%) populations. Right-sided variations were more common than the left side in all three groups as shown in Table 5. The female population showed an increased tendency of having unilateral AcRA (89 cases) as compared to the male population (77 cases), and the difference was not statistically significant (p>0.05). Single bilateral AcRA, double unilateral, and double bilateral AcRA were more prevalent among the male population.
Prevalence of AbRA:
Though AbRA can arise from the abdominal aorta or any of its branches like a celiac trunk, superior mesenteric artery, inferior mesenteric artery, main renal arteries, or iliac arteries, only the AbRA arising from the aorta (Ao-AbRA) or main renal artery (Re-AbRA) were found in our study (Table 6). A total of 126 patients showed AbRA (19.68%).
The unilateral Ao-AbRA showed predominance (85 cases in total) over all other categories of AbRA, as shown in Table 4. All bilateral Ao-AbRA (Figure 3A) and mixed (aortic and renal) origins of bilateral AbRA was seen exclusively in the female population (8 patients -2.5% and 5 patients – 1.56%, respectively). While the prevalence of unilateral or bilateral Re-AbRA (Figure 3B) showed increased tendency in the male population (p>0.05), the prevalence of unilateral Ao-AbRA showed predominance in the female population (p=0.044). No case of unilateral or bilateral double AbRAs detected.
Prevalence of PHB:
Females showed a slightly higher prevalence of bilateral PHB (p>0.05), while males showed a higher prevalence of unilateral PHB (p>0.05). Right PHB had a higher prevalence than the left PHB in both males and females (p>0.05) (Table 7).
Prevalence of LcRV:
Among the venous variations, unilateral LcRV was the most common variation found (63 cases -9.84%) (Figure 4A), with the male population showing slightly increased prevalence (p>0.05) and occurrence more towards the right side (p>0.05). Bilateral LcRV had equal prevalence in both male and female populations.
Prevalence of Multiple RV:
No cases of bilateral multiple RV were detected. Unilateral double RV showed slight male predominance (p>0.05) and an increased prevalence on the right side (Figure 4B) in both male and female populations (p=0.00003) (Table 9). No case of unilateral/bilateral triple or quadruple renal veins was detected.
Prevalence of RaLRV and CaLRV:
CaLRV was seen in only 5 patients, with majority being the female population (Table 10) (Figure 4C). RaLRV was the most common variation in the left RV course, having a total prevalence of 6.71% with slight predominance in the male population (p>0.05) (Figure 4D).
Statistical Association between RA and RV variations:
The right-sided late confluence of RV with right AcRA showed the most frequent occurrence (19 cases- 2.96%). The Chi-square test, however, showed no significant association between the renal artery and renal vein variations in both males (p>0.05) and females (p>0.05).
Discussion
The definitive location of the “embryonal wandering” kidneys determines their permanent vascular supply implying an abnormal location would lead to an abnormal vascular supply.8,9 Hence, the ectopic or ptotic kidneys were excluded from our study.
The male population showed an increased overall tendency in RA and RV variations as compared to females (p>0.05). Our study and the study by Ozkan et al.10 found the most common level of origin for right RA to be L1 (59.21% and 43%, respectively). However, the latter study found that the left RA origin was slightly more common at L2 (38% vs. 37% at L1) though we found the L1 level to be most common for left RA origin (51.71%). Famurewa et al.11 reported that both right and left renal arteries broadly originated between the upper margin of L1 and lower margin of L2, which fits well with our study.
Satyapal KS et al.7 reported a wide range of variations in the prevalence of the AdRA across various studies ranging from 8.7% to 75.7%, with an average of 28.1%. Our study's prevalence was 45.62%, which is close to the studies by Macalister A et al.12 of 43% and Ugurel et al.13 of 42%. Among AdRA, single AdRA had the most common occurrence like other studies in the literature.7,13,14 The prevalence of single AdRA of 41.87% in our study is close to the prevalence of 37.7% found by Kher GA et al.14 Occurrence of single AdRA was more frequent on the right side, which is congruent with the studies by Holden et al.15 Ozkan et al.10 and Ugurel et al.13
We detected increased prevalences of the AcRA over AbRA of 29.37% and 19.68%, respectively. Khamanarong et al.16 found a higher prevalence of AbRA, and Cinar C et al.2 found a higher prevalence of AcRA like our study. Among the AbRA, we had a particular interest in studying the prevalence of Re-AbRA as we could not find any English literature addressing the same. This may be because most of these arteries could have been mislabelled as early (prehilar) division of the main renal artery. We strictly followed the distinctions between the two as defined in the introduction and found the overall prevalence of Re-AbRA to be 5.15%. Interestingly, bilateral Ao-AbRA and bilateral mixed origin AbRA were exclusively found in the female population.
For easier control of haemorrhage during transplant and for suitable anastomosis, incision of the renal artery should be at 1.5 to 2 cms from the aortic origin. Hence determining PHB is of paramount importance. The prevalence of it across the existing literature has a wide range between 4.3% and 26.7%.2,10,15,17,18,19 depending on the investigation method. Our study showed a total of 115 patients (17.96%) having PHB with unilaterality seen in 15.15% and bilaterality in 2.81%. Our rate of 17.96% falls within the rate interval seen across the literature for PHB.
RV variations, in general, do not form a contraindication for donor nephrectomy. However, to prevent inadvertent incisions of RV, there is a need to know the variations like RaLRV and CaLRV. Also, planning for RV catheterisation for renin sampling becomes easier if the variations are known beforehand. On similar lines, venous variations become important before placing an inferior vena cava filter.
Studies by Koc et al.20 Raman et al.21 and Cinar C et al.2 found the prevalence of multiple right RV of 14.3%, 24%, and 21.6%, respectively. In our study, multiple right RV was found in 5.78% of the total population and is lower than the other studies. Cinar C et al.2 found a total prevalence of LcRV of 7.3%, while we found its prevalence to be a little higher (9.84%). Concerning the variations in the course of the left renal vein, Raman et al.21 found 2% RaLRV and 8% CaLRV while Cinar et al.2 found 4.2% RaLRV and 5.2% CaLRV. Our prevalence rate of 6.71% RaLRV is higher, and 0.78% CaLRV is lower than those studies. These differences in various RV variations in our study compared to other studies could be due to racial differences.
Only a single study available in the present literature has investigated the gender association with renal artery variations2 They found no significant difference between the gender in terms of RA variation prevalences, though they found PHB more frequently in men. We too observed an increased prevalence of unilateral PHB in men, but the bilateral PHB was more prevalent in women. However, the differences in these arterial variations among the gender were not significant statistically (p>0.05). Our study's interesting findings include the exclusive occurrence of bilateral Ao-AbRA and bilateral mixed origin of AbRA in the female population.
All venous variations except the CaLRV showed a male predominance in our study. Cinar et al.2 also found men to have increased prevalence rates of multiple right RV and RaLRV like our study. However, unlike our study, they found that the CaLRV had an increased prevalence in the male population and LcRV had near equal prevalences in the men and female populations. However, the differences in these venous variations among the gender were not significant statistically, and the same was true in our study.
Limitations of the study include no comparison with the digital subtraction angiography which is still the gold standard for vascular assessment and the interobserver variation among the radiologists was not assessed.
Conclusion:
Knowledge and awareness of renal vessel variations are crucial for radiologists and surgeons, and CECT forms an excellent modality in their evaluation. AdRA was the most common arterial variation, and among the venous variations, the unilateral LcRV formed the most common variation, especially on the right side. Re-AbRA, which is seldom studied in the available literature, had a prevalence of 5.15%, and bilateral Ao-AbRA and bilateral mixed origin AbRA were exclusively seen in females. No statistically significant association between the gender and vascular variations was seen. Likewise, no significant association between RA and RV variations was detected.
Source(s) of support: Nil
Presentation at a meeting: Nil
Conflicting Interest (If present, give more details): Nil
Acknowledgment:
The authors would like to thank Dr Prakashini, HOD and Professor, Radiology Dept., KMC Manipal and Dr Rajagopal K V, Professor, Radiology Dept., KMC Manipal for constant support and encouragement during this study.
Authors Contribution:
1. Karegowda H Lakshmikanth – Principal Investigator
2. Mathew Oshin - lead Investigator
3. Raju Vinay - lead Investigator
4. Pendem Saikiran - lead Investigator
5. Priyanka – lead investigator
6. Ramprasad Bolar – statistics and methodology.
Figure 1: VR images which show the difference between PHB (early branching) and Re-AbRA. Note in image A, the branch of main renal artery (thin white arrow) enters the kidney through the hilum suggestive of PHB while in image B the branch from main renal artery (bold white arrow) is coursing to its pole suggestive of Re-AbRA.
Figure 2: VR images showing, A – One AdRA represented by a left-sided AcRA (thin white arrow), B- Two AdRA represented by bilateral AcRA (bold white arrows), C- Three AdRA represented by two right-sided AcRA and one left-sided AcRA (thin yellow arrows) and D- Four AdRA represented by three AcRA (thin blue arrows) and one AbRA (thin white arrow)
Figure 3: VR images showing, A- Bilateral Ao-AbRA (thin white arrows) and B- Bilateral Re-AbRA (bold white arrows)
Figure 4: Axial MIP reconstructions during the venous phase of contrast study. A- shows left-sided LcRV (bold white arrow), B- shows double right renal vein (white asterisks), C- shows CaLRV (yellow arrows) and D- shows RaLRV (green arrow)
Englishhttp://ijcrr.com/abstract.php?article_id=4161http://ijcrr.com/article_html.php?did=4161
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Holden A, Smith A, Dukes P, Pilmore H, Yasutomi M. Assessment of 100 live potential renal donors for laparoscopic nephrectomy with multi-detector row helical CT. Radiology. 2005;237(3):973-80.
Khamanarong K, Prachaney P, Utraravichien A, Tong?Un T, Sripaoraya K. Anatomy of renal arterial supply. Radiology. 2004;17(4):334-6.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAnalysis of Relationship between the Curve of Spee and Various Skeletodental Parameters in Different Malocclusion Groups
English2023Madhav ManjunathEnglish Korayem MohammedEnglish Khajuria Kumar AmitEnglish Yadav MohitEnglishIntroduction: The spee curve was measured from the most distal section of the second molar to the incisal edge in this study. When the incisors are included in the interpolation, the curve becomes broader, flatter, and more variable. Aim: To analyse the relationship between the curve of spee and various skeletodental parameters in different malocclusion groups. Method: 120 untreated patients’ lateral cephalograms, study models, and frontal pictures were included in the study, and they were divided into five malocclusion groups. The research models were used to quantify COS depth, overjet, overbite, and arch depth. On frontal photographs, the facial index was calculated, while lateral cephalograms were used to examine other skeletaldental parameters (mandibular anterior dental height, mandibular posterior dental height, IMPA, mandibular plane angle, J-ratio, lower facial height, UFH/LFH, mandibular body length, and ramus height). Results: The COS depth was greatest in class II division 2 group and lowest in the class III malocclusion group. COS depth and overjet had a statistically significant positive link in class I, class II division 1, and class II subdivision, whereas COS depth and overbite had a statistically significant positive association in class II division 2 and class III. Conclusion: Overjet and IMPA were major contributors to the increasing curve of Spee in class II division 1, class I, whereas overbite and facial index were major contributors to the curve of Spee in class II division 2.
English IMPA, COS, Malocclusion, Overjet, Skeletodental, OverbiteIntroduction: Exaggerated curve of spee is a typical malocclusion seen in dental malocclusions with a deep vertical overbite, posterior extrusion, and incisor proclination.1 Increased curvature of spee has been linked to a brachycephalic facial pattern2 and short mandibular bodies.3
According to Osborn, the curve of spee is formed by a combination of elements such as orofacial structure growth, tooth eruption, neuromuscular system development, and craniofacial variance.4 In orthodontic practice, levelling the curve of spee is a common operation, and the more noticeable the curve is, the more space is necessary to flatten the dentition. As a result, determining the depth of the curve of spee is crucial to the orthodontic diagnostic and treatment protocol.5
The spee curve was measured from the most distal section of the second molar to the incisal edge in this study. When the incisors are included in the interpolation, the curve becomes broader, flatter, and more variable.6 The goal of this study was to see if the presence of a Spee curve could be related to facial metrical characteristics, as well as to see whether there was a correlation between the depth of a Spee curve and other skeletodental traits.
Materials and Methodology: The present cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Care Dental College, Guntur, Andhra Pradesh. The pre-treatment records (lateral cephalograms, study models and frontal photographs) of 120 subjects within the age range of 14-26 years were included in the study.
Based on the ANB angle, the 120 subjects selected were classified into three groups: Group I (skeletal class I malocclusion), Group II (skeletal class II malocclusion) and Group III (skeletal class III malocclusion). Group II, was further subdivided into Groups IIa, IIb and IIc, based on Angle’s classification of malocclusion (CDC/IEC/2020/020).
I. Analysis of Orthodontic study models:
Digital images were taken with a standardized photographic set-up and a DSLR camera to gain precision in measuring the depth of curve of Spee and arch depth. Photographs of the models' right, left, and occlusal surfaces were taken after they were put on the model platform. These images were then imported into Adobe Photoshop 7.0 for COS and arch depth measurements.
A. Curve of spee measurement: A horizontal line was drawn using the ruler tool, touching the incisal margins anteriorly and extending posteriorly to the distal cusp of the last erupted molar. The distance between the deepest cusp and another vertical line drawn perpendicular to the preceding line was measured. On the left side, a similar treatment was performed.
B. Arch depth Measurement: Photographs were cropped at 1:1 magnification, and then a horizontal line was drawn tangential to the mesial surface of one side's first molars and extending to the mesial surface of the contralateral side's first molar. Another vertical line was drawn perpendicular to this line at the level of incisal edges midway between central incisors, and the distance of this vertical line was quantified as arch depth.
II. Photographic measurements:
An extraoral frontal photograph at rest was taken to determine the facial form.
1. Softtissue nasion (N’)
2. Soft tissue Gnathion (Gn’)
3. Zygomatic prominence (Zy’)
Facial index (N?-Gn?/ Zy?-Zy?): It is taken as the ratio of the length of face to its maximal width between the zygomatic prominencies.
III. Cephalomteric Measurements:
SNA, SNB, Anterior mandibular dental height, Posterior mandibular dental height, Incisor mandibular plane angle (IMPA), Mandibular plane angle (SN-MP), Jarabak’s ratio (S-Go/N-Me), Lower facial height (LFH=ANS-Me), UFH/LFH (N-ANS/ANS-Me), Mandibular body length (Go – Pog) and Ramus height (Ar- Go).
Statistical analysis: Analysis was done using SPSS software, version 24. Test applied were Anova along with Tukey HSD Post Hoc test, Pearson correlation and multiple regression analysis.
Results: The mean and standard deviation of the depth of COS for each group were analyzed and it showed no clinically significant difference between right and left sides, so the mean value was taken into consideration.
The depth of curve of Spee was maximum in class II div.2 subjects (group IIb) and least in class III subjects (group III). Depth was observed in this order: class II div. 2> class II div. 1>class II sub div.> class I >class III with statistically significant difference (p= 0.01*) as shown in table 1.
There was a positive correlation between the depth of curve of spee and overjet in groups I, IIa, and IIc but there was no correlation in groups II b and group III. The overbite was positively correlated with the depth of curve of spee in groups IIb and group III as shown in table 2.
Multiple regression analysis showed that Overjet had a significant contribution to depth of cos in class IIc, class IIa and class I. Overbite had the contribution to depth of cos in class II div.2 malocclusions (β= 0.437) only. IMPA had the contribution to depth of cos in class II div.1 group and class II (Table 3).
Discussion: The assessment of the relationship of the curve of spee with multiple factors may help know the aetiology of the development of the curve of spee and treatment planning to rectify it. Hence, our present study was aimed to assess and correlate the relationship of curve of spee (COS) with dentoskeletal morphology to understand the influence of multiple factors that lead to its development.
According to Carter and McNamara, when the COS was measured on pretreatment dental casts, there was no variation in depth between male and female individuals.7 This was also reported by Farella and colleagues, hence no attempt was made to divide the sample by gender in this investigation.8
In the present study depth of the curve of spee was more in class II div.2 subjects (group 3), followed by class II div .1 subjects ( group 2) > class II subdiv. subjects (group 4)>class I subjects (group1) and least depth was seen in class III subjects (group 5). However, it did not show a statistically significant difference between class II div. 1 and div.2 subjects. This is supported by a study done by Veli and colleagues who also reported no significant difference in depth of curve of spee between class II div.1 and class II div.2 subjects.9
The depth of the spee curve grows greatly as the overjet10 grows, and the results of our investigation corroborated these findings. The results of this investigation revealed that when the overjet increases, the depth of the curve of spee in the mandibular arch rises. Veli and colleagues found a statistically significant relationship between the spee curve and the overjet.9 When overbite was compared to COS in different malocclusion groups, there was a statistically significant link. In class II div, Pearson correlation coefficient and multiple regression revealed a positive link between overbite and cos. Class II and III are the two groups. According to Burstone, deep bite therapy may include maxillary anterior tooth intrusion, mandibular anterior tooth intrusion, maxillary and mandibular posterior tooth extrusion, or any combination of these procedures.10
The facial index was connected to a deeper COS in class II div.2 malocclusions, but it did not exhibit a significant link with the curve of spee in other malocclusions, according to Pearson coefficient test findings. COS is more prominent in people with short faces and deep bites, according to Farella et al., who found that those with short faces and deep bites have higher COS.8
IMPA contributed to the curve of spee depth in class II div. 2 and class III malocclusion groups, according to multiple regression analysis. According to Balridge, a flattening of Spee's curve promotes an increase in arch circumference and decreased incisor proclination.11
Overall, the results of this study imply that the stomatognathic system compensates for dentoskeletal variation by altering the form of the spee curve, albeit only to a limited amount. One of the goals of orthodontic treatment is to level the curve of the spee, and to do so, the value of the curve of spee depth should be considered and quantified in space management procedures to avoid incisor flaring and, as a result, to ensure aesthetics, treatment stability, and function.
Conclusions: The depth of cos was greatest in class II div.2 groups followed by class II div1, class II subdiv., class I and class III with the least amount of depth. In class I malocclusion, overjet was positively correlated with COS. In class II div.2 malocclusion, overbite and facial index were related to COS. In class II sub div. malocclusion, overjet and mandibular plane angle were contributing factors for COS whereas Jarabak’s ratio was negatively related to it. In class III, IMPA was the major factor for the depth of COS.
Conflict of Interest: None
Source of Funding: None
Acknowledgement: None
Authors Contribution
Madhav M: Manuscript preparation, Data Collection
Korayem M: Statistical analysis
Khajuria AK: Manuscript editing
Yadav M: Data Collection
Englishhttp://ijcrr.com/abstract.php?article_id=4162http://ijcrr.com/article_html.php?did=41621. Strange RH. A textbook of orthodontia. 3rd edition. Philadelphia: Lea and febiger, 1950.
2. Barager FA, Osborn JW. Efficiency as a predictor of human jaw design in the saggital plane. J Biomech. 1987;20(5);447-57.
3. Ash M. Wheeler’s dental anatomy, physiology and occlusion. 7th ed. Philadelphia: SWB Saunders, 1993.
4. Osborn JW. Orientation of the masseter muscle and the COS about crushing forces on the molar teeth of primates. Am J Phy Anthropol. 1993;92:99-106.
5. Braun S, Hnat WP, Johnson BE. The curve of Spee revisited. Am J Orthod Dentofacial Orthop 1996;110:206-10.
6. Hitchcock HP. The curve of Spee in stone age man. Am J Orthod. 1983;84:248-53.
7. Carter GA, McNamara JA. Longitudinal dental arch changes in adults. Am J Orthod Dentofacial Orthop.1998;114:88-99.
8. Farella M, Michelotti A, Van Ejiden TM, Martina R. The curve of Spee and craniofacial morphology: a multiple regression analysis. Euro J Oral Sci. 2002;110(4):277-81.
9. Veli I, Ozturk MA, Uysal T. Curve of Spee and its relationship to the vertical eruption of teeth among different malocclusion groups. Am J Orthod Dentofacial Orthop. 2015;147:305-12.
10. Burstone CP. Deep overbite correction by the intrusion. Am J Orthod 1977;72:1-22.
11. Balbridge DW. Levelling of the curve of spee and its effect on mandibular arch length. JPO 1969;3:26-41
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareFoetal Foot Length - A Parameter to Estimate the Gestational Age Using Ultrasonography and its Relation with Femur Length
English2427Rao CBREnglish Sunkeswari SEnglish Patil SEnglishIntroduction: Foetal biometry is an important parameter to assess the gestational age of the foetus and has to be standardised based on the screening population. Foetal foot length has a characteristic pattern of normal growth and could be used to estimate gestational age. Aims- To establish the relationship between the foetal foot length and the gestational age and the femur length using the femur/ foot length ratio. Materials & Methods: The foetal foot length and femur length was noted by ultrasonography and the relation of foot length with gestational age and femur length were calculated. Results: There was a positive correlation between foot length and gestational age. The femur/foot length ratio was between 0.84 and 1.02. Conclusion: Foetal foot length can be used as an additional parameter to estimate gestational age.
EnglishIntroduction
Ultrasonography has emerged as a simple modality to assess the gestational age of foetuses because of its painless, non-invasive, non-ionizing, safe, portable, redoable, ease of access and relatively inexpensive nature. 1,2,3 Accurate knowledge of gestational age is important for appropriate obstetric care, scheduling, interpretation of certain antepartum tests, determination of foetal growth and designing interventions to prevent preterm births and related morbidities. 4,5,6
Foetal biometry is an important parameter to assess the gestational age of the foetus and has to be standardised based on the screening population. Various parameters have been used for this like crown-rump length, biparietal diameter, head circumference, abdominal circumference, femur length and humerus length. 7,8,9
Foetal foot length has a characteristic pattern of normal growth and could be used to estimate gestational age. 10,11,12,13,14 Femur/foot length ratio can also be used to identify dysplastic limb and to differentiate it from constitutional factors and growth retardations. 1,2,3The present study aims to establish the relationship between the foot length and the gestational age and the femur length using femur/ foot length ratio.
Methodology
The study was done in the Department of Radiology of a certain medical college in Karnataka, with a Philips HD6 ultrasound system over one year. The study subjects were 152 pregnant women of age 20 to 30 years attending the routine antenatal screening with the gestational age of 15 to 40 weeks. The gestational age was calculated by the last menstrual period and confirmed by the crown-rump length in early pregnancy ultrasound scan. The subjects were invited to participate in the study with written consent obtained under the approval of the institutional ethical committee (Ref: SDMIEC:023). The patients with known complications of pregnancy like oligohydramnios, polyhydramnios, diabetes, hypertension, pre-eclampsia and multiple gestations were excluded from the study. Femur length was measured as the maximum diaphyseal length of bone using electronic callipers. Foot length was measured as the longest distance from the posterior most of the foot to the tip of the first or second toe whichever was longer. The mean value of foot length and femur length for each gestational week was calculated from 15 to 40 weeks. The correlation and regression analysis were done to quantify the relationship using Microsoft Excel.
Results
The mean values of measurements of foot length and femur length are shown in table 1. The ratio of femur length to foot length ratio was calculated and was found to be between 0.84 and 1.02. It was observed that the foot length linearly increased from 1.8cm at 15weeks to 8.34cm at 40weeks of gestation. It can be interpreted with a 95% confidence interval that gestational age can be calculated from foetal foot length. The simple linear regression analysis shows a linear relationship between foot length and gestational age (gestational age = 3.92x foot length + 7.41) with high positive correlation (r= 0.99, pEnglishhttp://ijcrr.com/abstract.php?article_id=4163http://ijcrr.com/article_html.php?did=4163
Lakshmi, Adil S, Mallikarjunappa, Hameed A, Revathi R, Parimala M. Fetal gestational age estimation by fetal foot length measurement and fetal femur to foot length ratio in south Indian population- A prospective study. Int J Sci Res. 2019 oct;8(10):56–8.
Majmudar DK, Vaidya CV, Sanghrajka VJ. Accuracy of Foetal Foot Length and Femur / Foot Length Ratio in USG Estimation of Gestational Age. Int J Contemp Med Surg Radiol. 2019;4(2):2018–20.
Wong HS. A revisit of the fetal foot length and fetal measurements in early pregnancy sonography. Int J Womens Health. 2017;9:199–204.
Hern WM. Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstet Gynecol. 1984;63(1):26–32.
Srivastava A, Sharma U, Kumar S. To study correlation of foot length and gestational age of new born by new Ballard score. Int J Res Med Sci. 2015 Nov;3(11):3119–22.
Arshad M, Rahman F, Amir A, Khan K. Comparison of Parameters of Hand and Foot Growth with Gestational Age among Human Male and Female Foetuses - A Morph Metric Analysis. Int J Contemp Med Res. 2019;6(6) F1-F8.
Gavhane S, Kale A, Golawankar A, Sangle A. Correlation of foot length and gestational maturity in neonates. Int J Contemp Pediatr. 2016 Aug;3(3):705–8.
Singhal S, Tomar A, Masand R, Purohit A. A Simple Tool for Assessment of Gestational Age in Newborns Using Foot Length. J Evol Med Dent Sci. 2014 June ;3(23):6424–9.
Rao CBR, Sunkeswari S, Kalghatgi RN. The study of relation between the gestational age of human fetuses and the diaphyseal length of humerus using ultrasonography. NJCA 2017 oct;6(4): 266-72.
Mukta M, Prashant G, Vineet N. Fetal gestational age estimation by fetal foot length measurement and fetal femur to foot length ratio in indian population - a prospective study. J Evol Med Dent Sci. 2014;3(10):2620–5.
Rakkappan I, Kuppusamy N. Newborn Foot Length Measurement to Identify High-risk Neonate. Int J Sci Study. 2016 May;4(2):13–9.
Hemraj S, Acharya DK, Abraham SM, Vinayaka US, Ravichandra G. Fetal foot length and its sonographic correlation with gestational age. Donald Sch J Ultrasound Obstet Gynecol. 2017 April- June;11(2):141–5.
Manjunatha B, Nithin MD, Sameer S. Cross sectional study to determine gestational age by metrical measurements of foot length. Egypt J Forensic Sci. 2012;2(1):11–7.
Ho TY, Ou SF, Huang SH, Lee CN, Ger LP, Hsieh KS, et al. Assessment of Growth From Foot Length in Taiwanese Neonates. Pediatr Neonatol. 2009;50(6):287–90.
Salge AKM, Rocha ÉL, Gaíva MAM, Castral TC, Guimarães JV, Xavier RM. Foot length measurements of newborns of high and low risk pregnancies. Rev da Esc Enferm. 2017;51(1):5–9.
Hirst JE, Ha LTT, Jeffery HE. The use of fetal foot length to determine stillborn gestational age in Vietnam. Int J Gynecol Obstet. 2012;116(1):22–5.
Joshi K, Marahatta S, Karki S, Tamrakar S, Shrestha N. Fetal Foot Length and Femur/ Foot Length Ratio: Significance in Nepalese Context. Nepal J Radiol. 2012;1(1):15–22.
James DK, Dryburgh EH, Chiswick ML. Foot length: A new and potentially useful measurement in the neonate. Arch Dis Child. 1979;54(3):226–30.
Pandey VD, Singh V, Nigam GL, Usmani Y, Yadav Y. Fetal foot length for assessment of gestational age: A comprehensive study in north India. J Anat Soc India. 2016 Sep; 3(1C): 139-44.
Yüksel K, Günyeli ?, Do?anay M, U?ur M, Mollamahmuto?lu L. Ultrasonographic Assessment of The Fetal Foot Length for Gestational Age Estimation. Gynecol Obstet Reprod Med. 2006;12(1):27–9.
Bardale R, Sonar V. Assessment of Gestational Age from Hand and Foot Length. Indian J Forensic Med Pathol. 2008 April-June;1(2):47–51.
Streeter GL. Weight, sitting height, head size, foot length and menstrual age of the human embryo. Contrib embryo Cornegie Inst 1920; 11(3):143-70.
Campbell J, Henderson A, Campbell S. The foetal femur/ foot length ratio: A new parameter to assess dysplastic limb reduction. Obstet Gynecol 1988; 72 (2): 181-4.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareRole of High-Resolution Computed Tomography Temporal Bone in Evaluation of Patients with Chronic Suppurative Otitis Media (CSOM)
English2835Karegowda H LakshmikanthEnglish Singhal Rahul KumarEnglish Vinay RajuEnglishIntroduction: CSOM is chronic inflammatory changes of the tympanic cavity and one of the leading causes of chronic aural discharge which has potential for intracranial extension and associated middle ear complications. High-Resolution Computed Tomography (HRCT) is needed for the assessment of disease localisation, ossicular dignity, bony walls status and post-surgical assessment. Objective: To study the HRCT findings of the temporal bone in patients with CSOM and also to determine the efficacy of HRCT in patients with CSOM by comparing the preoperative findings with intraoperative findings (gold standard), whenever available. Method: Prospective observational study conducted over 14 months in 167 ears diagnosed with CSOM who underwent HRCT temporal bone, using Philips Incisive 128-slice MDCT scanner. The radiological findings were further compared with the intraoperative findings to calculate the sensitivity, specificity, negative predictive value, and positive predictive value(PPV) for diagnostic accuracy and further overall accuracy were calculated. Results: From a total of 167 ears, surgical and radiological findings showed a high level of sensitivity and specificity for location and extent of soft tissue density, ossicular status and tegmen erosion, tympanic membrane status, mastoid pneumatisation, scutum erosion with a p < 0.01 but less sensitive for facial canal erosion. Conclusion: HRCT scan is an excellent preoperative imaging modality for the otologist to predict disease during the surgery. Early identification of complications enables a better surgical approach and treatment plan thereby making high resolution computed tomography an essential workup diagnostic tool.
EnglishHigh Resolution, CSOM, Otitis, MediaIntroduction:
CSOM is a common condition seen in patients visiting the otolaryngology department. Cholesteatoma is a serious condition that can progressively enlarge and can be associated with complications because of erosion into surrounding structures like meninges, brain, internal carotid artery, jugular bulb and facial nerve.1-7
The diagnosis of aural cholesteatoma is made radiologically by Imaging methods, such as HRCT and MRI.HRCT findings suggesting cholesteatoma include scutum erosion, aditusadantrum widening, ossicles erosion, facial nerve canal erosion, tegmen erosion, mastoid destruction (automastoidectomy), sigmoid plate dehiscence, and bony external auditory canal erosion.8,9,10 Prior knowledge of the extension and the complications of cholesteatoma will help clinicians in surgical approach and treatment plan.
The study aimed to assess the role of HRCT temporal bone in the evaluation of patients with chronic suppurative otitis media (CSOM) patients with objectives being to study the HRCT findings of the temporal bone in patients with CSOM and also to determine the efficacy and role of HRCT temporal bone in patients with CSOM by comparing the preoperative findings with intraoperative findings (gold standard), whenever available.
Methods and design:
This prospective study was conducted at the Department of Radiodiagnosis and Imaging over 14 months (Aug. 2019 – November 2020). A total of 167 patients who were referred to the Department of Radiodiagnosis and clinically suspected of having CSOM, was the included subjects. Exclusion criteria were trauma or neoplastic growth involving the middle ear, previous middle ear operation, acute otitis media and granulomatous or residual or recurrent disease.
197 ears in 167 patients, clinically diagnosed with chronic suppurative otitis media were evaluated. Patients were referred to the Department of Radiodiagnosis for HRCT temporal bone which was performed using multi-slice detector Philips Incisive 128-slice CT scanner with serial 0.67 mm thin sections. Axial projections were obtained, Coronal and Sagittal reformatted images were obtained. For ossicular evaluation, the V reconstruction method was used.
Parameters of comparison were:
Soft tissue extension in the attic, aditus ad antrum, hypotympanum, mesotympanum, Prussak’s space, mastoid antrum, facial recess and sinus tympani.
Ossicular chain status.
Bony erosions involving scutum, facial canal, tegmen tympani, sigmoid plate, facial canal and lateral semi-circular canal.
Presence of cholesteatoma or granulation tissue.
Tympanum changes – Perforation/thickening/retraction.
Complications of cholesteatoma
Following surgery, these parameters were individually compared with surgical findings. These intra-operational results were regarded as the gold standard and correlated with radiological observations.
STATISTICAL ANALYSIS:
Comparative parameters between pre-operative HRCT and intraoperative findings were determined using Sensitivity(Sn), Specificity(Sp), negative predictive value(NPV) and positive predictive value(PPV) for diagnostic accuracy and overall accuracy were calculated and tabulated, taking surgery as the gold standard.
The association between radiological and intra-operative findings was tested using the Chi-square test to find out any statistically significant difference. A value of Englishhttp://ijcrr.com/abstract.php?article_id=4164http://ijcrr.com/article_html.php?did=4164
Lane JI, Lindell EP, Witte RJ, DeLone DR, Driscoll CLJR. Middle and inner ear: improved depiction with the multiplanar reconstruction of volumetric CT data. 2006;26(1):115-24.
Chatterjee P, Khanna S, Talukdar RJIJoO, Head, Surgery N. Role of high resolution computed tomography of mastoids in planning surgery for chronic suppurative otitis media. 2015;67(3):275-80.
Sreedhar S, Pujari K, Agarwal AC, Balakrishnan RJIJoO. Role of high-resolution computed tomography scan in the evaluation of cholesteatoma: A correlation of high-resolution computed tomography with intra-operative findings. 2015;21(2):103.
Kanotra S, Gupta R, Gupta N, Sharma R, Gupta S, Kotwal SJIJoO. Correlation of high-resolution computed tomography temporal bone (TB) findings with intraoperative findings in patients with cholesteatoma. 2015;21(4):280.
Prakash M, Tarannum AJIJoO, Head, Surgery N. Role of high resolution computed tomography of the temporal bone(TB) in preoperative evaluation of chronic suppurative otitis media. 2018;4(5):1287.
Karpagam B. High-Resolution CT Imaging in Pathologies of Temporal bone(TB).
Shah CP, Shah PC, Shah SD. Role of HRCT temporal bone in the pre-operative evaluation of cholesteatoma. Int J Med Sci Public Health 2014;3:69-72
Niveditha J, Chidananda R. Clinical study of the correlation between preoperative findings of HRCT with intra-operative findings of cholesteatoma in cases of CSOM. Indian J Anatomy Surgery Head, Neck Brain 2017;3(1):1-5.
Zeifer B. Radiology of the temporal bone. In: Thomas R, Staecker H, editors. Otolaryngology, basic science and clinical review. 1st edition. Thieme Medical Publishers; 2006: 431–442.
Mohammadi G, Naderpour M, Mousaviagdas M. Ossicular Erosion in Patients Requiring Surgery for Cholesteatoma. Iranian J Otorhinolaryngol. 2012;24(68):125–8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareFunctional Outcome of Distal End Radius Fractures Treated Conservatively in a Tertiary Care Centre
English3639Sujei SukumaranEnglish Dennis AntonyEnglishIntroduction: Distal radius fractures are one of the most common injuries that Orthopaedic surgeons face during their trauma practice. But it remains a dilemma to many surgeons whether to operate on patients with this kind of fracture. Objectives: Our study aimed to evaluate the functional outcome and postoperative complications of fractures of the distal end of the radius in the elderly managed conservatively in a tertiary care centre. Materials and Methods: A prospective study of cases of the distal end of radius fractures meeting the inclusion criteria admitted in Thrissur Government Medical College between 1-01-2018 to 1-06- 2019 was carried out. Fractures were classified according to the Frykman system and closed manipulative reduction attempted. After a minimum follows of 6 months the anatomical and functional outcomes were standardised using Lind storms anatomical and functional scoring system. Results: A series of 55 cases with the distal end of radius fracture were studied comprising of 24 males and 31 females. The largest contribution came from the age group of 60 to 65 years (50%). Slip and fall at home on hand was the commonest cause of injury (62.5%). Type I Frykman made the largest contribution with 22 cases. A total of 6 cases were found to develop complications including joint stiffness, paresthesia and malunion. The excellent anatomical reduction was achieved in 39 cases and good results in 9 cases. Functionally, 33 cases had an excellent outcome and 13 had a good result. Conclusion: This single-centre population series demonstrated good to excellent results in a majority of the patients after closed manipulative reduction of the distal radius, with outcomes and complications compared to other studies in the literature.
EnglishClosed manipulative reduction, Distal end radius fracture, Functional outcome, Lind storms anatomical scoring system, Lind storms functional scoring system, Single cohort studyINTRODUCTION
Lower end of radius fractures is arguably one of the most common fractures of the upper extremity, encountered in clinical practice and constitute almost 17 % of all fractures and 75% of all forearm fractures.1 This fracture shows a bimodal distribution with increased incidence in the young and in the elderly.2 Pathologically distal radial extraarticular fractures are relatively stable injuries that can prove quite challenging if not managed properly. Intraarticular fractures of the distal radius, comprise a distinct and complex subgroup of wrist injuries. Disfiguring and disabling residual deformities following comminuted distal radius fractures are common to this day.
Classifying the distal radius fractures to delineate the best treatment protocols has been a monumental task as evidenced by the numerous classification systems put forth by various studies through the centuries and their relative acceptance.
The commonly used classification is the Frykman classification which depends on the extent of involvement of the articular surface of the distal radiocarpal joint (DRCJ) and distal radio-ulnar (DRUJ) joints. 3
Type I: Transverse metaphyseal fracture includes both Colles and Smith fractures as angulation is not a feature
Type II: Type I + ulnar styloid fracture
Type III: Fracture involves the radiocarpal joint
Type IV: Type III + ulnar styloid fracture
Type V: Transverse fracture involves distal radioulnar joint
Type VI: Type V + ulnar styloid fracture
Type VII: Comminuted fracture with involvement of both the radiocarpal and radioulnar joints
Type VIII: Type VII + ulnar styloid fracture
The other commonly used classification systems are
Gartland and WerleyClassification
FernandezClassification
MeloneClassification
AOClassification
Current literature equally weighs the treatment principles of closed and surgical management. Most surgeons prefer the conservative approach to distal radius fractures in elderly patients through complicated fractures with articular incongruency is still a topic of debate. The consensus is that dorsally displaced fractures are managed conservatively or with percutaneous approaches; while volar displaced fractures are treated by open surgery. In this paper, we present results of 55 cases of distal radius fractures in patients above 60 years of age treated with closed manipulative reduction and below elbow POP immobilization. The purpose of this study is to evaluate the outcome of conservative treatment in the management of distal end radius fractures in elderly patients.
MATERIALS & METHODS
This is a single cohort study done among 55 elderly patients with distal end radius fractures treated by closed manipulative reduction and Plaster of Paris (POP)immobilization at Govt. Medical College, Thrissur from 01-07-2018 to 01-07-2019.
Patients above 60 years of age with distal radius fracture treated conservatively by closed manipulative reduction and below elbow slab attending the orthopaedics Department, Govt. Medical College Thrissur was included in the study.
Exclusion criteria included patients not consenting, compound fractures and severely comminuted intraarticular fractures.
The ethical clearance for the study was obtained vide Order No. B6-8772/2016/MCTCR (8) dated 28.6.2018. Thereafter, the data were obtained for all study patients as per the proforma after getting informed written consent. Age, sex, nature of trauma, site of the fracture, any associated injuries, any pain, swelling, and loss of functions were noted. On examination, any tenderness, deformity, swelling, distal vascularity, neurological deficit and associated other injuries were also noted. X rays of both AP and Lateral views were taken. After proper history taking, clinical examination, radiological workup, patients were taken up for closed manipulative reduction and below elbow POP slab application. Post reduction, distal vascularity and neurological status re-assessed. A post-procedure check X-ray was taken to assess acceptable reduction.
Patients were advised to active finger movement and limb elevation. Patients have been instructed symptoms of compartment syndrome and warned to consult an orthopaedician if symptoms develop. They were discharged on the same day itself. After 1-week, the POP slab was inspected and converted to POP above-elbow cast without losing reduction. Patients were followed in our Outpatient Department at the end of 1st week, 6th week, 3 months, and 6 months.
RESULTS
55 Cases of distal end radius fractures in elderly patients treated conservatively with closed reduction and POP immobilization were studied and analysed using Lindstrom’s functional grading criteria.4 Among 55 cases, 31(56.4%) patients were females and 24(43.6%) were males.
In our study, the age of patients ranged from a minimum of 60 years to 80 years. The maximum number of patients belong to the 60-65 years group. The mean age is 67.9 years. Considering the side of involvement, 37 (67%) Fractures were on the right side and 18(33%) fractures were on the left side.
Out of 55 cases, there was no residual disability in 31 cases, 12 cases showed minimal and 10 cases showed moderate disability and 2 showed severe disability. Grip strength was not lost in 30 cases whereas 18 cases showed slight loss and 8 cases showed moderate loss and 1 showed a severe loss. Grip strength was lost in cases complicated by infection or joint stiffness. There was no residual deformity in 33 cases while 12 cases had minimal, 8 had moderate and 2 cases had a gross deformity (Table 1 & 2). 59% of the patients reported excellent functional results (Figure 1).
Of the 55 patients in the study who were managed conservatively, only 9 developed one or other complications ranging from mild (blisters) to paresthesia of median nerve and reflex sympathetic dystrophy. 2 cases developed blisters which were promptly treated and healed well. Both of these cases went on to develop joint stiffness and a lower functional scoring. One of the cases developed paresthesia along with median nerve distribution. 3 cases developed reflex sympathetic dystrophy. (Table 3)
DISCUSSION
This study was done among 55 patients meeting inclusion and exclusion criteria over 12 months. Functional outcomes were measured by using Lindstrom criteria.4 The results of the study were compared with a similar study conducted by other authors.
Restoration of wrist function to pre-injury levels and limitation of pain at the lowest possible cost is the clinical goals.5 To optimize function and to reduce future degenerative disease with a subsequent disability, achievement of as near anatomic position as possible is required.5,6,7,8
Nakata R.Y, Chand Yogesh in their series of 22 patients compared the movements of the affected side with that of the opposite side and found it be as follows - palmar flexion 60°, dorsiflexion 60°, ulnar deviation 25, radial deviation 15°, pronation 63° and supination 65°.9
The results of movements and grip strength of our series were comparable to the majority of the above series, the average results in our series were palmar flexion 72.8°, dorsiflexion 67.5°, radial deviation-18.3°, ulnar deviation- 32.3°,pronation-72.4°and supination of 77.6°(Figure 2).
Our present study also showed an excellent grip in about 54.54 % of our cases, and good grip strength in 32.7 % of the cases and fair in 10.9% of cases. Poor grip strength was observed only
in 1.8% cases.
Gupta K.et al. in their study comparing open reduction & internal fixation with the closed manipulative reduction in volar displaced distal radial fractures obtained satisfactory results in 86% cases and fair results in 14% cases.10 This is comparable to our study where 83.5% satisfactory result was obtained.
CONCLUSION
This single centre population series demonstrated good to excellent results in the majority of patients after closed manipulative reduction of the distal radius, with outcomes comparable to other studies in the literature.
This study also corroborates the finding of other well-designed studies showing the association between radiographic, anatomical and functional outcomes in the patient population with distal end radius fractures as an improved functional outcome was noted in those cases where excellent anatomical reduction could be achieved.
The myriad of classification systems and management protocols also leads us to the conclusion that a full consensus about distal radius fracture classification and management will probably never be possible. This is because surgeons will always have their personal preferences and experience-based strategies to tackle this issue.
Even in this age where implants and aggressive operative treatment is warranted in many of the fracture patterns, distal end radius fractures in the elderly are one amongst the few in which properly closed reduction and cast application have retained their importance to date, the main reason being that the less demanding population are satisfied with minor deformities if they have reasonably good functional status. Time and again the new generation has to accept the classical teachings of our great teachers of the past.
Acknowledgement: The authors are indebted to the patients who participated in this study. The authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.
Source of Funding: Nil
Conflict of Interest: None
Authors’ Contribution: Sujei Sukumaran is responsible for framing the protocol, data collection and writing of first and final drafts. Dennis Antony was responsible for the concept, management and care of study participants, statistical analysis and proofreading of the drafts.
Englishhttp://ijcrr.com/abstract.php?article_id=4165http://ijcrr.com/article_html.php?did=4165
Colles A. On the fracture of the carpal extremity of the radius. Edinb MedSurg 1814; 10:182-6
Ilyas AM, Jupiter JB. Distal radius fractures: Classification of treatment and indications for surgery. Orthop Clin North Am2007;38(2):167-173.
Frykman, G. Fracture of the distal radius including sequelae–shoulder- hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand: Suppl 1997; 108:103+.
Lindstrom A. Fractures of the distal end of the radius: A clinical and statistical study of results. Acta Orthop Scand Suppl. 1959;4:1-118.
Gofton W, Liew A. Distal radius fractures: nonoperative and percutaneous pinning treatment options. Orthop Clin North Am 2008;38(2):175-185
Abramo A, Kopylov P, Tagil M. Evaluation of a treatment protocol in distal radius fractures: A prospective study in 581 patients using DASH as an outcome. Acta Orthop 2008;79(3):376-385.
Nijs S, Broos PL. Fractures of the distal radius: a contemporary approach.ActaChirBelg2004;104(4):401-412.
Short WH, Palmer AK, Werner FW, Murphy DJ. A biomechanical study of distal radial fractures. J Hand Surg Am1987;12(4):529-534.
Nakata RY, Chand Y, Matika JD: External fixation for wrist fractures: a biomechanical and clinical study Jr. Hand Surgery, 1986; 10 (A): 845-851
Gupta K, Gaonkar N, Sudhir K, Patel N, Koli V, Date S et al. To Compare Functional Outcome, Complications & Results of Open Reduction & Internal Fixation with Closed Reduction & External Fixation in Volar Displaced Distal Radial Fractures. J of Evidence-Based Med & Healthcare. 2015;2(9):1155-1167.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareCharacterization and Green Biosynthesis of Silver Nanoparticles using Raphanus sativus and its Antibacterial Activity against Urinary Tract Infection Causing E. coli
English4045K. JagathyEnglish S. MalathiEnglishEnglishIntroduction:
Nanosized silver nanoparticles have discovered colossal applications in the field of high affectability biomolecular identification and diagnostics, antimicrobials, cancer prevention agents and therapeutics, catalysis1 and miniature hardware. Nanoparticles can be blended by different methodologies like compound and photochemical responses in invert micelles, microwave helped, warm deterioration, electrochemical, sonochemical measures.
Plant interceded natural combination of nanoparticles is acquiring significance because of its straightforwardness, financially savvy and eco-friendliness. AgNPs could be efficient nanoparticles as they possess good catalytic and high performance permanent magnetic properties and also possess biomedical and cytotoxic activity.
Raphanus sativus (Radish) is a common vegetable crop in Asia. It has a lot of nutrients B and C just as gelatin, phytin, manganese, iron and copper. Leaves are utilized to treat looseness of the bowels, asthma, hack, the runs, urinary plot disease and hunger. 2 It contains ferulic corrosive, gentisic corrosive, Raphanus, erucic corrosive, sinapate, raphanin and sulforaphane. The seeds are carminative, diuretic and purgative. Roots have been utilized for treating syphilis, haemorrhoids, gonorrhoea,3malignant growth and urinary complaints.
In this investigation, plant-mediated synthesis of AgNPs was carried out using aqueous leaf extract of Raphanus sativus and characterized using UV-visible spectroscopy, Fourier transforms infrared spectroscopy and scanning electron microscopy. The antibacterial activities of the green synthesized AgNPs have been investigated against Gram-negative bacteria. In the present study, results showed that the reported AgNPs are having bactericidal and cytotoxic activities.
Materials and Methods:
To obtain silver nanoparticles the deionized water was used as a reaction medium, the reducing agent used was vegetable extract, i.e radish extract and the reagent used for the synthesis was silver nitrate which does not evolve any toxic hazard on the atmosphere.
Preparation of Fresh Radish Extract
Radishes were procured from the local market (Nov 2019) [figure: 1]. Aqueous extract of Raphanus sativus was prepared using 25 gm. It was washed completely in deionised water, dried, cut into little pieces and were bubbled in 150 ml of deionized water for 5-10 minutes. The concentrate was separated through Whatman No.1 channel paper and utilized for additional exploration.
Quantitative Phytochemical analysis:
For qualitative analysis of active phytochemicals in R. Sativus leaf extract. Preliminary Phytochemical analysis was carried out on Aqueous extract using standard protocol for determination of phytoconstituents including tannins, saponins, phlorotannins, anthraquinones, carbohydrates, reducing sugars, steroids, phytosterol, flavonoids, alkaloids, amino acids, terpenoids, chalcones and cardiac glycosides as described by Karunakar Rao et al. 4
Synthesis of silver nanoparticle
The leaf extract was prepared by boiling method. (fig:2 leaf extract)1mM silver nitrate was prepared (fig 4 A). The silver nanoparticle was synthesized. Green synthesised silver nanoparticles were reddish-brown. The colour of the extract changed from light yellow to reddish-brown after the addition of silver nitrate and on incubation for 90 minutes. The colouration was due to the excitation of the surface Plasmon vibration of the AgNo3. Change in colour after the reduction of silver ions to silver nanoparticles is shown in figure 4 B. The reduction rate and formation of nanoparticles can be increased further by an increase in incubation time. [Figure: 2]
Characterization of silver nanoparticles
The concentrate was centrifuged twice to confine the AgNPs and to kill the undesirable excess. It was dried in a hot air stove for 30 minutes at a temperature of 1000C. Integrated silver nanoparticles were affirmed by UV–Vis spectroscopy and it was done utilizing UV-Vis spectrophotometer in the 200–1100 nm range. Point by point examination of the morphology, size and appropriation of the nanoparticles was recorded by Scanning Electron Microscopy (SEM) machine and the presence of reflection by XRD designs. The conceivable useful gatherings in the combination and adjustment of nanoparticles were distinguished by performing FTIR investigation.
Urine Sample Processing:
MICROSCOPY:
Smears were prepared by placing a loopful of the sample on a clear glass slide and gram staining was done for microscopic examination.
CULTURE:
All the samples were inoculated onto Blood agar and MacConkey agar and the plates were incubated at 37ºC. Identification was done with IMVIC tests.
VIRULENCE FACTOR TESTING – BIOFILM [TISSUE CULTURE PLATE ASSAY]:
Isolates from fresh agar plates were inoculated in Trypticase Soy Broth and incubated for 24 hours at 37°C, then diluted with fresh Trypticase Soy Broth in 1 in 100 dilutions. Individual wells of sterile, polystyrene, 96 well?flat bottom tissue culture plate (TCP) wells filled with 0.2 ml aliquots of the diluted cultures and only broth served as a control to check sterility and nonspecific binding of media. The TCP was incubated for 18–24 h at 37°C. After incubation content of each well was gently removed by tapping the plates. Then wells were washed four times with 0.2 ml of PBS (pH 7.2) to remove free-floating “planktonic” bacteria. Wells were stained with crystal violet (0.1%). Excess stain was rinsed off by washing with deionized water, and the plate was kept for drying. 5 If the biofilm is formed by organisms, then wells are uniformly stained with crystal violet. The optical density (OD) of stained adherent bacteria was determined with a micro ELISA auto reader at a wavelength of 570 nm (OD 570 nm). An experiment was repeated thrice, and the data then were averaged, and standard deviation was calculated. The mean OD value obtained from media control was deducted from all the test OD values.
Results and Discussion:
Qualitative phytochemical analysis:
Phytochemical analysis revealed the presence of tannins, saponins, flavonoids, phlorotannins, anthraquinones, carbohydrates, reducing sugars, steroids, phytosterol, alkaloids, amino acids, terpenoids, cardiac glycosides and chalcones in R. Sativus niger extracts (Table 1).
In the study Rama koyyati et al., 6 states that polyphenols and alkaloids present as important phytochemicals in radish peel extract
Characterization of Green synthesized silver nanoparticles
UV-visible spectroscopy
The synthesis of silver nanoparticles had been confirmed by UV-visible spectroscopy. The UV-visible spectrum showed a distinct absorption beak at (279nm). This was due to the excitation of surface Plasmon resonance (SPR) by AgNPs. AgNPs have free electrons, which give rise to the SPR absorption band, due to the combined vibration of electrons of metal nanoparticles in resonance with the light wave. Thus the reduction of AgNPs in the aqueous solution of the silver complex during the reaction with the leaf extract of Raphanus sativus was confirmed by the UV- visible spectra (figure 3). Satyavati R.7in her study reveals that green synthesized silver nanoparticles by Coriandrum leaves had been absorbed in a peak value of 250nm by UV-visible spectroscopy
Detailed analysis of the morphology, size and distribution of the nanoparticles was seen by Scanning Electron Microscopy (SEM). The possible functional groups in the synthesis and stabilization of nanoparticles were identified by performing FTIR analysis.
FTIR ANALYSIS
FTIR measurement was carried out to identify the possible biomolecules responsible for capping and efficient stabilization of Ag nanoparticles by plant leaf extract.
To determine the presence of the functional group in biomolecule by interaction with metal ion by FTIR spectrum analysis. The peaks observed from extraction of Raphanus sativus are 3271, 2922, 1634, 1532, 1404, 1235, 1024, 874, 533, 400 cm-1. From the results the 3271 cm-1 corresponds to OH stretching vibration of alcohol, 2922 cm-1 indicated the presence of CH stretching vibration of an aromatic compound, 1634 cm-1 is associated with C=O stretching of carboxylic acid, biomolecule such as carbohydrate and protein,1404 cm-1 indicates the presence of CC bond in the aromatic ring, 1532 NH of the amide linkage, 1235 is attributing to CN stretching of amines, 1024 corresponds to COC, 874 assigned to CH, 533 corresponds to C-C-CN and C-C=O from the results which shows the presence of function group by reduction of silver nanoparticle. [figure: 4] A study by Garima Singh8 et al., mentioned that aromatic compounds present in the herbal plants shown specific peaks from 1630 – 1854 cm-1.
XRD analysis:
The XRDpatterns of dried AgNo3 synthesized silver nanoparticles using extracts of Raphanus sativus. A number of bragg reflection [fig: 5] shows a characteristic peak (at 2θ = 37.27°, 46.31°, 55.44° and 76.23°).
Virulence factors like biofilm activity by TCP method detected as biofilm producers. [figure: 6] A pathogenic study by Jayesh P10 proves that the antibacterial efficacy of metal nanoparticles quite effective due to strain specificity.
EVALUATION OF ANTIBACTERIAL ACTIVITY
The silver nanoparticles synthesized from Raphanus sativus exhibited the antibacterial to bacterial strain E.coli [UTI causing bacteria]. The results are presented in (Table: 2) as the average values of the zone of inhibition radii and MIC. [figure: 7]
The antibacterial activity and acting mechanism of silver nanoparticles (SNPs) on Escherichia coli ATCC 8739 were investigated in this study by analyzing the growth, permeability, and morphology of the bacterial cells following treatment with SNPs. The experimental results of Wen Ru Li et al.,9 indicated 10 milli g/ml SNPs could completely inhibit the growth of 10 (7) cfu/ml E. coli cells in liquid Mueller-Hinton medium.
SEM analysis:
Morphological character and size details of the green synthesized silver nanoparticles using the leaf extract Raphanus sativus was presented by SEM images. The size of the nanoparticles was investigational from the SEM image between the ranges of 40-90 nm (Fig 8). This size difference in the nanoparticles is due to the presence of proteins or other biomolecules from extract Raphanus sativus, which was bound in the surface of the nanoparticles and also the result showed that the green synthesized silver nanoparticles were spherical. The figure indicates that the synthesized silver nanoparticles are well separated showing no agglomeration.
Study of antimicrobial activity of nanosilver (ns) in tissue culture media, presented the SEM images too explicit the structure and mechanism of nanoparticle efficacy on bacteria. 11
Conclusion:
In this investigation, silver nanoparticles which were synthesized from Raphanus sativus leaf extricate indicated antibacterial action. Subsequently, it is demonstrated from this investigation that the silver nanoparticles blended from Raphanus sativus leaf separate appear to be encouraging and successful antibacterial operators against bacterial strains and strong cell reinforcement. This organic science approach towards the blend of silver nanoparticles is exceptionally fundamental exertion being tended to in nanomedicine on account of its differed favorable circumstances. Plant remove being very eco well disposed and practical can be utilized for the enormous scope combination of silver nanoparticles in nanotechnology preparing ventures.
Acknowledgement:
The authors would like to thank the authorities of the Microbiology department, Indo American college, Cheyyar, Tamilnadu, India for providing the laboratory facilities and support for this work.
AUTHORS CONTRIBUTION: Jagathy made substantial contributions to conception, acquisition of data, took part in drafting the article, or revising it critically for important intellectual content, Malathy made physiochemical analysis and final approval of the version to be published, and agreed to be accountable for all aspects of the work.
FUNDING: No funding sources
CONFLICT OF INTEREST: None declared
ETHICAL APPROVAL: The study was approved by the Institutional Ethics Committee and its number IRB/SAC/231
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Yogeswari R, Sikha B, Akshay Kumar O, Nayak P. Green synthesis of silver nanoparticles using Ocimum sanctum (Tulasi) and study of their antibacterial and antifungal activities.J. Microbiol. Antimicrob. 2012; 4(6): 103-109, November 2012-
Farooqui MA, Chauhan PS, Krishnamoorthy P, Shai J. Extraction of silver nanoparticles from the leaf extracts of Clerodendrum inerme. DIG J NANOMATER BIOS. 2010; 5: 43-49.
Jayesh P, Arup Kumar C, Siddhartha D, Suparna M. Strain specificity in antimicrobial activity of silver and copper nanoparticles. Acta Biomaterialia, 2008;4 (3):707–716.
Karunakar Rao K, Manisha RD, Ramchander M, Prashanthi Y. Microwave-assisted green synthesis of silver nanoparticles using Stigmaphyllon little leaves, their characterization and anti-microbial activity. Dig. J. Nanomater. Biostructures Dig J Nanomater bios. 2013; 3(1): 13-16.
Kim JS, Kuk E, Yu KN, Kim J-H, Sung-Jin Par K. Antimicrobial effects of silver nanoparticles. Nanomedicine: Nanotechnology, Biology and Medicine. 2007; 3(1): 95– 101
Koyyati R, Nagati V, Merug R, Manthurpadigya P. Biological synthesis of silver nanoparticles using Raphanus sativus var. longipinnatus leaf extract and evaluation of their antioxidant and antibacterial activity. Int J Med Pharm. 2013; 3 (4): 89-100.
Satyavati R, Balamurali Krishna M, Venugopal Rao S, Saritha R, Narayana Rao. Biosynthesis of Silver Nanoparticles Using Coriandrum Sativum Leaf Extract and Their Application in Nonlinear Optics. Advanced Science Letters.Vol. 3, 138–143, 2010. 27.
Singh G, Bhavesh R , Kasariya K , Sharma AR, Rajendra Pal SingH. Biosynthesis of silver nanoparticles using Ocimum sanctum (Tulsi) leaf extract and screening its antimicrobial activity. J. Nanoparticle Res.. 2011; 28(13):2981–2988.
Li WR, Xie XB, Shi QS, Zeng HY Ou-Yang YS, Chen YB. Antibacterial activity and mechanism of silver nanoparticles on Escherichia coli. Appl Microbiol. Biotechnol 2010; 85: 1115-1122
Jayesh R, Arup Kumar C, Siddhartha D, Suparna M. Strain specificity in antimicrobial activity of silver and copper nanoparticles. Acta Biomaterialia, 2008; 4(3): 707–716.
Salisu IB, Abubakar AS, Sharma M, Ramesh N. Pudake. Study of antimicrobial activity of nanosilver (ns) in tissue culture media.Int. J Curr Res. 2014; 6 (13): 01-05
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareStudy on Correlation of Visual Acuity and Foveal Thickness in Diabetic Macular Edema Patients
English4651Singh PunitEnglish Mehta NiklankEnglish Vora JainamEnglish Modi SamikshaEnglish Dholu SuchiEnglish Malhotra DevikaEnglishIntroduction: The purpose of this study was to clinically diagnose and quantify the Diabetic macular oedema in terms of Central Foveal Thickness (CFT) and Central Subfield Thickness (CST) on a 3D-OCT scan and its correlation with the visual acuity of subject patients enrolled in the study. Aims: • To Diagnose Diabetic macular oedema and its correlation with Visual Acuity. • To Quantify Diabetic macular oedema in terms of Central Foveal Thickness and Central Subfield Thickness. Methodology: In total 50 patients that met the inclusion and exclusion criteria were enrolled on the study, All patients underwent detailed ophthalmological examination. A complete ophthalmic examination including Visual acuity, Intraocular pressure, Anterior segment examination using slit-lamp biomicroscopy, dilated fundus examination through spectral-domain 3-D OCT and was assessed for the presence of diabetic macular oedema, changes in the fundus and its correlation with CFT (central foveal thickness) and CST (Central Subfield Thickness) were measured by OCT. Result: Mean BCVA was 0.59± 0.58 ranging from 0.02 to 3.0 on Log MAR. Macular thickness measured as CFT had a mean of 353.5±152.5 µ ranging 202 to 765 microns, whereas CST showed a mean of 370.5±144.4 microns ranging 231 to 770 microns. The BCVA had a moderate correlation with CST. Correlation of BCVA was better with CFT(spearman’s r=0.532;p=0.000)than that of CST(spearman’s r=0.586;p=0.000). Conclusion: We concluded that CFT is more accurate to predict the prognosis of visual outcome in cases of Diabetic macular oedema suggesting the worst visual outcome in cases with diffuse retinal thickening with increased CFT.
EnglishINTRODUCTION:
Diabetic macular oedema (DME) and Diabetic retinopathy (DR) are among the most common ocular complications of diabetes leading to blindness in the older age population in most of the developed countries.
Diabetes mellitus is a fast-growing global health problem that has huge social and economic consequences. It is estimated that in 2000, there were globally 171 million people aged more than 20 years suffering from this disease. This number is estimated to increase to 366 million by 2030. An ageing population and obesity are two main reasons for the increase in prevalence. The majority of this population resides in India and China.1
India remains top on ranking with estimates of about 31.7 million of the above population in 2000 and this would be expected to rise to 79.4 million by 2030.2
DR occurs both in type 1 and type 2 diabetes mellitus and has been shown that nearly all type 1 and 75 per cent of type2 diabetes will develop DR after 15 yr duration of diabetes.
In the developed country population, Diabetic retinopathy is the cause of visual disability in and in 33 % of Type-II DM (Diabetes mellitus) and 86 % of Type-I DM3
Due to diversified presentations of Diabetic macular oedema (DME), objective assessment by 3D spectral-domain optical coherence tomography (3D SD-OCT) have become a valuable tool.
Over the years, treatment options for DME have evolved and been studied, including grid laser photocoagulation, vitrectomy, intravitreal injection of bevacizumab,avastatin& corticosteroids.
The efficacy of this therapy has been evaluated by assessing the best-corrected visual acuity (BCVA) of patients and correlating with their macular thickness of affected using optical coherence tomography (OCT).
A correlation between BCVA and the OCT- measured macular thickness has been reported but its significance is variable.4
Through these studies, authors have found that eyes with Diabetic macular oedema have poor visual prognosis and outcomes despite complete successful treatment and resolution of oedema.
In this study, we assessed the macular thickness and correlated it with the best corrected visual acuity of study subjects. The patient’s macular thickness was calculated using 3D-OCT and quantified in terms of central foveal thickness and central subfield thickness and both the variables were compared in different population groups. Each population group in terms of age and sex were randomized and statistical analysis were done.
METHODS AND MATERIALS:
Study setting
The study was conducted in the Department of Ophthalmology, Dhiraj Hospital, SBKS Medical Institute and Research Centre, Piparia, Vadodara from May 2016 to April 2017
After getting approval from the ethical committee SBKS MI&RC,
Ethical clearance no: SVIEC/ON/MEDL/BNPG20/2115
Study design:
Prospective, Non-Randomized and Observational Study
Sample size: 50 diabetic cases
Patient selection was random
Study population:
Total 60 patients with diabetes that visited the Ophthalmology Department, Dhiraj hospital from the date of approval of the Ethics Committee till April 2018 were enrolled in the study. Out of all enrolled patients underwent detailed fundus examination and OCT of both eyes for clinical diagnosis of diabetic macular oedema and their correlation with central foveal thickness was assessed. The patient was enrolled in this cross-sectional study after informed consent was approved by the ethical committee.
Inclusion criteria:
Patients of average age >40 years
Any type of Diabetes Mellitus, irrespective of the duration of disease and clinical control.
VA and refraction with spherical equivalent between +5.00 to -5.00 D,
Diabetic retinopathy with clinically significant macular oedema.
The OCT retinal thickness of at least 230µm in the central subfield (CST)..
Exclusion criteria:
Marked retinal swelling: It attenuates the measurement beam and causes shadowing of the outer retinal layers. Thus, such eyes are to be excluded from the study.
Eyes with hard exudates: It causes intense shadowing effects, on horizontal and vertical OCT scan lines across the central fovea.
The presence of any other macular abnormality such as an epiretinal membrane or vitreomacular traction.
Significant media opacities (eg. Cataract of Grade III or more on LOCS grading, vitreous haemorrhage, corneal opacity) can result in a poor OCT signal.
Method of data collection:
All subjects went through an ophthalmological examination. This consisted of, medical history (including ocular and family histories), visual acuity, refraction, OCT testing of both the macula and peripapillary Nerve fibre layer using the 3D OCT unit on the same day.
Assessment of the patient:
It is a prospective cross-sectional study on patients from MAY 2016 to MAY 2017 attending, Dhiraj general hospital, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara who will satisfy all inclusion and exclusion criteria.
Firstly, based on history and lab reports, I found all the patients with diabetes.
Then patient’s visual acuity was noted and the patient was examined through slit-lamp biomicroscopy for anterior segment evaluation and fundus examination by direct and indirect ophthalmoscopy.
When diabetic retinopathy was confirmed by slit lamp and ophthalmoscopy finding, the fundus was examined on a 3D OCT machine.
On OCT machine thorough examination of the fundus was done, and a clear picture of the optic disc, macula, fovea will be taken and studied.
Then we correlate visual acuity and foveal thickness in the number of diabetic retinopathy patients and changes that will be seen after taking treatment in these parameters.
The macular thickness map was divided into nine sections, and it displayed as 3 concentric circles, I). the central circle, II). Inner ring and III) outer ring, with each ring divided into four quadrants. The central circle, inner ring, and outer ring are in the macular thickness map with diameters of 1 mm, 3 mm, and 6 mm, respectively.
The central disc, inner ring, and outer ring diameters will be taken as 1 mm, 2.22 mm, and 3.45 mm, respectively.
Retinal thickness maps were colour-coded, with brighter colours for thicker retinal areas and darker colours for thinner ones.
Result and analysis: -
We find 51 eyes from 31 patients who had clinically significant macular oedema which was demonstrated by a 3D-OCT scan.
Of this 9 eyes were excluded from the study: 3 patients had a vitreous haemorrhage, one had a cataract, 2 were with hard exudates and 3 patients had epiretinal membrane.
So we studied, 42 eyes from 50 patients contributed by 19 males and 9 females with a mean age of 58.7 years, ranging from 45-94 years
Table no.1 denotes a total of 28 patients who were randomized in terms of their age to remove age bias that can affect the causal relationship of the study population and its result.
Table no.2 denotes a total of 28 patients who were randomized in terms of their sex to remove sex bias that can affect the causal relationship of the study population and its result. After removing study subjects who were not fit for this study total of 28 patients were enrolled among which 19 were male subjects and 9 were female.
Table no:3 denotes the mean indices calculated from the study and this data were analysed statistically which were found to be significant.
Mean BCVA was 0.59± 0.58 ranging from 0.02 to 3.0 on Log MAR. Macular thickness measured as CFT had a mean of 353.5±152.5 µ ranging 202 to 765 microns, whereas CST showed a mean of 370.5±144.4 microns ranging 231 to 770 microns.
The BCVA had a moderate correlation with central subfield thickness.
Correlation of BCVA was better with Central foveal thickness (spearman’s r=0.532;p=0.000) than that of central subfield thickness (spearman’s r=0.586;p=0.000).
DISCUSSION:
OCT is a quick, non-invasive, daycare procedure with little expertise and good reproducible procedure of producing cross-sectional and high-resolution images of the retina.5,6,7,8,9,10Oct was specifically being utilized for years in the practice of ophthalmology for analysing diabetic macular oedema in terms of its morphology and it helps in analysing its severity and other associated retinal abnormalities. It helps in detecting the amount of Subretinal fluid if present and helps in guiding the treatment protocol for the disease.11,12
In the current study, CFT(central foveal thickness) had a mean of 353.5±152.5 µ ranging from 202 to 765 microns. Though there was a correlation there was also substantial variation in visual acuities at any given retina thickness. Some eyes with thickened macula also had good visual acuity and vice versa.
The patients who took part in this study were of diverse settings and were representative of patients with DME seen throughout developing countries like India. The population data of current study subjects are similar to other studies of diabetic macular oedema In developed countries.13-16 However, unlike the ETDRS, In this study people older than 70years of age were not excluded.17
It has been already established by many studies that, Decreased visual acuity and central macular thickness are correlated.18
The study by Kim et al.19 stated that the mean visual acuities and mean retinal thickness also varied among different study groups, groups with worse visual acuities was high retinal thickness as compared to other groups, and Otani et al.20,21 in their study, also reported that the central foveal thickness and the best-corrected visual acuity are intermediate negative correlated regardless of the different tomography features.
More recent studies have evaluated the relationship between visual function and microstructural changes in the fovea IS/OS (Inner segment and outer segment) junction and ELM(external limiting membrane) in DME (Diabetic macular oedema). In their study, Uji et al22,23 concluded that if a hyperreflective focus is present in the outer retina it has been found on SD-Oct that there is disruption of External limiting membrane and junction line of Inner segment /outer segment as well associated decreased best-corrected visual acuity in patients with diabetic macular oedema.
The retina is a compact tissue composed of a neural element and glial cell.24 Because glial cells occupy all the interneuron space, extracellular sniipace is virtually absent. Previous Histopathological studies by Yanoff et al25 indicate that the development of fluid accumulation within Muller's cells is the reason for the initiation of the development of macular oedema. Due to the accumulation of fluid inside muller’s cells it represents as sponge-like cystic swelling on 3D-OCT and due to accumulation of fluid in muller’s cells in long terms mat lead to liquefactive necrosis of muller’s cells as an immune response and adjacent neural cells leads to cystoid cavity formation in the retina.26In the histopathologic study of CME, Tso et al.27 demonstrated that cystoid spaces were located in the outer plexiform, inner plexiform, granular layers and the ganglion cell layer.
The results may be supported by histopathological findings of Yamamoto et al.,6 which suggests worse visual outcomes when compared with other subgroups of Diabetic macular oedema are associated with eyes with CME. Recently, Sun et al.28 have also found that disorganization of the retinal inner layers in the 1-mm foveal area is associated with worse VA.
The current study also investigated the Central foveal thickness and its correlation with Visual acuity in eyes with CME, the height of the cystoid space was not significantly correlated with VA or AMT but the correlation with CFT was significantly positive.
With the help of 3D-OCT, the Diabetic macular edema was studied in detail and quantified including sponge-like cystic swelling of the macula, cystoid macular oedema and central foveal thickness analysed. Central foveal thickness and diffuse retinal thickening were the most common feature and CME had the worst visual outcome.
This study provides the result that OCT may not be a single tool for visual acuity for the primary outcome in diabetic macular oedema studies.
The correlation of visual acuity and central retinal thickness measured by OCT is roughly linear. Other studies results were also similar; however, the strength of correlation varies among different studies.
Assessment of central macular thickness using Oct is certainly helpful clinically as it gives a lot of other information about the patient’s clinical outcomes and benefits.
Conclusion:
In our study, we analysed patients of diabetic macular oedema in terms of OCT parameters such as Central Foveal thickness, Central subfield thickness and correlated with the Best-corrected visual acuity of patients.
As there are many parameters available in OCT to analyse for different forms of retinal pathology. The accurate parameters to be studied are still a challenging task for most ophthalmologists in today’s world. Diabetic macular oedema is also the most common retinal pathology which requires OCT imaging as the most reliable modality for diagnosis, but variable parameters and newer technologies in OCT made it difficult for most of the practitioners to choose a single parameter and its correlation with disease entity, which is almost always essential for deciding a treatment plan.
We concluded that our OCT findings showed a correlation between visual acuity and diabetic macular oedema based on the CFT and CST values.
CFT is more accurate to predict the prognosis of visual outcome in cases of DME suggesting the worst visual outcome in cases with diffuse retinal thickening with increased CFT.
So from my study, I would like to conclude that CFT can be used as a single best parameter for assessing Diabetic macular oedema, In terms of its severity, quantification, progression and treatment plan of action. CFT is a highly reliable indicator for the plan of action to decide the treatment and prognosis of patients with DME.
Acknowledgement:
The Journey of doing research and analysis is never being easy as it requires teamwork. I am very grateful to all authors for their valuable contribution to every part of this study. I would sincerely like to thank Dr Punit Singh the principal author of this article, he is currently is working as a professor in the department of ophthalmology and he has achieved many milestones in life while practising as an Ophthalmologist. He has done fellowship in Glaucoma, cataract surgeries, Cornea and refractive surgeries as well in Medical retina. His knowledge about the Subject has been a valuable part of this study. He along with all other authors guided me in each step of obstacles and difficulties. I would also like to thank Dr Niklank Mehta the second author as a part for this article currently, Working as a resident in the Department of Ophthalmology. He provided immense support and motivation throughout study, He always helped and guided and rectified my errors and mistakes without any hesitancy. His knowledge about the OCT and parameters that he earned from his different sources of studies and hard work brought the idea of Doing this article.
The Other author Dr Samiksha Modi, Working as a resident of the department of Ophthalmology as a constant source of emotional support for all of us when we needed it. Her knowledge and experience about the field of research guided me on the way to finish an article on time, without her contribution and skills it would have been very difficult for me to complete the article.
I would Like to thank Dr Jainam Vora, Dr Devika Malhotra for their support and doing analysis work for this article they have very good skills in Statistical analysis and research. They can be called good mathematicians and good colleagues as well who helped anytime when they were asked for.
I Dr Suchi Dholu the corresponding author of this article, have been working as a resident in the department of ophthalmology, I contributed to this article with the workup of all patients and collecting the data and documentation. I took the consent of all the patients and their relatives to participate in this study.
Financial Disclosures: None
Conflicts of interests: No
Englishhttp://ijcrr.com/abstract.php?article_id=4167http://ijcrr.com/article_html.php?did=4167
Brussels, Atlas D. International Diabetes Federation. IDF Diabetes Atlas, 7th and. Brussels, Belgium: International Diabetes Federation, 2015.
Guariguata L, Whiting D, The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes research and clinical practice. 2011 Dec 1;94(3):322-32.
Lin S, Rocha VM, Taylor R. Artefactual inflation of type 2 diabetes prevalence in WHO STEP surveys. Tropical Medicine & International Health. 2019 Apr;24(4):477-83.
Basit A, Fawwad A, Qureshi H, Shera AS. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey(NDS), 2016–2017. BMJ Open. 2018 Aug 1;8(8):e020961.
Hee MR, Puliafito CA, Duker JS, Reichel E, Coker JG, Wilkins JR, et al. Topography of diabetic macular oedema with optical coherence tomography. Ophthalmology 1998; 105:360-370.
Hee MR, Puliafito CA, Wong C, Duker JS, Reichel E, Rutledge B, et al. Quantitative assessment of macular oedema with optical coherence tomography. Arch Ophthalmol 1995; 113:1019-1029.
Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical coherence tomography. Science 1991; 254(5035): 1178-1181.
Puliafito CA, Hee MR, Lin CP, Imaging of macular diseases with optical coherence tomography. Ophthalmology 1995; 102:217-229.
Hee MR, Puliafito CA, Wong C, Optical coherence tomography of central serous chorioretinopathy. Am J Ophthalmol 1995; 120:65-74
Hee MR, Puliafito CA, Wong C, Duker JS, Optical coherence tomography of macular holes. Ophthalmology 1995; 102:748-756.
Yamamoto S, Yamamoto T, Morphological and functional analyses of diabetic macular oedema by optical coherence tomography and multifocal electroretinograms. Graefes Arch Clin Exp Ophthalmol 2001; 239:96-101
Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular oedema. Am J Ophthalmol 2004; 137:313-322
Browning DJ, Zhang Z, Benfield JM, The effect of patient characteristics on response to focal laser treatment for diabetic macular oedema. Ophthalmology. 1997;104:466–72.
Andaman L, Olk RJ. Laser photocoagulation of diabetic macular oedema. Ophthalmic Surg Lasers. 1997;28:387–408
Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular oedema. Long-term visual results Ophthalmology.2014;23(3):162-165.
Bailey CC, Sparrow JM, Grey RHB, he national diabetic retinopathy laser treatment audit. I. Maculopathy. Eye. 1998;12:69–76.
Early Treatment Diabetic Retinopathy Study Research Group. Early treatment diabetic retinopathy study design and baseline patient characteristics. ETDRS report number 7. Ophthalmology. 1991;98:741–56.
Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular oedema. Am J Ophthalmol. 2006; 142:405-412
Browning DJ, Glassman AR, Aiello LP, Beck RW, Brown DM, Fong DS, et al. Diabetic Retinopathy Clinical Research Network Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular oedema. Ophthalmology. 2007; 114:525-536
Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular oedema with optical coherence tomography. Am J Ophthalmol. 1999; 127:688-693
Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N. Association of path morphology, photoreceptor status, and retinal thickness with visual acuity in diabetic retinopathy. Am J Ophthalmol. 2011; 151:310-317
Uji A, Murakami T, Nishijima K, Akagi T, Horii T, Arakawa N, et al. Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular oedema. Am J Ophthalmol 2012; 153:710-717.717.e1
Hogan MJ, Alvarado JA,histology of the human eye. Philadelphia: WB Saunders. 1971; 492
Yanoff M, Fine BS, Brucker AJ,. Pathology of human cystoid macular oedema. Surv Ophthalmol 1984; 28(Suppl):505-511.
Fine BS, Brucker AJ. Macular oedema and cystoid macular oedema. Am J Ophthalmol 1981; 92:466-481
Tso MOM. Pathology of cystoid macular oedema. Ophthalmology. 1982; 89:902-915
Sun JK, Lin MM, Lammer J, Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with centre-involved diabetic macular oedema. JAMA Ophthalmol. 2014; 132:1309-1316.
Murakami T, Yoshimura N., Structural changes in individual retinal layers in diabetic macular oedema. J Diabetes Res. 2013; 2013:920713.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareA Novel Dataset ‘Aravind’ for Retinal Image Analysis
English5256M. Vijaya MaheswariEnglish G. MurugeswariEnglishIntroduction: Diabetes is a disorder or a metabolic disease that increases the level of sugar in the blood. Untreated diabetes can cause serious issues to the eye. There are quite a several research works carried out in retina image analysis. For retinal image analysis, there are multifarious datasets available freely for research. Aim: The objective of the article is to introduce a new dataset namely ‘ARAVIND’ for retina image analysis for research purposes. Method: This dataset incorporates 98 images altogether which helps in pinpointing different types of eye defects like hemorrhages, microaneurysms, hard and soft exudates. Conclusion: The ‘ARAVIND’ dataset is freely available online that can be used by computer researchers in the field of medical image analysis which bridges the gap between the field of technology and science to a greater extent.
EnglishDataset, Exudates, Hemorrhages, Micro aneurysm and RetinaINTRODUCTION
Diabetes leads to various metabolic disorders and physiologic abnormalities in the body 1. The rapid growth of diabetes is a key indicator for the prevalence of various microvascular complications2. The number of people with diabetes is increasing year by year. Diabetes is increasing more in well-developed countries like the United States than in developing countries. Following the International Diabetes Federation (IDF), the threatening fact about diabetes is that 51% of the world population will likely have diabetes by the year 20453. The overriding reason for the cause of diabetes is the insalubrious lifestyle. Early detection and proper treatment of diabetes is a life-saving measure. The cost of treatment for diabetes varies from country to country. The consequences of diabetes may cause damage to the indispensable organs like the heart, retina etc.
Prolonged diabetes may affect the retina to a greater extent. Fundus/clinical images of the retina play a vital role after the diagnosis of diabetes. A proper eye examination is mandatory for patients with diabetes. Retinal abnormalities can lead to serious vascular diseases which do not show the earlier symptoms to the patients. In such cases, a high - quality fundus images provide finer details about the retina. The high-quality images help in detecting the abnormalities accurately.
Various datasets for retinal image analysis are available online which can be freely downloaded for detecting the defects in the human eye. Different algorithms were applied by the researchers or by the team of experts to extract the basic and finer details of the retina for the accurate identification of the abnormalities. The accuracy or efficiency of a code depends not only on the algorithm but also on the quality of the image. Hence, high-quality images are imperative for the researchers to prove their contribution to their research.
Diabetic Retinopathy
Diabetes is a metabolic disorder that heightens the level of sugar in the blood. The retina can be affected badly in persons who suffer from diabetes for a quite long period. This may lead to a disease called Diabetic Retinopathy (DR). This particular disease can be treated at the earlier stage whereas, in the advanced stage it might lead to blindness4. There are four different stages of diabetic retinopathy ranging from mild, moderate, severe non-proliferative to proliferative5. In the severe stage of this disease, the blood vessels get a leak and thereby leading to blindness. When a person is affected by this disease, ophthalmologists check for the presence of microaneurysms, haemorrhages, hard exudates and soft exudates. Fundus images are those images that are acquired using a high-quality camera in analyzing the retina. This fundus image vividly projects all the components of an eye. For the diagnosis of different retinal defects, fundus images are used. Accurate screening is necessary to identify other abnormalities in diabetic retinopathy patients. Figure 1 represents the internal structure of the human eye.
Retinal blood vessels comprise arteries and veins. Arteries of blood vessels bifurcate into branches of vessels. Retinal blood vessels are capable of carrying oxygen to different parts of the eye. The abnormalities of the retina that seems to appear in diabetic patients are elucidated in the following sections.
Micro Aneurysm
Micro aneurysms are the tiny blood spots in the capillaries of blood vessels of the retina. The presence of microaneurysm indicates the earlier stage of diabetic retinopathy in diabetic patients6. These abnormalities are always seen as groups or clusters. Sometimes it may occur in isolation also. The presence of microaneurysm can be identified by an eye dilation followed by screening, using fundus images. Figure 2 represents the retina image with microaneurysm which appears as white spots in the fundus images.
Hemorrhages
Haemorrhages are serious disorder that causes bleeding in the retina. In the advanced stage of diabetic retinopathy, haemorrhages might transpire which lead to the growth of abnormal new blood vessels. The new abnormal blood vessels may leak and the blood may occupy the central portion of the retina. Excessive blood leakage may cause retinal detachment which leads to the loss of vision. Figure 3 shows a retina image with a haemorrhage or leakage of blood.
Hard and Soft Exudates
Hard exudates are lipids in the pale yellowish colour that leaks from the capillaries of abnormal retinal blood vessels. This condition is referred to as chronic leakage in diabetic retinopathy patients7. Soft exudates are otherwise called cotton wool spots which appear as a whitish fluffy fibre layer in the abnormal vessels of the retina.8 The presence of hard and soft exudates is more common in Diabetic Retinopathy patients. Figure 4 (a) and (b) represents retina with hard exudates and soft exudates respectively.
ABOUT THE HOSPITAL
Aravind eye hospital9is the renowned hospital established in the year 1976 in Madurai, Tamil Nadu, India. This hospital works as a network of hospitals in various districts in the state of Tamil Nadu. This hospital has performed phenomenal work in treating millions of people with eye defects including surgeries. Aravind eye hospital also does outreach programs in remote villages by conducting free eye camps.
Privacy Policy
For some security and privacy reasons, the information about the patient’s details is not divulged anywhere. All images in the dataset are compressed lossless and are stored in a repository in Github10.
DATA SET
The images in this dataset are procured from a famous hospital in Tirunelveli city, South Tamil Nadu, India. The screening is done on patients between the ages of 30 and 70. This data set is divided into 5 different categories like (i) hard exudates, (ii) soft exudates, (iii) haemorrhages, (iv) microaneurysms and (v) retina with no defect. Each category comprises raw images obtained using the fundus camera. All the images are of high quality which includes colour images and few grayscale images. These images were acquired using an FF450 plus fundus camera with a 50ofield of view. The field of view of every image is circular. Each image is compressed in the format of JPEG. This dataset can be used for identifying different retinal diseases like hard, soft exudates, haemorrhages and detecting microaneurysms in diabetic patients. All the images in this dataset are used for clinical diagnosis. These images can be used alone as a standalone image or they can be used with the combination of other retinal images for comparative study. These images in this dataset can be used for testing image processing techniques such as enhancement, segmentation, etc. The number of images in each category is as follows: Table 1 recapitulates the categories of images in the dataset.
The description of the images is given in Table 2, including the name and size of the images in each category.
All the images in the dataset are compressed in JPEG format. The dimension of HM_14 (Hemorrhage category) is comparatively high because the retina is highly infected by the leakage of blood vessels. Similarly, an image in the hard exudates (HE_19) category also has a higher dimension due to the presence of a greater number of hard exudates. The images can be downloaded from the following URL:
https://github.com/ARAVINDDATASET/ARAVIND.git
SCOPE FOR COMPUTER RESEARCHERS
Using this dataset, the computer researchers can execute their research in the areas such as detection of abnormalities in the retina, segmentation of the blood vessels, identification of hard and soft exudates, localization of optic disc in the retina, classification, feature extraction, detection of haemorrhages and microaneurysm and grading the level of disease in the case of diabetic retinopathy patients.
DISCUSSION
Retina image analysis is an emerging research area for which many researchers are contributing by proposing new techniques for automatic diagnosis. At present, only very few Indian datasets are available for retina image analysis. There are hundreds of patients visiting the Aravind eye hospital, Tirunelveli every day for eye checkups and eye treatment. We have collected the retina images of various patients from the hospital and created a dataset that contains images of different categories like microaneurysm, haemorrhages, soft exudates, hard exudates and images with no defect. To motivate the research on retina image analysis, we would like to publish the database so that it could be used by the upcoming young researchers in the field of medical imaging. The dataset contains 98 retina images. This dataset is open to researchers for image analysis purposes.
CONCLUSION
The dataset “ARAVIND” is an image database that contains raw images of infected retina and retina with no defect. The images in this dataset can be used for image processing techniques and machine learning techniques to diagnose retinal disease. Using these images, the researchers can propose new algorithms for medical image analysis and thereby the usage of technology can be transferred to the field of medicine.
ACKNOWLEDGMENTS
We would like to acknowledge Aravind eye hospital, Tirunelveli, South Tamil Nadu, India for providing us with the dataset of retinal images. This dataset will help computer researchers to a greater extent to research in the field of medical imaging. We also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors, editors, and publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest: The authors declare there is no conflict of interest.
Funding Source: None
Ethical Clearance: There was no direct human intervention involved in this research.
Author’s Contribution: The images that are stored in the repository are real-time images that have been collected from Aravind Eye Hospital. Ground truth images are generated with the help of experts which can be used for evaluation purposes.
Englishhttp://ijcrr.com/abstract.php?article_id=4168http://ijcrr.com/article_html.php?did=41681. Tang J, Kern T. Inflammation in diabetic retinopathy. Progress in Retinal and Eye Research. 2011; 30(5):343-358.
2. Zhang X, Saaddine J, Chou C, Cotch M, Cheng Y, Geiss L et al. Prevalence of Diabetic Retinopathy in the United States, 2005-2008. JAMA. 2010; 304(6):649.
3. Research E, Atlas I. IDF Diabetes Atlas [Internet]. Idf.org. 2021. Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html
4. Diabetic retinopathy - Symptoms and causes [Internet]. Mayo Clinic. 2021. Available from: https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611.
5.[Internet].https://www.griswoldhomecare.com.2021.Availablefrom:https://www.griswoldhomecare.com/blog/2015/January/the-4-stages-of-diabetic-retinopathy-what-you-ca/
6. Tags C, Watch J, A, Glycosmedia A, Team E, questions F et al. Diabetic Retinopathy – Features of Diabetes: Microaneurysms [Internet]. Glycosmedia. 2021. Available from: https://www.glycosmedia.com/education/diabetic-retinopathy/diabetic-retinopathy-features-of-diabetes-microaneurysms/
7. Jaya T, Dheeba J, Singh N. Detection of Hard Exudates in Colour Fundus Images Using Fuzzy Support Vector Machine-Based Expert System. Journal of Digital Imaging. 2015; 28 (6):761-768.
8. Kavitha M, Palani S. Hierarchical classifier for soft and hard exudates detection of retinal fundus images. Journal of Intelligent & Fuzzy Systems. 2014; 27(5):2511-2528.
9. Home - Aravind Eye Care System [Internet]. Aravind Eye Care System. 2021 [cited 14 May 2021]. Available from: https://aravind.org
10.GitHub: Where the world builds software [Internet]. GitHub. 2021. Available from: https://github.com
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareMassive Myocardial Infarction Due to Acute Left Main Coronary Artery Occlusion in a Young Organophosphorus Poisoning: Case Report
English5760Gautam ArchanaEnglish Patil VijaysinhEnglish Rayannavar NikhileshEnglish Goel HimalayaEnglish Bhaleghare SakshiEnglish Bammidi RohitEnglishIntroduction: In the farmlands what has been found to be a common chemical for suicidal attempts are Organophosphate poison. This is common in many of the countries. Organophosphate poison is quite dangerous and can have impact once someone consume. Even the smell of this liquid or touch of the chemical to the skin can have a very harmful effect. Fatal left main carotid artery occlusion is rarely reported in literature. Aim: To study the case of consumption of Chlorpyriphos- cypermethrin combination Case Report: In the present paper we have reported a specific case of a person whose age was 25 years and who consumed a Chlorpyriphos- cypermethrin combination who later developed massive myocardial infarction with an ST-elevation >12 mm in aVR followed by a cardiac arrest. Discussion: Cardiac abnormalities are rare in organophosphorus compound poisoning. The patients have include arrhythmia, heart failure, cardiogenic shock, and sudden death. In those patients, clinical manifestations of damage caused by organophosphorus pesticides to the myocardium vary. Conclusion: During the management of organophosphorus compound poisoning, intensive cardiac monitoring should be considered.
EnglishMassive Myocardial Infarction, Acute LMCA Occlusion, Organophosphorous, Poisoning, Cardiac, Pyrethroid compound, Cypermethrin
Introduction
There are many types of inhibitors available, one of them are Organophosphate, it is potent cholinesterase inhibitors, which is capable of causing severe cholinergic toxicity following cutaneous exposure, inhalation or ingestion.1 Chlorpyriphos is a pesticide that contains a broad-spectrum chlorinated organophosphate.2 We use that to control many kinds of pests, termites, mosquitoes and roundworms. According to world health organization Chlorpyrifos is considered moderately hazardous on the base of acute toxicity. Exposure surpassing recommended levels has been linked to neurological effects, persistent developmental disorders, and autoimmune disorders. The symptoms of sever poisoning is seizures, unconsciousness, paralysis and suffocation from lung failure.3 A pyrethroid compound Cypermethrin widely used as an insecticide, is moderately toxic but excessive exposure can cause nausea, headache, muscle weakness, salivation, shortness of breath and seizures. Apart from the drug toxicity, these compounds cause many cardiac complications like QT prolongation, conduction blocks, arrhythmia. But rarely do they cause myocardial infarction.
Case report
A male who is 25 years old was admitted to the intensive care unit with of alleged history of intentional consumption of HAMLA (Chlorpyriphos 50% + Cypermethrin5%) around 50 ml followed by 3 episodes of vomiting. The patient was brought to the hospital within 3-4 hours of consumption. On examination he was drowsy, sweating profusely with GCS of 6 (E1 V2 M3), pupils were constricted 10 mm in anterior and inferior leads and ST-elevation around 12 mm in aVR. Sooner he developed cardiac arrest and could not be revived by CPR and inotropic supports. Biochemical cardiac markers sent at that time were positive with Serum Trop I of 3.5 ng/ml.
Discussion
Cardiac abnormalities are rare in organophosphorus compound poisoning. The patients have to include arrhythmia, heart failure, cardiogenic shock, and sudden death. In those patients, clinical manifestations of damage caused by organophosphorus pesticides to the myocardium vary. Myocardial injuries and myocardial infection are rarely reported, which cause by organophosphorus poisoning.
According to a study conducted by Aktar S et al. in 2019 on the complications of Organophosphorus poisoning, out of 100 cases, 29 had cardiac complications like premature ventricular contractions, prolonged QT, conduction block, polymorphic VT, Torsade de Pointes, sinus bradycardia which occurred during early hours of acute poisoning.1 But none of them had myocardial infarction as a complication in their study. For the development of these complications Hypoxia, electrolyte imbalance and acidosis is very important. Our case did not have any predisposing factors and never developed these complications. (Though metabolic acidosis was present when the admission is going on, it was corrected immediately).
According to a report of a case by P Joshi et al. on a 40-year- old patient with parathion consumption, it was found that patient had sinus bradycardia on admission. On the second day, the patient developed ST-segment elevation with T inversion in V3-V6 with Trop I of 3ng/ml. The patient was treated with antiplatelet, nitrates, LMWH and was discharged with the resolution of ST and T changes.2 In contrast to this, our case was a young male with no previous comorbidities who developed Massive myocardial infarction on day 4 with ECG showing ST elevation > 12 mm in aVR and ST depression in other leads >10mm, with serum Trop I of 3.5 ng/ml indicating blockade in LMCA territory.3 Later he had a cardiac arrest and could not be revived.
The mechanism of cardiotoxicity by these compounds is not completely understood.
There are few postulations by which OP compounds can cause cardiac toxicity.4, 5
1. Brief period of increased sympathetic tone. 2. Prolonged period of parasympathetic activity
3. QT prolongation followed by torsades de pointes. And also, other mechanism includes sympathetic/parasympathetic overactivity, hypoxia, dyselectrolemia and direct toxicity. Coronary vasospasm can also lead to myocardial infarction. Coronary vasospasm was caused by intracoronary injection of acetylcholine in individuals as demonstrated in a study conducted by Hario et al. and Yasue et al.. 6,7
In a person with previous coronary artery plaque, the release of vasoactive amines like histamines and catecholamines leads to penetration of collagen matrix of plaque-causing erosion and rupture causing myocardial infarction.8 Release of inflammatory cytokines like histamines, neutral proteases, platelet-activating factors, arachidonic acid products, chemokines causes vasospastic angina, nonvasospastic angina, myocardial infarction known as Kounis phenomenon.9
Serious cardiac complications cause by Patchy myocardial involvement as a result of direct cardiac toxicity.10,11 Myocardial may not be manifest clinically or on echocardiography because it is involved in patchy. Continuous cardiac monitoring should be undertaken to detect dynamic cardiac changes Continuous cardiac monitoring should be undertaken to detect dynamic cardiac changes.4
Conclusion
Organophosphorus poisoning can cause severe cardiac complications within few hours of exposure. Myocardial infarction occurs as a complication during the early phases of poisoning, but it also has chances of occurring during the recovery phases. Thus, during the management of organophosphorus compound poisoning, intensive cardiac monitoring should be considered.
Acknowledgement: We acknowledge the contribution of our university and department for the unending support.
Conflict of Interest: There is no conflict of Interest
Source of Funding: No Source of Funding
Authors Contribution: This is a collaborative work among both authors. Gautam Archana, Patil Vijaysinh, Rayannavar Nikhilesh and Goel Himalaya performed the statistical analysis, wrote the protocol, and wrote the first draft of the manuscript. Bhaleghare Sakshi, Bammidi Rohit managed the literature searches. All the authors read and approved the final manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=4169http://ijcrr.com/article_html.php?did=41691. Akhtar MS, Rehman AU, Akbar K, Hussain M, Atif MA, Hussain MS. Complications of organophosphorus poisoning. Prof. Med. J. 2020 Oct 10;27(10):2149-53.
2. Joshi P, Manoria P, Joseph D, Gandhi Z. Acute myocardial infarction: Can it be a complication of acute organophosphorus compound poisoning?. J Postg Med. 2013 Apr 1;59(2):142.
3. Knotts RJ, Wilson JM, Kim E, Huang HD, Birnbaum Y. Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? J Electroc. 2013 May 1;46(3):240-8.
4. Anand S, Singh S, Nahar Saikia U, Bhalla A, Paul Sharma Y, Singh D. Cardiac abnormalities in acute organophosphate poisoning. Clin Toxic. 2009 Mar 1;47(3):230-5.
5. Ludomirsky A, Klein HO, Sarelli P, Becker B, Hoffman S, Taitelman U, Barzilai J, Lang R, David D, DiSegni E, Kaplinsky E. QT prolongation and polymorphous (“torsade de pointes”) ventricular arrhythmias associated with organophosphorus insecticide poisoning. Am J Cardiol. 1982 May 1; 49(7):1654-8.
6. Horio Y, Yasue H, Okumura K, Takaoka K, Matsuyama K, Goto K, Minoda K. Effects of intracoronary injection of acetylcholine on coronary arterial hemodynamics and diameter. Am J Cardiol. 1988 Nov 1;62(13):887-91.
7. Yasue H, Touyama M, Shimamoto M, Kato H, Tanaka S, Akiyama F. Role of the autonomic nervous system in the pathogenesis of Prinzmetal's variant form of angina. Circulation. 1974 Sep;50(3):534-9.
8. Karasu-Minareci E, Gunay N, Minareci K, Sadan G, Ozbey G. What may happen after an organophosphate exposure: acute myocardial infarction. J Forensic Leg Med. 012 Feb 1;19(2):94-6.
9. Gázquez V, Dalmau G, Gaig P, Gómez C, Navarro S, Mercé J. Kounis syndrome: report of 5 cases. J Investig Allergol Clin Immunol. 2010 Jan 1;20(2):162-5.
10. Anand S, Singh S, Nahar Saikia U, Bhalla A, Paul Sharma Y, Singh D. Cardiac abnormalities in acute organophosphate poisoning. Clin. Toxicol.. 2009 Mar 1;47(3):230-5.
11. Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. Br J Clin. Pharmacol. 2016 Mar; 81(3):462-70.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareA Comparative Study of Intraocular Pressure Measurement between Gold-Mann Applanation Tonometer and Perkins Applanation Tonometer in Glaucoma Patients
English6165Singh PunitEnglish Thakkar BhoomiEnglish Kharas HushedarEnglish Pathak MudraEnglish Modi SamikshaEnglish Mehta NiklankEnglishIntroduction: The study was performed to check the efficacy of intraocular pressure (IOP) measured by the Perkins applanation tonometry (PAT) over the gold-mann applanation tonometry (GAT) and to present and investigate the results, applying appropriate statistical methods. Aims: To comparative intraocular pressure measurement between gold-mann applanation tonometer and Perkins applanation tonometer in glaucoma patients. Methodology: Total 100 eyes (right eyes) of 100 patients underwent both types of instruments for measuring the intraocular pressure IOP which are gold-mann applanation tonometry (GAT) and Perkins applanation tonometry (PAT). Data collected were used for statistical analysis. Student t-test was used to find significance level between two study groups and p < 0.05 was considered as the significance level. Result: Total 100 eyes of 100 patients were included. Intraocular pressure (IOP) values taken from the Gold-mann applanation tonometry (GAT) (which is a definitive measure) were ranged between 10-30 mmHg. Based on IOP all the population groups were divided into three groups the first group with IOP < 18 mmHg including 38 patients, the second group of 32 patients with IOP ranged between 18-24mmhg and the third group of patients with IOP >24mmhg. The mean intraocular pressure (IOP) measured by gold-mann applanation tonometry (GAT) in our study was 22.45 mmHg. The mean intraocular pressure (IOP) measurements done by Perkins applanation tonometry (PAT) was 22.12 mmHg. The mean difference in the measurement of intraocular pressure (IOP) between the two instruments in our study was found 0.33 mmHg. By studying both the methods of measuring IOP it has been found in our study that there is not much significant difference in measuring IOP with both the methods it’s only 0.33mmhg. Conclusion: The intraocular pressure IOP measured from the Perkins applanation tonometer is highly comparable with the intraocular pressure IOP measured from the Goldman applanation tonometry (GAT).
EnglishGlaucoma, Glaucoma patients, Goldmann applanation tonometry, Intraocular pressure, Perkins applanation tonometry, Student t-testIntroduction:
Intraocular pressure (IOP) defines as the fluid pressure inside the eyeball. In glaucoma patients and ocular hypertension (OHT) patients, measurement of the intraocular pressure (IOP) is an important part of any ophthalmic examination.1 Intraocular pressure (IOP) is one of the most important modifiable risk factors which leads to glaucomatous damage to the optic nerve. So intraocular pressure (IOP) is the best to target for the management of glaucoma. For the diagnosis and management of glaucoma, accuracy in the measurement of intraocular pressure (IOP) is the utmost priority.
Glaucoma, the 2nd leading cause of irreversible blindness worldwide.2 The risk of the development of glaucoma increases with the increase in intraocular pressure (IOP). Increased intraocular pressure also increases the risk of worsening of pre-existing glaucoma.
The production of the aqueous humour and its outflow across the globe generates pressure which is defined as the intraocular pressure (IOP). At present, there is no safe and practical method available for the direct measurement of intraocular pressure (IOP). So intraocular pressure (IOP) is measured indirectly via non-invasive method as the trans-corneal pressure gradient.3
Gold-mann applanation tonometry (GAT) is esteemed as an ideal method for the measurement of intraocular pressure (IOP). It is approved as a part of NICE (National Institute for Health and Clinical Excellence) guidelines for measurement of intraocular pressure (IOP) in ocular hypertension and chronic open-angle glaucoma patients. Nevertheless, these guidelines do not support similarly Perkins handheld applanation tonometer (PAT). They state that the Perkins applanation tonometry (PAT) which is the type of hand-held tonometry is a very useful method for screening the patient who cannot sit on the slit-lamp. But there are no arguments to submit that these methods are similar to the Gold-mann applanation tonometry (GAT).4
Therefore, our study aimed to check the efficacy of intraocular pressure (IOP) measured by the Perkins applanation tonometry (PAT) over the Goldmann applanation tonometry (GAT) and to present and investigate the results, applying appropriate statistical methods.
Materials and methods:
After obtaining approval from the ethical committee of SBKS MI&RC, piparia, waghodia, Vadodara the study was conducted.
The ethical clearance no: SVIEC/ON/MEDIL/BNPG20/D2114
One hundred patients with the diagnosis of glaucoma were included in the study who came for the regular follow-up in the Dhiraj hospital, Vadodara.
Inclusion Criteria:
Patients having primary open-angle glaucoma (POAG).
Patients having primary angle-closure glaucoma (PACG).
Patients having normal-tension glaucoma.
Patients having ocular hypertension.
Willing to participate.
Exclusion Criteria:
Pathology of the cornea like keratoconus, corneal scarring, previous corneal surgery, corneal infection.
Congenital glaucoma.
Secondary glaucoma.
Physical inability to sit on the slit lamp or keep open the eye.
Microphthalmos, buphthalmos, nystagmus, and blepharospasm.
Patients having astigmatism >3D.
Patients were not willing to participate.
Patients having ageEnglishhttp://ijcrr.com/abstract.php?article_id=4170http://ijcrr.com/article_html.php?did=4170
Medeiros FA, Brandt J, Liu J, Sehi M, Weinreb RN, Susanna R. IOP as a risk factor for glaucoma development and progression. Intraoc Pressure. 2007:59.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br. J. Ophthalmol. 2006 Mar 1;90(3):262-7.
De Moraes CG, Prata TS, Liebmann J, Ritch R. Modalities of tonometry and their accuracy with respect to corneal thickness and irregularities. J Optom. 2008 Jan 1;1(2):43-9.
Perkins ES. Hand-held applanation tonometer. Br J Ophthalmol. 1965 Nov;49(11):591.
Gordon MO, Kass MA, Ocular Hypertension Treatment Study Group. The Ocular Hypertension Treatment Study: design and baseline description of the participants. Archiv Ophthalmology. 1999 May 1;117(5):573-83.
Group CN. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol. 1998 Oct 1;126(4):498-505.
Arora R, Bellamy H, Austin MW. Applanation tonometry: a comparison of the Perkins handheld and Goldmann slit lamp-mounted methods. Clin Ophthalm (Auckland, NZ). 2014;8:605.
Mark HH, Mark TL. Corneal astigmatism in applanation tonometry. Eye. 2003 Jul;17(5):617-8.
McLellan GJ, Miller PE. Feline glaucoma—a comprehensive review. Veterin Ophthalm. 2011 Sep;14:15-29.
Andrade SF, Cremonezi T, Zachi CA, Lonchiati CF, Amatuzzi JD, Sakamoto KP, de Arruda Mello PA. Evaluation of the Perkins® handheld applanation tonometer in the measurement of intraocular pressure in dogs and cats. Veter Ophthalm. 2009 Sep;12(5):277-84.
Andrade SF, Kupper DS, de Pinho LF, Franco EC, Prataviera MV, Duarte RR, Junqueira JR. Evaluation of the Perkins handheld applanation tonometer in horses and cattle. J VET SCI. 2011 Jun;12(2):171.
Arora R, Bellamy H, Austin MW. Applanation tonometry: a comparison of the Perkins handheld and Goldmann slit lamp-mounted methods. Clin Ophthalm (Auckland, NZ). 2014;8:605.
Peres PW. Positioning central venous catheters–a prospective survey. Anaesth Intens Care. 1990 Nov;18(4):536-9.
Epstein DL. Chandler and Grant's glaucoma. Lea & Febiger. 1986.
Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophth. 1993 Jul 1;38(1):1-30.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareEffect of Lumbar Stabilisation Exercises using the Stable and Unstable Surface on Pain, Disability and Electromyography (EMG) Activity in Chronic Low Back Pain
English6670Sheema SaleemEnglish Moazzam Hussain KhanEnglishIntroduction: Non-specific low back pain is one of the common representations of musculoskeletal disorders which can be widely seen all over the world. It is mainly due to the unbalanced and weak muscles of the core, which plays a vital role in maintaining stability and mobility of the spine. Consequently causes recurrence of back pain with activities. The objective of the study: The study was done to evaluate the effects of lumbar stabilisation exercise using stable and unstable surfaces on pain, disability and electromyographic activity of the Erector spine and transverse abdomen are muscle in chronic low back pain patients (CLBP). Methods: Twenty-four patients with chronic low back pain were recruited in the study based on inclusion and exclusion criteria. They were randomly allocated into two groups i.e Group A (n=12) lumbar stabilization exercise (LSE) on a stable surface while Group B (n=12) LSE on an unstable surface for 3 sessions per week for 6 weeks in both the groups. The pain was assessed using the Numerous Pain Rating Scale (NPRS), functional disability using Modified Oswestry Disability Index (MODI) Scale and Muscle recruitment pattern using Electromyography (EMG). Result: Six weeks of interventions showed significant improvement in pain, functional disability and muscle activity of core muscles in both groups (p English
Introduction
Mechanical low back pain refers to pain caused by abnormal stress and strain on vertebral column muscles which can be due to poor posture, ill-designed ergonomics or incorrect bending and lifting motions. It is the common representative muscular disorder and consists of spinal instability which further can lead to malfunctioning neuromuscular control.1Chronic low back pain (CLBP) is normally continuous back pain lasting more than 3 months.2It is widely seen in 70-85% of the population with up to 80% of patients described at least one episode in their life.3According to the world health organization low back pain constituted 37% of all occupational hazards which occupy the first rank among all the diseases.4
To provide stability of the lumbar spine, core muscles strengthening and stabilization exercises are important, and Core muscles mainly consist of deep stabilizer muscles are transverse abdominis, multifidus, pelvic floor muscles etc and global muscles are erector spinae, rectus abdominis, latissimus dorsi etc.5 Core training emphasis strengthening and reconditioning of local and global muscles that work together to stabilize the spine.6 The local muscles are slow-twitch fibres while global muscles are torque-producing muscles. The inter-segmental local muscle groups provide stabilization and control over supine position with lower force production.7
The major problem is the weakness, lack of motor control and delayed speed of muscles contraction of deep trunk muscles such as multifidus and Transverse Abdominis muscles.8 Deep stabilizer muscles in chronic low back pain patients become weak and imbalanced leading to reduced proprioceptive sense which further leads to stability problems in the spine and recurrence of back pain.9Therefore to treat LPB, deep stabilizer muscles exercise is required to balance the muscle control and counteract muscle atrophy. Unstable training equipment, such as Swiss balls, tend to increase the difficulty of performing exercises using complete bodyweight and resistance using free weights.10 Exercises done using Swiss balls employ all body regions and extensively activities can be done in comparison with exercises done on fixed floors. Using balls for performing exercises therefore can enhance the ability of dynamic balance, stability and the flexibility of the spine and improve the sense of balance to prevent injuries.11So exercises were done on a stable and unstable surface to examine its effects and measures using NPRS scale, MODI scale and surface EMG of core muscles.
Recently a study was done to see the correlation between the effects of trunk stability and LBP It has been suggested that to stabilize the trunk, correlation of deep and superficial muscles are needed as they are directly attached to the spine and stabilization exercises helps in improving the function on of neuromuscular system and hence support as well protect the spine.12LSE also helps in maintaining the neutral position of the spine, which is best for unloading of the spine. But no study shows the effectiveness of LSE on stable and unstable surfaces and their impact on global and local core muscle activation patterns in CLBP.13
Therefore, the study aimed to determine effective treatment protocol for chronic low back patients by performing LSE on the stable or unstable surface and to find out which exercise is best for reduction of pain, improving the core muscles activities and decreasing the functioning disability in chronic low back pain.
Materials and methods
Design
Pre-test and post-test experimental design.
Participants and Procedure
A total of 24 male and female subjects having chronic non-specific low back pain were recruited based on inclusion and exclusion criteria. Participants were informed about the purpose, procedure and effects of the treatment before the experiment and written consent was taken from them. Ethical clearance was taken from Institutional Ethical Committee Jamia Millia Islamia.
Inclusion Criteria
Non-specific low back pain experienced at least from last 3 months, age 18- 45 years, NPRS score from 3 to 6, MODI score from 20% to 60% (minimal disability to moderate disability), able to attend the hospital for treatment over 6 weeks, Prone instability test positive, Extensor endurance test positive, Aberrant movement pattern present.10
Exclusion criteria
Patients who have infectious pathology or injury received surgical interventions for their back pain or were awaiting surgery, diagnosis of clinical depression or other specific psychiatric pathology, contradicted to do exercises.10
All the participants were advised to avoid any other treatment interventions and they were recruited for a 6-week training program.
Measures and Interventions
Demographic data of subjects age (2.1346±4.475), height (1.676±7.471.), weight (62.130±0.113) and BMI (21.922±0.610) were taken along with the pre-test outcome measures which include pain level, functional disability and EMG of transverse abdominis and erector spinae. To measure the pain, Numerical Pain Rating Scale (NPRS) was used with an 0-10 integral rating scale. Modified Oswestry Disability Index (MODI) was used to assess the functional disability in CLBP.14The coefficient of Cronbach’s alpha was 0.92 and test-retest correlation reliability was 0.93.10
Surface EMG of erector spinae and transverse abdominis were taken by attaching disposable bipolar electrodes with a diameter of 1 cm attached parallel to muscle fibres. Skin preparation was done before the experiment to reduce impedance. Muscle activity of Transverse Abdominis was recorded by attaching surface electrode 2 cm away from the anterior superior iliac spine anteromedially while the activation pattern of the Erector spinae was recorded by attaching electrodes at 3 cm apart from the spinous process at the lateral side.12Ground electrode was attached over the superior aspect of the iliac crest of the same side.15 Every second time of the isometric phase of each exercise the root mean square (RMS) of EMG amplitude was calculated and then mean RMS obtained from three Maximum Voluntary Contraction trials for each muscle was used to provide a basis for EMG amplitudes normalization of data obtained during the experimental exercises (%MVC). The static phase of the experimental exercise was analysed, using means of three trials. The root means square (RMS) for the 3 repetitions of TA and ES muscles were normalised using 100 (%MVC). 16
Treatments
Participants are randomly assigned into two groups by using computer randomization Group A (n=12) and Group B (n=12).In Group A patients performed Lumbar Stabilization exercises on a stable surface along with hot fomentation for 10 min while Group B received hot packs for 10 min along with lumbar stabilization exercises on an unstable surface i.e Swiss ball. Equilibrium is maintained for 10 sec with a break of 3 seconds between repetitions for 40 min a day. Exercise protocol for both the groups was Back Bridging Exercise, Prone on Elbow, Posterior Pelvic Tilt, Abdominal Crunches and abdominal hollowing. Patients were instructed to maintain the final position for 10 sec then return to the initial position.10
Before initiation of each exercise program patients were given detailed verbal commands and visual clues or illustrations of exercise to patients emphasizing the starting and ending position. The selection of appropriate Swiss balls was based on demographic data given earlier. Group B was advised that the hip region must be parallel to the floor and the patient knee must maintain an angle of 90°while sitting on the Swiss ball .17
Duration of treatment: Both groups received treatment for 3 days a week × 6 weeks, 10 times/set, 3 sets .10
Data analysis
Data were assessed by SPSS version 17.0.Shapiro -Wilk test for the normality of the distribution scores. The demographic characteristic and the baseline criterion measure were compared between the two experimental groups at the study evaluated by an independent t-test. Then a paired t-test was applied to analyze the effect of intervention in two groups for the measures of pain (NPRS), functional disability (MODI) and muscle activation of TA and ES muscles using EMG.
Results
Patients Demographic
To prove the homogeneity between the two groups contrasting baseline criterion measurement was done using an independent t-test. No significant difference seen in baseline value of (p>0.05), Table 1
Analysis of data within groups
Paired t-test was used to distinguish the comparison between outcome variables at the baseline and Post-test measures in Group A and Group B. There was a significant difference in NPRS as pre mean of pain was 4.58(0.996) and post mean was 0.50(0.07)* in Group A and Group B pre mean was 4.75(1.138) and post mean was 0.00(0.00)*which shows the significant reduction of pain after 6 weeks of intervention. Similarly, there were significant reductions in MODI and EMG shown in figures 1A, 1B, 1C.
Analysis of data between the two groups
An independent t-test was used to compare post-test criterion measurement between Group-A and Group-B. A significant difference was seen between the groups in Pain (NPRS) and EMG activity of transverse abdominal muscle but there was no significant difference in Functional Disability (MODI) and EMG activity of Erector Spinae as shown in table 2. This reveals that lumbar stabilisation exercises done on Swiss balls were effective in decreasing chronic pain and increasing muscle activity patterns of local core muscles.
Discussion
Patients having non-specific mechanical low back pain show physical deconditioning of the core and manifests as muscle atrophy, decreased muscle strength and endurance. The localised and unilateral cross-sectional area of core muscles was also reduced in these patients. Active rehabilitation of trunk musculature reduced LBP symptoms, increased muscle strength, cross-sectional area and endurance.18In the current study pain was evaluated by NPRS scale so that subjective pain intensity of patients with CLBP before and after 6 weeks of training can be assessed. The reason for the reduction of pain was due to unbalanced core muscles training which leads to deep muscles activation and improves neuromuscular control. Yoon et al 2013, reported that stabilization exercises help in the reduction of pain by decreasing the signal delivered to the pain receptive tissues such as ligaments and joint capsules and further decrease the load on the lumbar vertebrae and enhance the function of the core stabilizer muscles leads to trunk positional control 16, a result which is similar with our study result. Lee et al., 2014, reported a significant reduction in pain in CLBP after training with Swiss Ball 12, a result that is consistent with our study. Along with that our result also showed that pain intensity significantly decreases Group B than Group A which was due to increased co-contraction pattern and activation in local core muscles.
In this study, the Lumbar stabilization exercise helped in increasing proprioception and co-contraction of core muscle which provide stability to the spine. Therefore emphasis should be on the stabilization exercises instead of strengthening of the muscle in low back patients.19Similarly trunk stabilizers muscles are more likely activated by unstable surfaces than stable which can be used in low back pain patients.20 There was a significant improvement in MODI in both groups after six weeks of intervention. But there was no significant difference between the two groups. A score less than 20% indicates that functional disability was not regarded as a significant functional disability in the daily life of patients .21
Muscle activity of local and global muscle was evaluated by EMG before and after six weeks of intervention and it has been seen that the MVC value of Transverse Abdominis and Erector Spinae significantly improves in both groups. The activity of transverse abdominis showed significant improvement in Group B as compared to another group, while there was no notable difference in MVIC value of Erector Spinae muscle. According to some research, good activation of the local muscles can lead to optimal stabilization of the lower back during basic stabilization exercise (O’Sullivan et al., 2000? Richardson et al., 2004).22,9,25 In the study (Escamilia et al.,2005) concluded that local muscles have a greater proprioceptive function and the exercise done on Swiss balls stresses these muscles to a greater extent which lead to improvement in balance.23,24Similarly deep abdominal muscle plays a very important role in providing spinal stability than superficial abdominal muscles. Despite the local muscles having short moment arms, which are deep and tonic muscles functioning as stabilizers of lumbar segments whereas superficial muscles are movement generating muscles that provide overall stability.2
Future studies can be done using resistance exercise using thera-band to provide resistance during LSE on both surfaces. An activity related EMG can be integrated comprising both the local and global muscle Limitations of the study where long term follow up can be taken to determine the reversibility of the result and the result cannot be generalized to the whole population.
Conclusion: The result of the study demonstrated that both stable and unstable surfaces significantly improved pain, functional disability and muscle activation pattern of the core muscles. Whereas, exercises performed on unstable surfaces are more effective as they help in achieving trunk stability and increasing the muscle activation pattern of transverse abdominal muscle to a great extent than the exercises done on a stable surface.
Acknowledgement:
We thank all the participants who helped with data collection, clinic staff, director of the centre of physiotherapy and authors whose articles are cited and included in references to this manuscript.
Conflict of interest: We have no conflict of interest.
Financial support: None
Author’s Contribution:
Sheema Saleem: Conceptualisation, data collection, data analysis, manuscript writing, manuscript modification.
Moazzam Hussain Khan: Conceptualisation, data analysis, manuscript modification, corresponding with the editor.
Englishhttp://ijcrr.com/abstract.php?article_id=4171http://ijcrr.com/article_html.php?did=4171
Chung S, Lee J, Yoon J. Effects of stabilization exercise using a ball on multifidus cross-sectional area in patients with chronic low back pain.J. Sports Sci. Med. 2013 Sep; 12(3):533.
Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003 Aug 1; 13(4):371-9.
Waddell G. Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine. 1987 Sep 1; 12(7):632-44.
Manchikanti L. Epidemiology of low back pain. Pain physician. 2000 Apr 1;3(2):167-92.
Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord .1992 Dec 1; 5:390-.
Dagenais S, Haldeman S. Evidence-based management of low back pain. Elsevier Health Sciences; 2011.
McGill SM, Grenier S, Kavcic N, Cholewicki J. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003 Aug 1;13(4):353-9.
Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Current sports medicine reports. 2008 Jan 1; 7(1):39-44.
Parveen A, Nuhmani S, Hussain ME, Khan MH. Effect of lumbar stabilization exercises and thoracic mobilization with strengthening exercises on pain level, thoracic kyphosis, and functional disability in chronic low back pain.J. Complement. Integr Med. 2020 Jul 27; 1(ahead-of-print).
Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med .2013 Feb; 37(1):110.
Escamilla RF, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S, et al,. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010 May; 40(5):265-76.
Lee CW, Hwangbo K, Lee IS. The effects of combination patterns of proprioceptive neuromuscular facilitation and ball exercise on pain and muscle activity of chronic low back pain patients. J Phys Ther Sci. 2014; 26(1):93-6.
Behm DG, Drinkwater EJ, Willardson JM, Cowley PM. The role of instability rehabilitative resistance training for the core musculature. J Strength Cond. Res.2011 Jun 1; 33(3):72-81.
Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. J. Phys. Ther.2001 Feb 1;81(2):776-88.
Souza GM, Baker LL, Powers CM. Electromyographic activity of selected trunk muscles during dynamic spine stabilization exercises. Archi Phys Medic Rehab. 2001 Nov 1; 82(11):1551-7.
Yoon JS, Lee JH, Kim JS. The effect of swiss ball stabilization exercise on pain and bone mineral density of patients with chronic low back pain. J Phys Ther Sci. 2013; 25(8):953-6.
Carrière B, Tanzberger R. The Swiss ball: theory, basic exercises and clinical application. Sprin Sci Busin Med. 1998.
Lehman GJ, Gordon T, Langley J, Pemrose P, Tregaskis S. Replacing a Swiss ball for an exercise bench causes variable changes in trunk muscle activity during upper limb strength exercises. Dyn Med .2005 Dec; 4(1):1-7.
França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.Clinical Science. 2010, vol. 65, n. 10. ISSN. 1807; 5932:1013-7.
Sekendiz B, Cug M, Korkusuz F. Effects of Swiss-ball core strength training on strength, endurance, flexibility, and balance in sedentary women. J Strength Cond Res. 2010 Nov 1; 24(11):3032-40.
Karimzadeh, Farzaneh, Latafat Kar, Ghasemi, & Gholam Ali. The effect of 8 weeks of central stability training on pain and functional disability of mothers with low back pain in children with cerebral palsy. Scientific. Sci. J. Kurdistan Univ. Medical Sci. 2016; 21 (3): 34-44.
O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997 Dec 15; 22(24):2959-67.
Khan MH. How to deal with heterogeneity in people with low back pain? Saudi J. Sports Med. 2020 Jan 1;20(1):29.
Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002 Feb 15;27(4):399-405.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareA Review on Imaging Modalities and Techniques for Oral Malignancy Detection
English7178Nanditha B REnglish Geetha Kiran AEnglishOne of the most prevalent forms of cancers across the world is oral cancer which has a high rate of mortality mainly due to late diagnosis. Early diagnosis and proper medication provide the best chance of cure for oral cancer patients. Different imaging modalities have been developed by researchers for oral lesion screening and various image analysis techniques have been proposed for analyzing the oral images for malignancy detection. This paper aims to review various works in the literature related to different techniques for oral lesion screening and analysis of oral images for the detection of oral malignancies.
English Malignant, Benign, Oral cancer, Lesions, Texture featuresINTRODUCTION
Cancer is a condition of the human body where an uncontrolled division of abnormal cells takes place. Among all types of cancers worldwide, oral cancer takes the sixth position. It accounts for approximately 4% of all cancers and 2% of all cancer deaths worldwide 1. In India it is the common malignant neoplasm, accounting for 20-30% of all cancers2. There are many risk factors for oral cancer that include extensive use of tobacco, alcohol consumption, smoking and others3,4. Normally, oral cancer patients visit doctors at a later stage because most of the lesions are asymptomatic and they do not affect the normal day-to-day activities of the patients. Late diagnosis of oral cancer has led to increasing in mortality rate which can be reduced with timely diagnosis and proper treatment.
Oral cancer normally occurs in the oral cavity or throat. Different kinds of lesions occur in the oral cavity. These can be benign, premalignant or malignant lesions5. Figure 1 elucidates different kinds of oral lesions. A premalignant lesion has the potential to develop into a cancerous lesion. The most common oral precancerous lesions are oral leukoplakia, oral submucous fibrosis, oral erythroplakia, and Lichen Planus6. Benign lesions include lichenoid reactions, Candidiasis, pemphigus Vulgaris, aphthous ulcers, mucocele and others. These lesions have different textures, colours, shapes and sizes. Normally doctors suggest a biopsy and histopathological examinations for confirming the specific kind of lesion. The biopsy is an invasive, time-consuming and expensive procedure. Many times patients are unwilling to undergo a biopsy since it is painful. In low socio-economic places where there is no proper access to medical facilities and resources, it may not be possible for each individual to undergo a biopsy examination. Thus, it may not be possible to identify premalignant lesions at an early stage and hence might lead to a high fatality rate. In such an environment, it would be desirable to develop imaging models and techniques which are less expensive and easily accessible to all sections of people. Many researchers have been working towards oral malignancy identification by developing various oral screening models for capturing oral images and image analysis techniques for analyzing the oral images for identifying malignancies. The following sections present a detailed description of these methods.
IMAGING MODALITIES FOR ORAL CANCER SCREENING
Normally, doctors use intraoral cameras for visualizing the oral cavity of patients during the routine clinical examination which is shown in Figure 2. A novel smartphone-based imaging modality which uses an intraoral camera for the detection of oral cancer has been proposed by Bofan Song et al.7 in which an integration of two modes i.e autofluorescence light and white light has been used for capturing images of the oral cavity. This modality is useful in low-resource settings where mass screening can be carried out by social workers to screen high-risk populations. The dual-mode images are analyzed by using cloud-based image processing software and it can be communicated to remote specialists to decide the existence of malignancy.
A multimodal optical imaging system that combines white-light images, autofluorescence images and microendoscopic images for evaluating oral premalignant lesions in a non-invasive manner has been proposed by Eric. C.Yang et.al 8. This imaging system captures white light and autofluorescence images and generates a heat map that delineates suspicious regions based on the red-green ratio of the images. A high-resolution microendoscopic device that has higher specificity than fluorescence imaging is used to explore the suspicious regions for identifying the biopsy sites. This system is very useful in identifying the site of biopsy for suspicious lesions and avoiding biopsy for benign lesions.
A surgical headlight system has been modified to act as a visualization and imaging device that can capture images of the oral cavity by integrating multiple modalities like fluorescence imaging, white-light imaging and orthogonal polarization 9. The device is battery-powere and includes LED lights for visualization of the oral cavity and acquisition of images both in white light and fluorescent light. It is a low-cost and portable device and hence can serve as a promising device for oral cancer screening in low-resource settings.
A simple hand-held device that uses fluorescent reflectance for oral cavity visualization directly by the human observer or by camera recording for detecting oral malignancies has been proposed by Lane et al.10. This device makes use of blue light illumination for detecting tissue changes between normal and malignant lesions. This device can act as an adjunct to white-light reflectance for oral cancer screening and also it serves as a guiding device for identifying biopsy sites.
Optical instruments serve as useful tools for screening oral cancer because of their non-invasive nature and also due to the ease of use11. With the intent of facilitating minimum invasiveness in oral screening, the evaluation of optical instrument oralook has been considered by Morikawa et al.12 to demonstrate its usefulness as a convenient real-time device for oral cancer visualization. The subjective and objective evaluations are performed with fluorescent visualization images captured using this device which showed that optical instruments serve as better adjunct devices for oral cancer screening. One more useful screening device for differentiating cancerous and normal lesions through the use of fluorescence images is illumiscan13. This optical instrument has been used for differentiating squamous cell carcinoma from oral leukoplakia by analyzing the images captured using illumiscan. Results indicate that there is a significant difference in the luminance values of leukoplakia and squamous cell carcinoma. This device can be integrated with conventional screening techniques to serve as a better tool for oral cancer screening.
Apart from the visualization and image acquisition devices described so far, other imaging modalities are useful for staging and grading oral cancer. These include computer tomography (CT) 14, magnetic resonance imaging (MRI) 15, positron emission tomography (PET) and others.
Another popular imaging technique used for the diagnosis of squamous cell carcinoma is confocal laser endomicroscopy16 which has high rates of magnification and enables penetrating deep into the tissues for better diagnosis of oral malignancies.
TRADITIONAL TECHNIQUES TO ANALYSE ORAL IMAGES FOR MALIGNANCY DETECTION
Literature reveals the use of traditional image processing and machine learning techniques for oral image analysis to identify oral malignancies. Researchers have tried to develop different methods for analyzing oral images captured using various imaging modalities and acquisition devices. Table 1 lists the different types of images used by various researchers for oral malignancy detection using various techniques. These images include standard white light images, fluorescent images, hyperspectral images, microscopic images and others.
Images need to be analyzed for concluding whether there are malignancies present in the oral images or not. Different image analysis techniques have been developed that make use of image features for identifying whether they are normal or abnormal images.
Features serve as discriminating factors for identifying oral lesions as benign or malignant. Various features like colour, texture and shape have been identified by researchers as good differentiating features for analyzing oral images. A brief description of different features used for oral image analysis is provided in the following sections.
Gray Level Co-Occurrence Matrix (GLCM)
GLCM features are used to measure the variation in intensity at a particular pixel of interest. The GLCM specifies how frequently different combinations of grey levels co-occur in an image 17. The pairwise spatial co-occurrences of pixels separated by a particular angle and distance are computed by using GLCM. The GLCM texture features are contrast, correlation, dissimilarity, homogeneity, energy, entropy, mean, variance and standard deviation. Table 2 lists all GLCM features and their characteristics that are useful in analyzing oral images for detecting malignancies.
Gray Level Run Length Matrix (GLRLM)
A run is constituted by adjacent pixels with the same intensity in a particular direction. The GLRL matrix is a two-dimensional tabulation of such runs against quantized pixel intensities. A coarse texture would normally result in relatively longer runs while comparatively shorter runs would correspond to fine textures. The GLRL features are short-run emphasis (SRE), long-run emphasis (LRE), low grey-level run emphasis (LGRE), high grey-level run emphasis (HGRE), grey-level non-uniformity (GLN) and run-length non-uniformity (RLN). Researchers have used GLCM and GLRL features for the identification and classification of benign and malignant lesions.
Microscopic images of oral lesions have been classified into benign and malignant lesions by using GLCM and histogram techniques18. They have made use of 134 images of normal tissues and 135 images of malignant tissues. Six first-order texture features namely mean-variance, skewness, kurtosis, energy and entropy have been used. T-test and principal component analysis (PCA) methods have been used for selecting significant features. They achieved 100% accuracy with a linear support vector machine (SVM) classifier.
Intensity-based first-order statistical features, GLCM and GLRL features19 have been used for multiclass classification of colour oral images by using backpropagation-based artificial neural network classifier. The boxplot analysis method has been used to select 11 useful features for classification. Classification accuracy of 97.92% has been achieved.
Texture features, shape and morphology features, histogram oriented gradient (HOG) features, wavelet colour features, Tamura’s features and Law’s texture energy (LTE) features20 have been used for automated detection and classification of cancer from microscopic biopsy images. KNN classifier was used and an accuracy of 92.19% was achieved.
J.V Raja et al.21 made use of fractal features and GLCM features like angular second moment (ASM), contrast, inverse difference moment (IDM) and entropy for identifying oral cancers from CT images. They found that the lesion group recorded higher mean fractal dimension, ASM, contrast and IDM than in the normal group.
A combination of first-order statistical features, GLCM features and GLRL features22 has been used for classifying cyst and tumour lesions from dental panoramic images. Support vector machine has been used for classification. It is found that the combination of first-order statistical features and GLRLM achieved the highest accuracy of 94.44%.
Fractal Features
Fractal features are found to be useful for measuring the texture of images. Fractals are found to be useful in describing the geometric structure of objects. They give information about the roughness or smoothness of a region and describe the heterogeneity of a region in an image.
The fractal dimension of an image correlates with its roughness 23 and when used for image analysis, results indicate that the fractal dimension of an image increases with an increase in noise in the image.
Unsupervised classification of textured images is possible by calculating the fractal dimension (FD) using the differential box-counting method 24. Different fractal features namely, FD of the original image, high grey valued image, low grey valued image, horizontally smoothed image and vertically smoothed image perform the texture-based classification.
Gabor Features
Gabor features are very much suitable for the analysis of images since they contain a lot of texture information. Gabor filters have been extensively used for texture description in various image processing and analysis approaches. They decompose an image into multiple scales and orientations analyzing texture patterns more straightforward.
Gabor features find their use in many image analysis applications which convey local information in an image at different frequencies and orientations. Different texture features25 have been deployed for classifying oral histopathological images into normal and oral submucous fibrosis. Gabor features and fractal features are also among these features that achieve good results in performing the classification.
A computer-aided diagnosis (CAD) system for differentiating normal and abnormal thyroid nodules in biopsy images using wavelet features, grey level features and Gabor features has been proposed26. The background is segmented from the foreground objects in the cytology images by the application of morphological transformation and watershed segmentation techniques. Then, statistical features are used for training different classifiers and an accuracy of 93.33% was achieved by the use of a neural network classifier trained with Gabor features.
Colour Features
Colour is an important feature that is found to be useful in analyzing images. Colour features are the basic characteristic of the content of images.
Different colour features have been used to discriminate oral malignancies such as oral lichenoid reactions from oral leukoplakia.27, 28 The oral images are represented in five different colour representations namely, Red-Green-Blue RGB, Irg, Hue-Saturation-Index (HSI), I1I2I3 and La*b* have been used for analysing oral cavity images. Results show that the HSI colour system provided the best classification accuracy. 70 out of 74 lichenoid reactions and 14 out of 20 leukoplakia were correctly classified.
A semi-automatic method29 for the detection of oral lesion boundaries has been proposed where colour images are analyzed by converting them into single-band images. Several single bands were derived from original three-band images: R, G and B bands from RGB colour space, H, S and I bands from Hue-Saturation-Index (HIS) colour space, Rn, Gn and Bn bands from normalized RGB colour space, I1, I2 and I3 bands from I1I2I3 colour space. An active contour model is applied on each of these bands for detecting the boundaries of lesions.
A three-stage Color-Based Feature Extraction (CBFE) system has been proposed30 which includes colour normalization, automatic feature extraction and PCA learning algorithm and classification. Two transformed images are computed based on the hue component in the normalized image namely, normalized red component image and normalized blue component image. They have used a dataset of 79 microscopic images and achieved more than 90% classification accuracy.
RGB and HSV colour representation modalities31 have been used for discriminating normal tissues from two potentially premalignant lesions, oral lichen planus and oral submucous fibrosis. Classification accuracy of 78% was achieved by employing the HSV colour space for image analysis.
Local Binary Patterns
Local binary pattern (LBP) is one of the useful methods for feature extraction. The original LBP operator uses a 3X3 square neighbourhood centred at the given pixel. The algorithm assigns either 0 or 1to the 8 neighbouring pixels according to the equation
where N is the binary value assigned to the neighbouring pixel, gN denotes the grey-level value of the neighbouring pixel and gC is the gray-level value of the centre pixel. The resulting values are then concatenated into an 8 bit binary number. Its decimal representation is used for further computation. The global shape and the local texture of the images are obtained as a result of LBP operation.
The use of higher order spectra features (HoS) and local binary pattern (LBP) features has been evaluated32 for classifying normal, oral submucous fibrosis with dysplasia and oral submucous fibrosis without dysplasia. Twenty three HoS features and nine LBP features have been extracted and fed to a support vector machine (SVM) for automated diagnosis. Results show that LBP features provide a good sensitivity (82.85%) and specificity (87.84%), and the HoS features provide higher values of sensitivity (94.07%) and specificity (93.33%).
Seven features33 have been extracted from lesion images and the lesions have been classified as benign or malignant lesions. These features are perimeter, area, diameter, fractal dimension, lacunarity, histogram of oriented gradients, and local binary patterns. A classification system that was able to diagnose with an accuracy of 85% has been developed.
Different variants of LBP features, namely average LBP (ALBP), block-based LBP (BLBP), ELBP (Elliptical Local Binary Pattern), Uniform ELBP, LDP (Local Directional Pattern) and M-ELBP (Mean-ELBP) can also be used for classification tasks which can capture intrinsic and detailed micro-pattern features from images.
All these features have been deployed for classifying oral lesions into normal or abnormal lesions by using traditional machine learning algorithms like artificial neural networks, support vector machines, bayesian classifiers, decision tree classifiers, principal component analysis, linear discriminant analysis.
DEEP LEARNING TECHNIQUES FOR ORAL MALIGNANCY DETECTION
Deep learning is gaining popularity as an adjunctive tool for disease diagnosis and treatment to aid doctors in diagnosing various kinds of disorders. Many deep learning techniques for oral cancer diagnosis have been developed by researchers. Jeyaraj et al.34 have developed a deep learning method for detecting oral cancer from hyperspectral oral images. Deep convolution neural network (CNN) architecture with two partitioned layers, one for labelling and the other for classifying the labelled region has been proposed which achieved 91.4% classification accuracy with 94% sensitivity and 91% specificity.
Confocal laser endomicroscopic images16 have been classified into cancerous and non-cancerous by using deep convolution neural networks. LeNet-5 network has been used for building the CNN where the first layer is a convolution layer that consists of 64 filters sized 5x5 pixels, the next layer is the max-pooling layer of 3x3 pixels and one more is a convolution layer containing 32 filters sized 5x5 pixels, followed by a max-pooling layer of size 3x3 pixels and a fully connected layer with drop-out and an output layer. This method shows better performance compared to conventional classification techniques like texture-based methods.
Two deep learning techniques have been assessed by Roshan Alex et al.35 for the early detection of oral cancerous lesions. One deep learning method used is for classifying images using ResNet-101 and the second technique is the deployment of R-CNN for detecting lesions. ResNet-101 is a deep neural network with 101 layers and is used widely for various applications. Transfer learning has been used where ResNet has been pre-trained on the ImageNet database. The faster R-CNN has also been trained with the COCO database and data augmentation is also performed to increase the size of the dataset. Deep learning techniques used in this work for oral lesion detection and classification have shown promising results.
An open-source convolutional neural network toolbox7 for analysis of autofluorescence and white light images has been used for the classification of oral lesions into cancerous and normal lesions. To increase the size of a dataset, transfer learning has been used with the Image Net database and also data augmentation techniques like flipping and rotation have been used. Results indicate that deep learning techniques are effective in classifying oral lesions from multiple modalities.
Hyperspectral images have been classified into squamous cell carcinoma (SCC), thyroid cancer and normal tissues using deep learning architecture36. A convolutional neural network has been implemented using TensorFlow for the classification of cancerous and non-cancerous tissues. This architecture includes 6 convolutional layers, 3 fully connected layers and a softmax layer that generates the probability with which every pixel belongs to a class. The system classified cancerous and non-cancerous tissues with an accuracy of 80%.
Identification of oral precancerous lesions to classify them as benign or malignant using six different deep learning techniques has been developed37. Of these techniques, a deep learning architecture based on vgg19 differentiated benign and malignant lesions with an accuracy of 98%. Another convolution neural network model based on resnet50 architecture could make a multiclass classification of oral lesions with an accuracy of 97%.
DISCUSSION
An attempt has been made in this paper to review the existing research work carried out by different researchers in analysing oral images for the identification of malignancies. Different kinds of images like white light images, fluorescent images, hyperspectral images, microscopic images have been used in the literature for analysing the abnormalities in the images. Different features have been used for the image analysis to classify them as benign or malignant based on the differences in their texture, colour and fractal features. These are found to be good discriminators of different kinds of lesions. Also, the use of different imaging modalities is very effective in capturing oral images for facilitating their analysis by the use of various image processing and deep learning techniques.
CONCLUSION
One of the serious health issues being faced by many developing countries is that of the high incidence of oral cancer. Early diagnosis and treatment of oral cancer can increase the survival rate of patients. An effort has been made in this paper to review different imaging modalities that have been devised for oral cancer screening and also different image processing and machine learning approaches that are available for detecting oral cancer. Various texture analysis methods such as GLCM, GLRL, Gabor features, fractal features and local binary patterns have been explored for image analysis. Also, the use of different colour features for oral lesion analysis has been reviewed. These features are very useful in identifying malignancies and also in classifying images into different types of lesions. Also, various deep learning techniques have been developed which are found to be very useful in identifying oral malignancies. In addition to all the existing screening devices and techniques for oral cancer detection, novel imaging modalities and image analysis methods are still required for the early detection of oral malignancies.
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
Financial Support
No financial support has been obtained for this work
Conflict of interest
Authors have no conflict of interest
Authors contribution
All authors have substantially contributed to the conception and design of the manuscript and interpreting the relevant literature. The authors have drafted the manuscript and revised it carefully for important intellectual content.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareCausal Factors of Unwanted Fertility in India’s Easternmost Border State Manipur
English7984N. Sharat SinghEnglish Kh. Sundari DeviEnglishIntroduction: Unwanted fertility is a serious problem in achieving a stable population in India particularly in backward regions. Aim: The study is to examine the determinants of unwanted fertility in tribal-dominated valley areas of Manipur, Indian easternmost state internationally bordering Myanmar. Materials and Methods: A cross-sectional study of 1152 currently married women of age below 52 years was conducted under a cluster sampling scheme from May 2018 to April 2019. Logistic regression along with classical t – statistics explores the risk factors of unwanted fertility. Result: The fertility of tribal women (3.1) is significantly higher (PEnglishTribal, Odds ratio, Third birth, Education, Son preferenceINTRODUCTION
In India, higher fertility of tribal women is associated with low socioeconomic status, disadvantages of communication, poor infrastructures etc.1,2 Even after seven decades of national population policy (NPP-2000), fertility rates are higher for women in disadvantaged groups say for instance 2.5 children per women among scheduled tribes, 2.3 among scheduled castes, and 2.2 among other backward classes, compared with women who are not any of these groups (2.4 children) while all India figure of 2.2.3 Meanwhile, nationally unwanted fertility of 3rd birth transition is a serious demographic problem to population growth. Lack of education and son preference may be solely responsible for it. In India, son preference may be due to three major factors – economic, socio-cultural and religious utilities.4 In the patriarchal system of the family son is very important for the continuation of the family in the society and also religious functions that only sons can provide.5 In the case of intention, about 19% of Indian couples want more sons than daughters, but only 3 to 4% of them want more daughters than sons.3 While, the wanted fertility rate in the country is 1.8 children (defined by the ideal number of children at an average for a couple) in 2015-16 which is almost the same as 1.9 in 2005-06. However, the gap between the actual and wanted fertility rates is declined by half say from 0.8 in 2005-06 to 0.4 in 2015-16. But only five states – Meghalaya (2.8), Bihar (2.5), Manipur (2.3), Nagaland (2.3) and Mizoram (2.2) have wanted fertility rates above the national goal of replacement fertility level (2.1). In Manipur, 24.6% of ever-married women want more sons than daughters in 2015-16 which is declining from 31.2 in 2005-06; 36.5% in 1998-99 and 43.4% in 1992-93.3,6
The present study is thus carried out to examine the status of varied fertility indicators and determinants of unwanted fertility in tribal-dominated areas of rural Manipur valley to identify risk/causal factors in achieving the national socio-demographic goal for replacement fertility (2.1) or so-called nationally wanted fertility level. There are more than 33 scheduled tribes with about 30% of the total population in Manipur having a unique feature that it has the largest number of dialects with the least population.
MATERIALS AND METHODS
A cross-sectional as well as community-based study of 1152 currently married women (tribal: 50% and non-tribal: 50%) of age below 52 years was conducted through a cluster sampling scheme in four valley districts of Manipur – Bishnupur, Imphal East, Imphal West and Thoubal during May 2018 to April 2019 taking 1st May 2018 as reference date of the survey. Inhabited mainly by Mongoloid race, the study population is Indian easternmost State internationally bordering with Myanmar. The empirical data is analysed with SPSS vs 23. Though the term unwanted birth is generally defined to be the birth over the number of children a woman reported as her ideal number, a woman having at least 3rd live birth is treated to have unwanted birth in the present research.
In addition to the classical t-test, binary logistic regression models are adopted to examine the impacts of socio-demographic factors of unwanted fertility. The dependent variable is dichotomous defined as 1 (one) if the woman has at least 3rd live birth transition and 0, otherwise say the women have at most two live births. The independent variables are social class (tribal=1, non-tribal=0), education, income, age at menarche, age at marriage, mother’s age at 2nd delivery, desire number of the son (son preference), sex of 2nd live birth (male=1, female=0) and status of sterilization (wife is sterilized=1, otherwise=0). Among the variables, age, income and son preference have their quantitative values and hence no difficulties of measurement. For categorical variables – social class, sex and status of sterilization, a binary dummy variable (0, 1) is utilized. Taking education as an ordinal variable, it is measured by levels as Illiterate=1, under matriculate=2, matriculate =3, ten plus two=4, and graduate and above=5. The effects of the causal factors are comparatively explained in terms of their odds ratios (OR: eb).
Results
The fertility of tribal women (3.1) is found to be higher (PEnglishhttp://ijcrr.com/abstract.php?article_id=4173http://ijcrr.com/article_html.php?did=4173
Nanda S. Cultural determinants of human fertility: A study of tribal population in Orissa. Anthropol. 2005; 7(3): 221-227.
Saha KB, Verma S. High fertility among scheduled tribes of Madhya Pradesh. Indian J Med Res. 2006; 123: 89-90.
IIPS, ICF. National Family Health Survey (NFHS-4) 2015-16 2017, Mumbai, India.
Nath DC, Deka AK. The importance of a son in a traditional society: How elderly parents see it? Demo Ind. 2004; 33(1): 33-46.
Nath DC, Leonetti DL. Correlates of coital patterns in a traditional Indian society. Dynamics of population change (Emerging issues of 21st Century). Shipra Publication, Delhi. 2001: 57-67.
IIPS. National Family Health Survey. 2005-06, Manipur, 2008.
Yadava RC, Sharma SS.Closed birth interval versus most recent closed birth intervals. Demo Ind. 2004; 33(2): 249-263.
Vignoli D. Fertility change in Egypt: From the second to third birth. MPIDR Working Paper 2006-011.
Singh NS, Narendra RK. Determinants of waiting time to conception in Manipuri women. Kuwait Med J. 2007; 39(1): 39-43.
Singh NS, Sanajaoba N, Narendra RK. Survival analysis of duration of waiting time to conception. Elec J Appl Stat Appl. 2011; 4(2): 144-154.
Hussain R, Fikree FF, Berendes HW. The role of son preference in reproductive behaviour in Pakistan. Bull World Health Org. 2000; 78(3): 379-388.
Youssef RM. Duration and determinants of interbirth interval: Community-based survey of women on Southern Jordan. East Medit Health J. 2005; 11(4): 559-572.
Khawaja M, Randall A. Intifada Palestinian fertility and women’s education. Genus. 2006; LXII (1): 21-51.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAnalysis of COVID-19 Complications Using Deep Learning-Based Neuro-Fuzzy Classification Approach
English8589Modem Amarendhar ReddyEnglish M. James StephenEnglish P.V.G.D Prasad ReddyEnglishIntroduction: Nowadays, the use of technology in medical diagnosis, management, and patient care has exploded. Medical diagnosis is a difficult task that is frequently performed by professional developers. This inductive research objective is to investigate advanced machine learning techniques for effectively analyzing health data based on COVID-19 symptoms. There are numerous variables to consider when evaluating the disease, and determining the effect of COVID-19 on various human organs is not an easy task. Objective: This research aims to develop an adaptive medical diagnosis model for COVID-19 to ascertain and predict disease risk and detection. Methods: Frequently used models for classification are Adaptive Neuro-Fuzzy Inference System (ANFIS) and Deep learning-based Neural Networks (DNN). This article employs a Deep Neuro-Fuzzy System with a cooperative structure in its analysis. Results: This article predicts disease using a patient dataset from Mexico with over twenty input parameters or features. To develop a more accurate classification technique, the results of several Deep learning and Neuro-Fuzzy mechanisms are compared and analyzed. This study’s outcome can be extended to a larger number of input features and applied to the detection of additional diseases. Conclusion: The proposed Deep Learning-Based Neuro-Fuzzy classification model shows better complications and prediction results compared to others.
English Artificial Neural Networks, Adaptive Neuro-Fuzzy inference Systems, COVID-19, Deep Learning, Deep Neural Network, Deep Neuro-Fuzzy SystemsINTRODUCTION
Health diagnosis is a difficult task that is often demonstrated by competent engineers. The study will establish a model for adaptive medical diagnosis of COVID-19 to predict and assess disease incidence and detection. There are several factors when determining the disorder, so defining the effects of COVID-19 on various human organs is not an easy task.
Among the numerous machine learning models available, Adaptive Neuro-Fuzzy Inference System (ANFIS) and Deep Neural Network (DNN) are two well-known approaches to data classification. ANFIS is a network that combines fuzzy logic and neural networks. ANFIS has excelled in a variety of fields, including health care and forecasting. One of the challenges with ANFIS is the computational complexity involved in converting data to neural networks. The DNN model learns the features from the training data provided. One of the difficulties with DNN is that it makes predictions opaque and thus difficult to trackback.1, 2
In 2016, A.R.Karthekeyan published a paper describing a technique for increasing the accuracy and speed of processor training classifications by utilising fuzzy neural networks. While neural networks can benefit from data, they cannot be perceived—they are opaque to the human eye. Fuzzy Systems are interpretable but unintelligible language laws. We construct fuzzy data structures using Neural Network Domain Learning algorithms.1 The learning algorithms are capable of studying both fuzzy sets and fuzzy laws, and can also analyse the credit risk before making a bank loan decision. A fuzzy neural network or neuro-fuzzy system is a virtual engine that utilises neural network approximation methods to evaluate consumer information for credit risk management purposes and to identify the parameters of a fuzzy structure ( i.e., fuzzy sets, fuzzy rules). When it comes to bank loan decisions, the Fuzzy Neural network algorithm is all about simplifying the loan officer's role, monitoring it, and increasing performance and profitability.
Sudipta Roy, Shayak Sadhu, Samir Kumar Bandyopadhyay, Debnath Bhattacharyya, and Tai-Hoon Kim proposed a system for rapidly and accurately determining brain tumour type from an image in 2016. The proposed system enables rapid and accurate tumour identification and classification model using the class label. The proposed programme is structured in stages. The initial stage involves normalising an MRI image as input. The next stage entails extracting vectors of features from the image, which eliminates redundant data and provides input to the classifier. For each tuple of extracted vector functions, the classifier generates a classified output. A careful examination of the results demonstrates that our proposed method was extremely efficient and precise.2
In 2020, an advanced adaptive neuro-fuzzy inference system (ANFIS) using enhanced Flower Pollination Algorithm (FPA) and Salp Swarm Algorithm (SSA) was proposed for classification. SSA is used in conjunction with FPA to mitigate some of the FPA disadvantages like being stuck at the local optima). The proposed model, dubbed FPASSA-ANFIS, is centred on the idea of increasing ANFIS efficiency through the use of FPASSA to evaluate ANFIS parameters. The FPASSA-ANFIS model is evaluated by predicting and classification of labels. When compared to other available models, however, the FPASSA-ANFIS model outperforms them in accuracy and execution time. Additionally, they evaluated the model using two datasets and the results indicated an exceptional level of performance.3
Detlef D. Nauck and Andreas N. Urnberger discussed several significant milestones in the evolution of neuro-fuzzy systems.4 According to the paper, the best option for learning predictive models was to combine fuzzy systems and neural networks to create neuro-fuzzy systems. The article discussed the advancements made in the area of combining supervised learning methods and neuro-fuzzy systems.
A deep learning strategy was used to identify COVID-19 by recommending the use of just one see (YOLO) in conjunction with Darknet.5 Their format specified categorising files for COVID-19 by numerical (COVID vs No-Findings) and multi-class (COVID vs No-Findings vs Pneumonia) determinations, resulting in an 87.02 per cent precision. While academics recognised the value of deep learning, it has not been widely applied for realistic implementation in comparison to CBR systems. Additionally, a few experiments demonstrated that cumulative CBR but also deep learning were observed throughout domain acquisition and also the abstraction of attribute weights, even though the former performs the detection task.6-9
The incorporation of fuzzy logic and information gathering techniques was suggested as a way to improve the reaction time and throughput of the extraction phase with a case-based rationale for related offences.6 The fuzzy CBR proposed includes two additional components: a partial for the Fispro determination derived from a fuzzy decision tree and a partial for the case-premised argument advanced via the JColibri model.7 The primary goal of fuzzy logic is to reduce the difficulty associated with determining the level of compatibility between diabetic patients and self-care programmes. The researcher compared the findings to a few existing classification systems that make use of precision indicators such as showings indicators. The experimental results indicate that the fuzzy decision tree appears to be extremely effective at increasing the reliability of the diabetic classification and thus the CBR justification retrieval stage.
Various image classification models using Neuro Fuzzy algorithms were discussed by multiple authors but they haven’t explored using Hybrid Deep Neuro-Fuzzy systems.9-12 Combining fuzzy inference with deep neural networks has been applied to a variety of application areas, including traffic flow prediction and incident prediction.8
MATERIALS AND METHODS
The perspective of the Deep Neuro-Fuzzy model defined and used here is predictive analytics in nature and utilize COVID-19 patient records to improve healthcare quality. Building predictive models from a limited patient data set are incredibly difficult. Our research focuses on the prediction and prevention of COVID-19 disease by using a novel Deep Neuro-Fuzzy model. COVID-19 disease prediction is complicated by their complications and the patient's other comorbidities. There has been some recent work on COVID-19 predictive analysis, but all of it has relied on Neuro-Fuzzy algorithms or Deep learning. We developed a novel Deep Neuro-Fuzzy algorithm that combines the benefits of Neuro-Fuzzy and Deep Neural's network multi-layered structure. The flow diagram shows the overall steps taken to shape the methodology in Figure 1.
Due to the inconsistency of the patient's real-world data, passing the same data to the model may result in the error output. As a result, the data's quality must be preprocessed to ensure maximum accuracy. Data quality preprocessing entails the following steps: data lineage, data collection, custom metadata, and data preparation. Table 1 provides additional information about the data quality steps. The dataset used in this study is the COVID-19 patient data from Mexico with complications. The dataset contains 3,23,323 rows of data containing 25 features gathered from Google's research department.
After data preparation data, it was partitioned as training and testing datasets. Throughout this study, 70% of the dataset instances were chosen for the training and 30% for the testing. Additional testing datasets result in more efficient and reliable results when the proposed model is used.
ANFIS was first introduced by Jang with the integration of Fuzzy Logic(FL) and Artificial Neural Networks.14 Deep Neural Network learns the mapping from the datasets by calculating the weights of each neuron using error backpropagation.9-12
The Deep Neuro-Fuzzy model is composed of fuzzification, deep learning, and defuzzification components. These three components will be executed sequentially. The input layer will read data from the dataset, while the network will carry information about the three components. The Fuzzification component applies the fine-tuned data after preprocessing to the model, where each input xi in this layer is an adaptive Member Function that generates the membership degree. This component converts crisp values to a degree of fuzzy membership. The parameters in this component are trained by the optimization algorithm Gradient Descent(GD). The component devoted to deep learning is the most vital in this model. For deep learning's high level of abstraction, it processes data with a large number of input features. This component is initialised via the Fuzzification component's output. This component feeds fuzzy input signals forward to one of its hidden layers. The nodes in the hidden layer are connected in such a way that processed data is feed-forward to the next layers. The input elements are multiplied by the weight connections that correspond to them. This component makes use of a sigmoid activation function.13,14,15 The final component of the model is defuzzification. The deep learning component extracts and learns features from the dataset, which is then processed by the demulsifier, which generates the model's output. The output is determined by the fuzzy rules that were defined. The Deep Neuro-Fuzzy model is represented in Figure 2.
RESULTS AND DISCUSSION
After building the model according to the proposed methodology, we used an arbitrary slice as input to evaluate the model's effectiveness at classifying the slice into the class marks defined in the training dataset. The model's suggested technique has been implemented and validated in MATLAB. Twenty different types of labels are considered in this case, and the model is properly trained using the training data. Following training, the test dataset constructed from the input slice is compared to it. To determine the effectiveness of the classifier, the prediction is compared to the actual. With the test dataset, the built model achieves an accuracy of 97.1 per cent and a valid accuracy of 95.12 per cent, with a sensitivity of 100 per cent and a specificity of 99.95 per cent. Figures 3 and 4 depict the model's data visualisation and accuracy graph when training and testing data are used. Figure 3 shows the distribution of the patients’ data according to the severity of the disease. Red means severe and blue means asymptotic.
Additionally, experiments on the same dataset were conducted using ANFIS and DNN to compare the results to the Deep Neuro-fuzzy model. As shown in Table 2, the performance of the Deep Neuro-fuzzy model is better than that of the ANFIS and DNN.
CONCLUSION
Our approach is an advanced classifier that has been validated using a Deep Neuro-Fuzzy model for Covid-19 patient complications. On the collected dataset, the classifier achieved an accuracy of 97.1 per cent. It demonstrated the importance of function sub-selection. The function extraction process entails reducing the number of resources required to accurately represent a large range of data. Testing with a large number of variables typically requires a lot of memory and computational resources, or a classification algorithm that consistently matches the training sample and frequently generalises well to new samples. Extraction of features is a broad term that refers to techniques for constructing variable combinations that circumvent these issues while still accurately representing the data.
In this study, we attempted to use feature-rich datasets to conduct preliminary experiments. Additionally, a larger number of input features can be considered in the future. As a result, this model can be used for more than just classification problems and diseases in the future.
ACKNOWLEDGEMENTS
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
SOURCE OF FUNDING
This is a self-funded project
CONFLICTS OF INTEREST
There are no undisclosed conflicts of interest for the Authors.
AUTHOR CONTRIBUTION
M Amarendhar Reddy - 1) Analysis, design, implementation of the proposed model; 2) Conception and interpretation of dataset; 3) drafting the article, intellectual content review of the article; and 4) final version approval for publication
Dr. M.James Stephen - 1) Conception and design; 2) Intellectual content review of the article, and 3) final version approval for publication
Dr P.V.G.D Prasad Reddy - 1)Intellectual content review of the article; and 2) final version approval for publication.
Englishhttp://ijcrr.com/abstract.php?article_id=4174http://ijcrr.com/article_html.php?did=4174
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Benamina M, Atmani B, Benbelkacem S. Diabetes diagnosis by case-based reasoning and fuzzy logic. Int J Interact Multimed. 2018;5(3);72-80.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareColonization of Periodontal Pathogens in the Placenta is Associated with Low Birth Weight Babies: A Pilot Study
English9094Agarwal GEnglish Bansal SEnglish Chaudhary SEnglish Sharma MKEnglish Mishra VEnglish Roy TREnglishIntroduction: Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis. Aim: To evaluate the possible correlation between microorganisms present in the placental extract and subgingival plaque and calculus. Materials and Method: The study included 30 pregnant females distributed equally into the study (delivered preterm low birth weight babies) and the control group (delivered at normal term with normal weight babies). At the time of delivery, the sample of the placental extract was collected. Within two days postpartum clinical periodontal parameters of mothers i.e. subgingival plaque and calculus sample was collected. Placental extract and subgingival plaque and calculus samples were subjected to anaerobic culture, and various microorganisms present were identified. Spearman Rank Correlation test was used for seeing the correlation between plaque and placental microbial count. Results: A significant difference (pEnglish Periodontitis, Preterm, Low birth weight, Risk factor, Plaque, Microorganisms
Introduction: Preterm infants (born with a low birth weight) represent major social and economic public health problems in developing/developed nations. The World Health Organization (W.H.O.) has suggested that gestational age Englishhttp://ijcrr.com/abstract.php?article_id=4175http://ijcrr.com/article_html.php?did=4175
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Lopez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized controlled trial. J Periodontol. 2002;73:911–924.
Michalowicz BS, Hodges JS, Diangelis AJ, Lupo VR, Novak MJ, Ferguson JE, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006;355:1885–1894.
Offenbacher S, Lin D, Strauss R, McKaig R, Irving J, Barros SP, et al. Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: A pilot study. J Periodontol. 2006;77:2011–2024.
Offenbacher S, Jarad HL, ?Reilly PG. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998;3:233.
Collins JG, Smith MA, Arnold RR, Offenbacher S. Effects of Escherichia coli and Porphyromonas gingivalis lipopolysaccharide on pregnancy outcomes in the golden hamster. Infect Immun 1994;62:4652-4655.
Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionitis infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319:972-978.
Mueller-Heubach E, Rubinstein DN, Schwarz SS. Histologic chorioamnionitis and preterm delivery in different patient populations. Obstet Gynecol1990; 75:622-626.
Hill GB. Preterm birth: association with genital and possibly oral microflora. Ann Periodontol 1998;3:222-232.
Katz J, Chegini N, Shiverick KT, Lamont RJ. Localization of P. gingivalis in Preterm Delivery Placenta. J Dent Res. 2009; 88: 575–578.
Nakamura K H, Tateishi F, Nakamura T, Nakajima Y, Kawamata K, Douchi T, et al. The possible mechanism of preterm birth associated with periodontopathic Porphyromonas gingivalis. J Periodontal Res. 2011;46:497-504.
Ovalle A, Gamonal J, Martínez MA, Silva N, Kakarieka E, Fuentes A, et al. Relationship between periodontal diseases and ascending bacterial infection with preterm delivery. Rev Med Chil. 2009;137:504-514.
Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355:1885-1894.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371:75-84.
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Burton GJ, Sebire NJ, Myatt L, Tannetta D, Wang YL, Sadovsky Y, et al. Optimising sample collection for placental research. Placenta. 2014;35(1):9-22.
Moolya NN, Thakur S, Ravindra S, Setty SB, Kulkarni R, Hallikeri K. Viability of bacteria in dental calculus–A microbiological study. J Indian Soc Periodontol 2010;14(4):222.
Moreu G, Téllez L, González-Jaranay M. Relationship between maternal periodontal disease and low-birth-weight pre-term infants. J ClinPeriodontol. 2005;32:622-627.
Bearfield C, Davenport ES, Sivapathasundaram V. Possible association between amniotic fluid microorganism infection and microflora in the mouth. Brit J Ob Gyn 2002;109:527-533.
Ebersole JL, Novak MJ, Michalowicz BS. Systemic immune responses in pregnancy and periodontitis: relationship to pregnancy outcomes in the obstetrics and periodontal therapy (OPT) study. J Periodontol 2009;80:953-960.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareEffect of Drug Abuse Among Persons with Disabilities in South-East Nigeria
English95101Wada Bashir IsiakuEnglish Justina Ifeoma OfuebeEnglish Chidinma DedeEnglish Benedict Chimezie NwankwoEnglish Prince Onyemaechi NwekeEnglishIntroduction: Drug abuse is a universal and social problem with different harms that fluctuate in society. It has become a subject matter of public worry internationally because it adds potentially to deliberate or undeliberate harm. Hence, it is the responsibility of society to facilitate enforcement agencies to eradicate drug abuse in society at large. Objective: The research study examined the effect of drug abuse among persons with disabilities in society at large. Methods: The study adopted a descriptive survey design. The study sampled 688 respondents. The instrument used for data collection was a structured questionnaire. Cronbach Alpha Reliability Coefficient was used to determine the instruments which yielded reliability coefficients of 0.82. The research questions were answered using mean and standard deviation. The scales use for the questionnaire was Strongly Agree (SA), Agree (A), Disagree (D) and Strongly Disagree with the values of 4, 3, 2 and 1 respectively. These responses were based on positively worded items while the reverse was for the negatively worded items. The average score from coded data (4+3+2+1 =10/4) was 2.50. Results: The findings of the study revealed the causes of drugs abuse among persons with disabilities such as earliest influence to smoke, earliest influence to drink alcohol, unemployment, poor academic performance, parental rejection, family abuse, over-controlling by parents, and depression and anxiety among others. The findings of the study revealed preventive strategies to control drug abuse among persons with disabilities and the society at large, which include: dissemination of laws against drug abusers and the establishment of drug law enforcement agencies to monitor drug abuse offenders. Conclusion: Because of the above findings, it was concluded that government should frequently organize educational programs, media broadcasts, advertisements, seminars aimed at enlightening the youths and persons with disabilities on the dangers and consequences of drug abuse.
EnglishAdolescents, Disabilities, Drug abuse, Drug addiction, Health practitioners, Social problemsINTRODUCTION
As Nigeria witnessed a rapid rate of urbanization, some individuals becoming unable to adjust to their changing environment and circumstances. Consequently, such persons become victims of a disordered life and this takes to drugs for relief. Hence, such abusers become of great concern to the family and the society at large, because of the destabilizing effect of anonymity and suffering associated with the use of such drugs.6 During the oil boom days in Nigeria, from the beginning of 1970s dawn to 80s, there were jobs; Nigerians got themselves in the lavishness of materialism and excessive living habits. Hence, nobody thought of an alternative business or what to do to earn a living, lastly after the oil market distorted it bring a tryout of reduction of expenditure as an alternative of employment in the society at large.4It is against this backlash of economic plight that Nigerians had to look beyond the frontier of their nation for quick money-spinning business. However, the general public's underlying hatred was against cannabis use, because of the mental, social and actual impact because of the well-known clamor against the risk of deals and maltreatment of medications in Nigeria.17
Research evidence shows that drugs are also commonly abused among young people,21 such as valium, laxotan, activan, etc.20 Nevertheless, up till the end of seventies, the use of narcotic drugs that essentially relieve pain were used for medical and scientific purposes only and were kept in hard drug cupboards of hospitals to ensure adequate monitoring. Meanwhile, the abuse of narcotic drugs was then a phenomenon of health care workers only. Not until the arrest of a narcotic drug trafficker was made at the Murtala Mohammed International airport, Lagos in 1984, little or no attention was paid to the abuse of narcotic drugs.14 Unfortunately, the rising expectations and unfulfilled dreams have led to depression and experimentation with all kinds of drugs in society. The drug problem has eaten deep into the fabric of the society that some persons with disabilities cannot alter the environment in which they found themselves. Therefore, the public idea of persons that used drugs is severally distorted in a variety of ways, that is why.2 Studies posited that drug addictions are not a hallmark of moral failure or lack of willpower, but a complex disease that deserves long-term, broad therapy, very much like some other persistent condition. Even though individuals who have not battled with substance addiction might think that it is hard to get why individuals engaged in drug abuse.7 Also there are many reasons why some people start abusing drugs, and unfortunately, the consequences can be life-shattering.
Drug abuse is a universal physical condition and social problem with different conditions and harms that fluctuate in society at large. The use of psychoactive substances among adolescents, youths and persons with disabilities has become a subject matter of public worry internationally because it adds potentially to deliberate or undeliberate harm. Drug abuse can be defined as an emotional problem mainly influenced by current social factors in any given society. It refers to a condition where the drug is used to produce an effect that the drug is not designed to produce.15Drug abuse is defined as non-medical, self-administration of a substance to induce psychoactive effects, intoxication or altered body image, despite the knowledge of its potential adverse effects while drug misuse implies that a drug has a proper medical use and prescription and is being employed for an incorrect purpose. Drug abuse, according to Food and Drug Administration is an intentional therapeutic use of a drug product in an inappropriate way.9 Studies carried out by scholars reported that despite the efforts of Nigerian National Drug Law Enforcement Agency and other governmental agencies to stem the tide of substance abuse in Nigeria, there has been a consistent rapid rise in the number of cases of drug abuse among young people (ages 10- 24) in Nigeria.1
Operationally, drug abuse is defined as a patterned use of a drug in which the abuser devours the substance in amounts that are destructive or dangerous to their health. Therefore, when an individual perseveres in utilize of drugs despite the harms related to the use of the substance, substance dependence may be diagnosed. Consequently, uncontrollable and cyclical use may result in forbearance to the consequence of the drug and results in withdrawals symptoms when use is reduced. On the other hand, a disability is when an individual’s body or mind is impaired in such a way that they are unable to engage in one or more major activities in their life. Importantly, some people are born with a disability, while other disabilities may be a result of injury.11 Disabilities may increasingly get worse over time, remain unchanged, or even come and go depending on the specific disability, the harshness of symptoms, treatment, and the person.
Conversely, the causes of drug abuse and well predictive risk factors among persons with disabilities.10 The author further explains that the earliest influences to smoke, drink alcohol, or use drugs may come from the family, while factors related to drug use during adolescence include poor self-image, low religiosity, poor school performance, parental rejection, family dysfunction, abuse, under-or over-controlling by parents, and divorce. Similarly, common risk factors for teen drug abuse, include a family history of substance abuse; a mental or behavioural health condition, such as depression, anxiety or attention-deficit/hyperactivity disorder; and impulsive among others.13Other causes or risk factors associated with drug abuse among persons with learning disabilities include poor socioeconomic status, peer-group pressure influence, family problems and poor academic performance, unemployment, and broken home.12 Importantly, for any society or government to eradicate drug abuse must be ready to organize media broadcasts, advertisements and seminars aimed at enlightening the youths and persons with disabilities on the dangers and consequences of drug abuse.
Studies carried out by scholars mentioned various consequences of drug abuse that are so devastating and very shameful to the extent that both the national and international organizations across the globe are also worried about the spread of this scourge among the youths and persons with disabilities, which include mental disorder, social violence, gang formation, cultism, armed robbery, internet frauds, social miscreants, lawlessness among youths, lack of respect for elders, rape, loss of senses, instant death and wasting of precious and innocent lives and many more.15 Interestingly, the impact created by smoking tobacco relies upon the nicotine that is ingested from the smoke. While, a large number of the understudies move on from tobacco smoking to Marijuana smoking, which they trust could be all the more remarkable on them or make them hyperactive. The author further opined that drug habit is not only expensive; but difficult to sustain.5 Similarly, the symptoms of codeine overuse include: loss of joy in most loved exercises and diversions, absence of will in doing basic things throughout everyday life, detachment toward family, occasions, or friends and family, diminished interest in sex and fondness, loss of expert or individual drive, ignorance of how to conduct and passionate pain. Moreso, additional signs of clinical depression include itching, rash, lack of sexual drive, nausea, vomiting, pinpoint pupils, sweating, and urinary retention. However, drug abuse affects aspects of a person’s life beyond their physical health.18 The study further explained that drug abuse, especially over an extended period, could have numerous long-term health or psychological effects, such as depression, anxiety, panic disorders, increased aggression, loss of memory, Kidney damage, Liver disease, inability to learning, and lack of concentration.18
Similarly, one of the major consequences of drug abuse is dependence and addiction, characterized by compulsive drug cravings seeking behaviours and use that persist even in the face of negative consequences.15 The results of chronic drug use, help crime percentages, cultism, psychological sickness, low confidence and sense of pride, wounds to one's wellbeing, and turning into an oddball and carrying disgrace to their kinfolk.5 The result of biting kola-nut taking boring espresso and different substances that improve one to remain alert around evening time-could prompt compulsion and substance misuse which may result in negative health implications and adversely affect performance in examination contrary to the expectation of the students.16 Interestingly, major consequences as reported by some scholars opined that since the consequences of drug abuse are full of the negative impact that means there is a need to provide strategies to prevent or control such abuse among persons with disabilities since there are major indicators of the study.15
Studies have posited that the drug abuse problem is a global phenomenon despite intensive efforts directed at controlling it, the problem seems intractable.8 Nigeria and other African countries have in the past adopted measures aimed at controlling drug abuse among Nigerian youth and persons with disabilities, such as follows: pretrial detention of persons accused of serious drug abuse; severe trial and sentence penalties against drug offenders; mandatory prison sentences for large scale distributors of marijuana; establishment of drug law enforcement agency monitors drug abuse and persecute offenders among others. Other preventive strategies as measures for drug abuse are as follows: teaching and awareness programmes for persons with disabilities; resist peer pressure; manage stress and anxiety; increase taxes on addictive materials like cigarettes; campaigns to appeal to youth against drug abuse; control on OTC medication; and role of parents is imperative.13 Similarly, studies also suggested some effective strategies combat drug abuse, which includes: drug users with post-traumatic stress disorder to seek the help of a trained professional for treatment before it leads to substance use; parental monitoring to slow the expansion of drugs in the family situations; schools to introduce drug prevention programs; schools to introduce strict compliance rules and counselling support to reduce usage; schools based drug abuse prevention programmes; enforcement agencies to focus mainly on tracking the network deeply and prosecuting producers and suppliers; investigation of illegal drug trafficking is a specialized task; and creating awareness among citizens.18 Interestingly, studies also posited that early identification of the factors related to substance use can improve scopes for planning and preventive approaches for the vulnerable group before the problems get serious after which interventions become difficult.19
Statement of the Problem
Drug abuse is a global predicament and has become a social problem especially in Nigeria; it is common among the youths both within and outside the school system. The consumption of illicit drugs among youth especially among individuals with disabilities is considered as an immoral effect on their life. Importantly, sociologists, psychologists, special education professionals, health practitioners and other medical personnel have tried to find out remedies and to make possible suggestions on how to cut short this serious social problem in society. Undoubtedly, the abusers derive control from the act but such comfort is only temporary. There is no doubt to say that drug abuse is more constant among youth. It is against this backdrop that the study becomes helpful to society at large. Hence, this could draw the attention of the government to imported social habits, pornographic films and dealers of these illicit drugs in Nigeria. Importantly, the significance of this study attempt to provide a blueprint for checking the indiscriminate causes of drug abuse which are adversative to the ideals of this desired ethical revolution. Furthermore, the attempt could be made to find out the overall consequences of drug abuse both on the abuser's life and the society at large. It is also believed that with minor variations, the findings could be the same in any other area in the country.
Purpose of the Study
The general purpose of the study was to examine the effect of drug abuse on persons with disabilities in South-East, Nigeria. Specifically, the study sought to:
examined the causes of drug abuse among persons with disabilities.
ascertain the consequences of drug abuse among persons with disabilities.
determine strategies to control drug abuse among persons with disabilities.
Research Questions
The following research questions guided the study.
What are the causes of drug abuse among persons with disabilities?
What are the consequences of drug abuse among persons with disabilities?
What are the strategies to control drug abuse among persons with disabilities?
MATERIALS AND METHODS
The study adopted a descriptive survey design. The population of the study was 688 respondents drawn from South-East (Abia State, Anambra State, Ebonyi State, Enugu State and Imo State), Nigeria. There was no sampling since the population was manageable. The instrument for data collection was a structured questionnaire developed by the researchers titled: “Effect of Drug Abuse Persons DisabilitiesQuestionnaire (EDAPDQ)”. The instrument was validated by three experts, one from the Special Education Unit, Department of Educational Foundations; one from the Department of Human Kinetics and Health Education, and one from the Department of Science Education (Measurement and Evaluation Unit), Faculty of Education, University of Nigeria, Nsukka. The internal consistency of the instrument was determined using Cronbach Alpha for reliability analysis with the coefficient of 0.82 obtained. This indicates that the instrument was reliable. The research questions were answered using mean and standard deviation. The scales use for the questionnaire was Strongly Agree (SA), Agree (A), Disagree (D) and Strongly Disagree with the values of 4, 3, 2 and 1 respectively. The arithmetic mean of the scale of the items is 2.50, which means any item with a weighted mean value of 2.50 and above was considered acceptable, while any weighted mean of less than 2.50 was considered rejected or not accepted.
RESULTS AND DISCUSSION
Research Question One: What are the causes of drug abuse among persons with disabilities?
Table 1 showed the mean scores and standard deviation on causes of drug abuse among persons with disabilities. The respondents agreed on all the items in the table with mean scores above the mean standard of 2.50. The grand mean score of 2.83 with a standard deviation of 0.27 indicated that the items were agreed upon as the factors that lead to the drug among persons with disabilities which include: earliest influence to smoke, earliest influence to drink alcohol, and poor self-image, poor academic performance, parental rejection, family dysfunction, family abuse, over-controlling by parents, divorce, depression among others.
Research Question Two: What are the consequences of drug abuse among persons with disabilities?
Table 2 revealed the consequences of drug abuse among persons with disabilities. The items 13 – 34 were agreed by respondents with mean scores above the mean criterion of 2.50 with a grand mean score of 2.91 with a standard deviation of 0.27 correspondingly, which implies that the items mentioned above were agreed upon as the consequences of drug abuse among youth. Therefore the consequences of drug abuse among youth include the following: mental disorder, social violence, cultism, armed robbery, 419 syndrome, internet frauds, social miscreants, lack of respect for elders, rape, loss of senses, instant death, wasting of precious and innocent lives, loss of pleasure in favourite activities, and lack of will in doing simple things in life among others.
Research Question Three: What are the strategies to control drug abuse among persons with disabilities?
Table 3 shows the strategies to control drug abuse among persons with disabilities. The table indicated that items 34 – 45 have mean scores above the criterion mean of 2.50 which showed that they are accepted as the strategies to control drug abuse. The respondents accepted the items to be the strategies with a grand mean score of 2.82 and 0.27 standard deviation respectively. This entails that the strategies to control drug abuse among persons with disabilities include: dissemination of laws against drug abusers; pretrial detention of persons accused of serious drug abuse; severe trial and sentence penalties against drug offenders; and mandatory prison sentences for large scale distributors of marijuana among others.
DISCUSSION
The findings of the study revealed the causes of drugs abuse among persons with disabilities such as earliest influence to smoke, earliest influence to drink alcohol, poor self-image, poor academic performance, parental rejection, family dysfunction, family abuse, over-controlling by parents, divorce, depression, anxiety, low self-esteem, poor socioeconomic status, peer-group pressure influence, family problems, unemployment, and broken home. The findings of the study are inconsonant with the results which posited causes of drug abuse and well predictive risk factors of drugs abuse among persons with disabilities.10 The results further explains that the earliest influences to smoke, drink alcohol, or use drugs may come from the family, while factors related to drug use during adolescence include poor self-image, parental rejection, under-or over-controlling by parents, and divorce. The findings of the study are also in line with the results which posited common risk factors for teen drug abuse, which include: a family history of substance abuse; a mental or behavioural health condition, such as depression, anxiety or attention-deficit disorder; impulsive or risk-taking behaviour.13
The findings of the study revealed the consequences of drug abuse which include anger, irritability, sadness, self-criticism, loss of appetite, irregular sleep, increased erectile dysfunction, constant headache, urinary retention, relationship problems, poor academic performance; noticeable changes in appearance, loss of interest in formerly enjoyable activities; loss of memory, kidney damage, liver disease, inability to learning and lack of concentration. The findings of the study are line with the results which mentioned various consequences of drug abuse that are so devastating and very shameful to the extent that both the national and international organizations across the globe are also worried about the spread of this scourge among the youths and persons with disabilities, which include mental disorder, social violence, gang formation, cultism, internet frauds, social miscreants, lawlessness among youths, lack of respect for elders, rape, loss of senses, instant death and wasting of precious and innocent lives and many more.15
The findings of the study revealed preventive strategies to control drug abuse among persons with disabilities and the society at large, which include: teaching and awareness programmes for persons with disabilities; manage stress and anxiety; and increase taxes on addictive materials like cigarettes among others. The findings are inconsonant with the results which posited that the drug abuse problem is a worldwide phenomenon despite intensive efforts directed at controlling it, the problem seems intractable.8 Therefore, Nigeria and other African countries have in the past adopted measures aimed at controlling drug abuse among Nigerian youth and persons with disabilities as follows: dissemination of laws against drug abusers and pretrial detention of persons accused of serious drug abuse. The findings of the study are also in line with the results that suggested some effective strategies to combat drug abuse, which include: drug users with post-traumatic stress disorder to seek the help of a trained professional for treatment before it leads to substance use; parental monitoring to slow the expansion of drugs in family situations; schools to introduce drug prevention programs; schools to introduce strict compliance rules and counselling support to reduce usage; and schools based drug abuse prevention programmes among others.18
CONCLUSION
The abuse of drugs is a dilemma that is making true anxiety for individuals universally. However, the issue is predominant among young people and persons with disabilities who much of the time are uninformed about the dangers of inherited in medicating abuse. Furthermore, a large number of young people and individuals with disabilities occupied drug abuse out of frustration, poverty, absence of parental management, peer impact and pleasure. Notwithstanding, with a feasible guiding system, the issues can be handled. The efforts of the government to eliminate drug abuse in society at large have been severely constrained by factors such as unemployment, idleness, peer group pressures influence, bad parental upbringing etc. The consequences of drug abuse have been so appalling in society that it has wasted lives, caused various crimes, broken homes, caused accidents etc. However, this situation can take a turn for the better if all the recommendations recommended in the research study are used and strictly applied by the government and individuals in society.
RECOMMENDATIONS
Based on the findings of the study, the following recommendations are made:
Qualified health practitioners, special educationists and counsellors should be employed in helping drug addicts or those dependent on drugs by giving them special advice on the consequences of drug abuse.
Federal and State Ministry of Education should as matters of urgency add to the curricula, drug education at all levels of education
Government should organize educational programmes, media broadcasts, advertisements, seminars aimed at enlightening the youths and persons with disabilities on the dangers and consequences of drug abuse.
Parents should educate their children early enough on the risks associated with drug abuse.
Governments should ban joints or selling points for illicit substances and ensure that uncompleted buildings that are hide-out for the consumption and sale of illicit substances are completed by the owners or risk demolition.
Acknowledgement:
The researchers acknowledge the support received from the Special Education Unit, Department of Educational Foundations, University of Nigeria, Nsukka. The researchers also acknowledge all academic staff in the special education unit for their support in engaging participants for the study.
Conflict of Interest:
The authors declare that the research was conducted in absence of any conflict of interest.
Ethical Clearance: Not Required
Source of Funding: This research received no specific grant from any funding agencies.
Author’s Information:
Dr. Isiaku, Wada Bashir: Lecturer, Department of Psychology, Aminu Kano College of Islamic and Legal Studies, Kano state
Dr. Ofuebe, Justina Ifeoma: Lecturer, Department of Human Kinetics and Health Education, University of Nigeria, Nsukka (Corresponding Author)
Dede Chidinma: Postgraduate Student, Department of Educational Foundations, University of Nigeria, Nsukka
Dr Nwankwo, Benedict Chimezie: Lecturer, Department of Psychology, Ebonyi State University, Abakaliki
Nweke, Prince Onyemaechi: Research Fellow, Institute of Education, University of Nigeria, Nsukka
Englishhttp://ijcrr.com/abstract.php?article_id=4176http://ijcrr.com/article_html.php?did=4176REFERENCES
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareComparison of Bag and Non-Bag Extraction of Gall Stones through Laparoscopy
English102106Adith ChinnaswamiEnglish Prabhu PurushothamanEnglish Naresh DuthaluriEnglish Rekha ArcotEnglishIntroduction: Laparoscopic cholecystectomy (LC) has become the gold standard surgical procedure of choice for disorders involving the gall bladder and biliary tract. There are several intraoperative and postoperative complications associated with LC of which port site infections(PSI) are associated with high morbidity and mortality. The present study was carried out to compare the outcomes with bag and non -bag extraction of gall bladder in terms of the incidence of PSI. Methods: This randomized controlled trial was carried out among 326 adults who underwent LC for two years. The participants were randomized into bag extraction and non-bag extraction groups. Postoperatively, the participants were followed up for one week to evaluate the incidence of PSI. Results: The incidence of PSI among bag extraction was 1.4% compared to 9.1% in the non-bag extraction. The presence of diabetes mellitus, elevated glycosylated haemoglobin and immunocompromised status were proven to be risk factors for PSI. (pEnglish Bag extraction, End glove, Gall bladder diseases, Laparoscopic Cholecystectomy, Port site infections, Randomized controlled trialIntroduction
From the time of establishing cholecystectomy as the most preferred treatment option for cholelithiasis, surgical advancements have been on the rise and, for the past few decades, laparoscopic cholecystectomy (LC) has become the gold standard surgical procedure of choice for the disorders involving gall bladder and biliary tract. The reliability with LC is significantly higher, due to lower incidences of complications ranging from 1%-6%.1LC has, in recent times, replaced open cholecystectomy to a large extent except in cases of patients not being fit for general anaesthesia, or, in the presence of malignancies and intra-operative complications leading to conversion from laparoscopic procedure to an open procedure. The rates of such conversions have considerably reduced in the past two decades owing to an increase in the expertise of the surgeons, better understanding of the patient selection and improvement in laparoscopic instrumentation. According to studies published by Kaushik R et al. in a single-institution prospective study, the overall conversion rate was found to be 7.06%.2
The complications of LC, all though few in numbers, continue to challenge the surgeons about morbidity and mortality. The intraoperative complications can arise at any point during the surgery, from induction of the patient under general anaesthesia, injury during trocar insertion, respiratory compromise during carbon dioxide insufflation, injury to adjacent structures during dissection, common bile duct injury, trauma to the liver during dissection of the gall bladder, perforation of gall bladder leading to bile leak and spillage of stones during retrieval of the gall bladder. Post-operative complications are usually secondary to intraoperative complications, such as bile leak leading to biliary peritonitis or biliary fistula, spilt stones causing abscess formation. Port site complications such as port-site infections(PSI), port-site hernias and port site metastases have also been reported. According to a review done by Sasmal PK et al., the umbilical PSI is far more common than many other complications, ranging from 8% to 89%.3
Though the complications associated with laparoscopic cholecystectomy have decreased significantly over the past decade, in the quest to provide better patient care and further reduce chances of complications, it is important to be aware of the possible risk factors associated with various complications and how to reduce the chances of any complication associated with the surgery. With this background, the present study was undertaken to compare the post-operative port site wound infections in laparoscopic cholecystectomy between extraction of gall bladder by bag extraction versus non-bag extraction, and also evaluate the risk of PSI with various factors such as diabetes mellitus, Body mass index, hypoalbuminemia and the immuno-compromised status of patients.
Methodology
Study setting and participants
This randomized controlled study was carried out in the Department of General Surgery of our tertiary teaching institution among all the adult patients (aged >18 years) undergoing laparoscopic cholecystectomy (LC) for two years between January 2018 and December 2019. Patients with empyema of the gall bladder and those who were intraoperatively converted to open cholecystectomy were excluded from the analysis. A total of 326 participants were taken up for the study.
Randomization and blinding
The participants were randomized into either bag extraction or non-bag extraction of gall bladder before surgery. This was done by the sealed envelope technique. The study was carried out as a single-blind study.
Procedure
After obtaining informed consent, patients underwent routine preoperative workup and anaesthetic assessment. After adequate optimization, in a controlled setting, patients were taken up for surgery. Extraction of the gall bladder was done through the epigastric port. In non-bag extraction, the gall bladder was directly grasped with a claw and retrieved via the epigastric port. In the bag extraction group, a sterile plastic endo bag was created by cutting a sterilized bag and putting a purse-string suture around the mouth with a Roeder’s knot to tighten it. This bag was introduced through the 10mm port after the resection of the gall bladder from the gall bladder fossa. The gall bladder was manoeuvred into the end bag and mouth closed by tightening the Roeder’s knot. The specimen was then extracted through the epigastric port. Standard antibiotic protocol of three doses of Ceftriaxone, a third-generation cephalosporine dose pre-operatively and two doses postoperatively was followed uniformly for all the study participants.
Postoperatively, the port site used for gall bladder extraction was monitored for seven days to check for wound site infection. In case of any signs of an infection (pain, erythema, swelling or discharge), a wound swab was taken and sent for culture. The presence of positive growth on the wound culture was considered as port site infection. Participants were subsequently started on antibiotics for further management.
Data collection
A structured proforma was used to record demographic and other clinical particulars including diabetes mellitus and immunocompromised status of the study participants. Body mass index was measured and documented. The laboratory parameters including glycosylated haemoglobin, serum albumin and serum creatinine were documented. The underlying pathology of the gall bladder or biliary tract was also documented as infective or non-infective.
Data analysis
Data was entered and analyzed using SPSS ver 20 software. The incidence of port-site infections was documented as percentages. The comparison between bag and non-bag extraction was carried out using the chi-square test. A p-value Englishhttp://ijcrr.com/abstract.php?article_id=4177http://ijcrr.com/article_html.php?did=4177
Singh K, Ohri A. Difficult laparoscopic cholecystectomy: A Difficult laparoscopic cholecystectomy: A large series from north India. Indian J Surg. 2006; 68: 205-08.
Kaushik R, Sharma R, Batra R, Yadav TD, Attri AK, Kaushik SP et al. Laparoscopic Cholecystectomy: An Indian Experience of 1233 Cases. J Laparoendosc Adv Surg Tech A. 2002;12(1):21-5.
Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: A review of its management. World J Clin Cases. 2015; 3(10): 864–871.
Mir IS. Minimal access surgery port-site complications. JK Science. 2003; 10(3): 226 –8
Taj MN, Naeem M, Iqbal Y, Akbar Z. Frequency and prevention of laparoscopic port site infection. J Ayub Med Coll Abbottabad.2012; 24: 197-199.
Brockmann JG, Kocher T, Senninger NJ, Schurmann GM. Complications due to gall stones lost during LaparosocpicCholecystectomy: An analysis of incidence, clinical course and management. Surg Endosc. 2002;16: 1226 –32
SatheshKumar T, Saklani AP, Vinayagam R, Blackett RL. Spilt gallstones during laparoscopic cholecystectomy: a review of the literature. Postcard Med J 2004; 80: 77–9
Läuffer JM, Krahenbuhl L, Baer HU, Mettler M, Buchler MW. Clinical manifestations of lost gallstones after laparoscopic cholecystectomy: a case report with review of the literature. Surg Laparosc Endosc 1997;7:103 –12.
Hackan DJ, Rotstein OD. Host response to laparoscopic surgery: mechanisms and clinical correlates. Can J Surg 1998;41:103 –11
Saud JD, Abu Al-Hail MC. Surgical site infections after laparoscopic cholecystectomy. Bas J Surg 2010:1-6.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareCorrelation of High-density Lipoprotein (HDLc) with Acute Phase Reactants in COVID-19 Patients: An Observational Study in a Tertiary Care Hospital West Bengal
English107112Samadder SangitaEnglish Datta PriyankaEnglish Chakraborty SandipEnglish Ghosh ChinmoyEnglishIntroduction: Dyslipidemia plays an important role in the pathogenesis and evolution of critical illness, but limited information exists regarding the lipid metabolism of severe coronavirus disease 2019 (COVID-19) patients in India. Patients with COVID-19 feature hyper inflammation, suffer multiple organ dysfunctions, though if these patients develop dyslipidemia or not are unknown. Aim & Objective: We aimed to investigate if there is any correlation between high-density lipoprotein cholesterol (HDL-c) with serum C-reactive protein (CRP), D-Dimer, and serum ferritin in COVID-19 patients of West Bengal. Methodology: Sixty two patients with COVID-19 detected by RT-PCR admitted in General Medicine isolation ward and COVID block between 19th October and 10th December 2020 of a tertiary care teaching hospital was selected by semi-purposive sampling. Results: There were 40.3% patients in mild, 30.6% in moderate and 29% in the severe category. An increased level of D-dimer 1.4 IQR (0.64,3.27) μg/ml was found in patients with severe disease compared with mild group. Serum ferritin in the severe COVID-19 group was higher than in the mild COVID-19 group (485.6 ng/ml IQR(227.7-798.2)] vs 150.3ng/ml IQR(56.4-249.7). Compared with mild patients, severe COVID-19 patients presented with low HDL-C [median, 48 vs 38.3 P = 0.04] which suggested that low HDL-C may be correlated with the severity of COVID-19 patients. Conclusion: We concluded that low HDLc was associated with the inflammatory response. The hypolipidemia in COVID-19 patients would raise an urgent awareness to clinical physicians in the frontline against this global pandemic.
English COVID-19, CRP, D Dimer, Ferritin, HDL-C, Acute phase reactant, ARDS, RT-PCR, Heam oxygenase, SpO2Introduction :
Coronavirus disease-2019 (COVID-19) is an emerging infectious disease that has been declared a global public health emergency by the World Health Organization (WHO).1 the global COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus(SARS-CoV-2) has severely affected India. 2 Most of patients with COVID-19 have mild illness or maybe asymptomatic, about 5-10% of patients develop severe pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure eventually die.2 Why some individuals become critically ill, while others do not with COVID 19 infection, remains an unsolved puzzle. The majority of patients with COVID-19 were mild in the first few days, few progressed rapidly to acute respiratory failure, metabolic acidosis, septic shock, ARDS.
Early identification of risk factors for critical patients could facilitate appropriate supportive care and that may reduce mortality.3 A study with 138 laboratory-confirmed cases with COVID-19 showed the changes of the neutrophil count, lymphocyte count, and D-dimer levels. 4 Inflammations -related indicators were found higher in patients with COVID-19, like erythrocyte sedimentation rate (ESR), interleukin-6 and C-reactive protein (CRP)
Laboratory markers and radiological changes, Comorbidities have been proposed for risk stratification.5,6 There is evidence that elevated serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and hyperferritinemia are found in critical patients. These findings suggest there might be a role of cytokine storm in COVID-19 pathophysiology.7Dyslipidemia associated with SARS has been reported, although rarely. There was a report showing a lower level of total cholesterol (TC) in SARS patients as compared with healthy subjects.8 The report indicate that patients with coronavirus-related diseases may develop dyslipidemia but have been underrated.
Laboratory biomarkers can identify the severity of COVID-19. That’s is needed as resource allocation must be carefully planned, especially in the context of respiratory support, critical patient management.
In this study, we measured HDLc, serum C-reactive protein (CRP), D-dimer, and serum ferritin ) in COVID-19 patients. We aimed to investigate if there is any correlation between high-density lipoprotein cholesterol (HDL-c) with acute phase recant like serum C-reactive protein (CRP), D-dimer, and serum ferritin ) in COVID-19 patients
Materials and methods
Study design and participants
The present work was a single-centre, hospital-based study, conducted at Nil Ratan Sircar Medical College and Hospital, Kolkata which is a tertiary care teaching hospital, done between 19th October to 10th December 2020. The project was approved by the Institutional Ethical Committee. During the study, the status of the hospital changed from Level 2 (eligible to treat symptomatic patients with suspicion of COVID-19, but after confirmation of the diagnosis, the patients are to be transferred to Designated COVID Care Centre) to Level 4 (eligible to treat seriously symptomatic patients suffering from COVID-19). Patients admitted to the general Medicine isolation ward of N.R.S Medical College and Hospital and subsequently diagnosed as COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) from the oral and nasopharyngeal swab, and patients admitted directly to COVID block after diagnosis were selected by semi-purposive sampling. Total of 62 patients were included in this study. A “confirmed case” was defined as “A person with laboratory confirmation of COVID-19 infection by reverse transcriptase-polymerase chain reaction(RT-PCR), irrespective of clinical signs and symptoms”. Written, informed consent was taken from all of the patients.
The blood for detecting serum lipid concentration, blood samples were collected from each subject after at least 12 h of overnight fasting. For avoiding the interference of treatment to serum lipid concentration samples were drawn at admission, before starting definitive treatment and were tested at our central laboratory and department of Biochemistry. “Mild disease” was defined as fever with malaise or mild cough, but no shortness of breath. “Moderate disease” was defined in adults as the presence of dyspnoea with a respiratory rate of more than 24/min or SpO2 between 90 and 94% in room air, pneumonia not fulfilling the criteria of “severe” disease or presence of altered liver or renal function tests. Severe disease was defined as the presence of severe dyspnoea with a respiratory rate of more than 30/min or SpO2 less than 90% in room air, presence of ARDS, severe sepsis or septic shock.9,10
Serum Ferritin was tested in ADVIA Centaur XP immunoassay systems by chemiluminescent detection. D-dimer was tested in Stago-STA Compact Max Coagulometer from citrated plasma. CRP was tested by the immunoturbidimetry method. Serum HDL were measured in the Transasia instrument.
INCLUSION CRITERIA
1. Confirmed cases of COVID 19 (RT-PCR) patients admitted in General Medicine isolation ward, and COVID block 1 of NRS Medical College and Hospital, Kolkata
2. Aged 18 years or older
EXCLUSION CRITERIA:
Patients who had received glucocorticoids before coming to our hospital
HIV infected patients
Diagnosed patients with acute or chronic liver disease
Known Diabetic patients and on anti-diabetic medications
This study was approved by the institutional ethics board of our institute.
The clinical classifications are (1) mild, patients with minor symptoms and imaging showed no pneumonia.
(2) Moderate, patients with fever, symptoms of chest infection and imaging shows pneumonia.
(3) severe, patients have any of these a) respiratory distress, respiratory rate ≥ 30 beats/min; b) in resting condition, SpO2 ≤ 93%; c) arterial blood oxygen partial pressure/oxygen concentration ≤ 300 mmHg (1 mmHg = 0.133 kPa); d) pulmonary imaging shows lesion progressed more than 50% within 24–48 h.
(4) Critical patients, one of the following conditions: a) respiratory failure occurs and requires mechanical ventilation; b) Shock c) ICU admission is required for combined organ failure.
In this study, the patients with mild or moderate symptoms were included and the patients with severe or critical symptoms were classified as severe/critical group. The assessment of disease severity and laboratory tests were performed at the same time on the day of inpatient admission before treatment
STATISTICAL ANALYSIS
Data were entered in Microsoft Excel spreadsheet Continuous variables were expressed as median (interquartile range, Bivariate correlation analysis (Pearson correlation) was performed for analyzing the correlation of serum lipid concentration and other laboratory parameters. p< 0.05 was considered statistically significant.
Statistical analyses were performed using the SPSS 17. Institutional ethical clearance number : NMC : 6087, 16.10.2020
RESULTS: Among sixty-two patients, there was 33 male 29 female. There were 25 patients (40.3%) in the mild group, 19 patients (30.6%) in the moderate group and 18 patients (29%) in the severe group. The median age was 59.0 years (IQR 45.0–70.0). The most common symptoms at disease onset were fever (78.6%) and cough followed by shortness of breath. We observed substantial differences in the clinical and laboratory findings between the groups of patients. Table 1 shows Clinical laboratory findings of patients infected with SARS-COVID 19.
From the table, we can see patients with severe disease were significantly more likely to exhibit dysregulated coagulation function. An increased level of D-dimer 1.4 IQR (0.64,3.27) μg/ml was found in patients with severe disease compared with the mild group. HDL-c levels decreased significantly in severe cases as compared with levels in mild cases (p = 0.004). Compared to both moderate and severe patients, showed a significant increase in serum concentrations of C-reactive protein during hospitalization. Patients with severe disease courses had a far elevated level of CRP than mild or moderate patients. Our study reported patients with severe symptoms had a CRP concentration of 24.6 IQR(16.1-39.3)mg/L and patients with mild symptoms CRP concentration of 0.10 IQR(0.10-0.65) mg/L. In our study with 62 COVID-19 patients, it was found that individuals with moderate and severe COVID-19 exhibited increased serum ferritin level, being serum ferritin in the severe COVID-19 group significantly higher pEnglishhttp://ijcrr.com/abstract.php?article_id=4178http://ijcrr.com/article_html.php?did=41781. Bhandari S, Bhargava A, Sharma S, Keshwani P, Sharma R, Banerjee S . Clinical profile of COVID-19 infected patients admitted in a tertiary care hospital in North India. J Assoc Phys India.2020; 68:13–17
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14. Zheng Y., Xu H., Yang M. Epidemiological characteristics and clinical features of 32 critical and 67 noncritical cases of COVID-19 in Chengdu. J Clin Virol. 2020;127
15. Shen Y., Zheng F., Sun D. Epidemiology and clinical course of COVID-19 in Shanghai, China. Emerg. Microbes Infect. 2020;9(1):1537–1545.
16. Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M: COVID-19 and Liver. J HEPATOL 2020.
17. Wei X, Zeng W, Su J, Wan H, Yu X, Cao X, et al. Hypolipidemia is associated with the severity of COVID-19. J Clin Lipidol. 2020;14:297–304.
18. Gaw A. HDL-C and triglyceride levels: relationship to coronary heart disease and treatment with statins. Cardiovasc Drugs Ther. 2003;17:53–62.
19. Tran-Dinh A, Diallo D, Delbosc S, Varela-Perez LM, Dang QB, Lapergue B, et al. HDL and endothelial protection. Br J Pharmacol. 2013;169:493–511.
20.Tanaka S, Couret D, Tran-Dinh A, Duranteau J, Montravers P, Schwendeman A, et al. High-density lipoproteins during sepsis: from bench to bedside. Crit Care. 2020;24:134.
21.Santos-Gallego CG, Badimon JJ, Rosenson RS. Beginning to understand high-density lipoproteins. Endocrinol Metab Clin N Am. 2014;43:913–47.
22.Madsen CM, Varbo A, Tybjaerg-Hansen A, Frikke-Schmidt R, Nordestgaard BG. U-shaped relationship of HDL and risk of infectious disease: two prospective population-based cohort studies. Eur Heart J. 2018;39:1181–90.
23. Trinder M, Genga KR, Kong HJ, Blauw LL: Cholesteryl Ester Transfer Protein Inuences High-Density Lipoprotein Levels and Survival in Sepsis. Am J Respir Crit Care Med. 2019, 199(7):854-862
24. Young BE, Ong SWX, Kalimuddin S,. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore.JAMA. 2020;323(15):1488-1494.
25. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507–13.
26.Bonetti G, Manelli F, Patroni A,. Laboratory predictors of death from coronavirus disease 2019 (COVID?19) in the area of Valcamonica, Italy. Clin Chem Lab Med. 2020; 58(7): 1100– 1105
27. Al?Samkari H, Karp Leaf RS, Dzik WH,. COVID?19 and coagulation: bleeding and thrombotic manifestations of SARS?CoV?2 infection. Blood. 2020; 136: 489? 500
28.Lippi G, Plebani M (2020) The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med. 58(7):1063–1069
29. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN (2020) Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med. 382:e1
30. Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. medRxiv. 2020.04.06-20050575
31. Hu X., Chen D., Wu L., He G., Ye W. Low serum cholesterol level among patients with COVID-19 infection in Wenzhou, China. Clin Chim Acta. 2020;10:105–110
32. Fan J., Wang H., Ye G., Cao X., Xu X., Tan W. Letter to the Editor: low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019. Metabolism. 2020;107:154243
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAn Observational Study on the Effects of Antidepressant Treatment on Salivary Cortisol Secretion in Patients of Major Depressive Disorders
English113118KavitaEnglish Ravi Kant TiwariEnglish Usha JoshiEnglish Manoj Kumar SahuEnglishIntroduction: Altered cortisol secretion in the form of Cortisol Awakening Response (CAR) is one of the consistent features in patients with depression. Evidence suggests that antidepressant treatment might alter cortisol indicators in patients with depression. Aim and Objectives: This study was aimed to evaluate the changes in morning and evening salivary cortisol indicators in patients with major depressive disorders, who had received antidepressant treatment. Methods: The participants were sixty-four diagnosed cases of major depressive disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria, who were taking antidepressant medications from different groups for at least one month. The salivary cortisol values were taken as morning and evening samples at baseline and two follow up at two months intervals and compared by student’s t-test. Results: A significant difference (pEnglish Cortisol Awakening Response (CAR), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic Antidepressants (TCAs), Serotonin Norepinephrine reuptake inhibitors (SNRIs), Hypothalamic-pituitary-adrenal (HPA) axis, NeurotransmitterINTRODUCTION:
Depression is a leading medical contributor to the global burden of disease. It can become long-lasting with frequent recurrences. Females of the middle age group (between the ages of 25 and 45 years) are the major sufferers and are affected almost twice as likely (10%-25%) as males (5%-12%) to experience depression. Genetic predisposition is one of the important risk factors. Individuals with first-generation relatives with major depression have about 2 to 3 times greater chance of experiencing depression compared with individuals without a similar family history. 1In the pharmacotherapy of depression several novel classes of antidepressants have been introduced, but still only about 60-65%of patients with depression respond to antidepressant therapy. Depression is also responsible for 60%-70% of all suicides and about 10%-20% of cases with major depression eventually commit suicide.2 Despite the completion of multiple antidepressant drug treatments and aggressive treatment regimens, about 15% of the patients diagnosed with major depressive disorders (MDD) will continue to suffer from depression. Even among the patients who initially responded to antidepressant treatment as indicated by the reduction in their depressive symptoms, about 2/3rd of these patients fail to achieve complete remission of depressive symptoms.3
Among the neurotransmitters (NT) of monoamine systems, reuptake is the principal mechanism by which the action of NT is terminated. The first-generation antidepressants include monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). The MAOIs enhance monoaminergic neurotransmission by inhibiting monoamine metabolism and thereby enhancing neurotransmitter storage in secretory granules, while the TCAs act by inhibiting 5-HT and norepinephrine reuptake. While efficacious, these first-generation agents exhibit side effects and drug and food interactions that limit their use relative to the newer drugs. The newer second-generation antidepressants include selective serotonin reuptake inhibitors (SSRIs) and the serotonin-norepinephrine reuptake inhibitors (SNRIs)Selective Serotonin Reuptake Inhibitors (SSRIs)are the preferred initial choice to treat depression because of their safety, tolerability and overall efficacy.4
Cortisol participates in complex interactions with the hormonal and immune systems in humans as the hypothalamic-pituitary-adrenal (HPA) axis. Hyperactivity of the HPA axis is considered an important mechanism explaining the pathophysiology of depression. However, the association may not be entirely reproducible and consistent. The recent reviews indicated that the morning and evening cortisol concentrations are increased in patients with depression, and this increase was more pronounced in older patients with either melancholic or psychotic depression. Furthermore, HPA hyperactivity has been shown in patients who have recovered from depression, in non-depressed people with a parental history of depression, and people at increased risk of depression due to a personality characterized by neuroticism.5
Salivary cortisol which is a well-known stress hormone has a half-life of approximately 1 hour. Salivary cortisol represents the biologically active free cortisol in plasma. The therapeutic benefit of antidepressants takes about 2–4 weeks of treatment and their antidepressant effects might be due to alteration of the HPA axis.6
Keeping the above facts in mind, this study was aimed to evaluate the alterations in salivary cortisol level as morning and evening concentrations and to assess the effects of antidepressant treatment on these parameters.
MATERIALS AND METHODS:
The present prospective cohort study was carried out in the Department of Pharmacology and Psychiatry at Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital Raipur (C.G) over one year from June 2015 to June 2016. The study included the patients attending the psychiatry OPD with the diagnosis of Major Depressive Disorders (MDD) as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The sample size for this study was calculated by using the formula {n=z2.pq/d2} where q=1-p. By applying the values of z, d (absolute precision) and p (expected proportion in the population which was found from previous studies), to the above formula as 1.96, 5% and 5% respectively, the calculated sample size was found to be 73.7Total 90 subjects were recruited over one year of which 26 subjects loss to follow up and total 64 subjects came for regular follow up. The study had clearance from the Institutional Ethical committee.
Study population:
The selection of patients was done on the following inclusion and exclusion criteria-
Inclusion criteria-
Patients diagnosed as a case of major depression according to DSM IV criteria.
Patients diagnosed with a case of major depression who were taking antidepressant medications for at least one month.
Patients diagnosed with a case of major depression were taking antidepressant medications from different groups such as TCAs, SSRIs, SNRIs and atypical antidepressants.
Age group18 years and above.
Exclusion criteria-
Patients having hormonal disorders.
Patients having other psychiatric illnesses.
Pregnant and lactating mothers.
Patients having substance abuse disorders.
Methods and statistical analysis: All the subjects were informed in detail about the purpose of the study and gave their written consent. Detailed clinical history, drug history and other relevant information were taken from the patients. The levels of the salivary cortisol were measured as morning and evening samples, by the salimetric salivary cortisol ELISA kit, and taken as a baseline and then the two follow up done at the interval of 2 months. The changes in salivary cortisol levels were noted and these values were compared by student’s t-test. Statistical significance was set at PEnglishhttp://ijcrr.com/abstract.php?article_id=4181http://ijcrr.com/article_html.php?did=4181
Carpenter T, Grecian S, Reynolds R. Sex differences in early life programming of the hypothalamic-pituitary-adrenal axis in humans suggest increased vulnerability in females. Psychoneuroendocrinology.2015;61:32.
Levinson DF. The genetics of depression: a review. Biol Psychiatry.2006;60(2):84-92.
Otte C, Gold SM, Penninx BW, Pariante CM, Etkin A, Fava M, et al. Major depressive disorder. Nature Reviews Disease Primers. 2016 Sep 15;2:16065.
Joyce PR, Mulder RT, Luty SE, Sullivan PF, Mackenzie JM, Abbott RM, et al. Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline. Aust N Z J Psychiatry. 2002;36(3):384-391.
McKay MS, Zakzanis KK. The impact of treatment on HPA axis activity in unipolar major depression. J Psychiatric Res. 2009 Feb;44(3):183-192.
Dienes KA, Hazel NA, Hammen CL. Cortisol secretion in depressed, and at-risk adults. Psychoneuroendocrinology.2013;38(6):927-940.
Keller MB. Past, present, and future directions for defining optimal treatment outcome in depression: Remission and beyond. JAMA.2003; 289(23): 3152-3160.
Khan QU, Khan HA, Tauseef A, Hafeez F, Qamar M, Fatima SA, et al. Salivary cortisol levels in severely depressed patients and healthy individuals. Int J Med Sci Public Health .2019;8(5):21-25.
Herbert J, Ban M, Brown GW, Harris TO, Ogilvie A, Uher R, et al. Interaction between the BDNF gene Val/66/Met polymorphism and morning cortisol levels as a predictor of depression in adult women. Brit J Psychiatry. 2012;201(4);313-19.
Yonekura T, Takeda K, Shetty V, Yamaguchi M. Relationship between salivary cortisol and depression in adolescent survivors of a major natural disaster. J Physiol Sci.2014;64(4):261-67.
Howland RH, Wilson MG, Kornstein SG, Clayton AH, Trivedi MH, Wohlreich MM, et al. Factors predicting reduced antidepressant response: experience with the SNRI duloxetine in patients with major depression. Ann Clin Psychiatry. 2008;20(4):209-218.
Bhagwagar Z, Hafizi S, Cowen PJ. Increased salivary cortisol after waking in depression. Psychopharmac.2005;182(1):54-57.
Dedovic K, Ngiam J. The cortisol awakening response and major depression: examining the evidence. Neuropsychiatr Dis Treat. 2015;11:1181-9.
Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocr.2017;83:25-41.
Fischer S, Macare C, Cleare AJ. Hypothalamic-pituitary-adrenal (HPA) axis functioning as a predictor of antidepressant response-meta-analysis. Neurosci Biobehav Rev. 2017: 83:200-211.
Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocr.2009;34(10):1423-1436.
Hinkelmann K, Moritz S, Botzenhardt J, Muhtz C, Wiedemann K, Kellner M, et al. Changes in cortisol secretion during antidepressive treatment and cognitive improvement in patients with major depression: a longitudinal study. Psychoneuroendocr.2012;37(5):685-692.
Knorr U, Vinberg M, Gether U, Winkel P, Gluud C, Wetterslev J, et al. The effect of escitalopram versus placebo on perceived stress and salivary cortisol in healthy first-degree relatives of patients with depression—a randomised trial. Psych Res.2012; 200(2-3):354-360.
Juruena MF, Cleare AJ, Papadopoulos AS, Poon L, Lightman S, Pariante CM. The prednisolone suppression test in depression: dose-response and changes with antidepressant treatment. Psychoneuroendocrinology 2010; 35(10):1486–1491.
Wilhelm I, Born J, Kudielka BM, Schlotz M, Wust S.Is the cortisol awakening rise a response to awakening?Psychoneuroendocrinology 2007; 32(4):358–366.
Penninx BW, Nolen WA, Lamers F, Zitman FG, Smit JH, Spinhoven P, et al. Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2011 Sep;133(1-2):76-85.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareEfficacy of Direct Posterior Class I Restorations Instigating "Stamp Technique": A Case Series
English119123Ashwini BhangaleEnglish Nilima Ramdas ThosarEnglish Sphurti Pramod BaneEnglish Simran DasEnglishThe stamping technique is a simple method in restoring the non cavitated carious teeth with intact occlusal anatomy, in less chair-side time with perfection. This method has been appreciated to be precise and accurate to restore functional occlusion. This case report describes the esthetic restoration of non-cavitated caries by using an index to replicate its original anatomy.
English Stamp Technique, Class I restoration, Composite resin, Replication, Flowable stamp, Conservative dentistryIntroduction
Dentistry is forever witnessing the shift in materials and techniques about restoring posterior teeth. The use of dental amalgam has become obsolete in Pediatric Dentistry. The introduction of composite by Bowen in 1962 occurred due to the search for an ideal esthetic restorative material.1 However, experience and finesse are required when physically shaping a direct composite restoration. In indirect restorations, the contact, contour and occlusion are maintained in the laboratory while it is difficult to do so in a direct restoration intraorally.2Also, failure to achieve functional occlusion can cause an increase in the risk of stomatognathic musculature dysfunction.3
‘Stamp technique’ is a direct composite restorative procedure that was presented by Dr Waseem Riaz. Teeth that are non-extensively cavitated with occlusal morphology undisrupted are a clear indication for this technique. A negative replica is prepared first, termed as an index with either putty impression or flowable composite. This index is positioned and pressed firmly over the final incremental restorative layer to reproduce the original occlusal topography and reduced the time required for postoperative finishing.4 This case report primarily aims to confirm the Stamp technique’s efficacy using both putty impression material and micro brush embedded flowable composite.
Case Report 1
A 23-year-old female reported to the clinic with a chief complaint of blackish discolouration in the mandibular right first molar region accompanied by sensitivity to cold beverages’ consumption. In this case, the micro brush embedded flowable-composite technique was incorporated. Tooth isolation with a rubber dam was carried out to avoid contamination (Figure 1). The tooth of interest was then coated with a separating media (Figure 2). The flowable composite material was positioned sufficiently, covering the complete occlusal extent (Figure 3). A micro brush was decapitated for smooth conduct and implanted in the composite (Figure 4) and was then subjected to polymerization via light-curing (Figure 5). The attained index was detached from the tooth judiciously. Prophylaxis with pumice was done to remove the separating media. Cavity preparation was trailed by acid-etching with 37% orthophosphoric acid for 30 seconds (Figure 6) and rinsed off with water. The tooth was air-dried with an air spray and checked for the characteristic frosty appearance. The bonding agent was smeared with the applicator tip, and curing was done for 20 seconds (Figure 7). The restoration was accomplished in increments to support adequate and precise curing of the composite. Subsequently, the last incremental layer was placed; Teflon tape was sandwiched between the index and the composite layer, and the index was then gently placed over (Figure 8). The Teflon tape was removed carefully, and excessive material was wiped off without disrupting the stamped surface preceding the curing. The occlusion was checked with the bite paper, and restoration was subjected to final polishing on remarkably fewer marks (Figure 9, 10).
Case Report 2
A 26-year-old male reported to the clinic with a chief complaint of sensitivity in the right maxillary right first molar region. The putty Stamp technique was used in this patient. The tooth of interest was then cleaned prophylactically with pumice to remove debris. First, the light body and heavy body putty impression material was mixed evenly and then placed over the tooth of interest (Figure11). After the material’s setting, it was removed, and the index was modified by trimming it to the cervical level for its better placement (Figure 12). Later the tooth was isolated with a rubber dam (Figure 13). The cavity preparation (Figure 14) was done and acid-etching with 37% orthophosphoric acid for 30 seconds, followed by thorough rinsing with water spray (Figure 15). The tooth was air-dried with an air spray and checked for its distinctive frosty appearance. The bonding agent was smeared with the applicator tip (Figure 16) and was Light-cured for 20 seconds (Figure 17). The restoration was accomplished in increments to support adequate and precise curing of the composite. The putty stamp was placed firmly on the last incremental layer, the excessive material was wiped out with the instruments, and restoration was cured (Figure 18). The final restoration was checked for its high points with a bite paper and polished with pumice (Figure 19).
Discussion
The pit and fissures are the prime retentive areas for the amassing of the substrate and hence is one of the culprits accountable for caries. The molars and premolars are more prone to the pit and fissure caries owing to their occlusal morphology. Molars are the first teeth to be affected by caries. Maxillary molars are more affected than the mandibular molars as suggested by Demirci M et al.5 Maxillary molars are difficult to restore in indirect vision and require experience to carve out the grooves, fissures, and oblique ridge to imitate the morphology. For composite restoration, isolation may be difficult to attain in mandibular molars in hyper-salivating patients. Pit fissure caries superficially appears to be limited to the enamel but as the cavity preparation is progressed to obtain an infection-free dentin a substantial amount of enamel has already been excavated. Restoring the cavity and an excellent cusp-fossa relationship, aesthetics, and overall harmony can be time-consuming. Hence, the Stamp technique has been utilized. Though many dental professionals may not use it, it is undoubtedly an appreciable technique that can be integrated.
As per the author’s experience with this technique, the apparent advantage is feasibility and condensed time-span required for the restoration and the post-restoration adjustment for achieving accordance between the occlusion and aesthetics with flowable composite as the Putty index. Additionally, the reduction of voids is achievable since the stamp is pressed upon the final layer, which aids in its drastic eradication while restoring.6 This technique may be comfortable however, the disadvantage can be that it demands accuracy of performance and the proper placement of the stamp for getting noticeable results which is the prime motive. This can be overcome merely with regular rehearsal. Alternative dental materials that can be utilized for the stamp are Bite-wax, Pit-fissure sealant, Gingival dam, and Clear Poly-methylmethacrylate. 7
Conclusion
The Stamp technique is a boon to aesthetic dentistry. It is efficient indirect composite restoration and can competently benefit in replicating the occlusal topography, which is difficult to achieve with manual carving. This technique could be carried out using varied materials that can adapt to the function of a Stamp.
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.
Conflict of Interest: There are no conflicts of interest.
Source of funding: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=4182http://ijcrr.com/article_html.php?did=4182
Agrawal A, Manwar NU, Hegde SG, et al. Comparative Evaluation of Surface Hardness and Depth of Cure of Siloraneand Methacrylate-Based Posterior Composite Resins: An in Vitro Study. J Conserv Dent.2015;18(2):136–39.
Modi R, Gogiya R, Chandak M, Bhutda P.Stamp technique - a new perspective for composite resin restoration: A case report.IJCR. 2018;10(07):71406-71408.
Dawson EP. Evaluation, diagnosis and treatment of occlusal problems. 2nd Ed. C.V. Mosby Co. (Toronto); 1989
Murashkin A. Direct posterior composite restorations using stamp technique-conventional and modified: A case series. International Journal of Dentistry Research. 2017;2(1):3-7
Demirci M, Tuncer S, Yuceokur AA. Prevalence of caries on individual tooth surfaces and its distribution by age and gender in university clinic patients. Eur J Dent. 2010;4(3):270-279.
Pompeu JGF, Morais RC, Ferreira TO, et al. Occlusal Stamp Technique For Direct Resin Composite Restoration: A Clinical Case Report. Int J Recent Sci Res.2016; 7(7):12427-12430.
Mary G, Jayadevan A. Microbrush stamp technique to achieve occlusal topography for composite resin restorations – A technical report. J Sci Dent 2016;6.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareCommon Symptoms Experienced by Cancer Patients Undergoing Chemotherapy
English124128Uppu PraveenEnglish Meenakshisundaram ManickavasagamEnglish Sirala Jagadeesh NaliniEnglishIntroduction: Chemotherapy is one of the most commonly used treatments of choice for cancer and it leads to certain side effects. The oncology care team needs to identify the symptoms experienced by cancer patients who are under chemotherapy to resolve these side effects. Objective: To identify the most common side effects experienced by cancer patients undergoing chemotherapy. Methods: A cross-sectional survey is carried out in the Medical Oncology Outpatient department and Chemotherapy Units of Sri Ramachandra Hospital, Sri Ramachandra Institute of Higher Education, and Research (DU), Chennai, India, from February to March 2020. A convenient sampling technique was used to recruit a total of 150 cancer patients. Data collection was done through personal interviews and a review of their medical records. Approximately 15-20 minutes was required to obtain data from each participant. Results: Most (31%) of them had breast cancer, 21% of them had gynaecological tract cancer, around 20% of them had digestive tract cancer. Fatigue was the most (48%) commonly reported symptom, followed by vomiting (36%) and pain (29.3%). Other symptoms like itching, oral mucositis, urinary problems, dyspnoea were experienced by the cancer patients under chemotherapy. Conclusion: This study will help the oncology care team to understand the most common symptoms experienced by cancer patients who underwent chemotherapy. Identification and management of these symptoms will help the cancer patients to have adherence to the treatment.
EnglishCommon symptoms, Side effects, Chemotherapy, Quality of life, Cancer patientsIntroduction:
Every year more than 12 million new cancer cases are diagnosed across the globe. Different treatment modalities were also introduced and improved along with the increase in the prevalence of cancer. Chemotherapy is one of the most commonly used treatments of choice for cancer.1 The nature of Chemotherapy is to damage the cancer cells along with healthy cells which result in the development of certain side effects.2 The side effects of chemotherapy can be common among cancer patients and may result in life-threatening. Even cancer patients may experience these side effects when they are at home.3
The side effects result in certain manifestations like fatigue, loss of appetite nausea & vomiting, diarrhoea, constipation, insomnia, etc., which has an impact on cancer patients’ quality of life and may disturb the continuity of the treatment.4
The oncology care team needs to identify the symptoms experienced by the cancer patients who are under chemotherapy to resolve these side effects so that it can help cancer patients and the oncology care team to render continuity in treatment.5
Purpose/objective: To identify the most common side effects experienced by cancer patients undergoing chemotherapy.
Methods:
Study design and Setting
A cross-sectional survey is carried out in the Medical Oncology Outpatient department and Chemotherapy Units of Sri Ramachandra Hospital, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India, from February to March 2020.
Sample
A convenient sampling technique was used to recruit a total of 150 cancer patients. The following criteria were used to include the participants in this study
a) Cancer patients who are receiving Chemotherapy at any stage and any cycle.
b) Who is willing to participate in study
c) Both genders of 18 years of age or older than 18 years.
d) Who can speak and understand English and /or Tamil.
Data Collection Tool
It consists of 8 items related to the cancer patient's personal and clinical information i.e. Age in years, gender, type of cancer, duration of treatment, stage of cancer, cycles of Chemotherapy completed, type of Chemotherapy, side effects/symptoms experienced.
Data collection procedure
The participants who met the eligibility criteria were invited to participate in the study. Informed consent was obtained from the participants. The participant’s personal and clinical information was obtained by the researcher through personal interviews and a review of their medical records. Approximately 15-20 minutes was required to obtain data from each participant.
Ethical considerations
Ethical approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education Research (DU). Informed consent was obtained from the participants. The anonymity of the participants was maintained. (IEC-NI/19/JUL/70/45)
Statistical analysis
Data analysis was performed by using R-Studio Version 3.6.2. Descriptive statistics like frequency and percentages were used to represent the participant’s characteristics, clinical information, and common symptoms experienced by them.
Results:
Out of 150 participants, the majority (53.5%) were ≤ 55 years of age, most(66%) of them were females, around 60.7% of them have ≤ 4 months duration of treatment, the majority (59.3%) of them completed ≤ 5 cycles of chemotherapy, around 58% of them on curative chemotherapy, about 42.7% of them on IV stage of cancer, 21.3% of them on III stages of cancer (Table 1).
Regarding types of cancer, the majority (31.3%) of them were diagnosed with Breast cancer, around 14% of them had Ovarian cancer, 8.6% of them had rectal cancer, about 6.7% of them had Lung cancer and stomach cancer respectively, 4% of them had Cervical cancer and Multiple Myeloma respectively, 3.3% of them had Oesophageal cancer and endometrial cancer respectively, 2.7% of them had colon cancer, 2% of them had Prostate cancer (Table 2).
The majority (48%) of them experiencing fatigue as a common symptom, 36% of them experiencing vomiting, around 29% of them experiencing pain, about 26.7%of them experiencing loss of appetite, 23.3% of them experiencing nausea, 12.7% of them complains of disturbed sleep, 9.3% of them experiencing constipation, around 7.3% of them complaining diarrhoea, about 5.3% of them complained itching, 4.7% of them experienced fever, 4% of complained oral mucositis, only 3.3% of them experienced urinary problems and 1.3% of them complained about dyspnoea and stomach fullness. (Table 3)
Discussion:
This study shows that 53.5% of them were in the age group of ≤ 55 years, 66% of them were females and 59.3% of them completed more than 5 cycles of chemotherapy and 42.7% of them were in the IV stage of cancer which was similar to those reported in other studies performed by Pearce and Wochen. 2,3
Most (31%) of them had breast cancer, 21% of them had gynaecological tract cancer, around 20% of them had digestive tract cancer and 6.7% of them had lung cancer which was similar to those reported by Wochna and Nayak. 3,5
Fatigue was the most (48%) commonly reported symptom, followed by vomiting (36%) and pain (29.3%). Which was similar to those reported in other studies1,2,5. Loss of appetite (26.7%), nausea (23.3%) and disturbed sleep (12.7%) constipation (9.3%), and diarrhoea (7.3%) were frequent symptoms experienced by the cancer patients under chemotherapy.6,7,8
Other symptoms like itching, fever, oral mucositis, skin/nail discolouration, numbness, urinary problems, dyspnoea, and stomach fullness were reported by the chemotherapy cancer patients.9,10
Conclusion:
Chemotherapy is one of the most widely used treatment modalities for cancer and it leads to certain side effects. This study will help the oncology care team to understand the most common symptoms experienced by cancer patients who underwent chemotherapy. The symptoms like fatigue, vomiting, pain, loss of appetite, nausea and disturbed sleep, etc. Identification and management of these symptoms will help the cancer patients to have adherence to the treatment and leads to improvement in the quality of life.
Acknowledgement:
I would like to acknowledge Dr. P. Jovita M. Martin, Associate Consultant, Dr. A Ravichandran, Assistant Physician, Dr. Hannesha P, Senior Resident, Dr. Kumanan J, Senior Resident, Department of Medical Oncology, Sri Ramachandra Institute of Higher Education & Research (DU) for their immense support. The authors are also grateful to authors/editors/publishers of all those articles, journals from where the literature for this article has been reviewed and discussed.
Financial support: Nil
Conflict of interest: Nil
Author’s Contribution:
Mr. Uppu Praveen: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, approval of the version of the manuscript to be published.
Dr. Meenakshisundaram Manickavasagam: Conception and design of the study, acquisition of the data, drafting of the manuscript, revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published.
Dr. Sirala Jagadeesh Nalini: Conception and design of the study, revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published.
Englishhttp://ijcrr.com/abstract.php?article_id=4183http://ijcrr.com/article_html.php?did=4183
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareInfluence of Thoracic Manipulation on Type I Complex Regional Pain Syndrome Post-Upper Limb Trauma
English129135Manal MHEnglish Amir MSEnglish Hesham HREnglish Yasser RLEnglishIntroduction: Complex regional pain syndrome type I (CRPS I) is a chronic condition with disturbances in the sympathetic, somatosensory and motor nervous systems. Objective: To assess the efficacy of combined thoracic manipulation (TM) and traditional physical therapy treatment (TPT) versus TPT treatment alone on pain severity at rest and functional disability in CRPS I patients after upper-limb trauma. Methods: Thirty participants with CRPS I were divided into 2 groups equally at random. The control group (A) consisted of 15 patients with a median (interquartile range [IQR]) age of 53 (13) years. This group received TPT, which consisted of transcutaneous electrical neuromuscular stimulation, mirror therapy, and exercises. The experimental group (B) consisted of 15 patients with a median (IQR) age of 50 (12) years. This group received TPT and TM. The treatment was provided 3 days a week for 12 weeks. Before and after treatment, patients were assessed for pain severity using a visual analogue scale and functional disability using the questionnaire of Disability of Arm, Shoulder, and Hand. Results: As compared with before treatment, all patients showed significant improvement in all measured variables after treatment. Even so, there was a nonsignificant difference in pain severity at rest (p=0.09) , but favoured in group B. In terms of functional disability, there was a significant difference between the groups (pEnglish Complex regional pain syndrome, Function, Manipulation, Traditional treatment, Thoracic, Type IIntroduction
Complex regional pain syndrome(CRPS) is a chronic pain disorder characterised by sensory, motor, vasomotor, and sudomotor manifestations, that is often caused by an injury.1The frequency of CRPS ranged from 3.8–7.0%.[2,3] The highest prevalence occurs among individuals aged 40–60 years.4 It affects the upper extremities more often than the lower extremities and distally, but it can affect an entire limb, such as in shoulder–hand syndrome.5 CRPS has 2 clinical types. CRPS Type II occurs after severe nerve damage, and the rest cases are referred to as CRPS type I. 6
A recent study showed that subjects with CRPS have anti-autonomic antibodies (up to 70%) in their serum, this raises the likelihood that anti-autonomic antibodies are involved in the CRPS pathophysiology. 7,8 The sympathetic nervous system (SNS) involvement in CRPS is debatable. It was considered to be the key driver of CRPS symptoms. In normal circumstances, sympathetic behaviour does not affect nociceptors' discharge; but, in cases of CRPS, the SNS appears to regulate nociceptors. This is referring to as pain-maintained sympathetically.9 There is a close association between pain and the autonomic nervous system. Both the somatic and autonomic nervous systems work together as a single entity, with their functions influenced by one another.10
Conservative treatments for CRPS I have traditionally focused on the management of symptoms in the distal limb. Spinal dysfunction care in CRPS I has not been reported. Manipulation of the spine is a form of manual therapy using “hands-on” treatment techniques causing neurophysiological modifications in the peripheral and central nervous systems. The autonomic nervous system is responsible for preserving normal tissue consistency.11Thus, it's possible that both traditional tissue-specific mechanical techniques and indirect approaches can influence the function of the autonomic nervous system, resulting in good results.10
The sympathetic chain ganglia are located near the thoracic costovertebral and zygapophyseal joints and innervate the upper limb. It might be probable that the sympathetic chain ganglia are affected by thoracic dysfunction that arises from restriction at intraarticular or extraarticular soft tissue and can be related to distal symptoms in CRPS I. So, manipulation can improve joint mobility and reduce the compression on the ganglia.12Thus, thoracic spine manipulation can assist in the overall treatment of patients’ symptoms in CRPS I.
Among the available studies on this topic, none has involved a control group. As are all case studies, even though the results are interesting and encouraging for ongoing studies, the reviews are qualitative, and no concrete conclusions can be drawn.13 However, our study is the first to examine the impact of thoracic spine manipulation in CRPS I patients by comparing a control group and an experimental group. Thus, this study will provide additional care for the management of CRPS I after upper-limb trauma.
METHODS
Subjects
Initially, 36 participants were reported with CRPS I, based on the standards of the International Association for the Study of Pain.14A total of 30 participants of both genders(21 women, 9 men; age 40–60 years) completed the study. Patients were referred from orthopedists (10–18 weeks’ duration of illness) after sustaining fractures in different upper-limb regions (e.g., shoulder region [clavicle and proximal humerus], elbow region [distal humerus, proximal radius, and ulna], and wrist region [distal radius, ulna, and carpometacarpal bones]), and participants underwent surgical intervention for fixation. Our study was conducted in the clinic of outpatient in South Valley University, Egypt, between July 2018 and June 2020. The study was carried out according to Helsinki’s Declaration and was approved by the institutional review board of the Faculty of Physical Therapy at Cairo University (No. P.T.REC/012\002032). The sample size for the analysis was determined using a power of 80% and a level of confidence of alpha (0.05). Because of the dropout rate in the study, the sample size was increased to 36 patients, even though the sample size was estimated to be 15 patients per study group. Patients underwent spinal X-rays before the intervention. All patients signed a consent form. We excluded patients who had a stroke, any history of autoimmune or peripheral vascular diseases, diabetes, or T4 syndrome (examined by X-rays) as well as patients who had participated in a physical therapy program before the intervention.
Participants were divided into two groups of 15 patients at random. Group A underwent traditional physical therapy treatment (TPT) in the form of transcutaneous electrical neuromuscular stimulation (TENS), mirror therapy, and exercises, whereas group B received TPT plus thoracic manipulation (TM; Maitland screw technique grade V at the T3–T4 level). Treatment was given in 3 days per week for 3 months. All subjects received pharmacological treatment (anti-inflammatory drugs). The study was designed as a randomized, pre–posttest, controlled trial. The primary investigator used concealed envelope randomization, and patients were then offered the allocated therapy. Both patients and assistants were blinded. The first author, who completed a certified course in manual therapy, delivered the intervention for both groups.
Measurement procedures:
Measurement of pain severity using a visual analogue scale.
The patient was asked to draw a mark at the point representing their severity of pain at rest (during 1 day) perpendicular to the visual analogue scale (VAS) line. We measured the score by calculating the distance with millimetres on a 10-cm line between the “non-pain” anchor and the point made by a patient using a ruler, including a selection of scores from 0–100.15 A difference of >12 mm was considered the minimum clinically important difference.16
Measurement of functional disability using a questionnaire of the Disability of Arm, Shoulder, and Hand (DASH).
The DASH score includes a totally of 30 items: 6 for the symptom (1 for stiffness, 1 for weakness, 1 for tingling, 3 for pain) and 24 for function (3 for social function, 21 for physical function). By measuring the mean of at least 27 of 30 items (missing rule), self-assessment and scoring are converted (mean − 1) × 25 into a scale from 0 (no symptoms/full function) to 100 (maximum symptoms/no function). 17 We used the Arabic version, and patients were asked to provide answers based on their conditions during the past week.
Treatment procedures
TPT treatment
transcutaneous electrical neuromuscular stimulation (TENS): Both groups received TENS (Endomed 482, ENRAF, German) at a sensory stimulation level with a pulse width of 150 microseconds, high frequency of 100 Hz, and intensity to evoke a tingling sensation for 30 minutes. 18 Graded current rises and electrode location advancement into areas of increased sensitivity. 13 Only2 points were used for stimulation in a session.
Mirror therapy. Both groups received mirror therapy. The affected extremity was positioned behind a mirror and placing the unaffected extremity in front. When the sound limb turns, it appears that the affected limb is behaving normally because of the brain priorities visual feedback over proprioceptive input.19
Physical therapy exercises for the upper limb. Both groups received exercises in the form of gradual weight-bearing using different equipment such as (balls, balloons) at different patient positions 20, range-of-motion, resisting, stretching exercises,21 and fine-motor control training.22
TM
Patients in group B only received TM. A rotation gliding thrust, parallel to the apophyseal joint plane, was used by the screw technique to induce joint cavitation at T3–T4 using the hypothenar eminence of the left and right hands. The patient was asked to lie prone. On the patient’s left side, the therapist stood as upright as possible and resisted crouching, as this would restrict the technique and limit the thrust delivery. The therapist ensured that when applying forces against the transverse processes, good contact was made that did not slide over the skin. By leaning the bodyweight forward onto the arms, the therapist’s centre of gravity was shifted over the patient. Direct downward pressure and additional force-directed caudal with the left hand and cephalic with the right hand on the transverse processes were applied. Pre-Thrust tension was achieved by positioning the T3–T4 segment toward the end range of the available joint gliding. Then applied a downward and cephalic high-velocity, low-amplitude thrust against the transverse process of T3 while simultaneously applying a downward and caudal thrust against the transverse process of T4 23 (Fig. 1).
Statistical analysis
SPSS for Windows, version 24 was conducted to analyze the data (SPSS, Inc., Chicago, IL). The data were not normally distributed, according to normality tests including normal Q-Q plots, box plots, and the Shapiro–Wilk test. Accordingly, we used nonparametric tests (for within-group difference, Wilcoxon signed-rank test; for between-group difference, Mann–Whitney U test), chi-square test for the site of the fracture, and Z test for sex and side differences. The level of significance was 0.05). The non-significant difference in pretest pain severity or functional disability between the groups was observed (thus revealing homogenous groups), as shown in Table 2.
M, male; F, female; R: right side; L: left side. IQR, interquartile range. a Chi-square test.
Pain severity
In both groups, we found significant differences between pre-and post-treatment (p=0.001) VAS scores at rest, with a significant reduction of pain observed after treatment. There were nonsignificant post-treatment differences between the groups (p=0.09), but group B had reduced pain post-treatment as compared with group A (see Table 3).
Functional disability (DASH)
We found asignificant difference in DASH scores between pre- and posttreatment in both groups (p=0.001), with a significant reduction of disability posttreatment. There was significant difference (pEnglishhttp://ijcrr.com/abstract.php?article_id=4184http://ijcrr.com/article_html.php?did=41841- Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10(7):637-48. https://www.ncbi.nlm.nih.gov/pubmed/21683929/
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareComputational Medicine: A Review on Applicability of Machine Learning Techniques in Diagnosing Diseases
English136142Shah Alpa KavinEnglish Gulati RaviEnglishThe digitalization of health informatics is revolutionizing the discipline of medicine. The advancements to extract knowledge from complex clinical digitized data have led to significant developments in health care. Machine Learning techniques can infer medically actionable knowledge that will support doctors and health care stakeholders to deduce the best possible medical decisions. Objective: To evaluate the applicability of the Machine Learning model in diagnosing the disease. Methods: A systematic review and literature survey to understand and elaborate the significant impacts on the prognosis, detection, and diagnosis of diseases by using various Machine Learning techniques is carried out. Result: Various Machine Learning models have been effectively been used in recent years for classifying patients and normal. A combination of bagging and boosting techniques can foster results and open newer avenues of accurate predictions. Conclusion: A thorough study of the various research undertaken in the domain of computational medicine, it was speculated that Machine Learning models are useful in applications for disease diagnosis involving complex clinical data.
EnglishMachine learning, Supervised Learning, Support Vector Machines, Classification, Decision Trees, Computational medicine
INTRODUCTION
Computational medicine refers to the applications of computer-generated methods for the detection, diagnosis and prediction of diseases. In recent years, an unprecedented growth in the development of computational models, used as classification, prediction and diagnosis tools, have been witnessed. Machine Learning models have revolutionized the medical methods that serve as an invasive method in the prediction and detection of diseases. These methods can aid and can be the initial step in making the task inexpensive, giving numerical and accurate results in real-time.
Machine Learning task involves classifying a record that may be in the form of information in a flat file, or digitized images like Computed Tomography (CT) Scans, Mammography images, MRI images, Electronic Cardio Grams (ECGs), demographic information collected from hospitals, to name a few. Records of patients suffering from the disease are used to train the model. Once the model has been created, it can then be used to predict future unseen diseases. This automatic classification yields faster diagnosis, improving health standards. In remote areas of the country where the facility of specialists and hospitals might not be available in the nearby vicinity, these models can serve as clinical decision support systems for initial screening. Researchers work on developing efficient techniques for the detection of a disease; this might aid in early diagnosis of the disease, which otherwise could not be achieved because of the need for high accuracy and less execution time. Machine Learning has become a new kind of medical tool with the advancement of Information Technology 24 and has gained broader application prospects due to the rapid development of Electronic Health Records (HER). 25
This review paper is organized into the following sections. A brief overview of Machine Learning models is discussed in Section 2. Section 3 discusses various parameters used for evaluating the performance of the Machine Learning Model. Section 4 is the core of the paper that discusses the application of Machine Learning models for the prediction of diseases. Section 5 throws light on the challenges faced in implementing Machine Learning techniques. Finally, in Section 6, conclusions and future work perspectives are drawn.
A BRIEF OVERVIEW OF MACHINE LEARNING MODELS
Machine Learning is a computer program that learns and improves from the experiences that are in the form of past or historical data, performs a specific task and has a performance measure with which it performs. Machine Learning has varied applications in Healthcare, Insurance, Analytics, Recognition problems related to Images, Speech, and Video, to name a few. Machine Learning models can effectively help doctors and stakeholders to achieve their goals because of their fast and accurate recognition performance. These models help to classify whether the given record is suffering from a particular disease or not. For the sake of completeness, various algorithms that are used by researchers are discussed in brief.
Decision Trees (DT) is a versatile and powerful Machine Learning algorithm that performs both classification and regression tasks, capable of fitting complex datasets. In a decision tree, each internal node splits the instance space into two or more sub-spaces according to a discrete function of the input attributes values. Decision Trees are essential, and they form the basis for extended algorithms like Alternating Decision Trees and Random Forests.
The Alternating Decision Tree (ADT) is used for classifying and predicting labels in supervised learning. Traditional boosting decision tree algorithms such as CART and C4.5.22 have been successful in generating classifiers but the resulting decision trees created are complicated to interpret also. ADT combines the simplicity of a single decision tree with the effectiveness of boosting. Several weak hypotheses are merged to induce a boosted one. The classifier so created is easy to interpret for the classification rules.
Artificial Neural Networks (ANN) are robust classifiers that replicate the structure and functions of biological neural networks18 present in animal brains. An ANN is composed of connected units, also called nodes, which are inspired by neurons of biological brains. An ANN consists of an input layer, an output layer and one or more hidden layers. The Backpropagation Algorithm updates the weights of neurons to maximize classification accuracy. A Feed Forward Neural Network (FFNN) is a special type of ANN where the nodes of the structure do not form any cycle. The information moves only in one direction – forward – from the input nodes, through the hidden nodes and then finally to the output nodes.
Support Vector Machines (SVMs) is a non-probabilistic binary linear classifier. SVM constructs a hyperplane or set of hyperplanes in a high- or infinite-dimensional space to separate data19. It uses a kernel function for non-linear classification. The kernel maps data into the higher dimensionality that enables to obtain a better distribution, creating a better classification result. Various kernel functions like
Polynomial, Radial Basis Function (RBF) and Hyperbolic Tangent are used to reduce the generalization error of support-vector machines.
A Random Forest (RF) is an ensemble learning method that constructs a multitude of decision trees at training time and outputs the class that is the overall prediction of the individual trees 20. They are commonly used in classification and regression problems. RFs, help to rectify the overfitting problem of decision trees. They are efficient at working on large scale databases.
Naive Bayes (NB) algorithms are based on simple probabilistic classifiers that are based on Bayes' theorem with strong (naive) independence assumptions between the features under considerations21. Bayes classifiers are very efficient for solving the text categorization problems. They also have successful implications in automatic medical diagnosis.
K-Nearest Neighbor (K-NN) predicts the class label of new input. The algorithm uses the similarity of new input to its input samples in the training set.
Logistic Regression (LR) is applied for a binary classification problem to predict the value of determining variable y when y is [0, 1]. The negative class is represented by 0 and the positive class by 1.
PERFORMANCE INDICATORS FOR CLASSIFICATION PROBLEMS
Consider a model that is used to assess whether a person is suffering from chronic kidney disease17. Samples in the form of information based on attributes under consideration are available. The indicator True Positive (TP) indicates that samples are correctly diagnosed as suffering from chronic kidney disease. False Negative (FN) indicates that the samples were incorrectly diagnosed as suffering from chronic kidney disease. False Positive (FP) indicates the normal samples (not suffering from chronic kidney disease) and are incorrectly diagnosed. True Negative (TN) indicates the samples which were not having chronic kidney disease are correctly diagnosed as not having chronic kidney disease.
The Accuracy of this model will be the number of correctly predicted samples out of all the samples. Sensitivity or Recall is the metric that will evaluate a model’s ability to predict the True Positives of each class. Specificity is the metric that evaluates a model’s ability to predict the True Negatives of each class. Precision is the ratio between the True Positives and all the Positives. For our example, it would be the number of samples that are correctly identified as having a chronic disease out of all the samples having the disease. F1 Score is the harmonic mean of Precision and Recall. The following equations are used by various researchers to ascertain the performance of the model that has been created.
Fig. 1 shows a snapshot of WEKA Tool 28 used to display Accuracy, TP Rate, FP Rate, Precision, Recall, F-Measure (F1-Score) performed on Breast Cancer Wisconsin dataset using Decision Tree Algorithm.
Other metrics used by researchers is Area Under the Curve (AUC) and Receiver Operating Characteristics (ROC) Curve. They are essential evaluation metrics that are used for checking any classification model’s performance. ROC is a probability curve, and AUC represents the degree or measure of separability. Higher the AUC, better is the model at predicting correct as correct and incorrect as incorrect. i.e. higher the AUC, the better will be the model in differentiating between the samples with chronic kidney disease and no disease. The ROC curve plots True Positive Rate (TPR) vs False Positive Rate (FPR) at different classification thresholds. And AUC measures the entire two-dimensional area underneath the entire ROC curve.
APPLICATIONS OF MACHINE LEARNING MODELS IN MEDICINE
This section discusses applications of Machine Learning models that were developed by the researchers in the detection of various diseases. The section highlights benchmark papers focusing on different aspects like the source of data, the research aim, Machine Learning techniques used, various features used to develop the model, and the outcome of the work done. The research in these fields is increasing steeply, and hence the authors recommend interested audiences to dig into them further, by picking up the disease of interest for further intended study.
Liyang Wei et al.1proposed the Machine Learning model to predict the automated classification of clustered microcalcifications (MCs). The researchers aimed to assist radiologists in the better diagnosis of breast cancer from mammograms. 697 clinical mammograms from the Department of Radiology at the University of Chicago were used to train the model. Eight features like number of MCs in the cluster, mean effective volume of individual MCs, area and circularity of the cluster, standard deviation from the effective thickness, area and volume and irregularity were used. Machine Learning algorithms like SVMs, Kernel Fischer Discriminant (KFD), Relevance Vector Machine, FFNN and Adaboost were employed on the training dataset. The accuracy of SVM (0.8545) was highest amongst all the implemented algorithms.
Q. Li et al.2 developed an algorithm for the classification of Ventricular Fibrillation (VF) and rapid Ventricular Tachycardia (VT) that can aid in an automatic external defibrillator and patient monitoring. 67 records with 99 channels from ECG databases (the American Heart Association Database, the Creighton University Ventricular Tachyarrhythmia Database, and the MIT-BIH Malignant Ventricular Arrhythmia Database) were used by the researchers to train, test and validate the model. 14 ventricular fibrillation metrics were used as feature-set. The Machine Learning model was based on SVM. The developed model achieved Accuracy of 96.3%±3.4%, Sensitivity of 96.2%±2.7%, and Specificity of 96.2% ± 4.6%, which surpassed the results that were reported by current methods.
Bum Ju Lee et al.3 worked in the identification of risk factors that are associated with cholesterol levels. The researchers used Serum High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels to identify the best predictors for HDL and LDL cholesterol levels. Women-HDL: 15 features, Women-LDL: 12 features, Men-HDL: 18 features and Men-LDL: 8 features were identified as anthropometric characteristics. The dataset comprised 13,014 Korean Adults. NB and LR were used to create Machine Learning models and were conceived as better initial screening tools for HDL and LDL cholesterol. The results were analysed based on the AUC curve which resulted, HDL-NB-WOMEN: 0.708, HDL-NB-MEN: 0.651, HDL-LR-WOMEN: 0.713, HDL-LR-MEN: 0.651, LDL-NB-WOMEN: 0.657, LDL-NB-MEN: 0.615, LDL-LR-WOMEN: 0.654 and LDL-LR-MEN: 0.605.
Jaime Melendez et al.4 developed a model to detect textural abnormalities related to Tuberculosis (TB). The dataset comprised of 917 chest radiographs collected from a busy urban health centre in Lusaka, Zambia. During training, labelled feature vectors were used to learn an appropriate classification rule by detecting textural abnormalities related to TB. The researchers developed a framework with Multiple-Instance Learner (MIL) classifier within an Active Learning (AL). The proposed method significantly improved the MIL based classification with AUC 0.877 at the pixel level. The work done by the researcher was superior in comparison to SVM with AUC 0.802 at the pixel level.4
The pioneering work to analyse the predictive powers of phenotypes consisting of triglyceride (TG) levels and various anthropometric indices in predicting Type 2 diabetes was done by Bum Ju Lee et al.5 The researchers developed a clinical decision support system for the initial screening of Type 2 diabetes. The study was done on 11,937 Korean Adults (4,906 males and 7,031 females) collected from Korean Health and Genome Epidemiology Study database. 21 features were studied and were analysed through statistical inferences. NB and LR algorithms were used to evaluate the predictive accuracy of different phenotypes. The results were analysed by AUC, which resulted in 1) For men: AUC by NB = 0.653, AUC by LR = 0.661 and 2) For women: AUC by NB = 0.73, AUC by LR = 0.735.
EminaAlickovic and Abdulhamit Subasi6 used ECG heartbeat signal classification for the diagnosis of heart arrhythmia. They used RFs for creating the predictive model. The Accuracy for the MIT-BIH database achieved was 99.33% and for St. -Petersburg Institute of Cardiological Technics database was 99.95 %.
ZerinaMasetic and Abdulhamit Subasi7 worked to classify normal and congestive heart failure. The features were selected using the Autoregressive Burg Method. RF yielded 100% accuracy in predicting congestive heart failure.
Acute Kidney Injury (AKI) is a common occurrence in hospitalized older adults, which may result in progressive deterioration of renal function. Work done by Rohit J. Kate et al. 8 created a Machine Learning model based on LR for the detection of AKI. The data was collected from 25,521 adults having age > 60 years from Aurora Health Care, Inc. in one calendar year. 12 Demographics, 9 Laboratories, 12 Medications and 14 Comorbidities features were used in the model. The study done by the researchers was the first study that examined the difference between prediction and detection of AKI. With results of AUC = 0.743 for detection at a 95% confidence level, LR surpassed the results obtained by NB, DT, SVM and ensemble models.
33 brain volumetric measures, 14 hippocampal subregional volumetric measures, 66 regional cortical thickness measures were considered for 240 MRI images for brain imaging and general cognition for dementia. LaugeSørensenet al.9 used ensemble methods with bagging and feature selection to improve the performance of dementia classification. For optimal feature subset selection, bagging without replacement with Sequential Forward feature Selection (SFS) was implemented. Ensemble SVM with linear kernel achieved Accuracy of 55.6 %.
Somaya Hashem et al.10 evaluated various Machine Learning techniques for predicting advanced fibrosis for the staging of chronic liver diseases. A dataset comprising of 39,567 patients with chronic hepatitis C were trained on Machine Learning algorithms like ADT, genetic algorithm, particle swarm optimization, and multilinear regression models. Their study also found that Age, platelet count, AST, and albumin were important features for the prediction. The results of ADT predicted the staging with accuracy = 84.4% and ROC = 0.76. Their work suggested that prediction of advanced fibrosis after combining with serum biomarkers yielded non-invasive classification models.
Xinhua Wang et al.11 researched 77 patients from the emergency department and Intensive Care Unit (ICU) of The Second Affiliated Hospital of Wenzhou Medical University between January 2015 and January 2016 for early specific diagnosis and effective evaluation of sepsis. 160 features were reduced to 5 features using the feature combination technique. Their work got an 81.6% recognition rate, 89.57% sensitivity, and 65.77% specificity. The researchers used chaotic fruit fly optimization to improve the performance of the kernel model.
192 individuals from the Clinical Research Centre for Medical Equipment Development (CRCMeD) were studied by Katsufumi Inoue et al.12. They classified whether the recorded signals correspond to healthy subjects or patients with dysphagia by using features extracted from respiratory flow, laryngeal motion, and swallowing sounds. The SVM based model yielded Accuracy of 86.4%, Sensitivity of 67.5% and Specificity of 93.3%.
Q. Zou13 studied 68,994 individuals from the hospital’s physical examination data from Luzhou, China, for predicting diabetes mellitus. Techniques like Principal Component Analysis (PCA) and Minimum Redundancy Maximum Relevance (mRMR) were used to reduce the dimensionality of the feature set. The researcher implemented DT, RF and Neural Network, out of which RF achieved the highest Accuracy equal to 80.84%.
The aim of the examining study done by Miguel Patrícioet al.14was to develop and assess a prediction model for breast cancer. 166 patients from the Gynaecology Department of the University Hospital Centre of Coimbra (CHUC), between 2009 and 2013, who were diagnosed with Breast Cancer, were studied. The Machine Learning model was based on anthropometric data and parameters collected from routine blood analysis. Glucose, Resistin, Age and BMI were important features of breast cancer biomarkers to implement into screening tests. The researchers implemented SVM, LR and RF. The results were Sensitivity [82% to 88%], and Specificity [85% to 90%] and AUC with 95% CI in the range of [0.87, 0.91] were the best for SVM.
36 informative locations on the tibiofemoral cartilage compartment from 3D MR imaging on 100 pairs of knee data and MR images from the Osteoarthritis Initiative (OAI) were studied to see the feasibility of Machine Learning algorithms like ANN, SVM, RF and NB by Yaodong Du et al.15. The measurements of Kellgren and Lawrence (KL) grade, Joint Space Narrowing on Medial compartment (JSM) grade and Joint Space Narrowing on Lateral compartment (JSL) grade provided vivid perspective to measure the progression of knee osteoarthritis disease. Using PCA the 36-dimensional feature set was reduced to an 18-dimensional medial feature set and 18-dimensional lateral feature set. The results obtained were 1) KL Grade: ANN [AUC = 0.761 and F-measure = 0.714]; 2) JSM Grade: [RF AUC = 0.785 and F-measure = 0.743]; 3) JSL Grade: [ANN with AUC = 0.695 and F-measure = 0.796].
Time-stamped vital signs and laboratory values were extracted from 401 patients’ EHR to predict Acute Respiratory Distress Syndrome (ARDS). The researchers NarathipReamaroonet al.16 implemented LR, RF, and SVMs with class-weighted cost functions and uncertain labels to predict ARDS. With the Accuracy = 0.8157 and AUROC =08548 which was highest for SVM with uncertain labels, it suggests the applicability of uncertain labels, as uncertain labels are very common in clinical diagnosis.
The Chronic Kidney Disease (CKD) data set available from the University of California Irvine (UCI) Machine Learning Repository was used by researchers Jiongming Qin et al. 17 to detect CKD. Various Machine Learning algorithms like LR, RF, SVM, k-NN, NB and FFNN were used to develop the Machine Learning Model. An integrated model with a combination of LR and RF by using perceptron achieved the highest Accuracy of 99.83%.
As discussed in this section, it is clear that many machine learning techniques are used for the classification of diseases by using metrics like Accuracy, ROC/AUC, Sensitivity and Specificity. SVMs are the most widely researched techniques that are giving good results for classifying diseases. SVMs work with fewer features, yet are powerful for achieving better results. Table 1 describes various techniques and their implementations in classifying various diseases. This comparative analysis also makes clear that a lot of scopes still exists in exploring other techniques that use bagging and boosting mechanisms.
DISCUSSIONS AND CHALLENGES IN IMPLEMENTING MACHINE LEARNING TECHNIQUES
The privacy of the patients that contribute towards generating the dataset to be used in the Machine Learning model must be maintained by imposing security rules. Proper cleaning and curating of data are required before the use of data in the model. Again, data is available in heterogeneous places like archived medical data, pathological labs, EHRs, electronic prescribing tools and databases from insurances, which makes it very challenging to bring together. Unified data formats must be created that may help to mitigate the problem related to interoperability.
Various clinical record sources, different symptom descriptions, and the possibility of attachment of more than one disease to one clinical record pose many challenges towards the implementation of Machine Learning techniques. Due to the digitization of health care records, many redundant symptoms may be collected. Not all features contribute towards the predictability of the model or to increasing the model performance. How can a significant subset of features be selected from these features is also one of the critical aspects of data modelling and understanding. Current Machine Learning techniques are best suited for binary classification. More sophisticated models that can be abstracted on multi-class or multi-label problems have potential benefits as more than one associated disease may diagnose a patient.
One major challenge is that real-world data might differ altogether from training data. This challenge poses a limitation to the clinical model for classification. A prospective model, possessing intelligence to challenge unseen data remains obscure. The researchers must include several measures to report and summarize the performance of the Machine Learning Model. The clinicians and the researchers must join hands to reach a consensus for a common understanding of generated results. Many research papers do not attempt to present such information. As an essential implementation aspect, a relatable workflow model should be created for the practising clinicians that can support the diagnostic process. Machine Learning techniques are developed on a long history of research in traditional medical science and have an encoding of the semantics of medical data. This use of ontologies guiding the learning process may permit human experts to understand and retrace decision processes more effectively.
CONCLUSIONS AND PERSPECTIVES FOR FUTURE WORK
The review encompasses various diseases that are predicted using Machine Learning techniques. These classification problems contribute towards solving traditional classification problems in the context of biomedical and clinical applications. There always exists a level of uncertainty while diagnosing diseases. The diagnosis label can be used as the classification label or predictive outcome for a Machine Learning task. The review suggests that diagnostic uncertainty can be supported by Machine Learning techniques in labelling many diseases. Various algorithms like RF, NB, SVMs, DT and NN can have possible implications to classify other medical diseases in actual clinical diagnosis in future as well.
Deep Neural Networks (DNN) have the potential to benefit a wide range of biological research applications including annotation, semantic linking, and even interpretation of complex biological data in areas including biomarker development, drug discovery, drug repurposing, and clinical recommendations. Researchers can study DNN concerning traditional machine learning methods to deliver substantial improvements. The increased collaboration between researchers in computing and biological studies will have promising advancements towards the applicability of Machine Learning algorithms and techniques for advanced healthcare systems.
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
Authors declare no conflict of interest with anyone.
SOURCE OF FUNDING
No external agencies are involved in funding the work.
AUTHOR’S CONTRIBUTION
Author 1 contributed towards conceptual study, analysis and drafting of the manuscript. Author 2 performed the critical revision of the article.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareComparative Study of Outcome of Patients with ST-Segment Elevation Myocardial Infarction in Diabetics and Non-Diabetics
English143148Mankar Parikshit GajananEnglish Thorat Sanjay TukaramEnglish Virendra C. PatilEnglishIntroduction: Although myocardial infarction is often depicted as a modern disease it was recognized before the modern era. There were references to what could be recognized today as angina pectoris, myocardial infarction and sudden death in ancient Egyptian, Greek, Biblical and the lmudic sources. Coronary angiogram performed 6-9 days showed patent vessel in all patients of group-I as compared to only 2 patients of group-II. Ejection Fraction (EF) increased from 38% to 47% in group I as compared to unchanged 40% as assayed by gated b ejection fraction lood pool imaging after 35 days. Aim: The aim here is to compare the outcome of patients with ST-Segment Elevation Myocardial Infarction (STEMI) myocardial infractions in diabetics and non-diabetics. Method: The method that we have adopted for our research is carried on patients admitted to the Medical Intensive Care Unit (MICU) of Krishna Institute of Medical Sciences, Karad over 18 months from October 2018 to March 2020. This study was approved by the institutional ethics and protocol committee. Protocol number 0257/2018-2019. Result: We studied 160 patients, 80 nondiabetic and 80 diabetic patients of ‘ST’- Segment myocardial infarction in Krishna institute of medical sciences and research centre, Karad. Out of 160 patients in the present study majority of the cases were from 60-69(38.8%) years of age. Duration of hospital stay was significantly higher in diabetic patients compared to non-diabetic patients (p=0.023). No significant difference was observed in the final outcome (deaths and discharge) between the two groups. Conclusion: Failed thrombolysis in acute myocardial infarction was more in diabetic ‘ST’ segment elevation myocardial infarction patients as compared to non-diabetic ‘ST’ segment elevation myocardial infarction patients. Even when promptly receiving thrombolytics, the outcome in the diabetic group, both in terms of mortality and morbidity was worse as compared to the nondiabetic group.
EnglishSt-segment, Myocardial Infarction, Diabetic, Coronary artery, Thrombolysis, HypotensionIntroduction:
Although myocardial infarction is often depicted as a modern disease it was recognized before the modern era. There were references to what could be recognized today as angina pectoris, myocardial infarction and sudden death in ancient Egyptian, Greek, Biblical and lmudic sources. William Heberden in 1768 presented his classic description of angina pectoris in a lecture before the Royal College of Physicians and it was published in 1772.1dam Hammer, a physician in Monneheim is credited with the first antemortem diagnosis of coronary thrombosis with an autopsy showing a clot in a coronary artery in 1898. Sir William Osler in 1910, delivered a lecture to the Royal College of Physicians, which noted that he had found the condition to be more common amongst his private or upper-class patients than the poorer classes he saw at St. Bartholomew’s hospital, noting also the tendency of the disease to have a familial disposition. He thus combined the modern etiological theories of the interaction between environment and genetics.2
Favaloro RG et al. in 1971 developed the first effective coronary bypass grafting using reversed saphenous veins. He also concluded that treating an acute MI with coronary bypass grafting within 6 hours of onset could reverse the effects of acute MI limit infarct size and improve MI postoperatively. Berg and colleagues from Spokane, Washington in 1975 published one of the first papers advocating the use of Coronary artery bypass grafting (CABG) for the treatment of acute MI and showed the benefit of surgical intervention by decreasing mortality rates significantly when revascularization was accomplished in < 6 hours.3Anderson et al. in 1983 randomized 50 patients with chest pain of fewer than four hours duration and persistent ST-segment elevation, Intracoronary streptokinase treated patients had significant improvement in global ejection fraction 10 days after therapy. The reperfusion rate in streptokinase treated patients was 79% with significant improvement in echocardiographic wall motion index and less loss of R-wave amplitude compared to control. A trend towards decreased mortality occurred in the streptokinase-treated group, but it did not reach statistical significance.4
In the GISSI study conducted in 1986, a total of 11806 patients were randomized to either intravenous streptokinase or control within 12 hours of symptom onset. At 21 days overall hospital mortality was 10.7% in streptokinase versus 13% in control, an 18% reduction. The benefit was most striking in patients treated within 3 hours (relative risk 0.74) from symptom onset, it remained statistically significant in the 3-6 hour group (0.80). A non-statistically significant reduction of mortality in the 6 to 9 hour (0.87) group and this difference reversed in the 9 to 12 hours group (relative rate 1.19) probably because the numerator and denominator in the late treated group were very small producing unstable estimates.5 Leoncini M et al. in 1994 evaluated the effectiveness of late thrombolysis (6-24 hours) in 15 patients with pre and post-treatment perfusion scintigraphy with TC99m sestamibi. 7 patients with perfusion recovery (group-1) showed a significant decrease in uptake score compared to 8 patients with absent or minimal perfusion recovery after thrombolysis (group-II). Defect score further reduced in group-I patients along with the decrease in asynergic score assayed by 2D echo significantly after 35 days compared to group II patients. Coronary angiogram performed 6-9 days showed patent vessel in all patients of group-I as compared to only 2 patients of group-II. EF increased from 38% to 47% in group I as compared to unchanged 40% as assayed by gated blood pool imaging after 35 days. Thus, it was demonstrated that it is still possible to obtain effective reperfusion and the consequent salvage of jeopardized tissue demonstrated by the recovery of both regional and global left ventricular function.6, 7
Complications
(A) Bleeding
Thrombolysis aims to lyse the thrombus in the artery and establish blood flow since this process involves activation of the plasminogen and the expected complication is bleeding. A thrombus which is preventing a vascular leak in a blood vessel is also lysed and leads to bleeding. Bleeding can occur in various places and is usually classified as either 1 Intracranial or 2 Systemic
1 Intracranial
Recent studies signify the incidence and risk factor for intracranial haemorrhage. The risk is around 0.3 - 0.5 %. These complications are rarely diagnosed because a massive infarct or haemorrhage may cause sudden death before imaging studies could be done and the death is usually attributed to a cardiac cause.
In the ISIS-318 trial 0.4% without heparin, 0.6% with heparin the risk of ICH is more with the heparin used group than the other. However, there was decreased risk of thrombotic stroke when heparin was used. IV heparin use in STEMI has increased the risk for intracranial haemorrhage but the risk of an ischemic stroke is less.
2 Systemic bleeding
The thrombolysis patient is at high risk for any invasive procedures and also for coronary Angiogram or PTCA.
(B)Immunologic complications
The active compound of streptokinase is produced by beta-hemolytic streptococcus; since it is a common pathogen it leads to frequent allergic reactions. These allergic manifestations are acute and delayed. Delayed is characterized by fever, arthralgia, leukocytoclastic vasculitis, renal failure, interstitial pulmonary abnormalities.
(C)Hypotension
Hypotension occurs in MI due to failure of ventricles to pump blood, inadequate filling of ventricles etc. Hypotension may occur following thrombolysis due to the massive release of vasodilatory chemokines like HMWK and bradykinin. In a trial it was established that fall of 35 mmHg in systolic BP in patients treated with streptokinase and that 38% had systolic BP Englishhttp://ijcrr.com/abstract.php?article_id=4186http://ijcrr.com/article_html.php?did=41861. Schlant RC, Alexander RW, O'Rourke RA, Hurst JW. The Heart, Arteries, and Veins: Volume One. McGraw-Hill; 1994.
2. Sleight P. Myocardial infarction. In: Weatherall DJ, Ledingham J.G.G., Warrell D.A. editors Oxford Textbook of Medicine, 5th Edition. Oxford; Oxford Press: 2018. P. 2331-2348.
3. Berg R Jr, Selinger SL, Leonard JJ, Coleman WS, DeWood M. Acute evolving myocardial infarction. A surgical emergency. J. Thorac. Cardiovasc. Surg. 1984;88(11):902-906.
4. Anderson JL, Marshall HW, Bray BE, Lutz JR, Frederick PR, Yanowitz FG, Datz FL, et al.. A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction. N Engl J Med, 1983; 308(6): 1312-8.
5. Gruppo Italiano Per lo Studio della Streptochinasi nell’ Infarto miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986;1(2): 397-402.
6. Leoncini M, Marcucci G, Santoro GM, Sciagrà R, Bini L, Bisi G, et al.. [Late thrombolysis in acute myocardial infarct. Demonstration of myocardial tissue salvage by the assessment of pre- and post- thrombolytic perfusion and left ventricular function]. G Ital Cardiol. 1994;24(11):1359-70.
7. Zairis MN, Lyras AG, Makrygiannis SS, Psarogianni PK, Adamopoulou EN, Handanis SM, et al.. Type 2 diabetes and intravenous thrombolysis outcome in the setting of ST-elevation myocardial infarction. Diabetes Care. 2004;27(4):967-71.
8. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Lancet. 1986;1(2):397-402.
9. ISIS-3: a randomized comparison of streptokinase vs tissue plasminogen activator vs anistreplase and aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. ISIS-3 (Third International Study of Infarct Survival) Collaborative Group. Lancet. 1992;339(3):753-70.
10. Von Essen R, Schmidt W, Uebis R, Edelmann B, Effert S, Silny J, et al.. Myocardial infarction and thrombolysis. Electrocardiographic short-term and long-term results using precordial mapping. Br Heart J. 1985;54(7):6-10.
11. Hathi V, Anadkat M. A Comparative Study of In-Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction with and Without Diabetes Mellitus, after Thrombolytic Therapy; In Government Hospital of Rajkot, Gujarat, India. J Assoc Physicians India. 2017;65(11):22-25.
12. Sulehria SB, Nabeel M, Awan AK. Failure of Streptokinase Therapy in Diabetic and Non-Diabetic Patients Presenting with ST-Elevation Myocardial Infarction Pak J Med Health Sci. 2014;8(3):750-52.
13. Iqbal, S., Bari M, S. Bari, M. Islam, M. Majumder, M. A. Islam, et al. A Comparative Study of St Segment Resolution between Diabetic and Non-Diabetic ST-Segment Elevation Myocardial Infarction Patients following Streptokinase Thrombolysis Cardiovasc. J.2019;11(2):118-122.
14. Singh RK, Trailokya A, Naik MM. Post-Reteplase Evaluation of Clinical Safety & Efficacy in Indian Patients (Precise-In Study). J Assoc Physicians India. 2015;63(4):30, 32-5.
15. Shah I, Hafizullah M, Shah ST, Gul AD, Iqbal A. Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus. Pak Heart J 2012; 45 (01): 3338.
16. INJECT Investigators. International Joint Efficacy Comparison of Thrombolytics. Randomized, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction (INJECT): trial to investigate equivalence. Lancet. 1995;346(8971):329-36.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareKnowledge and Practices About COVID-19 Pandemic in Pakistan
English149154Sikander Ghayas KhanEnglish Bareera SaeedEnglish Malik Muhammad QasimEnglish Atif IkramEnglish Hassan SohailEnglish Maria ShahzadiEnglish Laiba ZahidEnglish Ambreen SadafEnglishIntroduction: Coronavirus (COVID-19) illness, which has been labelled a pandemic, was caused by the year 2019. It was labeled a worldwide emergency on January 30th, 2020. Objective: To assess the knowledge and practices about the covid-19 pandemic in Pakistan Material and Methods: From April 1, 2021, to May 6, 2021, a cross-sectional online survey was performed. Residents of Punjab and Baluchistan, Pakistan, who were 18 or older male and female could read and understand English and Urdu who had completed the entire questionnaire were the subjects of the study. A structured close-ended online questionnaire based on expert opinions and literature was used to collect data. Software Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyse the data. Results: The maximum number of the participants 330 (88.2%) were aware of the existence of coronavirus disease and there is no relationship between the categorical variables of gender (p= .144; p> .000). The majority of females 78 (20.8%) always, 72 (19.2%) often washed their hands with soap for twenty minutes significantly higher than males 52 (13.8%) 64 (17.0%) that indicates p< .001. Similarly, the majority of females used ordinary mask 94 (25.0%) always, 46 (12.2 %) often as compared to males 56 (14.3%); always, 59 (15.7) often and the majority of participants 345 (85.0%) were practising the general SOPs and value of p EnglishCOVID-19, Coronavirus disease, Pandemic, perception, Knowledge, Awareness, PakistanIntroduction
After the horrid waves that have encircled the entire world the COVID-19 pandemic affects the lives of every human. Everyone's life was impacted in every way by a new mysterious epidemic, which sparked the global emergency "COVID-19" pandemic. This COVID-19 pandemic was caused by an equivalent infective agent. Such viruses have conjointly caused outbreaks antecedently together with severe metabolism syndrome (SARS)-CoV and therefore the Middle East metabolism syndrome (MERS)-CoV. Coronavirus (COVID-19) eruption first arisen from the municipality of the urban centre, Wuhan, China in 2019. It’s a terrible kind of like its previous strain SARS-CoV that was well-known to cause a plague in 2002.1 Another strain MERS-CoV was 1st known in the Asian nation in 2012. COVID-19 is 1st known in urban centre, China then it unfolds to multiple countries and become a major danger for the world. On twenty-sixth February 2020, the primary cause of coronavirus emerges in Pakistan. Pakistan had 5038 confirmed COVID-19 cases and 86 deaths as of 12 April 2020. The highest number of cases were encountered (N=2425), followed by Sindh (N=1318), Khyber Pakhtunkhwa (N=696), Baluchistan (N=228). (N=216), Gilgit Baltistan (N=118) and Azad Jammu, Kashmir (N=35). All religious congregations and services have been suspended, marriage/banquet facilities are closed and all festivities have been cancelled. The full lock-down in the country has been put in. It was estimated that there were 13,328 COVID-19 cases across the country on 27 March 2020 (10,018 active cases, 281 deaths and 3029 recoveries).2
The predominant symptoms of this infective agent are health problem area unit fever and cough, however there's a variety of symptoms like dry cough, headache, fatigue, headache, diarrhea, fluid production, sym?t?m?ti?, lym?h??yt??eni?, and dyspnea are some of the most common symptoms of COVID-19 infection, whereas some patients could also be well.3 Patients were made a diagnosis with a painful respiratory disease that was later known as VID-19 infection.Till the last week of January 2020 almost 1975 patients were infected with coivd-19 virus in china. The incidence and prevalence found increased to 7734 in just five days, from January 30th to January 31st. Show how quickly the infection appeared.4 On the other hand the first infected person of covid 19 as case in the United States was registered on the 22nd of January 2020. 5 To date, there are 4,178,156 well-reported cases all over the world and the highest confirmed cases were reported in Italy, the United State of America, Spain and the United Kingdom.6 The infection of COVID-19 than a comrade in the nursing period is about to five days when these symptoms appear. 7 It takes approximately 6-41 days from the onset of symptoms to death to form a community of fourteen days.8
However, this period differs depending on the treatment plan and the patient's age. 9 China take strong and bold steps to control the pandemic. The success of that for the most part depends upon the public’s response towards the management measures that are taken. 10 In the Republic of Korea, measures were taken as early as three Jan 2020 well before the first confirmed case. On twenty-six February, the govt. opened first drive-through testing facility. The Republic of Korea took a pro-active approach to mass testing and active self-isolation. 11 Whereas within the United States of America (USA), timely steps weren't taken because of that range the amount the number of infected cases within the USA rose drastically and have become the country with the best number of confirmed cases within the world. in keeping with World Health Organization (WHO), the USA has confirmed cases of one,215,571 and 67,146 deaths.12
The case studies of China, the Republic of Korea and America showed that diseases police investigation pattern is connected with the behaviour of Governments and therefore the response of the overall public. The literature suggests that lack of awareness and incomprehension among Health Care workers (HCWs) leads to delayed diagnostics, disease spread and poor infection management practices. A systematic study on COVID-19 patients found that the groups most vulnerable were those with asthma, diabetes, cardiovascular and breathing systems.12 chronic blockade-related pulmonary disorders are fivefold higher risk of serious COVID-19. Poor awareness of the disease in the population is involved with a rise in the spread of infection and death rates, in particular high-risk groups.13 Therefore, controlling morbidity and mortality by COVID-19 effectively and minimizing it involves the shift in the behaviour of the general population, in particular high-risk classes, informed by people's awareness and expectations. Poor awareness of the disease in the population is involved with a rise in the spread of infection and death rates, in particular high-risk groups. Therefore, control and minimizing the morbidity of and mortality from COVID-19 successfully involves changing the behaviour of the general public, especially the high-risk groups, influenced by people's awareness and practice.14
Now, to contain the COVID-19 eruption in Pakistan, public understanding of the illness should be evaluated effective strategy might be created considering the public’s awareness relating to COVID-19 during this current study, the researcher investigated the data, knowledge and practices among Punjab and Baluchistan Pakistan residents relating to COVID-19 throughout the eruption. Therefore it is of the utmost importance, that the general public has good knowledge about each measurement (physical separation, proper hand hygiene, use of a facial mask, and breathing etiquette). The study was therefore conducted to evaluate among Pakistanis COVID-19 awareness, attitudes and preventive practices.15
Materials and Methods
The study design was observational cross-sectional and a convenient sampling technique was used to draw the sample from the population. Data was collected from April 01, 2020, to May 06, 2020, through an online google form link. Data was collected from different segments of society included labour class, businessmen, office workers, and other professionals from Punjab and Baluchistan. The age range was 18 to 65 years. A total of 374 participants were included in the study. The research was carried out in compliance with the Institutional Analysis Ethics (Ref No: IRB-UOL-FAHS/812/2021)and the Declaration. The study's goals, nature, and process were all described in the consent type. The secrecy and obscurity were highly maintained. A questionnaire and google form link was developed based on a close ended questionnaire with three sections relates to demographic information, questions based on knowledge attitudes and practices related to coronavirus. The questionnaire was developed with the reference of related published international content and with the suggestions of experts. Data was collected with in-person and online data collection strategies. The online link was sent to different segments of the population through WhatsApp, email and social media as the researcher itself collected the data from those who had no online access. Descriptive statistics (frequency, percentages, means, and standard deviations) and chi-square test was used
Results
In this study, a total of 374 participants were included in the final analysis, of which 47.3% were female and 52.7% were male with an average age of 30.73±11.09 years (SD) ranging from 18 to 65 years.
Table 1 shows the socio-demographic information that was collected, including gender, age, education, occupation, marital status, and location of permanent residence. 51.1% of respondents were married, 48.9% were unmarried. The majority were respondents (21.3%), had a bachelor’s level of education (21.4%) were having master level and (19.8%) were having the postgraduate level of education. Participants included in this study were belongs to different occupations (23.5%) were office workers and (51.1%) were belongs to other domains of occupation.
In the knowledge component, Table 2 depicts the findings. The maximum number of the male participants (167; 44.6%) than female ( 163; 43.5%) were aware regarding the existence of coronavirus disease and there is no relationship between the categorical variables of gender (p= .149), the majority of female participants acquired knowledge through social media (152; 40.6%) than male participants (124; 33.2%) the value of p = .000 that indicate significant relationship, almost (152; 40.6%, p=.022) female participants agreed to the fact that COVID-19 is a serious disease and can be transmitted and there is no significant association among male and female. The majority of female participants (168; 44.9%) had knowledge about factors of spreading and both genders had statistically significance (p=.001). The majority of Female Participants (127, 34.0%) considered statistically significantly (p=.000) that the covid 19 is a treatable disease. A gigantic amount of participants (female 154, 41.2%; male 153, 41.0% ), knew that COVID-19 infection can be by touching eyes, nose and mouth (p=.049). Almost all (female 165, 44.1%; male 155; 41.4%) of participants were having statistically significant knowledge about wearing the mask can protect from covid-19(p=.000).
In table 3 for each question of practice, the Majority of females (20.9%; always, 19.3%; often) washed their hands with soap for twenty minutes significantly higher than males (13.9%, always; 17.0%; often) that indicates p< .000. Similarly, the majority of females used an ordinary mask (25.1%; always, 12.3% often) as compared to males (15.2%; always, 16.0%often) and p 90%) used conservative measures.19 Government-sponsored efforts that identify the reasons, symptoms, and pathways might also be approximations of the high incidence of good manners used by just 50% of well-informed individuals, but these awareness initiatives are more focused on promoting preventative measures like facial expressions, social skipping, and hand hygiene practices.20
Continuous monitoring of the execution of preventative measures, a review of current initiatives, and therefore the renewal of such actions are all required to manage the epidemic. This study adds to the findings of earlier research in Pakistan by revealing the current status of awareness and practices measures taken.21 The study has several obvious shortcomings. First, because this is frequently an online survey design, the answer is heavily reliant on dependability and partially on the capacity to recall, making it less susceptible to memory bias. However, due to the community's policy of closure and termination, manual completion of the test was not possible. Second, because the sample size was insufficient, the bulk of respondents came from the province of Punjab and Baluchistan, limiting population availability across Pakistan.
Conclusion:
The participants from Punjab and Baluchistan have a better understanding of the COVID-19 and most of the participants are practising SOPs. However, more awareness is needed to improve the situation and stop the virus from spreading. These findings support the need for effective and targeted health education programmes that focus on COVID-19 information, resulting in a high level of positive attitudes and the adoption and maintenance of safe habits.
Acknowledgement:
I would like to say thank you to Professor Jamel for the English proofreading of this article.
Source of Funding:
This research was not funded.
Authors’ Contribution:
The idea of the study was Barrera Saeed and Muhammad Sikander Ghayas Khan, a Study designed by Muhammad Sikander Ghayas Khan, Write up, editing and data analysis done by Barrera Saeed, Data Collection from Baluchistan was done by Dr Malik Muhammad Qasim. Data Collection from Punjab done by Muhammad Sikander Ghayas Khan, Barrera Saeed, Hassan Sohail, Atif Ikram, Laiba Zahid, Ambreen Sadaf, Maria Shazadi, Barrera Saeed and Hassan Social entered the data on SPSS. Article Reviewed and final approval was made by Muhammad Sikander Ghayas Khan.
Englishhttp://ijcrr.com/abstract.php?article_id=4187http://ijcrr.com/article_html.php?did=41871. Saunders-Hastings PR, Krewski D. Reviewing the history of pandemic influenza: understanding patterns of emergence and transmission. Pathogens. 2016;5(4):66.
2. Organization WH. Novel Coronavirus ( 2019-nCoV): situation report, 3. 2020.
3. McKibbin WJ, Fernando R. The global macroeconomic impacts of COVID-19: Seven scenarios. 2020.
4. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int JEnviron Res PublicHealth. 2020;17(5):1729.
5. Van Bavel JJ, Boggio P, Capraro V, Cichocka A, Cikara M, Crockett M, et al. Using
social and behavioural science to support COVID-19 pandemic response. 2020.
6. Organization WH. Modes of transmission of the virus causing COVID-19: implications for IPC precaution recommendations: scientific brief, 27 March 2020: World Health Organization2020.
7. Surveillances V. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly. 2020;2(8):113-22.
8. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID?19 based on current evidence. J Med Virol. 2020.
9. Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nature Medicine. 2020:1-5.
10. Nesteruk I. Statistics based predictions of coronavirus 2019-nCoV spreading in mainland China. MedRxiv. 2020.
11. Chen X, Yu B. First two months of the 2019 Coronavirus Disease (COVID-19) epidemic in China: real-time surveillance and evaluation with a second derivative model. Global Health Research Policy. 2020;5(1):1-9.
12. Lin Q, Zhao S, Gao D, Lou Y, Yang S, Musa SS, et al. A conceptual model for the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, China with individual reaction and governmental action. Int J Infect Dis. 2020;93:211-6.
13. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. Jama. 2020.
14. Cheng S-C, Chang Y-C, Chiang Y-LF, Chien Y-C, Cheng M, Yang C-H, et al. First case of Coronavirus Disease 2019 (COVID-19) pneumonia in Taiwan. J Formos Med Assoc. 2020.
15. Schwartz J, King C-C, Yen M-Y. Protecting health care workers during the COVID-19 coronavirus outbreak-Lessons from Taiwan's SARS response. Clin Infect Dis. 2020.
16. Organization WH. Coronavirus disease 2019 (COVID-19): situation report, 70. 2020.
17. Chiu A. Trump has no qualms about calling coronavirus the ‘Chinese Virus’. That's a dangerous attitude, experts say. The Washington Post. 2020;20.
18. Graham A, Cullen F, Pickett J, Jonson C, Haner M, Sloan M. Faith in Trump, Moral Foundations, and Social Distancing Defiance During the Coronavirus Pandemic. Moral Foundations, and Social Distancing Defiance During the Coronavirus Pandemic (April 22, 2020). 2020.
19. Jacoby SM. Return of the Repressed: Will the Coronavirus Bring a Great Transformation to America? Available at SSRN 3587048. 2020.
20. Burke RM. Active monitoring of persons exposed to patients with confirmed COVID-19—United States, January–February 2020. MMWR Morbidity and mortality weekly report. 2020;69.
21. Liu P, Beeler P, Chakrabarty RK. COVID-19 Progression Timeline and Effectiveness of Response-to-Spread Interventions across the United States. medRxiv. 2020
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAssociation of ABO Blood Group with Oral Cancer and Precancer - A Case-control Study
English155161Isha GauravEnglish Vela DesaiEnglish Karamdeep SinghEnglish Satinder SinghEnglish Sukhmani SangheraEnglish Anmol KaurEnglish Alisha MadanEnglishBackground: Oral cancer is creating an alarming situation globally. It is the commonest cancer in India, accounting for 50–70% of total cancer mortality. Oral cancer is amenable to primary and secondary prevention. The relationship between ABO blood groups and carcinogenesis or progression of human tumors has been reported by many investigators. Aim: To evaluate the association of ABO Blood Group System with Potentially Malignant Oral Lesions and Oral Cancer and also assess other risk factors associated with age, sex and tobacco habit. Material and Method: The research was a case-control study including 200 subjects selected using the random sampling technique into 4 groups, two control and two experimental 100 each. Details regarding demographics and oral habits were noted followed by blood group testing and comparison of blood groups and Rh status of all 4 groups. For statistical analysis, a Chi-square test was used to assess the relationship between ABO blood groups and oral precancer and cancer. The probability level was fixed at ≤0.05. Results: A significant association between the blood group A and the defined diseases could be determined. Common age group for Oral cancer was found to be 51-60 years with male preponderance. Oral Submucous Fibrosis was the most prevalent precancerous disorder with smokeless tobacco being the chief etiological factor. Conclusion: ABO blood group may have a role in the causation of oral precancer and cancer, and this novel finding provides a hint that ABO blood group may be used as a possible indicator although we cannot rule out the presence of residual confounding by other predisposing factors for oral cancer. Nonetheless, further investigations that include more diverse study populations are warranted.
EnglishABO blood group, Oral Precancer, Oral Cancer, OSMF, Risk factors, Biomarker Introduction
Oral cancer (OC) is the commonest cancer in India, accounting for 50–70% of total cancer mortality and accounts for the highest incidence among Asian countries.1
Global descriptions of international patterns and trends in oral cancer are informative in providing insight into the shifting epidemiologic patterns and the potential prevention of these tumours.2
Oral cancer is amenable to primary and secondary prevention.3 Intense efforts towards early detection and prevention are required. A decision to introduce population-based screening should be taken into account which requires development of an affordable, acceptable, easy to use, reliable and easily identifiable biomarker to combat with the cost of screening.
It is known that oral cancer is caused by the interaction between environmental factors and genetic variations. Tobacco chewing is generally considered as the primary local etiological factor for oral cancer with smoking and alcohol acting as co-factors.4
Recent studies have revealed the possibility of ABO blood group antigens role in development of cancer.
ABO blood group is one of genetic factors that has been hypothesized in the aetiology of various chronic diseases. The association between ABO blood group and risk of cancer has been known for more than 60 years but received little attention. The author in the year 1953 were the first to notice the correlation between gastric cancer and blood group A.5 Since then, the relationship between ABO blood groups and carcinogenesis or progression of human tumors has been reported by many investigations.6 In India, studies have shown that individuals with blood group A have a predisposition for oral cancer. Association between ABO blood group and the risk of cancer might vary among different races or ethnicities.7 We decided to further prove the hypothesis on a defined population of East central Rajasthan and also included potentially malignant disorders that serve as precursors of oral cancer in the study. By performing this simple test and counselling the susceptible genera might reduce a load of oral cancer in our population.
Aim
The present study aimed to evaluate if any of the ABO blood groups are associated with increased risk of precancer and cancer and also assess other risk factors associated with age, sex and tobacco habit.
Material and Methods
The study was conducted in Jaipur Dental College and RUHS College of Dental Sciences, Jaipur, Rajasthan. The study aimed to assess the consideration of the blood group as a risk factor in the occurrence of precancer and cancer. The study was based on the assumption that blood group type is a risk factor in the causation of cancer in various parts of the body and there was an urge to further research if the assumption holds for oral cancer and potentially malignant disorders.
200 subjects were included in the study, randomly selected from patients attending the OPD of Jaipur Dental College and RUHS College of Dental Sciences in 4 groups - two control and two experimental 200 each. The 4 groups of data collection in the study were as follows:
• 50 healthy individuals
• 50 healthy individuals with tobacco habit but no lesion
• 50 individuals with potentially malignant lesions
• 50 individuals with oral cancer
The subjects were drawn from the general population visiting OPD during a specified period.
The sample selection criteria were as follows.
Inclusion Criterion
• Subjects who gave informed consent.
• Subjects matching the diagnostic criteria for various potentially malignant lesions.
• Subjects with oral cancer that were histopathologically confirmed.
Exclusion Criterion
• Subjects with no histopathological confirmation for oral cancer.
• Subjects with the genetic disorder.
• Subjects with any sort of bleeding disorder or on oral anticoagulants.
• Subjects with a critical illness.
• Subjects not willing to be part of the study.
All the study subjects were personally interviewed regarding their socio-demographic profile, medical history, oral hygiene, dietary history, tobacco habit history using a structured Performa. Tobacco history including type (chewing, smoking or both), frequency, and duration was recorded.
After acquiring all the relevant information regarding the demographic profile of the subjects, a thorough oral examination was done.
Patients belonging to the healthy group were then subjected to the ABO blood grouping procedure. Patients having oral lesions (Potentially malignant or oral cancer) were further evaluated. The four most frequently encountered potentially malignant disorders were considered in the study.
1. Leukoplakia
2. Oral Submucous Fibrosis
3. Oral Lichen Planus
4. Combination of any of these
Toluidine blue testing was done for all patients having oral lesions and patients suspected of malignancy were considered for biopsy.
This was followed by ABO blood group testing. Various blood typing techniques have been available which is different from each other in many prospectuses. . In this study we used the Slide Method due to its following advantages: The test completes in 5–10 min, is inexpensive and requires only a small volume of blood typing reagents.
Statistical Analysis
All the subjects data were recorded and entered in separate Excel sheets (Microsoft Excel, Microsoft Office 2010, USA). After that, the data were evaluated statistically using SPSS software (Statistical Package for Social Sciences). The Chi-Square tests with Fisher’s definitive test were used to compare and reach the conclusion for the results of this study.
Results
The study sample had 4 groups – Healthy, Habit without lesion, precancer and oral cancer. Age and sex were matched for the Healthy group.
Table 1 and Graph 1 shows the age-wise distribution of the sample. The 4 subject groups were sorted into 7 age groups wiz. 21-30 years, 31-40 years,41-50 years,51-60 years and 61-70 years. In the healthy group, the subjects were selected equally in each age group in a count of 10 totalling 50. Most subjects in the habit without lesion group belonged to the 21-30 age group. Likewise, subjects in precancer and oral cancer belonged to 41-50 and 51-60 respectively.
Table 2 demonstrates the no. of males and females in the 4 groups. Males were found to be more in the habit without lesion group, precancer group and cancer group.
Table 3 depicts the frequency of various precancerous lesions in the study group. OSMF was the most frequently encountered precancerous lesion followed by Leukoplakia, OLP and a combination of these lesions.
Table 4 shows the constancy of various tobacco habits in subjects groups and it was seen that smoking was more prevalent in the habit with no habit lesion group whereas smokeless tobacco was more prevalent in the precancer and oral cancer groups
Table 5 summarizes the variance of blood groups in the sample. The frequencies of blood types A, B, AB and O were B(56%)>O(36%)>A(4%)=AB(4%) among healthy participants while those for habit without lesion group were O(38%)>B(34%)>A(20%)>AB(8%). These were compared to precancer and oral cancer group showing A(38%)>B(34%)>AB(20%)>O(8%) for Precancer and A(50%)>B(30%)>O(18%)>AB(2%) for Oral cancer. Chi-Square test (table 6) with significance level set as .05 demonstrated a significant difference with blood group A preponderance for both Precancer and Oral Cancer.
Table 6 Chi-square analysis for the association of Blood groups in various groups
Discussion
India has one-third of oral cancer cases in the world.8 40% of cancers of the body in India are oral cancers. Cancer in its all forms accounts for about 12% of deaths throughout the world and is thus considered a killer disease.9
The prime reason for this high mortality and morbidity is attributed to the delay in diagnosis and prompt treatment. Relentless research in the field of oncology has led to the advent of novel procedures for the early detection of oral cancers.10
While most of the efforts usually focus on therapy and outcomes, the need for risk factors evaluation, screening for early detection cannot be overlooked.11
Oral cancer to a large extent is a self-induced disease. To plan preventive measures, it is important to understand the risk factors associated with the disease.12
The two main factors which influence most diseases are genetic and epigenetic.13
Epigenetic factors like cigarette smoking, tobacco chewing, body mass index, diet, poor oral hygiene vary with lifestyle. The ABO blood group is a genetically determined variable and therefore is not a modifiable risk factor.
ABO blood group is an easily accessible factor in a patient’s genetic make-up.14 The relationship of blood groups with incidence, clinicopathologic parameter, and prognosis has been studied in many cancers, such as gastric, breast, skin, oesophagus, cardiac, lung, laryngeal, hypopharyngeal, salivary gland, gynecologic, colorectal, pancreatic, bone, urinary bladder, renal, testicular, uveal melanoma, and prostate. In some tumours, alteration of ABO antigens is associated with malignant transformation. Apart from cancers, ABO blood groups have also been associated with disease entities, such as pulmonary tuberculosis, leprosy, syphilis, malaria, coronary artery disease, diabetes mellitus, vitiligo, infertility, schizophrenia, goitre, glucose-6-phosphate dehydrogenase deficiency, gout, and hepatic dysfunctions.15
In the present study blood group, B was found to be the maximum among the healthy group owing to the generalized prevalence of the B blood group in the population of Rajasthan followed by blood Group O, A and AB. Also, Rh-negative subjects were low in the overall control and study group.
This is by a study done by Behra and Joshi (2013)16 in Rajasthan revealing that the commonest ABO blood group is B(36.4%), followed by O (31.7%), A(22.2%) and AB(9.4%) respectively. Rh Positive are 91.75% and Rh-negative is 8.25%.
In our study, the frequency of blood group "A" was predominant in both Precancer and Oral cancer groups.
One of the authors has cocluded that there is increased risk of cancer of the stpomach in the patients having Blood Group A as compared to those who were having blood group O.5
Although studies relating ABO, Precancer and Oral cancer have shown variable results.
Bryne et al.18 demonstrated no significant results; Jaleel BF et al.9, S Bhateja and G Arora15, Saxena S et al.19, Venu K et al.20, Shishodia NP et al.21 showed a preponderance of blood group A; Mortazavi H et al.22, Jyoti Byakodi JR and Pushpanjali K23 2014, Nikam P et al.24, Ramesh G et al.25, Rao S and Abraham TT 11 concluded blood group B to be responsible for increased risk for oral cancer; Singh K et al.26, Kakava K et al.27 found blood group O to be the culprit; Jalili L et al.28, Gupta DK et al.29, manifested the predominance of blood group AB.
There is a lot of literature showing the association of various blood groups with ceratin specified type of cancer, however different authors have a different opinions in this regard. The difference in the research could be due to the assessment of the small size of the sample, wider variation of ABO frequencies occurring over relatively limited areas even in populations considered ethnically homogeneous30,31
The antigen of ABO blood groups has been expressed on the outermost surface of the human tissues such as epithelium sensory neurons, platelets, and the vascular endothelium.32
Certain authors have suggested that the ABO blood group antigens should be termed ABH histo-blood group antigens to emphasize that they are primarily tissue antigens.33,34 ABH antigens appear earlier in evolution in ectodermal or endodermal tissue than in mesenchymal hematopoietic tissue and cells, including RBCs.33
ABO blood group system extends beyond transfusion medicine and several reports have suggested an important involvement in the development of cardiovascular, oncological and other diseases
The underlying mechanism for the possible relationship between blood type and cancer has not been clearly defined to date. Some investigators have proposed that the ABO gene products themselves have a direct role in tumorigenesis.35 The ABO blood group genes are mapped to 9q region where genetic alterations are common in most cancers.36
Alternatively, others have proposed the idea that altered ABO glycosyltransferase or glycosylation pattern itself could be causative.35,37,38
Two genome-wide association studies have shown significant associations between the ABO locus and serum levels of both TNF-α and intercellular adhesion molecule-1, consistent with the association of inflammation and cancer. A secretory phenotype theory has also been suggested, which is more common in O blood type.35
Although the main objective of the present study was to unravel the relationship between ABO blood groups and Precancer and Oral cancer, we also considered the demographics of subjects under study. The number of subjects in the age category of 21-30 years was proportionately higher (32%)in the habit without lesion group. According to recent data by Grover S et al39, summarizing the findings of Global Adult Tobacco Survey -2 (GATS-2), in India, the overall mean age of initiation of tobacco use was 19.3 years.
Adolescence and early adulthood, i.e., 15 to 24 years, are considered to be in the most susceptible phase of life for initiation of tobacco use in India.40,41
Precancer and Oral cancer were more prevalent in age groups 41-50 years and 51-60 years respectively. Oral cancer incidence increases with age and a vast majority of cases reported are diagnosed between 50 to 60 years.41 This can be attributed to the indiscriminate usage of tobacco and tobacco-related products, over a prolonged period, leading to genetic damage.
Data on age-adjusted rates (AARs) of incidence of oral cancer presented by Sharma S et al.42 showed mouth cancer in the central region of India was maximum in the 70- to 75-year age group and that in northeast and west regions of India in 60- to 69-year age group. According to many researchers, most age groups showing precancer noted was 30 to 50years.43,44
Additionally, with sex-matched in the healthy group, subjects in the rest three groups were more likely to be males as compared to females. The same observation has been made by other authors also.45,46
This difference could be related to the difference in habit frequency between male and female individuals, diet, or other physiological factors. According to GATS, tobacco use in India has been higher among males than females.42,47,48 The present study exhibited a strong correlation between the presence of the chewing habit in all the precancerous lesions and oral cancer as compared to subjects in the habit without lesion group where smoking was more prevalent. A relatively lesser impact of smoking may be due to the indirect and relatively shorter duration of contact with tobacco in the oral cavity in comparison to the habit of tobacco chewing. It is possible that smoking and alcohol are greater risk factors in the presence of other habits such as chewing tobacco/pan masala but do not seriously affect the risk of oral lesions by themselves.46
Smokeless tobacco products use has been considered as the main component for the higher prevalence in South East Asia.41
41 India has one of the highest tobacco users in the world both in number and relative share.49 Smokeless tobacco is also highly addictive and causes cancer of the head and neck, oesophagus and pancreas, besides many oral diseases.50
It was observed that the most common precancerous lesion was Oral submucous fibrosis (50%) followed by leukoplakia (26%), lichen planus (16%) and combination lesion (8%). Similar findings were found in other related studies by Kumar S et al.48 and Singh N et al.51.
Several surveys have shown an increase in the incidence of OSMF attributed to the use of smokeless tobacco chiefly gutkha and paan masala, especially among youngsters.45 However Faiz et al.52 found Leukoplakia to be more prevalent than OSMF. The incidence of the death rate due to cancer has shown a sharp acceleration in the last 2 decades. Oral cancer is a lethal disease thus every way by which it can be curbed should be pondered. Advancements are required in techniques that can sort out individuals who tend to get cancer in presence of other risk factors and also differentiate patients with precancerous lesions who have a high risk of developing cancer so that occurrence of cancer can be averted.
Conclusion
Association of Blood group A with Precancer and Oral cancer warrants the use of blood group type together with other risk factors. Early and regular cancer screening should be advised to patients of susceptible blood groups if any known and established etiologic factors like tobacco or alcohol abuse are found. Racial and ethnic distribution of blood groups vary thus present study may not be truly representative of all the pre cancer and oral cancer cases in the community. By employing a simple blood grouping test during community field programs, we can target the people with blood group A in the age group of 40-59 years having tobacco chewing habits and educate them that they are more at risk to develop oral cancer than people with other blood groups Hence, further prospective study in this regard with larger sample size is recommended.
The authors of this study declared “No Conflict of interest”
Acknowledgement: Nil
Funding Information: Nil
Author Contribution:
Isha Gaurav: Proposed the Aim and Objective of the study, Planned the Protocol, Assessment of the results, Collection of the data, Submission of the paper
Vela Desai: Overall Supervision of the study, Critical Evaluation
Karamdeep Singh: Collection of the data, Laboratory Procedures
Satinder Singh: Statistical Analysis, table and Figures
Sukhmani Sanghera: Data Assessment, Written the manuscript
Anmol Kaur: Assistance in Sample collection, data collection, assistance in managing patients, writing
Alisha Madan: Reviewing the manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=4188http://ijcrr.com/article_html.php?did=4188
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareAn Extensive Survey on Applications of Advanced Deep Learning Algorithms on Detection of Neurodegenerative Diseases and in Tackling the Security Threats in their Treatment Protocol
English162164Vignesh Balaji SEnglish Vergin Raja Sarobin MEnglish L. Jani AnbarasiEnglish N. AnushaEnglish D. DhanyaEnglish Benson Edwin RajEnglish M.L. ValarmathiEnglishIntroduction: A degenerative disorder results in deterioration of the structure or functions of the “nervous system”, either by killing or rupturing the nerve cells, which is known as a neurodegenerative disease. The most frequently occurring nerve disorder is “Parkinson’s Disease”. Objectives: The main objective is to focus on neurodegenerative Parkinson’s disease its analysis using deep neural networks. Materials and Methods: This survey briefly reviews some literature on advanced Deep learning algorithms in the diagnosis of neurodegenerative diseases and their treatment protocol. Results: This paper presented few techniques followed by various researchers; accuracy, sensitivity, recall achieved by the methodologies have been presented for Parkinson’s disease. Conclusion: In conclusion, this study has reviewed some significant datasets related to Parkinson’s disease, applications of advanced deep learning algorithms in their detection, and to ensure advanced neurodegenerative disorder treatments that make use of Brain Computing Interface.
English Deep Learning, Parkinson’s Disease, Deep Brain Stimulation, Machine Learning, Convolution Neural Network, Medical Analysis Introduction:
Neurons are the basic building blocks of the human nervous system. When these structures are ruptured or dead, our bodies do not replace them. This leads to neurodegenerative diseases like Alzheimer's and Parkinson's. These diseases are incurable and cause the patient's brain to deteriorate over time, eventually leading to death. Dementias are the most common neuro disorders, and Alzheimer's disease is the most common cause of dementia.1 This paper focuses on the use of deep learning models to detect the occurrence of neurodegenerative diseases such as Alzheimer's and Parkinson's.
Parkinson's disease, also known as "PD," is a form of neurodegenerative disease that causes involuntary trembling, kinetic difficulties, and a lack of self-coordination. As the disease progresses, it can pose a physical and mental challenge to patients, resulting in several issues such as depression, memory loss, behavioural changes, exhaustion, and sleep disturbances. The percentage of patients with "early-onset" is less than 10%.2 Elderly people are more likely to be affected by this ailment. Some common symptoms include,
Resting Tremor/Tremble.
Limbs and trunk stubbornness.
Hindrance in kinetic activities.
Loss of balance.
Depression
Emotional and behavioural changes
Difficulty in speaking, etc.
Existing Datasets
Different data types are available for analyzing the Parkinson’s disease (a) “PPMI”3 or “Parkinson’s Progression Markers Initiative” dataset. There are seventy-two data tables available in PPMI that includes both lab and clinical data. (b) Physionet - “DBS Dataset”4 includes rest tremor velocity recordings of the index finger for sixteen patients, who undertake “Electrical DBS” either it is unilateral or bilateral.
Deep Learning Models:
Some of the existing deep learning models that are used for analyzing Parkinson’s disease are (a) Convolutional Neural Network (CNN) (b) Restricted Boltzmann Machine (c) Siamese Neural Networks (d) Residual Network (ResNet) (e) U-Net and (f) LSTM
Prediction of Parkinson’s disease
Wu Wang et al.5 proposed an innovative deep-learning technique that is based on “premotor features” to classify an individual as affected with Parkinson’s disease or not. Different hyperparameter configurations are used to create three models: "DEEP1," "DEEP2," and "DEEP3," as well as an ensemble of the three models called "DEEP-EN." These models take into account things like "rapid eye movement" and "level of spinal fluid" As compared to other algorithms on a dataset of 183 healthy people and 411 early Parkinson's disease patients, the proposed deep learning model outperforms them all, with an average accuracy of 96.45%.
K. H. Leung et al.6 have proposed a hybrid approach to predict the "MDS-UPDRS-III" score at "year 4" based on "year 0" and "year 1" results. The functionality is extracted from the "DAT-SPECT" images with the "Google InnceptionnV3" model7 which is well-suited for medical data.8,9,10Veronica Munoz Ramrez et al.11 suggested a deep learning approach based on “quantitative Magnetic Resonance Imaging” data that uses autoencoders and a technique14,15,16 called “anomaly scoring” to identify Parkinson's disease patients. This model obtained optimal results with “Area Under Curve” or “AUC” of 0.83, 0.80 and 0.74 for the “SAE”, “saved” and “Dave”, respectively. Conceptual research on brain jacking in deep brain stimulation (DBS) and its autonomy was suggested by Jonathan Pugh et al.12. To demonstrate the possibilities of brain jacking in a brain computing interface, the authors produced three conceptual case studies (BCI). This research also discusses the obligations and ethics that must be adhered to when developing advanced BCI applications. Heena Rathore et al.13 have proposed an algorithm for third-party prediction of various attacks in DBSs. This approach employs the long short-term memory (LSTM RNN) to forecast and predict rest tremor velocity (RTV), a form of characteristic that aids in the assessment of the severity of neuro disorders.
COMPARATIVE ANALYSIS
A variety of methods have been used to diagnose Parkinson's disease (PD), and we can see that transfer learning methodologies have good accuracy with little data. Leung et al.6proposes a parallel hybrid approach for detecting Parkinson's disease based on neuroimage data and clinical information. Table 1 shows a comparison of different algorithms for detecting Parkinson's disease.
CONCLUSION
Every year, a significant proportion of the world's population is affected by neuro disorders. Since early detection is critical for care and is often a difficult challenge, the use of intelligent systems in conjunction with medical experts is critical in detecting them. Some advanced deep learning models in the areas of identification and implementing protection in their treatment protocol have been reviewed in this paper. The PPMI database is the most commonly used dataset for Parkinson's disease classification. The model based on a parallel approach has demonstrated exceptional efficiency. The transfer learning method is assumed to aid in achieving maximum accuracy with the least amount of data. While Deep Brain Stimulation holds promise for treating Parkinson's disease, it also poses significant risks. Also detecting attacks on Deep Brain stimulators is used successfully for detecting various attack patterns. These types of methods will be needed to ensure that Brain Computing Interfaces are used safely. To summarize, this research looked at some important datasets related to Alzheimer's disease and Parkinson's disease, as well as the applications of advanced deep learning algorithms in their identification and the protection of advanced neurodegenerative disorder therapies that use Brain Computing.
ACKNOWLEDGEMENT
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest
The Author(s) declare(s) that there is no conflict of interest
Contribution of Authors:
All the authors have made contributions like conceived and designed the analysis; collected the data; analysing of data and paper writing.
Source of funding:
No funding was provided for this work
Englishhttp://ijcrr.com/abstract.php?article_id=4189http://ijcrr.com/article_html.php?did=4189
Alzheimer’s Disease, https://www.neurodegenerationresearch.eu/, June 25, 2019
Parkinson's Disease, https://www.nia.nih.gov/health/parkinsons-disease, June 2020
Parkinson's Progression Markers Initiative, https://www.ppmi-info.org/access-data-specimens/download-data/, June 2020.
PhysioNet, https://physionet.org/about/database/, June 2020
Wang W, Lee J, Harrou F, Sun Y. Early detection of Parkinson’s disease using deep learning and machine learning. IEEE Access. 2020 Aug 12;8:147635-46.
Leung KH, et al. Using deep-learning to predict the outcome of patients with Parkinson’s disease. NSS/MIC 2018. IEEE Nuclear Science Symposium and Medical Imaging Conference Proceedings. 2018 Nov 10. p. 1-4
Gulshan, V., et al. 2016. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. Jama, 316(22), pp.2402-2410.
Esteva A, et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017 Feb;542(7639):115-8.
Geetha S, Anbarasi LJ, Raj BE, Gupta A, Prasad AV. AR Learning Platform for Mentally Differently Abled Children. ITT 2020. Sev International Conference on Information Technology Trends 2020 Nov 25. Dubai. p. 180-184
Rajpurkar P, Hannun AY, Haghpanahi M, Bourn C, Ng AY. Cardiologist-level arrhythmia detection with convolutional neural networks. arXiv preprint arXiv:1707.01836. 2017 Jul 6.
Ramírez VM, Kmetzsch V, Forbes F, Dojat M. Deep Learning Models to Study the Early Stages of Parkinson's Disease. ISBI 2020. IEEE 17th International Symposium on Biomed Imag. 2020 Apr 3. p. 1534-1537.
Pugh J, Pycroft L, Sandberg A, Aziz T, Savulescu J. Brainjacking in deep brain stimulation and autonomy. Eth Inform Techn. 2018 Sep;20(3):219-32.
Rathore H, Al-Ali AK, Mohamed A, Du X, Guizani M. A novel deep learning strategy for classifying different attack patterns for deep brain implants. IEEE ACCESS. 2019 Feb 20;7:24154-64.
Anbarasi LJ, Mala A. EPR hidden medical image secret sharing using DNA cryptography. Int J Eng Technol. 2014;6:1346-56.
Anbarasi LJ, Vincent MJ, Mala GA. A novel visual secret sharing scheme for multiple secrets via error diffusion in halftone visual cryptography. ICRTIT 2011. Int Conference on Recent Trends Inform Techn. 2011 Jun 3, Chennai, India. p. 129-133
Sharon JJ, Anbarasi LJ, Raj BE. DPSO-FCM based segmentation and Classification of DCM and HCM Heart Diseases. ITT 2018. Fifth HCT Information Techn Trend. 2018 Nov 28:41-46
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareDrug Sensitivity Pattern in Diabetic and Non Diabetic Patients Suffering from Urinary Tract Infection
English165169Kaila Niyti VinodEnglish Thorat Sanjay TukaramEnglishIntroduction: Urinary tract infection (UTI) is a spectrum of disease caused by microbial invasion of the genitourinary tract that extends from the renal cortex of the kidney to the urethral meatus. The predisposing factors for UTI can be anatomical abnormalities of the urinary tract, Impaired local protective mechanisms, deteriorating immune status, cognitive impairment, comorbid conditions such as diabetes, malignancy, steroid use and chronic debility. Urine serves as an excellent culture medium, to avoid false-positive results transportation should be immediate. Sample should be stored in a refrigerator at 4oC for 48hrs if there is a delay of more than one to two hours. Aim: Here is to study the drug sensitivity pattern in diabetic and non-diabetic patients with urinary tract infections. Method: That we have adopted for our research is carried on patients diagnosed with Urinary tract infection with or without a history of type 2 Diabetes mellitus who were admitted in medical wards in Krishna Hospital and Medical Research Centre, Karad during the study period of 18 months. This study was conducted over 18 months. (October 2018 to March 2020). Ethical clearance from the college and university committee was taken. Result: In the present study, a total of 90 patients diagnosed with urinary tract infections were observed. Among them 45 patients were diabetics and 45 patients were non-diabetics. In the current study, the diabetic group had 26 females (57.78%) and 19 were males (42.22%) and the non-diabetic group had 29 females (64.44%) and 16 males (35.56%) males. Conclusion: Urinary tract infection is one of the common infections requiring hospitalization. In the present study female gender was predominantly affected with urinary tract infection in both groups (i.e. Diabetics and non-diabetics).
English Diabetic, Urinary tract infection, Cystine lactose electrolyte deficient, Urine, Microbial genitourinary tract, KidneyIntroduction
Urinary tract infection (UTI) is a spectrum of disease caused by microbial invasion of the genitourinary tract that extends from the renal cortex of the kidney to the urethral meatus. The predisposing factors for UTI can be anatomical abnormalities of the urinary tract, Impaired local protective mechanisms, deteriorating immune status, cognitive impairment, comorbid conditions such as diabetes, malignancy, steroid use and chronic debility. Women are more susceptible to UTI because of their urinary tract anatomy and reproductive physiology. The female to male ratio of UTI among geriatrics and younger population shows great variation 50:1 and 2:1 respectively.1
Laboratory diagnosis can be detected by microscopic examination of a fresh sample of urine collected by appropriate methods. Further diagnosis can be confirmed by isolation of the significant number of bacteria on urine culture. Apart from microbiological investigations further work to detect the exact cause, predisposing factors, presence of anomalies and complications can be done by radiological tools and other methods. Sample collection: Clean catch mid-stream urine sample (MSU): This is the most easily and most commonly collected sample. Clean catch mid-stream urine collected in a wide-mouthed, sterile and leak-proof plastic container of 30 ml capacity.2,3 Patient is asked to wash the perineum and the genitalia thoroughly with mild soap and water. Antiseptics for washing or cleaning are not recommended.4
They are particularly used to obtain a sample in elderly men, who don’t have urinary retention problems but have serious functional or mental disabilities, such as dementia. It carries a lower risk of infection than indwelling catheters.5 Invasive methods: Straight catheterization/ In and Out Urinary Catheterization. It yields a sample of the same quality as suprapubic aspirate but carries the risk of the introduction of bacteria to the bladder. It is preferred only when a clean voided sample cannot be obtained and suprapubic sampling is contraindicated.6 Under all aseptic precautions catheter is lubricated and directed in the cleansed urethra initial 15-30 ml is discarded. The mid or low flow urine sample is collected into the vacutainer or a sterile container.
Transportation: Urine serves as an excellent culture medium, to avoid false-positive results transportation should be immediate. Sample should be stored in a refrigerator at 4oC for 48hrs if there is a delay of more than one to two hours.7 Transportation in a container with boric acid at a final bacteriostatic concentration of 1.8% is another alternative to refrigeration. Dip-slide method: Urine is collected in a dip slide container that has different media seeded on a small tray. Extra urine is drained out and charged dip slides are then incubated. Limitations of this technique are microscopic analysis and quantification of bacteria cannot be done. It is useful for screening a large number of patients, geriatric nursing homes and for use in clinics remote from the laboratory.4 Microscopic examination is a standard technique for examining urine specimens microscopically has not been established. An uncentrifuged sample of urine is examined for the presence of polymorphs or pus cells and bacteria.
Wet mount: The presence of an increased number of pus cells (normal excretion of leukocytes is about 106 in 24 hours) in urine indicates pyuria. This is an indication of infection in the urinary tract when culture fails to show significant growth either due to antibiotic effect or if the bacteria require special media. One leukocyte per seven high power fields corresponds with 104 leukocytes per ml. Anything more than this is considered significant. Contamination is suspected when there is the presence of squamous epithelial cells (from perineum and vagina) on microscopy.4 Gram’s stain is an inexpensive method to detect bacteriuria. The presence of even one organism per oil immersion field in uncentrifuged urine has a sensitivity of 94% and specificity of 90% for detecting colony counts of 105 CFU/ml. It can provide a quick detection of gram-positive or Gram-negative bacteria before culture reports come where pyuria has been observed on a wet film to start an empirical treatment.8
Culture Quantitative culture: Urinary pathogens grow well on simple as well as selective media with an overnight incubation at 37oC. Blood agar, MacConkey agar and Cystine lactose electrolyte deficient (CLED) agar are the preferred media used. MacConkey and CLED agar have an added advantage as they can distinguish lactose fermenters from non-lactose fermenters. They also inhibit Proteus spp. from swarming and CLED agar is less inhibitory to Staphylococcus saprophyticus. Blood agar is recommended for nutritionally exact in organisms. In the standard loop method, a sterile loop, nichrome or platinum wire of SWG 28 is used which delivers a volume of 0.004 ml volume which yields around 400 colonies, the count then will be 105. Alternatively, since this may produce confluent growth making it difficult to obtain isolated colonies, a sterile loop holding 0.001ml is ideal. The growth of about 100 colonies by this method indicates the presence of 105 bacteria/ml of urine.2,4 Filter paper method: Standard filter paper strip of L shape (12 x 6 mm), sterilized at 160oC for one hour is used. Angulated end and foot is dipped into a well-mixed, uncentrifuged sample of urine and pressed on selected media and is kept for incubation. This method is quite rapid and economical because eight to ten samples can be tested at the same time on a single plate. Growths are noted as semi-confluent and confluent depending on the number of colonies. Approximately 25 colonies of bacilli or 30 colonies of cocci correspond to105CFU/ml.4
Identification: The Gram staining of the growth on the plate is done. The preliminary tests like motility, catalase and oxidase are performed. The biochemical reactions like Hugh Leifson’s oxidation fermentation, nitrate reduction, indole, methyl red, Voges- Proskauer, citrate, triple sugar iron agar, sugar fermentation, urease, lysine decarboxylation, arginine dehydrogenation, ornithine decarboxylation and phenylalanine deaminase (PPA) tests to differentiate bacilli. Staphylococcus aureus can be differentiated from coagulase-negative Staphylococcus spp. based on tube coagulase test. The Novobiocin test can further differentiate Staphylococcus saprophyticus from other species of Staphylococcus. Catalase test can differentiate Streptococcus spp. from Staphylococcus spp. Enterococcus spp. can easily be identified based on bile esculin and sugar fermentation tests.
Aim:
To study the drug sensitivity pattern in diabetic and non-diabetic patients with urinary tract infection.
Objectives:
• To assess the prevalence of urinary tract infection in diabetic and non-diabetic patients
• To assess the yield of urine culture in diabetic and non-diabetic patients suffering from urinary tract infection and the common causative organisms
• To study the comparison of drug sensitivity patterns in diabetic and non-diabetic patients suffering from urinary tract infection
Methods
This was a Cross-Sectional and observational Study. The study was carried on patients diagnosed with Urinary tract infection with or without a history of type 2 Diabetes mellitus who were admitted to medical wards in Krishna Hospital and Medical Research Centre, Karad during the study period of 18 months. This study was conducted over 18 months. (October 2018 to March 2020). Ethical clearance from the college and university committee was taken. After ethical clearance, permission was taken from the head of departments. (Protocol Number 0258/2018-2019). According to a study conducted by S M Aswani et al.,[9] the prevalence of bacteriuria in diabetic and non-diabetic patients in their study was found as 30.5%,
So, p 30.5%
Using formula for sample size (n) calculation,
Where, p = 30.5% = 0.305 q = 1 - p = 0.695
Taking e, absolute error of 10%, e = 0.1 So, n = 4 x 0.305 x 0.695
0.1 x 0.1
n = 84.79 ≈ 85
A minimum of 85 patients will be included in the study, rounding it off to 90 for better yield and statistical results. n= 90. A total of 90 patients were enrolled for the present Cross-Sectional and observational study, 45 each from diabetic and non-diabetic groups.
Inclusion criteria: All patients aged >18 years presenting at tertiary care centre at Krishna hospital Karad. The first episode of symptomatic and asymptomatic bacteria, in both diabetic and non-diabetic patients. Patients with or without symptoms of UTI with significant Pyuria. Significant Pyuria is defined as more than 5 WBC per high power field in males and more than 8 WBC per high power field in females. Patients with fasting blood glucose levels of 126mg/dl or higher or random blood glucose levels of 200mg/dl or higher or patients with glycosylated HbA1C levels of 6.5% or higher will be in included as patients with diabetes mellitus.
Exclusion criteria: Age less than 18 years. Gestational diabetes mellitus, Immunocompromised states-HIV, patients on steroids, malignancy, transplant recipients, Reproductive tract infection Investigations. Blood sugar levels (Fasting, Postprandial, Random), Glycosylated haemoglobin (HbA1c), Urine routine microscopy, Urine culture and sensitivity.
For estimation of fasting blood glucose levels, early morning venous blood samples with 8 hours of no-calorie intake were taken with the aseptic precautions in an Ethylenediaminetetraacetic acid (EDTA) sodium fluoride vacutainer (1ml). Similarly, samples were collected for 2 hours postprandial and random blood glucose estimation. Blood sugar levels (fasting, postprandial and random) were calculated by Trinder‘s method (Glucose Oxidase-Peroxidase Method) automatically on the EM360 Transasia machine. For estimation of blood HbA1c levels, venous blood samples were collected in EDTA vacutainer (2ml) with the aseptic precautions and were tested by latex immunoturbidimetric test (automatically) on EM360 Transasia machine. It reflects blood sugar levels over the past 8 to 12 weeks.
Results
In the present study, a total of 90 patients diagnosed with urinary tract infections were observed. Among them 45 patients were diabetics and 45 patients were non-diabetics. In the current study, the diabetic group had 26 females (57.78%) and 19 were males (42.22%) and the non-diabetic group had 29 females (64.44%) and 16 males (35.56%) males. The Female: Male ratio in this study was 1.57:1. The mean age group found in this study was about 55.02 years with the majority of subjects falling in the age group of 41 to 50 years and 51 to 60 years.
Elevated fasting blood sugar levels were found in 45.55% of cases and postprandial blood sugar levels in 31.11% of cases. A significant difference was seen between the urine sugar values of the participants. The most common organism isolated was E Coli in 66.7% cases followed by Klebsiella spp.14.4% cases, Enterobacter spp. In 6.7% cases, Coagulase Positive Staphylococcus in 6.7% cases and Pseudomonas aerogenosa in 5.6% cases. The most common organism isolated in both diabetics and non-diabetics was E Coli amounting to 46.7% and 53.3% cases respectively. This was followed by Klebsiella spp. for both diabetics and non-diabetics amounting to 61.5% and 38.5% cases respectively. Among Coagulase Positive Staphylococcus isolates 33.3% cases were diabetics and 66.7% cases were non-diabetics. Also Enterobacter spp. isolates were seen in 33.3% cases of diabetics and 66.7% cases of non-diabetics. Pseudomonas aerogenosa were all seen in diabetics (100%).
There was a significant difference between the diabetics and non-diabetics with regards to Trimethoprim + Sulfamethoxazole resistance with 57.1% cases seen in diabetics and 42.9% cases in non-diabetics. There was a significant difference between the diabetics and non-diabetics with regards to Ampicillin resistance, with diabetic patients showing more resistance. There was a significant difference between the diabetics and non-diabetics with regards to Amoxicillin resistance, with diabetic patients showing more resistance. There was a significant difference between the diabetics and non-diabetics with regards to 1st generation Cephalosporins resistance, with diabetic patients showing more resistance.
There was a significant difference between the diabetics and non-diabetics with regards to Nitrofurantoin resistance, with diabetic patients showing more resistance. There was no significant difference between the diabetics and non-diabetics with regards to Fluoroquinolones resistance. Comparison based on the number of drugs resistant in diabetic and non-diabetic groups was found to be significant where overall the diabetic group had more number of drug resistance. Their a significant association between the number of drugs an organism is sensitive or resistant to with the presence of diabetes.
Discussion
Demographic profile and frequency distribution of age of study population
Out of all 90 cases, 55(61.1%) were females and 35(38.9%) were males. The Female: Male ratio in the present study was 1.57:1 According to Akbar daad et al. who conducted a hospital-based study of a total of 182 patients and found 114 (62.63%) were females and 68 (37.36%) were males.10 The female: male ratio was 1.6:1 which was similar to the present study. In another study done by Ramrakhia S, Raja K, Dev K, et al.. who conducted a hospital-based study found that female: male ratio was 1.28 :1 which had 288 (56.25%) females and 224 (43.75%)11 males and the study of Christy VR et al.. conducted an epidemiological study on urinary tract infections found female: male ratio 1.29:1 which had 1029(56.41%) females and 795 (43.58%) males12 which was lower than the present study but however it was still found that the prevalence of urinary tract infection was higher in females as compared to males. The study from Kumar R, Kumar R, Perswani P, et al.. had 256 patients in the diabetic group with a female: male ratio of 1.28:1, there were 112 (43.7%) males and 144 (56.3%) females.13 Considering non-diabetic group there were more women (n = 156; 62.4%) than men (n = 94; 37.6%) which was similar to the present study.
The majority of the patients were from the age group of 51 to 60 years, 33 patients (36.7%) followed by 41 to 50 years with 23 patients (25.6%), 61 to 70 years with 17 cases (18.9%), 9 cases less than 40 years (10%) and 8 cases in the age group of 71 to 80 years (8.9%). The mean age of our study was 55.02 years. According to Magliano et al.. the study reported that 58% of subjects were in the age group of 60 years and above while comparing to the present study there were 45.55% of patients in the same age group.14 According to the study from Aswani SM et al.. the mean age among diabetic and non-diabetic patients was 60.2 ± 13.76 years and 53.47 ± 18.56 years.9
Maharjan, Narayani & Thapa et al.. study has shown average age of subjects affected with urinary tract infection was 51 to 70 years (45.9%)15 which was similar to the present study. The study of Christy VR et al.. has shown patients affected with urinary tract infection fallen in the age group of 50 years and above where 38.92% which was lower than the present study.12 The study from Kumar R, Kumar R, Perswani P, et al.. mean age group affected was 56 +/- 11years which is found to be similar to the present study.13 In the present study, fasting blood sugar level was raised in 41 cases (45.55%) suffering from urinary tract infection and postprandial blood sugar was raised in 28 cases (31.11%) According to the study done by Hamdan HZ et al.. it was found that 54.2% cases of urinary tract infections had elevated fasting blood sugar levels16 being similar to present study. The study done by Sharma S, Govind B, Naidu SK, Kinjarapu S, Rasool M et al.. had found 96% cases with elevated fasting sugar levels.17 which is higher than the present study. The most common organism isolated in the present study was E Coli in 60 cases (66.7%) followed by Klebsiella spp. in 13 cases (14.4%), Enterobacter spp. in 6 cases (6.7%), Coagulase Positive Staphylococcus in 6 cases (6.7%) and Pseudomonas aerogenosa in 5 cases (5.6%). The study done by Kumar R, Kumar R, Perswani P, et al. also showed most common organisms isolated as E Coli in 21 cases (60%) followed by Klebsiella spp. in 6 cases (17.1%), Enterobacter spp. in 3 cases (8.6%), Coagulase Positive Staphylococcus in 2 cases (5.7%) and Pseudomonas aerogenosa in 5 cases (14.3%)13, results being similar to the present study.
Antimicrobial drug sensitivity and resistance pattern among diabetics and non-diabetics. Trimethoprim + Sulfamethoxazole sensitivity & resistance in Diabetics and non-diabetics. Total 70 cases (77.8%) were resistant to Trimethoprim + Sulfamethoxazole & 20 cases were sensitive (22.2%) in the present study out of the resistant cases,40 cases were diabetic (57.1%) and rest 30 were non-diabetic (42.9%). The study from Akbar daad et al. showed Trimethoprim + Sulfamethoxazole resistance in 50% diabetic cases and 27% non-diabetic cases 10 which is similar to our study. According to the study from Aswani SM et al. showed Trimethoprim + Sulfamethoxazole resistance in 38.9% diabetic cases and 30.2% non-diabetic cases.9 Ampicillin sensitivity & resistance in Diabetics and non-diabetics. Total 57 cases (63.3%) were resistant to Ampicillin & 33 cases were sensitive (36.7%) in the present study. Out of a total of 57 cases resistant to Ampicillin, 36 cases were diabetic (63.2%) and the rest 21 were non-diabetic (36.8%). According to the study from Aswani SM et al. showed Ampicillin resistance in 16.7% diabetic cases and 17% non-diabetic cases.9 Akbar daad et al. showed Ampicillin resistance in 8% diabetic cases and 15% non-diabetic cases.10
Conclusion
Urinary tract infection is one of the common infections requiring hospitalization. The presence of diabetes mellitus increases the susceptibility to urinary tract infection. In the present study female gender was predominantly affected with urinary tract infection in both groups (i.e. Diabetics and non-diabetics). In the present study, the predominant isolates were E.coli and Klepsiella spp. for both diabetic and non-diabetic groups. Most of the isolates showed intermediate to low levels of resistance to one or more antimicrobials tested. Diabetic subjects showed resistance to multiple antimicrobial drugs as compared to non-diabetic subjects. This indicates that regular surveillance is required to establish reliable information about the sensitivity and resistance pattern of urinary tract infective pathogen for empirical therapy of diabetic patients with urinary tract infection. According to the results of the present study, Nitrofurantoin, Fluoroquinolones and first-generation Cephalosporins (Cephalexin and Cefadroxil) can be used empirically till culture and sensitivity reports are awaited.
Acknowledgement: We acknowledge the contribution of our university and department for the unending support.
Conflict of Interest: There is no conflict of Interest
Source of Funding: No Source of Funding
Authors Contribution: This is a collaborative work among both authors. Niyti Vinod Kaila, Sanjay Tukaram Thorat performed the statistical analysis, wrote the protocol, and wrote the first draft of the manuscript. Niyti Vinod Kaila managed the literature searches. Both the authors read and approved the final manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=4190http://ijcrr.com/article_html.php?did=41901. Venkatesh RK, Prabhu MM, Nandakumar K, Sreedhara K, Pai R. Urinary tract infection treatment pattern of elderly patients in a tertiary hospital setup in south India: a prospective study. J Young Pharm 2016;8(2):108-13.
2. Forbes BA, Sahm DF, Weissfeld AS. Diagnostic microbiology. St Louis: Mosby; 2007. p. 842-543.
3. Tawab KA, Gheith O, Al Otaibi T, Nampoory N, Mansour H, Halim MA, Nair P, Said T, Abdelmonem M, El-Sayed A, Awadain W. Recurrent urinary tract infection among renal transplant recipients: risk factors and long-term outcome. Exp Clin Transplant. 2017 Apr 1;15(2):157-63.
4. Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. Laboratory strategy in the diagnosis of infective syndromes. Mackie and McCartney practical medical microbiology. 1996;14: 53-94.
5. Holroyd S. Indwelling urinary catheterisation: evidence-based practice. J. Community Health Nurs. 2019 Oct 1;33(5).
6. Hinkel A, Finke W, Bötel U, Gatermann SG, Pannek J. Increasing resistance against antibiotics in bacteria isolated from the lower urinary tract of an outpatient population of spinal cord injury patients. Urol. Int. 2004;73(2):143-8.
7. Porter IA, Brodie J. Boric Acid Preservation of Urine Samples. Br Med J 1969;2(5653):353-55.
8. Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis 2004;38(8):1150–8.
9. Maharjan, Narayani, Thapa, Niresh,Maharjan, Muna, Sharma, Vijay, Maharjan, Nabina, Paudyal, Rabin. The pattern of bacteria causing urinary tract infection and their antibiotic susceptibility profile in diabetic and non-diabetic patients in Lalitpur, Nepal-a hospital-based study. 20187; 7. 1248-5348.
10. Ramrakhia S, Raja K, Dev K, Kumar A, Kumar V, Kumar B. (September 17, 2020) Comparison of Incidence of Urinary Tract Infection in Diabetic vs Non-Diabetic and Associated Pathogens. Cureus 12(9): e10500. doi:10.7759/cureus.10500
11. Christy VR, Athinarayanan G, Mariselvam R, Dhasarathan P, Singh RAJA (2019) Epidemiology of urinary tract infection in south India. Biomed Res Clin Prac 4:
12. Kumar R, Kumar R, Perswani P, Taimur M, Shah A, Shaukat F. (August 22, 2019) Clinical and Microbiological Profile of Urinary Tract Infections in Diabetic versus Non- Diabetic Individuals. Cureus 11(8): e5464 doi:10.7759/cureus.5464
13. Magliano, Enrico, Grazioli, Vittorio, Deflorio, Loredana, Leuci, Antonia, Mattina, Roberto, Romano, Paolo,Cocuzza, Clementina. (2012). Gender and Age-Dependent Etiology of Community-Acquired Urinary Tract Infections. Sci World J. 2012. 349597.
14. Aswani SM, Chandrashekar U, Shivashankara K, Pruthvi B. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australas Med J. 2014 Jan 31;7(1):29-34.
15. Hamdan HZ, Kubbara E, Adam AM, Hassan OS, Suliman SO, Adam I. Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan. Ann. Clin. Microbiol. Antimicrob.. 2015 Dec 1;14(1):26.
16. Sharma S, Govind B, Naidu SK, Kinjarapu S, Rasool M. Clinical and Laboratory Profile of Urinary Tract Infections in Type 2 Diabetics Aged over 60 Years. J Clin Diagn Res. 2017 Apr;11(4):OC25.
17. KU, Shah AH, Fawwad A, Sabir R, Butt A. Frequency of urinary tract infection and antibiotic sensitivity of uropathogenic in patients with diabetes. Pak J Med Sci. 2019;35(6):1664-1668.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareRole of Endothelial Dysfunction in Cardiovascular Disease: Potential Therapeutic Target
English170173Korzh OleksiiEnglishIntroduction: The vascular endothelium is a layer of endothelial cells lining the lumen of blood vessels, lymphatic vessels, the heart and other organs. Normal endothelium protects cardiovascular diseases, while vascular endothelial pathology is the main cause of many cardiovascular diseases. Aim: Here we summarize current knowledge about endothelial function from bench to bedside. Methods: We review the studies demonstrating the significance of vascular endothelium and evaluating the potential role of drugs targeting endothelial function in the management of cardiovascular diseases. Results: Endothelial dysfunction is a discovered phenomenon that makes a significant contribution to the pathophysiology of numerous cardiovascular conditions associated with vasoconstriction, thrombosis and inflammatory conditions. In clinical settings, the assessment of endothelial functions is attracting increasing attention due to its growing importance for cardiovascular diseases. Since cardiovascular endothelial dysfunction is also detected in patients with heart failure, it is expected to play an important role as a predictive predictor of cardiovascular events. Moreover, vascular endothelial function may be the goal of a comprehensive treatment of diseases for the prevention of cardiovascular diseases. Conclusion: Recent publications have highlighted emerging modulators of endothelial functions, and potential therapeutic and diagnostic goals with major clinical consequences.
Englishhttp://ijcrr.com/abstract.php?article_id=4191http://ijcrr.com/article_html.php?did=4191Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareComparative Evaluation of Antifungal Effect of Origanum Oil Solution and Povidone Iodine Aqueous Solution on Scleral Resin: An In-Vitro Study
English174178Pande Samidha S.English Sathe Kambala SeemaEnglish Godbole Dubey SurekhaEnglish Revankar Ramnath P.EnglishAim: To compare and evaluate the antifungal effect of origanum oil and povidone-iodine aqueous solution on scleral resin. Introduction: Ocular prosthesis being a part of maxillofacial prosthodontics aims to restore and repair the ophthalmic cavity. An important prerequisite for a prosthesis is the eradication of plaque accumulation due to bacteria. To neglect probable infections in the patient’s ophthalmic cavity a naturally available antifungal agent was tested in this study. Methods and Material: In this study, 40 custom made scleral resin disks (20 in each group) immersed in 2 different solutions were studied for their antifungal activity. The evaluation of this property was done by calculating the zone of inhibition around the disks propelled in the specific agar media. Statistical Analysis: Descriptive and analytical statistics were done. The data is represented in mean and standard deviation. The normality of continuous data was analysed by the Shapiro-Wilk test. As the data followed a normal distribution, parametric tests were used to analyse the data. The independent sample t-test and paired sample t-test were used to check to mean differences. The level of significance was kept at pEnglishOcular prosthesis, Antifungal, Origanum oil, C.Albicans, SDA, Maxillofacial, ProstheticsINTRODUCTION:
Ocular prosthesis is a part of maxillofacial prosthodontics that aims to restore and repair the ophthalmic cavity which aims in beautifying the compromised patients face. It also aids to improve the psychology and social development of the patient thus enhancing the quality of life.1
The ocular prosthesis has seen exponential growth for a decade. This development is due to improved materials, enhanced postoperative management and the rising patient requirement. A diversity of materials are being used nowadays for ocular prostheses.2
As this prosthesis has an intimate and dynamic relationship with the ocular surface it carries a threat of infection throughout their life and has a major effect on the esthetics of the patient esthetics. Proper function and retention act as an important factor in the success of this type of prosthesis.2
An important prerequisite for a prosthesis is the eradication of plaque accumulation due to bacteria. To neglect probable infections in the patient’s ophthalmic cavity, the ocular prosthesis should be removed on a routine basis and disinfection should be done; after which it can be inserted again.3
AIM:
To compare and evaluate the antifungal effect of origanum oil and povidone-iodine aqueous solution on scleral resin
OBJECTIVES:
Evaluation of the antifungal effect of origanum oil solution on scleral resin
Evaluation of the antifungal effect of povidone-iodine aqueous solution on scleral resin
To compare and determine the efficacy of antifungal property of origanum oil solution with the povidone-iodine aqueous solution on scleral resin
STUDY DESIGN AND METHODOLOGY:
MATERIALS USED-
Scleral resin disks
Povidone-iodine aqueous solution
Origanum oil solution
PREPARATION OF SAMPLE AND GROUPS-
Preparation of scleral resin disks (40) using a custom mould was done and was divided into two groups ( Group A (20)–scleral resin to be immersed in origanum oil solution Group B(20)–scleral resin to be immersed in povidone-iodine aqueous solution) [Fig.1]
METHOD TO CHECK ANTIFUNGAL PROPERTY –
The fungal suspension containing strains of C. Albicans was prepared.[Fig.2] Scleral resin disks of both the groups (A and B) were immersed in the fungal suspension for the desired period after which the disks were incubated for 24hrs for the organisms to grow
Phase I
A sterile swab was taken from the surface of these incubated disks and cultured in Sabouraud’s dextrose agar (SDA) and incubated at 37°C. The disks of group A were immersed in an origanum oil solution(60%) and the disks of group B in 10% povidone-iodine aqueous solution(betadine) [Fig.3]
Phase II
After 15 minutes of immersion of the disks of both groups in the two solutions, the antifungal potential of the testing solutions was evaluated by Agar well diffusion method. For this evaluation, previously cultured Petri dishes containing Sabouraud’s dextrose agar (SDA) which were cultured using the swab technique for C. Albicans were taken. After this, the plates containing agar were left for drying. Using sterile cork borer 3 wells or cups were made. The disks which were immersed in the solution were inserted in the wells of the inoculation of the particular media agar plates. [Fig.4] The plates were kept on hold for 10 min so that essential oils get diffused. After which incubation of these plates was carried out at 37°C for 48 h. Finally, after the incubation period, examination of plates detected the existence of clear zones of growth inhibition surrounded the wells which contained the testing solutions, which pointed to their efficacy against C.albicans. [Fig.5] The zone of inhibition was recognized by measurement of the good diameter (in millimetres) in one plane using the Vernier scale.[Table.1]
STATISTICAL ANALYSIS:
Descriptive and analytical statistics were done. The data is represented in mean and standard deviation. The normality of continuous data was analysed by the Shapiro-Wilk test. As the data followed a normal distribution, parametric tests were used to analyse the data. The independent sample t-test and paired sample t-test were used to check to mean differences. The level of significance was kept at PEnglishhttp://ijcrr.com/abstract.php?article_id=4192http://ijcrr.com/article_html.php?did=4192
Garg A, Shenoy KK. A comparative evaluation of the effect on water sorption and solubility of a temporary soft denture liner material when stored either in distilled water, 5.25% sodium hypochlorite or artificial saliva: An in vitro study. J Indian Prosthodont Soc. 2016 Jan;16(1):53.
Kawano F, Dootz ER, Koran Iii A, Craig RG. Sorption and solubility of 12 soft denture liners. J Prosthet Dent. 1994 Oct 1;72(4):393-8.
Council on Dental Materials. Revised ADA specification no 12 for denture base polymer. J Am Dent Assoc. 1975;90:145-54
Srivatstava A, Ginjupalli K, Perampalli NU, Bhat N, Ballal M. Evaluation of the properties of a tissue conditioner containing origanum oil as an antifungal additive. J Prosthet Dent. 2013 Oct 1;110(4):313-9.
Aziz HK. Evaluation of adding ginger oil on sorption and solubility of soft liners using different saliva pH levels. Iraqi Dent.J. 2015 Aug 15;37(2):43-50.
Manohar V, Ingram C, Gray J, Talpur NA, Echard BW, Bagchi Det al.Antifungal activities of origanum oil against Candida albicans. Mol Cell Biochem. 2001 Dec 1;228(1-2):111-7.
Kanathila H, Bhat AM, Krishna PD. The effectiveness of magnesium oxide combined with tissue conditioners in inhibiting the growth of Candida albicans: an in vitro study. Indian J Dent Res. 2011 Jul 1;22(4):613.
Hosseinzadeh S, Jafarikukhdan A, Hosseini A, Armand R. The application of medicinal plants in traditional and modern medicine: a review of Thymus vulgaris. Int J ClinMed. 2015;6(09):635.
Williams D, Lewis M. Pathogenesis and treatment of oral candidosis. J. Oral Microbiol. 2011 Jan 1;3(1):5771.
Patra B, Das MT, Dey SK. A review on Piper betle L. J Med Plants Stud. 2016;4:185-92.
Cleff MB, Meinerz AR, Xavier M, Schuch LF, Meireles MC, Rodrigues MR, Mello JR et al. In vitro activity of Origanum vulgare essential oil against Candida species. Braz J Microbiol. 2010 Mar;41(1):116-23.
Reller LB, Weinstein M, Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis. 2009 Dec 1;49(11):1749-55.
Adams A, Kumar S, Clauson M, Sahi S. Anti-yeast activities of Origanum oil against human pathogenic yeasts. Adv Biosci Biotech. 2011 Apr 1;2(2):103.
Ali I, Khan FG, Suri KA, Gupta BD, Satti NK, Dutt P, Afrin F, Qazi GN, Khan IA et al. In vitro antifungal activity of hydroxychavicol isolated from Piper bettle L. Ann Clin Microbiol Antimicrob. 2010 Dec 1;9(1):7.
Kambala SS, Rathi D, Borle A, Rajanikanth K, Jaiswal T, Dhamande M. et al.Evaluating the colour stability of ocular prosthesis after immersion in three different immersion media: An in vitro study. J IntSoc of Prevent Comm Dent. 2020 Mar 1;10(2):226.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareTo Access the Effects of Cigarettes Smoking and Nicotine Dependency in Lung Function of Healthy Smokers Using Fagerstorm’s Questionnaire and Spirometry
English179185Mani Sathish KumarEnglish Ganesh GayathriEnglish Mani AnbumaranEnglish Vadivelu GangadharanEnglishIntroduction: Globally, India stands second to China in the total number of smokers. Recent findings showed huge growth in adult male smokers in the country. One out of five adults i.e 20% adults smoke all over the world, With over the 20th century it killed around 100 million people. Objective and Methodology: The purpose of this study is to analyse the effects of cigarette smoking and nicotine dependency on lung function of healthy smokers using Fagerstrom’s questionnaire and spirometry. Where along with the history, spirometry and Fagerstrom’s questionnaire is asked. The test is performed on 76 patients who are divided into four categories based on Fagerstrom’s questionnaire namely low nicotine dependence, low – moderate nicotine dependence, moderate nicotine dependence, and high dependence. The differences in the mean value of each parameter between the four categories of smokers based on the duration of smoking and also on the number of cigarettes smoked per day were analyzed and discussed. Result: The mean FVC of the patients with high dependence (54.12± 18.893) is lesser and the mean FVC of the patients with low dependence (72.85±14.072) is greater. This concludes higher nicotine dependence has reduced FVC and there is near significance between each category and the mean FEV1 of the patients with high dependence (42.12± 21.437) is lesser and the mean FEV1 of the patients with low dependence (67.58±18.322) is greater. Conclusion: This concludes the high dependence on nicotine has reduced FEV1 and there is near significance between each category. An increase in Nicotine dependence level decreases the BMI moderately.
English Smoking, Nicotine, Dependency, Spirometry, Fagerstrom’s, Lung capacity, BMIINTRODUCTION
Recent findings showed huge growth in adult male smokers in the country. Within 17 years the statistics have grown high from 79 million’s to 108 million.1This problem is compounded by the fact that the rate of cigarette smoking in young people continues to steadily increase.2
Smoking is a known risk factor for chronic obstructive pulmonary disease, cardiovascular and cerebrovascular diseases 3 and a cause of different cancers.3Cigarette smoke can trigger exacerbations of asthma, reduce lung function and increase health care utilization including hospital admissions.4,5
Smoking behaviours in India are also peculiar with a large number of people using non-conventional forms of tobacco in hookah, bidi, or chillum.6,7 Lung cancer is nearly 6-times common in hookah smokers compared to non-smokers,6 and Chillum smoking has been demonstrated to result in a much higher increase in end-tidal carbon monoxide levels than cigarette smoking.7
As cigarettes are costlier compared to other tobacco products like bides and dipping tobacco, the young male population is shifting from costly cigarettes to these cheaper products landing themselves in more trouble. We used Fagerstrom’s nicotine dependency test (FTND) score to categorize the smokers into low, low to moderate, moderate and high nicotine dependents.8 However the number of cigarettes per day in the FTND itself is found to be a better item than the whole of the FTND questionnaire.9
AIMS AND OBJECTIVES
AIM:
The purpose of this study is to analyse the effects of cigarette smoking and nicotine dependency in lung function of healthy smokers using Fagerstrom’s questionnaire and spirometry.
OBJECTIVES:
The relationship between nicotine dependence level and lung functions among cigarette smokers.The relationship between Age and BMINicotine dependence level among the cigarette smokers
MATERIALS AND METHODS
This Prospective observational study was conducted upon 76patients, who presented to the department of TB and Respiratory Medicine from JAN 2019 – JAN 2020 at Saveethamedical college and hospital, after ethical committee clearance
Inclusion criteria:
Only male patients, Age >18 yrs, Patients with chief complaints and history of smoking, active smokers and ex-smokers.
Exclusion criteria:
Non-smokers, Patient unable to perform PFT, Test not reaching 6-second, expiration time, Active pulmonary tuberculosis, Active haemoptysis, Presence of pleural disease, Cor-Pulmonale, Resting heart rate >120/ min, Systolic blood pressure > 180mm Hg, Diastolic blood pressure > 100mm Hg, female patients.
Considering the prevalence rate of 14.2% daily smokers in Tamil Nadu as reported in the Global adult tobacco survey (GATS India,2010) report and with a power of 80% and a 5% alpha error, the sample size calculated was 76. The study participants were recruited from the chest medicine OPD. After taking an informed consent on explaining the risk and benefit of the study, smokers patients will, undergo a pulmonary function test (spirometry). Spirometry is done using a standard spirometer (flow-based spirometer). Basic anthropometric data like age, weight to the nearest kilograms and height to the nearest centimetres, were recorded. Pulmonary function testing was performed according to the standards of the American Thoracic Society/European respiratory society task force guidelines. Each study participant performed 2 to 3 forced expiratory manoeuvres. The best attempt was saved. FVC, FEV1, FEV1/FVC, FEF 25-75%, PEF are noted.
The subjects were explained about the study protocol and questions raised by them were cleared. Based on their FTNDquestionnaire.9
RESULTS
Out of 76 patients who participated in the study, 64.5% of patients are current smokers and 35.5% of the patients are Ex-smokers.
It is observed that from (Table-1) 15.79% of the patients are having smoking habit for up to 5 years, 28.94 % of the patients have 6-15 years of smoking habit, whereas 32.9% and 28.94% of the patients are having smoking habits for 16-25 years and more than 26 years respectively.
It is noted that From(Table-2) 42.1% of the patients agreed that the take within 31-60 minutes smoke the first Cigarette, 35.5% of the patients took 5-30 minutes for them to smoke the first Cigarette and 22.4% of the patients agreed that they took less than five minutes for smoking first Cigarette after waking(Figure-2).10,11
It is observed from (Table -3) that 76.3% of the patients denied that they are finding it difficult to refrain from smoking in places where it is forbidden (Figure-3). However, 23.7% of patients agreed with the same.12
43.4 % of the patients agreed that they use to smoke 10 or fewer cigarettes, 40.8 % of the patients accepted that they use to smoke 11-20 cigarettes (Figure-4),14 13.2 % of the patients honestly agreed that they use to smoke 21-30 cigarettes and only 2.6 % of the patients use to smoke more than 30 cigarettes (Table-5).15
It is noted from the above table that 65.8 % of the patients agreed that they won’t smoke if they are sick in bed most of the day (Table-4). 34.2 % of the patients honestly agreed that they use to smoke even if they are sick in bed most of the days.13
It is noted that 19.7% of the patients agreed that they can smoke more frequently in the morning and 80.3 % of the patients accepted that they are not frequent smokers in the morning (figure-5).16,17
The difference in nicotine dependency on lungs function
This section presents the Comparison of nicotine dependence levels on lung functions among cigarette smokers. To compare the nicotine dependence level on lung functions one way ANOVA is used. The results are shown in the following (Table-6).
Null hypothesis H01: There is no significant difference between nicotine dependence levels concerning the lungs function.
The F-value of 3.243 indicates that the null hypothesis H01 is rejected at a 1% level. It is noted that the mean FVC of the patients with high dependence (54.12) is lesser and the mean FVC of the patients with low dependence (72.85) is greater. This concludes the high nicotine dependence has reduced FVC.
F-value of 3.090 indicates that the null hypothesis H01 is rejected at a 1% level.18 It is noted that the mean FEV1 of the patients with high dependence (42.12) is lesser and the mean FEV1 of the patients with low dependence (67.58) is greater. This concludes the high dependence on nicotine has reduced FEV1.19
F-value of 3.225 indicates that the null hypothesis H01 is rejected at a 1% level. It is noted that the mean FEV1/FVC of the patients with high dependence (74.75) is lesser and the mean FEV1/FVC of the patients with low dependence (94.00) is greater. This concludes the high nicotine dependence has reduced FEV1/FVC.
F-value of 2.983 indicates that the null hypothesis H01 is rejected at a 1% level. It is noted that the mean PEF of the patients with high dependence (47.87) is lesser and the mean PEF of the patients with low dependence (73.58) is greater.20 This concludes the high nicotine dependence has reduced PEF.
F-value of 3.163 indicates that the null hypothesis H01 is rejected at a 1% level. It is noted that the mean FEF25-75 of the patients with high dependence (29.12) is lesser and the mean FEF25-75 of the patients with low dependence (57.50) is greater. This concludes the high nicotine dependence has reduced FEF25-75.
Influence of cigarettes smoked on nicotine dependency
This section presents the Influence of cigarettes smoked on nicotine dependency among cigarette smokers. A sample of 76 patients was selected for the study. To study the Influence of cigarettes smoked on nicotine dependency, one way ANOVA is used. The results are shown in the following table.
Null hypothesis H02: There is no influence of cigarettes smoked on nicotine dependency
From the above (Table-7) the F-value of 50.726 indicates that the null hypothesis H02 is rejected at a 1% level. It is noted that the mean nicotine dependence of the patients who smoke more than 30 cigarettes (8.50) is higher and the dependence level of patients smoking less than 10 cigarettes (2.93) is less. This concludes the increase in smoking more cigarettes have improved the nicotine dependency level.
Relationship between age, BMI and Nicotine dependence level
This section gives clarity about the relationship between age, BMI and Nicotine dependence level among cigarette smokers. Karl Pearson’s correlation coefficient is obtained and the results are shown in the following table.
Null hypothesis H03: There is no significant relationship between age and Nicotine dependence level
Null hypothesis H04: There is no significant relationship between BMI and Nicotine dependence level
It is observed that the correlation coefficient (0.315) between age and Nicotine dependence level is positive and significant at 1% level; in this case, the null hypothesis H03is rejected. It is concluded that as age increases the Nicotine dependence level increases moderately.
It is observed that the correlation coefficient (-0.265) between BMI and Nicotine dependence level is negative and significant at 5% level; in this case, the null hypothesis H04is rejected. It is concluded that an increase in Nicotine dependence levels decreases the BMI moderately among cigarette smokers.
DISCUSSION:
The differences in the mean value of each parameter between the four categories of smokers based on the duration of smoking and also on the number of cigarettes smoked per day were analyzed and discussed.21
Out of 76 patients who participated in the study, 64.5% of the patients are current smokers and 35.5% of the patients are Ex-smokers there predominant chief complaints discussed in (Figure-1).22
The findings resulted in 9.22% of the patients are having smoking habits up to 5 years, 28.94 % of the patients have 6-15 years of smoking habit,23 whereas 32.9% and 28.94% of the patients are having smoking habits for 16-25 years and more than 26 years respectively.24
It is understood that 15.79% of the patients are smoking 1-5 cigarettes per day, 28.94% of the patients are smoking 6-10 cigarettes per day,25 19.74% of the patients are smoking 11-15 cigarettes per day,26 another 19.74% of the patients are smoking 16-20 cigarettes per day and 15.79% of the patients agreed that they smoke 20 and more Cigarettes per day.27
The sample test was performed to find the significant difference between the four categories having nicotine dependency levels concerning PFT observations.
The result showed that the F-value of 3.243(P=0.015) and the mean FVC of the patients with high dependence (54.12± 18.893) are lesser and the mean FVC of the patients with low dependence (72.85±14.072) is greater. This concludes the high dependence on nicotine has reduced FVC and there is near significance between each category.28
The result showed that the F-value of 3.090(P=0.032)and the mean FEV1 of the patients with high dependence (42.12± 21.437) are lesser and the mean FEV1 of the patients with low dependence (67.58±18.322) is greater. This concludes the high dependence on nicotine has reduced FEV1 and there is near significance between each category.29
The result showed that the F-value of 3.225(P=0.023)and the mean FEV1/FVC of the patients with high dependence (74.75±17.161) are lesser and the mean FEV1/FVC of the patients with low dependence (94.00±13.724) is greater.30 This concludes the high nicotine dependence has reduced FEV1/FVC and there is near significance between each category.
The result showed that the F-value of 2.983(P=0.049)and the mean PEF of the patients with high dependence (47.87±18.825) are lesser and the mean PEF of the patients with low dependence (73.58±18.598) is greater. This concludes the high dependence on nicotine has reduced PEF and there is near significance between each category.31
The result showed that the F-value of 3.163(P=0.021)and the mean FEF25-75 of the patients with high dependence (29.12±24.062) are lesser and the mean FEF25-75 of the patients with low dependence (57.50±25.346) is greater. This concludes the high nicotine dependence has reduced FEF25-75 and there is near significance between each category.
The correlation coefficient (0.315) between age and Nicotine dependence level is positive and significant at a 1% level.32 It is concluded that as age increases the Nicotine dependence level increases moderately.
The correlation coefficient (-0.265) between BMI and Nicotine dependence level is negative and significant at a 5% level. It is concluded that an increase in Nicotine dependence levels decreases the BMI moderately among cigarette smokers.
CONCLUSION:
To conclude, our study suggests that nicotine dependency is the indirect root cause for the declined lung functions of a healthy smoker. The statistical significance of the results confirms the decrease in lung function with an increase in nicotine dependency. And also Age and BMIreduce lung function in nicotine dependency of healthy smokers. Nicotine craving causes the smoker to smoke more and more.34 Smoking cessation is the only way to prevent further decline in lung function and recovery of damaged lungs to a certain extend.
Fagerstrom’squestionnaire playing an important role in detecting nicotine dependency. Hence it higher scores more in nicotine dependence and it accelerates the lung function capacity declined quicker.35
Early intervention with counselling and adequate treatment using this questionnaire prevent schronic lung diseases.
Acknowledgement: I thank the department and my colleagues and the authors who contributed to the work and special mention to all the patients who have participated in the study without hesitance and I also thank our management and the Journal committee for accepting and publishing the study.
Source of Funding: None
Authors Contribution: Data Collection, Statistics and article writeup.
Conflict of Interest: None
IEC Letter No: SMC/IEC/2020/02/112
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13. Bach, P.B. Variations in lung cancer risk among smokers. Journal of the National Cancer Institute (JNCI), 2003. 95(6): p. 470-478.
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16. Health, U.D.o. and H. Services, The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. 709.
17. D'Souza MS, Markou A . Neuronal mechanisms underlying the development of nicotine dependence: implications for novel smoking-cessation treatments. Addict SciClinPract. 2011; 6 (1): 4–16. PMC 3188825. PMID 22003417
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19. Piper M, McCarthy D, Timothy S. Assessing tobacco dependence: A guide to measure evaluation and selection. Nicot Tobac Res. 2006; 8 (3): 339–351. doi:10.1080/14622200600672765. ISSN 1462-2203.PMID 16801292.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareHeart Rate Variability and its Modulation Across Lifecycle Among Healthy Individuals
English186192Sharma SowmyaEnglish Thomas TinkuEnglish Sambashivaiah SucharitaEnglishIntroduction: Autonomic imbalance is known to play a key role in health and disease. However, there is a lack of data exploring the sympathovagal balance across the lifecycle among the healthy Asian Indians Objective: To compare the changes in HRV (Heart rate variability) indices among clusters of the healthy population across the life cycle. Methods: Analysis was performed on pooled data categorised into 4 study groups including fetal (n=90), child (n=90), young adult (n=134), and old (n=85). ECG was collected and subjected to HRV power spectral analysis. Results: There was a significant difference in all log-transformed HRV indices between the study groups (pEnglishAgeing, Heart rate variability, Lifecycle, Sympathovagal balance, Healthy, Autonomic imbalanceIntroduction:
The "sympathovagal balance" reflects the state of the autonomic nervous system which results from the sympathetic and parasympathetic influences.1 Though physiological modulations of sympathovagal balance are known to occur throughout the life of an individual especially with ageing, it is often studied in isolation. Longitudinal assessment of sympathovagal balance across the lifecycle is not feasible. Therefore, the next best approach involving cross-sectional studies have been attempted.2,3There are pockets of longitudinal studies exploring sympathovagal balance among healthy individuals with a focus on middle-aged and elderly populations.4 However, there is a lack of data especially from fetal, childhood phases and across the life cycle.
Sympathovagal imbalance (SVI) between the sympathetic and parasympathetic nervous systems has emerged as one of the key pathophysiological mechanisms by which one could explain the role of the autonomic nervous system in various clinical disorders.5,6 This is relevant especially among Asian Indians in whom reports of cardiovascular disease and metabolic syndrome are on the rise. South Asians including Indian's makeup one-quarter of the world's population and are at a greater risk of developing the chronic disease at a much younger age.7 Asian Indian phenotypes differ metabolically, with the majority developing chronic disease even at a normal body weight called “metabolically obese”. The presence of ectopic fat along with reduced muscle mass/function makes their body composition different from other populations.8,9 It will be interesting to explore the changes in a sympathovagal balance associated with age and body mass index (BMI) across the life cycle among the healthy Asian Indian population. This will help delineate the sympathovagal changes between healthy and disease states. Therefore, the current study is the first of its kind from healthy Asian Indians exploring the physiological changes across the life cycle ie., fetal to old age.
Heart rate variability (HRV) is a non-invasive technique widely used to quantify modulations in sympathetic and parasympathetic branches of the autonomic nervous system.10 Of late the advent of fetal HRV has allowed the exploration of autonomic modulation during fetal life as well.11 The impact of environmental factors during fetal life contributing to the development of chronic disease during adulthood needs to be explored. While a large body of literature using animal models have suggested the role of sympathetic nervous system activation to partially explain this phenomenon,12 this remains to be studied among humans. The study aimed to compare the changes in HRV indices among clusters of the healthy population of various ages across the life cycle i.e. from fetus to old age. Also, the study aimed to understand if body mass index plays a role in modulating age-related changes in HRV indices in each of the study groups.
Methodology:
Data collected from 4 studies on various age groups of healthy populations at the Department of Physiology were used for the present analysis. The data collected include general characteristics, anthropometric parameters, and HRV indices derived using power spectral analysis. All participants provided written informed consent to take part in the studies which were approved by the Institution Ethics Review Board( IERB study ref Nos 113/2010, 168/2013,1/44/07). The baseline data was used for the current analysis from the data set which included healthy individuals to look at various physiological perturbations on heart rate variability indices. Details of the study groups including their recruitment details are as follows:
Fetal Group:
Data from 90 healthy women with a singleton pregnancy in their 3rd trimester were used for the present study. The participants were recruited from the Obstetrics outpatient department. The mothers were screened for the following inclusion and exclusion criteria: women with multiple pregnancies, those with chronic diseases like diabetes and hypertension were excluded from the study. Blood pressure measurements were performed to rule out orthostatic intolerance and gestational hypertension. An oral glucose challenge test was also performed to rule out gestational diabetes mellitus. Raw abdominal ECGs for maternal and fetal HRV indices and anthropometric details like the height and weight of the mother were collected on the same day of the visit.
Child group:
Data from 90 healthy children between the age of 3 to 8 years was collected from an ongoing birth cohort. The HRV was performed on children after parental consent and assent. A general physical examination was performed by a paediatrician to rule out any ailments present or past. The anthropometric measurement of height in meters and weight in kilograms which was used to calculate the body mass index (kg/m2) and ECG for HRV indices were collected on the same day of the visit.
Young adult and Older Adult group:
Data on heart rate variability and anthropometry of 134 young adult males between 20-40 years and 85 older adults above 60 years were analyzed. As part of the recruitment process, participants were screened for chronic diseases (diabetes or hypertension), any form of anaemia, cancer, chronic infection including tuberculosis and neuropathy. None of the subjects reported any symptoms suggestive of peripheral and autonomic neuropathy. Lead II ECG and anthropometry was recorded. The institutional ethical board had approved the research study
Assessment of heart rate variability:
For collecting fetal ECGs, subjects were instrumented for the recording of both maternal and fetal ECG (Monica DK, UK) by placing pre-gelled disposable silver electrodes (Ambu blue sensor, Copenhagen, Denmark) on the maternal abdomen. After instrumentation and a mandatory 30-minute rest period, continuous abdominal ECG was obtained for 10 minutes in a quiet room in the supine position. Subjects were asked to avoid unnecessary movements during this period. ECG was collected using a sampling frequency of 900 Hz using an IBM compatible PC and a data acquisition package (Monica, UK). The data acquisition system collects raw ECG from which both maternal and fetal ECG were extracted. The same has been validated.13 The system also includes a threshold peak detection system, from which RR intervals of both mother and fetus were derived and used for power spectral analysis.14
In the child, young adult, and old group, lead II ECG was recorded following instrumentation. Following rest in supine posture for 30 minutes, measurements were performed for 10 minutes. Details of the signal processing and mathematical calculations have been discussed earlier. 15Briefly, spectral analysis was performed using a Fast Fourier Transform. The frequency resolution was 0.0078 and the highest frequency evaluated was 0.4 Hz. The spectra obtained were averaged and power was calculated in two bands. The low-frequency band which is believed to reflect, predominantly the sympathetic nerve activity to the heart was calculated between 0.04-0.15 Hz band of RR power. The high-frequency band which is believed to reflect parasympathetic nerve activity to the heart was calculated from 0.15-0.4 Hz. Along with absolute power, HRV indices were also calculated as normalised units where the power in the low and high-frequency bands is expressed as a percentage of the total power minus the power of the very-low-frequency band (0.0-0.04 Hz).16
Statistical analysis:
The normality of the data was examined using the Kolmogorov–Smirnov test. The data is represented as mean and standard deviation when normally distributed and median (Interquartile range) when not normally distributed. As the HRV indices were not normally distributed, log-transformed data were used for further analysis. One-way ANOVA/ Kruskal Wallis test was used to analyze the effect of age groups on HRV indices. Post-hoc Bonferroni’s test was used to examine pair-wise differences between age groups. The effect of weight/BMI in the association between age group HRV was examined using multiple linear regression of log-transformed HRV indices. Effect size (Cohen’s d) comparison between the study groups in the post hoc analysis was performed to compare the pattern of changes in HRV indices between the groups. Statistical significance was considered at p ≤0.05. The interaction effect of BMI and groups was examined in regression analysis of log-transformed HRV indices and statistical significance of interaction was considered at pEnglishhttp://ijcrr.com/abstract.php?article_id=4195http://ijcrr.com/article_html.php?did=4195
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Longin E, Dimitriadis C, Shazi S, Gerstner T, Lenz T, König S et al. Autonomic nervous system function in infants and adolescents: impact of autonomic tests on heart rate variability. Pediatr Cardiol. 2009 Apr; 30(3):311-24
Parashar R, Amir M, Pakhare A, Rathi P, Chaudhary L. Age-Related Changes in Autonomic Functions. J Clin Diagn Res. 2016 Mar;10(3): CC11-15
Jandackova VK, Scholes S, Britton A, Steptoe A. Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study. J Am Heart Assoc. 2016 Feb12;5(2):e002365
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Pal GK, Adithan C, Amudharaj D, Dutta TK, Pal P, Nandan PG, et al. Assessment of sympathovagal imbalance by spectral analysis of heart rate variability in prehypertensive and hypertensive patients in Indian population. Clin Exp Hypertens. 2011;33(7):478-83
Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. J Cardiovasc Dis Res. 2012 Jul;3(3):204-11
Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84(1):137-44.
Sucharita S, Pranathi R, Correa M, Keerthana P, Ramesh LJ, Bantwal G, et al. Evidence of higher intramyocellular fat among normal and overweight Indians with prediabetes. Eur J Clin Nutr. 2019; 73:1373–81.
Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017Sep; 5:258
Schneider U, Bode F, Schmidt A, Nowack S, Rudolph A, Doelcker E, et al. Developmental milestones of the autonomic nervous system revealed via longitudinal monitoring of fetal heart rate variability
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Montalvo-Jaramillo CI, Pliego-Carrillo AC, Peña-Castillo MÁ, Echeverria JC, Becerril-Villanueva E, Pavon L, et al. Comparison of fetal heart rate variability by symbolic dynamics at the third trimester of pregnancy and low-risk parturition. Heliyon. 2020 Mar 12;6(3):e03485
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24HealthcareFinger Entrapment in Metallic Curtain Holder Clamp: A Novel Case Report
English193196Shah KrunalEnglish Agrawal AdityaEnglish Patel KadamEnglish Nayak HardikEnglish Shah PrasannaEnglish Golwala PareshEnglishIntroduction: Finger entrapment in metallic bands is a commonly encountered situation. Usual victims are children, adolescents and psychiatric patients . It causes obstruction to lymphatic and venous drainage leading to edema distal to constriction, which further leads to a neurovascular compromise and presents as a surgical emergency. Aims: We present a case of unconventional method used to salvage finger from foreign body entrapment. Case Report: A 21 year old Male presented to us with his right ring finger being stuck in a metallic curtain holder clamp. Multiple attempts were made to remove the entrapped finger with conventional methods and home remedies, subsequently, it was removed by an electric motor driven metal cutting saw, which brings a new treatment modality in such unusual cases. Discussion: Trapping of fingers in metallic constricting bands has solutions ranging from simple home remedies to specialized cutting instruments. Constriction can lead to obstruction of venous and lymphatic drainage leading to edema and hence further detoriating the constriction and arterial obstruction leads to gangrenous changes. In our case after several failed attempts using home remedies by patient, metallic curtain holding clamp was finally removed by an innovative method using an electric motor driven metallic cutting saw. Thus, this unconventional method is helpful for tackling such uncommon situations faced by doctors in emergency department. Conclusion: Electric cutting saw when used cautiously can help to remove Finger entrapment in metallic bands. It requires due diligence and patience to carry out the procedure to salvage the finger.
EnglishEntrapped finger, Ring finger, Curtain holding clamp, Electric saw, Lubricant, Hacksaw blade, PatientsINTRODUCTION:
A Finger getting entrapped in a metallic clamp is a commonly seen condition in children and adolescents. In most of the cases, it is associated with trauma to hand or finger, or leads to edema of finger distal to where the clamp is trapped due to lymphatic or venous obstruction.
“Finger entrapment” also been described in psychiatric Patients.1,2and in geriatric group.3 There are also descriptions of fingers getting stuck in plug holes of kitchen sink4 and hardened metal auto parts.5 Delay in the presentation of these patients to the hospital, may layout serious complications like finger ischemia, infection, tendon attrition or ultimately the need for surgical amputation.
Various methods and techniques are described in rescue of such trapped digits. We have a case of an adult male getting his finger trapped into a metallic curtain holder clamp and its subsequent removal, finally using an electric saw after several failed attempts using home remedies.
MATERIALS AND METHODS:
A 21 year old male adult presented to emergency department in Dhiraj hospital, Sumandeep University with his right ring ?nger being stuck in a metallic curtain holder clamp for 2 hours during occupational activity (Fig.1). Patient himself had made several forceful attempts to remove it. Further unsuccessful attempts to remove the trapped ?nger were made at primary health care centre by applying soap followed by oil as a lubricant to the ?nger and then trying to forcefully pull the ?nger out. After many unsuccessful attempts patient was then brought to our hospital. Ethical clearance number -34523
On Presentation at the emergency department, the finger distal to the clamp appeared swollen and was bleeding. Removal was ?rst attempted by applying lignocaine jelly at junction of clamp and entrapped finger part for better lubrication and pain relief after submerging hand in ice water for 3 minutes to reduce edema. However, the attempt was unsuccessful. The next attempt was with the Hacksaw blade but could not get much success. An electric cutting saw was then arranged from the Maintenance Department of the hospital (Fig.2).
A primary trial to cut the metallic clamp far from the ?nger was made to test the saw. Patient was then shifted to Operation Theatre after taking written and informed consent. Under general Anesthesia, patient was positioned supine with arm fully extended pronated. Tail end of two forceps were used to provide some elevation and protection from injuring the finger below the clamp and cutting was done in a start stop fashion using electric saw, with 5 seconds of cutting followed by 5 seconds of hold with continuous irrigation with normal saline to minimize debris and thermal injury. Within 15 mins , the finger was released without any iatrogenic trauma (Fig.3).
Bleeding was then stopped by pressure bandaging. Capillary filling, temperature and oxygen saturation and finger movement were assessed and found to be normal. Bony injury was ruled out with post-operative x-rays (Fig.4&5).
Patients was given volar slab for support and reduction of swelling along with analgesics and serratiopeptidase drugs.
On 1 week follow-up, there was no residual sequelae or complication seen. Circumferential abraded wound was well healed.
CASE REPORT
A 21 year old male adult presented to emergency department in Dhiraj hospital, Sumandeep University with his right ring ?nger being stuck in a metallic curtain holder clamp for 2 hours during occupational activity (Fig.1). Patient himself had made several forceful attempts to remove it. Further unsuccessful attempts to remove the trapped ?nger were made at primary health care centre by applying soap followed by oil as a lubricant to the ?nger and then trying to forcefully pull the ?nger out. After many unsuccessful attempts patient was then brought to our hospital. Ethical clearance number - 34523
On Presentation at the emergency department, the finger distal to the clamp appeared swollen and was bleeding. Removal was ?rst attempted by applying lignocaine jelly at junction of clamp and entrapped finger part for better lubrication and pain relief after submerging hand in ice water for 3 minutes to reduce edema. However, the attempt was unsuccessful. The next attempt was with the Hacksaw blade but could not get much success. An electric cutting saw was then arranged from the Maintenance Department of the hospital (Fig.2).
DISCUSSION:
Trapping of fingers in metallic constricting bands has solutions ranging from simple home remedies to specialized cutting instruments. Constriction can lead to obstruction of venous and lymphatic drainage leading to edema and hence further detoriating the constriction and arterial obstruction leads to gangrenous changes. Usually patients present after multiple failed attempts at removal of the trapped objects by using force or lubrication using soap ,oil or ointments. Such attempts tend to further worsen the situation and it might require amputation thereafter. Therefore early consultation at tertiary care center is essential to prevent such consequences.
Several techniques of such trapped fingers have been described over the years. Basically these techniques are divided into ‘Non Cutting’ and ‘Cutting’ methods.6 Choice strictly depends upon various factors such as Age, cooperation of the patient, nature of injury and physical nature of the constricting materials etc.
Non cutting techniques involve removal without disturbing its integrity, suited best for small lightweight objects like Rings.
These techniques involves home remedies like lubrication of finger using soap, oil, ointments etc. but with that several others steps are to be taken such as elevation of the hand and ice application to reduce the edema to facilitate the removal. Adequate analgesics should be given and if required various nerve digit blocks can be given.7 Kates3 described the use of a rubber elastic bandage to draw blood from finger to reduce the swelling. It thus helps to remove ring without cutting it. Cresap8 also described the use of elastic bandage for exsanguination and a blood pressure cuff as a tourniquet but he repeated the process of exsanguination four times to reduce the swelling. Inoue et al.9 described another simple method using finger of a surgical glove which is cut at both ends to get cylinder shaped piece of latex.
Cutting techniques are used for hard metallic objects which can be manual cutters or power cutting devices. Ricks10 and Sazwan11 et al. described removal of hard metal ring by a diamond tipped dental burr. Taylor and Boyd4 also described use of a dental volvere for removal of hard metal auto part stuck in a injured finger. Hajivassiliou12 and Woodburn13 have also shared their separate experiences in removal of constricting objects using a hand-held inexpensive 'hobbydrill'. McElfrish14 described an 'elastic pull technique' in which an elastic band is slid beneath the constricting object and on lubrication, both ends of the elastic are pulled circumferentially and distally.
In our case after several failed attempts using home remedies by patient, metallic curtain holding clamp was finally removed by an innovative method using an electric motor driven metallic cutting saw. Thus, this unconventional method is helpful for tackling such uncommon situations faced by doctors in emergency department.
CONCLUSION
Electric cutting saw when used cautiously can help to remove Finger entrapment in metallic bands. It requires due diligence and patience to carry out the procedure to salvage the finger. With this novel technique we can remove finger entrapment without any further complications in emergency ward.
Conflict of interest: nil
AUTHOR’S CONTRIBUTION
1.Shah Krunal: Perfomed procedure
2.Shah Prasanna:Assisted procedure
3.Patel Kadam :Preoperative assessment ,Preparing report
4.Nayak Hardik : Post operative care, Preparing report
5.Golwala Paresh :Proof reading
6.Agrawal Aditya:Proof reading
Englishhttp://ijcrr.com/abstract.php?article_id=4196http://ijcrr.com/article_html.php?did=4196
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Cresap CR. Removal of a hardened steel ring from an extremely swollen ?nger. Am J Emerg Med. 1995;13(3):318–320.
Inoue S, Akazawa S, Fukuda H,. Another simple method for ring removal. Anesthesiology. 1995;83:1133–1134.
Ricks R. Removal of a tungsten carbide wedding ring with a diamond-tipped dental drill. J Plast Reconstr Aesthet Surg. 2010;63(9):e701–e702.
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14 McElfrish EC, Peterson-Elijah RC. Removal of a tight ring by the rubber band. J Hand Surg [Br]. 1991;16:225–226
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24Healthcare
Investigating the Levels of Assertiveness and Self-Esteem Among Nurses Working in Hospital Settings
English197201Samir K. ChoudhariEnglish Sangeeta PatilEnglish Manda PukeEnglish Mahadeo ShindeEnglish
Introduction: It is generally accepted that assertiveness and high levels of self-esteem are healthy behavioural qualities for all people to possess. It is well acknowledged that assertiveness is one of the most crucial behavioural characteristics for professional nurses. Aims: The purpose of this study was to determine the levels of assertiveness and self-esteem that are held by nurses that work in a certain hospital. Materials and Methods: This research was conducted in a non-experimental setting among Registered Nurses, and a total of sixty of them were chosen through the use of the Simple Random approach. The research was started once approval had been granted by the environment and informed consent had been obtained from the participants. The use of a structured questionnaire allowed for an evaluation of nurses’ assertive behaviour as well as their levels of self-esteem. Statistics, both descriptive and inferential, were applied to the study of and analysis of the data that had been obtained. Result: The findings of this study reveal that the majority of nurses working in hospital settings have a self-esteem that is higher than average, with 60% of them having higher self-esteem than the other 40%, who had an average level of self-esteem. While 63.33 percent of nurses displayed good assertive behaviour and 36.67 percent displayed average assertive behaviour, Conclusion: The findings of this study indicate that the majority of nurses had a high or average degree of self-esteem when they were working in their separate settings, and their behaviour was seen to be forceful.
EnglishEstimate, Assertiveness, Self-Esteem, Skills, Behavioural, Nurse-patient.http://ijcrr.com/abstract.php?article_id=4649http://ijcrr.com/article_html.php?did=4649Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411320EnglishN2021October24Healthcare
Nurses’ Levels of Assertiveness and Self-Esteem in a Healthcare Facilities
English202206Samir K. ChoudhariEnglish Mahadeo ShindeEnglish
Introduction: It is generally accepted that assertiveness and high levels of self-esteem are healthy behavioural qualities for all people to possess. It is well acknowledged that assertiveness is one of the most crucial behavioural characteristics for professional nurses. Aims: The purpose of this study was to determine the levels of assertiveness and self-esteem that are held by nurses that work in a certain hospital Materials and Methods: This research was conducted in a non-experimental setting among Registered Nurses, and a total of sixty of them were chosen through the use of the Simple Random approach. The research was started once approval had been granted by the environment and informed consent had been obtained from the participants. The use of a structured questionnaire allowed for an evaluation of nurses’ assertive behaviour as well as their levels of self-esteem. Statistics, both descriptive and inferential, were applied to the study of and analysis of the data that had been obtained. Result: The findings of this study reveal that the majority of nurses working in hospital settings have a self-esteem that is higher than average, with 60% of them having higher self-esteem than the other 40%, who had an average level of self-esteem. While 63.33 percent of nurses displayed good assertive behaviour and 36.67 percent displayed average assertive behaviour, Conclusion: The study came to the conclusion that the majority of the nurses had a high or medium degree of self-esteem while they were working in their separate settings, and that their behaviour was also found to be forceful.
EnglishEstimate, Assertiveness, Self-Esteem, Behavioural skills, Nurse-patient, Professional nurseshttp://ijcrr.com/abstract.php?article_id=4650http://ijcrr.com/article_html.php?did=4650
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